Body Compositions Correlate With Overt Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt: A Multicentre Cohort Study.

BACKGROUND: The relationship between body composition and the risk of overt hepatic encephalopathy (OHE) following transjugular intrahepatic portosystemic shunt (TIPS) needs to be investigated. METHODS: Overall, 571 patients from 5 medical centers were included. To assess body compositions, we evaluated skeletal muscle indices, adipose tissue indices, sarcopenia, and myosteatosis at the third lumbar vertebral level. Univariate and Multivariate logistic regression analyses were performed to identify independent risk factors for post-TIPS OHE. An integrated score was then constructed using stepwise multiple regression analyses, with a cut-off value selected using the best Youden index. Finally, the Akaike information criterion (AIC) was performed to compare the integrated score and independent risk factors on their ability in predicting post-TIPS OHE. RESULTS: Sarcopenia and all skeletal muscle indices had limited associations with post-TIPS OHE. The index of the subcutaneous adipose tissue (SATI) (P=0.005; OR: 1.034, 95% CI: 1.010-1.058) and myosteatosis (297 cases, 52.01%, 125 with OHE, 42.09%; P=0.003; OR: 1.973; 95% CI: 1.262-3.084) were both ascertained as independent risk factors for post-TIPS OHE. The integrated score (ScoreALL=1.5760 + 0.0107 * SATI + 0.8579 * myosteatosis) was established with a cutoff value of -0.935. The akaike information criterion (AIC) of ScoreALL, SATI, and myosteatosis was 655.28, 691.18, and 686.60, respectively. CONCLUSIONS: SATI and myosteatosis are independent risk factors for post-TIPS OHE. However, the integrated score was more significantly associated with post-TIPS OHE than other skeletal muscle and adipose tissue factors.

Effect of suture closure and staple closure on postoperative wound complications in patients undergoing knee replacement surgery: A meta-analysis.

The purpose of this meta-analysis is to determine if the application of stitching in the closed area of the knee arthroplasty remains significantly superior to that of the staples. Data sources: EMBASE, Cochrane Libraryand, publications, and the Web of Science. Patients were treated with staples for closure of their wounds, or with conventional stitches for closure of wounds. The main findings were surgical site infection, wound dehiscence, and cutting time. The secondary results were the time to completion, the duration of the hospitalization, and the time to discharge. We incorporated the SIX trial into the meta-analyses with Review Manager V.5.3. The hazard ratio was computed as a therapeutic outcome with respect to the heterogeneity. For more than 50% of heterogeneous samples, we employed a stochastic effect model. The results showed that there was no significant difference in the degree of infection, the degree of dehiscence, the length of the cut and the degree of satisfaction of the wound. But the time to close the wound and the time to operate were significantly different. The time needed to close the wound was shorter than that of the suture (OR, -227. 22; 95% CI, -238. 74, -215. 69 p < 0. 0001); The time taken to replace the knee was also significantly lower among those who had been stapled sutures (OR, -5.46; 95% CI, -10. 43, -0.49 p = 0. 03). Wound closing materials are an afterthought for many orthopaedic surgeons. Together, the findings from a number of comparative studies indicate that the selection of wound closure materials might affect the outcome of the surgery. The evidence, however, is weak because of the heterogeneous approach adopted in earlier research. This study program is intended to provide guidance on how to select the best wound closure material for the purpose of identifying if there is any difference in the incidence of injuries among traditional stitches and staples.

Differentiating the effects of anger and sadness: A perspective of spontaneous trait inference.

In the present research, three experiments were conducted to examine the effects of anger and sadness on spontaneous trait inferences (STIs). Using a probe recognition paradigm, Experiment 1 revealed that angry participants made more errors in response to probes following trait-implying behaviours than sad participants did. Using a false recognition paradigm, Experiments 2 and 3 revealed that angry participants made more errors in response to systematic pair trials than sad participants did. The three experiments provided convergent evidence that angry individuals were more inclined to form STIs than sad individuals were. The current research first demonstrated the different effects of specific negative mood states (anger vs. sadness) on STIs, providing further insight into the relationship between mood and STIs.

Myosteatosis is an independent risk factor for overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunting.

