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Deng X, Liao W, Jiang X, Tu S, Xie X, Xiao Y, Chen W, Zeng H, Ding C. Establishment and validation of systemic inflammatory index model and risk assessment of PVT in cirrhosis after splenectomy-a retrospective study. PeerJ 2025; 13:e19254. [PMID: 40376556 PMCID: PMC12080476 DOI: 10.7717/peerj.19254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 03/12/2025] [Indexed: 05/18/2025] Open
Abstract
Objective The study aimed to create and validate a straightforward nomogram to predict portal vein thrombosis (PVT) in cirrhotic patient post-splenectomy, and investigate the predictive potential of systemic inflammation markers. One objective of the study was to develop a predictive model utilizing these markers to detect high-risk individuals early on. Methods A retrospective analysis was conducted on 184 cases of patients with cirrhosis who underwent splenectomy at The First Affiliated Hospital of University of South China from January 2015 to September 2023. The cohort was randomly divided into training (n = 130) and validation (n = 54) groups. Univariate and multivariate logistic regression analysis was employed to construct the prediction model. The performance of the nomogram was evaluated based on its ability to discriminate, calibrate, and demonstrate clinical utility. Results According to univariate and multivariate logistic regression analysis, we found six prediction indexes of PVT in patients with cirrhosis after splenectomy: postoperative neutrophil-to-lymphocyte ratio (NLR), postoperative derived NLR (dNLR), C-reactive protein to albumin ratio (CAR), portal vein diameter (DPV), platelet change value (PVB), and D-dimer (p-value < 0.05). Our clinical prediction model was created based on the aforementioned risk factors and demonstrated superior predictive power in both the primary cohort (AUC = 0.876) and validation cohort (AUC = 0.817). The calibration curve demonstrated satisfactory agreement between model predictions and actual observations, and the decision curve analysis (DCA) curve indicated high clinical net benefit. Conclusion Postoperative NLR, dNLR, CAR, PVB, DPV, and D-dimer were identified as the independent risk factors of PVT in cirrhotic patients post splenectomy. We had successfully established and validated a novel predictive model with good performance, based on systemic inflammatory indices in predicting PVT in cirrhosis after splenectomy.
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Affiliation(s)
- Xin Deng
- The First Affiliated Hospital, Department of Hepatopancreatobiliary Surgery, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Wenyan Liao
- The First Affiliated Hospital, Department of Gynaecology and Obstetrics, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Xinmiao Jiang
- The First Affiliated Hospital, Department of Hepatopancreatobiliary Surgery, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Shun Tu
- The First Affiliated Hospital, Department of Hepatopancreatobiliary Surgery, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Xiangmin Xie
- The First Affiliated Hospital, Department of Hepatopancreatobiliary Surgery, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Yuji Xiao
- The First Affiliated Hospital, Department of Hepatopancreatobiliary Surgery, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Wuyao Chen
- The First Affiliated Hospital, Department of Hepatopancreatobiliary Surgery, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Huan Zeng
- The First Affiliated Hospital, Department of Gynaecology and Obstetrics, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Chengming Ding
- The First Affiliated Hospital, Department of Hepatopancreatobiliary Surgery, Hengyang Medical School, University of South China, Hengyang, Hunan, China
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Jenkins P, Sorrell L, Zhong J, Harding J, Modi S, Smith JE, Allgar V, Roobottom C. Management of penetrating splenic trauma; is it different to the management of blunt trauma? Injury 2025; 56:112084. [PMID: 39701904 DOI: 10.1016/j.injury.2024.112084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Revised: 11/08/2024] [Accepted: 12/08/2024] [Indexed: 12/21/2024]
Abstract
PURPOSE We compare the treatment and outcomes of penetrating and blunt splenic trauma at Major Trauma Centres (MTC) within the UK. METHODS Data obtained from the national Trauma Audit Research Network database identified all eligible splenic injuries admitted to MTC within England between 01/01/17-31/12/21. Demographics, mechanism of injury, splenic injury classification, associated injuries, treatment, and outcomes were compared. RESULTS Penetrating injuries accounted for 5.9 % (235/3958) of splenic injuries, compared to blunt at 94.1 % (3723/3958). Most penetrating injuries (91.5 %, 215/235) resulted from stabbing. There was a statistically significant difference in first treatment between penetrating and blunt splenic injuries (p < 0.001), but similar trends between GSW and stab injuries. Most penetrating injuries were managed conservatively (68.9 %,162/235), with 10.6 % (25/235) embolized compared to 13.2 % (491/3723) for blunt splenic injury. More penetrating injuries (20.4 %, 48/235) underwent splenectomy compared to blunt injuries (8.8 %, 326/3723). Those receiving embolization after penetrating trauma had an 8.0 % (2/25) 30-day mortality compared with blunt at 8.6 % (42/491) and compared with 2.1 % (1/48) and 12.3 % (40/326) of those who received splenectomy in the penetrating and blunt groups, respectively. 8 out of the 25 penetrating trauma patients who underwent embolisation (32.0 %) required splenectomy due to embolisation failure compared to 5.3 % (26/491) in the blunt trauma group. CONCLUSION A trend is seen towards the use of operative management in penetrating splenic trauma. There is a high splenic embolisation failure rate (32.0 %) in penetrating trauma although mortality for those embolised was similar to the blunt injury group.
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MESH Headings
- Humans
- Wounds, Nonpenetrating/therapy
- Wounds, Nonpenetrating/mortality
- Wounds, Nonpenetrating/surgery
- Wounds, Nonpenetrating/epidemiology
- Spleen/injuries
- Spleen/surgery
- Male
- Wounds, Penetrating/therapy
- Wounds, Penetrating/mortality
- Wounds, Penetrating/surgery
- Wounds, Penetrating/epidemiology
- Female
- Trauma Centers/statistics & numerical data
- Adult
- Embolization, Therapeutic
- Middle Aged
- Splenectomy/statistics & numerical data
- Treatment Outcome
- Injury Severity Score
- Retrospective Studies
- Wounds, Stab/mortality
- Wounds, Stab/therapy
- United Kingdom/epidemiology
- England/epidemiology
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Affiliation(s)
- P Jenkins
- University Hospital Plymouth NHS Trust, UK.
| | - L Sorrell
- Department of Statistics, University of Plymouth, UK
| | - J Zhong
- Leeds General Infirmary, Leeds, UK
| | - J Harding
- University of Hospital Coventry and Warwickshire, UK
| | - S Modi
- Southampton General Hospital, UK
| | - J E Smith
- University Hospital Plymouth NHS Trust, UK
| | - V Allgar
- Department of Statistics, University of Plymouth, UK
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Erten E, Ucaner B, Cimen S. Retrospective investigation of patients undergoing splenectomy: Our 8-year clinical experience in a single center. North Clin Istanb 2025; 12:231-238. [PMID: 40330514 PMCID: PMC12051002 DOI: 10.14744/nci.2025.67503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Revised: 12/25/2024] [Accepted: 01/11/2025] [Indexed: 05/08/2025] Open
Abstract
OBJECTIVE Elective splenectomy is often performed due to hematological diseases. In this study, we aimed to investigate the splenectomy procedures performed in our clinic under emergency and elective conditions by analyzing the surgical techniques applied, surgical indications, and the clinical and demographic data of the patients, while seeking to discuss this subject, which holds a significant place in general surgical practice, in light of current literature. METHODS Patients who underwent splenectomy surgery in the general surgery clinic of a tertiary care hospital between September 2016 and September 2024 were included in the study. Clinical and demographic data of the patients were collected retrospectively through the hospital information management system records. RESULTS The mean age of 89 patients included in the study was 41.0±18.8 years (18-76 years). The male/female ratio was 1.3/1. The most common indication for splenectomy was trauma (38.2%). This was followed by mass (29.2%), splenomegaly (14.6%), and immune thrombocytopenic purpura (ITP) (14.6%). Of the patients, 62.9% underwent open surgery, while 37.1% were operated on using the laparoscopic technique. Of the patients, 57.3% underwent elective surgery, while emergency surgery was planned for 42.7%. CONCLUSION While splenectomy is a life-saving intervention in emergency conditions, it has become the most important treatment in some hematological diseases. Firstly, accurate surgical indication and the selection of an appropriate surgical technique tailored to the patient are of critical importance. There are still controversial issues in the current literature regarding the indications for splenectomy and the surgical technique to be applied.
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Affiliation(s)
- Ela Erten
- Department of Anesthesiology, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkiye
| | - Burak Ucaner
- Department of General Surgery, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkiye
| | - Sebnem Cimen
- Department of General Surgery, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkiye
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Martire B, Beni A, Mastrototaro MF, Santilli V, Ottaviano G, Montin D, Rizzo C, Sgrulletti M, Miraglia del Giudice M, Costagliola G, Moschese V. Vaccinations in Pediatric Hematology and Oncology: Biologic Basis, Clinical Applications, and Perspectives. Vaccines (Basel) 2025; 13:397. [PMID: 40333279 PMCID: PMC12031037 DOI: 10.3390/vaccines13040397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2025] [Revised: 04/04/2025] [Accepted: 04/07/2025] [Indexed: 05/09/2025] Open
Abstract
Children with hemato-oncological diseases represent a heterogeneous population at heightened risk for vaccine-preventable diseases. Their immunosuppressed state reduces vaccine efficacy and raises safety concerns regarding live attenuated vaccines due to the risk of viral reactivation. The immunological and clinical implications of the single conditions are significantly different; therefore, specific vaccination strategies are needed. Despite the availability of vaccine guidelines for immunocompromised patients, clinical practice remains highly variable. It is generally recommended to avoid vaccinations during chemotherapy, with some exceptions for influenza, pneumococcal, and, in some countries, hepatitis B vaccines. The timing of immune recovery after chemotherapy depends on the specific treatment and most guidelines recommend administering vaccines 3-6 months after treatment cessation. Concerning HSCT, the timing of immune recovery is affected by several factors such as the HSCT platform, graft-versus-host disease (GvHD), and infections. Inactivated vaccines are typically administered 3-6 months post-HSCT, while live attenuated vaccines are delayed for at least two years. In children with asplenia or hyposplenism, recommendations focus on immunization against encapsulated bacteria, with tailored schedules based on the patient's age and underlying condition. This paper explores the biological factors influencing vaccination efficacy and safety in pediatric hematology and oncology patients. It also provides an updated overview of the available evidence and current vaccination guidelines. Finally, this paper highlights the main clinical and research areas for further improvement to provide tailored vaccination schedules for this vulnerable population.
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Affiliation(s)
- Baldassarre Martire
- Unità Operativa Complessa (UOC) of Pediatrics and Neonatology, Maternal-Infant Department, “Monsignor A.R. Dimiccoli” Hospital, 70051 Barletta, Italy;
| | - Alessandra Beni
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy;
| | - Maria Felicia Mastrototaro
- Unità Operativa Complessa (UOC) of Pediatrics and Neonatology, Maternal-Infant Department, “Monsignor A.R. Dimiccoli” Hospital, 70051 Barletta, Italy;
| | - Veronica Santilli
- Research Unit of Clinical Immunology and Vaccinology, Academic Department of Pediatrics (DPUO), IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy;
| | - Giorgio Ottaviano
- Department of Pediatrics, Fondazione IRCCS San Gerardo Dei Tintori, 20900 Monza, Italy;
| | - Davide Montin
- Division of Pediatric Immunology and Rheumatology, “Regina Margherita” Children Hospital, 10126 Turin, Italy;
| | - Caterina Rizzo
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Mayla Sgrulletti
- Pediatric Immunopathology and Allergology Unit, Policlinico Tor Vergata, University of Rome Tor Vergata, 00133 Rome, Italy; (M.S.); (V.M.)
| | - Michele Miraglia del Giudice
- Department of Woman, Child and of General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Giorgio Costagliola
- Section of Pediatric Hematology and Oncology, Azienda Ospedaliero Universitaria Pisana, 56100 Pisa, Italy;
| | - Viviana Moschese
- Pediatric Immunopathology and Allergology Unit, Policlinico Tor Vergata, University of Rome Tor Vergata, 00133 Rome, Italy; (M.S.); (V.M.)
