BACKGROUND Acute bleeding due to esophageal varices(EVs)is a life-threatening complication in patients with cirrhosis.The diagnosis of EVs is mainly through upper gastrointestinal endoscopy,but the discomfort,contrain...BACKGROUND Acute bleeding due to esophageal varices(EVs)is a life-threatening complication in patients with cirrhosis.The diagnosis of EVs is mainly through upper gastrointestinal endoscopy,but the discomfort,contraindications and complications of gastrointestinal endoscopic screening reduce patient compliance.According to the bleeding risk of EVs,the Baveno VI consensus divides varices into high bleeding risk EVs(HEVs)and low bleeding risk EVs(LEVs).We sought to identify a non-invasive prediction model based on spleen stiffness measurement(SSM)and liver stiffness measurement(LSM)as an alternative to EVs screening.AIM To develop a safe,simple and non-invasive model to predict HEVs in patients with viral cirrhosis and identify patients who can be exempted from upper gastrointestinal endoscopy.METHODS Data from 200 patients with viral cirrhosis were included in this study,with 140 patients as the modelling group and 60 patients as the external validation group,and the EVs types of patients were determined by upper gastrointestinal endoscopy and the Baveno Ⅵ consensus.Those patients were divided into the HEVs group(66 patients)and the LEVs group(74 patients).The effect of each parameter on HEVs was analyzed by univariate and multivariate analyses,and a noninvasive prediction model was established.Finally,the discrimination ability,calibration ability and clinical efficacy of the new model were verified in the modelling group and the external validation group.RESULTS Univariate and multivariate analyses showed that SSM and LSM were associated with the occurrence of HEVs in patients with viral cirrhosis.On this basis,logistic regression analysis was used to construct a prediction model:Ln[P/(1-P)]=-8.184-0.228×SSM+0.642×LSM.The area under the curve of the new model was 0.965.When the cut-off value was 0.27,the sensitivity,specificity,positive predictive value and negative predictive value of the model for predicting HEVs were 100.00%,82.43%,83.52%,and 100%,respectively.Compared with the four prediction models of liver stiffness-spleen diameter to platelet ratio score,variceal risk index,aspartate aminotransferase to alanine aminotransferase ratio,and Baveno VI,the established model can better predict HEVs in patients with viral cirrhosis.CONCLUSION Based on the SSM and LSM measured by transient elastography,we established a non-invasive prediction model for HEVs.The new model is reliable in predicting HEVs and can be used as an alternative to routine upper gastrointestinal endoscopy screening,which is helpful for clinical decision making.展开更多
predicting high-risk esophageal varices based on liver and spleen stiffness".Acute bleeding caused by esophageal varices is a life-threatening complication in patients with liver cirrhosis.Due to the discomfort,c...predicting high-risk esophageal varices based on liver and spleen stiffness".Acute bleeding caused by esophageal varices is a life-threatening complication in patients with liver cirrhosis.Due to the discomfort,contraindications,and associated complications of upper gastrointestinal endoscopy screening,it is crucial to identify an imaging-based non-invasive model for predicting high-risk esophageal varices in patients with cirrhosis.展开更多
[Objectives]To observe the clinical efficacy of Modified Huan'gan Lipi Decoction combined with acupuncture in the treatment of spleen deficiency and liver hyperactivity type tic disorders(TD).[Methods]Sixty patien...[Objectives]To observe the clinical efficacy of Modified Huan'gan Lipi Decoction combined with acupuncture in the treatment of spleen deficiency and liver hyperactivity type tic disorders(TD).[Methods]Sixty patients with spleen deficiency and liver hyperactivity type TD were randomly divided into a treatment group of 40 cases and a control group of 20 cases.The treatment group received Modified Huan'gan Lipi Decoction combined with acupuncture,and the control group received Haloperidol Tablets.After 4 weeks of treatment,the Yale Global Tic Severity Scale(YGTSS)score,the total score of TCM syndrome and the clinical efficacy were compared between the two groups before and after treatment.[Results]After treatment,the total effective rate of 87.5%in the treatment group was higher than 80.0%in the control group(P>0.05);the total score of YGTSS and the total score of TCM syndromes in the two groups were compared within groups,P﹤0.01;between groups,P﹤0.01.The recurrence rates of the treatment group and the control group were 11.1%and 71.4%,respectively.The difference between the two groups was statistically significant(P﹤0.01).[Conclusions]Modified Huan'gan Lipi Decoction combined with acupuncture in the treatment of spleen deficiency and liver hyperactivity type TD can significantly improve the patient's tic symptoms,and its long-term efficacy is stable.展开更多
An inflammatory pseudotumor (IPT) is a relatively rare lesion characterized by chronic inf iltration of inflammatory cells and areas of f ibrosis. IPTs are diff icult to diagnose because of the absence of specif ic sy...An inflammatory pseudotumor (IPT) is a relatively rare lesion characterized by chronic inf iltration of inflammatory cells and areas of f ibrosis. IPTs are diff icult to diagnose because of the absence of specif ic symptoms or of characteristic hematological or radiological f indings. In this study, a case of a woman aged over 70 years was reported, who presented with a general malaise lasting more than two months. A computed tomography scan demonstrated a diffusely spread lesion of the liver with a portal vein occlusion and a splenic lesion surrounded by a soft density layer. Since the percutaneous liver biopsy showed f indings that suggested an IPT, although the radiological f indings did not exclude the possibility of a malignancy, we performed a percutaneous spleen biopsy to enable a more defi nitive diagnosis. The microscopic f indings from the spleen specimen lead us to a diagnosis of IPT involving the liver and spleen. Sub-sequent steroid pulse therapy was effective, and rapid resolution of the disease was observed.展开更多
Aseptic abscesses are an emergent entity and have been described in inflammatory bowel disease,especially in Crohn's disease,and in other diseases.However,aseptic abscesses associated with Beh et's disease are...Aseptic abscesses are an emergent entity and have been described in inflammatory bowel disease,especially in Crohn's disease,and in other diseases.However,aseptic abscesses associated with Beh et's disease are extremely rare.We report a Japanese male diagnosed with an incomplete type of Beh et's disease who developed multiple aseptic abscesses of the spleen and liver.In 2002,the spleen abscesses were accompanied by paroxysmal oral aphthous ulcers and erythema nodosum.As the patient's response to antibiotic treatment was inadequate,a splenectomy was performed.Severe inflammatory cell infiltration,largely of polymorphonuclear neutrophils,was observed without evidence of bacterial or fungal growth.Although the patient had no history of ocular symptoms or genital ulcers,a diagnosis of incomplete Beh et's disease was made according to the Japanese diagnostic criteria because of the presence of paroxysmal arthritis and epididymitis since 2002.In 2005,multiple liver abscesses developed with right hypochondrial pain and seemed to be attributed to Beh et's disease because the abscesses yielded negative results during a microbiologic investigation and failed to go into remission under antibiotic therapy.Oral prednisone(15 mg/d) was started in May 2006,and the abscesses dramatically disappeared 4 wk after treatment.Although the patient had a relapse of the liver abscesses in association with the tapering of prednisone,the augmentation of prednisone dosage yielded a response.The abscesses of the liver and spleen were strongly suggested to be attributed to Beh et's disease.Clinician should be aware of the existence of aseptic abscesses as uncommon manifestations of Beh et's disease.展开更多
