Therefore, we decided to use PBDL for this study In BDL lobes, F

Therefore, we decided to use PBDL for this study. In BDL lobes, F4/80-positive cells were increased. The Ale-lip treatment succeeded in deleting F4/80-positive cells (Fig. 1A). Thus, Ale-lip injection can be utilized as a new tool for Kupffer cell depletion. Inflammatory cytokines mainly produced from Kupffer cells were up-regulated in BDL lobes, whereas the Ale-lip treatment markedly inhibited the production of TNF-α

and IL-1β (Fig. 1B). Kupffer cell-depleted mice showed an increase of Nutlin-3a solubility dmso injured lesion in BDL lobes and serum ALT level after the surgery (Fig. 1C). Interestingly, 24 hours after common BDL (Supporting Fig. 2) as well as PBDL (Fig. 1C), there were no significant differences in histological liver injury and elevated ALT activities between control and Kupffer cell-depleted mice. These findings indicate that Kupffer cells were not involved in the early stage of liver damage that occurs by BDL, but in the late JNK pathway inhibitors stage. As previously reported,20 treatment with TNF-α plus GalN strongly induced hepatocyte destruction and massive hemorrhage with apoptotic cells in nonligated lobes of PBDL animals, whereas hemorrhagic damage and hepatocyte apoptosis were blunted in BDL lobes (Supporting Fig. 3A-C). Kupffer cell depletion itself did not induce hepatocyte apoptosis (Supporting Fig. 3D). In Kupffer cell-depleted livers, GalN plus TNF-α treatment induced hemorrhagic liver damage and hepatocyte apoptosis

with the cleavage of poly (ADP-ribose) polymerase (PARP), which is the downstream target of caspase-3, both in nonligated and BDL lobes (Fig. 2A-C). In the BDL lobes, proliferation cell nuclear antigen (PCNA) or Ki67-positive hepatocytes were increased with up-regulation of cyclin E expression (Fig. 2D-F), indicating that BDL induces hepatocyte regeneration. In Kupffer cell-depleted livers the expressions of PCNA, Ki67, and

cyclin E were decreased (Fig. 2D-F). Thus, Kupffer cells are important for survival and regeneration of hepatocytes after BDL. Fibrosis was induced in BDL lobes as demonstrated by Sirius red staining, hydroxyproline content, expression of α-smooth muscle actin (α-SMA) and desmin, MCE and messenger RNA (mRNA) expression of collagen-α1(I) and transforming growth factor (TGF)-β1 (Fig. 3). Kupffer cell-depleted mice showed reduced fibrosis in BDL lobes (Fig. 3). The number and the activation of HSCs were decreased by Kupffer cell depletion as assessed by desmin and α-SMA expression, respectively. These results suggest that the decrease in the fibrogenic response by Kupffer cell depletion is due to a lack of signal from Kupffer cells to activate and proliferate HSCs. To further elucidate the mechanisms by which Kupffer cells contribute to BDL-mediated functional changes in liver injury, survival of hepatocyte, regeneration, and fibrosis, we focused on ASMase. The protein level of ASMase (Supporting Fig.

Our data demonstrate that miR-200a is frequently down-regulated i

Our data demonstrate that miR-200a is frequently down-regulated in HCC tissues in comparison with the adjacent noncancerous hepatic tissues, a finding that is consistent with other reports.35, 36 Reduced levels of the histone H3 acetylation at the mir-200a promoter and increased levels of HDAC4 mRNA were also observed in HCCs. Because HDAC4 alone is enzymatically inactive, CCI-779 in vitro it may suppress the transcription of miR-200a and induce the histone H3 deacetylation at the mir-200a promoter by recruiting catalytically active HDACs into transcriptional

corepressor complexes.37 Therefore, further investigations are required to fully elucidate the nature of HDAC4-containing repressor complexes at the mir-200a promoter. In addition to miR-200a, the miR-200 family also includes miR-200b, miR-200c, miR-141, and miR-429, with miR-200b, miR-200a, and miR-429 being located on chromosome 1 and miR-200c and miR-141 being located on chromosome 12. Both clusters are encoded