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5
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Ramjist JK, Dubljevic T, Lapidus-Krol E, Grace RF, Heeney MM, Oni MO, Towerman A, Davidoff A, Takemoto C, Brown RL, Brungardt J, Beaman M, Rice HE, Nichols S, Saadai P, Carcao M, Langer JC. Correlation of Genetic Mutation With Outcomes in Children With Hereditary Spherocytosis Undergoing Partial Splenectomy: A Multicentre Study. J Pediatr Surg 2025; 60:162229. [PMID: 39999712 DOI: 10.1016/j.jpedsurg.2025.162229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2025] [Accepted: 01/26/2025] [Indexed: 02/27/2025]
Abstract
PURPOSE Hereditary Spherocytosis (HS) is a common genetic hematological disorder causing a life-long hemolytic anemia, with sequela of hemolysis. Children with severe HS commonly undergo partial or total splenectomy (PS, TS); PS confers the theoretical advantage of maintaining splenic immune function, but may be associated with regrowth, ongoing hemolysis, and need for completion splenectomy. HS can be caused by 5 different pathogenic gene variants. A rare and severe form is caused by homozygous/compound heterozygous mutations in the SPTA1 gene, coding for alpha spectrin. We hypothesized this form of HS is associated with worse outcomes following PS. METHODS Following REB approval, a retrospective chart review of children with HS undergoing PS between 2000 and 2023 was conducted across 7 sites in the USA and Canada. Pre- and post-operative hematological values and need for completion splenectomy were analyzed. P < 0.05 was significant. RESULTS Of 51 eligible patients, 10 had SPTA and 41 had non-SPTA1 HS. The SPTA1 group underwent PS at a younger age to non-SPTA1 (5.1 vs 9.6 yr, p = 0.003), and had lower pre-operative hemoglobin (86.2 vs 98.8 g/L, p = 0.04). There were no differences between groups regarding peri-operative surgical or hematological outcomes. The SPTA1 group required completion splenectomy at a higher rate than the non-SPTA1 group (70.0 % vs 24.4 %, p = 0.01). CONCLUSION Children with SPTA1 HS are more likely to require completion splenectomy following PS than children with other HS-causing mutations. These results support the role of genetic testing to permit an evidence-based individualized approach to patient selection for partial vs. total splenectomy. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Joshua K Ramjist
- Division of General & Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, The University of Toronto, Toronto, ON, Canada.
| | - Tamara Dubljevic
- Division of General & Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, The University of Toronto, Toronto, ON, Canada
| | - Eveline Lapidus-Krol
- Division of General & Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Rachael F Grace
- Division of Hematology/Oncology, Boston Children's Hospital, Boston, MA, USA
| | - Matthew M Heeney
- Division of Hematology/Oncology, Boston Children's Hospital, Boston, MA, USA
| | - Morohuntodun O Oni
- Division of Hematology/Oncology, Boston Children's Hospital, Boston, MA, USA
| | - Alison Towerman
- Division of Hematology & Oncology, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Andrew Davidoff
- Department of Surgery, and Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Clifford Takemoto
- Department of Surgery, and Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Rebeccah L Brown
- Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Joseph Brungardt
- Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Makenzie Beaman
- Division of Pediatric General Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Henry E Rice
- Division of Pediatric General Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Shari Nichols
- Department of Surgery, UC Davis Medical Center, Sacramento, CA, USA
| | - Payam Saadai
- Department of Surgery, UC Davis Medical Center, Sacramento, CA, USA
| | - Manuel Carcao
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, The University of Toronto, Toronto, ON, Canada
| | - Jacob C Langer
- Division of General & Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, The University of Toronto, Toronto, ON, Canada
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6
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Huang JF, Kuo LW, Hsu CP, Cheng CT, Chan SY, Li PH, Chen SA, Wang CC, Tee YS, Ou Yang CH, Liao CH, Fu CY. Long-term follow-up of infection, malignancy, thromboembolism, and all-cause mortality risks after splenic artery embolization for blunt splenic injury: comparison with splenectomy and conservative management. BJS Open 2025; 9:zraf037. [PMID: 40231931 PMCID: PMC11997966 DOI: 10.1093/bjsopen/zraf037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2024] [Accepted: 01/26/2025] [Indexed: 04/16/2025] Open
Abstract
BACKGROUND Non-operative management, including splenic artery embolization, is preferred for blunt splenic injuries, but its long-term risks need further investigation. Long-term splenic functions were assessed in patients with blunt splenic injuries, hypothesizing that splenic artery embolization would preserve function and reduce long-term risks. METHODS This retrospective cohort study used Taiwan's National Health Insurance Research Database to analyse patients with blunt splenic injuries from 2004 to 2019. To balance baseline characteristics across the treatment groups, inverse probability of treatment weighting was used based on propensity scores. Outcomes of main interest included the incidence and cumulative infection, malignancy, thromboembolism, and all-cause mortality risks after one year. RESULTS Altogether, 18 771 patients sustained blunt splenic injuries; 8195 were eligible for inclusion. The mean age was 38.4 years, with male predominance (70.5%). Outcomes were compared between splenectomy, splenic artery embolization, and conservative treatment groups. After applying a generalized boosted model with inverse probability of treatment weighting, patients who underwent splenic artery embolizations or conservative treatment had lower infection risks than those in the splenectomy group. The conservative treatment group had a lower malignancy risk than the splenectomy group. Patients with blunt splenic injuries who underwent splenic artery embolizations or conservative treatment had a lower thromboembolism risk than those who underwent splenectomies. CONCLUSION Long-term infection, malignancy, thromboembolism, and all-cause mortality risks were not significantly different between the splenic artery embolization and conservative treatment groups. In contrast, patients who underwent splenectomies had increased infection, malignancy, thromboembolism, and all-cause mortality risks. Clinicians must be familiar with the potential long-term complications associated with the different treatment modalities for splenic injuries and provide appropriate prophylactic measures.
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Affiliation(s)
- Jen-Fu Huang
- Division of Trauma and Emergency Surgery, Department of General Surgery, Jen-Ai Hospital, Dali Branch, Taichung, Taiwan
- Division of Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Centre, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ling-Wei Kuo
- Division of Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Centre, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Po Hsu
- Division of Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Centre, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Tung Cheng
- Division of Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Centre, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Sheng-Yu Chan
- Division of Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Centre, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pei-Hua Li
- Division of Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Centre, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Szu-An Chen
- Division of Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Centre, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Cheng Wang
- Division of Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Centre, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-San Tee
- Division of Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Centre, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Hsiang Ou Yang
- Division of Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Centre, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Hung Liao
- Division of Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Centre, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Yuan Fu
- Division of Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Centre, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Li H, Wang J, Rong L, Li J, Xue Y, Fang Y, Wang Y. Hereditary non-spherocytic hemolytic anemia with GPI mutations successfully treated with allogeneic hematopoietic stem cell transplantation: a first report of two cases. J Mol Med (Berl) 2025; 103:265-271. [PMID: 39836218 DOI: 10.1007/s00109-025-02514-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2024] [Revised: 01/06/2025] [Accepted: 01/07/2025] [Indexed: 01/22/2025]
Abstract
Glucose phosphate isomerase (GPI) deficiency caused by GPI gene mutations is a rare heterogenous condition that causes hereditary non-spherocytic hemolytic anemia (HNSHA). Patients who suffer from severe anemia may need more effective treatment. Here, clinical data and genetic testing results of two cases of HNSHA with GPI mutations treated with allogeneic hematopoietic stem cell transplantation (allo-HSCT) were retrospectively analyzed. Specifically, two unrelated 6-year-old male patients with severe hemolytic anemia had hemoglobin (Hb) below the normal range despite frequent blood transfusions. Two novel missense mutations in the GPI gene were detected in them, respectively. They underwent peripheral blood stem cell (PBSC) transplantation successfully, and there was no anemia post-transplantation. In conclusion, HNSHA caused by mutations of the GPI gene is inherited in an autosomal recessive (AR) manner. Allo-HSCT offers an acceptable therapeutic efficacy and improvement of quality of life in HNSHA patients with GPI mutations. Our study expands the genetic spectrum of GPI deficiency. KEY MESSAGES: We reported for the first time that two cases of hereditary non-spherocytic hemolytic anemia with GPI mutations successfully treated with allogeneic hematopoietic stem cell transplantation (allo-HSCT). Two novel missense mutations in GPI gene were detected in each of the two cases, respectively, which were predicted to be pathogenic or damaging. Our study expands the genetic spectrum of GPI deficiency. Allo-HSCT offers an acceptable therapeutic efficacy and improvement of quality of life in HNSHA patients with GPI mutations.
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Affiliation(s)
- Huimin Li
- Department of Hematology and Oncology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, Jiangsu Province, China
| | - Jiali Wang
- Department of Hematology and Oncology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, Jiangsu Province, China
| | - Liucheng Rong
- Department of Hematology and Oncology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, Jiangsu Province, China
| | - Jian Li
- Department of Oncology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, Jiangsu Province, China
| | - Yao Xue
- Department of Hematology and Oncology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, Jiangsu Province, China
| | - Yongjun Fang
- Department of Hematology and Oncology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, Jiangsu Province, China.
| | - Yaping Wang
- Department of Hematology and Oncology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, Jiangsu Province, China.
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Rey Chaves CE, Díaz S, Gómez Garnica D, Cardenas O, Noguera P, Ortíz Marín M, Velandia V, Conde D, Rojas Gómez MC, Gómez Zuleta M. Postoperative outcomes after splenectomy: a 20-year single-center experience in Colombia. BMC Surg 2024; 24:362. [PMID: 39550596 PMCID: PMC11568579 DOI: 10.1186/s12893-024-02637-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 10/15/2024] [Indexed: 11/18/2024] Open
Abstract
BACKGROUND Splenectomy indications are well documented; however, several infectious complications and potentially life-threatening conditions could arise after splenectomy. We aim to describe a 20-year single-center experience of postoperative outcomes after splenectomy and perform a subgroup analysis according to approach and surgical setting with a 30-day, 90-day, and 1-year follow-up. STUDY DESIGN A retrospective cohort study was conducted between 2003 and 2023. We included all patients aged 18 years and older who underwent splenectomy. A description of clinical and operative variables with infectious outcomes was performed. Subgroup analyses were performed between open or laparoscopic approach and surgical setting. RESULTS A total of 134 patients were included. Female patients constituted 52.99% (n = 71) of cases, with a mean age of 51.01 ± 20.79 years. The most frequent surgical indication for splenectomy was trauma in 31.34% (n = 42), and a laparoscopic approach was indicated in 41.79% (n = 56). Overwhelming post-splenectomy syndrome (OPSI) was evidenced in 2.24% (n = 3) of the population. Surgical characteristics such as operative time, intraoperative blood loss, and intensive care requirement and unit length of stay were higher in open and trauma patients. CONCLUSION Our data describe the demographic, clinical and operative characteristics of patients undergoing splenectomy in Colombia, providing a solid basis for future research. The results obtained on overwhelming postsplenectomy syndrome (OPSI) and postoperative complications are comparable with those reported in the international literature, reinforcing the validity of our findings. Further prospective studies in this population are needed to optimize management strategies and improve clinical outcomes, particularly in higher risk subgroups.