OBJECTIVE: The relationship between skeletal muscle and adipose tissue compositions and risk of overt hepatic encephalopathy (OHE) following transjugular intrahepatic portosystemic shunt (TIPS) treatment needs to be investigated. METHODS: A total of 282 patients were collected from two medical centres. The median time of follow-up was 48.23 + 1.36 months and the first-year results of all patients after TIPS therapy were collected. The muscle and adipose tissue indices were quantified at the third lumbar vertebra level. Sarcopenia and myosteatosis were defined according to previous researches. Receiver operating characteristic curves, chi-square test, univariate and multivariate logistic regression analyses were employed to investigate the potential association between muscle and adipose indices, sarcopenia, myosteatosis and the risk of developing post-TIPS OHE. RESULTS: All skeletal muscle indices, adipose tissue indices and sarcopenia had limited associations with post-TIPS OHE. Myosteatosis (148 cases, 52.5%, 55 with OHE, 37.2%) was identified as an independent risk factor for post-TIPS OHE. with P  < 0.001 in Chi-square test, P  < 0.001, odds ratio (OR): 2.854, 95% confidence interval (CI): 1.632-4.993 in univariate logistic regression analyses, and P  = 0.007, OR: 2.372, 95% CI: 1.268-4.438 in multivariate logistic regression analyses, respectively. CONCLUSION: Our results showed that myosteatosis was proven as an independent risk factor for the development of post-TIPS OHE.

Research Advances in Lotus Leaf as Chinese Dietary Herbal Medicine.

Lotus leaf (Heye), the dry foliage of Nelumbo nucifera Gaertn, has been valuable as a dietary herbal medicine for thousands of years. Phytochemical studies indicated that alkaloids and flavonoids are the main components of Heye. Polysaccharides, terpenes, and amino acids are also active ingredients. The drug properties of Heye are mild and bitter. Meridian tropism is mainly distributed in the liver, spleen, and stomach meridian. In the Traditional Chinese medicine (TCM) theoretical system, it is in many formulas for the therapy of various symptoms, including wasting-thirst induced by summer heat, diarrhea caused by summer heat-dampness and spleen deficiency, hematochezia, flooding and spotting, among others. Nowadays, the extracts and active components of Heye demonstrate multiple bioactivities, for instance anti-obesity, anti-inflammatory, anti-oxidant, cardiovascular protective, anticancer, hepatoprotective, hypoglycemic, antiviral, antimicrobial, as well as hemostatic activities. This review will provide an overview of Heye serving as a typical plant with functions of both medicine and food, including its practical applications in terms of TCM and healthy diet, phytochemistry, pharmacological activity, together with its toxicity. Besides, the new points and prospects of Heye in the overview are also outlined straightforwardly.

Anti-Alzheimer's disease active components screened out and identified from Hedyotis diffusa combining bioaffinity ultrafiltration LC-MS with acetylcholinesterase.

ETHNOPHARMACOLOGICAL RELEVANCE: Hedyotis diffusa is a traditional ethnomedicinal plant in local communities in northeastern Asia and used to treat inflammation, nervous breakdown, among others. In recent years, it has been applied in the treatment of Alzheimer's disease (AD), while the specific chemical components responsible for the activity remain need to be explored. AIM OF THE STUDY: To prepare, screen and identify the potential anti-AD active components from Hedyotis diffusa. MATERIALS AND METHODS: The acetylcholinesterase (AChE) inhibitory activity of four different extracts of Hedyotis diffusa were initially assessed using a spectrophotometric Ellman's method. A more accurate LC-MS/MS screening method combining functional enzyme assay and affinity ultrafiltration (AU) screening assay was developed and applied for the screening of natural compound inhibitors of AChE from Hedyotis diffusa. The binding mode was further investigated between protein and ligands via molecular docking. Subsequently, CL4176, a transgenic nematode model for AD, was used for activity validation of one of these components. RESULTS: N-butanol extract of Hedyotis diffusa (NHD) appeared significant inhibitory activities on AChE, were chosen to delve deeper. Five bioactive components targeting AChE were screened out and identified using AU coupled to liquid chromatography-mass spectrometry. Molecular docking technique further confirmed the results of the screening assay. Finally, quercetin-3-O-sophoroside (QS) was confirmed as a potent anti-AD agent by in vivo experiments in C. elegans. CONCLUSION: This study explores a new idea for screening anti-AD active components from traditional medicine. The findings provide a molecular structure and bioactivity basis for future potential applications of Hedyotis diffusa in medical industries.

Improving physicochemical properties and pharmacological activities of ternary co-amorphous systems.

