Will partial splenic embolization followed by splenectomy increase intraoperative bleeding?

BACKGROUND: Partial splenic embolization (PSE) has been suggested as an alternative to splenectomy in the treatment of hypersplenism. However, some patients may experience recurrence of hypersplenism after PSE and require splenectomy. Currently, there is a lack of evidence-based medical support regarding whether preoperative PSE followed by splenectomy can reduce the incidence of complications. AIM: To investigate the safety and therapeutic efficacy of preoperative PSE followed by splenectomy in patients with cirrhosis and hypersplenism. METHODS: Between January 2010 and December 2021, 321 consecutive patients with cirrhosis and hypersplenism underwent splenectomy at our department. Based on whether PSE was performed prior to splenectomy, the patients were divided into two groups: PSE group (n = 40) and non-PSE group (n = 281). Patient characteristics, postoperative complications, and follow-up data were compared between groups. Propensity score matching (PSM) was conducted, and univariable and multivariable analyses were used to establish a nomogram predictive model for intraoperative bleeding (IB). The receiver operating characteristic curve, Hosmer-Lemeshow goodness-of-fit test, and decision curve analysis (DCA) were employed to evaluate the differentiation, calibration, and clinical performance of the model. RESULTS: After PSM, the non-PSE group showed significant reductions in hospital stay, intraoperative blood loss, and operation time (all P = 0.00). Multivariate analysis revealed that spleen length, portal vein diameter, splenic vein diameter, and history of PSE were independent predictive factors for IB. A nomogram predictive model of IB was constructed, and DCA demonstrated the clinical utility of this model. Both groups exhibited similar results in terms of overall survival during the follow-up period. CONCLUSION: Preoperative PSE followed by splenectomy may increase the incidence of IB and a nomogram-based prediction model can predict the occurrence of IB.

Network pharmacology and molecular docking technology for exploring the effect and mechanism of Radix Bupleuri and Radix Paeoniae Alba herb-pair on anti-hepatitis: A review.

The Radix Bupleuri and Radix Paeoniae Alba herb-pair (RRH) are the most classic compatible drug pair for the treatment of hepatitis. However, the underlying mechanism remains unclear. Therefore, network pharmacology and molecular docking were conducted to investigate the prospective therapeutic constituents, targets, and pharmacological mechanisms of RRH in the treatment of hepatitis. The active components of RRH from the TCMSP database and disease-related targets from the OMIM, PharmGkb, GeneCards, TTD, and DrugBank databases were identified. The "drug-target-disease" network diagram and protein-protein interaction (PPI) network were constructed using Cytoscape (v3.8.0) and Online STRING 11.0. GO and KEGG pathway enrichment analyses were performed using R version 4.1.2, and molecular docking was performed to verify the results. We placed 176 overlapping cross genes into Online STRING 11.0 and obtained 14 core targets. A "Component-Target-GO-KEGG" network diagram was constructed, which was composed of 7 components, 14 targets, 10 biological processes, and 10 signal pathways. A total of 2413 GO biological processes and 174 KEGG pathways were explored for hepatitis treatment. Quercetin, kaempferol, isorhamnetin, and beta-sitosterol, which are the main bioactive components, were employed to bind the disease's hub targets, ensuring fulfillment of spatial and energy matching. The anti-hepatitis mechanism of RRH may be associated with several targets including RELA, AKT1, JUN, MAPK1, TP53, CCND1, MYC, NFKBIA, CDKN1A, and their respective signaling pathways. The main bioactive components in RRH, including quercetin, kaempferol, isorhamnetin, and beta-sitosterol, were used to bind the hub targets of the disease, which may provide insights into drug development for hepatitis.

LigaSure technique for splenectomy: A systematic review and meta-analysis.

BACKGROUND: This study aimed to clarify the optimal management of the LigaSure technique and conventional techniques during splenectomy. METHODS: All databases, including CBM, CNKI, WFPD, Medline, EMBASE, PubMed, and Cochrane databases up to April 2023, were searched for relevant studies comparing the LigaSure technique with conventional techniques. Six studies, extracted by 2 independent reviewers, were evaluated for blood loss, operative time, conversion, mortality, hospital stay, and transfusion. RESULTS: The blood loss was significantly higher in the convention group than in the LigaSure group (WMD = -48.98, 95% CI: -62.41 to -35.55, P < .00001). Meanwhile, the mean operative time was significantly shorter in LigaSure group than in convention group (WMD = -10.57; 95% CI: -12.35 to -8.78), P < .00001). No significant differences were found regarding the conversion rate, hospital stay, morbidity, and transfusion. CONCLUSIONS: The LigaSure technique has comparable effects to conventional techniques, but to some extent reduces blood loss and operative time.

Changes in Hepatic Function After Splenectomy for Hepatolenticular Degeneration, Cirrhosis, and Hypersplenism.

