Introduction: Splenectomy is the surgical removal of the spleen. It can be performed during various pathologies, ranging from abdominal trauma to hemoglobinopathies. The progress made in the knowledge of the immune fu...Introduction: Splenectomy is the surgical removal of the spleen. It can be performed during various pathologies, ranging from abdominal trauma to hemoglobinopathies. The progress made in the knowledge of the immune functions of the spleen and the fear of post-splenectomy infectious complications have favored the development of surgical or non-surgical splenic preservation techniques calling into question the dogma of splenectomy. The aim of this study was to determine the indications for splenectomy. Methodology: This was a retrospective, descriptive study lasting 5 years in the general surgery department of the Ignace Deen National Hospital. All files of splenectomized patients were included, our variables were clinical, therapeutic and progressive. Results: We collected 42 cases of splenectomies out of the 2478 surgical procedures performed, representing 1.7% of the department’s surgical activities. The average age was 44 years. The age group of 41 to 50 years was the most represented, i.e. 26% (n = 11) of cases. Sex ratio = 1. Abdominal pain was the reason for consultation in patients, i.e. 100% (n = 42) of cases. The antecedents were dominated by recurrent malaria with 52.3% (n = 22) of cases, then recurrent anemia in 21% (n = 9), and 16.7% (n = 7) had sickle cell disease. Splenomegaly was found in 31 patients, or 73.6%. Ultrasound was performed in all patients. The indications for splenectomy were: isolated splenomegaly with risk of rupture (38%, n = 16), hypersplenism (26%, n = 11) and trauma to the spleen (19.04%, n = 8). Total splenectomy was performed in all cases. The surgical consequences were favorable in 85.7%, (n = 36) with morbidity of 14% (n = 6) and mortality of 9.52% (n = 4). The average length of hospitalization was 10.4 days with extremes of 1 and 22 days. Conclusion: Splenectomy constitutes a relatively common surgical procedure in our context. The indications for splenectomy were isolated splenomegaly with risk of rupture, hypersplenism and trauma to the spleen and total splenectomy was the rule.展开更多
BACKGROUND Portal vein thrombosis(PVT)is a commonthsn complication after splenectomy in patients with cirrhosis.However,the predictors of postoperative PVT are not known.AIM To investigate the predictors of PVT after ...BACKGROUND Portal vein thrombosis(PVT)is a commonthsn complication after splenectomy in patients with cirrhosis.However,the predictors of postoperative PVT are not known.AIM To investigate the predictors of PVT after splenectomy in patient with cirrhosis.METHODS A total of 45 patients with cirrhosis who underwent splenectomy were consecutively enrolled from January 2017 to December 2018.The incidence of PVT at 1 months,3 months,and 12 months after splenectomy in patients with cirrhosis was observed.The hematological indicators,biochemical and coagulation parameters,and imaging features were recorded at baseline and at each observation point.The univariable,multivariable,receiver operating characteristic curve and timedependent curve analyses were performed.RESULTS The cumulative incidence of PVT was 40.0%,46.6%,and 48.9%at 1 months,3 months,and 12 months after splenectomy.Multivariable analysis showed that portal vein diameter(PVD)≥14.5 mm and monthsdel end-stage liver disease(MELD)score>10 were independent predictors of PVT at 1 months,3 months,and 12 months after splenectomy(P<0.05).Time-dependent curve showed that the cumulative incidence of PVT was significantly different between patients with MELD score≤10 and>10(P<0.05).In addition,the cumulative incidence of PVT in the PVD≥14.5 mm group was significantly higher than that in the PVD<14.5 mm group(P<0.05).CONCLUSION Wider PVD and MELD score>10 were independent predictors of PVT at 1 months,3 months,and 12 months after splenectomy in patient with cirrhosis.展开更多
BACKGROUND Robotic-assisted partial splenectomy(RAPS)is a superior approach for treating splenic cysts and splenic hemangiomas,as it preserves the immune function of the spleen and reduces the risk of overwhelming pos...BACKGROUND Robotic-assisted partial splenectomy(RAPS)is a superior approach for treating splenic cysts and splenic hemangiomas,as it preserves the immune function of the spleen and reduces the risk of overwhelming post splenectomy infection.Curren-tly,there are no standardized guidelines for performing a partial splenectomy.CASE SUMMARY Four patients with splenic cysts or splenic hemangiomas were treated by RAPS.Critical aspects with RAPS include carefully dissecting the splenic pedicle,accurately identifying and ligating the supplying vessels of the targeted segment,and ensuring precise hemostasis during splenic parenchymal transection.Four successful RAPS cases are presented,where the tumors were removed by pret-reating the splenic artery,dissecting and ligating the corresponding segmental vessels of the splenic pedicle,transecting the ischemic segment of the spleen,and using electrocautery for optimal hemostasis.Four patients underwent successful surgeries with minimal bleeding during the procedure,and there were no signs of bleeding or recurrence postoperatively.CONCLUSION Four cases confirm the feasibility and superiority of RAPS for the treatment of benign splenic tumors.展开更多
