Endoscopic band ligation or endoscopic tissue adhesive injection in the treatment of gastric varices:Which is better?

The combination of endoscopic ultrasound with endoscopic treatment of type 1 gastric variceal hemorrhage may improve the robustness and generalizability of the findings in future studies.Moreover,the esophageal varices should also be included in the evaluation of treatment efficacy in subsequent studies to reach a more convincing conclusion.

Efficacy of Cyanoacrylate Tissue Adhesive Application in the Management of Corneal Perforations at Preah Ang Duong Hospital in Cambodia

Purpose: The study was to evaluate the efficacy of cyanoacrylate tissue adhesive (CTA) application in corneal perforations. Method: This was a prospective study on 20 patients of corneal perforations who received cyanoacrylate tissue adhesive application as treatment between March 2021 and March 2022 at Preah Ang Duong Hospital. The primary outcome measure was success rate of CTA application, while the secondary outcome was to measure postoperative best-corrected visual acuity (BCVA) and ocular complications. Results: The mean age of patients was 44.15 ± 16.05 years old and 7 (35%) were female. Causes of perforation were microbial infection in 12 patients (60%), trauma in 5 patients (25%), and sterile melting in 3 patients (15%). The perforation of size smaller than 1.5 mm was in 8 patients (40%) while 12 patients (60%) had perforated size between 1.5 mm to 3 mm. The perforation was 60% (12 patients) central, 25% (5 patients) paracentral, and 15% (3 patients) peripherally. Out of 20 patients, 5 patients (25%) received CTA application more than 1 time. The mean glue retention was 57.60 ± 31.84 days. Success rate of glue application (defined as intact globe without surgical intervention regardless of number of CTA applications) was 85%. At the last visit, 7 patients (35%) had BCVA of 6/120 or better. Common complications were uveitis (45%), ocular hypertension (30%), cataract (25%) and neovascularization (20%). No serious complications were found. Conclusion: Cyanoacrylate tissue adhesive is an effective treatment option in sealing corneal perforations with no serious complications. .

Adhesive cryogel particles for bridging confined and irregular tissue defects

Background Reconstruction of damaged tissues requires both surface hemostasis and tissue bridging.Tissues with damage resulting from physical trauma or surgical treatments may have arbitrary surface topographies,making tissue bridging challenging.Methods This study proposes a tissue adhesive in the form of adhesive cryogel particles(ACPs) made from chitosan,acrylic acid,1-ethyl-3-(3-dimethylaminopropyl) carbodiimide(EDC) and N-hydroxysuccinimide(NHS).The adhesion performance was examined by the 180-degree peel test to a collection of tissues including porcine heart,intestine,liver,muscle,and stomach.Cytotoxicity of ACPs was evaluated by cell proliferation of human normal liver cells(LO2)and human intestinal epithelial cells(Caco-2).The degree of inflammation and biodegradability were examined in dorsal subcutaneous rat models.The ability of ACPs to bridge irregular tissue defects was assessed using porcine heart,liver,and kidney as the ex vivo models.Furthermore,a model of repairing liver rupture in rats and an intestinal anastomosis in rabbits were established to verify the effectiveness,biocompatibility,and applicability in clinical surgery.Results ACPs are applicable to confined and irregular tissue defects,such as deep herringbone grooves in the parenchyma organs and annular sections in the cavernous organs.ACPs formed tough adhesion between tissues[(670.9±50.1) J/m^(2) for the heart,(607.6±30.0) J/m^(2) for the intestine,(473.7±37.0) J/m^(2) for the liver,(186.1±13.3) J/m^(2) for the muscle,and(579.3±32.3) J/m^(2) for the stomach].ACPs showed considerable cytocompatibility in vitro study,with a high level of cell viability for 3 d[(98.8±1.2)%for LO2 and(98.3±1.6)%for Caco-2].It has comparable inflammation repair in a ruptured rat liver(P=0.58 compared with suture closure),the same with intestinal anastomosis in rabbits(P=0.40 compared with suture anastomosis).Additionally,ACP-based intestinal anastomosis(less than 30 s) was remarkably faster than the conventional suturing process(more than 10 min).When ACPs degrade after surgery,the tissues heal across the adhesion interface.Conclusions ACPs are promising as the adhesive for clinical operations and battlefield rescue,with the capability to bridge irregular tissue defects rapidly.