BACKGROUND: Patients with hepatic reticulum degeneration (HLD) may eventually develop complications of cirrhosis with splenomegaly and hypersplenism, requiring splenectomy to alleviate hypersplenism and complete lifelong copper therapy. The purpose of this study is to investigate the effect of splenectomy on liver function in patients with hypersplenism. METHODS: A retrospective systematic analysis was conducted on the liver function indicators of 220 HLD patients who underwent splenectomy from January 2015 to January 2018 before surgery and on days 1, 3, 5, 7, and 14 after surgery. Among them, 30 patients were followed up for 6 months. RESULTS: The Child score increased on the 1st day after surgery and gradually decreased after the 1st day. The level of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TB) increased 5 days after surgery (P < .01) and decreased on the 14th day after surgery (P < .01); the level of albumin (ALB) decreased on the 1st, 3rd, and 5th day after surgery (P < .01) and increased on the 14th day (P < .01). The follow-up results of the patient for 6 months showed that the levels of ALT and AST decreased, while the levels of ALB increased 6 months after surgery. CONCLUSION: Splenectomy is proved to be beneficial for the improvement of liver function in HLD patients combined with hypersplenism, which realize a lifelong anti-copper treatment.

The mechanism of peach kernel and safflower herb-pair for the treatment of liver fibrosis based on network pharmacology and molecular docking technology: A review.

Peach kernel and safflower herb-pair (PKSH) are widely used in traditional Chinese medicine for the treatment of liver fibrosis. Therefore, network pharmacology was performed to explore potential therapeutic targets and pharmacological mechanisms of PKSH. The active components of PKSH from the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform database and potential targets of liver fibrosis from the Online Mendelian Inheritance in Man, Pharmacogenetics and Pharmacogenomics Knowledge Base, GeneCards, and DrugBank Database were identified. The protein-protein interaction network was constructed using Cytoscape (v3.8.0). Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses were performed for the treatment of liver fibrosis, and molecular docking was carried out to verify the results of network pharmacology analysis. After screening disease-related genes, 179 intersection genes overlapped between 196 target proteins of the active compound and 9189 potential disease targets. Furthermore, we obtained 15 hub nodes and 146 edges to establish a related network diagram using CytoNCA. 2559 Gene Ontology biological processes underlying PKSH have been explored for the treatment of liver fibrosis, in which the response to oxidative stress plays a vital role. Furthermore, Kyoto Encyclopedia of Genes and Genomes enrichment analysis revealed that PKSH might play a role in inhibiting liver fibrosis, mainly through the PI3K-Akt signaling pathway. PKSH can regulate the response to oxidative stress through the PI3K-Akt signaling pathway for the treatment of liver fibrosis. The main bioactive components in PKSH, including quercetin and luteolin, can activate the PI3K-Akt signaling pathway by binding with the hub targets of the disease, which may provide insights into drug development for liver fibrosis.

Nomogram-based prediction of portal vein system thrombosis formation after splenectomy in patients with hepatolenticular degeneration.

Objective: Splenectomy is a vital treatment method for hypersplenism with portal hypertension. However, portal venous system thrombosis (PVST) is a serious problem after splenectomy. Therefore, constructing an effective visual risk prediction model is important for preventing, diagnosing, and treating early PVST in hepatolenticular degeneration (HLD) surgical patients. Methods: Between January 2016 and December 2021, 309 HLD patients were selected. The data were split into a development set (215 cases from January 2016 to December 2019) and a validation set (94 cases from January 2019 to December 2021). Patients' clinical characteristics and laboratory examinations were obtained from electronic medical record system, and PVST was diagnosed using Doppler ultrasound. Univariate and multivariate logistic regression analyses were used to establish the prediction model by variables filtered by LASSO regression, and a nomogram was drawn. The area under the curve (AUC) of receiver operating characteristic (ROC) curve and Hosmer-Lemeshow goodness-of-fit test were used to evaluate the differentiation and calibration of the model. Clinical net benefit was evaluated by using decision curve analysis (DCA). The 36-month survival of PVST was studied as well. Results: Seven predictive variables were screened out using LASSO regression analysis, including grade, POD14D-dimer (Postoperative day 14 D-dimer), POD7PLT (Postoperative day 7 platelet), PVD (portal vein diameter), PVV (portal vein velocity), PVF (portal vein flow), and SVD (splenic vein diameter). Multivariate logistic regression analysis revealed that all seven predictive variables had predictive values (P < 0.05). According to the prediction variables, the diagnosis model and predictive nomogram of PVST cases were constructed. The AUC under the ROC curve obtained from the prediction model was 0.812 (95% CI: 0.756-0.869) in the development set and 0.839 (95% CI: 0.756-0.921) in the validation set. Hosmer-Lemeshow goodness-of-fit test fitted well (P = 0.858 for development set; P = 0.137 for validation set). The nomogram model was found to be clinically useful by DCA. The 36-month survival rate of three sites of PVST was significantly different from that of one (P = 0.047) and two sites (P = 0.023). Conclusion: The proposed nomogram-based prediction model can predict postoperative PVST. Meanwhile, an earlier intervention should be performed on three sites of PVST.

Clinical observation and risk assessment after splenectomy in hepatolenticular degeneration patients associated with hypersplenism.

