| Objective: To observe the effects of Radix Salviae Militiorrhiza (RSM) on the portal blood flow and the esophageal variceal pressure in cirrhotic patients with portal hypertension, meanwhile a new noninvasive esophageal varix manometrical digital video system was to be designed. Methods: (1) Forty-nine cases of liver cirrhosis were enrolled and divided randomly into two groups. The control group was treated with conventional therapy and the tested group was treated with RSM. The parameters, including esophageal varix pressure (EVP), portal hemodynamics indexes, endotoxin as well as blood-activating factors were determined before and 2 weeks after treatment; (2) A complete experimental assessment of the esophageal varix manometry (EVM) potentials and limitations was conducted in the model consisting of an artificial esophagus containing an artificial varices (water-filled tube) in vitro; (3) A new noninvasive esophageal varix manometrical digital video system (EDVS) was developed on the basis of improvement of EVM. We designed the software of esophageal varix pressure automatic digital gauge, which can collect and compress the video signal from endoscopy. The device may record the detailed course of pressure measurement by digital video. By apartline technique checking the collected digital image and synchronous real-time pressure, it could be automatically found that the moment when the pressure of an endoscopic balloon equilibrates the intravariceal pressure. At that time, the intravariceal pressure represent the pressure of the endoscopic balloon. Results: (1) After administration of RSM, the diameter of portaldecreased (P<0.05). The measured EVP in RSM group was decreased by 2.91 2.74 mmHg (P<0.05) ,which was decreased by 12.33 12.61% (P<0.05) than that of pretreatment, but the level of endotoxin and blood-activating factors was showed a poor decrease. Every parameter in the control group did not exhibit a decrease; (2)Linear regression analysis showed a good correlation between the real pressure in the varix of different diameter (3,6,9mm) and the balloon pressure measured by EVM (r=0.983~ 0.995) in vitro. No obvious pressure measurement bias was found for any of the varices, except in a 3 mm diameter varix where the bias was found to be high (bias=-7.9?2.6cmH20).The measured pressure in the varix was not affected by mimic esophageal wall elasticity. Interobserver reliability of measurement assessed by two endoscopists was excellent; (3) The new noninvasive esophageal varix manometrical digital video system had solved three critical problem: It could accurately find out the marked transverse lines by edge finding technique, eliminate the abnormal folder on marked transverse lines by curve fiting techinique, and eliminate the possible effect of esophageal peristalsis the slight movement of varix by dynamic tracking, respectively. We found that the endoscopic balloon pressure equilibrates the intra-tube pressure when the 1/3 height of mimic varix were collapsed or returned in vitro. A good correlation was found in linear regression analysis (r=0.994,P=0.000) . No obvious pressure measurement bias was found. Conclusions: (D RSM could effectively decrease portal hypertension and EVP in liver cirrhosis; (2) Measurement of pressure in esophageal varice by EVM may give reliable results in large and medium-sized varices and may be unaffected by esophageal wall elasticity; (3) The mimic intravariceal pressure were assessed by the new noninvasive esophageal varix manometrical digital video system without the investigator's subjective judgement. |
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