The formation of co-amorphous by combining low molecular weight compounds with drugs is a relatively new technology in the pharmaceutical field, which can significantly improve the solubility, dissolution, and stability of poorly water-soluble drugs. However, in our previous studies, the binary co-amorphous system of andrographolide-oxymatrine (AP-OMT) was found to have obvious recrystallization and poor dissolution behavior. Therefore, in this study, we designed three stable ternary co-amorphous systems to improve the physicochemical properties of the binary co-amorphous system of AP-OMT. The ternary co-amorphous systems were prepared with AP, OMT, and trans-cinnamic acid (CA), p-hydroxycinnamic acid (pHCA), or ferulic acid (FA). Intermolecular hydrogen bonds were confirmed by spectroscopy and molecular dynamics simulation. Solubility studies showed that the solubility of the ternary co-amorphous systems of AP-OMT-CA/pHCA/FA was significantly increased compared with that of crystalline AP. Dissolution experiments suggested that the ternary co-amorphous systems of AP-OMT-CA/pHCA/FA exhibited better dissolution behavior without significant recrystallization compared to the binary co-amorphous AP-OMT. The stability study confirmed that the ternary co-amorphous system of AP-OMT-CA/pHCA/FA maintained good physical stability in the long term for 18 months. In addition, pharmacological experiments revealed that the ternary co-amorphous systems of AP-OMT-CA/pHCA/FA have an excellent safety profile and its anti-Alzheimer's disease effects are significantly improved compared to that of the binary co-amorphous systems of AP-OMT. Moreover, this study also found that reducing the pKa value of low molecular weight co-formers would affect the intermolecular interactions and improve the solubility of drugs in the ternary co-amorphous systems. In conclusion, we have successfully prepared ternary co-amorphous systems of AP-OMT-CA/pHCA/FA by amorphization technique, which improves the physicochemical properties of the binary co-amorphous systems of AP-OMT and anti-Alzheimer's disease activity in the Caenorhabditis elegans model. The mechanism for the influence of the pKa value of the co-formers on the physicochemical properties of the ternary co-amorphous system was preliminarily explored, providing theoretical guidance for the development of the ternary co-amorphous system.

Preoperative prediction of overt hepatic encephalopathy caused by transjugular intrahepatic portosystemic shunt.

PURPOSE: Preoperative prediction of overt hepatic encephalopathy (OHE) should be performed in patients with variceal bleeding treated using the transjugular intrahepatic portosystemic shunt (TIPS) procedure. A reliable prediction tool is therefore required. METHOD: Patients with cirrhosis-related variceal bleeding treated using the TIPS procedure were screened at two hospitals. Patients classified as Child-Pugh Class B were identified. The least absolute shrinkage and selection operator method and the backward stepwise selection method were used to screen the clinical and radiological characteristics of participants. Then, models were constructed accordingly to predict OHE. Area under the receiver operating characteristic curves, calibration curves, and decision curves were performed to discover the optimal model. Finally, whether clinical factors influenced the performance of our optimal model was tested. RESULTS: A total of 191 patients were included (training cohort: 127 cases; validation cohort: 64 cases). Three novel radiological independent risk factors were found. The combined model outperformed the models containing clinical factors or radiological characteristics alone. The areas under the curve for the training and validation cohorts were 0.901 and 0.903, respectively, with satisfactory calibration and decision curves. The Model for End-Stage Liver Disease score, serum sodium, albumin, total bilirubin, and age exhibited limited influence on the performance of the combined model. CONCLUSIONS: These radiological characteristics are also independent risk factors for post-TIPS OHE. Combining clinical factors and radiological characteristics was an effective means of predicting OHE. This study's model could be used for preoperative selection of appropriate patients before the TIPS procedure is performed.

HLA-G on peripheral blood CD4(+) T lymphocytes: a potential predictor for acute renal rejection.

HLA-G Expression in grafts and serum has been shown to improve graft acceptance. However, its expression on peripheral blood lymphocytes (PBLs) during acute rejection (AR) remains unknown. In this study, we serially monitored HLA-G expression on CD4(+) and CD8(+) PBLs of 66 recipients undergoing renal transplantation using flow cytometry at different time points before and after transplantation, as well as during AR episode. In stable recipients, HLA-G expression on CD4(+) PBLs declined during the first week after transplantation and increased continuously with immunosuppressive therapy. Then, expression declined gradually after 1 month and remained at a higher level compared with pretransplantation. When AR occurred, HLA-G expression decreased significantly compared with the stable level. In three recipients suffering from recurrent rejection, it remained at a low level despite impact immunosuppressive treatment. With mix lymphocyte assay, HLA-G(+) CD4(+) T cells showed inhibitory role on proliferation of peripheral blood mononuclear cell. HLA-G expression on CD8(+) PBLs was almost undetectable at different time points in the recipients and healthy controls. Our results suggest that HLA-G on CD4(+) PBLs might provide a potential marker for the early diagnosis of renal AR and for the immunosuppressive status of recipients.

Prediction of overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunt treatment: a cohort study.

