Fecal microbiota transplantation prevents hepatic encephalopathy in rats with carbon tetrachloride-induced acute hepatic dysfunction

AIM To investigate whether fecal microbiota transplantation(FMT) prevents hepatic encephalopathy(HE) in rats with carbon tetrachloride(CCl4)-induced acute hepatic dysfunction.METHODS A rat model of HE was established with CCl4. Rat behaviors and spatial learning capability were observed, and hepatic necrosis, intestinal mucosal barrier, serum ammonia levels and intestinal permeability were determined in HE rats receiving FMT treatment. Furthermore, the expression of tight junction proteins(Claudin-1, Claudin-6 and Occludin), Toll-like receptor(TLR) 4/TLR9, interleukin(IL)-1β, IL-6 and tumor necrosis factor(TNF)-α was examined.RESULTS FMT improved rat behaviors, HE grade and spatial learning capability. Moreover, FMT prevented hepaticnecrosis and intestinal mucosal barrier damage, leading to hepatic clearance of serum ammonia levels and reduced intestinal permeability. The expression of TLR4 and TLR9, two potent mediators of inflammatory response, was significantly downregulated in the liver of rats treated with FMT. Consistently, circulating proinflammatory factors such as interleukin(IL)-1β, IL-6 and tumor necrosis factor-α were remarkably decreased, indicating that FMT is able to limit systemic inflammation by decreasing the expression of TLR4 and TLR9. Importantly, HE-induced loss of tight junction proteins(Claudin-1, Claudin-6 and Occludin) was restored in intestinal tissues of rats receiving FMT treatment. CONCLUSION FMT enables protective effects in HE rats, and it improves the cognitive function and reduces the liver function indexes. FMT may cure HE by altering the intestinal permeability and improving the TLR response of the liver.

Bleeding control during complex laparoscopic surgeries of the spleen:current status and challenges

Severe intra-operative bleeding has limited the application of complex laparoscopic splenectomy(LS),including laparoscopic total splenectomy(LTS)and laparoscopic partial splenectomy(LPS).Therefore,reducing bleeding risk in complex LS has become a subject of major interest[Supplementary Figure 1,http://links.lww.com/CM9/B377].