Background: Both hepatolenticular degeneration (HLD) and viral hepatitis B (HBV) can cause hypersplenism, but whether splenectomy is needed or can be performed in HLD patients associated with hypersplenism is still controversial. At present, HLD combined with hypersplenism has not been listed as the indication of splenectomy. Objective: This study aimed to investigate the efficacy, risks, and postoperative complications of splenectomy in HLD patients associated with hypersplenism. Methods: We retrospectively analyzed the clinical data of 180 HLD patients with hypersplenism who underwent splenectomy in the Department of General Surgery, First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, from January 2001 to December 2015. To evaluate the efficacy of splenectomy, the hemogram of white blood cells (WBC), red blood cells (RBC), platelets (PLT), and the liver function indexes including alanine aminotransferase, aspartate aminotransferase, and total bilirubin were recorded before surgery and 1, 3, 5, 7, and 14 days after surgery. In addition, the clinical data of 142 HBV patients with hypersplenism who underwent splenectomy over the same period were also recorded and compared with that of HLD patients. In particular, aiming to assess the risks of splenectomy in HLD, we also compared postoperative complications and 36-month mortality between the two groups. Result: The level of WBC, RBC, and PLT were all elevated after splenectomy in both the HLD group and the HBV group. However, there was no significant difference in the variation of hemogram after splenectomy between the two groups (P > 0.05). Similarly, the variation of liver function indexes showed no statistical difference between the two groups. In terms of the incidence of postoperative complications including abdominal bleeding, pancreatic leakage, portal vein thrombosis treatment, incision infection, lung infection, and 36-month mortality, there were no significant differences between the two groups. Conclusion: After splenectomy, the hemogram as well as liver function in the HLD group improved a lot and showed a consistent tendency with that in the HBV group. Meanwhile, compared to the HBV group, there was no significant difference in the incidence of postoperative complications in the HLD group. All these results indicate that splenectomy in HLD patients combined with hypersplenism is completely feasible and effective.

Postoperative Outcomes Following a Modified Method of Surgical Division of the Splenic Pedicle in 719 Patients During Splenectomy for Portal Hypertension: A 12-Year, Retrospective, Single-Center Study.

BACKGROUND Portal hypertension associated with liver cirrhosis can be treated by splenectomy. During splenectomy, the gastrosplenic and the splenorenal ligaments that form the hilar splenic pedicle can be surgically divided by several approaches, with the aim to reduce portal vein thrombosis (PVT) and postoperative pancreatic fistula (PPF). This 12-year retrospective study from a single center aimed to evaluate postoperative outcomes following use of a modified method of surgical division of the splenic pedicle (MSDSP) in 719 patients who underwent splenectomy for portal hypertension (PH). MATERIAL AND METHODS From January 2010 to December 2021, 719 consecutive cirrhotic patients with PH and splenomegaly underwent splenectomy in our department. According to different methods of surgical division of the splenic pedicle, patients were divided into a Control Group (n=349) and a Study Group (n=370). The characteristics of the patients, perioperative indicators, postoperative complications (PVT, PPF and abdominal hemorrhage) and follow-up data were compared between the 2 groups. Propensity score matching was conducted to adjust for differences in preoperative characteristics at a 1: 1 ratio, resulting in 260 patients in each group. RESULTS After PSM was conducted, intraoperative blood loss, PVT, PPF, and hospital stay were decreased significantly in the matched Study Group (all P<0.01). Both groups showed similar results concerning recurrent esophagogastric variceal bleeding and overall survival during the follow-up period. CONCLUSIONS Our MSDSP help to reduce postoperative complications and shorten hospital stay.

Calycosin Improves Intestinal Mucosal Barrier Function after Gastrectomy in Rats through Alleviating Bacterial Translocation, Inflammation, and Oxidative Stress.

Objective: Calycosin is the main bioactive extract of Astragali Radix with anti-inflammation, antioxidant, and anticancer properties. Here, our study evaluated the protective effects and mechanisms of calycosin on intestinal mucosal barrier under gastrectomy. Methods: After receiving gastrectomy, the rats were administrated with 20 mg/kg, 40 mg/kg, or 80 mg/kg calycosin. Endotoxin, bacterial translocation, and intestinal bacterial flora were assayed. Intestinal injury was detected via hematoxylin and eosin staining. Tight junction indicators (occludin, claudin, and ZO-1) and apoptotic proteins (Bax, Bcl-2, and cleaved caspase 3) were examined in intestinal tissues. Inflammatory indicators (IL-1ß, IL-6, and TNF-α) were examined in serum or intestinal specimens via ELISA. Apoptosis was assessed via TUNEL staining. IgA + B cells in intestinal tissues and sIgA in intestinal lumen were examined through immunohistochemistry and ELISA, respectively. Oxidative stress indicators (TSH, SOD, CAT, GSH-Px, and MDA) were also detected via ELISA. Results: Our results showed that calycosin administration decreased endotoxin levels in peripheral blood, intestine, and portal vein blood; lowered the bacterial translocation ratio; and regained the balance among intestinal bacterial flora (comprising bifidobacterium, lactic acid bacillus, enterobacter, enterococcus, aerobic bacteria, and anaerobic bacteria) in the rats with gastrectomy. After calycosin treatment, intestinal mucosal damage of the rats with gastrectomy was ameliorated, with the increase in expression of tight junction proteins. Additionally, calycosin reduced intestinal inflammation, apoptosis, secretion of sIgA, and oxidative stress in the rats with gastrectomy. Conclusion: Altogether, our findings demonstrate that calycosin may improve intestinal mucosal barrier function under gastrectomy via reducing bacterial translocation, inflammation, and oxidative stress.