BACKGROUND/PURPOSE: Overt hepatic encephalopathy (HE) risk should be preoperatively predicted to identify patients suitable for curative transjugular intrahepatic portosystemic shunt (TIPS) instead of palliative treatments. METHODS: A total of 185 patients who underwent TIPS procedure were randomised (130 in the training dataset and 55 in the validation dataset). Clinical factors and imaging characteristics were assessed. Three different models were established by logistic regression analyses based on clinical factors (ModelC), imaging characteristics (ModelI), and a combination of both (ModelCI). Their discrimination, calibration, and decision curves were compared, to identify the best model. Subgroup analysis was performed for the best model. RESULTS: ModelCI, which contained two clinical factors and two imaging characteristics, was identified as the best model. The areas under the curve of ModelC, ModelI, and ModelCI were 0.870, 0.963, and 0.978 for the training dataset and 0.831, 0.971, and 0.969 for the validation dataset. The combined model outperformed the clinical and imaging models in terms of calibration and decision curves. The performance of ModelCI was not influenced by total bilirubin, Child-Pugh stages, model of end-stage liver disease score, or ammonia. The subgroup with a risk score ≥ 0.88 exhibited a higher proportion of overt HE (training dataset: 13.3% vs. 97.4%, p < 0.001; validation dataset: 0.0% vs. 87.5%, p < 0.001). CONCLUSION: Our combination model can successfully predict the risk of overt HE post-TIPS. For the low-risk subgroup, TIPS can be performed safely; however, for the high-risk subgroup, it should be considered more carefully.

Repressive effects of resveratrol on androgen receptor transcriptional activity.

BACKGROUND: The chemopreventive effects of resveratrol (RSV) on prostate cancer have been well established; the androgen receptor (AR) plays pivotal roles in prostatic tumorigenesis. However, the exact underlying molecular mechanisms about the effects of RSV on AR have not been fully elucidated. A model system is needed to determine whether and how RSV represses AR transcriptional activity. METHODOLOGY: The AR cDNA was first cloned into the retroviral vector pOZ-N and then integrated into the genome of AR-negative HeLa cells to generate the AR(+) cells. The constitutively expressed AR was characterized by monitoring hormone-stimulated nuclear translocation, DNA binding, and transcriptional activation, with the AR(-) cells serving as controls. AR(+) cells were treated with RSV, and both AR protein levels and AR transcriptional activity were measured simultaneously. Chromatin immunoprecipitation (ChIP) assays were used to detect the effects of RSV on the recruitment of AR to its cognate element (ARE). RESULTS: AR in the AR (+) stable cell line functions in a manner similar to that of endogenously expressed AR. Using this model system we clearly demonstrated that RSV represses AR transcriptional activity independently of any effects on AR protein levels. However, neither the hormone-mediated nucleus translocation nor the AR/ARE interaction was affected by RSV treatment. CONCLUSION: We demonstrated unambiguously that RSV regulates AR target gene expression, at least in part, by repressing AR transcriptional activity. Repressive effects of RSV on AR activity result from mechanisms other than the affects of AR nuclear translocation or DNA binding.

HLA class I (ABC) upregulation on peripheral blood CD3+/CD8+ T lymphocyte surface is a potential predictor of acute rejection in renal transplantation.

BACKGROUND: Renal transplantation is currently the prevalent therapy for most patients with end-stage renal disease. No clinical markers for such rejection have been universally accepted. We aimed to investigate the possibility of use of human leukocyte antigen (HLA) class I (ABC) on peripheral blood CD3+/CD8+ T lymphocytes as a marker of acute rejection. METHODS: For recipients undergoing renal transplantation from September 2007 to November 2008, peripheral blood samples were obtained pretransplantation and at days 3 and 7 posttransplantation when the patients were still hospitalized and at weeks 2 and 3 and months 1, 2, 3, and 6 posttransplantation. For patients with fever, lumbodynia, gross hematuria, or oliguria after transplantation, blood samples were collected immediately before and at days 3 and 7 after the administration of anti-inflammatory regents. The level of HLA class I (ABC) on peripheral-blood CD3+/CD8+ T lymphocytes was measured on flow cytometry. RESULTS: For the 79 transplant recipients, the level of HLA class I (ABC) on peripheral-blood CD3+/CD8+ T lymphocytes was consistently elevated during the first 3 weeks after transplantation, declined gradually to pretransplantation levels, then tapered off and remained stable. Patients experiencing acute rejection (AR) or not after transplantation did not differ in level of HLA class I (ABC) up to 6-month follow-up, except at days 14 and 21 after transplantation, when the level was higher for patients experiencing AR (P<0.01). CONCLUSIONS: Upregulation of HLA class I (ABC) on peripheral-blood CD3+/CD8+ T lymphocytes could be used as an accurate and reliable predictor of AR after renal transplantation.