CT Appearance Following Partial Nephrectomy for Renal Cell Carcinoma Using Tissue Adhesive Bioglue

Background: The use of biological sealants has greatly increased during nephron sparing surgery. In many cases the bulk of the material was erroneously mistaken for tumor recurrence. Objective: To describe the characteristic appearance of biological adhesive material used for tumor bed closure on computerized tomography (CT) following nephrone sparing surgery (NSS) for renal cell carcinoma, in order to differentiate between typical features of the adhesive material and local tumor recurrence. Design, Setting and Participants: We retrospectively reviewed follow-up CT scans of 120 patients who underwent NSS for T1N0M0 RCC. In all cases tumor bed was closed during surgery with biological tissue adhesive (BioGlue). Results and Limitations: During 1994-2009, 120 patients with a single T1 renal cell carcinoma lesion, underwent NSS with closure of tumor bed with bio adhesive material. There were 66 males and 47 females with mean age of 58.7 years (median: 58 years, range: 28 - 85 years). Mean follow-up time was 45 ± 34 months (median 42, range 12 - 168). During follow-up, 3 patients had local recurrence at the site of previous enucleated lesion. In the first post-operative CT scan the BG appeared as a heterogeneous mass with sharp edges measuring 20 - 70 HU with no attenuation following the injection of contrast material. In subsequent follow-up scans the BG in most patients remained stable in size;in few patients slight reduction in size was observed probably due to the resolution of post-operative hematoma. Tumor recurrence that was documented in 3 patients was seen as a heterogeneous mass with attenuation of more than 20 HU following the injection of contrast material. In sequential CT’s the mass was increasing in size. Conclusions: BG appears as a non-enhancing stable mass in sequential CT’s following NSS, hence could be differentiated from local tumor recurrence. The ability to differentiate between normal post-operative status and recurrence could be compromised in patients with decreased renal function in whom contrast material could not be used.

Low Molecular Weight Poly(Lactide-<i>co</i>-Caprolactone) for Tissue Adhesion and Tetracycline Hydrochloride Controlled Release in Wound Management

The use of biopolymers as bioadhesives for human tissue is becoming a preferred alternative to suturing due to their superior adhesive, biocompatible, and biodegradable properties. In this work, low molecular weight poly(L-lactide-co-ε-caprolactone) (P(LA-co-CL) was synthesized to achieve the glass transition temperature (Tg) of the copolymer at ambient temperature so that during application on the skin, the copolymer when combined with chitosan (CHI) into the CHI/P(LA-co-CL) film could provide the strong support at the injury site. Using alcohols with different numbers of hydroxyl groups as the co-initiator in polymerization provided the distinctive characteristics of copolymers. Among all copolymers synthesized, P(LA-co-CL) copolymer using pentaerythritol as the co-initiator when combined with CHI at the ratio of copolymer/CHI at 70/30 yielded the good film properties in tissue adhesion and tetracycline hydrochloride release.

Expression of transcription factors Slug in the lens epithelial cells undergoing epithelial-mesenchymal transition induced by connective tissue growth factor

AIMTo investigate the expression of transcription factors Slug in human lens epithelial cells (HLECs) undergoing epithelial-mesenchymal transition (EMT) induced by connective tissue growth factor (CTGF).METHODSHLECs were treated with CTGF of different concentrations (20, 50 and 100 ng/mL) or without CTGF (control) for 24h. The morphological changes of HLECs were analysed by microscopy. The expression and cellular localization of Slug was evaluated by immumo-fluorescence. Expressions of Slug, E-cadherin and alpha smooth muscle actin (&#x003b1;-SMA) were further determined by Western blot analysis.RESULTSHLECs showed spidle fibrolasts-like characteristics and loosely connected each other after CTGF treatment. The immuno-fluorescence staining indicated that Slug was localized in the nuclei and its expression was induced by CTGF. The relative expressions of Slug protein were 1.64&#x000b1;0.11, 1.96 &#x000b1;0.03, 3.12 &#x000b1;0.10, and 4.08&#x000b1;0.14, respectively, in response to control group and treatment with CTGF of 20, 50 and 100 ng/mL (F=443.86, P&#x0003c;0.01). The increased Slug protein levels were correlated well with up-expression of &#x003b1;-SMA (0.78&#x000b1;0.05, 0.85&#x000b1;0.06, 2.17&#x000b1;0.15, 2.86&#x000b1;0.10; F=449.85, P&#x0003c;0.01) and down-expression of E-cadherin (2.50&#x000b1;0.11, 1.79&#x000b1;0.26, 1.05&#x000b1;0.14, 0.63&#x000b1;0.08; F=101.55, P&#x0003c;0.01).CONCLUSIONTranscription factor Slug may be involved in EMT of HLECs induced by CTGF in vitro.