as polycistronic transcripts. Our results show that HDAC4 regulates the expression of the miR-200b, miR-200a, miR-429 cluster, but does not regulate the other cluster. Other reports have demonstrated that HDAC inhibitors induce up-regulation of miR-200c,15, 17 and therefore we speculated that other HDACs may participate in the regulation of the miR-200c and miR-141 cluster. Interestingly, we observed that miR-200a, in turn, negatively regulated HDAC4 expression by directly targeting the complementary sites in the 3′-UTR selleck products of HDAC4 mRNA, generating a double negative feedback loop. Feedback loops are common in many genetic pathways involving miRNAs, and they seem to enhance the robustness of gene networks.38 A significant inverse correlation was also observed between HDAC4 and miR-200a in human HCC tissues. Copy number alterations of

miR-200a and HDAC4 were not found in HCC tissues compared with matched controls. Other proteins such as ZEB1,24 SIRT1,22 p53,39 and gata-binding factors23 can also regulate the expression of miR-200a. Therefore, there is an intricate mechanism regulating the expression of miR-200a and HDAC4 in HCCs. Further investigations are required to elucidate whether the up-regulation of HDAC4 or the down-regulation of miR-200a is the initial 上海皓元 factor of this loop in HCC. Recently, many studies have demonstrated that miRNAs may affect the epigenetic mechanism. For instance, miR-152 induced aberrant DNA methylation in HCC by targeting the DNA methyltransferase 1, as demonstrated in our previous study.40 Other miRNAs, such as miR-148a/b,41 miR-1,20 and miR-449a19, have also been reported to target epigenetic modifying enzymes and modulate the epigenetic transcriptional-regulatory process. However, whether miRNAs can affect the histone acetylation level in HCC remains largely unknown.

The assumption of a gradual increase

The assumption of a gradual increase learn more in antiviral effectiveness that explains

the initially slow decrease in viral load still needs to be validated, even though it is supported by the observation that the active forms of mericitabine in vitro take ∼48 hours to accumulate to steady-state triphosphate levels.13 It is noteworthy that RBV, which needs to be phosphorylated to its monophosphate, diphosphate, and triphosphate analogues, when given as monotherapy also induces a monophasic viral decline consistent with the variable effectivenss assumption.29 Second, our model does not distinguish between the cytidine and the uridine triphosphates, which could have slightly different potencies selleck products and are expected to accumulate at different rates. Third, it is hard to precisely estimate ε1, ε2, and δ, because they have overlapping effects on the viral load decline. At least one additional sampling measurement between days 1 and 4 would be necessary to estimate more precisely the initial antiviral effectiveness, ε1. However, the fact that the CE and the VE models provided very similar estimates of ε and δ (Tables 1 and 2) is an indication that these parameters were precisely estimated, and consequently that infected cell loss/death

may be playing a minor role in the overall viral load decline. Lastly, for the sake of parameter identifiability, the target cell level was assumed constant throughout the study period. The kinetics of HCV MCE RNA rebound after the end of treatment may be affected by the increased availability of target cells,30 and hence our estimates of the rate at which antiviral effectiveness decays after the end of treatment may not be as reliable

as we would wish. Recent developments in viral dynamic modeling have emphasized the interplay between the kinetics of intracellular viral RNA and the extracellular viral kinetics measured by serum levels of HCV RNA.31 Within the context of such models it has been shown that the initial rate of decline of serum HCV RNA is proportional to the ability of drug to block the late stages of virion production (i.e., assembly/secretion).32 If a drug does not block virion assembly/secretion, there may be release of preformed virions during the first phase of viral decline that masks the intrinsic plasma HCV clearance rate.32 Thus the slow initial viral decline observed with mericitabine may reflect the fact that blocking NS5B has only a minimal effect on blocking virus assembly/secretion into the circulation. However, even if a minimal effect in blocking virus assembly/secretion is taken into account using a model that incorporates intracellular events,32 a gradual decrease in the virus production rate, as in the VE model, is still required to fit the data (not shown).

