Clinical value of liver and spleen shear wave velocity in predicting the prognosis of patients with portal hypertension

AIM To explore the relationship of liver and spleen shear wave velocity in patients with liver cirrhosis combined with portal hypertension,and assess the value of liver and spleen shear wave velocity in predicting the prognosis of patients with portal hypertension.METHODS All 67 patients with liver cirrhosis diagnosed as portal hypertension by hepatic venous pressure gradient in our hospital from June 2014 to December 2014 were enrolled into this study. The baseline information of these patients was recorded. Furthermore,67 patients were followed-up at 20 mo after treatment,and liver and spleen shear wave velocity were measured by acoustic radiation force impulse at the 1^(st) week,3^(rd) month and 9^(th) month after treatment. Patients with favorable prognosis were assigned into the favorable prognosis group,while patients with unfavorable prognosis were assigned into the unfavorable prognosis group. The variation and difference in liver and spleen shear wave velocity in these two groups were analyzed by repeated measurement analysis of variance. Meanwhile,in order to evaluate the effect of liver and spleen shear wave velocity on the prognosis of patients with portal hypertension,Cox's proportional hazard regression model analysis was applied. The ability of those factors in predicting the prognosis of patients with portal hypertension was calculated through receiver operating characteristic(ROC) curves.RESULTS The liver and spleen shear wave velocity in the favorable prognosis group revealed a clear decline,while those in the unfavorable prognosis group revealed an increasing tendency at different time points. Furthermore,liver and spleen shear wave velocity was higher in the unfavorable prognosis group,compared with the favorable prognosis group; the differences were statistically significant(P < 0.05). The prognosis of patients with portal hypertension was significantly affected by spleen hardness at the 3^(rd) month after treatment [relative risk(RR) = 3.481]. At the 9^(th) month after treatment,the prognosis was affected by liver hardness(RR = 5.241) and spleen hardness(RR = 7.829). The differences between these two groups were statistically significant(P < 0.05). The ROC analysis revealed that the area under the curve(AUC) of spleen hardness at the 3^(rd) month after treatment was 0.644,while the AUCs of liver and spleen hardness at the 9^(th) month were 0.579 and 0.776,respectively. These might predict the prognosis of patients with portal hypertension.CONCLUSION Spleen hardness at the 3^(rd) month and liver and spleen shear wave velocity at the 9^(th) month may be used to assess the prognosis of patients with portal hypertension. This is hoped to be used as an indicator of predicting the prognosis of patients with portal hypertension.

Efficacy and safety of Guipi Decoction combined with conventional Western medicine in the treatment of insomnia with deficiency of heart and spleen:a meta-analysis

Objective:To systematically evaluate the efficacy and safety of Guipi Decoction combined with Western medicine in the treatment of insomnia with deficiency of heart and spleen.Methods:English databases(PubMed,Web of Science,The Cochrane Library,EMBASE)and Chinese databases(CNKI,Wanfang database,China Biomedical Literature Service System,VIP database)were searched by computer.Randomized controlled trials of Guipi Decoction on insomnia with deficiency of heart and spleen were searched from the database construction to November 2021.After the first and second authors independently screened the literature,extracted the data and evaluated the risk of bias in the included studies,meta-analysis was performed using RevMan5.3 software.Results:A total of 9 RCTS were included after screening,including 914 patients.Meta-analysis results showed that:Total effective rate[RR=1.22,95%CI(1.16,1.30),P<0.00001],total PSQI score[MD=-3.05,95%CI(-3.96,-2.14),P=0.008],number of night awakening times[[MD=-1.18,95%CI(-1.42,-0.94),P<0.00001],adverse reaction rate[RR=0.32,95%CI(0.21,0.51),P<0.00001]were better than the control group,and the differences were statistically significant.Conclusion:The current evidence shows that,compared with pure using conventional western medicine,belongs to the spleen decoction combined western medicine therapy,cases both deficiency type of insomnia in the total effective rate,reducing the total PSQI score(improve sleep quality,sleep efficiency,sleep disorder,daytime function,etc.),reducing frequency of nighttime awakening,security,have more advantages.However,due to the limitation of the quality and quantity of articles included in the study,more randomized,double-blind,large-sample clinical studies are needed to confirm the above conclusions.

