Effects of Low-dose and High-dose Rifaximin in the Treatment of Covert Hepatic Encephalopathy.

Background and Aims: Rifaximin is effective in preventing and treating hepatic encephalopathy (HE). This study aimed to investigate the efficacy and safety of different dosages of rifaximin in the treatment of cirrhotic patients with covert HE (CHE). Methods: In this single-center, randomized, controlled, open-label study, CHE was diagnosed using a combination of the psychometric HE score and the EncephalApp Stroop test. Cirrhotic patients with CHE were recruited and randomly assigned to low-dose rifaximin 800 mg/day, high-dose rifaximin (1,200 mg/day), and control groups, and were treated for 8 weeks. The sickness impact profile (SIP) scale was used to evaluate the health-related quality of life (HRQOL) of patients. Forty patients were included in the study, 12 were assigned to the low-dose group, 14 to the high-dose group, and 14 patients to the control group. Results: The percentage of patients with CHE reversal was significantly higher in both the low-dose (41.67%, 5/12) and high-dose (57.14%, 8/14) groups than in the control group (7.14%, 1/14) at 8 weeks (p=0.037 and p=0.005, respectively). In addition, both doses of rifaximin resulted in significant improvement of the total SIP score compared with the control group. There were no significant differences in the CHE reversal rate, total SIP score improvement, and incidence of adverse event between the low-dose and high-dose groups (p>0.05). Conclusions: Low-dose rifaximin reverses CHE and improves HRQOL in cirrhotic patients with comparable effects and safety to high-dose rifaximin.

New formula for predicting standard liver volume in Chinese adults.

AIM: To obtain a reference range of morphological indices and establish a formula to accurately predict standard liver volume (SLV) in Chinese adults. METHODS: Computed tomography (CT)-estimated total liver volume (CTLV) was determined in 369 Chinese adults. Age, sex, body weight, body height, body mass index, and body surface area (BSA) were recorded using CT. Total splenic volume, portal venous diameter (PVD), splenic venous diameter (SVD), and portal venous cross-sectional area (PVCSA) were also measured by CT. Stepwise multiple linear regression analysis was performed to evaluate the impact of each parameter on CTLV and to develop a new SLV formula. The accuracy of the new formula was compared with the existing formulas in a validation group. RESULTS: The average CTLV was 1205.41 ± 257.53 cm3 (range, 593.80-2250.10 cm3). The average of PVD, SVD and PVCSA was 9.34 ± 1.51 mm, 7.40 ± 1.31 mm and 173.22 ± 48.11 mm2, respectively. The CT-estimated splenic volume of healthy adults varied markedly (range, 46.60-2892.30 cm3). Sex, age, body height, body weight, body mass index, and BSA were significantly correlated with CTLV. BSA showed the strongest correlation (r = 0.546, P < 0.001), and was used to establish a new model for calculating SLV: SLV (cm3) = 758.259 × BSA (m2)-124.272 (R2 = 0.299, P < 0.001). This formula also predicted CTLV more accurately than the existing formulas, but overestimated CTLV in elderly subjects > 70 years of age, and underestimated liver volume when CTLV was > 1800 cm3. CONCLUSION: Our new BSA-based formula is more accurate than other formulas in estimating SLV in Chinese adults.

The evaluation of non-invasive multi-slice spiral computed tomography-based indices for the diagnosis and prognosis prediction of liver cirrhosis.

OBJECTIVE: This study aimed to evaluate easily available computed tomography (CT)-based parameters for assessing the presence and severity of cirrhosis and predicting complications in Chinese patients with cirrhosis. METHODS: CT-based morphological indices were determined in 167 patients with cirrhosis and 244 healthy volunteers. The correlation of morphological indices with Child-Pugh score and cirrhotic complications was analyzed using Spearman's correlation analysis. The area under the receiver operating characteristic curve (AUROC) was used to analyze the diagnostic performance of the indices. Sensitivity and specificity were determined. RESULTS: Patients with cirrhosis had a lower total liver volume (TLV) and a larger total splenic volume (SV) than healthy individuals. There was a significant difference in the portal venous diameter, splenic venous diameter and portal venous cross-sectional area between the two groups. A low TLV/SV ratio was strongly associated with liver cirrhosis; with a cut-off value of 4.27 for the diagnosis of cirrhosis TLV/SV had a sensitivity of 87.7% and a specificity of 84.9%, and AUROC of 0.921. Further analysis showed that TLV/SV was accurate in discriminating between mild and moderate/severe cirrhosis and could be used for predicting complications of cirrhosis. CONCLUSION: The easily available parameters of CT can accurately evaluate the severity of cirrhosis in Chinese patients.

[Comparative study on effects of static pressure stimulation on release of PGE2 and IL-6 in fibroblasts in the rat "Zusanli" and its adjacent areas].

OBJECTIVE: To provide some possible theoretical and experimental basis for the modern biomedical mechanism of "receiving stimulation, preventing and treating diseases", by exploring the effects of pressure signal's biological transformation of rat "Zusanli" (ST 36) fascia tissue fibroblasts under mechanical stimulation. METHODS: Pressure was given on rat "Zusanli" (ST 36) and its adjacent area's fascia tissue cells cultured in vitro and identified by morphology. The contents of prostaglandin E2 (PGE2) and interleukin-6 (IL-6) in culture medium were detected. RESULTS: The fascia tissue cells in "Zusanli" and its adjacent area are almost consisted of fibroblasts. The pressure stimulation significantly accelerated the synthesis and release of PGE2 and IL-6. CONCLUSION: Acupoint and non-acupoint fibroblasts can directly receive mechanical stimulation, and then the mechanical signals were transformed as biological ones.