Research on Portal Venous Hemodynamics and Influencing Factors of Portal Vein System Thrombosis for Wilson's Disease after Splenectomy.

Objective: Splenectomy is one crucial solution for hypersplenism with portal hypertension. However, portal vein system thrombosis (PVST) caused by hemodynamic changes affects the prognosis of patients. We analyze the changes in portal vein hemodynamics following splenectomy for Wilson's disease combined with portal hypertension and the influencing factors that lead to PVST. Methods: A retrospective cohort study was conducted, in which 237 Wilson's disease patients with hypersplenism underwent splenectomy. The hemodynamic indices of the portal vein were monitored before surgery and on the 1st, 7th, and 14th days around surgery. The patients were divided into PVST and non-PVST groups. The clinical factors were identified by univariate and multivariate logistic regression. The Logit P was calculated according to the logistic regression prediction model, and the ROC curve for each independent factor was plotted. Results: The portal vein velocity, flow, and inner diameter showed a downward trend around surgery, with statistically significant differences between each time point (P < 0.01). The PVST incidence rate was 55.7%. Univariate analysis revealed that the platelet (PLT) levels on the postoperative 3rd and 7th days (P = 0.001; P < 0.001), D-dimer (D-D) on the postoperative 7th and 14th days (P = 0.002; P < 0.001), preoperative portal vein velocity, flow, diameter (P < 0.001), and splenic vein diameter (P < 0.001) were all statistically and significantly different between the two groups. Multivariate logistic regression revealed a significant increase in PLT on the postoperative 7th day (OR = 1.043, 95% CI, 1.027-1.060, P < 0.001) and D-D on the postoperative 14th day (OR = 1.846, 95% CI, 1.400-2.435, P < 0.001). Preoperative portal and splenic vein diameters (OR = 1.565, 95% CI, 1.213-2.019, P = 0.001; OR = 1.671, 95% CI, 1.305-2.140, P < 0.001) were the risk factors for PVST. However, preoperative portal vein velocity and flow (OR = 0.578, 95% CI, 0.409-0.818, P = 0.002; OR = 0.987, 95% CI, 0.975-0.990, P = 0.046) were protective factors for PVST. Logit P was calculated using a logistic regression prediction model with a cut-off value of -0.32 and an area under receiver operating characteristic curve of 0.952 with 88.61% accuracy. Conclusions: Splenectomy relieves portal hypertension by reducing the hemodynamics index. PVST is linked to multiple factors, including preoperative portal vein diameter, velocity, flow, and splenic vein diameter, especially PLT on the postoperative 7th day and D-D on the postoperative 14th day. The predictive model is accurate in predicting PVST.

Development and Validation of a Clinical Prediction Model for Complicated Appendicitis in the Elderly.

Background: For elderly patients with mild clinical symptoms of uncomplicated appendicitis(UA), non-surgical treatment has been shown to be feasible, whereas emergency surgical treatment is recommended in elderly patients with complicated appendicitis(CA), but it is still challenging to accurately distinguish CA and UA before treatment. This study aimed to develop a predictive model to assist clinicians to quickly determine the type of acute appendicitis. Methods: We retrospectively studied the clinical data of elderly patients with acute appendicitis who visited the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine from January 2012 to January 2022. The patients were divided into UA group and CA group, and the general conditions, medical history, physical examination, laboratory examination and imaging examination were compared between the two groups, and SPSS 26.0 and R 4.0.2 software were used to establish CA clinic. Predict the model, and validate it internally. Results: The clinical data of 441 elderly patients with acute appendicitis were collected, 119 patients were excluded due to incomplete clinical data or other diseases. Finally, 332 patients were included in the study and divided into UA group (n = 229) and CA group (n = 103). By analyzing the clinical data of the two groups of patients, the duration of abdominal pain [OR = 1.094, 95% CI (1.056-1.134)], peritonitis [OR = 8.486, 95% CI (2.017-35.703))] and total bilirubin [OR = 1.987, 95% CI (1.627-2.426)] were independent predictors of CA (all p < 0.01). The model's Area Under Curve(AUC) = 0.985 (95% CI, 0.975-0.994). After internal verification by Bootstrap method, the model still has high discriminative ability (AUC = 0.983), and its predicted CA curve is still in good agreement with the actual clinical CA curve. Conclusion: We found that a clinical prediction model based on abdominal pain duration, peritonitis, and total bilirubin can help clinicians quickly and effectively identify UA or CA before treatment of acute appendicitis in the elderly, so as to make more scientific clinical decisions.

Alterations of gut microbiome and effects of probiotic therapy in patients with liver cirrhosis: A systematic review and meta-analysis.