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Affiliation(s)
- Carlos Eduardo Rey Chaves
- Estudiante de posgrado Cirugía General, Facultad de Medicina, Pontificia Universidad Javeriana, Carrera 6A #51A-48, Bogotá, D.C., 111711, Colombia.
| | - Sebastián Díaz
- Cirujano General, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - David Gómez Garnica
- Cirujano General, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Oscar Cardenas
- Estudiante de pregrado, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Paula Noguera
- Estudiante de pregrado, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Manuela Ortíz Marín
- Estudiante de pregrado, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Vanessa Velandia
- Estudiante de pregrado, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Danny Conde
- Cirugía Hepatobiliar y pancreática, Hospital Universitario Mayor - Méderi, Bogotá, Colombia
| | | | - María Gómez Zuleta
- Cirujano General, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
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9
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Zheng K, Dai Q, Chen S, Wang G, Zhao H, Geng X, Huang F. Increased Risk of Short-Term Infection After Liver Transplantation Combined With Splenectomy: Clinical Retrospective Study. Transplant Proc 2024; 56:1870-1877. [PMID: 39237387 DOI: 10.1016/j.transproceed.2024.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 08/24/2024] [Indexed: 09/07/2024]
Abstract
AIM The safety of liver transplantation and simultaneous splenectomy (LTSP) is still controversial. This study aimed to compare postoperative outcomes and infection in liver transplant recipients with and without simultaneous splenectomy. METHODS Clinical data of patients who underwent liver transplantation (LT) from May 2015 to March 2023 in the First Affiliated Hospital of Anhui Medical University were retrospectively analyzed. The main parameters measured were culture results, infection incidence, pathogens, postoperative complications, and overall survival rates. RESULTS Of 149 patients, 35 who underwent LTSP were assigned to the LTSP group, and the remaining 114 were assigned to the LT group. The postoperative infection incidence in the LTSP group was significantly higher than in the LT group within 1 month after transplantation. The two groups had no significant differences in pathogens details and overall survival rate. SP, postoperative days (POD) 3 Neutrophil to lymphocyte ratio (NLR), POD 7 NLR, and POD 7 Hemoglobin (HGB) were independent risk factors for postoperative infection in multivariate analysis. CONCLUSION LTSP increases the risk of short-term postoperative infections, and postoperative NLR can be used as a marker of infection.
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Affiliation(s)
- Kezhong Zheng
- Department of Hepatobiliary Pancreas and Transplantation, First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Qingqing Dai
- Department of Hepatobiliary Pancreas and Transplantation, First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Song Chen
- Department of Hepatobiliary Pancreas and Transplantation, First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Guobin Wang
- Department of Hepatobiliary Pancreas and Transplantation, First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Hongchuan Zhao
- Department of Hepatobiliary Pancreas and Transplantation, First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Xiaoping Geng
- Department of Hepatobiliary Pancreas and Transplantation, First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Fan Huang
- Department of Hepatobiliary Pancreas and Transplantation, First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China.
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10
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Muhmood A, Liu J, Liu D, Liu S, Azzam MM, Junaid MB, Hou L, Le G, Huang K. Mitigation of Deoxynivalenol (DON)- and Aflatoxin B1 (AFB1)-Induced Immune Dysfunction and Apoptosis in Mouse Spleen by Curcumin. Toxins (Basel) 2024; 16:356. [PMID: 39195766 PMCID: PMC11359138 DOI: 10.3390/toxins16080356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Revised: 08/04/2024] [Accepted: 08/06/2024] [Indexed: 08/29/2024] Open
Abstract
In the context of the potential immunomodulatory properties of curcumin in counteracting the detrimental effects of concurrent exposure to Deoxynivalenol (DON) and Aflatoxin B1 (AFB1), a comprehensive 28-days trial was conducted utilizing 60 randomly allocated mice divided into four groups. Administration of curcumin at a dosage of 5 mg/kg body weight in conjunction with DON at 0.1 mg/kg and AFB1 at 0.01 mg/kg body weight was undertaken to assess its efficacy. Results indicated that curcumin intervention demonstrated mitigation of splenic structural damage, augmentation of serum immunoglobulin A (IgA) and immunoglobulin G (IgG) levels, elevation in T lymphocyte subset levels, and enhancement in the mRNA expression levels of pro-inflammatory cytokines TNF-α, IFN-γ, IL-2, and IL-6. Furthermore, curcumin exhibited a suppressive effect on apoptosis in mice, as evidenced by decreased activity of caspase-3 and caspase-9, reduced expression levels of pro-apoptotic markers Bax and Cytochrome-c (Cyt-c) at both the protein and mRNA levels, and the maintenance of a balanced expression ratio of mitochondrial apoptotic regulators Bax and Bcl-2. Collectively, these findings offer novel insights into the therapeutic promise of curcumin in mitigating immunosuppression and apoptotic events triggered by mycotoxin co-exposure.
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Affiliation(s)
- Azhar Muhmood
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China; (A.M.); (J.L.); (D.L.); (S.L.); (L.H.); (G.L.)
- Institute of Animal Nutritional Health, Nanjing Agricultural University, Nanjing 210095, China
- MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China
| | - Jianxin Liu
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China; (A.M.); (J.L.); (D.L.); (S.L.); (L.H.); (G.L.)
- Institute of Animal Nutritional Health, Nanjing Agricultural University, Nanjing 210095, China
- MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China
| | - Dandan Liu
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China; (A.M.); (J.L.); (D.L.); (S.L.); (L.H.); (G.L.)
- Institute of Animal Nutritional Health, Nanjing Agricultural University, Nanjing 210095, China
- MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China
| | - Shuiping Liu
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China; (A.M.); (J.L.); (D.L.); (S.L.); (L.H.); (G.L.)
- Institute of Animal Nutritional Health, Nanjing Agricultural University, Nanjing 210095, China
- MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China
| | - Mahmoud M. Azzam
- Animal Production Department, College of Food and Agriculture Sciences, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Muhammad Bilawal Junaid
- Department of Plant Production, College of Food and Agriculture Sciences, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Lili Hou
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China; (A.M.); (J.L.); (D.L.); (S.L.); (L.H.); (G.L.)
- Institute of Animal Nutritional Health, Nanjing Agricultural University, Nanjing 210095, China
- MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China
| | - Guannan Le
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China; (A.M.); (J.L.); (D.L.); (S.L.); (L.H.); (G.L.)
- Institute of Animal Nutritional Health, Nanjing Agricultural University, Nanjing 210095, China
- MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China
| | - Kehe Huang
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China; (A.M.); (J.L.); (D.L.); (S.L.); (L.H.); (G.L.)
- Institute of Animal Nutritional Health, Nanjing Agricultural University, Nanjing 210095, China
- MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China
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11
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Maraspin V, Ogrinc K, Bogovič P, Rojko T, Ružić-Sabljić E, Wormser GP, Strle F. Erythema Migrans in Patients with Post-Traumatic Splenectomy. Microorganisms 2024; 12:1465. [PMID: 39065233 PMCID: PMC11278708 DOI: 10.3390/microorganisms12071465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/28/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Information on asplenic Lyme borreliosis (LB) patients with erythema migrans (EM) is lacking. We compared the course and outcome of 26 EM episodes in 24 post-trauma splenectomized patients (median age 51 years) diagnosed at a single clinical center in Slovenia during 1994-2023 with those of 52 age- and sex-matched patients with EM but with no history of splenectomy. All patients were followed for one year. A comparison of pre-treatment characteristics revealed that EM in splenectomized patients was of shorter duration before diagnosis (4 vs. 8 days, p = 0.034) with a smaller EM diameter (10.5 vs. 14 cm, p = 0.046), and more frequently fulfilled criteria for disseminated LB (3/26, 11.5% vs. 0%, p = 0.034). Treatment failure occurred in 5/26 (19.2%) EM episodes in splenectomized patients versus 0/52 in non-splenectomized patients (p = 0.003). The five treatment failure cases were retreated with antibiotic regimens used to treat EM and had complete resolution of all symptoms/signs. In conclusion, our study showed that splenectomized adult patients with EM differ somewhat in presentation and more often have treatment failure compared with non-splenectomized patients with EM.
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Affiliation(s)
- Vera Maraspin
- Department of Infectious Diseases, University Medical Centre Ljubljana, 1525 Ljubljana, Slovenia; (V.M.); (K.O.); (P.B.); (T.R.)
| | - Katarina Ogrinc
- Department of Infectious Diseases, University Medical Centre Ljubljana, 1525 Ljubljana, Slovenia; (V.M.); (K.O.); (P.B.); (T.R.)
| | - Petra Bogovič
- Department of Infectious Diseases, University Medical Centre Ljubljana, 1525 Ljubljana, Slovenia; (V.M.); (K.O.); (P.B.); (T.R.)
| | - Tereza Rojko
- Department of Infectious Diseases, University Medical Centre Ljubljana, 1525 Ljubljana, Slovenia; (V.M.); (K.O.); (P.B.); (T.R.)
| | - Eva Ružić-Sabljić
- Institute of Microbiology and Immunology, Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Gary P. Wormser
- Department of Medicine, Division of Infectious Diseases, New York Medical College, Valhalla, NY 10595, USA;
| | - Franc Strle
- Department of Infectious Diseases, University Medical Centre Ljubljana, 1525 Ljubljana, Slovenia; (V.M.); (K.O.); (P.B.); (T.R.)
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12
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Muhmood A, Tang J, Li J, Liu S, Hou L, Le G, Liu D, Huang K. No-observed adverse effect levels of deoxynivalenol and aflatoxin B1 in combination induced immune inhibition and apoptosis in vivo and in vitro. Food Chem Toxicol 2024; 189:114745. [PMID: 38763499 DOI: 10.1016/j.fct.2024.114745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 04/29/2024] [Accepted: 05/16/2024] [Indexed: 05/21/2024]
Abstract
Mycotoxins are toxic metabolites produced by fungal species, commonly exist in animal feeds, and pose a serious risk to human as well as animal health. But limited studies have focused on combined effects of no-observed adverse effect levels. In vivo study, 6 weeks old twenty-four mice were individually exposed to Deoxynivalenol (DON) at 0.1 mg/kg BW, Aflatoxin B1 (AFB1) at 0.01 mg/kg BW, and mixture of DON and AFB1 (0.1 mg/kg BW and 0.01 mg/kg BW, respectively) for 28 days. Then, DON at 0.5 μg/mL, AFB1 at 0.04 μg/mL, and mixtures of DON and AFB1 (0.5 μg/mL, 0.04 μg/mL, respectively) were applied to porcine alveolar macrophages (PAMs) in vitro study. Our in vivo results revealed that the combined no-observed adverse effect levels of DON and AFB1 administration decreased IgA and IgG levels in the serum, the splenic TNF-α, IFN-γ, IL-2 and IL-6 mRNA expression and T-lymphocyte subset levels (CD4+ and CD8+) in the spleen. Additionally, the combined administration increased caspase-3, caspase-9, Bax, Cyt-c, and decreased Bcl-2 protein expression. Taken together, the combined no-observed adverse effect levels of DON and AFB1 could induce immunosuppression, which may be related to apoptosis. This study provides new insights into the combined immune toxicity (DON and AFB1).
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Affiliation(s)
- Azhar Muhmood
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, Jiangsu Province, China; Institute of Animal Nutritional Health, Nanjing Agricultural University, Nanjing, 210095, Jiangsu Province, China; MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, Jiangsu Province, China
| | - Jiangyu Tang
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, Jiangsu Province, China; Institute of Animal Nutritional Health, Nanjing Agricultural University, Nanjing, 210095, Jiangsu Province, China; MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, Jiangsu Province, China
| | - Jinyan Li
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, Jiangsu Province, China; Institute of Animal Nutritional Health, Nanjing Agricultural University, Nanjing, 210095, Jiangsu Province, China; MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, Jiangsu Province, China
| | - Shuiping Liu
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, Jiangsu Province, China; Institute of Animal Nutritional Health, Nanjing Agricultural University, Nanjing, 210095, Jiangsu Province, China; MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, Jiangsu Province, China
| | - Lili Hou
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, Jiangsu Province, China; Institute of Animal Nutritional Health, Nanjing Agricultural University, Nanjing, 210095, Jiangsu Province, China; MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, Jiangsu Province, China
| | - Guannan Le
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, Jiangsu Province, China; Institute of Animal Nutritional Health, Nanjing Agricultural University, Nanjing, 210095, Jiangsu Province, China; MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, Jiangsu Province, China
| | - Dandan Liu
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, Jiangsu Province, China; Institute of Animal Nutritional Health, Nanjing Agricultural University, Nanjing, 210095, Jiangsu Province, China; MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, Jiangsu Province, China
| | - Kehe Huang
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, Jiangsu Province, China; Institute of Animal Nutritional Health, Nanjing Agricultural University, Nanjing, 210095, Jiangsu Province, China; MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, Jiangsu Province, China.
