Portal Vein Width Research Articles

Transcatheter arterial chemoembolization plus Sorafenib versus transcatheter arterial chemoembolization plus Lenvatinib for intermediate hepatocellular carcinoma

Background: Recent studies have highlighted that TACE in conjunction with Lenvatinib (TACE-L) offers a promising adjunct therapy for advanced HCC patients, outperforming TACE plus Sorafenib (TACE-S). However, there has been a lack of research comparing these two regimens for intermediate HCC. Aims: This study aims to address the research gap by evaluating the efficacy of TACE-L versus TACE-S in intermediate HCC patients. Methods: A retrospective analysis was conducted on a cohort of consecutive intermediate HCC patients who received either TACE-L or TACE-S from November 2018 to December 2022. Portal vein width was assessed using abdominal NMRI or Doppler ultrasonography, and inflammatory markers were derived from routine blood counts. The primary outcomes of interest were overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and adverse drug reactions (ADRs). Results: The study included 117 patients, with 56 in the TACE-S group and 61 in the TACE-L group. The TACE-S group demonstrated superior OS (HR = 1.704, 95% CI: 1.012–2.870, p = 0.045) compared to the TACE-L group. No significant difference was observed in PFS (HR:1.512, 95% CI: 0.988–2.313, p = 0.057) between the two groups. Subgroup analyses revealed that male patients, those with cirrhosis, and those with more than four tumors had better OS and PFS in the TACE-S group than in the TACE-L group. Inflammatory markers were comparable between the groups. The TACE-S group experienced a higher incidence of palmar-plantar erythrodysesthesia syndrome (PPE) (14/56 [25%] vs. 5/61 [8.1%], p = 0.014) but a lower incidence of hypertension (3/56 [5.3%] vs. 11/61 [18%], p = 0.035) compared to the TACE-L group. Conclusions: In patients with intermediate HCC, TACE-S was found to be more effective in terms of OS than TACE-L. No significant disparity was noted in PFS between the two treatment groups.

Analysis of factors related to recanalization of portal vein thrombosis in liver cirrhosis: a retrospective cohort study

BackgroundPortal vein thrombosis (PVT) is a common complication of liver cirrhosis, yet there are fewer studies about predictors of PVT recanalization. We aimed to further explore the predictors of recanalization in cirrhotic PVT to facilitate accurate prediction of patients’ clinical status and timely initiation of appropriate treatment and interventions. To further investigate the benefits and risks of anticoagulant therapy in cirrhotic PVT patients.MethodsA retrospective cohort study of patients with cirrhotic PVT in our hospital between January 2016 and December 2022, The primary endpoint was to analyze predictors of PVT recanalization by COX regression. Others included bleeding rate, liver function, and mortality.ResultsThis study included a total of 82 patients, with 30 in the recanalization group and 52 in the non-recanalization group. Anticoagulation therapy was the only independent protective factor for portal vein thrombosis recanalization and the independent risk factors included massive ascites, history of splenectomy, Child-Pugh B/C class, and main trunk width of the portal vein. Anticoagulation therapy was associated with a significantly higher rate of PVT recanalization (75.9% vs. 20%, log-rank P < 0.001) and a lower rate of PVT progression (6.9% vs. 54.7%, log-rank P = 0.002). There was no significant difference between different anticoagulation regimens for PVT recanalization. Anticoagulation therapy did not increase the incidence of bleeding complications(P = 0.407). At the end of the study follow-up, Child-Pugh classification, MELD score, and albumin level were better in the anticoagulation group than in the non-anticoagulation group. There was no significant difference in 2-year survival between the two groups.ConclusionAnticoagulation, massive ascites, history of splenectomy, Child-Pugh B/C class, and main portal vein width were associated with portal vein thrombosis recanalization. Anticoagulation may increase the rate of PVT recanalization and decrease the rate of PVT progression without increasing the rate of bleeding. Anticoagulation may be beneficial in improving liver function in patients with PVT in cirrhosis.