BACKGROUND: Alterations in the gut microbiome usually occur in liver cirrhosis. Gut microbiome dysregulation damages the liver and accelerates the development of liver fibrosis. Probiotic treatment has gradually become a major method for improving the prognosis of liver cirrhosis and reducing its complications. However, alterations in the gut microbiome have revealed different results, and the therapeutic effects of various probiotics are inconsistent. METHODS: We searched the PubMed, Medline, EMBASE, ScienceDirect, and Cochrane databases up to August 2022 and conducted a systematic review and meta-analysis of 17 relevant studies. RESULTS: The counts of Enterobacter (standardized mean difference [SMD] -1.79, 95% confidence interval [CI]: -3.08 to -0.49) and Enterococcus (SMD -1.41, 95% CI: -2.26 to -0.55) increased significantly in patients with cirrhosis, while the counts of Lactobacillus (SMD 0.63, 95% CI: 0.12-1.15) and Bifidobacterium (SMD 0.44, 95% CI: 0.12-0.77) decreased significantly. Blood ammonia (weighted mean difference [WMD] 14.61, 95% CI: 7.84-21.37) and the incidence of hepatic encephalopathy (WMD 0.40, 95% CI: 0.27-0.61) were significantly decreased in the probiotic group. As for mortality (MD 0.75, 95% CI: 0.48-1.16) and the incidence of spontaneous bacterial peritonitis (WMD -0.02, 95% CI: -0.07 to 0.03), no significant differences were found between the probiotic and placebo groups. CONCLUSION: In summary, the gut microbiome in cirrhosis manifests as decreased counts of Lactobacillus and Bifidobacterium and increased counts of Enterobacter and Enterococcus. Targeted supplementation of probiotics in cirrhosis, including Lactobacillus combined with Bifidobacterium or Bifidobacterium alone, can reduce blood ammonia and the incidence of hepatic encephalopathy. The effect is similar to that of lactulose, but it has no obvious effect on mortality and spontaneous bacterial peritonitis.

Hemorheological Alteration in Patients with Cirrhosis Clinically Diagnosed with Portal Vein System Thrombosis After Splenectomy.

BACKGROUND Portal vein system thrombosis (PVST) is a common and serious complication after splenectomy. Key factors, including wider diameters of the portal vein, decreased liver function, and high flow volume of portosystemic collateral vessel, are recognized PVST risks. Relationships between PVST and altered hemorheology, including increased plasma viscosity, remain unclear. We investigated hemorheological alterations and explored risk factors of PVST in patients with cirrhosis after splenectomy. MATERIAL AND METHODS Data on patients with cirrhosis who underwent splenectomy were collected retrospectively from January 2018 to June 2020. Color Doppler ultrasonography was performed after splenectomy. Hemorheological indexes were compared between groups. Receiver operating characteristic (ROC) analysis was conducted to analyze risk factor cutoff values. Univariate and multivariate analyses were conducted to explore risk factors of PVST. RESULTS A total of 50 patients were divided into a PVST group (n=30) and control group (n=20). Hemorheological indexes of activated partial thromboplastin time, fibrinogen degradation products (FDP), D-dimer, middle shear rates 50 and 30, low shear rates 5 and 1, and hematocrit in the PVST group were significantly higher than those of the control group (P<0.05). FDP and low shear rate 1 were found to be risk factors of PVST after splenectomy by multivariate analysis. ROC analysis showed that the cutoff points for FDP and low shear rate 1 were ≥38.6 ug/mL and ≥16.855 mPa.s, respectively. CONCLUSIONS PVST after splenectomy is closely related to hemorheological alteration. FDP and low shear rate 1 may be valuable markers of PVST.

Significance of Amylase Monitoring in Peritoneal Drainage Fluid after Splenectomy: A Clinical Analysis of Splenectomy in 167 Patients with Hepatolenticular Degeneration.

Different kinds of complications after splenectomy in hepatolenticular degeneration patients with hypersplenism have been reported in the past decades, but studies on pancreatic fistula and the corresponding targeted prevention and treatment after splenectomy still remain much unexplored. The present work investigated the pathogenic factors of pancreatic fistula after splenectomy and the variation tendency of amylase in drainage fluid, aiming to verify the significance of monitoring amylase in the abdominal drainage fluid in the early diagnosis of pancreatic fistula after splenectomy. One hundred sixty-seven patients with hepatolenticular degeneration and hypersplenism who underwent splenectomy in the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine from January 2016 to August 2018 were selected and analyzed. The amylase in the abdominal drainage fluid was monitored routinely after splenectomy. We also conducted the statistics on the incidence of different types of pancreatic fistula and analyzed the influence factors of pancreatic fistula formation. After splenectomy, biochemical fistula occurred in 11 patients (6.6%), grade B fistula in six patients (3.6%), grade C fistula in one patient (0.6%), and the incidence of pancreatic fistula was 4.2 per cent (biochemical fistula excluded). The amylase in the peritoneal drainage fluid was closely concerned with the incidence of pancreatic fistula according to our statistics. Furthermore, by analyzing the different influence factors of pancreatic fistula, Child-Pugh grading of liver function (P = 0.041), pancreatic texture (P = 0.029), degree of splenomegaly (P = 0.003), and operative method (P = 0.001) were supposed to be closely related to the formation of pancreatic fistula. Monitoring of amylase in peritoneal drainage fluid is regarded as an important physiological parameter in the early diagnosis of pancreatic fistula after splenectomy, which provides effective clinical reference and plays a significant role in preventing the occurrence and development of pancreatic fistula.