AIM To investigate gut microbial diversity and the interventional effect of Xiaoyaosan(XYS) in a rat model of functional dyspepsia(FD) with liver depression-spleen deficiency syndrome. METHODS The FD with liver depres...AIM To investigate gut microbial diversity and the interventional effect of Xiaoyaosan(XYS) in a rat model of functional dyspepsia(FD) with liver depression-spleen deficiency syndrome. METHODS The FD with liver depression-spleen deficiency syndrome rat model was established through classic chronic mild unpredictable stimulation every day. XYS group rats received XYS 1 h before the stimulation. The models were assessed by parameters including state ofthe rat, weight, sucrose test result and open-field test result. After 3 wk, the stools of rats were collected and genomic DNA was extracted. PCR products of the V4 region of 16 S rD NA were sequenced using a barcoded Illumina paired-end sequencing technique. The primary composition of the microbiome in the stool samples was determined and analyzed by cluster analysis.RESULTS Rat models were successfully established, per data from rat state, weight and open-field test. The microbiomes contained 20 phyla from all samples. Firmicutes, Bacteroidetes, Proteobacteria, Cyanobacteria and Tenericutes were the most abundant taxonomic groups. The relative abundance of Firmicutes, Proteobacteria and Cyanobacteria in the model group was higher than that in the normal group. On the contrary, the relative abundance of Bacteroidetes in the model group was lower than that in the normal group. Upon XYS treatment, the relative abundance of all dysregulated phyla was restored to levels similar to those observed in the normal group. Abundance clustering heat map of phyla corroborated the taxonomic distribution. CONCLUSION The microbiome relative abundance of FD rats with liver depression-spleen deficiency syndrome was significantly different from the normal cohort. XYS intervention may effectively adjust the gut dysbacteriosis in FD.展开更多
AIM To explore the relationship of liver and spleen shear wave velocity in patients with liver cirrhosis combined with portal hypertension,and assess the value of liver and spleen shear wave velocity in predicting the...AIM To explore the relationship of liver and spleen shear wave velocity in patients with liver cirrhosis combined with portal hypertension,and assess the value of liver and spleen shear wave velocity in predicting the prognosis of patients with portal hypertension.METHODS All 67 patients with liver cirrhosis diagnosed as portal hypertension by hepatic venous pressure gradient in our hospital from June 2014 to December 2014 were enrolled into this study. The baseline information of these patients was recorded. Furthermore,67 patients were followed-up at 20 mo after treatment,and liver and spleen shear wave velocity were measured by acoustic radiation force impulse at the 1^(st) week,3^(rd) month and 9^(th) month after treatment. Patients with favorable prognosis were assigned into the favorable prognosis group,while patients with unfavorable prognosis were assigned into the unfavorable prognosis group. The variation and difference in liver and spleen shear wave velocity in these two groups were analyzed by repeated measurement analysis of variance. Meanwhile,in order to evaluate the effect of liver and spleen shear wave velocity on the prognosis of patients with portal hypertension,Cox's proportional hazard regression model analysis was applied. The ability of those factors in predicting the prognosis of patients with portal hypertension was calculated through receiver operating characteristic(ROC) curves.RESULTS The liver and spleen shear wave velocity in the favorable prognosis group revealed a clear decline,while those in the unfavorable prognosis group revealed an increasing tendency at different time points. Furthermore,liver and spleen shear wave velocity was higher in the unfavorable prognosis group,compared with the favorable prognosis group; the differences were statistically significant(P < 0.05). The prognosis of patients with portal hypertension was significantly affected by spleen hardness at the 3^(rd) month after treatment [relative risk(RR) = 3.481]. At the 9^(th) month after treatment,the prognosis was affected by liver hardness(RR = 5.241) and spleen hardness(RR = 7.829). The differences between these two groups were statistically significant(P < 0.05). The ROC analysis revealed that the area under the curve(AUC) of spleen hardness at the 3^(rd) month after treatment was 0.644,while the AUCs of liver and spleen hardness at the 9^(th) month were 0.579 and 0.776,respectively. These might predict the prognosis of patients with portal hypertension.CONCLUSION Spleen hardness at the 3^(rd) month and liver and spleen shear wave velocity at the 9^(th) month may be used to assess the prognosis of patients with portal hypertension. This is hoped to be used as an indicator of predicting the prognosis of patients with portal hypertension.展开更多
Cubital tunnel syndrome is a disease in which ulnar nerve is compressed by its surrounding tissues,and its main clinical manifestations are pain,sensory disturbance and dyskinesia.Its incidence rate is the second high...Cubital tunnel syndrome is a disease in which ulnar nerve is compressed by its surrounding tissues,and its main clinical manifestations are pain,sensory disturbance and dyskinesia.Its incidence rate is the second highest among peripheral nerve entrapment diseases,and it is one of the common clinical diseases.The theory of liver,spleen and kidney can guide the treatment of cubital tunnel syndrome with traditional Chinese medicine and acupuncture.By discussing the traditional Chinese medicine(TCM)pathogenesis and treatment principles of cubital tunnel syndrome,it provides modern medical theoretical support for TCM treatment of cubital tunnel syndrome.展开更多
Objective:This study was designed to explore the characteristics of gut microbiota in CHB patients with two most common traditional Chinese medicine(TCM)Syndromes—damp heat syndrome and liver depression and spleen de...Objective:This study was designed to explore the characteristics of gut microbiota in CHB patients with two most common traditional Chinese medicine(TCM)Syndromes—damp heat syndrome and liver depression and spleen deficiency syndrome.Methods:According to the diagnostic criteria of Western medicine,TCM and screening exclusion criteria,65 cases of CHB with damp heat syndrome and 28 cases of CHB with liver depression and spleen deficiency syndrome were finally included in the study.All the basic information was gathered and the fresh fecal samples were collected for 16S rDNA sequencing.16S rDNA of gut microbiota was sequenced using Illumina hiseq 2,500 high-throughput sequencing platform.Based on the optimized sequence,Operational Taxonomic Units(OTU)clustering analysis and taxonomic annotation were carried out.Results:The difference in relative abundance of gut microbiota was significant between damp heat syndrome and liver depression and spleen deficiency syndrome in CHB patients.Cyanobacteria was only found in damp heat syndrome.The relative abundance of Erysipelotrichia and Subdoligranulum were higher in liver depression and spleen deficiency syndrome,while the relative abundance of Rhodospirillales,Alphaproteobacteria and Lachnospira were higher in the damp heat syndrome.LDA Effect Size(LEfSe)analysis showed that Lachnospira,Olsenella and Subdoligranulum had significant difference in species among the two TCM syndromes.Conclusion:The different characteristics of gut microbiota in the two TCM syndromes of CHB patients may play an important role in syndrome formation of TCM,which provides a new field of vision for the accurate diagnosis and treatment of TCM.展开更多
The method of warming the kidney and strengthening the spleen is widely used in the treatment of ulcerative colitis (UC) with significant curative effect.This paper reviews the relevant literature in recent years.
