42 Wistar rats were divided into three groups at random, liver cirrhosis (LC), portal vein stricture (PVS) and sham operation (SO) group. The changes of barrier capability of gastric mucosa in portal hypertensive rats were observed. The results demonstrated: the splanchnic blood flow of the portal hypertensive rats increased, as compared with the normal control group (Ｐ＜0.001), but actually gastric mucosa was under the condition of ischemia. Mucosa of gastric wall glycoprotein and PGE2 of gastric mucosa decreased, as compared with the normal control (Ｐ＜0.01); and more seriously decreased in cirrhotic portal hypertensive rats, there was no significant difference about amount of the basal acid secretion (BAS) among the three groups, but the amount of H＋ backdiffusion (H＋BD) was obviously increased, as compared with the normal control group (Ｐ＜0.001). The amount of H＋BD of cirrhotic portal hypertensive rats was the highest among this three groups. The results suggest that the barrier capability of gastric mucosa with portal hypertension is lower than that of the normal control group and much lower with cirrhotic portal hypertensive rats. The portal hypertensive gastropathy is associated with the lower capability of defense of gastric mucosa. The condition of liver function contributes to the change of barrier capability of gastric mucosa.
ObjectiveTo introduce the new nomenclature scheme of the International Working Group (1995) on hepatic nodules, and summarize the imaging features of various hepatic nodules in light of their pathological characteristics, and evaluate the diagnostic values of various imaging facilities.MethodsUltrasound, computed tomography(CT), magnetic resonance imaging(MRI), and angiographic CT were reviewed and introduced.ResultsMany of these types of hepatic nodules play a role in the de novo and stepwise carcinogenesis of hepatocellular carcinoma(HCC) in the following steps: regenerative nodule, lowgrade dysplastic nodule, highgrade dysplastic nodule, small HCC, and large HCC. Accompanying such transformations, there are significant alterations in the blood supply and perfusion of these hepatic nodules.ConclusionModern stateoftheart medical imaging facilities can not only delineate and depict these hepatic nodules, but also provide important clues for the characterization of focal hepatic lesions in most cases, thus facilitating the early detection, diagnosis and management of HCC in its early stage.
To investigate the change of the portal venous pressure (PVP), conjugated glycocholic acid (CGA) and pancreatic glucagon (PG) concentration in rats peripheral and portal venous blood in the course of experimental liver cirrhosis induced with carbon tetrachloride and to investigate the mentioned changes after portalazygous devascularization. The authors found that in the early stage of cirrhosis the PVP and the concentration of CGA and PG in peripheral venous blood were increased markedly, CGA in portal vein was decreased and PG in portal vein was increased in early stage of liver cirrhosis.With the extent of liver cirrhosis the indexes above changed more markedly. After portalazygous devascularization the concentration of CGA in peripheral vein in the cirrhotic rats was increased but PVP, the concentration of CGA in portal vein and PG in peripheral and portal vein did not change.There was no change in nornal rats. The results suggest that the variation in CGA in peripheral vein can accurately reflect the degree of damage to liver cells, thus making the diagnosis of liver cirrhosis earlier and judging the degree and prognosis of liver cirrhosis.The concentration of PG in portal venous and peripheral vein relate to PVP in liver cirrhosis.Portalazygous devascularization can maintain PVP and PG in portal vein and do not affect liver function of the control rats but it can damage liver cell in cirrhotic rats.