Correlation of matrix metalloproteinase－2, －9, tissue inhibitor－1 of matrix metalloproteinase and CD44 variant 6 in head and neck cancer metastasis

This study aimed to explore the molecular mechanism in tumor invasion and metastasis. The expression of matrix metalloproteinase 2, 9 (MMP 2, MMP 9), tissue inhibitor 1 of matrix metalloproteinase (TIMP 1), cell adhesion molecule 44 variant 6 (CD44v6), HER2/neu and p53 was investigated in 154 patients with head and neck squamous cell carcinoma (SCC) by ABC and ImmunoMax immunohistochemical method. Their clinical relevance and correlation were analysed. The expression of MMP 2, MMP 9, TIMP 1, CD44v6, HER2/neu and p53 was found in cancer cells in 87.01%, 85.71%, 68.18%, 98.05%, 55.19% and 50.65% cases respectively. Linear regression and correlation analysis revealed that there was close positive relationship ( P <0.05) between the expression of MMP 2 and MMP 9, TIMP 1 and CD44v6, HER2/neu and MMP 9, MMP 2 and p53. Up regulation of MMP 2 was accompanied by advanced T stage ( P <0.01) . There was also a trend of MMP 2 expression being related with tumor metastasis. Increased expression of HER2/neu was found in patients with tumor recurrence( P <0.05). The expression of TIMP 1 was higher in laryngeal cancer than that in pharyngeal cancer, and higher in keratinizing and non keratinizing SCC than that in basaloid SCC( P <0.05). These findings suggested that MMP 2 and MMP 9, HER2/neu and MMP 9, MMP 2 and p53 had a coordinate function in aggression of tumor; that MMP 2 had a more important function than MMP 9 in tumor invasion and metastasis; and that HER2/neu might serve as a biomarker for poor prognosis in HNSCC.

Bioactive citrate-based polyurethane tissue adhesive for fast sealing and promoted wound healing

As a superior alternative to sutures,tissue adhesives have been developed significantly in recent years.However,existing tissue adhesives struggle to form fast and stable adhesion between tissue interfaces,bond weakly in wet environments and lack bioactivity.In this study,a degradable and bioactive citrate-based polyurethane adhesive is constructed to achieve rapid and strong tissue adhesion.The hydrophobic layer was created with polycaprolactone to overcome the bonding failure between tissue and adhesion layer in wet environments,which can effectively improve the wet bonding strength.This citrate-based polyurethane adhesive provides rapid,non-invasive,liquid-tight and seamless closure of skin incisions,overcoming the limitations of sutures and commercial tissue adhesives.In addition,it exhibits biocompatibility,biodegradability and hemostatic properties.The degradation product citrate could promote the process of angiogenesis and accelerate wound healing.This study provides a novel approach to the development of a fast-adhering wet tissue adhesive and provides a valuable contribution to the development of polyurethane-based tissue adhesives.

Perihepatic adhesions: An unusual complication of hemolysis, elevated liver enzymes and low platelet syndrome

We present a case of symptomatic perihepatic adhesions,which developed after a pregnancy complicated by hemolysis,elevated liver enzymes and low platelet(HELLP)syndrome,in which a subcapsular liver hematoma occurred.Our patient presented with complaints of persistent,severe right-sided upper abdominal pain.The complaints developed gradually,one year after a pregnancy that had been complicated by HELLP syndrome with a subcapsular liver hematoma.The hematoma had resolved spontaneously.An upperabdominal magnetic resonance imaging revealed a density between liver and diaphragm at the site of the former subcapsular hematoma,suspect of perihepatic adhesions.The presence of perihepatic adhesions was confirmed during a laparoscopy and treated by adhesiolysis in the same session.The adhesions may have developed in response to the degradation process of the subcapsular liver hematoma during conservative treatment.This case of perihepatic adhesions may therefor be the first presentation of a long term sequel of subcapsular liver hematoma in HELLP syndrome.