Clinical Observation on the Treatment of Insomnia in Germany with Deficiency of Heart and Spleen by the Ear Bean Therapy

Objective: To observe the effect of insomnia patients with deficiency of heart and spleen in Germany by the therapy of ear points pressing with bean. Methods: A total of 80 cases of insomnia with deficiency of heart and spleen in Germany were divided into the observation group and the control group, with 40 cases in each group. The patients in the control group were treated with oral modified Guipi Decoction(归脾汤), while the patients in the observation group were treated with oral traditional Chinese medicine(TCM) and the therapy of ear points pressing with bean. The efficacy, sleep quality, the TCM syndromes score and the incidence of adverse reactions were compared between the two groups. Results: The effective rate in the observation group was higher than that in the control group, and there was statistical difference between the two group(P<0.05). After treatment, the Pittsburgh sleep quality index scale(PSQI) score, insomnia severity index(ISI) score and the TCM syndromes score in the two groups were decreased sharply(P<0.01), and those scores in the observation group were lower than that in the control group(P<0.05). There was no adverse reaction between the two groups. Conclusion: The therapy of ear points pressing with bean is effective on insomnia in Germany, which is worth further study and promotion.

Biological basis of “depression with liver-qi stagnation and spleen deficiency syndrome”: A digital gene expression profiling study

Objective:To investigate the biological basis of“depression with liver-qi stagnation and spleen deficiency syndrome”.Methods:A digital gene expression profiling method was conducted to explore global changes in the mRNA transcriptome in a rat model of depression with liver-qi stagnation and spleen deficiency syndrome.Real-time quantitative polymerase chain reaction(q-PCR)was performed to verify the five genes most interest based on the Kyoto Encyclopedia of Genes and Genome(KEGG)analysis.Sini San,which disperses stagnated liver qi and strengthens the spleen,was administered to the model rats to observe whether it could reverse these genetic changes in the liver.Results:Forty-six differentially expressed genes were identified.Three of the five genes of most interestdHnf4a,Hnf4g and Cyp1a1dbased on KEGG analysis,were confirmed by realtime q-PCR.Sini San reduced the gene expression changes of Hnf4a,Hnf4g and Cyp1a1 in the rat model.Conclusions:Hnf4a,Hnf4g and Cyp1a1 are involved in“depression with liver-qi stagnation and spleen deficiency syndrome”.These findings indicate that depressed rats with liver-qi stagnation and spleen deficiency syndrome are at risk of liver diseases.Furthermore,our results will inform exploration of the etiology of depression and help in the development of effective therapeutic strategies.

T-CELL SUBSETS OF PERIPHERAL BLOOD AND SPLEEN IN HEPATOCARCINOMA-BEARING RATS

T-cell subsets from peripheral blood and spleen were investigated prospectively by flow cytometry in a murine intrahepatic implanted tumor model. Peripheral blood OX-19+ cells (pan T-cells) and W3/25+ cells (Th cells) decreased with tumor development in tumor-bearing rats, giving significant differences when compared with healthy rats. No significant changes were found in OX-8+ cells (Ts cells). Hence, Th Ts ratio in tumor-bearing rats was lower than that in control group. Meanwhile, on day 17 following tumor implantation, in tumor-bearing rats with intrahepatic or peritoneal metastasis, there were less W3/25+ cells and more OX-8+ cells than those of hepatoma-bearing rats without metastasis (p<0.01). In the spleen, the phenotypes of lymphocyte markers showed less OX-8+ cells and more OX-12+ cells (B cells) tumor-bearing rats. It was suggested that, in tumor-bearing host, not only was T-cell immune function inhibited, but also there was abnormal distribution of T-cell subsets. It seems that there is a close relationship between tumor growth and its spread and a lower Th/Ts ratio.