Doppler ultrasound compared to shear wave elastography for assessment of liver cirrhosis

BackgroundThe progression of liver fibrosis to cirrhosis is a dynamic process necessitating non-invasive evaluation modalities. This study aims to evaluate the ability of Doppler ultrasound studies (DUS) in defining morphological and hemodynamic blood flow changes in the hepatic vasculature coinciding with advanced liver fibrosis.MethodsA prospective study was conducted on 100 patients with liver cirrhosis (F4). All cases underwent liver stiffness (LS) measurement by shear wave elastography (SWE), along with DUS to evaluate the liver texture, splenic size, hepatic artery resistive index (HARI), portal and splenic vein diameters, portal vein velocity (PVV), and hepatic vein waveform (HVV). All measures were assessed concurrently with a highly qualified single operator.ResultsPatients aged 55.5 ± 10.2 years with male predominance (72%). A highly significant correlation was found between LS by SWE and hepatic parenchymal texture, splenic size, portal vein width, and HVV (monophasic and biphasic) (p < 0.001). There were also high significant positive correlations (p < 0.001) between LS and PVV. However, there was no definitive correlation between LS and HARI, as well as splenic vein diameter.ConclusionThe widely available economic Doppler studies including portal vein velocity and hepatic vein waveform changes could be of substantial diagnostic value to liver cirrhosis.Study designProspective cohort study, employing descriptive and analytical statistics.

Establishment of Biliary Atresia Prognostic Classification System via Survival-Based Forward Clustering - A New Biliary Atresia Classification.

To develop a machine learning algorithm with prognosis data to identify different clinical phenotypes of biliary atresia (BA) and provide instructions for choosing treatment schemes. Six hundred thirty-nine cases of type III BA were retrospectively collected from the Children's Hospital of Fudan University from Jan 1st, 2017 to Dec 1st, 2019 as a training dataset, and a survival-based forward clustering method, which can also be used to predict the subtype of a new patient was developed to identify BA subtypes. A total of 2 clusters were identified (cluster 1 = 324 and cluster 2 = 315), where cluster 2 had a lower 2 y native liver survival post-Kasai rate. The infant patients in cluster 2 have higher weight, liver, and spleen volume, wider portal vein width, and older operative age; worse coagulation and liver function results; higher grade of liver fibrosis and detection rate of hepatic portal fibrous mass, and higher recent infection detection rate of herpes simplex virus type I. With the proposed prognostic classification system, the authors predicted the subtypes of the 187 cases of type III BA in a testing dataset collected from the whole year of 2020. The p-value computed from the log-rank testing for the Kaplan-Meier survival curves of the predicted two testing groups was 0.0113. This classification system would be a convenient tool to choose appropriate treatment and accelerate the choice-making between clinicians and infant patients.

Prognostic Analysis of Liver Cirrhosis Patients with Cerebral Infarction and/or Gastrointestinal Hemorrhage: A Retrospective Cohort Study.

Background To explore the risk factors of gastrointestinal hemorrhage and/or cerebral infarction complications in liver cirrhosis and provide evidence for early prevention, clinical diagnosis, and treatment of liver cirrhosis. Methods 200 liver cirrhosis patients were analyzed: liver cirrhosis (n = 78), liver cirrhosis complicated with cerebral infarction (n = 43), liver cirrhosis complicated with gastrointestinal hemorrhage (n = 57), and liver cirrhosis complicated with gastrointestinal hemorrhage and cerebral infarction (n = 22). The incidence of disease in each group of patients at different times was calculated. Multivariate logistic regression was used to analyze the risk factors of liver cirrhosis patients with gastrointestinal hemorrhage and cerebral infarction. After 12 months of follow-up, the mortality rate of each group was calculated. Results The incidences of gastrointestinal hemorrhage, cerebral infarction, and gastrointestinal hemorrhage combined with cerebral infarction in patients with liver cirrhosis were 21.5%, 28.5%, and 11%, respectively. The width of the portal vein, D-2 polymer, albumin (ALB), and hemoglobin (Hb) were predictors of gastrointestinal hemorrhage and cerebral infarction in patients with liver cirrhosis. Age, hypertension, bleeding history, infection, portal vein width, and D-2 polymer were confirmed as risk factors for gastrointestinal hemorrhage and cerebral infarction in patients with liver cirrhosis. ALB and Hb were independent protective factors. Patients with liver cirrhosis and gastrointestinal hemorrhage with cerebral infarction had the worst survival. Conclusion Age, hypertension, bleeding history, infection, portal vein width, and D-2 polymer are all independent risk factors for gastrointestinal bleeding and cerebral infarction, while ALB and Hb are independent protective factors.