The assumption of a gradual increase

The assumption of a gradual increase SCH 900776 order in antiviral effectiveness that explains

the initially slow decrease in viral load still needs to be validated, even though it is supported by the observation that the active forms of mericitabine in vitro take ∼48 hours to accumulate to steady-state triphosphate levels.13 It is noteworthy that RBV, which needs to be phosphorylated to its monophosphate, diphosphate, and triphosphate analogues, when given as monotherapy also induces a monophasic viral decline consistent with the variable effectivenss assumption.29 Second, our model does not distinguish between the cytidine and the uridine triphosphates, which could have slightly different potencies this website and are expected to accumulate at different rates. Third, it is hard to precisely estimate ε1, ε2, and δ, because they have overlapping effects on the viral load decline. At least one additional sampling measurement between days 1 and 4 would be necessary to estimate more precisely the initial antiviral effectiveness, ε1. However, the fact that the CE and the VE models provided very similar estimates of ε and δ (Tables 1 and 2) is an indication that these parameters were precisely estimated, and consequently that infected cell loss/death

may be playing a minor role in the overall viral load decline. Lastly, for the sake of parameter identifiability, the target cell level was assumed constant throughout the study period. The kinetics of HCV 上海皓元 RNA rebound after the end of treatment may be affected by the increased availability of target cells,30 and hence our estimates of the rate at which antiviral effectiveness decays after the end of treatment may not be as reliable

as we would wish. Recent developments in viral dynamic modeling have emphasized the interplay between the kinetics of intracellular viral RNA and the extracellular viral kinetics measured by serum levels of HCV RNA.31 Within the context of such models it has been shown that the initial rate of decline of serum HCV RNA is proportional to the ability of drug to block the late stages of virion production (i.e., assembly/secretion).32 If a drug does not block virion assembly/secretion, there may be release of preformed virions during the first phase of viral decline that masks the intrinsic plasma HCV clearance rate.32 Thus the slow initial viral decline observed with mericitabine may reflect the fact that blocking NS5B has only a minimal effect on blocking virus assembly/secretion into the circulation. However, even if a minimal effect in blocking virus assembly/secretion is taken into account using a model that incorporates intracellular events,32 a gradual decrease in the virus production rate, as in the VE model, is still required to fit the data (not shown).

HSCs are liver pericytes that reside in the space between parench

HSCs are liver pericytes that reside in the space between parenchymal cells and sinusoidal endothelial cells of the liver.[2] HSCs are rich in vitamin A and store nearly 80% of retinoids of the whole body in its lipid droplets in the cytoplasm.[3, 4] Interestingly, recent studies[5-15] suggest that HSCs participate in the liver immunity. In this paper, we review the recent development in HSC-mediated

immunity and the significance of these new observations. HCV represents one of the major causes of liver fibrosis. The rate of progression of liver fibrosis varies widely in the chronic HCV infection, and progresses to cirrhosis within 20 years in an estimated 20–30% of individuals with chronic HCV infection.[16] The role of HSCs in FK506 in vivo HCV-mediated liver fibrosis has been well documented. HCV-infected hepatocytes release transforming growth factor-β1 (TGF-β1) and other profibrogenic factors that differentially modulate HSC expression of ABC294640 several key genes involved in liver fibrosis.[17] HCV infection-induced hepatocyte

apoptosis is a common feature in chronic HCV infection.[18, 19] Apoptosis results in the generation of apoptotic bodies (ABs), which are subsequently cleared by phagocytosis. Several studies showed that HSCs have the ability to engulf ABs through phagocytosis, which can trigger a profibrogenic response.[20, 21] It was reported that ABs derived from HCV-infected Huh7 cells exhibited a more pronounced effect on profibrotic genes expression in HSCs than HCV-negative ABs.[22] Besides the indirect effects of HCV on HSCs function through infected

hepatocytes, several studies[23-26] 上海皓元 indicated that there is also a direct contact between HCV and HSCs. The potential interaction between HSCs and HCV is suggested by the observation that HSCs express high levels of CD81 protein,[23] a key entry coreceptor for HCV.[24] It has been demonstrated that the HCV E2 protein can directly bind to CD81 on HSC surface, inducing fibrogenic effects on HSCs.[25] In addition to HCV envelope protein, HCV core and nonstructural proteins have also been shown to affect HSC functions.[26] Recombinant HCV core and NS3 proteins could increase intracellular calcium concentration and reactive oxygen species production in activated HSCs.[26] HCV core protein could increase HSC proliferation, and NS3-NS5 protein preferentially induced pro-inflammatory cytokines in HSCs. The roles of HSCs in HCV infection-mediated liver fibrosis are summarized in Table 1. HSCs have recently been implicated to play a novel role in the liver immunity. It was reported that HSCs could induce vigorous natural killer T (NKT) cell responses in vitro and in vivo, and promote homeostatic proliferation of NKT cells.[13] In addition, HSCs could elicit antigen-specific T cells and inhibit bacterial infection in a Listeria monocytogenes infection model.