Prevention strategies of postoperative adhesion in soft tissues by applying biomaterials:Based on the mechanisms of occurrence and development of adhesions

Postoperative adhesion(POA)widely occurs in soft tissues and usually leads to chronic pain,dysfunction of adjacent organs and some acute complications,seriously reducing patients’quality of life and even being life-threatening.Except for adhesiolysis,there are few effective methods to release existing adhesion.However,it requires a second operation and inpatient care and usually triggers recurrent adhesion in a great incidence.Hence,preventing POA formation has been regarded as the most effective clinical strategy.Biomaterials have attracted great attention in preventing POA because they can act as both barriers and drug carriers.Nevertheless,even though much reported research has been demonstrated their efficacy on POA inhibition to a certain extent,thoroughly preventing POA formation is still challenging.Meanwhile,most biomaterials for POA prevention were designed based on limited experiences,not a solid theoretical basis,showing blindness.Hence,we aimed to provide guidance for designing anti-adhesion materials applied in different soft tissues based on the mechanisms of POA occurrence and development.We first classified the postoperative adhesions into four categories according to the different components of diverse adhesion tissues,and named them as“membranous adhesion”,“vascular adhesion”,“adhesive adhesion”and“scarred adhesion”,respectively.Then,the process of the occurrence and development of POA were analyzed,and the main influencing factors in different stages were clarified.Further,we proposed seven strategies for POA prevention by using biomaterials according to these influencing factors.Meanwhile,the relevant practices were summarized according to the corresponding strategies and the future perspectives were analyzed.

Prevention of peritoneal adhesions:A promising role for gene therapy

Adhesions are the most frequent complication of abdominopelvic surgery,yet the extent of the problem,and its serious consequences,has not been adequately recognized.Adhesions evolved as a life-saving mecha-nism to limit the spread of intraperitoneal inflammatory conditions.Three different pathophysiological mechanisms can independently trigger adhesion formation.Mesothelial cell injury and loss during operations,tissue hypoxia and inflammation each promotes adhesion formation separately,and potentiate the effect of each other.Studies have repeatedly demonstrated that interruption of a single pathway does not completely prevent adhesion formation.This review summarizes the pathogenesis of adhesion formation and the results of single gene therapy interventions.It explores the prom-ising role of combinatorial gene therapy and vector modif ications for the prevention of adhesion formation in order to stimulate new ideas and encourage rapid advancements in this field.

Bioinspired Injectable Self-Healing Hydrogel Sealant with Fault-Tolerant and Repeated Thermo-Responsive Adhesion for Sutureless Post-Wound-Closure and Wound Healing

Hydrogels with multifunctionalities,including sufficient bonding strength,injectability and self-healing capacity,responsive-adhesive ability,fault-tolerant and repeated tissue adhesion,are urgently demanded for invasive wound closure and wound healing.Motivated by the adhesive mechanism of mussel and brown algae,bioinspired dynamic bonds cross-linked multifunctional hydrogel adhesive is designed based on sodium alginate(SA),gelatin(GT)and protocatechualdehyde,with ferric ions added,for sutureless post-wound-closure.The dynamic hydrogel cross-linked through Schiff base bond,catechol-Fe coordinate bond and the strong interaction between GT with temperature-dependent phase transition and SA,endows the resulting hydrogel with sufficient mechanical and adhesive strength for efficient wound closure,injectability and self-healing capacity,and repeated closure of reopened wounds.Moreover,the temperature-dependent adhesive properties endowed mispositioning hydrogel to be removed/repositioned,which is conducive for the fault-tolerant adhesion of the hydrogel adhesives during surgery.Besides,the hydrogels present good biocompatibility,near-infrared-assisted photothermal antibacterial activity,antioxidation and repeated thermo-responsive reversible adhesion and good hemostatic effect.The in vivo incision closure evaluation demonstrated their capability to promote the post-wound-closure and wound healing of the incisions,indicating that the developed reversible adhesive hydrogel dressing could serve as versatile tissue sealant.