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13
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Zhang JH, Chen H, Ruan DD, Chen Y, Zhang L, Gao MZ, Chen Q, Yu HP, Wu JY, Lin XF, Fang ZT, Zheng XL, Luo JW, Liao LS, Li H. Adult type I Gaucher disease with splenectomy caused by a compound heterozygous GBA1 mutation in a Chinese patient: a case report. Ann Hematol 2024; 103:1765-1774. [PMID: 38509388 DOI: 10.1007/s00277-024-05710-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 03/12/2024] [Indexed: 03/22/2024]
Abstract
Gaucher disease (GD) is an autosomal recessive ailment resulting from glucocerebrosidase deficiency caused by a mutation in the GBA1 gene, leading to multi-organ problems in the liver, spleen, and bone marrow. In China, GD is extremely uncommon and has a lower incidence rate than worldwide. In this study, we report the case of an adult male with an enlarged spleen for 13 years who presented with abdominal distension, severe loss of appetite and weight, reduction of the three-line due to hypersplenism, frequent nosebleeds, and bloody stools. Regrettably, the unexpected discovery of splenic pathology suggestive of splenic Gaucher disease was only made after a splenectomy due to a lack of knowledge about rare disorders. Our patient's delayed diagnosis may have been due to the department where he was originally treated, but it highlights the need for multidisciplinary consultation in splenomegaly of unknown etiology. We then investigated the patient's clinical phenotypes and gene mutation features using genetically phenotypical analysis. The analysis of the GBA1 gene sequence indicated that the patient carried a compound heterozygous mutation consisting of two potentially disease-causing mutations: c.907C > A (p. Leu303Ile) and c.1448 T > C (p. Leu483Pro). While previous research has linked the p. Leu483Pro mutation site to neurologic GD phenotypes (GD2 and GD3), the patients in this investigation were identified as having non-neuronopathic GD1. The other mutation, p. Leu303Ile, is a new GD-related mutation not indexed in PubMed that enriches the GBA1 gene mutation spectrum. Biosignature analysis has shown that both mutations alter the protein's three-dimensional structure, which may be a pathogenic mechanism for GD1 in this patient.
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Affiliation(s)
- Jian-Hui Zhang
- Department of Traditional Chinese Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Hui Chen
- Department of Traditional Chinese Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Dan-Dan Ruan
- Department of Traditional Chinese Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Ying Chen
- Department of Traditional Chinese Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
- Department of Traditional Chinese Medicine, Fujian Provincial Hospital, Fuzhou, China
| | - Li Zhang
- Department of Traditional Chinese Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
- Department of Nephrology, Fujian Provincial Hospital, Fuzhou, China
| | - Mei-Zhu Gao
- Department of Traditional Chinese Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
- Department of Nephrology, Fujian Provincial Hospital, Fuzhou, China
| | - Qian Chen
- Department of Traditional Chinese Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Hong-Ping Yu
- Department of Traditional Chinese Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Jia-Yi Wu
- Department of Traditional Chinese Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Xin-Fu Lin
- Department of Traditional Chinese Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
- Department of Pediatrics, Fujian Provincial Hospital, Fuzhou, China
| | - Zhu-Ting Fang
- Department of Traditional Chinese Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Xiao-Ling Zheng
- Department of Traditional Chinese Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.
- Department of Digestive Endoscopy, Fujian Provincial Hospital, Fuzhou, China.
| | - Jie-Wei Luo
- Department of Traditional Chinese Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.
- Department of Traditional Chinese Medicine, Fujian Provincial Hospital, Fuzhou, China.
| | - Li-Sheng Liao
- Department of Traditional Chinese Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.
- Department of Hematology, Fujian Provincial Hospital, Fuzhou, China.
| | - Hong Li
- Department of Traditional Chinese Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.
- Department of Traditional Chinese Medicine, Fujian Provincial Hospital, Fuzhou, China.
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14
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Ali Q, Ma S, Liu B, Niu J, Liu M, Mustafa A, Li D, Wang Z, Sun H, Cui Y, Shi Y. Supplementing Ryegrass Ameliorates Commercial Diet-Induced Gut Microbial Dysbiosis-Associated Spleen Dysfunctions by Gut-Microbiota-Spleen Axis. Nutrients 2024; 16:747. [PMID: 38474875 DOI: 10.3390/nu16050747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/24/2024] [Accepted: 02/29/2024] [Indexed: 03/14/2024] Open
Abstract
The type and composition of food strongly affect the variation and enrichment of the gut microbiota. The gut-microbiota-spleen axis has been developed, incorporating the spleen's function and maturation. However, how short-chain fatty-acid-producing gut microbiota can be considered to recover spleen function, particularly in spleens damaged by changed gut microbiota, is unknown in geese. Therefore, the gut microbial composition of the caecal chyme of geese was assessed by 16S rRNA microbial genes, and a Tax4Fun analysis identified the enrichment of KEGG orthologues involved in lipopolysaccharide production. The concentrations of LPS, reactive oxygen species, antioxidant/oxidant enzymes, and immunoglobulins were measured from serum samples and spleen tissues using ELISA kits. Quantitative reverse transcription PCR was employed to detect the Kelch-like-ECH-associated protein 1-Nuclear factor erythroid 2-related factor 2 (Keap1-Nrf2), B cell and T cell targeting markers, and anti-inflammatory/inflammatory cytokines from the spleen tissues of geese. The SCFAs were determined from the caecal chyme of geese by using gas chromatography. In this study, ryegrass-enriched gut microbiota such as Eggerthellaceae, Oscillospiraceae, Rikenellaceae, and Lachnospiraceae attenuated commercial diet-induced gut microbial alterations and spleen dysfunctions in geese. Ryegrass significantly improved the SCFAs (acetic, butyric, propionic, isovaleric, and valeric acids), AMPK pathway-activated Nrf2 redox signaling cascades, B cells (B220, CD19, and IgD), and T cells (CD3, CD4, CD8, and IL-2, with an exception of IL-17 and TGF-β) to activate anti-inflammatory cytokines (IL-4 and IL-10) and immunoglobulins (IgA, IgG, and IgM) in geese. In conclusion, ryegrass-improved reprogramming of the gut microbiota restored the spleen functions by attenuating LPS-induced oxidative stress and systemic inflammation through the gut-microbiota-spleen axis in geese.
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Affiliation(s)
- Qasim Ali
- Department of Animal Nutrition and Feed Science, College of Animal Science and Technology, Henan Agricultural University, Zhengzhou 450046, China
| | - Sen Ma
- Department of Animal Nutrition and Feed Science, College of Animal Science and Technology, Henan Agricultural University, Zhengzhou 450046, China
- Henan Key Laboratory of Innovation and Utilization of Grassland Resources, Zhengzhou 450002, China
- Henan Herbage Engineering Technology Research Center, Zhengzhou 450001, China
| | - Boshuai Liu
- Department of Animal Nutrition and Feed Science, College of Animal Science and Technology, Henan Agricultural University, Zhengzhou 450046, China
- Henan Key Laboratory of Innovation and Utilization of Grassland Resources, Zhengzhou 450002, China
- Henan Herbage Engineering Technology Research Center, Zhengzhou 450001, China
| | - Jiakuan Niu
- Department of Animal Nutrition and Feed Science, College of Animal Science and Technology, Henan Agricultural University, Zhengzhou 450046, China
| | - Mengqi Liu
- Department of Animal Nutrition and Feed Science, College of Animal Science and Technology, Henan Agricultural University, Zhengzhou 450046, China
| | - Ahsan Mustafa
- Department of Animal Nutrition, Sichuan Agricultural University, Chengdu 611130, China
| | - Defeng Li
- Department of Animal Nutrition and Feed Science, College of Animal Science and Technology, Henan Agricultural University, Zhengzhou 450046, China
- Henan Key Laboratory of Innovation and Utilization of Grassland Resources, Zhengzhou 450002, China
- Henan Herbage Engineering Technology Research Center, Zhengzhou 450001, China
| | - Zhichang Wang
- Department of Animal Nutrition and Feed Science, College of Animal Science and Technology, Henan Agricultural University, Zhengzhou 450046, China
- Henan Key Laboratory of Innovation and Utilization of Grassland Resources, Zhengzhou 450002, China
- Henan Herbage Engineering Technology Research Center, Zhengzhou 450001, China
| | - Hao Sun
- Department of Animal Nutrition and Feed Science, College of Animal Science and Technology, Henan Agricultural University, Zhengzhou 450046, China
- Henan Key Laboratory of Innovation and Utilization of Grassland Resources, Zhengzhou 450002, China
- Henan Herbage Engineering Technology Research Center, Zhengzhou 450001, China
| | - Yalei Cui
- Department of Animal Nutrition and Feed Science, College of Animal Science and Technology, Henan Agricultural University, Zhengzhou 450046, China
- Henan Key Laboratory of Innovation and Utilization of Grassland Resources, Zhengzhou 450002, China
- Henan Herbage Engineering Technology Research Center, Zhengzhou 450001, China
| | - Yinghua Shi
- Department of Animal Nutrition and Feed Science, College of Animal Science and Technology, Henan Agricultural University, Zhengzhou 450046, China
- Henan Key Laboratory of Innovation and Utilization of Grassland Resources, Zhengzhou 450002, China
- Henan Herbage Engineering Technology Research Center, Zhengzhou 450001, China
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15
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Mitani H, Chosa K, Kondo S, Fukumoto W, Kajiwara K, Yoshimatsu R, Matsumoto T, Yamagami T, Awai K. Perioperative proximal splenic artery embolization in cirrhotic patients with splenomegaly. MINIM INVASIV THER 2024; 33:35-42. [PMID: 37909461 DOI: 10.1080/13645706.2023.2275652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/04/2023] [Indexed: 11/03/2023]
Abstract
INTRODUCTION The purpose of this study was to determine the effect of proximal splenic artery embolization (SAE) in cirrhotic patients with splenomegaly who underwent surgical laparotomy. MATERIAL AND METHODS This retrospective observational study included 8 cirrhotic patients with splenomegaly. They underwent proximal SAE before- (n = 6) or after (n = 2) laparotomy. Vascular plugs or coils were placed in the proximal splenic artery. The diameter of the portal vein and the splenic volume were recorded. Clinical outcome assessments included platelet counts, the model for end-stage liver disease (MELD) score, and complications. RESULTS After embolization, the portal venous diameter was significantly smaller (pre: 13.6 ± 2.7 mm, post: 12.5 ± 2.3 mm, p = 0.023), the splenic volume was significantly decreased (pre: 463.2 ± 145.7 ml, post: 373.3 ± 108.5 ml, p = 0.008) and the platelet count was significantly higher (pre: 69.6 ± 30.8 × 103/μl, post: 86.8 ± 27.7 × 103/μl, p = 0.035). Before embolization, the median MELD score was 12; after embolization, it was 11 (p = 0.026). No patient developed post-treatment complications after embolization. CONCLUSIONS The reduction of hypersplenism by perioperative proximal SAE may be safe and reduce the surgical risk in cirrhotic patients with splenomegaly.