Spleen has been considered a neglected organ so far, even though is strictly linked to liver. The spleen plays an important role in the modulation of the immune system and in the maintenance of peripheral tolerance vi...Spleen has been considered a neglected organ so far, even though is strictly linked to liver. The spleen plays an important role in the modulation of the immune system and in the maintenance of peripheral tolerance via the clearance of circulating apoptotic cells, the differentiation and activation of T and B cells and production of antibodies in the white pulp. Moreover, splenic macrophages are able to remove bacteria from the blood and protect from sepsis during systemic infections. We review the spleen function and its assessment in humans starting from the description of spleen diseases, ranging from the congenital asplenia to secondary hyposplenism. From the literature data it is clear that obesity in humans affects different compartments of immune system, even thought there are still few data available on the implicated mechamisms. The intent is to enable clinicians to evaluate the newly recognized role of metabolic and endocrine functions of the spleen with special emphasis to obesity and nonalcoholic fatty liver disease in the context of the available literature.Moreover, understanding the spleen function could be important to develop appropriate prevention strategies in order to counteract the pandemia of obesity. In this direction, we suggest spleen longitudinal diameter at ultrasonography, as simple, cheap and largely available tool, be used as new marker for assessing splenic function, in the context of the so-called liver-spleen axis.展开更多
BACKGROUND: The microenvironment within solid tumors has often been shown to exhibit an acidic extracellular pH. Although the morphologic and functional differences in natural killer (NK) cells of the liver and spleen...BACKGROUND: The microenvironment within solid tumors has often been shown to exhibit an acidic extracellular pH. Although the morphologic and functional differences in natural killer (NK) cells of the liver and spleen have been reported previously under physiological conditions, the difference under acidic conditions is still unclear. This study was to investigate the differences in the morphological and functional characteristics between rat liver and spleen NK cells under normal and acidic conditions in vitro. METHODS: Liver and spleen NK cells were isolated and purified from Sprague-Dawley rats by density gradient centrifugation and the Dynabeads FlowComp TM Flexi system, and stimulated for 4 days with or without IL-2 or treated with low pH or control for different times. Morphology was examined by scanning electron microscopy (SEM) and transmission electron microscopy (TEM), cell death and proliferation assays were performed by flow cytometry, IFN-γ production was tested by ELISA, and cytotoxic activity was evaluated by lactate dehydrogenase (LDH) release assay. RESULTS: Liver NK cells had significantly higher levels of cytotoxic activity than spleen NK cells under normal and acidic conditions, and the maximum difference was observed at pH 5.6. Further analysis revealed that the cytotoxic activity of NK cells was correlated with morphology, cell death, proliferative activity and IFN-γ production. By TEM, liver NK cells contained a greater number of electron-dense granules per cell at pH 5.6.Moreover, a modest elevation of cell death and reduction of proliferation of liver NK cells occurred within a range of 5.6-7.2. Interestingly, an acidic extracellular pH only marginally, and not significantly, suppressed IFN-γ production by liver NK cells. CONCLUSION: The sharp morphological and functional differences shown by the two types of NK cells in vitro indicate that liver NK cells are unexpectedly resistant to pH shock.展开更多
AIM: To investigate spleen status in psoriasis and itsrelationship with hepatic steatosis, Psoriasis Area and Severity Index, and insulin resistance.METHODS: Seventy-nine psoriatic patients who were not suffering from...AIM: To investigate spleen status in psoriasis and itsrelationship with hepatic steatosis, Psoriasis Area and Severity Index, and insulin resistance.METHODS: Seventy-nine psoriatic patients who were not suffering from any chronic inflammatory disease were retrospectively selected for inclusion in this study,and their complete medical records were accessed.An age- and sex-matched group of 80 non-psoriatic,obese patients was included as a control. The following relevant data were collected: age, sex, weight, height,body mass index, waist circumference, blood pressure,insulin resistance status, age at psoriasis onset, and severity of psoriasis. Abdominal ultrasonography was performed to determine spleen longitudinal diameter(SLD), and hepatic steatosis grade.RESULTS: The SLD of control obese patients was greater than that of psoriatic subjects(P = 0.013),but body mass index predicted the size of the spleen in psoriatic patients(P < 0.001). The SLD of psoriatic patients with normal weight was significantly reduced with respect to the overweight/obese psoriatic patients(P = 0.002). A multiple regression analysis revealed that body mass index was a unique predictor of the spleen size(P < 0.001). Finally, the disease duration predicted the spleen size in psoriatic subjects(P =0.038).CONCLUSION: This study shows a correlation between the SLD and the duration of psoriasis.展开更多
AIM:To study the liver and spleen volume variations in hepatic fibrosis patients at different histopathological stages.METHODS:Multidetector computed tomography (MDCT) scan was performed in 85 hepatic fibrosis patient...AIM:To study the liver and spleen volume variations in hepatic fibrosis patients at different histopathological stages.METHODS:Multidetector computed tomography (MDCT) scan was performed in 85 hepatic fibrosis patients.Liver volume (LV) and spleen volume (SV) were measured.Fifteen healthy individuals served as a control group (S0).The patients were divided into stage 1 (S1) group (n=34),stage 2 (S2) group (n=25),stage 3 (S3) group (n=16),and stage 4 (S4) group (n=10) according to their histopathological stage of liver fibrosis.RESULTS:The LV and standard LV(SLV)had a tendency to increase with the severity of fibrosis,but no statistical difference was observed in the 5 groups (LV:F=0.245,P=0.912;SLV:F=1.902,P =0.116).The SV was gradually increased with the severity of fibrosis,and a statistically significant difference in SV was observed among the 5 groups (P < 0.01).The LV/SV ratio and SLV/SV ratio were gradually decreased with the aggravation of hepatic fibrosis,and statistically significant differences in both LV/SV and SLV/SV were found among the 5 groups (P < 0.01).CONCLUSION:The absence of obvious LV reduction in patients with chronic liver disease may be a morphological index of patients without liver cirrhosis.The SV is related to the severity of fibrosis,and the spleen of patients with advanced fibrosis is enlarged evidently.The LV/SV ratio and SLV/SV ratio are of a significant clinical value in the diagnosis of advanced liver fibrosis.展开更多
BACKGROUND Ventral hernia,also known as incisional hernia,is a common complication of previous surgery.The contents of ventral hernia may include omentum,preperitoneal fat,small intestine or colon.However,ventral hern...BACKGROUND Ventral hernia,also known as incisional hernia,is a common complication of previous surgery.The contents of ventral hernia may include omentum,preperitoneal fat,small intestine or colon.However,ventral hernia with protrusion of more than two parenchymal organs simultaneously is extremely rare,and its repair is very complex and difficult.Surgeons should make a comprehensive assessment based on their own experience and the individual characteristics of the hernia.In addition,psychological therapy should be emphasized in the whole treatment process.CASE SUMMARY We report a rare case of asymptomatic giant ventral hernia for 15 years in a 21-year-old female.The patient underwent umbilical hernia repair at the age of 1 year.Approximately 5 years later,ventral hernia recurred and repair with Mesh was performed,but the operation failed due to postoperative infection,and a huge mass appeared in the left abdominal wall.The mass increased gradually with the development and maturity of the body.Computerized tomography scan demonstrated that the patient's total spleen,part of the pancreas and left lobe of the liver were simultaneously herniated through the abdominal incisional hernia.As the patient was unable to endure the inconvenience of life and the potential risk of spleen or liver rupture,she underwent a ventral hernia repair with Mesh at our hospital.The operation was successful and the patient had a good recovery.During a 3-mo follow-up,the patient remained asymptomatic and the appearance of the surgical incision was greatly improved.CONCLUSION Ventral hernia is a common complication of abdominal surgery.Ventral hernia with protrusion of more than two parenchymal organs simultaneously is extremely rare.Surgeons should pay attention to the psychological treatment while restoring the abdominal physiological function in ventral hernia patients.展开更多