Natural biopolymers derived hydrogels with injectable,self-healing,and tissue adhesive abilities for wound healing

Developing a biocompatible and multifunctional adhesive hydrogel with injectability and self-healing ability for promoting wound healing is highly anticipated in various clinical applications.In this paper,we present a novel natural biopolymer-derived hydrogel based on the aldehyde-modified oxidized guar gum(OGG)and the carboxymethyl chitosan(CMCS)for efficiently improving wound healing with the encapsulation of vascular endothelial growth factor(VEGF).As the hydrogels are synthesized via the dynamically reversible Schiff base linkages,it is imparted with excellent self-healing ability and good shear thinning behavior,which make the hydrogel be easily and conveniently injected through a needle.Besides,the physiochemical properties,including porous structure,mechanical strength and swelling ratio of the hydrogel can be well controlled by regulating the concentrations of the OGG.Moreover,the hydrogel can attain strong adhesion to the tissues at physiological temperature based on the Schiff base between the aldehyde group on the hydrogel and the amino group on the tissue.Based on these features,we have demonstrated that the VEGF encapsulated hydrogel can adhere tightly to the defect tissue and improve wound repair in the rat model of defected skin by promoting cell proliferation,angiogenesis,and collagen secretion.These results indicate that the multifunctional hydrogel is with great scientific significance and broad clinical application prospects.

Surface activity of cancer cells:The fusion of two cell aggregates

A key feature that distinguishes cancer cells from all other cells is their capability to spread throughout the body.Although how cancer cells collectively migrate by following molecular rules which influence the state of cell-cell adhesion contacts has been comprehensively formulated,the impact of physical interactions on cell spreading remains less understood.Cumulative effects of physical interactions exist as the interplay between various physical parameters such as(1)tissue surface tension,(2)viscoelasticity caused by collective cell migration,and(3)solid stress accumulated in the cell aggregate core region.This review aims to point out the role of these physical parameters in cancer cell spreading by considering and comparing the rearrangement of various mono-cultured cancer and epithelial model systems such as the fusion of two cell aggregates.While epithelial cells undergo volumetric cell rearrangement driven by the tissue surface tension,which directs cell movement from the surface to the core region of two-aggregate systems,cancer cells rather perform surface cell rearrangement.Cancer cells migrate toward the surface of the two-aggregate system driven by the solid stress while the surface tension is significantly reduced.The solid stress,accumulated in the core region of the two-aggregate system,is capable of suppressing the movement of epithelial cells that can undergo the jamming state transition;however,this stress enhances the movement of cancer cells.We have focused here on the multi-scale rheological modeling approaches that aimed at reproducing and understanding these biological systems.

子宫内膜异位症患者异位内膜组织中Ninj1、IL-1β及PGP-9.5的表达及意义

目的探讨子宫内膜异位症(endometriosis,EMT)患者的异位内膜组织中神经损伤诱导蛋白1(Ninj1)、白细胞介素-1β(IL-1β)及蛋白基因产物9.5(PGP-9.5)的表达及与痛经的关系。方法以2020年4月—2021年4月在我院行妇科术后病理检查确诊为卵巢EMT患者的异位内膜组织40例为A组,并获取其中20例患者的在位子宫内膜组织为B组,收集同期20例子宫肌瘤患者的正常子宫内膜组织作为C组。根据有无痛经将A组分为痛经亚组与非痛经亚组,每组20例。采用免疫组织化学方法检测A、B、C组内膜组织中Ninj1、IL-1β及PGP-9.5的表达,并分析其相关性;采用酶联免疫吸附试验检测A组与C组患者外周血中IL-1β的表达水平。结果A组患者外周血中IL-1β的表达水平显著高于C组(t=-4.184,P<0.05);与C组相比,A、B组内膜组织中3种蛋白阳性表达构成比均明显升高(χ^(2)=4.286~19.394,P<0.05),与B组相比,A组内膜组织中3种蛋白阳性表达构成比明显升高(χ^(2)=4.149~5.272,P<0.05)。痛经亚组内膜组织中Ninj1与PGP-9.5蛋白阳性表达构成比明显高于非痛经亚组(χ^(2)=8.533、11.905,P<0.05)。A组内膜组织中Njnj1与PGP-9.5、IL-1β的表达呈正相关(r=0.733、0.628,P<0.05)。结论Ninj1、IL-1β及PGP-9.5在异位内膜组织中阳性表达比例较高,可能参与EMT的发生与发展;痛经亚组内膜组织中Ninj1与PGP-9.5蛋白的阳性表达构成比高于非痛经亚组,可能与EMT疼痛发生机制密切相关。