Industrial activities such as smelting emissions,mineral combustion and industrial wastewater discharge might lead to copper pollution in the environment.This kind of copper pollution has harmful effects on aquatic o ...Industrial activities such as smelting emissions,mineral combustion and industrial wastewater discharge might lead to copper pollution in the environment.This kind of copper pollution has harmful effects on aquatic o rganisms,plants and animals through direct or indirect exposure.However,the current understanding of the toxicity of copper is rather limited.Copper overload can perturb intracellular homeostasis and induce oxidative stress and e ven cell death.Recently,cuproptosis has been identified as a copper-dependent form of cell death induced by o xidative stress in mitochondria.We uncover here that zinc transporter 1(ZNT1)is an important regulator involved in cuproptosis.Firstly,we established the copper overload-induced cell death model with the overexpression of copper importer SLC31A1 in HeLa cells.Using this model,we conducted unbiased genome-wide CRISPR-Cas9 screens in cells treated with copper.Our results revealed a significant enrichment of ZNT1 gene in both library A and library B plasmids.Knocking out of ZNT1 in HeLa cells notably prevented cuproptosis.Subsequent knockout of metal transcription factor 1(MTF1)in ZNT1-deficient cells nearly abolished their ability to resist copper-induced cell death.However,overexpression of metallothionein 1X(MT1X)in the double-knockout cells could p artially restored the resistance to cuproptosis by loss of MTF1.Mechanistically,knockout of ZNT1 could promote MT1X expression by activating MTF1.As a consequence,the interaction between MT1X and copper was e nhanced,reducing the flow of copper into mitochondria and eliminating mitochondria damage.Taken together,this study reveals the important role of ZNT1 in cuproptosis and shows MTF1-MT1X axis mediated resistance to c uproptosis.Moreover,our study will help to understand the regulatory mechanism of cellular and systemic copper homeostasis under copper overload,and present insights into novel treatments for damages caused by both genetic copper overload diseases and environmental copper contamination.展开更多
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 ...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.展开更多
Mountain streams act as conveyors of sediments within the river continuum,where the physical transport of sediments between river reaches through the catchment or between individual parts(e.g.,between hillslopes and c...Mountain streams act as conveyors of sediments within the river continuum,where the physical transport of sediments between river reaches through the catchment or between individual parts(e.g.,between hillslopes and channels)of the catchment is assumed.This study focused on sediment connectivity analysis in the SlavíčRiver catchment in the MoravskoslezskéBeskydy Mts in the eastern part of the Czech Republic.The connectivity index and connectivity index target modelling were combined with an analysis of anthropogenic interventions.Additionally,field mapping,grain size of bed sediments and stream power analysis were used to obtain information about connectivity in the catchment.Based on the analysis and obtained results,terrain topography is the current main driving factor affecting the connectivity of sediment movement in the SlavíčRiver catchment.However,the modelling provided valuable information about high sediment connectivity despite different recent land use conditions(highly forested area of the catchment)than those in historical times from the 16th to 19th centuries when the SlavíčRiver catchment was highly deforested and sediment connectivity was probably higher.The analysis of anthropogenic interventions,field mapping,grain size of bed sediments and stream power analysis revealed more deceleration of sediment movement through the catchment,decreased sediment connectivity with bed erosion,and gradual river channel process transformation in some reaches.Field mapping has identified various natural formations and human-induced changes impacting the longitudinal and lateral connectivity in the SlavíčRiver.For instance,embankments along 48%of the river's length,both on the right and left banks,significantly hinder lateral sediment supply to the channel.Stream power index analysis indicates increased energy levels in the flowing water in the river's upper reaches(up to 404.8 W m^(-2)).This high energy is also observed in certain downstream sections(up to 337.6 W m^(-2)),where it is influenced by human activities.These conditions lead to intensified erosion processes,playing a crucial role in sediment connectivity.Similar observations were described in recent studies that pointed out the long-term human interventions on many streams draining European mountains,where a decrease in sediment connectivity in these streams is linked with sediment deficits and the transformation of processes forming channels.展开更多