Study on the Characteristics of Gut Microbiota in Chronic Hepatitis B(CHB)Patients with Damp Heat Syndrome and Liver Depression and Spleen Deficiency Syndrome

Objective:This study was designed to explore the characteristics of gut microbiota in CHB patients with two most common traditional Chinese medicine(TCM)Syndromes—damp heat syndrome and liver depression and spleen deficiency syndrome.Methods:According to the diagnostic criteria of Western medicine,TCM and screening exclusion criteria,65 cases of CHB with damp heat syndrome and 28 cases of CHB with liver depression and spleen deficiency syndrome were finally included in the study.All the basic information was gathered and the fresh fecal samples were collected for 16S rDNA sequencing.16S rDNA of gut microbiota was sequenced using Illumina hiseq 2,500 high-throughput sequencing platform.Based on the optimized sequence,Operational Taxonomic Units(OTU)clustering analysis and taxonomic annotation were carried out.Results:The difference in relative abundance of gut microbiota was significant between damp heat syndrome and liver depression and spleen deficiency syndrome in CHB patients.Cyanobacteria was only found in damp heat syndrome.The relative abundance of Erysipelotrichia and Subdoligranulum were higher in liver depression and spleen deficiency syndrome,while the relative abundance of Rhodospirillales,Alphaproteobacteria and Lachnospira were higher in the damp heat syndrome.LDA Effect Size(LEfSe)analysis showed that Lachnospira,Olsenella and Subdoligranulum had significant difference in species among the two TCM syndromes.Conclusion:The different characteristics of gut microbiota in the two TCM syndromes of CHB patients may play an important role in syndrome formation of TCM,which provides a new field of vision for the accurate diagnosis and treatment of TCM.

Experience of Treating Hypertension from Liver and Spleen Among Middle-Aged and Young Patients:A Summary

Qi deficiency of the spleen and stomach,transportation,phlegm and dampness generate endogenous and turbid phlegm that violates the position of yang clearance.As a result,dizziness cis resulted.The author believes that the incidence of middle-aged and young patients with hypertension is mostly related to the dysfunction of liver and spleen.Liver depression and qi stagnation is the beginning of the onset;spleen deficiency and dyskinesia is the norm of the onset;and liver and spleen imbalance is the origin of the onset.It is advocated that regulating the liver and spleen to restore the rise and fall,harmonizing qi and blood and preventing lesions are the main treatment methods for the treatment of middle-aged and young people’s hypertension,which is conducive to the development of more clinical diagnosis and treatment ideas for hypertension amomg middle-aged and young people.

ACUPUNCTURE TREATMENT FOR 100 CASES WITH INSOMNIA OF THE TYPE OF THE HEART AND SPLEEN DEFICIENCY

cases of insomnia of the type of heart and spleen deficiency were treated by acupuncture.Results indicated that 95 cases were cured,accounting for 95%;3 cases were markedly effective,accounting for 3% and the 2 cases were ineffective,accounting for 2%,the total effective rate was 98%.

Discussion on Traditional Chinese Medicine Treatment of Liver-Depression-Spleen-Deficiency Type Insomnia Based on the State-Target Theory and the Regulation of Microbiome-Gut-Brain Axis

Insomnia has become an urgent clinical problem in modern society.Current research has found that the gut flora-gut-brain axis plays an important role in regulating insomnia.The state-target theory is a product of the combination of traditional Chinese medicine and modern molecular biology technology.This paper clarifies the correlation between the state-target theory,the intestinal flora-gut-brain axis,and liver-depression-spleen-deficiency insomnia.The use of traditional Chinese medicine to regulate the structure and abundance of intestinal flora was also explored,aiming to integrate traditional Chinese medicine with Western medicine for the prevention and treatment of liver-depression-spleen-deficiency insomnia.

Therapeutic efficacy observation of acupuncture plus medicine for laryngopharyngeal reflux due to liver-qi stagnation and spleen deficiency