血清CTGF、PGE2与子宫肌瘤剔除术后宫腔粘连的关系

目的探究血清结缔组织生长因子(CTGF)、前列腺素E2(PGE2)与子宫肌瘤患者剔除术后发生宫腔粘连的关系。方法选取2021年6月至2023年6月平顶山市第一人民医院收治的155例接受子宫肌瘤剔除术的患者为研究对象。对所有患者进行为期6个月的随访,根据术后是否发生宫腔粘连将患者分为发生宫腔粘连组和未发生宫腔粘连组。对比两组患者的血清CTGF、PGE2水平,使用多因素logistic回归分析子宫肌瘤患者剔除术后发生宫腔粘连的影响因素,并采用受试者工作特征(ROC)曲线探究血清CTGF、PGE2对子宫肌瘤患者剔除术后发生宫腔粘连的应用价值。结果经过6个月的随访,共有3例患者失访,在152例行子宫肌瘤剔除术的患者中,术后发生宫腔粘连45例,术后宫腔粘连发生率为29.61%。发生宫腔粘连组患者子宫手术史、术后用药情况与未发生宫腔粘连组患者相比,差异有统计学意义(P<0.05)。发生宫腔粘连组的血清CTGF、PGE2水平均较未发生宫腔粘连组患者高(P<0.05)。多因素logistic回归分析结果显示,具有子宫手术史、术后未坚持用药、血清CTGF及PGE2水平均为影响子宫肌瘤患者剔除术后发生宫腔粘连的危险因素(P<0.05)。血清CTGF、PGE2水平及两者联合预测子宫肌瘤患者剔除术后发生宫腔粘连的曲线下面积(AUC)值分别为0.784、0.771、0.805,特异度分别为79.69%、76.24%、81.45%,灵敏度分别为78.22%、77.93%、84.51%,联合检测AUC值、特异度、灵敏度均高于单一检测(P<0.05)。结论血清CTGF、PGE2水平与子宫肌瘤患者剔除术后发生宫腔粘连具有一定关联,联合以上两个指标可帮助预测子宫肌瘤患者剔除术后发生宫腔粘连的风险。

基于Langer线的穿刺体位对肿瘤化疗患者输液港难免性医用黏胶相关皮肤损伤的预防效果研究

目的探究基于Langer线的无损伤针穿刺体位对肿瘤化疗患者输液港难免性黏胶相关皮肤损伤的预防效果。方法通过平行胸部Langer线对床头抬高60~90°和平卧位穿刺进行皮肤软组织力学、表皮屏障功能理论分析,然后选取2019年5月至2020年5月南京医科大学第一附属医院肿瘤科79例植入胸壁输液港、既往应用Ⅳ3000及液体敷料皮肤保护性屏障仍出现输液港黏胶相关性皮肤损伤的患者为研究对象。采用前瞻性自身前后对照,干预前采用平卧位穿刺,干预后床头抬高60~90°穿刺,比较两种穿刺体位对输液港黏胶相关性皮肤损伤预防效果和带针期间舒适度的影响。结果干预后患者输液港黏胶相关性皮肤相关性损伤总发生率较干预前显著降低(P<0.001),机械性损伤发生率、接触性皮炎发生率较干预前显著降低(均P<0.05),输液港带针期间舒适度较干预前明显提高(P<0.001),且不增加患者穿刺时的疼痛感(P=0.692)。结论床头抬高60~90°穿刺可降低肿瘤化疗患者输液港难免性黏胶相关皮肤损伤,提高患者带针期间的舒适度。