Effect of glucocorticoids on the function of microvascular endothelial cells in the human femoral head bone.

BACKGROUND: The pathogenesis of glucocorticoid (GC)-induced osteonecrosis (ON) of the femoral head remains unclear. Recent research has suggested that it is closely associated with injured bone microvascular endothelial cells (BMECs). However, few studies have used BMECs to perform research pertaining ON of the femoral head. OBJECTIVES: The objective of this study was to investigate the functional changes of BMECs treated with a GC and to detect the changes in related genes using microarrays. MATERIAL AND METHODS: Cells were isolated using an enzymatic method and identified with EC markers, such as von Willebrand factor (vWF), CD31 and vascular endothelial cadherin (VE-cadherin). Bone microvascular endothelial cells were treated with 0.1 mg/mL and 0.3 mg/mL of hydrocortisone to establish a GC-damaged model of BMECs. The mRNA microarrays were used to detect the differential expression profiles between BMECs with and without GC damage. RESULTS: Primary cells appeared as having a cobblestone-like morphology. Immunofluorescence staining revealed that the cells were 100% positive for vWF and CD31, and near 100% positive for VE-cadherin. It also confirmed that the cells were BMECs. Bone microvascular endothelial cells treated with 0.1 mg/mL of hydrocortisone showed shrinkage, and those treated with 0.3 mg/mL of hydrocortisone mostly showed apoptosis. The mRNA microarray showed that genes associated with endothelial cells, such as endothelin 1 (ET-1) receptor, angiotensin II (AII) receptor, intercellular adhesion molecule 1 (ICAM-1), and plasminogen activator inhibitor 1 (PAI-1), were upregulated, and genes associated with endothelial nitric oxide synthase (eNOS), endothelin 1 (ET-1), prostaglandin I2 (PGI2) synthase, PGI2 receptor, vascular endothelial growth factor (VEGF), prostaglandin E (PGE) synthase, and PGE receptor were downregulated. The results of quantitative polymerase chain reaction (qPCR) validation were consistent with the findings of mRNA microarrays. CONCLUSIONS: Glucocorticoids promoted BMECs to express vasoconstrictors and procoagulant factors and related receptors, and decreased the expression of vasodilators and their receptors.

Effect of Qihuang Decoction Combined with Enteral Nutrition on Postoperative Gastric Cancer of Nutrition and Immune Function.