Objective To observe the clinical efficacy of acupuncture plus medicine in treating laryngopharyngeal reflux due to liverqi stagnation and spleen deficiency.Methods A total of 70 patients were divided into a control group and an observation group by the random number table method,with 35 cases in each group.Both groups were treated with conventional medications,and the observation group was treated with additional acupuncture therapy.The reflux symptom index(RSI)and reflux finding score(RFS)were evaluated.Esophageal motility indicators such as lower esophageal sphincter pressure(LESP)and upper esophageal sphincter pressure(UESP),and salivary pepsin level were measured.The clinical efficacy was also compared.Results The total effective rate of the observation group was higher than that of the control group(P<0.05).After treatment,the RSI and RFS scores in both groups decreased significantly(all P<0.05),and the RSI and RFS scores in the observation group were significantly lower than those in the control group(both P<0.05).There were no significant changes in the LESP and UESP in the control group(both P>0.05),while LESP and UESP in the observation group increased significantly(both P<0.05),and higher than those in the control group(both P<0.05).The salivary pepsin levels in both groups decreased(both P<0.05),and the salivary pepsin level in the observation group was significantly lower than that in the control group(P<0.05).Conclusion Acupuncture plus medicine can improve symptoms and signs in patients with laryngopharyngeal reflux due to liver-qi stagnation and spleen deficiency,and regulate esophageal motility and salivary pepsin level.Its efficacy is more significant compared with medicine alone.

Tonifying Kidney, Lung, and Spleen Combined with Western Medicine for Stable Chronic Obstructive Pulmonary Disease: A Systematic Review

Introduction:This study aimed to evaluate the clinical effectiveness and safety of tonifying kidney,lung,and spleen(TKLS)combined with Western medicine for stable chronic obstructive pulmonary disease(COPD).Materials and Methods:Randomized controlled trials(RCTs)of TKLS for stable COPD were searched from four databases including Pub Med,the Cochrane Library,China Biology Medicine,and China National Knowledge Infrastructure from inception to December 2017.Two reviewers independently screened the literature,extracted the data,and assessed the risk of bias in the included studies.Rev Man5.3 software was used for meta-analysis.Results:Fourteen RCTs involving 1339 patients with stable COPD were included.Five of the included articles described the specific method of randomization,1 of them was double-blind method research,and 1 of them was single-blind method research.Compared with the conventional Western medicine(CWM)group,the use of TKLS,if combined with CWM demonstrated significantly improved effective rate(relative risk=1.25,95%confidence interval[CI]:1.18–1.33,P<0.00001),decreased traditional Chinese medicine syndrome score(mean difference[MD]-5.72,95%CI:-8.31 to-3.14,P<0.0001),Decreased St George's Respiratory Questionnaire total score(MD-7.39,95%CI:-10.46 to-4.31,P<0.00001),increased 6-min walk distance in meters(MD 78.46,95%CI:60.18–96.73,P<0.00001),increased forced expiratory volume 1%(MD 6.49,95%CI:3.64–9.33,P<0.00001),increased CD4(MD 9.84,95%CI:6.73–12.94,P<0.00001),CD8(MD-1.84,95%CI:-3.62 to-0.06,P=0.04)and CD4/CD8(MD 0.26,95%CI:0.20–0.32,P<0.0001),and increased immunoglobulin M(MD 0.15,95%CI:0.10–0.20 P<0.00001)..Conclusions:For stable COPD,TKLS combined with CWM is superior to CWM alone with regard to clinical effectiveness,symptoms,and quality of life.The above conclusion needs to be validated by further well-designed,multicentric,large-scale,double-blinded RCTs.

Discussion on the Theoretical Basis of Banxia Xiexin Decoction in the Treatment of Insulin Resistance Obesity

Through reading Chinese ancient book Huangdi Nejing,and summarizing and analyzing related literature,the basic pathogenesis of obesity have been found to be the stomach preponderance and spleen weakness,and the imbalance of ascending and descending.Banxia Xiexin Decoction not only has the functions of relieving heat to inhibit stomach intake,supplementing deficiency to assist spleen transport,regulate the ascending and descending,but also has the effects of improving insulin resistance and regulating glucolipid metabolism.Therefore,it is suggested that Banxia Xiexin Decoction can be used in the treatment of insulin resistant obesity,which provides ideas and methods for its treatment.

Effects of Rare Earth Ce on Nonspecific Immunity in Mice

Mice were watered with cerous nitrate solution (2, 20, 200 mg·kg-1) according to daily drinking water volume for 50 days and the effects of cerous nitrate on nonspecific immunity in mice were investigated. The results showed that the total number of peripheral white blood cell, the clearance rate of charcoal particles, the indices of thymus and spleen were increased on different degrees, and associated with the watering dose, noting that these indices were increased significantly by cerous nitrate at a dose of 20 mg·kg-1 compared with control group. Therefore, it was concluded that the nonspecific immunity could be improved by rare earth Ce in mice.