养血散寒通脉方治疗血虚寒凝型子宫内膜异位症的临床研究

【目的】观察养血散寒通脉方(由当归四逆加吴茱萸生姜汤加减而成)治疗血虚寒凝型子宫内膜异位症(EMS)的临床疗效。【方法】将120例血虚寒凝型EMS患者随机分为研究组和对照组,每组各60例。研究组给予养血散寒通脉方治疗,对照组给予少腹逐瘀颗粒治疗,疗程为3个月,并于疗程结束后随访1年。观察2组患者治疗前后各种疼痛评分[包括经期腹痛视觉模拟量表(VAS)评分和痛经、非经期盆腔痛、性交痛、盆腔压痛、骶韧带结节触痛分级评分]、卵巢子宫内膜异位囊肿大小及血清糖类抗原125(CA125)、血管内皮生长因子(VEGF)、可溶性细胞间黏附分子1(SICAM-1)、基质金属蛋白酶9(MMP-9)、组织金属蛋白酶抑制因子2(TIMP-2)水平的变化情况,并观察2组患者的临床疗效、安全性、复发情况及妊娠情况。【结果】(1)研究过程中,研究组脱落3例,对照组脱落5例,最终共112例患者纳入统计分析,其中研究组57例,对照组55例。(2)治疗3个月后,研究组的总有效率为92.98%(53/57),对照组为85.45%(47/55),组间比较,研究组的疗效明显优于对照组(P<0.05)。(3)治疗后,2组患者的各种疼痛评分(包括经期腹痛VAS评分和痛经、非经期盆腔痛、性交痛、盆腔压痛、骶韧带结节触痛分级评分)均较治疗前明显下降(P<0.05),且研究组的下降幅度均明显优于对照组(P<0.05)。(4)治疗后,2组患者的卵巢子宫内膜异位囊肿均略有缩小,但组内治疗前后及治疗后组间比较,差异均无统计学意义(P>0.05)。(5)治疗后,2组患者血清CA125、VEGF、SICAM-1、MMP-9水平均较治疗前下降(P<0.05),血清TIMP-2水平均较治疗前升高(P<0.05),且研究组对血清CA125、VEGF、SICAM-1、MMP-9水平的下降幅度及对血清TIMP-2水平的升高幅度均明显优于对照组(P<0.05)。(6)随访1年,研究组的复发率为30.19%(16/53),明显低于对照组的68.09%(32/47),组间比较,差异有统计学意义(P<0.05)。研究组21例有生育要求,其中14例妊娠,妊娠率为66.67%(14/21);对照组20例有生育要求,其中4例妊娠,妊娠率为20.00%(4/20);组间比较,研究组的妊娠率明显高于对照组,差异有统计学意义(P<0.05)。(7)治疗期间,2组患者均无明显不良反应发生,且患者的血、尿、大便常规及心电图、肝肾功能等安全性指标均无异常变化。【结论】养血散寒通脉方治疗血虚寒凝型EMS患者疗效确切,能够显著缓解患者各种疼痛症状,改善妊娠结局,有效调节血清CA125、VEGF、SICAM-1、MMP-9、TIMP-2水平。

Evaluation of the efficacy and safety of endoscopic band ligation in the treatment of bleeding from mild to moderate gastric varices type 1

BACKGROUND According to practice guidelines,endoscopic band ligation(EBL)and endoscopic tissue adhesive injection(TAI)are recommended for treating bleeding from esophagogastric varices.However,EBL and TAI are known to cause serious complications,such as hemorrhage from dislodged ligature rings caused by EBL and hemorrhage from operation-related ulcers resulting from TAI.However,the optimal therapy for mild to moderate type 1 gastric variceal hemorrhage(GOV1)has not been determined.Therefore,the aim of this study was to discover an individualized treatment for mild to moderate GOV1.AIM To compare the efficacy,safety and costs of EBL and TAI for the treatment of mild and moderate GOV1.METHODS A clinical analysis of the data retrieved from patients with mild or moderate GOV1 gastric varices who were treated under endoscopy was also conducted.Patients were allocated to an EBL group or an endoscopic TAI group.The differences in the incidence of varicose relief,operative time,operation success rate,mortality rate within 6 wk,rebleeding rate,6-wk operation-related ulcer healing rate,complication rate and average operation cost were compared between the two groups of patients.RESULTS The total effective rate of the two treatments was similar,but the efficacy of EBL(66.7%)was markedly better than that of TAI(39.2%)(P<0.05).The operation success rate in both groups was 100%,and the 6-wk mortality rate in both groups was 0%.The average operative time(26 min)in the EBL group was significantly shorter than that in the TAI group(46 min)(P<0.01).The rate of delayed postoperative rebleeding in the EBL group was significantly lower than that in the TAI group(11.8%vs 45.1%)(P<0.01).At 6 wk after the operation,the healing rate of operation-related ulcers in the EBL group was 80.4%,which was significantly greater than that in the TAI group(35.3%)(P<0.01).The incidence of postoperative complications in the two groups was similar.The average cost and other related economic factors were greater for the EBL than for the TAI(P<0.01).CONCLUSION For mild to moderate GOV1,patients with EBL had a greater one-time varix eradication rate,a greater 6-wk operation-related ulcer healing rate,a lower delayed rebleeding rate and a lower cost than patients with TAI.