BACKGROUND Upper endoscopy is the gold standard for predicting esophageal varices in China.Guidelines and consensus suggest that patients with liver cirrhosis should undergo periodic upper endoscopy,most patients unde...BACKGROUND Upper endoscopy is the gold standard for predicting esophageal varices in China.Guidelines and consensus suggest that patients with liver cirrhosis should undergo periodic upper endoscopy,most patients undergo their first upper endoscopy when esophageal variceal bleeds.Therefore,it is important to develop a non-invasive model to early diagnose esophageal varices.AIM To develop a non-invasive predictive model for esophageal varices based on liver and spleen volume in viral cirrhosis patients.METHODS We conducted a cross-sectional study based on viral cirrhosis crowd in the Second Affiliated Hospital of Xi'an Jiaotong University.By collecting the basic information and clinical data of the participants,we derived the independent risk factors and established the prediction model of esophageal varices.The established model was compared with other models.Area under the receiver operating characteristic curve,calibration plot and decision curve analysis were used to test the discriminating ability,calibration ability and clinical practicability in both the internal and external validation.RESULTS The portal vein diameter,the liver and spleen volume,and volume change rate were the independent risk factors of esophageal varices.We successfully used the factors to establish the predictive model[area under the curve(AUC)0.87,95%CI:0.80-0.95],which showed better predictive value than other models.The model showed good discriminating ability,calibration ability and the clinical practicability in both modelling group and external validation group.CONCLUSION The developed non-invasive predictive model can be used as an effective tool for predicting esophageal varices in viral cirrhosis patients.展开更多
Objective:To investigate the biological basis of“depression with liver-qi stagnation and spleen deficiency syndrome”.Methods:A digital gene expression profiling method was conducted to explore global changes in the ...Objective:To investigate the biological basis of“depression with liver-qi stagnation and spleen deficiency syndrome”.Methods:A digital gene expression profiling method was conducted to explore global changes in the mRNA transcriptome in a rat model of depression with liver-qi stagnation and spleen deficiency syndrome.Real-time quantitative polymerase chain reaction(q-PCR)was performed to verify the five genes most interest based on the Kyoto Encyclopedia of Genes and Genome(KEGG)analysis.Sini San,which disperses stagnated liver qi and strengthens the spleen,was administered to the model rats to observe whether it could reverse these genetic changes in the liver.Results:Forty-six differentially expressed genes were identified.Three of the five genes of most interestdHnf4a,Hnf4g and Cyp1a1dbased on KEGG analysis,were confirmed by realtime q-PCR.Sini San reduced the gene expression changes of Hnf4a,Hnf4g and Cyp1a1 in the rat model.Conclusions:Hnf4a,Hnf4g and Cyp1a1 are involved in“depression with liver-qi stagnation and spleen deficiency syndrome”.These findings indicate that depressed rats with liver-qi stagnation and spleen deficiency syndrome are at risk of liver diseases.Furthermore,our results will inform exploration of the etiology of depression and help in the development of effective therapeutic strategies.展开更多
[Objectives] To establish animal models of fatty liver due to liver depression and spleen deficiency that were suitable for activity discovery of traditional Chinese medicine( TCM) compounds,efficacy evaluation,new dr...[Objectives] To establish animal models of fatty liver due to liver depression and spleen deficiency that were suitable for activity discovery of traditional Chinese medicine( TCM) compounds,efficacy evaluation,new drug research and development and correspondence between prescription and syndrome of TCM. [Methods] A syndrome score scale that was suitable for evaluating the rat models was established according to the evolvement rules of etiology and pathogenesis of TCM and the modern clinical pathological mechanism. At the same time,bifendate pills and Sanqi Zhigan pills were selected as drug counterevidence for the models. Rats in model groups were given different proportions of high-fat and low-protein fodder and different concentrations of alcohol every day,and intraperitoneally injected with porcine serum twice a week. Drug groups were given with bifendate pills and Sanqi Zhigan pills( 8. 1 mg/kg,and 2. 7 g/kg) respectively for 14 consecutive days.During the experiment,general status,weight,daily fodder intake and daily water intake of the animals were observed,and TCM syndromes were scored. After the experiment,the levels of alanine aminotransferase( ALT),aspartate aminotransferase( AST),γ-glutamine transpeptidase( γ-GT),total cholesterol( TC),triglycerides( TG),low density lipoprotein-cholesterol( LDL-C),and high density lipoprotein-cholesterol( HDL-C) in serum were detected,and the pathological changes in liver tissue were observed. [Results] Compared with the control group,body weight,daily fodder and water intake of rats increased slowly in the model group,and the levels of ALT,AST,γ-GT,TC,TG and LDL-C increased significantly,while the level of HDL-C dropped. Pathological examination showed that steatosis and fat granule were observed in hepatocytes of rats in the model group. Behavioral observation found that main symptoms and minor symptoms of rats in the model group conformed to the syndrome manifestation of liver depression and spleen deficiency,which suggested that the three model groups were established successfully. Among them,three rats died in model group 1,and one rat died in model group 2. The manifestation of all the above lesions can be alleviated by drug counterevidence. [Conclusions]The animal model of fatty liver due to liver depression and spleen deficiency shows an obviously lower mortality and shorter duration and can be used for research of correlation between prescription and syndrome and its mechanism.展开更多
Qi deficiency of the spleen and stomach,transportation,phlegm and dampness generate endogenous and turbid phlegm that violates the position of yang clearance.As a result,dizziness cis resulted.The author believes that...Qi deficiency of the spleen and stomach,transportation,phlegm and dampness generate endogenous and turbid phlegm that violates the position of yang clearance.As a result,dizziness cis resulted.The author believes that the incidence of middle-aged and young patients with hypertension is mostly related to the dysfunction of liver and spleen.Liver depression and qi stagnation is the beginning of the onset;spleen deficiency and dyskinesia is the norm of the onset;and liver and spleen imbalance is the origin of the onset.It is advocated that regulating the liver and spleen to restore the rise and fall,harmonizing qi and blood and preventing lesions are the main treatment methods for the treatment of middle-aged and young people’s hypertension,which is conducive to the development of more clinical diagnosis and treatment ideas for hypertension amomg middle-aged and young people.展开更多
AIM To investigate changes in spleen stiffness measurements(SSMs) and other non-invasive tests(NITs) after treatment with direct-acting antivirals(DAAs) and identify predictors of SSM change after sustainedvirological...AIM To investigate changes in spleen stiffness measurements(SSMs) and other non-invasive tests(NITs) after treatment with direct-acting antivirals(DAAs) and identify predictors of SSM change after sustainedvirological response(SVR). METHODS We retrospectively analysed 146 advanced-chronic liver disease(ACLD) patients treated with DAA with available paired SSM at baseline and SVR24. Liver stiffness(LSM), spleen diameter(SD), platelet count(PLT) and liver stiffness-spleen diameter to platelet ratio score(LSPS) were also investigated. LSM ≥ 21 k Pa was used as a cut-off to rule-in clinically significant portal hypertension(CSPH). SSM reduction > 20% from baseline was defined as significant.RESULTS SSM significantly decreased at SVR24, in both patients with and without CSPH; in 44.8% of cases, SSM reduction was > 20%. LSPS significantly improved in the entire cohort at SVR24; SD and PLT changed significantly only in patients without CSPH. LSM significantly decreased in 65.7% of patients and also in 2/3 patients in whom SSM did not decrease. The independent predictor of decreased SSM was median relative change of LSM. CSPH persisted in 54.4% patients after SVR. Delta LSM and baseline SSM were independent factors associated with CSPH persistence.CONCLUSION SSM and other NITs significantly decrease after SVR, although differently according to the patient's clinical condition. SSM faithfully reflects changes in portal hypertension and could represent a useful NIT for the follow-up of these patients.展开更多
基金Supported by the Shaanxi Provincial Key Research and Development Plan,No.2020SF-159.