Safety of the Aqueous Extract of the Leaves of Senna alata (L.) Roxb. (Leguminosae-Caesalpinioideae), a Plant Used in Benin to Treat Infections

Description of the Subject: Senna alata (L.) was a plant in the Benin pharmacopoeia used to treat skin infections. Objectives: The aim of our work was to test its harmlessness in vivo. Method: Wistar rats received by gavage a single dose of 2000 mg/kg of Senna alata leaves aqueous extract for the Acute Oral Toxicity (AOT) test. For the sub-Chronic Oral Toxicity (SCT) test, rats force-fed the extract at a daily dose of 300 mg/Kg of body weight for 28 days. The weight of the rats was taken and the blood samples were collected on Day 0, then respectively day 14 for the AOT and Day 28 for the SCT. The renal balance was carried out by dosage of the creatinine, the liver balance by the transaminases AST and ALT and the blood balance by the hemogram. The liver, kidneys and spleen were removed for histological analysis. The results were analyzed using the Student test, with the significance level set at 5%. Results: The weight of the rats did not change significantly in the acute or subchronic oral toxicity tests suggesting an absence of physical disturbance in the rats. Serum creatinine did not vary significantly, suggesting preservation of renal function. That was the same for ASAT and ALAT transaminases, indicating an absence of hepatic cytolysis. In hematology, the hemoglobin level and the number of blood platelets did not vary significantly, suggesting that the extract did not create anemia and did not influence blood coagulation. Hepatic, renal and splenic parenchyma showed no atypia. Conclusion: The aqueous extract of Senna alata (L.) leaves did not reveal any acute or subchronic toxicity and offered prospects for its use in the treatment of infections.

Clinical observation of acupuncture plus acupoint sticking therapy for insomnia and its influence on subjective and objective sleep indicators

Objective To observe the effects of acupoint sticking therapy of different dosages and durations on the subjective and objective sleep indicators in insomnia patients.Methods Ninety-six patients with insomnia due to liver-Qi stagnation and spleen deficiency were divided into a high-dosage 7 d group(25 cases),a high-dosage 14 d group(22 cases),a low-dosage 7 d group(21 cases),and a low-dosage 14 d group(28 cases)using the random numbers generated in a stratified and stage-by-stage manner in combination with the visiting sequence.The four groups all received the same acupuncture treatment,but acupoint sticking therapy varied in dosage and duration.Before and after treatment,the actigraphic readings(total time in bed,total sleep time,sleep efficiency,number of wake bouts,length of wakes after asleep,and sleep latency),Pittsburgh sleep quality index(PSQI)score,and symptoms score of traditional Chinese medicine(TCM)were observed.A correlation analysis was conducted among the subjective and objective indicators.Results The PSQI score was positively correlated with the total time in bed and total sleep time(P<0.05).After treatment,the sleep latency,PSQI scores,and TCM symptoms scores changed significantly in the four groups(P<0.05).The total sleep time and sleep efficiency gained improvements after treatment in the high-dosage 14 d and low-dosage 14 d groups(P<0.05).The high-dosage acupoint sticking groups had longer total sleep time compared with the low-dosage groups of the same treatment duration(P<0.05).After treatment,the length of wakes after asleep,PSQI scores,and TCM symptoms scores were better in the 14 d groups than in the 7 d groups of the same acupoint sticking dosage(P<0.05).Conclusion Given the same acupuncture treatment,acupoint sticking therapy of different treatment durations produces different effects on the length of wakes after asleep,PSQI score,and TCM symptoms score in insomnia patients,and the 14-day acupoint sticking treatment is superior to the 7-day treatment.