Objective To explore the effect of cyclopamine （Cyc） which is the inhibitor of the Hedgehog signaling pathway on portal venous pressure of normal and liver cirrhosis rats, and it’s possible mechanisms. Moreover, to provide the experimental basis of drug efficacy and clinical treatment. Methods Thirty two healthy male SD rats were randomly average divided into four groups：normal control group, normal treatment group, liver cirrhosis control group, and liver cirrhosis treatment group. The liver cirrhosis models of rat were established by using the thioacetamide （TAA） method, which made 0.03% of TAA as the initial water concentration, and then the concentration of TAA in drinking water was adjusted according to the changes of the weekly body weight of rats lasting for twelve weeks. In thirteenth week, intraperitoneal injection of corn oil （0.1 ml/100 g body weight, 1 time/d） were performed lasting for a week in rats of the normal control group and liver cirrhosis control group; intraperitoneal injection of Cyc 〔1 mg （0.1 ml）/100 g body weight, 1 time/d〕were performed lasting for a week in rats of the normal treatment group and liver cirrhosis treatment group. In fourteenth week, the liver function, portal venous pressure （PVP）, and the ration of liver or spleen weight to body weight were detected, the expressions of α-smooth muscle actin （α-SMA） and typeⅠcollagen α1 （Col1α1） of hepatic stellate cell were detected by using immunohistochemistry. Results PVP were （10.7±0.9） and （12.3±1.3） cm H2O （1 cm H2O=0.098 kPa） in normal control group and normal treatment group, respectivly, the latter was higher than the former （t=-2.918，P=0.011）. PVP were （21.8±0.7） and （14.3±1.4） cm H2O in liver cirrhosis control group and liver cirrhosis treatment group, respectivly, the latter was lower than the former（t=13.602，P=0.000）. The expressions of α-SMA and Col1α1 in liver cirrhosis treatment group was lower than the liver cirrhosis control group. There were no significant difference of the liver function and ration of liver or spleen weight to body weight between the treatment group and the control group （P＞0.05）. Conclusion Cyclopamine could signally reduce the PVP of liver cirrhosis rats through reducing the expressions of α-SMA and Col1α1.
Objective To explore the cause, diagnosis, and treatment methods of portal vein thrombosis （PVT） after splenectomy. Methods The clinical data of 29 patients who were got splenectomy because of portal hypertension or traumatic splenic rupture from August 2002 to August 2008 in our hospital were analyzed retrospectively. Results Tweenty-seven patients with PVT were treated successfully, whose thrombi were absorbed completely or partially. One case died of peritonitis，septic shock，and multiple organ failure. One case died of hematemesis, hepatic coma，and multiple organ failure. Tweenty-four patients were followed up, the follow-up time was 0.5 to 3 years, the average was 2 years. Two cases died of massive hemorrhage, 1 case died of hepatic encephalopathy，and 1 case died of liver failure. Two cases occurred deep venous thrombosis in one year after treatment, and the remaining patients had no recurrence of venous thrombosis. Conclusions PVT have some connection with the raise of blood platelet and the hemodynamic changes of the portal vein system after splenectomy. Standardization of operation, early diagnosis, early line anticoagulant，and antiplatelet adhesion therapy are effective way to prevent and treat PVT.
Objective To review the value of imaging assessment of stem cell transplantation in treatment for liver cirrhosis.Methods The related literatures in recent years were collected,and the applications of different radiological techniques and strategies of stem cell transplantation in treatment for liver cirrhosis were summarized.Results Stem cell transplantation in treatment for liver cirrhosis was feasible and effective. Radiological assessment could supply the prompt and accurate information for clinic to choose the proper therapeutic method.The curative effect could also be accurately assessed by radiological techniques.Conclusion Radiological examination is important for the assessment of stem cell transplantation in treatment for liver cirrhosis.
ObjectiveTo introduce the technique of threedimensional portal venography of multidetector row spiral CT and its clinical application in the evaluation of the portosystemic collateral shunts of liver cirrhosis. MethodsAll relevant literatures were retrospectively reviewed on the application of twodimensional and threedimensional reconstruction techniques such as MIP, SSD, VRT of multidetector row spiral CT to demonstrate the collateral vessels of liver cirrhosis.ResultsThe distribution, pathway and anatomy of portosystemic collateral vessels were well shown by multidetector row spiral CT portal venography. Conclusion Multidetector row spiral CT portal venography provides excellent depiction of the anatomic characteristics of the collateral shunts and enables the continuous tracing of vascular structures, thus it is very helpful in the imaging evaluation of the collateral vessels of liver cirrhosis.