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Affiliation(s)
- Hidenori Mitani
- Department of Diagnostic Radiology, Hiroshima University Hospital, Hiroshima, Japan
| | - Keigo Chosa
- Department of Diagnostic Radiology, Hiroshima University Hospital, Hiroshima, Japan
| | - Shota Kondo
- Department of Diagnostic Radiology, Hiroshima University Hospital, Hiroshima, Japan
| | - Wataru Fukumoto
- Department of Diagnostic Radiology, Hiroshima University Hospital, Hiroshima, Japan
| | - Kenji Kajiwara
- Department of Diagnostic Radiology, National Hospital Organization Kure Medical Center, Hiroshima, Japan
| | - Rika Yoshimatsu
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kochi, Japan
| | - Tomohiro Matsumoto
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kochi, Japan
| | - Takuji Yamagami
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kochi, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Hiroshima University Hospital, Hiroshima, Japan
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16
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Jin Y, Shi M, Feng J, Zhang Z, Zhao B, Li Q, Yu L, Lu Z. Splenectomy ameliorates liver cirrhosis by restoring the gut microbiota balance. Cell Mol Life Sci 2024; 81:32. [PMID: 38214780 PMCID: PMC11072996 DOI: 10.1007/s00018-023-05055-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/27/2023] [Accepted: 11/15/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Dysbiosis of gut microbiota is frequent in liver cirrhosis (LC) patients, and splenectomy (SP) has been reported to improve LC. Herein, we report the effects of SP on gut microbiota, especially on Veillonella parvula, a Gram-negative coccus of the gastrointestinal tract, in LC mice, and the underlying mechanism. METHODS LC mice models were induced by tail vein injection of concanavalin A (ConA), followed by SP. 16 s rRNA sequencing was conducted to analyze the effects of ConA induction and SP on mouse gut microbiota and the gene expression affected by gut microbiota. LC mice receiving SP were gavaged with Veillonella parvula. Likewise, hepatic stellate cells (HSC) and hepatocytes (HC) were induced with conditioned medium (CM) of Veillonella parvula. RESULTS SP alleviated LC in mice by restoring gut barrier function and maintaining gut microbiota balance, with Veillonella as the key genus. The Veillonella parvula gavage on LC mice reversed the ameliorative effect of SP. The CM of Veillonella parvula promoted the activation of HSC and the release of IL-6, IL-1β, and TNF-α. Also, the CM of Veillonella parvula induced HC pyroptosis and the release of ALT and AST. Veillonella parvula represented an imbalance in the gut microbiota, thus enhancing gut-derived endotoxins in the liver with the main target being Tlr4/Nlrp3. Inhibition of Tlr4 blocked Veillonella parvula-induced HC damage, HSC activation, and subsequent LC progression. CONCLUSION SP-mediated gut microbiota regulation ameliorates ConA-related LC progression by inhibiting Tlr4/Nlrp3 in the liver.
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Affiliation(s)
- Ye Jin
- Department of General Surgery, Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, 150081, Heilongjiang, People's Republic of China.
| | - Meixin Shi
- Department of Pathophysiology, Harbin Medical University, Harbin, 150086, Heilongjiang, People's Republic of China
| | - Jing Feng
- Department of General Surgery, Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, 150081, Heilongjiang, People's Republic of China
| | - Zhengwei Zhang
- Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, Heilongjiang, People's Republic of China
| | - Bingbing Zhao
- Department of Pathophysiology, Harbin Medical University, Harbin, 150086, Heilongjiang, People's Republic of China
| | - Qingyu Li
- Department of General Surgery, Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, 150081, Heilongjiang, People's Republic of China
| | - Ligen Yu
- Department of Pathophysiology, Harbin Medical University, Harbin, 150086, Heilongjiang, People's Republic of China
| | - Zhaoyang Lu
- Department of General Surgery, Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, 150081, Heilongjiang, People's Republic of China.
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Segger L, Lerchbaumer MH, Collettini F, Hamm B, Fleckenstein FN, Fehrenbach U, Gebauer B, Auer TA. Percutaneous Computed Tomography (CT) Fluoroscopy-Guided Biopsy of the Spleen Using Fibrin Glue as a Sealant. Diagnostics (Basel) 2024; 14:162. [PMID: 38248038 PMCID: PMC10814976 DOI: 10.3390/diagnostics14020162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
Some authors consider the risk of bleeding an absolute contraindication to percutaneous image-guided splenic puncture. While splenic punctures are mainly performed at specialized centers, no technique for the closure of the puncture tract has been broadly established. The aim of this study was to investigate the effectiveness and safety of a percutaneous image-guided biopsy of the spleen using fibrin glue to plug the tract. A total of 27 requests for splenic image-guided interventions were identified between 2010 and 2021 and considered for inclusion in our retrospective single-center study. Seven patients needed to be excluded, which left twenty patients who underwent a percutaneous computed tomography (CT) fluoroscopy-guided biopsy of a splenic lesion during this period. In all patients, a 17G coaxial needle with an 18G core biopsy needle was used. Diagnostic adequacy and accuracy were evaluated, and complications were classified using the CIRSE classification system for adverse events. Diagnostic adequacy was 100% (20/20), and a median of four samples were collected. Diagnostic accuracy was 80% (16/20). The four off-target samples included one inconclusive finding and three samples of regular spleen tissue. The overall complication rate was 5% (1/20). No mild (grade 1-2) or moderate (grade 3-4) complications occurred. One severe (grade 5-6) complication occurred. Although controversial and potentially high-risk, diagnostic percutaneous biopsies of the spleen appear to be relatively safe with the use of fibrin glue to seal the tract.
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Affiliation(s)
- Laura Segger
- Department of Radiology, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.C.); (B.H.); (F.N.F.); (U.F.); (B.G.); (T.A.A.)
| | | | - Federico Collettini
- Department of Radiology, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.C.); (B.H.); (F.N.F.); (U.F.); (B.G.); (T.A.A.)
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.C.); (B.H.); (F.N.F.); (U.F.); (B.G.); (T.A.A.)
| | - Florian Nima Fleckenstein
- Department of Radiology, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.C.); (B.H.); (F.N.F.); (U.F.); (B.G.); (T.A.A.)
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany
| | - Uli Fehrenbach
- Department of Radiology, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.C.); (B.H.); (F.N.F.); (U.F.); (B.G.); (T.A.A.)
| | - Bernhard Gebauer
- Department of Radiology, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.C.); (B.H.); (F.N.F.); (U.F.); (B.G.); (T.A.A.)
| | - Timo A. Auer
- Department of Radiology, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.C.); (B.H.); (F.N.F.); (U.F.); (B.G.); (T.A.A.)
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany
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Luo X, Lin X, Lin R, Yang Y, Wang C, Fang H, Huang H, Lu F. Analysis of long-term outcomes after minimally invasive spleen-preserving distal pancreatectomy under the 'Kimura-first' strategy. J Minim Access Surg 2024; 20:81-88. [PMID: 37843169 PMCID: PMC10898644 DOI: 10.4103/jmas.jmas_350_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 04/06/2023] [Accepted: 07/03/2023] [Indexed: 10/17/2023] Open
Abstract
INTRODUCTION Spleen-preserving distal pancreatectomy (SPDP) can be carried out by the Kimura technique (KT) or Warshaw technique (WT). This study aimed to evaluate the long-term post-operative outcomes of the two minimally invasive SPDP methods under the 'Kimura-first' strategy with a particular focus on the haemodynamic changes in the splenogastric circulation. PATIENTS AND METHODS The electronic medical records and follow-up data of patients who underwent minimally invasive SPDP in our centre from March 2016 to July 2022 were reviewed. The haemodynamic changes in splenogastric circulation were monitored by post-operative computed tomography (CT) images, and the risks they caused were assessed by long-term follow-up. RESULTS A total of 112 patients (KT = 93 and WT = 19) were included in the study. The tumour size in the WT group was significantly larger than that in the KT group ( P = 0.02). We also found less blood loss for patients who underwent KT ( P = 0.02). The occurrence of gastric varices was significantly higher in the WT group ( P = 0.022). There was no gastrointestinal bleeding in either group. There were two cases of splenic infarction in the WT group (11.1%), and the incidence was higher than that in the KT group ( P = 0.026). The infarct area gradually decreased during periodic CT examinations and disappeared completely at the last review. The two groups of patients had similar results across the 15 items in three areas of the quality of life questionnaire. CONCLUSIONS The 'Kimura-first' strategy, in which the WT is used as an alternative to the KT when the splenic vessels cannot be safely preserved, is feasible, and safe for minimally invasive SPDP.
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Affiliation(s)
- Xin Luo
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Xianchao Lin
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Ronggui Lin
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Yuanyuan Yang
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Congfei Wang
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Haizong Fang
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Heguang Huang
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Fengchun Lu
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
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19
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Annecchiarico M, Varricchio A. Robotic Treatment of Splenic Diseases. SCRUB NURSE IN MINIMALLY INVASIVE AND ROBOTIC GENERAL SURGERY 2024:315-325. [DOI: 10.1007/978-3-031-42257-7_33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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20
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Chen Z, Lin Y. A commentary on 'Minimally invasive versus open total pancreatectomy: a systematic review and meta-analysis'. Int J Surg 2024; 110:600-601. [PMID: 37738018 PMCID: PMC10793832 DOI: 10.1097/js9.0000000000000770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/09/2023] [Indexed: 09/23/2023]
Affiliation(s)
| | - Yonghua Lin
- Hepatological Surgery Department, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China
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21
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Mansour M, Nassar K, Masri M, Kanas M, Aldrea F, Alzaylaa Y, Salloum H, Ahmad Y, Samha R, Kanjawi O. A massive primary hydatid splenic cyst was successfully managed through open total splenectomy: a case report and review article. Ann Med Surg (Lond) 2023; 85:5208-5213. [PMID: 37811073 PMCID: PMC10553008 DOI: 10.1097/ms9.0000000000001217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/12/2023] [Indexed: 10/10/2023] Open
Abstract
Background Cystic echinococcosis (CE) is a parasitic infection that is caused by the tapeworm Echinococcus granulosus. CE is very common, especially in the rural areas of developing countries. The most commonly affected organs by hydatid cysts are the liver and the lungs. However, the primary splenic hydatid cyst (PSHC) is a very rare manifestation of CE with an incidence of 0.5-8%. Case presentation A 17-year-old female patient presented with abdominal pain which gradually increased over months, along with anorexia and vomiting. Computerized tomography showed a massive splenic cystic mass. An open total splenectomy was performed. By follow-up, the platelet count and a postoperative chest X-ray were normal. The patient was prescribed Albendazole and analgesics. The pathological study confirmed the diagnosis of PSHC. Conclusion Despite the occurrence of PSHC being very rare, it is very important to take it into consideration, especially in endemic areas.
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Affiliation(s)
| | | | - Mahmod Masri
- Faculty of Medicine, Al Azhar University, Cairo, Egypt
| | - Mahmoud Kanas
- Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | | | - Yara Alzaylaa
- Department of Internal Medicine, AlMujtahed Hospital, Damascus
| | | | | | | | - Omar Kanjawi
- Department of General Surgery, Tishreen Hospital, Manbij, Aleppo, Syrian Arab Republic
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22
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Okubo S, Shindoh J, Kobayashi Y, Hashimoto M. New Prediction Model for Platelet Increase After Non-Trauma Splenectomy. Indian J Surg 2023; 85:1075-1080. [DOI: 10.1007/s12262-022-03644-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/03/2022] [Indexed: 12/16/2022] Open
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Li Y, Zhang Y, Qin L, Shang H, Li P, Xiao B, Ye Y, Xu X, Zhang X, Wang L. Analysis of Hematological Indices and Splenectomy Rates in 2,130 Patients with Hemoglobin H Diseases or β-Thalassemia. Acta Haematol 2023; 146:458-464. [PMID: 37573774 DOI: 10.1159/000533233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 07/24/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION Splenomegaly and hypersplenism are common complications of thalassemia patients due to the excessive clearance of defective red blood cells from the spleen. To date, splenectomy has been considered one of the most effective treatments for splenomegaly, reducing clinical severity among thalassemia patients. Thus, we aim to investigate the differences in splenectomy rates and hematological indices among thalassemia patients with different genotypes. METHOD In this study, we analyzed the clinical data of thalassemia in 2,130 patients admitted to the 923rd Hospital of the People's Liberation Army from January 2006 to December 2020, and the statistical software SPSS 26.0 was applied to analyze the data. RESULT Of the 2,130 patients with thalassemia, 265 patients underwent splenectomy. It was determined that significantly more patients with hemoglobin H (HbH) disease, a form of α-thalassemia, have undergone splenectomy than β-thalassemia patients (20% vs. 7%). Further, HbH disease patients were diagnosed at a significantly older age than β-thalassemia patients. CONCLUSION The greater probability of HbH disease patients undergoing splenectomy is likely influenced by multiple factors, including their lower dependency on transfusion, leading to high spleen compensatory stress on the spleen, and the destruction of defective erythrocytes. In contrast, β-thalassemia is clinically more severe and less tolerant of hemoglobin fluctuations. Based on these findings, clinicians are suggested to pay more attention to HbH disease patients as many of them are still under-transfused, which could lead to chronic hemolysis and more severe hepatosplenomegaly. These results might offer insight for improving the clinical management of patients with different types of thalassemia.