文摘Introduction: Splenectomy is the surgical removal of the spleen. It can be performed during various pathologies, ranging from abdominal trauma to hemoglobinopathies. The progress made in the knowledge of the immune functions of the spleen and the fear of post-splenectomy infectious complications have favored the development of surgical or non-surgical splenic preservation techniques calling into question the dogma of splenectomy. The aim of this study was to determine the indications for splenectomy. Methodology: This was a retrospective, descriptive study lasting 5 years in the general surgery department of the Ignace Deen National Hospital. All files of splenectomized patients were included, our variables were clinical, therapeutic and progressive. Results: We collected 42 cases of splenectomies out of the 2478 surgical procedures performed, representing 1.7% of the department’s surgical activities. The average age was 44 years. The age group of 41 to 50 years was the most represented, i.e. 26% (n = 11) of cases. Sex ratio = 1. Abdominal pain was the reason for consultation in patients, i.e. 100% (n = 42) of cases. The antecedents were dominated by recurrent malaria with 52.3% (n = 22) of cases, then recurrent anemia in 21% (n = 9), and 16.7% (n = 7) had sickle cell disease. Splenomegaly was found in 31 patients, or 73.6%. Ultrasound was performed in all patients. The indications for splenectomy were: isolated splenomegaly with risk of rupture (38%, n = 16), hypersplenism (26%, n = 11) and trauma to the spleen (19.04%, n = 8). Total splenectomy was performed in all cases. The surgical consequences were favorable in 85.7%, (n = 36) with morbidity of 14% (n = 6) and mortality of 9.52% (n = 4). The average length of hospitalization was 10.4 days with extremes of 1 and 22 days. Conclusion: Splenectomy constitutes a relatively common surgical procedure in our context. The indications for splenectomy were isolated splenomegaly with risk of rupture, hypersplenism and trauma to the spleen and total splenectomy was the rule.
基金Supported by the National Natural Science Foundation of China,No.81800528Natural Science Foundation of Gansu Province,No.20JR5RA364Key Research and Development Project of Gansu Province,No.20YF2FA011。
文摘BACKGROUND Portal vein thrombosis(PVT)is a commonthsn complication after splenectomy in patients with cirrhosis.However,the predictors of postoperative PVT are not known.AIM To investigate the predictors of PVT after splenectomy in patient with cirrhosis.METHODS A total of 45 patients with cirrhosis who underwent splenectomy were consecutively enrolled from January 2017 to December 2018.The incidence of PVT at 1 months,3 months,and 12 months after splenectomy in patients with cirrhosis was observed.The hematological indicators,biochemical and coagulation parameters,and imaging features were recorded at baseline and at each observation point.The univariable,multivariable,receiver operating characteristic curve and timedependent curve analyses were performed.RESULTS The cumulative incidence of PVT was 40.0%,46.6%,and 48.9%at 1 months,3 months,and 12 months after splenectomy.Multivariable analysis showed that portal vein diameter(PVD)≥14.5 mm and monthsdel end-stage liver disease(MELD)score>10 were independent predictors of PVT at 1 months,3 months,and 12 months after splenectomy(P<0.05).Time-dependent curve showed that the cumulative incidence of PVT was significantly different between patients with MELD score≤10 and>10(P<0.05).In addition,the cumulative incidence of PVT in the PVD≥14.5 mm group was significantly higher than that in the PVD<14.5 mm group(P<0.05).CONCLUSION Wider PVD and MELD score>10 were independent predictors of PVT at 1 months,3 months,and 12 months after splenectomy in patient with cirrhosis.
基金Supported by Nantong“14th Five-Year”Science and Education to Strengthen Health Project,General Surgery Medical Key Discipline,No.42.
文摘BACKGROUND Robotic-assisted partial splenectomy(RAPS)is a superior approach for treating splenic cysts and splenic hemangiomas,as it preserves the immune function of the spleen and reduces the risk of overwhelming post splenectomy infection.Curren-tly,there are no standardized guidelines for performing a partial splenectomy.CASE SUMMARY Four patients with splenic cysts or splenic hemangiomas were treated by RAPS.Critical aspects with RAPS include carefully dissecting the splenic pedicle,accurately identifying and ligating the supplying vessels of the targeted segment,and ensuring precise hemostasis during splenic parenchymal transection.Four successful RAPS cases are presented,where the tumors were removed by pret-reating the splenic artery,dissecting and ligating the corresponding segmental vessels of the splenic pedicle,transecting the ischemic segment of the spleen,and using electrocautery for optimal hemostasis.Four patients underwent successful surgeries with minimal bleeding during the procedure,and there were no signs of bleeding or recurrence postoperatively.CONCLUSION Four cases confirm the feasibility and superiority of RAPS for the treatment of benign splenic tumors.