Platelet-to-Portal Vein Width Ratio and Platelet-to-Spleen Thickness Ratio Can Be Used to Predict Progressive Liver Fibrosis Among Patients With HBV Infection With HBeAg-Negativity and a Normal ALT Level.

BackgroundSome people infected with the hepatitis B virus (HBV) with a normal level of alanine aminotransferase (ALT) are at risk of disease progression. We evaluated the value of platelet-to-portal vein width ratio (PPR) and platelet-to-spleen thickness ratio (PSR) to predict progressive liver fibrosis among patients with HBV infection with HBV e antigen (HBeAg)-negativity and a normal ALT level.MethodsHBV surface antigen (HBsAg)-positive and HBeAg-negative individuals with a normal ALT level were enrolled. The inflammation grade (G) and fibrosis stage(S) were analyzed according to pathological features. Then, two groups (<S2 vs. ≥S2) among people with a normal ALT level were divided based on the pathological diagnosis, and the clinical characteristics were summarized.ResultsSeventy-three individuals among 142 patients with HBsAg-positivity and HBeAg-negativity had a normal ALT level. Also, 83.56% (61/73) individuals showed progressive liver fibrosis (≥S2). The ALT level and aspartate aminotransferase (AST) between the two groups differed (21.01 ± 7.40 vs. 25.37 ± 7.90 U/L, p = 0.08; 29.49 ± 13.56 vs. 30.16 ± 21.88 U/L, p = 0.92, respectively). Portal-vein width, serum levels of albumin and globulin, AST-to-Platelet Ratio Index (APRI), and Fibrosis 4 (FIB-4) score were not significantly different between the two groups (p > 0.05). The platelet count, PPR, and PSR were significantly different between the two groups [(145.92 ± 14.55) ×109/L vs. (126.38 ± 23.85) ×109/L, p = 0.008; 10.80 ± 1.30 vs. 9.01 ± 1.97, p = 0.004; 4.21 ± 0.65 vs. 3.33 ± 0.89, p = 0.02, respectively]. The PPR and PSR decreased gradually upon fibrosis aggravation (p < 0.05). Based on the cut off value of the PPR (9.07) and PSR (3.54), their sensitivity and specificity was 0.917 and 0.525, and 0.833 and 0.541, respectively.ConclusionThe PPR and PSR can be employed to assess earlier fibrosis progression among patients with HBV infection with HBeAg-negativity and a normal ALT level.

Effects of primary preventive treatment under endoscope for esophageal and gastric varices on bleeding rate and its relevant factors