In addition, TLC failed to further decrease PM-MRP2 in cells tran

In addition, TLC failed to further decrease PM-MRP2 in cells transfected with PD-MARCKS. These results suggest that phosphorylation of MARCKS is necessary for the TLC-induced retrieval of MRP2. see more The aim of the present study was to further define the mechanism by which TLC induces the retrieval of MRP2. The present study showed that TLC increased PM localization of PKCϵ, and a kinase-dead DN-PKCϵ

inhibited TLC-induced MRP2 retrieval. In addition, DN-PKCϵ inhibited TLC-induced increases in the phosphorylation of MARCKS, and PD-MARCKS inhibited TLC-induced MRP2 retrieval. These results suggest that TLC-induced MRP2 retrieval involves the activation of PKCϵ followed by the phosphorylation of MARCKS, as discussed later. PKCϵ has been suggested to be involved in TLC-induced cholestasis.9 However, this conclusion is based on indirect evidence. The strongest evidence in favor of this hypothesis is the reversal of TLC-induced membrane translocation of PKCϵ and cholestasis by tauroursodeoxycholate.9 In

the present study, we tested this hypothesis more directly by using DN-PKCϵ. As previously reported in rat hepatocytes,5, 10 TLC induced the translocation of PKCϵ to the PM and the retrieval of MRP2 from the PM in HuH-NTCP cells selleck compound as well as rat hepatocytes. TLC failed to induce MRP2 retrieval when cells were transfected with kinase-dead DN-PKCϵ, and this indicates that the PKCϵ kinase activity is needed for TLC-induced MRP2 retrieval. This is the first direct demonstration of a role for PKCϵ in MRP2 retrieval by TLC. Our MCE studies also provide evidence for PKCϵ-mediated phosphorylation of MARCKS by TLC. MARCKS is a PKC substrate and binds noncovalently to PM.12 MARCKS phosphorylation leads to its translocation to the cytosol in chromaffin cells.18 A previous study35 reported that PMA translocated MARCKS from the PM to the cytosol in HepG2 cells, and this effect, based on inhibition by chemical inhibitors of

PKCs, appeared to be mediated via Ca2+-dependent and Ca2+-independent PKCs. However, whether PMA phosphorylated MARCKS was not determined. In the present study, we observed that TLC induced phosphorylation of MARCKS, increased the cytosolic levels of pMARCKS, and decreased PM-MARCKS. Thus, TLC-mediated phosphorylation of MARCKS results in the dissociation of MARCKS from the membrane. In addition, TLC-induced MARCKS phosphorylation was inhibited in cells transfected with DN-PKCϵ. These results suggest that TLC, acting via PKCϵ, phosphorylates MARCKS and results in the dissociation of MARCKS from the PM. The present study suggests that MARCKS phosphorylation by PKCϵ is involved in MRP2 retrieval by TLC. This is supported by the fact that TLC failed to induce MRP2 retrieval in cells transfected with PD-MARCKS (Fig. 7).

In addition, 607% of the patients enrolled received rituximab-ba

In addition, 60.7% of the patients enrolled received rituximab-based chemotherapy, which has been demonstrated as able to increase the HCV replication in anti-HCV–positive patients.7 In conclusion, neither occult HCV infection nor its reactivation under strong immunosuppressive chemotherapy were found in the present study in oncohematological patients who were anti-HCV- and HCV RNA–negative. Our data and those of others6, 8 suggest the nonexistence of occult HCV infection. Nicola Coppola M.D., Ph.D.*, Mariantonietta Pisaturo M.D.*, Salvatore Guastafierro M.D.†, Gilda Tonziello M.D.*, Antonello Sica M.D., Ph.D.†, Caterina

