Clinical acupuncture therapy for chronic cholecystitis: A protocol for systematic review and meta-analysis.

ABSTRACT: Chronic cholecystitis is a common chronic disease in clinical practice. The incidence of chronic cholecystitis is gradually increasing due to changes in eating habits and even if acute infections aren't treated in time, it can cause serious complications, continue to plague people's daily life and become an economic burden to society. Currently, the curative effect of chronic cholecystitis under the control of western medicine is still lacking and there are adverse reactions. However, based on current clinical controlled trials acupuncture therapy for chronic cholecystitis has gradually become a complementary treatment. Therefore, this systematic review aims to explore the safety and feasibility of acupuncture therapy in the treatment of chronic cholecystitis. METHODS: We will search the following databases: Medline, PubMed, Cochrane Database of Systematic Reviews, Embase, Chinese Biomedical Literatures Database, China National Knowledge Infrastructure, Wang Fang Database, Chinese Scientific Journal Database from inception to February 2021 without any language restriction. At the same time, relevant literature will be searched manually. The main search terms include: "Acupuncture," "Cholecystitis." Data entry will be completed by 2 researchers separately. After entry, cross-checking will be performed to ensure the authenticity of the information. The main outcome criteria include: including the total effective rate of the patient; the traditional Chinese medicine symptom score of the patient includes: abdominal pain, tenderness in the right upper abdomen, and so on; secondary outcome criteria include: gallbladder contraction function and gallbladder thickness, VAS scores, recurrence rate, adverse reactions; use Cochrane risk bias assessment to evaluate and score the included randomized controlled trial; meta-analysis will be performed using RevMan 5.4.0 software. The heterogeneity test is based on the thresholds of P and I2, In order to use solid or random effects models. RESULTS: This systematic review only evaluates the safety and limitations of acupuncture therapy in the treatment of chronic cholecystitis. We will report the full text in the near future. CONCLUSION: This study will explore the safety and limitations of acupuncture therapy in the treatment of chronic cholecystitis, so that acupuncture therapy will be more widely used clinically. TRIAL REGISTRATION NUMBER: INPLASY202120020.

[The effectiveness of the application of medicinal mineral water from the 'Omonkhona' source in the patients presenting with the diseases of the hepatobiliary system]. / Éffektivnost' primeneniia lechebnoi mineral'noi vody iz istochnika 'Omonkhona' u patsientov s zabolevaniiami gepatobiliarnoi sistemy.

BACKGROUND: Investigations into the medicinal properties of 'Omonkhona' mineral water used for the treatment of hepatobiliary pathology make up the entirely new field of balneological research in Uzbekistan. AIM: The objective of the present study was to identify the hepatoprotective and choleretic components of the 'Omonkhona' mineral water and elucidate their action in the patients presenting with the diseases of the hepatobiliary system. MATERIAL AND METHODS: A total of 77 patients suffering from the diseases of the hepatobiliary system were available for the examination including 38 patients with chronic hepatitis (CH), 17 with chronic cholecystitis (CC), and 22 patients with liver cirrhosis (Cr). All the patient were prescribed drinking the mineral water (from 1.0 to 3.0 liters per day) during consequtive 12-14 days. The clinical, biochemical, and instrumental studies were carried before and after the treatment. RESULTS: The treatment with 'Omonkhona' water resulted either in the complete elimination or the significant alleviation of pain in the right hypochondrium. The patients presenting with CH and CC experienced normalization of ESR even though it remained high in the Cr patients. All the patients exhibited a decrease of specific gravity of the urine, probably due to the diuretic effect of the mineral water. The biochemical studies of blood and bile showed that the initially slightly enhanced bilirubin levels, alanine aminotransferase and alkaline phosphatase activities in the CH and CC patients normalized after a course of the treatment with 'Omonkhona' mineral water (p<0.05). No such changes were documented in the patients with liver cirrhosis. The patients with CH and CC experienced the two-fold reduction in the intensity of inflammation whereas the bilirubin and bile acid levels increased although the relative cholesterol content decreased and the cholate-cholesterol coefficient increased (p<0.05). The Cr patients demonstrated only insignificant changes of these parameters. The ultrasound examination showed that the CC patients treated with 'Omonkhona' mineral water had a decrease in the swelling of the gallbladder walls, the improvement of its motor function and the disappearance of the stagnation phenomenon. In the CH patients, there was a significant decrease in the cranio-caudal size of the right lobe of the liver, the cranio-caudal size of the left lobe, and the anteroposterior size of the left lobe (p<0.05). A decrease in the acoustic conductivity was noted that can probably be attributed to the reduced swelling of the liver parenchyma. The Cr patients had no significant changes of these parameters following the treatment. CONCLUSIONS: The results of this study give evidence that the treatment of the diseases of the hepatobiliary system with 'Omonkhona' mineral water exerts the well apparent positive influence on the patients presenting with CC and CH even though its beneficial effect was less pronounced in the patients with livre cirrhosis.