Objective: To investigate the effects of primary preventive treatment under endoscope for esophageal and gastric varices on bleeding rate and its relevant factors. Methods: 127 cases with liver cirrhosis accompanied with esophageal and gastric varices without bleeding history were included in the endoscopic and non-endoscopic treatment group, respectively. Informed consent was obtained from both groups. Gastric varices (Lgf) and esophageal varices (Leg) were diagnosed according to LDRf classification criteria, and the corresponding treatment scheme was selected according to the recommended principle of this method.The incidence rate of bleeding from ruptured esophageal varices were observed at 3, 6 months, and 1, and 2 years in the treated and the untreated group, and the patients with different Child-Pugh scores were followed-up for 2 years. Gender, age, etiology, varicose degree, Child-Pugh grade, platelet count, prothrombin activity, portal vein thrombosis, collateral circulation, portal vein width and other factors affecting the bleeding rate were assessed. Measurement data were described as mean ± standard deviation (x¯±s), and qualitative data of categorical variables were expressed as percentage (%), and χ2 test was used. Results: 127 cases were followed up for 2 years. There were 55 cases in the endoscopic treatment group (18 cases underwent band ligation, 2 cases underwent band ligation combined with tissue adhesive embolization, 28 cases underwent sclerotherapy, and 7 cases underwent sclerotherapy combined with tissue adhesive embolization). Recurrent bleeding and hemorrhage was occurred in 5 (9.1%) and 28 cases (38.9%), respectively (P<0.05). In addition, there were 72 cases in the untreated group (P<0.05). Severe varicose veins proportions in treated and untreated group were 91.1% and 85.1%, respectively (P>0.05). There was no statistically significant difference in liver cirrhosis-related medication and β-blocker therapy between the treated and untreated group (P>0.05). There was no statistically significant difference in the bleeding rate between the different treated groups (P>0.05). The bleeding rates at 3, 6 months, 1, and 2 years in endoscopic treated and untreated group were 2.00% vs. 2.59% (P>0.05), 2.30% vs. 5.88% (P>0.05), 3.10% vs. 7.55% (P>0.05) and 4.00% vs. 21.62% (P<0.05), respectively. All patients with Child-Pugh grade A, B and C in the treated and the untreated group were followed-up for 2 years, and the bleeding rates were 1.8% vs. 8.1% (P<0.05), 1.1% vs. 9.4% (P<0.05) and 9.1% vs. 10.1% (P>0.05), respectively. There were statistically significant differences in the rupture and bleeding of esophageal and gastric varices, varices degree, Child-Pugh grade and presence or absence of thrombosis formation in portal vein (P<0.05); however, no statistically significant differences in gender, age, etiology, platelet count, prothrombin activity, collateral circulation and portal vein width (P>0.05). There was no intraoperative bleeding and postoperative related serious complications in the treated group. Conclusion: The risk of initial episodes of bleeding from esophageal and gastric varices is significantly correlated with the varices degree, Child-Pugh grade, and portal vein thrombosis. Primary preventive treatment under endoscope is safe and effective for reducing the long-term variceal bleeding risk from esophageal and gastric varices.

Relationship between portal vein width and portal vein thrombosis in patients with hepatitis B cirrhosis

Relationship between portal vein width and portal vein thrombosis in patients with hepatitis B cirrhosis

Selective Esophagogastric Devascularization in the Modified Sugiura Procedure for Patients with Cirrhotic Hemorrhagic Portal Hypertension: A Randomized Controlled Trial.

Aim Portal hypertension is a series of syndrome commonly seen with advanced cirrhosis, which seriously affects patient's quality of life and survival. This study was designed to access the efficacy and safety of selective esophagogastric devascularization in the modified Sugiura procedure for patients with cirrhotic hemorrhagic portal hypertension. Methods Sixty patients with hepatitis B cirrhotic hemorrhagic portal hypertension and meeting the inclusion criteria were selected and randomly divided by using computer into the selective modified Sugiura group (sMSP group, n = 30) and the modified Sugiura group (MSP group, n = 30). The primary endpoint measurement is the postoperative rebleeding rate. Secondary endpoint measurements included free portal venous pressure, liver Child–Pugh score, liver volume, portal vein width and blood flow velocity, survival rate, quality of life, and dysphagia as well as other complications one year postoperatively. This trial is registered with ChiCTR, number ChiCTR2000033468. Results There was no statistically significant difference in rebleeding rates within one year after surgery between patients in the sMSP and MSP groups (χ = 0.11, p=0.73). In comparison with the MSP group, the Child–Pugh score of liver function in the sMSP group significantly increased (χ = 6.4, p=0.04) and the incidence of dysphagia was significantly reduced (χ = 6.23, p=0.01) one year after surgery. There was a statistically significant difference in the quality of life between the two groups. However, there were no statistically significant differences in free portal venous pressure (MD = −3.44, 95% CI: −7.87 to 0.98, p=0.12), postoperative liver volume (3 months: MD = -258.81, 95% CI: −723.21 to 205.57, p=0.24; 1 year: MD = −320.12, 95% CI: −438.43 to 102.78, p=0.16), postoperative portal vein width (3 months: MD = −0.06, p=0.50; 1 year: MD = 0.17, p=0.21), portal vein flow velocity (3 months: MD = 1.64, p=0.21; 1 year: MD = −1.19, p=0.57), 1-year survival rate (χ = 1.01, p=0.31), and other complications between the two groups. Conclusions Selective esophagogastric devascularization in the modified Sugiura procedure may not lower the incidence of rebleeding in the short term based on our findings. However, it may significantly improve quality of life of patients with cirrhotic hemorrhagic portal hypertension, improve liver function, and reduce postoperative dysphagia.