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Affiliation(s)
- Yaoyun Li
- Department of Pediatrics, 923rd Hospital of the People's Liberation Army, Nanning, China
| | - Yaqing Zhang
- Office of Clinical Trial Institute, Jiangbin Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Lang Qin
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China,
- Innovation Center for Diagnostics and Treatment of Thalassemia, Nanfang Hospital, Southern Medical University, Guangzhou, China,
- Guangdong Genetics Testing Engineering Research Center, Guangzhou, China,
| | - Hangning Shang
- Clinical Laboratory, 923rd Hospital of the People's Liberation Army, Nanning, China
| | - Pingping Li
- Clinical Laboratory, 923rd Hospital of the People's Liberation Army, Nanning, China
| | - Bin Xiao
- Department of Pediatrics, 923rd Hospital of the People's Liberation Army, Nanning, China
| | - Yuhua Ye
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Innovation Center for Diagnostics and Treatment of Thalassemia, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Genetics Testing Engineering Research Center, Guangzhou, China
| | - Xiangmin Xu
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Innovation Center for Diagnostics and Treatment of Thalassemia, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Genetics Testing Engineering Research Center, Guangzhou, China
| | - Xinhua Zhang
- Department of Hematology, 923rd Hospital of the People's Liberation Army, Nanning, China
| | - Li Wang
- Department of Pediatrics, 923rd Hospital of the People's Liberation Army, Nanning, China
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Hsieh CL, Tsai TS, Peng CM, Cheng TC, Liu YJ. Spleen-preserving distal pancreatectomy from multi-port to reduced-port surgery approach. World J Gastrointest Surg 2023; 15:1501-1511. [PMID: 37555124 PMCID: PMC10405122 DOI: 10.4240/wjgs.v15.i7.1501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/28/2023] [Accepted: 05/06/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Minimally invasive pancreatic surgery via the multi-port approach has become a primary surgical method for distal pancreatectomy (DP) due to its advantages of lower wound pain and superior cosmetic results. Some studies have applied reduced-port techniques for DP in an attempt to enhance cosmetic outcomes due to the minimally invasive effects. Numerous recent review studies have compared multi-port laparoscopic DP (LDP) and multi-port robotic DP (RDP); most of these studies concluded multi-port RDP is more beneficial than multi-port LDP for spleen preservation. However, there have been no comprehensive reviews of the value of reduced-port LDP and reduced-port RDP. AIM To search for and review the studies on spleen preservation and the clinical outcomes of minimally invasive DP that compared reduced-port DP surgery with multi-port DP surgery. METHODS The PubMed medical database was searched for articles published between 2013 and 2022. The search terms were implemented using the following Boolean search algorithm: ("distal pancreatectomy" OR "left pancreatectomy" OR "peripheral pancreatic resection") AND ("reduced-port" OR "single-site" OR "single-port" OR "dual-incision" OR "single-incision") AND ("spleen-preserving" OR "spleen preservation" OR "splenic preservation"). A literature review was conducted to identify studies that compared the perioperative outcomes of reduced-port LDP and reduced-port RDP. RESULTS Fifteen articles published in the period from 2013 to 2022 were retrieved using three groups of search terms. Two studies were added after manually searching the related papers. Finally, 10 papers were selected after removing case reports (n = 3), non-English language papers (n = 1), technique papers (n = 1), reviews (n = 1), and animal studies (n = 1). The common items were defined as items reported in more than five papers, and data on these common items were extracted from all papers. The ten studies included a total of 337 patients (females/males: 231/106) who underwent DP. In total, 166 patients (females/males, 106/60) received multi-port LDP, 126 (females/males, 90/36) received reduced-port LDP, and 45 (females/males, 35/10) received reduced-port RDP. CONCLUSION Reduced-port RDP leads to a lower intraoperative blood loss, a lower postoperative pancreatic fistula rate, and shorter hospital stay and follow-up duration, but has a lower spleen preservation rate.
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Affiliation(s)
- Ching-Lung Hsieh
- Department of Computer Science and Information Engineering, Feng Chia University, Taichung 40724, Taiwan
- Department of Surgery, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Tung-Sheng Tsai
- PhD Program of Electrical and Communications Engineering, Feng Chia University, Taichung 40724, Taiwan
| | - Cheng-Ming Peng
- Department of Surgery, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Teng-Chieh Cheng
- Da Vinci Minimally Invasive Surgery Center, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Yi-Jui Liu
- Department of Automatic Control Engineering, Feng Chia University, Taichung 407, Taiwan
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Wang T, Ge X, Li X, Liu T, Liang F, Zhou Z. A 0D-3D multi-scale model of the portal venous system coupled with the entire cardiovascular system applied to predict postsplenectomy hemodynamic metrics. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38083238 DOI: 10.1109/embc40787.2023.10340121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Splenectomy is a common surgery for portal hypertensive patients with splenomegaly. Although splenectomy is able to effectively relieve the complications of portal hypertension, it also increases the risk of portal venous system thrombosis remarkably. Previous studies demonstrated that the hemodynamic metrics of the portal venous system could be employed in predicting the risk of postsplenectomy thrombosis, and 3D models were utilized to simulate the blood flow in the portal venous system. Aiming to reflect the global effect of splenectomy and better simulate the hemodynamic metrics, in this study, a 0D-3D multi-scale model of the portal venous system coupled with the entire cardiovascular system was constructed based on population-averaged data in combination with patient-specific preoperative clinical measurements. The pre- and postoperative global blood flows as well as the variations were calculated successfully, and the flow field and time-averaged wall shear stress of the portal venous system were simulated. The model-simulated spatial distributions of the hemodynamic metrics in the portal venous system were comparable with the regions suffering from thrombosis after splenectomy. These results imply that the present model could reflect the reallocation of the blood flow in the splanchnic circulation after splenectomy and simulate the hemodynamic metrics of the portal venous system, which would promote the more accurate risk stratification of postsplenectomy thrombosis and improve the patient-specific postoperative management.Clinical Relevance- The computational model developed by the present study provides a feasible scheme for simulating postsplenectomy hemodynamic metrics of the portal venous system more accurately, which would benefit the risk prediction and prophylaxis of portal venous system thrombosis for portal hypertensive patients receiving splenectomy.
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Kim Y, Koutsouras GW, Bourdages G, Beutler T. Insidious onset of spontaneous spinal epidural hematoma in immune thrombocytopenic purpura: a case-based review. Childs Nerv Syst 2023; 39:1903-1909. [PMID: 37126139 DOI: 10.1007/s00381-023-05963-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/16/2023] [Indexed: 05/02/2023]
Abstract
INTRODUCTION Spontaneous spinal epidural hematoma (SSEH) can result from various etiologies with a variable degree of neurological deficits. Here, we describe a rare case of SEH secondary to immune thrombocytopenic purpura (ITP) in a child and review the literature of SSEH caused by ITP. CASE REPORT A 9-year-old female who presented with rapid neurological decline, including bowel and bladder incontinence and paraparesis. A SSEH was observed extending from C2 to T6, causing a mass effect on the spinal cord. Her platelet count was only 7000/µL. Multidisciplinary care was established with neurosurgery, pediatric hematology, and pediatric surgery. The patient was managed emergently with splenectomy and surgical evacuation, with multilevel laminectomy and laminoplasty for evacuation of the hematoma. After a short course of rehabilitation, the patient regained all neurological function. CONCLUSION We report the first case of cervicothoracic SSEH secondary to ITP in a child managed with emergent splenectomy and surgical evacuation with multilevel lamoplasty. We also described the methods of timely diagnosis, urgent management, and overall prognosis of patients with this condition.
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Affiliation(s)
- YeonSoo Kim
- Department of Neurosurgery, SUNY Upstate University Hospital, Syracuse, NY, USA
| | - George W Koutsouras
- Department of Neurosurgery, SUNY Upstate University Hospital, Syracuse, NY, USA.
| | - George Bourdages
- Department of Neurosurgery, SUNY Upstate University Hospital, Syracuse, NY, USA
| | - Timothy Beutler
- Department of Neurosurgery, SUNY Upstate University Hospital, Syracuse, NY, USA
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Mizera J, Pilch J, Giordano U, Krajewska M, Banasik M. Therapy in the Course of Kidney Graft Rejection-Implications for the Cardiovascular System-A Systematic Review. Life (Basel) 2023; 13:1458. [PMID: 37511833 PMCID: PMC10381422 DOI: 10.3390/life13071458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023] Open
Abstract
Kidney graft failure is not a homogenous disease and the Banff classification distinguishes several types of graft rejection. The maintenance of a transplant and the treatment of its failure require specific medications and differ due to the underlying molecular mechanism. As a consequence, patients suffering from different rejection types will experience distinct side-effects upon therapy. The review is focused on comparing treatment regimens as well as presenting the latest insights into innovative therapeutic approaches in patients with an ongoing active ABMR, chronic active ABMR, chronic ABMR, acute TCMR, chronic active TCMR, borderline and mixed rejection. Furthermore, the profile of cardiovascular adverse effects in relation to the applied therapy was subjected to scrutiny. Lastly, a detailed assessment and comparison of different approaches were conducted in order to identify those that are the most and least detrimental for patients suffering from kidney graft failure.
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Affiliation(s)
- Jakub Mizera
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, 50-551 Wroclaw, Poland
| | - Justyna Pilch
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, 50-551 Wroclaw, Poland
| | - Ugo Giordano
- University Clinical Hospital, Wroclaw Medical University, 50-551 Wroclaw, Poland
| | - Magdalena Krajewska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, 50-551 Wroclaw, Poland
| | - Mirosław Banasik
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, 50-551 Wroclaw, Poland
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Li G, Qiang Y, Li H, Li X, Dao M, Karniadakis GE. In silico and in vitro study of the adhesion dynamics of erythrophagocytosis in sickle cell disease. Biophys J 2023; 122:2590-2604. [PMID: 37231647 PMCID: PMC10323029 DOI: 10.1016/j.bpj.2023.05.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/12/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023] Open
Abstract
Erythrophagocytosis occurring in the spleen is a critical process for removing senescent and diseased red blood cells (RBCs) from the microcirculation. Although some progress has been made in understanding how the biological signaling pathways mediate the phagocytic processes, the role of the biophysical interaction between RBCs and macrophages, particularly under pathological conditions such as sickle cell disease, has not been adequately studied. Here, we combine computational simulations with microfluidic experiments to quantify RBC-macrophage adhesion dynamics under flow conditions comparable to those in the red pulp of the spleen. We also investigate the RBC-macrophage interaction under normoxic and hypoxic conditions. First, we calibrate key model parameters in the adhesion model using microfluidic experiments for normal and sickle RBCs under normoxia and hypoxia. We then study the adhesion dynamics between the RBC and the macrophage. Our simulation illustrates three typical adhesion states, each characterized by a distinct dynamic motion of the RBCs, namely firm adhesion, flipping adhesion, and no adhesion (either due to no contact with macrophages or detachment from the macrophages). We also track the number of bonds formed when RBCs and macrophages are in contact, as well as the contact area between the two interacting cells, providing mechanistic explanations for the three adhesion states observed in the simulations and microfluidic experiments. Furthermore, we quantify, for the first time to our knowledge, the adhesive forces between RBCs (normal and sickle) and macrophages under different oxygenated conditions. Our results show that the adhesive forces between normal cells and macrophages under normoxia are in the range of 33-58 pN and 53-92 pN for sickle cells under normoxia and 155-170 pN for sickle cells under hypoxia. Taken together, our microfluidic and simulation results improve our understanding of the biophysical interaction between RBCs and macrophages in sickle cell disease and provide a solid foundation for investigating the filtration function of the splenic macrophages under physiological and pathological conditions.