Complications of a severe autoimmune hemolytic anemia crisis: transfusional iron overload and gangrenous cholecystitis.

BACKGROUND: Evans syndrome is a rare autoimmune disorder that is defined by the simultaneous or sequential presence of two or more cytopenias without an obvious underlying precipitating cause. Evans syndrome usually follows a chronic relapsing and remitting course and is quite rare, making it difficult to evaluate in clinical studies. CASE REPORT: A 66-year-old male patient with a 17-year history of Evans syndrome presented with fulminant autoimmune hemolytic anemia (AIHA). He presented with a markedly elevated C-reactive protein (CRP; 46 mg/L [normal, 0-5 mg/L]) before onset of a decrease in hemoglobin. He required the transfusion of 20 units of red blood cells while awaiting response to aggressive immunosuppressive therapy including high-dose corticosteroids, intravenous immunoglobin therapy, and rituximab. He achieved a complete hematologic response. RESULTS: His postdischarge course was complicated by acute cholecystitis requiring laparoscopic cholecystectomy. In addition, his transfusional iron overload requiring 16 phlebotomies to reduce his ferritin level from 4933 µg/L to 326 µg/L, with phlebotomies ongoing every 2 weeks to achieve a ferritin level of less than 100 µg/L. CONCLUSION: Neither transfusional iron overload nor acute cholecystitis are well-recognized complications of a severe episode of AIHA. An elevated CRP has been recently recognized as an important prognostic marker in patients with immune thrombocytopenic purpura and this case suggests a need to evaluate its utility in AIHA.

[A case of a patient with bile secretion disorder for whom an egg yolk lecithin-containing liquid diet was used for enteral nutrition].

For elderly people who are difficult to operate, percutaneous transhepatic gallbladder drainage (PTGBD) is conducted instead. In PTGBD, the bile is drained externally and impaired absorption of fat is a concern. Egg yolk lecithin, which is a fat emulsifier, is not easily broken in emulsion even under a low-pH condition, and the emulsified state is stable. Even in bile duct ligation rats, the emulsifier in egg yolk lecithin emulsion is reported to be superior to lipid absorption using other emulsifiers. Emulsification with egg yolk lecithin may possibly contribute to improvement of nutrition during biliary excretion disorders such as external drainage. We report a case of good progress with enteral nutrition with egg yolk lecithin-mixed liquid diet after PTGBD for acute cholecystitis. The patient was an 80-year-old man with a history of myocardial infarction and dementia. He was diagnosed with calculous cholecystitis, and conservative treatment was started. His cholecystitis was exacerbated, and PTGBD was performed on day 12 of the disease. On imaging, the lower extremities of the duodenum were edematous because of the spread of inflammation. Glutamine preparation alone was administered after resuming fasting. A liquid diet containing egg yolk lecithin, 200 ml of K-LEC (1 kcal/ml), was started from day 23, and was administered three times daily. Liquid diet dose was increased to 1,200 kcal/day with added dietary fiber on day 29. The patient's overall condition improved, and transthyretin level and body weight increased. Thereafter, after swallowing training, the patient was switched to oral meal intake from day 37.

[Immunotropic reaction onto balneotherapy by mineral water «naftusia¼ of women with hyperplasia of the thyroid gland and non-calcular cholecystitis].