Hepatic ultrasonography in three breeds of healthy calves: Nellore, Curraleiro Pe-duro and Pantaneiro.

An ultrasonography was performed in 21 healthy male calves of Nellore (n=8), Curraleiro Pe-duro (n=7) and Pantaneiro (n=6) breeds, between 8 and 12months, with the objective to display information about size, position and ultrasonographic parenchymal patterns of the liver, in addition to the topography of the gallbladder, right kidney and major vessels. The measurements used were dorsal margin distance (DMD) and ventral margin distance (VMD) of the liver, viewable extension (VE) of the liver, the caudal vena cava (CVC), width (CVCW) and depth (CVCD) and the portal vein (PV), width (PVW) and depth (PVD). The measures DMD, VMD and VE were similar, and the organ's longest visible extension was in 11th ICS. CVC was more frequently observed in the 11th and 10th ICS, despite being visible from the 12th to the 9th ICS in Nellore and still 8th ICS in Curraleiro Pe-duro and Pantaneiro. CVCD was lower in the 10th and 9th ICS in Nellore. The PV presented higher observation frequency in the 10th ICS. The measures PVD and PVW were higher in Nellore in the 11th, 10th and 9th ICS. To our knowledge, this report is the first to document ultrasonographic findings in three healthy calves. Considering the three breeds, the results show no differences in the ultrasonographic features as regard to the measurements and visualization of the position, size and vasculature of the liver and there was no additional information about the topography of the gallbladder and the right kidney.

Correlational study on portal vein thrombosis of liver cirrhosis

Objective: To study the relevant factors influencing the portal vein thrombosis (PVT) in patients with liver cirrhosis, and the effect of PVT formation on the complications and clinical manifestations of liver cirrhosis. And further investigate the treatment of PVT. Methods: 199 cirrhotic cases with portal vein thrombosis who were hospitalized from January 1, 2014 to October 31, 2018 were selected as PVT group. 199 cirrhotic cases without portal vein thrombosis during the same period were randomly selected as control group to collect the relevant clinical data. Univariate analysis and logistic regression model analysis were carried out on the factors that may affect the formation of PVT, and the complications of cirrhotic patients with PVT were statistically analyzed. According to different data, statistical analysis was performed by t-test, Z- test, χ2 test or Fisher's exact probability method. Results: Univariate analysis results showed that there were statistical differences (P < 0.05) between the two groups on the parts of etiologies of cirrhosis, portal vein width, white blood cells, red blood cells, hemoglobin, platelets, alanine transaminase, aspartate transaminase, alkaline phosphatase, γ - glutamyltransferase, cholinesterase (CHE), blood sugar, total cholesterol, triglyceride, prothrombin time, fibrinogen and thrombin time. Logistic regression model analysis results showed that alcoholic cirrhosis [OR = 3.125 (95% confidence interval, 1.414-6.906), P = 0.005], and portal vein widening [OR = 5.814 (95% confidence interval, 2.746-12.307), P < 0.001] were independent influencing factors of PVT formation in cirrhosis. PVT formation in cirrhosis made patients more susceptible to leukopenia [OR = 1.594 (95% confidence interval, 1.015-2.502), P = 0.043] and CHE reduction [OR = 4.267 (95% confidence interval, 2.313-7.869) P < 0.001]. Gastroesophageal variceal bleeding, ascites, pleural effusion, esophageal varices, severe gastroesophageal varices, and hospitalization length were significantly elevated in PVT group than the control group, and the difference was statistically significant (P < 0.05). Conclusion: Alcoholic cirrhosis and portal vein widening are the factors influencing the formation of PVT in liver cirrhosis. Patients with PVT in liver cirrhosis are more susceptible to leukopenia and CHE reduction. The formation of PVT makes patients with liver cirrhosis more susceptible to rupture and bleeding of gastroesophageal varices, severe gastroesophageal varices, ascites, and pleural effusion and other clinical manifestations, thereby prolonging the length of hospital stay.