文摘Industrial activities such as smelting emissions,mineral combustion and industrial wastewater discharge might lead to copper pollution in the environment.This kind of copper pollution has harmful effects on aquatic o rganisms,plants and animals through direct or indirect exposure.However,the current understanding of the toxicity of copper is rather limited.Copper overload can perturb intracellular homeostasis and induce oxidative stress and e ven cell death.Recently,cuproptosis has been identified as a copper-dependent form of cell death induced by o xidative stress in mitochondria.We uncover here that zinc transporter 1(ZNT1)is an important regulator involved in cuproptosis.Firstly,we established the copper overload-induced cell death model with the overexpression of copper importer SLC31A1 in HeLa cells.Using this model,we conducted unbiased genome-wide CRISPR-Cas9 screens in cells treated with copper.Our results revealed a significant enrichment of ZNT1 gene in both library A and library B plasmids.Knocking out of ZNT1 in HeLa cells notably prevented cuproptosis.Subsequent knockout of metal transcription factor 1(MTF1)in ZNT1-deficient cells nearly abolished their ability to resist copper-induced cell death.However,overexpression of metallothionein 1X(MT1X)in the double-knockout cells could p artially restored the resistance to cuproptosis by loss of MTF1.Mechanistically,knockout of ZNT1 could promote MT1X expression by activating MTF1.As a consequence,the interaction between MT1X and copper was e nhanced,reducing the flow of copper into mitochondria and eliminating mitochondria damage.Taken together,this study reveals the important role of ZNT1 in cuproptosis and shows MTF1-MT1X axis mediated resistance to c uproptosis.Moreover,our study will help to understand the regulatory mechanism of cellular and systemic copper homeostasis under copper overload,and present insights into novel treatments for damages caused by both genetic copper overload diseases and environmental copper contamination.
基金Supported by National Natural Science Foundations of China,No.82174160and Anhui Natural Science Foundation,No.2008085QH389。
文摘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.
基金supported by an internal grant of the University of Ostrava[SGS10/PřF/2021-Specificity of fluvial landscape in the context of historical and future changes].
文摘Mountain streams act as conveyors of sediments within the river continuum,where the physical transport of sediments between river reaches through the catchment or between individual parts(e.g.,between hillslopes and channels)of the catchment is assumed.This study focused on sediment connectivity analysis in the SlavíčRiver catchment in the MoravskoslezskéBeskydy Mts in the eastern part of the Czech Republic.The connectivity index and connectivity index target modelling were combined with an analysis of anthropogenic interventions.Additionally,field mapping,grain size of bed sediments and stream power analysis were used to obtain information about connectivity in the catchment.Based on the analysis and obtained results,terrain topography is the current main driving factor affecting the connectivity of sediment movement in the SlavíčRiver catchment.However,the modelling provided valuable information about high sediment connectivity despite different recent land use conditions(highly forested area of the catchment)than those in historical times from the 16th to 19th centuries when the SlavíčRiver catchment was highly deforested and sediment connectivity was probably higher.The analysis of anthropogenic interventions,field mapping,grain size of bed sediments and stream power analysis revealed more deceleration of sediment movement through the catchment,decreased sediment connectivity with bed erosion,and gradual river channel process transformation in some reaches.Field mapping has identified various natural formations and human-induced changes impacting the longitudinal and lateral connectivity in the SlavíčRiver.For instance,embankments along 48%of the river's length,both on the right and left banks,significantly hinder lateral sediment supply to the channel.Stream power index analysis indicates increased energy levels in the flowing water in the river's upper reaches(up to 404.8 W m^(-2)).This high energy is also observed in certain downstream sections(up to 337.6 W m^(-2)),where it is influenced by human activities.These conditions lead to intensified erosion processes,playing a crucial role in sediment connectivity.Similar observations were described in recent studies that pointed out the long-term human interventions on many streams draining European mountains,where a decrease in sediment connectivity in these streams is linked with sediment deficits and the transformation of processes forming channels.