OBJECTIVE: Early nutritional support in patients with gastric cancer can improve their nutritional status, but the impact on immune function has not been confirmed. This study aimed to analyze the effects of Qihuang decoction combined with enteral nutrition on nutrition and the immune function of postoperative gastric cancer. METHODS: 120 patients with postoperative gastric cancer in the study group and 117 in the control group were selected as the study subjects from our hospital at random. Indications of nutrition and immune and the rates of complications were compared the day before surgery and 1, 3, 7, and 14 days after surgery. RESULTS: Indications of nutrition except hemoglobin (HB) in the study group were significantly higher than those before operation and the albumin (ALB) and prealbumin (TP) were significantly increased 7 and 14 days after surgery (P < 0.001 and P < 0.001 and P < 0.001 and P < 0.001 and P < 0.001 and P < 0.001 and P < 0.001 and P < 0.001 and P < 0.001 and P < 0.001 and P < 0.001 and P < 0.001 and P < 0.001 and P < 0.001 and P < 0.001 and P < 0.001 and P < 0.001 and P < 0.001 and P < 0.001 and P < 0.001 and P < 0.001 and P < 0.001 and P < 0.001 and P < 0.001 versus P < 0.001 and P < 0.001) and the protein (PA) 3, 7, and 14 days after surgery (P=0.011, P=0.002, and P=0.022) in the study group compared to those in the control group. Cellular and humoral immunity indications in the study group are significantly higher than those before operation compared to those in the control group, and the CD3+, CD4+, and CD4+/CD8+ were significantly increased 7 and 14 days after surgery (P=0.027 and P < 0.001 versus P=0.008 and P < 0.001 versus P=0.010 and P < 0.001) and IgA, IgG, and IgM 3, 7, and 14 days after surgery in the study group (P < 0.001, P < 0.001, and P < 0.001 versus P < 0.001, P < 0.002, and P < 0.001 versus P < 0.001, P < 0.001, and P < 0.001). The complications such as abdominal, lung, wound, and urinary infection were also significantly decreased (P χ 2 =0.017; P < 0.001 and P < 0.001 versus P < 0.001 and P < 0.001) and the protein (PA) 3, 7, and 14 days after surgery (P=0.011, P=0.002, and P=0.022) in the study group compared to those in the control group. Cellular and humoral immunity indications in the study group are significantly higher than those before operation compared to those in the control group, and the CD3+, CD4+, and CD4+/CD8+ were significantly increased 7 and 14 days after surgery (P=0.027 and P < 0.001 versus P=0.008 and P < 0.001 versus P=0.010 and P < 0.001) and IgA, IgG, and IgM 3, 7, and 14 days after surgery in the study group (P < 0.001, P < 0.001, and P < 0.001 versus P < 0.001, P < 0.002, and P < 0.001 versus P < 0.001, P < 0.001, and P < 0.001). The complications such as abdominal, lung, wound, and urinary infection were also significantly decreased (P χ 2 =0.017; P < 0.001 and P < 0.001 versus P < 0.001 and P < 0.001) and the protein (PA) 3, 7, and 14 days after surgery (P=0.011, P=0.002, and P=0.022) in the study group compared to those in the control group. Cellular and humoral immunity indications in the study group are significantly higher than those before operation compared to those in the control group, and the CD3+, CD4+, and CD4+/CD8+ were significantly increased 7 and 14 days after surgery (P=0.027 and P < 0.001 versus P=0.008 and P < 0.001 versus P=0.010 and P < 0.001) and IgA, IgG, and IgM 3, 7, and 14 days after surgery in the study group (P < 0.001, P < 0.001, and P < 0.001 versus P < 0.001, P < 0.002, and P < 0.001 versus P < 0.001, P < 0.001, and P < 0.001). The complications such as abdominal, lung, wound, and urinary infection were also significantly decreased (P χ 2 =0.017; P < 0.001 and P < 0.001 versus P < 0.001 and P < 0.001) and the protein (PA) 3, 7, and 14 days after surgery (P=0.011, P=0.002, and P=0.022) in the study group compared to those in the control group. Cellular and humoral immunity indications in the study group are significantly higher than those before operation compared to those in the control group, and the CD3+, CD4+, and CD4+/CD8+ were significantly increased 7 and 14 days after surgery (P=0.027 and P < 0.001 versus P=0.008 and P < 0.001 versus P=0.010 and P < 0.001) and IgA, IgG, and IgM 3, 7, and 14 days after surgery in the study group (P < 0.001, P < 0.001, and P < 0.001 versus P < 0.001, P < 0.002, and P < 0.001 versus P < 0.001, P < 0.001, and P < 0.001). The complications such as abdominal, lung, wound, and urinary infection were also significantly decreased (P χ 2 =0.017; P χ 2 =0.036; P χ 2 =0.041; P χ 2 =0.004). CONCLUSIONS: Qihuang decoction combined with enteral nutrition can promote the absorption of enteral nutrition with improving the immune and reducing complications of infection.

Platelet's Rule of Change and Clinical Significance before and after Splenectomy.

Portal vein system thrombosis (PVST) is a form of venous thrombosis, which behaves as a common and potentially life-threatening complication after splenectomy. Numerous studies have been made to investigate the mechanism and the risk factors of PVST. However, the research on the prevention and treatment of PVST associated with platelet's (PLT) rule of change is rare. This work mainly investigates the PLT's rule of change and its correlativity with the formation of PVST after splenectomy. The retrospective study included 117 patients who underwent splenectomy from August 2014 to June 2018 and monitored by blood routine, D-dimer (D-D), and portal vein system ultrasound routinely after splenectomy. The changes of PLT and D-D were recorded and compared before and after each operation. We analyzed the changes of PLT and D-D as well as the incidence of PVST postoperatively. Most of the patients' PLT increased significantly after splenectomy. On the first day after operation, there were 80 patients' (68.38%) PLT recovered to normal or above normal. The proportion of patients with abnormally high PLT value on the seventh and fourteenth day were 60.68 per cent and 81.20 per cent, respectively. Thereinto, there were 67 patients' (57.26%) PLT beyond 500 × 109/L on the 14th day. The D-D of all patients exceeded the normal range on the first, seventh, and fourteenth day after operation, and the difference was statistically significant (P < 0.05), which behaved similar like PLT. Meanwhile, our color Doppler ultrasonography showed that the incidence of PVST was 70.79 per cent. Among the patients with PVST, 82 (100%) patients' PLT was increased after operation. The PLT of patients increased obviously after splenectomy. The increased blood viscosity caused by the consecutive elevation of PLT may result in a higher PVST incidence. Early intervention and treatment are needed clinically for PVST after splenectomy.

Association Between Changes in Splanchnic Hemodynamics and Risk Factors of Portal Venous System Thrombosis After Splenectomy with Periesophagogastric Devascularization.