Characterization of portal hypertension in hepatosplenic schistosoma mansoni patients using B-mode ultrasound

This study was designed to characterize portal hypertension (PH) by assessing cirrhosis, estimating portal vein (PV) width and spleen size, identifying ascites and deciding abnormal collateral rout...

Correlations of MMP-2 and MMP-9 gene polymorphisms with the risk of hepatopulmonary syndrome in cirrhotic patients: A case-control study

Hepatopulmonary syndrome (HPS) increases the mortality of patients who suffered from liver cirrhosis, especially patients plagued by severe hypoxemia. Gene polymorphisms are reported to be related to the risk of HPS in cirrhotic patients. Thus, our study aims to elucidate the correlation between MMP-2 and MMP-9 gene polymorphisms and HPS in cirrhotic patients. A total of 152 cirrhotic patients suffering from HPS as well as another 152 cirrhotic patients without HPS were recruited. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was performed for MMP-2 and MMP-9 gene polymorphisms and logistic regression analysis for the relationship between clinicopathological features and HPS occurrence in cirrhotic patients. There were significant differences in genotype and allele frequency of MMP-2 rs243865 and MMP-9 rs3918242 polymorphisms between the HPS and control groups. CC/CT genotype and C allele of MMP-2 rs243865 polymorphism as well as CC/TT genotype and T allele of MMP-9 rs3918242 polymorphism increased the risk of HPS in cirrhotic patients. Genotypes of rs243865 and rs3918242 polymorphisms had remarkable correlations with spider nevi, clubbed fingers (toes), transaminase elevation, portal vein width, esophageal varices, Child-Pugh classification and partial pressure of arterial oxygen (PaO2). Logistic regression analysis showed that rs243865 and rs3918242 polymorphisms, spider nevi, clubbed fingers (toes), esophageal varices, and Child-Pugh classification were closely associated with the occurrence of HPS in cirrhotic patients. Our findings demonstrate that MMP-2 rs243865 polymorphism and MMP-9 rs3918242 polymorphism can increase the risk of HPS occurrence in cirrhotic patients, which provides a potential target for prevention of HPS in cirrhotic patients.

Risk factors analysis of early rebleeding after endoscopic treatment of esophageal varices

Objective To investigate the risk factors of early rebleeding after endoscopic treatment of esophageal varices. Methods A retrospective analysis was performed on the clinical data of 384 cirrhotic patients with esophageal varices. The factors of early rebleeding group[n=36 (9.4%)] and non-bleeding group (n=348) were compared by single factor analysis and multivariate analysis of Logistic regression. Results Single factor analysis showed that there were differences between the two groups in cirrhosis with hepatocellular carcinoma, Child-Pugh classification, Child-Pugh score, ascites volume, portal vein thrombosis, portal vein width, portal hypertensive gastropathy, shapes and numbers of varicose veins, numbers of varicose vein ligation, varicose vein red syndrome, albumin, total bilirubin, prothrombin time, prothrombin activity and platelet number. Further multivariate analysis showed that mass ascites (P=0.000, OR=7.614, 95%CI: 3.590-16.147), portal vein thrombosis (P=0.003, OR=2.867, 95%CI: 1.429-5.750), portal hypertensive gastropathy (P=0.000, OR=6.212, 95%CI: 3.036-12.711), and Child-Pugh C (P=0.008, OR=3.078, 95%CI: 1.338-7.083) were independent risk factors of early rebleeding after endoscopic treatment. Conclusion The early rebleeding rate was high after endoscopic treatment of esophageal varices. Patients with massive ascites, portal vein thrombosis, portal hypertensive gastropathy and Child-Pugh C should be highly vigilant for early rebleeding. Key words: Esophageal varices; Endoscopic variceal ligation; Endoscopic injection sclerotherapy; Early rebleeding