OBJECTIVE: Introduction: Hyperplasia of the thyroid gland is recetly widespread, especially among women, with pathology. At structural changes of a gland there are various types of violations of the hormonal status of the organism - from hyperthyroidism through euthyroidism to hypothermia. The aim: The article aims at investigation of the peculiarities of the influence of mineral water "Naftusia" on the immunological status of women with non-calcular cholecystitis and hyperplasia of the thyroid gland, as well as the substantiation of the possibilities of using balneotherapy in the treatment of this pathology on the basis of the obtained data. PATIENTS AND METHODS: Materials and methods: Object of investigation- hyperplasia of the thyroid gland in the presence of women's non calcular cholecystitis. Subject of research -hormonal and immune status and their changes under the influence of mineral water "Naftusia". Methods of investigation: general clinical, standard laboratory methods of examination, special clinical and laboratory methods: physiological, biochemical, statistical. The evaluation of the immune system was carried out by determining the serum total blood levels of total immunoglobulins G, M, A. The level of immunoglobulins in the blood serum was determined by radial immune diffusion according to Mancini. RESULTS: Results and conclusions: The analysis of obtained results, makes it possible to characterize fully the positive influence of such a non-medicamentous item, as the use of mineral water "Naftusia" for the treatment of noncalcular cholecystitis. Under the influence of water "Naftusia", in one way or another, the cellular and phagocytic links of immunity are normalized. It can be assumed that a positive effect on the immune system is realized through the normalization of the processes of division and differentiation of cells of the immune system, in particular on the membrane level.

[The influence of sinusoidal modulated currents on the fatty acid composition of plasma and blood erythrocytes in the patients presenting with chronic cholecystitis]. / Vliyanie sinusoidal'nykh modulirovannykh tokov na sostav zhirnykh kislot plazmy i eritrotsitov krovi u patsientov s khronicheskim kholetsistitom.

The objective of the present study was to evaluate the effectiveness of the treatment with sinusoidal modulated currents on lipid metabolism in the patients presenting with chronic cholecystitis in the state of remission. PATIENTS AND METHODS: The study included 25 patients with chronic non-calculosis cholecystitis in phase of remission and 20 healthy subjects (controls). We studied the serum lipid spectrum as well as the fatty acid composition of plasma and blood erythrocytes before and after therapy with sinusoidal modulated currents applied to the right-sided hypochondrium region. RESULTS AND DISCUSSION: The treatment of the patients with chronic cholecystitis in remission with the use of sinusoidal modulated currents produced moderate lipid-modulatory and membranotropic effects mediated through the activation of the processes of lipid metabolism that may result in the depletion of the pool of essential polyunsaturated fatty acids. CONCLUSION: The results of this study give evidence that it is advisable to treat the patients presenting with chronic cholecystitis by sinusoidal modulated currents in the combination with the oral intake of exogenous polyunsaturated fatty acids.

[The contingency of the therapeutic effectiveness with the peculiarities of the non-pharmacological treatment of the patients presenting with chronic cholecystitis]. / Sopryazhennost' terapevticheskoi effektivnosti s osobennostyami nemedikamentoznogo lecheniya bol'nykh khronicheskim kholetsistitom.

The elaboration of new technologies for the medical rehabilitation of the patients presenting with chronic cholecystitis in combination with chronic opisthorchiasis is a topical problem facing modern clinical gastroenterology. The application of up-to-date non-pharmacological therapeutic modalities, such as ultrahigh-frequency (UHF) therapy concomitantly with group chronophysiotherapy makes it possible to significantly improve the final outcome of the treatment. The results of clinical studies give evidence of the favourable influence of the combined chronorehabilitative treatment including UHF therapy on the characteristics of the functional state of the biliary-hepatic system and of the organism as a whole. The positive dynamics of these characteristics is suggestive of the high (up to 87,5%) therapeutic effectiveness of the proposed treatment. The investigations into the relationship between this effect and the peculiarities of the combined therapeutic modalities have demonstrated their correlation (χ2=104,13; p=0,0001; V-Kramer´s coefficient =0,35) and showed that the use of combined chronorehabilitation including UHF therapy based on the application of phone resonance radiation guarantees (and is a predictor of) high therapeutic effect (percent concordance =95,6%; standard coefficient=2,13; p=0,001) of the treatment of the patients with chronic cholecystitis in combination with chronic opisthorchiasis. The statistical analysis of the results of application of the modern non-pharmacological therapeutic modalities and the chronobiological approach for the purpose of the combined treatment of patients presenting with chronic cholecystitis in combination with opisthorchiasis with the use of contingency table and logit regression, allowed not only to estimate the interdependence and interrelation between the characteristics of interest but also to reveal predictors of therapeutic effectiveness. These findings are of great practical importance since they can be used for the choice of therapeutic strategies for the management of this category of patients.

[Effects of acupuncture of Jianjing (GB 21) on gallbladder volume and symptoms of cholecystitis patients].