BACKGROUND The purpose of this study was to investigate splanchnic hemodynamic changes and determine an optimal cutoff value for risk factors of portal venous system thrombosis (PVST) after splenectomy with periesophagogastric devascularization (SPD) in cirrhotic patients with esophageal and gastric variceal bleeding (EGVB) and portal hypertension (PH). MATERIAL AND METHODS Data on patients who underwent SPD were collected retrospectively from January 2013 to December 2017. Color Doppler ultrasound was performed to detect hemodynamic changes of the hepatic artery, splenic artery, splenic vein, and portal vein in included patients (n=60) and healthy volunteers (n=30). Outcomes were compared between preoperative and postoperative biochemical indicators. The cutoff values for hemodynamics were identified using receiver operating characteristic (ROC) curve analysis, and univariate and multivariate analyses of risk factors of PVST were performed. RESULTS In our series, hemodynamic indexes of splenic artery, spleen vein, and portal vein in the study group were significantly higher than that of the control group (P<0.05). Multivariate analysis revealed that the portal vein flow and the internal diameter of the portal vein were significantly correlated with PVST. The ROC analysis revealed that the cutoff points for portal vein flow and internal diameter of the splenic vein and portal vein were ≥1822.32 ml/min, ≥1.37 cm, and ≥1.56 cm, respectively. CONCLUSIONS SPD is an effective treatment in cirrhotic patients with concomitant EGVB and PH by increasing hepatic artery flow and decreasing portal vein flow. High portal vein flow and wider diameters of the portal vein and splenic vein are important markers of PVST.

Two Biliary Cannulation Techniques for ERCP in Patients With Intradiverticular Papilla: A Retrospective Review.

PURPOSE: To compare the effectiveness and complications of the different cannulation techniques for bile duct stones removal in patients with intradiverticular papilla. MATERIALS AND METHODS: The records of 472 patients with common bile duct (CBD) stones who underwent endoscopic retrograde cholangiopancreatography (ERCP) procedures for bile duct stones removal from January 2014 to December 2016 were retrospectively reviewed. A total of 42 patients with CBD stones were included in the study and data of included patients were collected retrospectively. The outcomes and complications of ERCP procedures were compared. RESULTS: Of 42 ERCP procedures included in the study, patients were divided into Two-devices-in-one-channel group (n=20) and Endoclip group (n=22). The success rate of CBD cannulation at first attempt in Two-devices-in-one-channel and Endoclip groups was 85.0% (17/20) and 54.5% (12/22), respectively (P<0.05). The average time it took to cannulation in Endoclip group was much longer than that in Two-devices-in-one-channel Group (17.55±2.06 vs. 10.6±2.75 min, P<0.05). Overall complications occurred in 3 cases of Two-devices-in-one-channel group and in 4 cases of Endoclip group, respectively (15.0% vs. 18.2%, P>0.05). There was no statistically significant difference between groups regarding the complications. CONCLUSIONS: Two-devices-in-one-channel and Endoclip techniques are both safe and effective for bile duct cannulation in patients with intradiverticular papilla.

Qihuang decoction promotes the recovery of intestinal immune barrier dysfunction after gastrectomy in rats.

OBJECTIVE: This study aims to observe the effect of Qihuang decoction on small intestinal mucosal barrier after gastrectomy in rats. MATERIALS AND METHODS: A total of 80 Wistar rats were randomly divided into normal group, sham operation group, enteral nutrition group (EN) and Qihuang decoction group (EN+QH), there were 20 rats in each group. Both the EN group and the EN+QH group underwent gastrectomy. Instillation of enteral nutrition in the small intestine was performed after operation in the EN group. Instillation of enteral nutrition and Qihuang decoction in the small intestine was performed after operation in the EN+QH group. Only the abdominal incision and closing was performed in the sham operation group without drug and nutritional intervention. The expression levels of tight junction proteins in intestinal epithelial cells were determined by western blotting method. The sIgA content in different anatomic sites of intestinal mucosa was determined by double antibody-PEG radioimmunoassay technique. The number of IgA+B cells in different anatomic sites of intestinal mucosa was determined by immunohistochemical method. RESULTS: The sIgA content in the sham operated group was significantly lower than that of normal group (P<0.05). The sIgA content and the number of IgA+B cells in Peyer's patches and lamina propria lym-phocytes in the EN+QH group were significantly higher than that of EN group (P<0.01, P<0.05). The expression levels of RhoA, Rac1 and Cdc42 increased in the EN group, and the phosphorylation levels of occludin, claudin-1, claudin-5, ZO-1 and ZO-2 also increased in the EN group, while the expression levels of non-phosphorylated occluding, claudin-1, claudin-5, ZO-1 and ZO-2 proteins decreased in the EN group (P<0.01, P<0.05). After treatment of Qihuang decoction for 7 days, compared with EN group, the expression levels of RhoA, Rac1 and Cdc42, and the phosphorylation levels of occludin, claudin-1, claudin-5, ZO-1 and ZO-2 significantly decreased in the EN+QH group, while the expression levels of non-phosphorylated occluding, claudin-1, claudin-5, ZO-1 and ZO-2 proteins significantly increased in the EN+QH group (P<0.01, P<0.05). CONCLUSIONS: Qihuang decoction can promote the proliferation and differentiation of IgA+B lymphocytes and increase the sIgA content in intestinal mucosal immune barrier after gastrectomy in rats, it also can promote the expression of tight junction proteins to improve the permeability of intestinal mucosa and promote the recovery of intestinal immune barrier dysfunction in rats after gastrectomy by inhibiting the tight junction associated proteins' phosphorylation induced by Rho/ROCK signaling pathway.