Combination measurement of liver and spleen stiffness with portal vein width to evaluate risk of bleeding in esophageal and gastric varices patients

To evaluate the utility of combined liver stiffness measurement (LSM) and spleen stiffness measurement (SSM), by transient elastography, along with measurement of portal vein width (PVW) for evaluating risk of bleeding in patients with esophageal and gastric varices (EV). A total of 73 patients with cirrhosis who were treated in the Department of Gastroenterology of the Second Affiliated Hospital of Xi'an Jiaotong University between April 2014 and March 2015 were included in the study. Child-Pugh classifications were obtained, portal vein widths were measured by ultrasound, liver and spleen stiffness were measured by transient elastography using FibroTouch®. Patients were examined by electronic endoscopy, upper abdominal computed tomography and standard serum testing. The serum indexes of fibrosis (aspartate aminotransferase (AST) to platelet ratio index (APRI), and AST to alanine aminotransferase ratio (AAR)) were calculated. Patients were grouped according to the results of gastroscopy, with severe (EV) and high risk of bleeding comprising group A and no or mild-to-moderate EV and low risk of bleeding comprising group B. Statistical analysis was carried out with t-test for continuous variables and χ(2) test for categorical variables to first screen out variables different between groups then the correlation with severe EV was assessed by generating receiver operating characteristic (ROC) curves. Lastly, binary logistic regression was used to evaluate the performance of combined variables for diagnosing severe EV and their predictive value for risk of bleeding. Group A and B showed significant differences for LSM, SSM and PVW (all P < 0.05). The cutoff values for diagnosing severe EV were 23.4 kPa for LSM, 40.3 kPa for SSM and 11.5 mm for PVW, with areas under the ROC curve (AUROC) as 0.655, 0.788 and 0.709 respectively. For combined measurements, the AUROC was 0.773 for LSM plus PVW and 0.840 for LSM plus PVW (with highest diagnostic performance). Combination of SSM plus PVW measurement shows high diagnostic performance for evaluating severe EV, and better performance than LSM plus SSM plus PVW and LSM plus PVW, with good predictive value for risk of EV bleeding.

Gallbladder wall thickness combined with acoustic radiation force impulse imaging, portal vein width and biochemical parameters for assessing liver fibrosis caused by hepatitis

Gallbladder wall thickness combined with acoustic radiation force impulse imaging, portal vein width and biochemical parameters for assessing liver fibrosis caused by hepatitis

Non-invasive assessment of portal hypertension in patients with liver cirrhosis using FibroScan transient elastography

To investigate the clinical value of FibroScan transient elastography for assessing portal hypertension in liver cirrhosis patients by determining the relationship between the liver or spleen stiffness measurement with the imaging parameters of esophageal varices, portal vein width, spleen volume, and splenic vein width. A total of 259 patients with liver cirrhosis underwent FibroScan measurement, ultrasound, computed tomography and routine blood analyses. One-hundred-and-one of those patients also underwent endoscopy to diagnose esophageal varices. Receiver operating characteristic (ROC) curves were generated and the areas under the curves (AUCs) were calculated to assess the accuracy of the FibroScan liver and spleen stiffness measurements to predict esophageal varices. Pearson's correlation analysis was used to assess the relationship between clinical features. The median liver and spleen stiffness of the cirrhotic patients were 24.27 kPa and 44.64 kPa, respectively. Liver and spleen stiffness increased in conjunction with increases in Child-Pugh score. Liver stiffness was positively correlated with spleen stiffness (P less than 0.05). Liver and spleen stiffness were positively correlated with esophageal varices, portal vein width, spleen thickness, spleen volume, and splenic vein width. The correlation of spleen stiffness was higher than that of liver stiffness. Spleen stiffness was also negatively correlated with white blood cell count and platelet count. Liver and spleen stiffness also increased in conjunction with increased severity of esophageal varices. The AUC of spleen stiffness was higher than that of liver stiffness for predicting esophageal varices (0.804 vs. 0.737). The optimal cut-off level of spleen stiffness was 44.5 kPa (sensitivity: 88%; specificity: 68%). The estimated prevalence of esophageal varices was 97.87% and the optimized cut-off level of liver stiffness was 18.0 kPa. FibroScan appears to be a clinically valuable non-invasive method to assess portal hypertension in cirrhotic patients. Both liver and spleen stiffness measurements correlated with portal hypertension but the spleen stiffness measurement may be of higher clinical value.