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Affiliation(s)
- Guansheng Li
- Division of Applied Mathematics, Brown University, Providence, Rhode Island
| | - Yuhao Qiang
- Department of Materials Science and Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - He Li
- School of Chemical, Materials and Biomedical Engineering, University of Georgia, Athens, Georgia.
| | - Xuejin Li
- Department of Engineering Mechanics and Center for X-Mechanics, Zhejiang University, Hangzhou, China
| | - Ming Dao
- Department of Materials Science and Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts.
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Li G, Qiang Y, Li H, Li X, Buffet PA, Dao M, Karniadakis GE. A combined computational and experimental investigation of the filtration function of splenic macrophages in sickle cell disease. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.05.31.543007. [PMID: 37398427 PMCID: PMC10312537 DOI: 10.1101/2023.05.31.543007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Being the largest lymphatic organ in the body, the spleen also constantly controls the quality of red blood cells (RBCs) in circulation through its two major filtration components, namely interendothelial slits (IES) and red pulp macrophages. In contrast to the extensive studies in understanding the filtration function of IES, there are relatively fewer works on investigating how the splenic macrophages retain the aged and diseased RBCs, i.e., RBCs in sickle cell disease (SCD). Herein, we perform a computational study informed by companion experiments to quantify the dynamics of RBCs captured and retained by the macrophages. We first calibrate the parameters in the computational model based on microfluidic experimental measurements for sickle RBCs under normoxia and hypoxia, as those parameters are not available in the literature. Next, we quantify the impact of a set of key factors that are expected to dictate the RBC retention by the macrophages in the spleen, namely, blood flow conditions, RBC aggregation, hematocrit, RBC morphology, and oxygen levels. Our simulation results show that hypoxic conditions could enhance the adhesion between the sickle RBCs and macrophages. This, in turn, increases the retention of RBCs by as much as five-fold, which could be a possible cause of RBC congestion in the spleen of patients with SCD. Our study on the impact of RBC aggregation illustrates a 'clustering effect', where multiple RBCs in one aggregate can make contact and adhere to the macrophages, leading to a higher retention rate than that resulting from RBC-macrophage pair interactions. Our simulations of sickle RBCs flowing past macrophages for a range of blood flow velocities indicate that the increased blood velocity could quickly attenuate the function of the red pulp macrophages on detaining aged or diseased RBCs, thereby providing a possible rationale for the slow blood flow in the open circulation of the spleen. Furthermore, we quantify the impact of RBC morphology on their tendency to be retained by the macrophages. We find that the sickle and granular-shaped RBCs are more likely to be filtered by macrophages in the spleen. This finding is consistent with the observation of low percentages of these two forms of sickle RBCs in the blood smear of SCD patients. Taken together, our experimental and simulation results aid in our quantitative understanding of the function of splenic macrophages in retaining the diseased RBCs and provide an opportunity to combine such knowledge with the current knowledge of the interaction between IES and traversing RBCs to apprehend the complete filtration function of the spleen in SCD.
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Affiliation(s)
- Guansheng Li
- Division of Applied Mathematics, Brown University, Providence, Rhode Island, 02906
| | - Yuhao Qiang
- Department of Materials Science and Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, 02139
| | - He Li
- School of Chemical, Materials and Biomedical Engineering, University of Georgia, Athens, Georgia, 30602
| | - Xuejin Li
- Department of Engineering Mechanics and Center for X-Mechanics, Zhejiang University, Hangzhou, Zhejiang 310027, China
| | - Pierre A. Buffet
- Université Paris Cité and Université des Antilles, Inserm, Biologie Intégrée du Globule Rouge, 75015, Paris, France
- Laboratoire d′Excellence du Globule Rouge, 75015, Paris, France
| | - Ming Dao
- Department of Materials Science and Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, 02139
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Ogbuanya AU, Anyanwu SNC. The role of clinical and sonographic assessments in pre-operative evaluation of patients with splenic injuries in a resource-limited economy. Afr Health Sci 2023; 23:785-794. [PMID: 37545906 PMCID: PMC10398455 DOI: 10.4314/ahs.v23i1.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
Background Splenic trauma has been recognized as the most common cause of preventable deaths amongst trauma patients. Due to paucity of modern diagnostic imaging facilities in our setting, determination of the error rates and role of the simple, available diagnostic approaches are worthwhile and relevant to the practice of general surgery. Objectives The aim was to determine the role and diagnostic accuracy of clinical and sonographic assessments of splenic injuries. Methods This was a prospective study of the value of pre-operative clinical and sonographic assessments of patients with splenic injuries in our setting. Results A total of 111 patients with abdominal trauma were evaluated. Of these, splenic injuries were confirmed in 75 patients intra-operatively, mainly from blunt trauma. Of the 97 cases diagnosed by clinical method, 66(68.0%) were confirmed by intraoperative findings. Similarly, of 86 sonographic diagnoses of splenic injuries, 61 (70.9%) truly had splenic trauma. Sensitivity for sonographic and clinical assessments was 84.7% and 78.9% respectively. False positive and negative rates for clinical (27.3% versus 44.1%) and ultrasonographic (29.1% versus 40.0%) assessments were high. Conclusions Majority of splenic injuries were due to blunt abdominal trauma. The two diagnostic methods showed high sensitivity, but performed poorly for other validity tests.
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Affiliation(s)
- Aloysius U Ogbuanya
- Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Nigeria
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Robotic versus laparoscopic distal pancreatectomy on perioperative outcomes: a systematic review and meta-analysis. Updates Surg 2023; 75:7-21. [PMID: 36378464 PMCID: PMC9834369 DOI: 10.1007/s13304-022-01413-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022]
Abstract
Robotic surgery has become a promising surgical method in minimally invasive pancreatic surgery due to its three-dimensional visualization, tremor filtration, motion scaling, and better ergonomics. Numerous studies have explored the benefits of RDP over LDP in terms of perioperative safety and feasibility, but no consensus has been achieved yet. This article aimed to evaluate the benefits and drawbacks of RDP and LDP for perioperative outcomes. By June 2022, all studies comparing RDP to LDP in the PubMed, the Embase, and the Cochrane Library database were systematically reviewed. According to the heterogeneity, fix or random-effects models were used for the meta-analysis of perioperative outcomes. Odds ratio (OR), weighted mean differences (WMD), and 95% confidence intervals (CI) were calculated. A sensitivity analysis was performed to explore potential sources of high heterogeneity and a trim and fill analysis was used to evaluate the impact of publication bias on the pooled results. Thirty-four studies met the inclusion criteria. RDP provides greater benefit than LDP for higher spleen preservation (OR 3.52 95% CI 2.62-4.73, p < 0.0001) and Kimura method (OR 1.93, 95% CI 1.42-2.62, p < 0.0001) in benign and low-grade malignant tumors. RDP is associated with lower conversion to laparotomy (OR 0.41, 95% CI 0.33-0.52, p < 0.00001), and shorter postoperative hospital stay (WMD - 0.57, 95% CI - 0.92 to - 0.21, p = 0.002), but it is more costly. In terms of postoperative complications, there was no difference between RDP and LDP except for 30-day mortality (RDP versus LDP, 0.1% versus 1.0%, p = 0.03). With the exception of its high cost, RDP appears to outperform LDP on perioperative outcomes and is technologically feasible and safe. High-quality prospective randomized controlled trials are advised for further confirmation as the quality of the evidence now is not high.
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Efared B, Bako ABA, Younssa H, Boubacar I, Zabeirou A, Koura HH, Boureima HS, Amadou S, Coulibaly IS, Lassey JD, Nouhou H. Splenic lymphangiomas as a common indication for splenectomy: a case series with literature review. BMC Surg 2022; 22:446. [PMID: 36582009 PMCID: PMC9801652 DOI: 10.1186/s12893-022-01898-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Splenic lymphangiomas (SL) are very rare benign cystic lesions found in pediatric population. Their occurrence in adults is exceptional. Splenectomy is the common management of splenic lesions for diagnostic and/or therapeutic purpose. Our aim is to report additional cases of SL diagnosed on splenectomy specimens at our Pathology laboratory with literature review. METHODS This is a retrospective study including all cases of splenectomy recorded at our Pathology laboratory (June 2020-August 2022). We performed a comparison of clinicopathological features between patients with SL and those with other benign splenic diseases. RESULTS Sixteen cases of splenectomy were included. The mean age was 30.25 years (range of 6-70 years). The final histopathological diagnoses were congestive spleens in all cases of sickle cell disease (SCD) (5/16 patients, 31.25%), splenic cystic lymphangiomas (4/16 patients, 25%), capsular splenic infiltration by gastric and colic cancers (3/16 cases, 18.75%), splenic abscess (2/16 cases, 12.5%) and splenic rupture with subcapsular hematoma (1/16 patients, 6.25%). 12/16 patients (75%) had benign splenic conditions (4/12 with SL, 5/12 with SCD, 2/12 with abscess and 1/12 with splenic trauma). Patients with SL were older than those with other benign splenic conditions (mean age of 28.27 years versus 20.87 years). Also patients with SL presented with massive splenomegaly (mean splenic weight of 1675 g versus 418.75 g, mean splenic size of 19.62 cm versus 14.63 cm). Open surgery was performed in 15/16 patients (93.75%). CONCLUSION Unlike previous studies, our series shows that SL are a common indication for splenectomy and occur in older patients with massive cystic splenomegaly. Open splenectomy is still an usual surgical practice in our country.
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Affiliation(s)
- Boubacar Efared
- grid.10733.360000 0001 1457 1638Faculté des Scientes de la Santé (FSS), Université Abdou Moumouni, BP: 10896, Niamey, Niger ,grid.414237.70000 0004 0635 4264Laboratoire de cytologie et d’anatomie pathologiques, Hôpital National de Niamey, Niamey, Niger
| | - Aïchatou Balaraba Abani Bako
- grid.10733.360000 0001 1457 1638Faculté des Scientes de la Santé (FSS), Université Abdou Moumouni, BP: 10896, Niamey, Niger ,Hôpital Général de Référence, Niamey, Niger
| | - Hama Younssa
- grid.10733.360000 0001 1457 1638Faculté des Scientes de la Santé (FSS), Université Abdou Moumouni, BP: 10896, Niamey, Niger ,grid.414237.70000 0004 0635 4264Service de chirurgie générale et viscérale, Hôpital National Amirou B. Diallo, Niamey, Niger
| | - Idrissa Boubacar
- grid.414237.70000 0004 0635 4264Laboratoire de cytologie et d’anatomie pathologiques, Hôpital National de Niamey, Niamey, Niger
| | | | | | | | - Soumaila Amadou
- grid.414237.70000 0004 0635 4264Service de Chirurgie générale et viscérale, Hôpital National de Niamey, Niamey, Niger
| | | | - James Didier Lassey
- grid.10733.360000 0001 1457 1638Faculté des Scientes de la Santé (FSS), Université Abdou Moumouni, BP: 10896, Niamey, Niger ,Hôpital Général de Référence, Maradi, Niger
| | - Hassan Nouhou
- grid.10733.360000 0001 1457 1638Faculté des Scientes de la Santé (FSS), Université Abdou Moumouni, BP: 10896, Niamey, Niger
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Higashino N, Kawai N, Sonomura T, Fukuda K, Sato H, Ikoma A, Kawai M, Minamiguchi H. Percutaneous transsplenic venous embolization of elevated jejunal varices after pancreaticoduodenectomy: A case report. Radiol Case Rep 2022; 18:737-740. [PMID: 36582761 PMCID: PMC9792728 DOI: 10.1016/j.radcr.2022.11.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 11/20/2022] [Indexed: 12/23/2022] Open
Abstract
Recent advances in chemotherapy and radiotherapy have led to an increase in the number of long-term survivors of pancreatic cancer. However, this has also increased the number of patients suffering from ectopic varices and bleeding owing to left-sided portal hypertension and thrombocytopenia caused by splenomegaly after pancreaticoduodenectomy combined with resection of the splenic vein. A 65-year-old woman with varices of the elevated jejunum due to left sided portal hypertension after pancreaticoduodenectomy had repeated melena, which started about 1 year before admission. We describe the first reported case of percutaneous transsplenic venous embolization using metallic coils, which successfully achieved hemostasis of refractory bleeding from the elevated jejunal varices after pancreaticoduodenectomy.