OBJECTIVE: To observe the effect of acupuncture of Jianjing (GB 21) and non-acupoint on gallbladder volume and clinical symptoms of chronic cholecystitis patients. METHODS: Sixty cases of chronic cholecystitis patients were equally randomized into Jianjing (GB 21) group and non-acupoint group. A filiform needle was inserted into Jianjing (GB 21) or non-acupoint (2 cun lateral to the mid-point between the spinous processes of the 6th and 7th cervical vertebrae) on the right side, manipulated for a while till "Deqi", and retained for 30 min. A color Doppler ultrasound scanner was used to detect the volume of the gallbladder before and 15 min after acupuncture stimulation and 30 min after withdrawal of the acupuncture needle. Changes of the patients symptoms of shoulder-back pain, stomachache, distension and nausea were evaluated according to the patients' complaints. RESULTS: After acupuncture intervention, the remission rates of shoulder-back pain and stomachache in non-acupoint and GB 21 groups were 56.67% and 90.00% respectively, while the effective rates of the patients' gastric distention and nausea in non-acupoint and GB 21 groups were 16.67% and 23.33%, respectively. The therapeutic effect of Jianjing (GB 21) was apparently superior to that of non-acupoint in pain relief (P < 0.05). Fifteen min following acupuncture stimulation and 30 min after withdrawal of the acupuncture needle, the gallbladder volume in cholecystitis patients with deflated gallbladder was increased apparently in GB 21 group (P < 0.01), and that in patients with expanded gallbladder was decreased significantly (P < 0.01). No significant differences were found among pre-, during and post-treatment in the non-acupoint group in the effects of acupuncture on regulation of the deflated and expanded gallbladder volume (P > 0.05). CONCLUSION: Acupuncture stimulation of Jianjing (GB 21) can effectively relieve shoulder-back pain and stomachache, and regulate the volume of the deflated and expanded gallbladder in cholecystitis patients. The effect of acupuncture of non-acupoint is relatively poorer in relieving the cholecystitis patients' symptoms and regulating the gallbladder volume.

[Observation of effect on contraction function of gallbladde by acupuncture at Jianjing (GB 21)].

OBJECTIVE: By B ultrasound, the changes of contraction function of gallbladder by acupuncture at Jianjing (GB 21) were observed and the internal relations between Jianjing (GB 21) and cholecystitis were explored, in order to explore the better therapy. METHODS: Two hundreds cases who had been diagnosed as cholecystitis (acalculous cholecystitis) were classified in observation group, including gallbladder expanding (84 cases) and gallbladder constricting (116 cases); 100 cases who had examined as healthy were taken in control group. Acupuncture at Jianjing (GB 21) on right shoulder was applied in both groups. Through B ultrasound examination, the changes of gallbladder volume in both groups were compared before acupuncture, 15 min after needle insertion and 30 min after needle withdrawing. RESULTS: The gallbladder volume of gallbladder expanding and gallbladder constricting cases were constricted or expanded 15 min after needle insertion and 30 min after needle withdrawing, and there were statistical significances (all P < 0.01). Compared the outcomes at different time points after acupuncture with that before acupuncture, the changes of gallbladder constricting were unobvious (both P > 0.05) in control group. In observation group, the pain relief rate for 142 cases companied with shoulder and back pain was 98.6% (140/142). CONCLUSION: Acupuncture at Jianjing (GB 21) can improve the gallbladder constricting, regulate bidirectional function of expanding and constricting, and efficiently relieve shoulder and back pain.

[Biliary pathology in patients with type 2 diabetes mellitus and methods for its correction with the use of health resort and spa factors].

Diagnostics and treatment of hepatobiliary pathologies are known to be the indispensable prerequisites for the successful compensation of diabetes mellitus (DM). The present study revealed disturbances of bile-producing and bile-secreting functions of the liver in all the examined patients with DM. Moreover, the biochemical composition of bile and the ratio of its major components proved to be pathologically altered. The treatment program based at the Metallurg health resort including consumption of the local mineral water resulted in the significant improvement of the hepatic secretory function and normalization of motor-tonic activity of the bile-secreting system in patients presenting with type 2 diabetes mellitus at the stage of noncalculous cholecystitis.

Hepatic and biliary damage after transarterial chemoembolization for malignant hepatic tumors: incidence, diagnosis, treatment, outcome and mechanism.