The value of serum-ascites albumin gradient for predicting esophageal-gastric fundus variceal bleeding

Objective To screen the risk factors of esophageal-gastric fundus variceal bleeding,in order to provide a more economical and less invasive method for predicting esophageal-gastric fundus variceat bleeding. Methods A total of 168 diagnosed liver cirrhosis patients accompanied with ascites and 60 cases of liver cirrhosis patients with primary hepatic carcinoma were enrolled. Followed up for one year, the esophageal-gastric fundus variceal bleeding was observed and analyzed with statistic methods. Results Unconditional single factor logistic regression model analysis indicated that albumin level of ascites, serum-ascites albumin gradients (SAAG), platelets, activated partial thromboplastin time (APTT), portal vein width, length and thickness of the spleen were independent risk factors,age and serum albumin were protective factors. Multifactor analysis indicated SAAG, APTT, and portal vein width were the independent risk factors, OR was 3.559 , 2.468 and 2. 608 respectively.After building receiver operating characteristic curve, the best SAAG cut-off value was 18.50 g/L, of which the sensitivity was 96.3％ and specificity was 56.3％. Conclusion SAAG has good value in predicting esophageal-gastric fundus variceal bleeding. Key words: Hypertension, portal; Serum albumin; Ascites; Esophageal and gastric varices; Gastrointestinal hemorrhage; receiver operating characteristic curve

Effect of anluohuaxian tablet combined with γ-IFN on schistosomal liver fibrosis

The therapeutic effects of anluohuaxian tablet combined with gamma-IFN on schistosomal liver fibrosis and its mechanism were studied in a murine model and clinical cases of schistosomal liver fibrosis. Fifty Kunming mice were randomly divided into 5 groups: normal control group, infection control group, anluohuaxian tablet-treated group, gamma-IFN-treated group and combined treatment (anluohuaian tablet+gamma-IFN) group. Pathologic changes in liver, including hepatic pigmentation and the size of schistosomal egg granuloma, were observed by HE staining after treatment for 8 weeks. The expression of the type I and collagen III, and TIMP-1 was detected by immunohistochemistry. TGF-beta1 mRNA expression was examined by real-time fluorescent quantitative PCR. Sixty patients with schistosomal liver fibrosis were divided into treatment group and control group. The patients in treatment group were treated with anluohuaxian tablet in combination with gamma-IFN for 6 months. Before and after treatment, the changes of symptoms and signs, liver function, serum liver fibrosis indexes and imaging indexes were observed. The results showed that as compared with infection control group, all forms of treatments relieved the hepatic pathological injury with apparently diminished size of schistosomal egg nodules and decreased percentage of pigmentation (P<0.05). Furthermore, the expression of collagen I and III, TIMP-1, and TGF-beta1 mRNA in combined treatment group was significantly decreased as compared with anluohuaxian tablet-treated and gamma-IFN-treated groups (P<0.05). In the clinical observation, the serum liver fibrosis indexes, the portal vein width as well as the spleen thickness was significantly reduced in treatment group as compared with control group (P<0.05). It was concluded that the combined use of anluohuaxian tablet with gamma-IFN in schistosomal liver fibrosis could protect liver function, alleviate liver fibrosis, and could be used as a choice in treating patients with schiatosomal liver fibrosis.