Drainage of ascites in cirrhosis

For cirrhotic refractory ascites,diuretics combined with albumin and vasoactive drugs are the first-line choice for ascites management.However,their therapeutic effects are limited,and most refractory ascites do not respond to medication treat-ment,necessitating consideration of drainage or surgical interventions.Con-sequently,numerous drainage methods for cirrhotic ascites have emerged,including large-volume paracentesis,transjugular intrahepatic portosystemic shunt,peritoneovenous shunt,automated low-flow ascites pump,cell-free and concentrated ascites reinfusion therapy,and peritoneal catheter drainage.This review introduces the advantages and disadvantages of these methods in different aspects,as well as indications and contraindications for this disease.

Approach to persistent ascites after liver transplantation

Persistent ascites(PA)after liver transplantation(LT),commonly defined as ascites lasting more than 4 wk after LT,can be expected in up to 7%of patients.Despite being relatively rare,it is associated with worse clinical outcomes,including higher 1-year mortality.The cause of PA can be divided into vascular,hepatic,or extrahepatic.Vascular causes of PA include hepatic outflow and inflow obstructions,which are usually successfully treated.Regarding modifiable hepatic causes,recurrent hepatitis C and acute cellular rejection are the leading ones.Considering predictors for PA,the presence of ascites,refractory ascites,hepatorenal syndrome type 1,spontaneous bacterial peritonitis,hepatic encephalopathy,and prolonged ischemic time significantly influence the development of PA after LT.The initial approach to patients with PA should be to diagnose the treatable cause of PA.The stepwise approach in evaluating PA includes diagnostic paracentesis,ultrasound with Doppler,and an echocardiogram when a cardiac cause is suspected.Finally,a percutaneous or transjugular liver biopsy should be performed in cases where the diagnosis is unclear.PA of unknown cause should be treated with diuretics and paracentesis,while transjugular intrahepatic portosystemic shunt and splenic artery embolization are treatment methods in patients with refractory ascites after LT.

Effect of Qinggan Huayu granule on H22 liver ascitic tumor mice

Objective:To evaluate the therapeutic effect of Qinggan Huayu granule on mice with H22 liver cancer ascites tumor.Methods:A H22 liver cancer ascites mouse model was established by intraperitoneally injecting H22 liver cancer cells.Mice were randomly divided into the model group,the Ganfule group(1.35 g/kg),the fluorouracil group(50 mg/kg i.p),the Qinggan Huayu granule groups at low(0.67 g/kg),medium(1.34 g/kg),and high(2.68 g/kg)doses.Then the mice were administered continuously for 10 days and body weight and abdominal circumference were monitored every 3 days.On day 11,eight rats in each group were randomly selected for dissection to detect the amount of peritoneal water,peritoneal permeability and histopathological changes.The remaining mice were observed for survival.In addition,the vascular endothelial growth factor A(VEGFA)and vascular endothelial growth factor receptor 2(VEGFR2)were determined by Western blotting.Results:Compared with the model group,the weight growth of mice in the fluorouracil group and the medium-dose and high-dose Qinggan Huayu granule groups was slower(P<0.05).Moreover,the abdominal circumference of mice in each treatment group was increased slowly.There were significant differences in abdominal circumference between the fluorouracil group,the medium-dose group and the control group from day 6(P<0.05)while the abdominal circumference of the high dose group was significantly smaller than that of the control group from day 12(P<0.05).Moreover,compared with the model group,the amount of ascites in the medium-and high-dose Qinggan Huayu granule groups was decreased significantly(P<0.05).The optical density value of ascites supernatant in medium-and high-dose Qinggan Huayu granule group and the fluorouracil group decreased significantly(P<0.05)and the survival period of the medium-dose Qinggan Huayu granule group and the fluorouracil group was prolonged prominently(P<0.05).There was no significant difference in the low-dose Qinggan Huayu granule group and the Ganfule group.Peritoneal histopathological assay showed more complete peritoneal structure,less edema and less angiogenesis of the peritoneum in the fluorouracil group and the medium-and high-dose Qinggan Huayu granule group,which was better than that of the Ganfule group and the low-dose group.Compared with the model group,the expressions of VEGFA and VEGFR2 in the medium-dose Qinggan Huayu granule group decreased significantly(P<0.05,P<0.01).Conclusion:Qinggan Huayu granule can inhibit ascites production in the mice model with H22 liver cancer ascites tumor,prolong the survival of mice,and reduce peritoneal permeability and suppress the increase of peritoneal neovascularization.The mechanism may be related to the inhibition of VEGF/VEGFR pathway.

Study of the Effects of the Chinese Herbal Prescription Combinedwith Copper and Ferum on the Malignancy ot Cancer Cells

As compared with normal cells, cancer cells or malignant cells were morphologically abnor-mal : their contact inhibition and normal growth order were lost, the DNA content and ploid increased and suchkind of cells were transplantable. It the malignancy should be decreased or the malignant cells reversed, theabove abnormal changes could be reduced or disappear. BALB/c mice bearing ascites liver cancer wereused, Chinese herbal prescription combined with copper and ferrum (CHPCCF) was given by gavage for 10days, and then some cell-biological parameters were measured; further , the ascites cancer cells (controland treatment) were removed and retransptanted to another mice and observed. The results showed that inCHPCCF treatment group, DNA content of the cancer cells was decreased, and the proliferation index wasreduced (control : 83 . 4 ± 2 . 6, CHPCCF group : 78. 8 ± 1 . 5 ; or control : 67. 2 ± 1 . 3 , CHPCCF group : 64. 2 ±l . 6, P < 0. 02) , the number of the cancer cells in Gl phase increased obviously, but, those of S + G2Mphases decreased ( P < 0. 05 ￣ 0. 01 ) ; on the DNA histogram, the diploid peak became higher and bigger,but aneuploid or multiploid peaks became smaller. Furthermore, retransplanted experiments showed that in2/10 animals, the tumors did not grow, and in other 8/10 animals , the tumors grew, but the tumors' sizewere smaller than that of the control ; the growth inhibition rate was 71 . 7% ￣ 88. 3% ; and tumors ' grewslowly ; the growth curve of the tumors in CHPCCF group was considerably lower than that of the control ; thesurvival period of retransplanted animals was prolonged significantly (from 26. 1 ± 11 . 8 to 38. 1 ± 9. 6, or to39 . 6 ± 7 . 2 days, P<0 . 01 ); the increase in life span was 46% and 52% respectively. The results suggestedthat CHPCCF could reduce the malignancy of mice liver cancer cells.