文摘BACKGROUND Acute bleeding due to esophageal varices(EVs)is a life-threatening complication in patients with cirrhosis.The diagnosis of EVs is mainly through upper gastrointestinal endoscopy,but the discomfort,contraindications and complications of gastrointestinal endoscopic screening reduce patient compliance.According to the bleeding risk of EVs,the Baveno VI consensus divides varices into high bleeding risk EVs(HEVs)and low bleeding risk EVs(LEVs).We sought to identify a non-invasive prediction model based on spleen stiffness measurement(SSM)and liver stiffness measurement(LSM)as an alternative to EVs screening.AIM To develop a safe,simple and non-invasive model to predict HEVs in patients with viral cirrhosis and identify patients who can be exempted from upper gastrointestinal endoscopy.METHODS Data from 200 patients with viral cirrhosis were included in this study,with 140 patients as the modelling group and 60 patients as the external validation group,and the EVs types of patients were determined by upper gastrointestinal endoscopy and the Baveno Ⅵ consensus.Those patients were divided into the HEVs group(66 patients)and the LEVs group(74 patients).The effect of each parameter on HEVs was analyzed by univariate and multivariate analyses,and a noninvasive prediction model was established.Finally,the discrimination ability,calibration ability and clinical efficacy of the new model were verified in the modelling group and the external validation group.RESULTS Univariate and multivariate analyses showed that SSM and LSM were associated with the occurrence of HEVs in patients with viral cirrhosis.On this basis,logistic regression analysis was used to construct a prediction model:Ln[P/(1-P)]=-8.184-0.228×SSM+0.642×LSM.The area under the curve of the new model was 0.965.When the cut-off value was 0.27,the sensitivity,specificity,positive predictive value and negative predictive value of the model for predicting HEVs were 100.00%,82.43%,83.52%,and 100%,respectively.Compared with the four prediction models of liver stiffness-spleen diameter to platelet ratio score,variceal risk index,aspartate aminotransferase to alanine aminotransferase ratio,and Baveno VI,the established model can better predict HEVs in patients with viral cirrhosis.CONCLUSION Based on the SSM and LSM measured by transient elastography,we established a non-invasive prediction model for HEVs.The new model is reliable in predicting HEVs and can be used as an alternative to routine upper gastrointestinal endoscopy screening,which is helpful for clinical decision making.
基金the Shaanxi Provincial Key Research and Development Plan,No.2020SF-159.
文摘predicting high-risk esophageal varices based on liver and spleen stiffness".Acute bleeding caused by esophageal varices is a life-threatening complication in patients with liver cirrhosis.Due to the discomfort,contraindications,and associated complications of upper gastrointestinal endoscopy screening,it is crucial to identify an imaging-based non-invasive model for predicting high-risk esophageal varices in patients with cirrhosis.
基金Supported by Program of Ningxia Acupuncture and Moxibustion Clinical Medicine Research Center。
文摘[Objectives]To observe the clinical efficacy of Modified Huan'gan Lipi Decoction combined with acupuncture in the treatment of spleen deficiency and liver hyperactivity type tic disorders(TD).[Methods]Sixty patients with spleen deficiency and liver hyperactivity type TD were randomly divided into a treatment group of 40 cases and a control group of 20 cases.The treatment group received Modified Huan'gan Lipi Decoction combined with acupuncture,and the control group received Haloperidol Tablets.After 4 weeks of treatment,the Yale Global Tic Severity Scale(YGTSS)score,the total score of TCM syndrome and the clinical efficacy were compared between the two groups before and after treatment.[Results]After treatment,the total effective rate of 87.5%in the treatment group was higher than 80.0%in the control group(P>0.05);the total score of YGTSS and the total score of TCM syndromes in the two groups were compared within groups,P﹤0.01;between groups,P﹤0.01.The recurrence rates of the treatment group and the control group were 11.1%and 71.4%,respectively.The difference between the two groups was statistically significant(P﹤0.01).[Conclusions]Modified Huan'gan Lipi Decoction combined with acupuncture in the treatment of spleen deficiency and liver hyperactivity type TD can significantly improve the patient's tic symptoms,and its long-term efficacy is stable.
文摘An inflammatory pseudotumor (IPT) is a relatively rare lesion characterized by chronic inf iltration of inflammatory cells and areas of f ibrosis. IPTs are diff icult to diagnose because of the absence of specif ic symptoms or of characteristic hematological or radiological f indings. In this study, a case of a woman aged over 70 years was reported, who presented with a general malaise lasting more than two months. A computed tomography scan demonstrated a diffusely spread lesion of the liver with a portal vein occlusion and a splenic lesion surrounded by a soft density layer. Since the percutaneous liver biopsy showed f indings that suggested an IPT, although the radiological f indings did not exclude the possibility of a malignancy, we performed a percutaneous spleen biopsy to enable a more defi nitive diagnosis. The microscopic f indings from the spleen specimen lead us to a diagnosis of IPT involving the liver and spleen. Sub-sequent steroid pulse therapy was effective, and rapid resolution of the disease was observed.
文摘Aseptic abscesses are an emergent entity and have been described in inflammatory bowel disease,especially in Crohn's disease,and in other diseases.However,aseptic abscesses associated with Beh et's disease are extremely rare.We report a Japanese male diagnosed with an incomplete type of Beh et's disease who developed multiple aseptic abscesses of the spleen and liver.In 2002,the spleen abscesses were accompanied by paroxysmal oral aphthous ulcers and erythema nodosum.As the patient's response to antibiotic treatment was inadequate,a splenectomy was performed.Severe inflammatory cell infiltration,largely of polymorphonuclear neutrophils,was observed without evidence of bacterial or fungal growth.Although the patient had no history of ocular symptoms or genital ulcers,a diagnosis of incomplete Beh et's disease was made according to the Japanese diagnostic criteria because of the presence of paroxysmal arthritis and epididymitis since 2002.In 2005,multiple liver abscesses developed with right hypochondrial pain and seemed to be attributed to Beh et's disease because the abscesses yielded negative results during a microbiologic investigation and failed to go into remission under antibiotic therapy.Oral prednisone(15 mg/d) was started in May 2006,and the abscesses dramatically disappeared 4 wk after treatment.Although the patient had a relapse of the liver abscesses in association with the tapering of prednisone,the augmentation of prednisone dosage yielded a response.The abscesses of the liver and spleen were strongly suggested to be attributed to Beh et's disease.Clinician should be aware of the existence of aseptic abscesses as uncommon manifestations of Beh et's disease.