Observation on clinical effects of acupoint thread-embedding method for non-alcoholic fatty liver disease

Objective： To observe the clinical effects of acupoint thread-embedding method for non-alcoholic fatty liver disease （NAFLD） in pattern of liver qi stagnation and spleen deficiency. Methods： A total of 180 cases in conformity with the diagnostic criteria of NAFLD in pattern of liver qi stagnation and spleen deficiency were randomly divided into a treatment group and a control group, 90 cases in each group, and finally 88 cases in the treatment group and 90 cases in the control group were recruited for statistics. The treatment group was managed by acupoint thread-embedding method, and the control group was treated by oral administration of Polyene Phosphatidylcholine capsules. Both groups were treated for 6 months. Before and after the treatment, liver enzymology, blood fat test, abdominal B ultrasonic examination, and assessment of clinical effects were respectively processed. Results： After treatment, alanine transaminase （ALT）, aspartate transaminase （AST）, total cholesterol （TC）, and triglyceride （TG） decreased in the treatment group, and were significantly different from those in the control group after treatment （all P〈0.05）. There was no statistically significant inter-group difference in the degree of fatty liver （by B ultrasound examination） before treatment （P〉0.05）. After treatment, the improvement degree of fatty liver in the treatment group was more significant than that in the control group （P〈0.05）. The total effective rates were 89.8% in the treatment group and 76.7% in the control group, with a statistically significant difference between the two groups （P〈0.05）. Conclusion： The acupoint thread-embedding method can reduce the levels of ALT, AST, TC and TG in NAFLD patients, and can improve the pathologic degree of fatty liver and its clinical effects are remarkably better than that of oral medications.

Effects of intradermal needle therapy plus pinaverium bromide on gastrointestinal hormone levels in irritable bowel syndrome-diarrhea patients

Objective:To observe the clinical efficacy difference in treating irritable bowel syndrome-diarrhea(IBS-D)of liver-qi stagnation and spleen-deficiency pattern with different treatment protocols,and the effects on serum levels of 5-hydroxytryptamine(5-HT),substance P(SP)and vasoactive intestinal peptide(VIP),for unveiling the mechanism of intradermal needle therapy plus pinaverium bromide in treating IBS-D.Methods:A total of 123 IBS-D patients were divided into an observation group,a Western medication group and an integrated Western and Chinese medication group using the random number table method,with 41 cases in each group.The Western medication group was given oral pinaverium bromide,50 mg each time and 3 times a day.The integrated Western and Chinese medication group was given additional Chinese herbal medicine Tong Xie Yao Fang,one dose each day.The observation group was given additional intradermal needle therapy on the basis of the Western medication group.The whole intervention lasted for 6 weeks.Before and after treatment,the scores of gastrointestinal symptoms,traditional Chinese medicine(TCM)symptoms,irritable bowel syndrome(IBS)symptom severity scale(IBS-SSS)and IBS quality of life(IBS-QOL)questionnaire,as well as the serum levels of 5-HT,SP and VIP were observed.The clinical efficacy was estimated.Results:The total effective rate was 92.7%in the observation group,68.3%in the Western medication group and 78.1%in the integrated Western and Chinese medication group.The total effective rate was higher in the observation group than in the other two groups,and higher in the integrated Western and Chinese medication group than in the Western medication group,showing statistical significance(all P<0.05).After treatment,the scores of gastrointestinal symptoms,TCM symptoms and IBS-SSS showed significant decreases in the three groups,presenting statistical significance compared with the baseline(all P<0.05);the scores of gastrointestinal symptoms,TCM symptoms and IBS-SSS were notably lower in the observation group than in the other two groups(all P<0.05),and lower in the integrated Western and Chinese medication group than in the Western medication group(all P<0.05).After treatment,the eight component scores of IBS-QOL showed significant increases in the three groups compared with the baseline(all P<0.05);the eight component scores in IBS-QOL were significantly higher in the observation group than in the other two groups(all P<0.05),and higher in the integrated Western and Chinese medication group than in the Western medication group(all P<0.05).After treatment,the serum levels of 5-HT,SP and VIP decreased markedly in the three groups compared with the baseline(all P<0.05);the serum levels of 5-HT,SP and VIP were significantly lower in the observation group than in the other two groups(all P<0.05),and lower in the integrated Western and Chinese medication group than in the Western medication group(P<0.05).Conclusion:Treatment with intradermal needle therapy plus pinaverium bromide results in significant improvements in the gastrointestinal symptoms and quality of life in patients with IBS-D of liver-qi stagnation and spleen deficiency pattern,and effectively regulates the gastrointestinal hormone production.