Objective To evaluate the effect of laparoscopic splenectomy （LS） and open splenectomy （OS） forhypersplenism secondary to liver cirrhosis with portal hypertension. Methods Cochrane Central Register of Controlled Trials， Cochrane Database of Systematic Reviews， Medline， Embase， CINAHL， CBM， CNKI， VIP and WanFang database were searched for randomized control trials or retrospective studies related to the effect of LS and OS for hyper-splenism secondary to liver cirrhosis with portal hypertension. Then studies were screened according to the inclusion and exclusion criterias， data were collected， and quality of studies were evaluated. RevMan 5.1.0 software was used for meta-analysis. Results Seventeen retrospective studies and one randomized control trial were enrolled. The results of meta analysis showed that， the estimated blood loss， postoperative hospital stay， rate of postoperative complication， and WBC level on 1 day after operation of LS group were significantly lower or shorter than those of OS group （P＜0.05）. However， there were no significant differences on operative time， WBC level on 7 days after operation， postoperative platelets （1 day and 7 days after operation）， alanine aminotransferase （1 day and 7 days after operation）， and total bilirubin （1 day and 7 days after operation） between LS group and OS group （P＞0.05）. Conclusions LS may be more effective to reduce blood loss， postoperative hospital stay， and rate of postoperative complication in patients with hypersplenism secondary to liver cirrhosis with portal hypertension in comparison to OS. However， the effectiveness of LS on liver function is not clear.
Objective To explore the correlation between liver volume variation of posthepatitic cirrhosis patients and the severity of the disease. Methods One hundred and eleven patients with normal livers and 74 posthepatitic cirrhosis patients underwent volume CT scan. The relation between normal liver volume and body height, body weight and body surface area was studied by linear regression and correlation method, the standard liver volume equation was deduced. The change ratio of liver volume in cirrhotic patients was calculated and compared with Child classification. Results The mean normal liver volume of Chinese adults was （1 225.15±216.23） cm3, there was a positive correlation between liver volume and body height, body weight 〔liver volume (cm3)=12.712×body weight (kg)+450.44〕 and body surface area 〔liver volume (cm3)=876.02×body surface area (m2)-297.17〕. The mean liver volume of Child A, B and C patients were （1 077.77±347.01） cm3, (1 016.35±348.60) cm3 and (805.73±208.85) cm3 respectively. The liver volume and liver volume index was significantly smaller in Child C patients than those in Child A and B patients (P＜0.05); while liver volume change ratio was higher in Child C patients (P＜0.05). Conclusion Liver volume variation of cirrhotic patients can be quantitatively assessed by 16 slices helical CT volume measurement and standard liver volume equation. The change of the liver volume is correlated with the severity of liver cirrhosis.
Objective To investigate the mediating effect of nursing intervention of sleep hygiene on insomnia in patients with liver cirrhosis. Methods One hundred and eighteen cirrhotic patients with grade-A liver function and insomnia treated between June 2012 and January 2015 were divided into control group (n=52) and intervention group (n=66) with random number table method. The control group received conventional nursing only, while the intervention group was given nursing intervention of sleep hygiene. The sleep quality of patients in the two groups on admission and discharge were surveyed and compared based on Pittsburgh sleep quality index (PSQI). The nursing effect was also compared between the two groups on discharge. Results There was no statistically significant difference in total score and scores for each factor of PSQI between the two groups of patients on admission (P>0.05). However, the total score and scores for each factor of PSQI on discharge in both groups were significantly lower than those on admission (P<0.05). Besides, the scores in the intervention group were significantly lower than those in the control group (P<0.05). The effect of nursing in the intervention group was superior to that in the control group (P<0.001). Conclusions Nursing intervention of sleep hygiene can effectively improve sleep quality in cirrhotic patients with grade-A liver function. The role of nursing intervention in the treatment of insomnia should be taken seriously.