基金Supported by National Natural Science Foundation of China,No.81273919 and No.81673727National Basic Research Program of China(973 Program)No.2013CB531703
文摘AIM To investigate gut microbial diversity and the interventional effect of Xiaoyaosan(XYS) in a rat model of functional dyspepsia(FD) with liver depression-spleen deficiency syndrome. METHODS The FD with liver depression-spleen deficiency syndrome rat model was established through classic chronic mild unpredictable stimulation every day. XYS group rats received XYS 1 h before the stimulation. The models were assessed by parameters including state ofthe rat, weight, sucrose test result and open-field test result. After 3 wk, the stools of rats were collected and genomic DNA was extracted. PCR products of the V4 region of 16 S rD NA were sequenced using a barcoded Illumina paired-end sequencing technique. The primary composition of the microbiome in the stool samples was determined and analyzed by cluster analysis.RESULTS Rat models were successfully established, per data from rat state, weight and open-field test. The microbiomes contained 20 phyla from all samples. Firmicutes, Bacteroidetes, Proteobacteria, Cyanobacteria and Tenericutes were the most abundant taxonomic groups. The relative abundance of Firmicutes, Proteobacteria and Cyanobacteria in the model group was higher than that in the normal group. On the contrary, the relative abundance of Bacteroidetes in the model group was lower than that in the normal group. Upon XYS treatment, the relative abundance of all dysregulated phyla was restored to levels similar to those observed in the normal group. Abundance clustering heat map of phyla corroborated the taxonomic distribution. CONCLUSION The microbiome relative abundance of FD rats with liver depression-spleen deficiency syndrome was significantly different from the normal cohort. XYS intervention may effectively adjust the gut dysbacteriosis in FD.
基金Supported by Medical and Health Science and Technology Program of Zhejiang Province,2017,No.2017KY590
文摘AIM To explore the relationship of liver and spleen shear wave velocity in patients with liver cirrhosis combined with portal hypertension,and assess the value of liver and spleen shear wave velocity in predicting the prognosis of patients with portal hypertension.METHODS All 67 patients with liver cirrhosis diagnosed as portal hypertension by hepatic venous pressure gradient in our hospital from June 2014 to December 2014 were enrolled into this study. The baseline information of these patients was recorded. Furthermore,67 patients were followed-up at 20 mo after treatment,and liver and spleen shear wave velocity were measured by acoustic radiation force impulse at the 1^(st) week,3^(rd) month and 9^(th) month after treatment. Patients with favorable prognosis were assigned into the favorable prognosis group,while patients with unfavorable prognosis were assigned into the unfavorable prognosis group. The variation and difference in liver and spleen shear wave velocity in these two groups were analyzed by repeated measurement analysis of variance. Meanwhile,in order to evaluate the effect of liver and spleen shear wave velocity on the prognosis of patients with portal hypertension,Cox's proportional hazard regression model analysis was applied. The ability of those factors in predicting the prognosis of patients with portal hypertension was calculated through receiver operating characteristic(ROC) curves.RESULTS The liver and spleen shear wave velocity in the favorable prognosis group revealed a clear decline,while those in the unfavorable prognosis group revealed an increasing tendency at different time points. Furthermore,liver and spleen shear wave velocity was higher in the unfavorable prognosis group,compared with the favorable prognosis group; the differences were statistically significant(P < 0.05). The prognosis of patients with portal hypertension was significantly affected by spleen hardness at the 3^(rd) month after treatment [relative risk(RR) = 3.481]. At the 9^(th) month after treatment,the prognosis was affected by liver hardness(RR = 5.241) and spleen hardness(RR = 7.829). The differences between these two groups were statistically significant(P < 0.05). The ROC analysis revealed that the area under the curve(AUC) of spleen hardness at the 3^(rd) month after treatment was 0.644,while the AUCs of liver and spleen hardness at the 9^(th) month were 0.579 and 0.776,respectively. These might predict the prognosis of patients with portal hypertension.CONCLUSION Spleen hardness at the 3^(rd) month and liver and spleen shear wave velocity at the 9^(th) month may be used to assess the prognosis of patients with portal hypertension. This is hoped to be used as an indicator of predicting the prognosis of patients with portal hypertension.
基金TCM science and Technology project of Hebei Provincial Administration of Traditional Chinese Medicine in 2021(No.2021352):The therapeutic effect of cubital tunnel expansion plasty combined with Huangqi Guizhi Wuwu Decoction on cubital tunnel syndrome。
文摘Cubital tunnel syndrome is a disease in which ulnar nerve is compressed by its surrounding tissues,and its main clinical manifestations are pain,sensory disturbance and dyskinesia.Its incidence rate is the second highest among peripheral nerve entrapment diseases,and it is one of the common clinical diseases.The theory of liver,spleen and kidney can guide the treatment of cubital tunnel syndrome with traditional Chinese medicine and acupuncture.By discussing the traditional Chinese medicine(TCM)pathogenesis and treatment principles of cubital tunnel syndrome,it provides modern medical theoretical support for TCM treatment of cubital tunnel syndrome.
基金The Sixth Group of National Senior Chinese Medicine Experts’ Academic Experience Inheritance Project [approval:State Administration of Traditional Chinese Medicine (2017) No.29]the Foshan High Level Medical Key Discipline Construction Project and "Peak Climbing Plan" for Foshan High Level Hospital Construction[approval:Foshan Municipal Government Office,No. 2019 (01)]
文摘Objective:This study was designed to explore the characteristics of gut microbiota in CHB patients with two most common traditional Chinese medicine(TCM)Syndromes—damp heat syndrome and liver depression and spleen deficiency syndrome.Methods:According to the diagnostic criteria of Western medicine,TCM and screening exclusion criteria,65 cases of CHB with damp heat syndrome and 28 cases of CHB with liver depression and spleen deficiency syndrome were finally included in the study.All the basic information was gathered and the fresh fecal samples were collected for 16S rDNA sequencing.16S rDNA of gut microbiota was sequenced using Illumina hiseq 2,500 high-throughput sequencing platform.Based on the optimized sequence,Operational Taxonomic Units(OTU)clustering analysis and taxonomic annotation were carried out.Results:The difference in relative abundance of gut microbiota was significant between damp heat syndrome and liver depression and spleen deficiency syndrome in CHB patients.Cyanobacteria was only found in damp heat syndrome.The relative abundance of Erysipelotrichia and Subdoligranulum were higher in liver depression and spleen deficiency syndrome,while the relative abundance of Rhodospirillales,Alphaproteobacteria and Lachnospira were higher in the damp heat syndrome.LDA Effect Size(LEfSe)analysis showed that Lachnospira,Olsenella and Subdoligranulum had significant difference in species among the two TCM syndromes.Conclusion:The different characteristics of gut microbiota in the two TCM syndromes of CHB patients may play an important role in syndrome formation of TCM,which provides a new field of vision for the accurate diagnosis and treatment of TCM.
文摘The method of warming the kidney and strengthening the spleen is widely used in the treatment of ulcerative colitis (UC) with significant curative effect.This paper reviews the relevant literature in recent years.