Sagnelli Ph.D.*, Maria Giovanna Ferrara M.D.†, Evangelista Sagnelli M.D.* ‡, * Department of Public Medicine, Section Dabrafenib of Infectious Diseases, Naples, Italy, † Haematology Unit, Second University of Naples, Naples, Italy, ‡ Division of Infectious Diseases, Azienda Ospedaliera Sant’Anna e San Sebastiano di Caserta, Caserta, Italy. “
“Platelets contain not only hemostatic factors but also many growth factors that play important roles in wound healing and tissue repair. Platelets have already been used

for the promotion of tissue regeneration in the clinical setting, such as dental implantation and plastic surgery. Thrombocytopenia, which is frequently found in patients with chronic liver disease and cirrhosis, is due to various causes such as decreased thrombopoietin production and accelerated platelet destruction caused by hypersplenism. However, the relationship between thrombocytopenia and hepatic pathogenesis GSK1120212 molecular weight and the role of platelets in chronic liver disease are poorly understood. In acute liver injury, it is reported that platelets are recruited to the liver and contribute medchemexpress to liver damage by promoting the induction of chemotactic factors and the accumulation

of leukocytes in the liver, whereas platelets or mediators released by platelets can have a protective effect against liver injury. In this review, we highlight the recent accumulated knowledge concerning the role of platelets in chronic liver disease and acute liver injury. Chronic liver disease (CLD), which results in liver cirrhosis and an increased risk of carcinogenesis, is a major cause of mortality and morbidity in many countries.[1, 2] Liver fibrosis represents the consequences of a sustained wound healing response to chronic liver injury induced by a variety of causes including viral infection, alcohol abuse, autoimmune disorders, drug use, cholestasis, and metabolic diseases.[3, 4] Currently, liver transplantation is the only curative approach for end-stage liver cirrhosis, but this process is associated with serious problems, such as graft shortage in living-donor liver transplantation, surgical complications, organ rejection, and high cost.

Forty-four rust-infected

Forty-four rust-infected selleck chemical sunflower leaf samples were collected from 25 geographical locations. Freshly produced spores were used to study physiological race differentiation on a set of nine differentials. Race 300 was the most prevalent race observed over all locations with a 59% frequency followed by races 735, 310, 500, 724 and 737. To evaluate hybrids and varieties for resistance screening, spores of race 300 were used to inoculate 65 hybrids, and five open-pollinated varieties selected from breeding programmes and from the seed market. None of the confection hybrids and open-pollinated varieties was immune to race 300. Conversely, among oilseed hybrids, 3% of them showed immunity,

12% highly resistant, 59% resistant and 26% showed susceptible reactions. Open-pollinated varieties were the most Apoptosis Compound Library susceptible to race 300 followed by confection and oilseed sunflower hybrids. Results from this study are projected to assist breeders in selection of hybrids and varieties against prevalent race as our results showed a diversity of resistance levels to race 300. “
“Royal Palms (Roystonea regia) with symptoms such as

severe chlorosis, stunting, collapse of older fronds and general decline were observed in the state of Selangor, Malaysia. Using polymerase chain reaction (PCR) amplification with phytoplasma universal primer pair P1/P7 followed by R16F2N/R16R2 and fU5/rU3 as nested PCR primer pairs, all symptomatic plants tested positively for phytoplasma. Results of phylogenetic and virtual RFLP analysis of the 16S rRNA gene sequences revealed that the phytoplasma associated with Royal Palm yellow decline (RYD) was an isolate of ‘Candidatus Phytoplasma asteris’ belonging to a new 16SrI-subgroup. These results show that Roystonea regia is a new host for the aster yellows phytoplasma (16SrI). This is the first report on the presence of 16SrI phytoplasma on Royal Palm trees in Malaysia. MCE公司
“Fusarium

poae is one of the Fusarium species isolated from grains associated with Fusarium head blight (FHB), whose occurrence has increased in the last years. In this study, a total of 105 F. poae isolates from Argentina, Belgium, Canada, England, Finland, France, Germany, Hungary, Italy, Luxembourg, Poland, Switzerland and Uruguay were evaluated using sequence-related amplified polymorphism (SRAP) to analyse the capacity of this molecular marker to evaluate the F. poae genetic variability. The molecular analysis showed high intraspecific variability within F. poae isolates, and a partial relationship was revealed between variability and the host/geographic origin. Analysis of molecular variance (amova) indicated a high genetic variability in the F. poae collection, with most of the genetic variability resulting from differences within, rather than between American and European populations.