OBJECTIVE: To provide an overview of recent studies on transarterial chemoembolization-related hepatic and biliary damage (TRHBD) in patients with malignant hepatic tumors (MHT) and to explore the reasons for TRHBD. METHODS: Literature on the treatments for MHT by TACE was sought in PubMed and the related information was summarized. RESULTS: TRHBD is found to occur in the hepatic parenchymal cells, biliary tree and blood-vascular system. The damage is mainly due to ischemia resulting from embolic materials such as gelatin sponge and lipiodol. In addition, clinicians' skill levels in non-superselective catheterization, the health condition of the patients, and the chemical agents used may also be related to the damage. Most of the deterioration can be reversed if the patients are diagnosed and treated properly and promptly. CONCLUSIONS: Understanding the mechanisms of TRHBD more comprehensively is helpful in developing effective methods for prevention and treatment.

[Observation on the leptin level in the subcutaneous tissues of the high temperature reaction zone along the abdominal gallbladder Meridian in rabbits with cholecystitis].

OBJECTIVE: To observe the content of leptin in the abdominal subcutaneous tissues of the higher temperature zone along the Gallbladder (GB) Meridian in cholecystitis rabbits so as to explore the correlation between the temperature response and the leptin level. METHODS: Twenty-five rabbits were randomized into normal control group (n = 10) and cholecystitis model group (n = 15). Cholecystitis model was established by injection of Escherichia coli solution (0.1 mL) into the gallbladder via common bile duct after surgery. Three, 7 and 11 days following modeling, the abdominal surface thermographic images along the GB Meridian were collected by the AGA-782-type infrared imaging system (AGA's capacity). And then the subcutaneous tissues of the high temperature reaction region and the contralateral corresponding tissues of different groups were collected for assaying the leptin contents in the supernatant by radioimmunoassay after processing (homogenization and centrifugation) and for observing the morphological structure under light microscopy after sectioning and staining (toluidine blue). RESULTS: Thermographic images showed that about 70% of the animals in the model group, various lengths of high temperature reaction (0.5-1.4 degrees C) zones or bands in the abdominal region along the bilateral GB Meridian were seen, in comparison with the control group. The leptin levels in the ipsilateral (affected side) and contralateral (healthy side) tissues of the abdominal high temperature reaction zones along the GB Meridian were significantly higher in the model group than in the control group (P < 0.01), suggesting a close correlation between the leptin content change and the high temperature reaction. In addition, most fat cells were crowded to distribute closely along the blood vessels in the subcutaneous tissues of the higher temperature reaction zone in the model group, but those of the control group distribute more loosely along the blood vessels. CONCLUSION: The leptin content in the abdominal sub- cutaneous tissues of high temperature reaction zone along the GB Meridian is higher in cholecystitis rabbits, suggests a relevance of the endocrine function of fat cells to the high temperature reaction along the GB Meridian.

[Daily variation of some cardiovascular parameters in healthy children and in those with chronic cholecystitis, changes on mud cure].

Studies covered chronologic algorithm of physiologic parameters in healthy children and those with hepato-biliary diseases. 71.3% of children suffering from hepato-biliary diseases appeared to have significant desynchronization. The authors conducted time-wise optimization of mud care in children with cholecystitis. Findings are that mud care has considerable sanogenous effect and could be recommended as a treatment for children with ecologically mediated cholecystitis.

[Low-mineral water and sapropel in the treatment of chronic cholecystitis in children in conditions of polluted environment].

The comparison of the course of chronic cholecystitis in children living in healthy and polluted regions of the Chelyabinsk Territory has demonstrated that industrial enronmental pollution deteriorates the course of chronic cholecystitis. Drinking of low-mineral water and sapropel application on hepatic area improved clinical parameters in the examinees.

[Correction of the gastric and duodenal motility by laser puncture in pancreatobiliary diseases]. / Korrektsiia motoriki zheludka i dvenadtsatiperstnoi kishki pri zabolevaniiakh organov pankreatobiliarnoi zony metodom lazeropunktury.

96.7 percent of patients with affections of organs of the pancreatobiliary zone displayed motor function disorders of upper portions of the alimentary canal (AC). A characteristic sign of the pathological process in pancreatobiliary organs is decreased frequency of recordable biopotentials and qualitative changes in electrogastrogrames. Changes in qualitative characteristics of the electrogastrogram are clearly related to increase in the intraduodenal pressure recordable with the aid of the "open catheter" technique. Laseropuncture is an effective supplementary method for correction of motility disorders in the upper portions of AC in those patients presenting with affections of the pancreatobiliary organs.