文摘Spleen has been considered a neglected organ so far, even though is strictly linked to liver. The spleen plays an important role in the modulation of the immune system and in the maintenance of peripheral tolerance via the clearance of circulating apoptotic cells, the differentiation and activation of T and B cells and production of antibodies in the white pulp. Moreover, splenic macrophages are able to remove bacteria from the blood and protect from sepsis during systemic infections. We review the spleen function and its assessment in humans starting from the description of spleen diseases, ranging from the congenital asplenia to secondary hyposplenism. From the literature data it is clear that obesity in humans affects different compartments of immune system, even thought there are still few data available on the implicated mechamisms. The intent is to enable clinicians to evaluate the newly recognized role of metabolic and endocrine functions of the spleen with special emphasis to obesity and nonalcoholic fatty liver disease in the context of the available literature.Moreover, understanding the spleen function could be important to develop appropriate prevention strategies in order to counteract the pandemia of obesity. In this direction, we suggest spleen longitudinal diameter at ultrasonography, as simple, cheap and largely available tool, be used as new marker for assessing splenic function, in the context of the so-called liver-spleen axis.
基金supported by grants from the National Natural Science Foundation of China (30671987 and 81000065)
文摘BACKGROUND: The microenvironment within solid tumors has often been shown to exhibit an acidic extracellular pH. Although the morphologic and functional differences in natural killer (NK) cells of the liver and spleen have been reported previously under physiological conditions, the difference under acidic conditions is still unclear. This study was to investigate the differences in the morphological and functional characteristics between rat liver and spleen NK cells under normal and acidic conditions in vitro. METHODS: Liver and spleen NK cells were isolated and purified from Sprague-Dawley rats by density gradient centrifugation and the Dynabeads FlowComp TM Flexi system, and stimulated for 4 days with or without IL-2 or treated with low pH or control for different times. Morphology was examined by scanning electron microscopy (SEM) and transmission electron microscopy (TEM), cell death and proliferation assays were performed by flow cytometry, IFN-γ production was tested by ELISA, and cytotoxic activity was evaluated by lactate dehydrogenase (LDH) release assay. RESULTS: Liver NK cells had significantly higher levels of cytotoxic activity than spleen NK cells under normal and acidic conditions, and the maximum difference was observed at pH 5.6. Further analysis revealed that the cytotoxic activity of NK cells was correlated with morphology, cell death, proliferative activity and IFN-γ production. By TEM, liver NK cells contained a greater number of electron-dense granules per cell at pH 5.6.Moreover, a modest elevation of cell death and reduction of proliferation of liver NK cells occurred within a range of 5.6-7.2. Interestingly, an acidic extracellular pH only marginally, and not significantly, suppressed IFN-γ production by liver NK cells. CONCLUSION: The sharp morphological and functional differences shown by the two types of NK cells in vitro indicate that liver NK cells are unexpectedly resistant to pH shock.
文摘AIM: To investigate spleen status in psoriasis and itsrelationship with hepatic steatosis, Psoriasis Area and Severity Index, and insulin resistance.METHODS: Seventy-nine psoriatic patients who were not suffering from any chronic inflammatory disease were retrospectively selected for inclusion in this study,and their complete medical records were accessed.An age- and sex-matched group of 80 non-psoriatic,obese patients was included as a control. The following relevant data were collected: age, sex, weight, height,body mass index, waist circumference, blood pressure,insulin resistance status, age at psoriasis onset, and severity of psoriasis. Abdominal ultrasonography was performed to determine spleen longitudinal diameter(SLD), and hepatic steatosis grade.RESULTS: The SLD of control obese patients was greater than that of psoriatic subjects(P = 0.013),but body mass index predicted the size of the spleen in psoriatic patients(P < 0.001). The SLD of psoriatic patients with normal weight was significantly reduced with respect to the overweight/obese psoriatic patients(P = 0.002). A multiple regression analysis revealed that body mass index was a unique predictor of the spleen size(P < 0.001). Finally, the disease duration predicted the spleen size in psoriatic subjects(P =0.038).CONCLUSION: This study shows a correlation between the SLD and the duration of psoriasis.
基金Supported by Science and Technology Program of Beijing Education Committee,No.KM200810025002
文摘AIM:To study the liver and spleen volume variations in hepatic fibrosis patients at different histopathological stages.METHODS:Multidetector computed tomography (MDCT) scan was performed in 85 hepatic fibrosis patients.Liver volume (LV) and spleen volume (SV) were measured.Fifteen healthy individuals served as a control group (S0).The patients were divided into stage 1 (S1) group (n=34),stage 2 (S2) group (n=25),stage 3 (S3) group (n=16),and stage 4 (S4) group (n=10) according to their histopathological stage of liver fibrosis.RESULTS:The LV and standard LV(SLV)had a tendency to increase with the severity of fibrosis,but no statistical difference was observed in the 5 groups (LV:F=0.245,P=0.912;SLV:F=1.902,P =0.116).The SV was gradually increased with the severity of fibrosis,and a statistically significant difference in SV was observed among the 5 groups (P < 0.01).The LV/SV ratio and SLV/SV ratio were gradually decreased with the aggravation of hepatic fibrosis,and statistically significant differences in both LV/SV and SLV/SV were found among the 5 groups (P < 0.01).CONCLUSION:The absence of obvious LV reduction in patients with chronic liver disease may be a morphological index of patients without liver cirrhosis.The SV is related to the severity of fibrosis,and the spleen of patients with advanced fibrosis is enlarged evidently.The LV/SV ratio and SLV/SV ratio are of a significant clinical value in the diagnosis of advanced liver fibrosis.
基金Supported by the National Natural Science Foundation of China,No.81172269 and No.30972910Jiangsu Provincial Commission of Health and Family Planning,No.Z201603+1 种基金Youth talent support program of Nanjing City during the 13th Five-Year Plan Period,No.QRX17107Natural Science Fund of Nanjing Medical University,No.2017NJMU041.
文摘BACKGROUND Ventral hernia,also known as incisional hernia,is a common complication of previous surgery.The contents of ventral hernia may include omentum,preperitoneal fat,small intestine or colon.However,ventral hernia with protrusion of more than two parenchymal organs simultaneously is extremely rare,and its repair is very complex and difficult.Surgeons should make a comprehensive assessment based on their own experience and the individual characteristics of the hernia.In addition,psychological therapy should be emphasized in the whole treatment process.CASE SUMMARY We report a rare case of asymptomatic giant ventral hernia for 15 years in a 21-year-old female.The patient underwent umbilical hernia repair at the age of 1 year.Approximately 5 years later,ventral hernia recurred and repair with Mesh was performed,but the operation failed due to postoperative infection,and a huge mass appeared in the left abdominal wall.The mass increased gradually with the development and maturity of the body.Computerized tomography scan demonstrated that the patient's total spleen,part of the pancreas and left lobe of the liver were simultaneously herniated through the abdominal incisional hernia.As the patient was unable to endure the inconvenience of life and the potential risk of spleen or liver rupture,she underwent a ventral hernia repair with Mesh at our hospital.The operation was successful and the patient had a good recovery.During a 3-mo follow-up,the patient remained asymptomatic and the appearance of the surgical incision was greatly improved.CONCLUSION Ventral hernia is a common complication of abdominal surgery.Ventral hernia with protrusion of more than two parenchymal organs simultaneously is extremely rare.Surgeons should pay attention to the psychological treatment while restoring the abdominal physiological function in ventral hernia patients.