11 This finding perhaps reinforces our understanding of the risk

11 This finding perhaps reinforces our understanding of the risk factors for GVB. It has been shown that gastric varices can bleed at lower pressures compared with esophageal varices, suggesting that reduction in portal pressure will have less influence in bleeding risk or that a greater magnitude in pressure reduction

is necessary to protect against bleeding.12 Other risk factors (in particular the size of gastric varices) that in turn influence wall tension may also be important. The median size of gastric varices in the study was 20 mm and obturation of varices was achieved in all patients. Patients treated with cyanoacrylate all had a reduction in the size of gastric varices, in contrast to over a third of patients in the other arms having an increase ROCK inhibitor in size of gastric varices. There was no difference in the appearance of esophageal varices or appearance/worsening of portal hypertensive

gastropathy during follow-up in the two groups. Certain aspects of the Mishra et al.10 findings must be considered carefully. It is not clear from the three-arm study whether a Bonferroni multiple comparison correction was used. Therefore, the findings may not withstand close statistical scrutiny. In practice, particularly outside of large specialized units, many patients may be ineligible for treatment given the strict inclusion criteria. Although no complications from cyanoacrylate were observed, in less expert hands this may not always be the case. It may be difficult to convince patients or clinicians Vemurafenib research buy to accept prophylactic cyanoacrylate if it has not been

shown to be more effective than propranolol in improving survival. This brings into question the choice of NSBBs. The recent demonstration that carvedilol was more effective than band ligation in preventing bleeding from esophageal varices makes one wonder how this drug would compare with cyanoacrylate.13 Only one-third Arachidonate 15-lipoxygenase of patients in the Mishra et al. study responded to propranolol, and because carvedilol has been shown to be more effective at lowering portal pressure in a greater proportion of patients,14 the results could have been different. NSBBs would also treat esophageal varices and portal hypertensive gastropathy. The caveat is that NSBBs should be used with caution in patients with advanced cirrhosis, in particular those with refractory ascites.15 In conclusion, it is clear that carefully selected patients with large gastric varices should receive prophylactic treatment to prevent bleeding. Despite the promise shown by cyanoacrylate, further controlled trials comparing cyanoacrylate with beta-blockers such as carvedilol or even thrombin injection16 are necessary. The latter therapy shows promise and, due to ease of use and lack of complications compared with cyanoacrylate, may be a more attractive option; however, it has yet to be studied in a controlled clinical trial.

11 This finding perhaps reinforces our understanding of the risk

11 This finding perhaps reinforces our understanding of the risk factors for GVB. It has been shown that gastric varices can bleed at lower pressures compared with esophageal varices, suggesting that reduction in portal pressure will have less influence in bleeding risk or that a greater magnitude in pressure reduction

is necessary to protect against bleeding.12 Other risk factors (in particular the size of gastric varices) that in turn influence wall tension may also be important. The median size of gastric varices in the study was 20 mm and obturation of varices was achieved in all patients. Patients treated with cyanoacrylate all had a reduction in the size of gastric varices, in contrast to over a third of patients in the other arms having an increase BVD-523 cell line in size of gastric varices. There was no difference in the appearance of esophageal varices or appearance/worsening of portal hypertensive

gastropathy during follow-up in the two groups. Certain aspects of the Mishra et al.10 findings must be considered carefully. It is not clear from the three-arm study whether a Bonferroni multiple comparison correction was used. Therefore, the findings may not withstand close statistical scrutiny. In practice, particularly outside of large specialized units, many patients may be ineligible for treatment given the strict inclusion criteria. Although no complications from cyanoacrylate were observed, in less expert hands this may not always be the case. It may be difficult to convince patients or clinicians Selleckchem Palbociclib to accept prophylactic cyanoacrylate if it has not been

shown to be more effective than propranolol in improving survival. This brings into question the choice of NSBBs. The recent demonstration that carvedilol was more effective than band ligation in preventing bleeding from esophageal varices makes one wonder how this drug would compare with cyanoacrylate.13 Only one-third Bcl-w of patients in the Mishra et al. study responded to propranolol, and because carvedilol has been shown to be more effective at lowering portal pressure in a greater proportion of patients,14 the results could have been different. NSBBs would also treat esophageal varices and portal hypertensive gastropathy. The caveat is that NSBBs should be used with caution in patients with advanced cirrhosis, in particular those with refractory ascites.15 In conclusion, it is clear that carefully selected patients with large gastric varices should receive prophylactic treatment to prevent bleeding. Despite the promise shown by cyanoacrylate, further controlled trials comparing cyanoacrylate with beta-blockers such as carvedilol or even thrombin injection16 are necessary. The latter therapy shows promise and, due to ease of use and lack of complications compared with cyanoacrylate, may be a more attractive option; however, it has yet to be studied in a controlled clinical trial.