基金Supported by Key Research and Development Plan of Shaanxi Province,No.2020SF-222。
文摘BACKGROUND Upper endoscopy is the gold standard for predicting esophageal varices in China.Guidelines and consensus suggest that patients with liver cirrhosis should undergo periodic upper endoscopy,most patients undergo their first upper endoscopy when esophageal variceal bleeds.Therefore,it is important to develop a non-invasive model to early diagnose esophageal varices.AIM To develop a non-invasive predictive model for esophageal varices based on liver and spleen volume in viral cirrhosis patients.METHODS We conducted a cross-sectional study based on viral cirrhosis crowd in the Second Affiliated Hospital of Xi'an Jiaotong University.By collecting the basic information and clinical data of the participants,we derived the independent risk factors and established the prediction model of esophageal varices.The established model was compared with other models.Area under the receiver operating characteristic curve,calibration plot and decision curve analysis were used to test the discriminating ability,calibration ability and clinical practicability in both the internal and external validation.RESULTS The portal vein diameter,the liver and spleen volume,and volume change rate were the independent risk factors of esophageal varices.We successfully used the factors to establish the predictive model[area under the curve(AUC)0.87,95%CI:0.80-0.95],which showed better predictive value than other models.The model showed good discriminating ability,calibration ability and the clinical practicability in both modelling group and external validation group.CONCLUSION The developed non-invasive predictive model can be used as an effective tool for predicting esophageal varices in viral cirrhosis patients.
基金This work was supported by a grant from the National Basic Research Program of China(973 Program No.2011CB505106).
文摘Objective:To investigate the biological basis of“depression with liver-qi stagnation and spleen deficiency syndrome”.Methods:A digital gene expression profiling method was conducted to explore global changes in the mRNA transcriptome in a rat model of depression with liver-qi stagnation and spleen deficiency syndrome.Real-time quantitative polymerase chain reaction(q-PCR)was performed to verify the five genes most interest based on the Kyoto Encyclopedia of Genes and Genome(KEGG)analysis.Sini San,which disperses stagnated liver qi and strengthens the spleen,was administered to the model rats to observe whether it could reverse these genetic changes in the liver.Results:Forty-six differentially expressed genes were identified.Three of the five genes of most interestdHnf4a,Hnf4g and Cyp1a1dbased on KEGG analysis,were confirmed by realtime q-PCR.Sini San reduced the gene expression changes of Hnf4a,Hnf4g and Cyp1a1 in the rat model.Conclusions:Hnf4a,Hnf4g and Cyp1a1 are involved in“depression with liver-qi stagnation and spleen deficiency syndrome”.These findings indicate that depressed rats with liver-qi stagnation and spleen deficiency syndrome are at risk of liver diseases.Furthermore,our results will inform exploration of the etiology of depression and help in the development of effective therapeutic strategies.
基金Supported by National Major Scientific and Technological Special Project for"Significant New Drugs Development"(2009ZX09502-015)Autonomous Innovation and Achievement Transformation Project of Shandong Province(2014ZZCX02104)+1 种基金Project of National Natural Science Foundation(81374059)Special Fund for Taishan Scholar Project(Ns201511107)
文摘[Objectives] To establish animal models of fatty liver due to liver depression and spleen deficiency that were suitable for activity discovery of traditional Chinese medicine( TCM) compounds,efficacy evaluation,new drug research and development and correspondence between prescription and syndrome of TCM. [Methods] A syndrome score scale that was suitable for evaluating the rat models was established according to the evolvement rules of etiology and pathogenesis of TCM and the modern clinical pathological mechanism. At the same time,bifendate pills and Sanqi Zhigan pills were selected as drug counterevidence for the models. Rats in model groups were given different proportions of high-fat and low-protein fodder and different concentrations of alcohol every day,and intraperitoneally injected with porcine serum twice a week. Drug groups were given with bifendate pills and Sanqi Zhigan pills( 8. 1 mg/kg,and 2. 7 g/kg) respectively for 14 consecutive days.During the experiment,general status,weight,daily fodder intake and daily water intake of the animals were observed,and TCM syndromes were scored. After the experiment,the levels of alanine aminotransferase( ALT),aspartate aminotransferase( AST),γ-glutamine transpeptidase( γ-GT),total cholesterol( TC),triglycerides( TG),low density lipoprotein-cholesterol( LDL-C),and high density lipoprotein-cholesterol( HDL-C) in serum were detected,and the pathological changes in liver tissue were observed. [Results] Compared with the control group,body weight,daily fodder and water intake of rats increased slowly in the model group,and the levels of ALT,AST,γ-GT,TC,TG and LDL-C increased significantly,while the level of HDL-C dropped. Pathological examination showed that steatosis and fat granule were observed in hepatocytes of rats in the model group. Behavioral observation found that main symptoms and minor symptoms of rats in the model group conformed to the syndrome manifestation of liver depression and spleen deficiency,which suggested that the three model groups were established successfully. Among them,three rats died in model group 1,and one rat died in model group 2. The manifestation of all the above lesions can be alleviated by drug counterevidence. [Conclusions]The animal model of fatty liver due to liver depression and spleen deficiency shows an obviously lower mortality and shorter duration and can be used for research of correlation between prescription and syndrome and its mechanism.
文摘Qi deficiency of the spleen and stomach,transportation,phlegm and dampness generate endogenous and turbid phlegm that violates the position of yang clearance.As a result,dizziness cis resulted.The author believes that the incidence of middle-aged and young patients with hypertension is mostly related to the dysfunction of liver and spleen.Liver depression and qi stagnation is the beginning of the onset;spleen deficiency and dyskinesia is the norm of the onset;and liver and spleen imbalance is the origin of the onset.It is advocated that regulating the liver and spleen to restore the rise and fall,harmonizing qi and blood and preventing lesions are the main treatment methods for the treatment of middle-aged and young people’s hypertension,which is conducive to the development of more clinical diagnosis and treatment ideas for hypertension amomg middle-aged and young people.
文摘AIM To investigate changes in spleen stiffness measurements(SSMs) and other non-invasive tests(NITs) after treatment with direct-acting antivirals(DAAs) and identify predictors of SSM change after sustainedvirological response(SVR). METHODS We retrospectively analysed 146 advanced-chronic liver disease(ACLD) patients treated with DAA with available paired SSM at baseline and SVR24. Liver stiffness(LSM), spleen diameter(SD), platelet count(PLT) and liver stiffness-spleen diameter to platelet ratio score(LSPS) were also investigated. LSM ≥ 21 k Pa was used as a cut-off to rule-in clinically significant portal hypertension(CSPH). SSM reduction > 20% from baseline was defined as significant.RESULTS SSM significantly decreased at SVR24, in both patients with and without CSPH; in 44.8% of cases, SSM reduction was > 20%. LSPS significantly improved in the entire cohort at SVR24; SD and PLT changed significantly only in patients without CSPH. LSM significantly decreased in 65.7% of patients and also in 2/3 patients in whom SSM did not decrease. The independent predictor of decreased SSM was median relative change of LSM. CSPH persisted in 54.4% patients after SVR. Delta LSM and baseline SSM were independent factors associated with CSPH persistence.CONCLUSION SSM and other NITs significantly decrease after SVR, although differently according to the patient's clinical condition. SSM faithfully reflects changes in portal hypertension and could represent a useful NIT for the follow-up of these patients.