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Key Words
- CT, computed tomography
- CTV, computed tomography during venography
- EO, ethanolamine oleate
- Elevated jejunal varices
- LSPH, left-sided portal hypertension
- Left-sided portal hypertension
- PD, pancreaticoduodenectomy
- PSE, partial splenic artery embolization
- PV, portal vein
- Pancreaticoduodenectomy
- Percutaneous transsplenic venous embolization
- SMV, superior mesenteric vein
- STS, sodium tetradecyl sulfate
- SV, splenic vein
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Affiliation(s)
- Nobuyuki Higashino
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayamashi, Wakayama 641-8509, Japan
- Corresponding author.
| | - Nobuyuki Kawai
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayamashi, Wakayama 641-8509, Japan
| | - Tetsuo Sonomura
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayamashi, Wakayama 641-8509, Japan
| | - Kodai Fukuda
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayamashi, Wakayama 641-8509, Japan
| | - Hirotatsu Sato
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayamashi, Wakayama 641-8509, Japan
| | - Akira Ikoma
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayamashi, Wakayama 641-8509, Japan
| | - Manabu Kawai
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroki Minamiguchi
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayamashi, Wakayama 641-8509, Japan
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Siu M, Levin D, Christiansen R, Kelly E, Alouidor R, Kamine TH. Prophylactic Splenectomy and Hyposplenism in Spaceflight. Aerosp Med Hum Perform 2022; 93:877-881. [PMID: 36757247 DOI: 10.3357/amhp.6079.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND: There is debate whether astronauts traveling to space should undergo a prophylactic splenectomy prior to long duration spaceflight. Risks to the spleen during flight include radiation and trauma. However, splenectomy also carries significant risks.METHODS: Systematic review of data published over the past 5 decades regarding risks associated with splenectomies and risks associated with irradiation to the spleen from long duration spaceflight were analyzed. A total of 41 articles were reviewed.RESULTS: Acute risks of splenectomy include intraoperative mortality rate (from hemorrhage) of 3-5%, mortality rate from postoperative complications of 6%, thromboembolic event rate of 10%, and portal vein thrombosis rate of 5-37%. Delayed risks of splenectomy include overwhelming postsplenectomy infection (OPSI) at 0.5% at 5 yr post splenectomy, mortality rate as high as 60% for pneumococcal infections, and development of malignancy with relative risk of 1.53. The risk of hematologic malignancy increases significantly when individuals reach 40 Gy of exposure, much higher than the 0.6 Gy of radiation experienced from a 12-mo round trip to Mars. Lower doses of radiation increase the risk of hyposplenism more so than hematologic malignancy.CONCLUSION:For protection against hematologic malignancy, the benefits of prophylactic splenectomy do not outweigh the risks. However, there is a possible risk of hyposplenism from long duration spaceflight. It would be beneficial to prophylactically provide vaccines against encapsulated organisms for long duration spaceflight to mitigate the risk of hyposplenism.Siu M, Levin D, Christiansen R, Kelly E, Alouidor R, Kamine TH. Prophylactic splenectomy and hyposplenism in spaceflight. Aerosp Med Hum Perform. 2022; 93(12):877-881.
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Klotz R, Schilling C, Kuner C, Hinz U, Klaiber U, Holze M, Tjaden C, Loos M, Büchler MW, Hackert T. Central pancreatectomy prevents postoperative diabetes. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2022. [PMID: 36457298 DOI: 10.1002/jhbp.1296] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/17/2022] [Accepted: 11/28/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Central pancreatectomy (CP) can be performed as an alternative surgical approach to distal pancreatectomy (DP) in the treatment of benign or low-grade malignant lesions located in the neck and body of the pancreas, aiming to reduce loss of parenchyma and therefore organ failure. The objective of this study was to evaluate the short- and long-term outcome of CP in comparison to DP. METHODS Patients who received CP in a large tertiary care pancreatic surgery center between 2001 and 2020 were identified from a prospectively maintained database and compared via propensity score matching with patients receiving DP during the same time period. Perioperative rate of complications and long-term outcome of pancreatic endocrine and exocrine function were evaluated. RESULTS One hundred and seven patients undergoing open CP were compared to 107 patients with open DP. No significant difference in rates or severity of most surgical complications could be found including postoperative pancreatic fistula, intraabdominal fluid collection, delayed gastric emptying and wound infection. However, patients receiving CP had a significantly higher risk of grade C postpancreatectomy hemorrhage (PPH) (CP: 10 patients, 9.3% versus DP: 1 patient, 0.9%; p = .0019). Perioperative mortality was comparable. Long-term follow-up of 60 matched pairs revealed significantly less patients with new-onset diabetes after CP (eight patients, 13.3%) compared to DP (22 patients, 36.7%, p = .0056). CONCLUSION CP offers an improved endocrine long-term outcome at the expense of a higher risk of PPH without increased perioperative mortality. As evidence on this parenchyma sparing surgical technique is sparse, more prospective data are needed.
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Affiliation(s)
- Rosa Klotz
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany.,Study Center of the German Society of Surgery, Heidelberg, Germany
| | - Constanze Schilling
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Charlotte Kuner
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Ulf Hinz
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Ulla Klaiber
- Department of General Surgery, Division of Visceral Surgery, University Hospital Vienna, Vienna, Austria
| | - Magdalena Holze
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany.,Study Center of the German Society of Surgery, Heidelberg, Germany
| | - Christine Tjaden
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Martin Loos
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Markus W Büchler
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Thilo Hackert
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
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Lu H, Zheng C, Xiong B, Xia X. Efficacy and safety of heparin plus dexamethasone after partial splenic embolization for liver cirrhosis with massive splenomegaly. BMC Gastroenterol 2022; 22:470. [PMID: 36402985 PMCID: PMC9675231 DOI: 10.1186/s12876-022-02580-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The aim of this study was to investigate the efficacy and safety of the combination of low-molecular-weight heparin + dexamethasone after partial splenic embolization in cirrhotic patients with massive splenomegaly. METHODS This study included 116 patients with liver cirrhosis complicated with massive splenomegaly who underwent PSE in Union Hospital from January 2016 to December 2019, and they met the criteria. They were divided into two groups: PSE + Hep + Dex group (N = 54) and PSE group (N = 62). We conducted a retrospective study to analyze the efficacy and safety of the two groups of patients. RESULTS The volume of splenic embolization was 622.34 ± 157.06 cm3 in the PSE + Hep + DEX group and 587.62 ± 175.33 cm3 in the PSE group (P = 0.306). There was no statistically difference in the embolization rate of the spleen between the two groups (P = 0.573). WBC peaked 1 week after PSE and PLT peaked 1 month after PSE in both groups; it gradually decreased later, but was significantly higher than the preoperative level during the 12-month follow-up period. The incidences of abdominal pain (46.3% vs 66.1%, P = 0.039), fever (38.9% vs 75.8%, P < 0.001), PVT (1.9% vs 12.9%, P = 0.026), refractory ascites (5.6% vs 19.4%, P = 0.027) were lower in the PSE + Hep + DEX group than in the PSE group. The VAS score of abdominal pain in PSE group was higher than that in PSE + Hep + DEX group on postoperative days 2-8 (P < 0.05). Splenic abscess occurred in 1(1.6%) patient in the PSE group and none (0.0%) in the PSE + Hep + DEX group (P = 0.349). CONCLUSIONS The combined use of dexamethasone and low-molecular-weight heparin after PSE is a safe and effective treatment strategy that can significantly reduce the incidence of complications after PSE (such as post-embolization syndrome, PVT, refractory ascites).
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Affiliation(s)
- Haohao Lu
- grid.33199.310000 0004 0368 7223Department of Radiology, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022 China ,grid.412839.50000 0004 1771 3250Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022 China
| | - Chuansheng Zheng
- grid.33199.310000 0004 0368 7223Department of Radiology, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022 China ,grid.412839.50000 0004 1771 3250Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022 China
| | - Bin Xiong
- grid.33199.310000 0004 0368 7223Department of Radiology, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022 China ,grid.412839.50000 0004 1771 3250Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022 China
| | - Xiangwen Xia
- grid.33199.310000 0004 0368 7223Department of Radiology, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022 China ,grid.412839.50000 0004 1771 3250Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022 China
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Zhao Y, Zhou R, Guo Y, Chen X, Zhang A, Wang J, Ji F, Qin B, Geng J, Kong G, Li Z. Improvement of gut microbiome and intestinal permeability following splenectomy plus pericardial devascularization in hepatitis B virus-related cirrhotic portal hypertension. Front Immunol 2022; 13:941830. [PMID: 36159870 PMCID: PMC9493484 DOI: 10.3389/fimmu.2022.941830] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/15/2022] [Indexed: 11/17/2022] Open
Abstract
The gut microbiome is an essential component of the intestinal mucosal barrier, critical in regulating intestinal permeability. Microbiome dysbiosis and intestinal permeability changes are commonly encountered conditions in patients with cirrhosis and are closely related to its development and further complications. However, alterations in the gut microbiome and intestinal permeability in chronic hepatitis B virus (HBV) patients with cirrhotic portal hypertension after undergoing a splenectomy plus pericardial devascularization (SPD) have not been investigated. This study recruited 22 patients who were measured against themselves on the study parameters before and after an SPD, along with 20 healthy controls. Methodologically, fecal samples were collected for gut microbiome analysis by 16S ribosomal DNA sequencing, and peripheral blood samples were obtained to examine the liver function and intestinal permeability. This study showed that the community structure of the gut microbiomes in patients before the SPD exhibited obvious differences from those in the healthy control group. They also exhibited a decreased bacterial community richness, increased intestinal permeability, and enhanced inflammation compared with the healthy controls. These issues were further aggravated two weeks after the SPD. There was also evidence of significantly higher abundances of Streptococcaceae, Enterobacteriaceae, and Enterococcaceae than those in the healthy control group. However, 12 months after the surgery, 12 of the 16 patient-associated genera recovered, of which 10 reached normal levels. Additionally, the microbiome diversity increased; the bacterial composition was back to a level similar to the healthy controls. Liver function, intestinal permeability, and inflammation levels all improved compared with preoperative levels. Furthermore, correlation analyses indicated that the five recovered bacterial taxa and the Shannon diversity index were correlated with several improved clinical indicators. Altogether, the improvements in the liver function and intestinal permeability in HBV-related cirrhotic patients may be related to the restoration of the gut microbiome after an SPD.
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Affiliation(s)
- Yang Zhao
- Shaanxi Provincial Clinical Research Center for Hepatic & Splenic Diseases, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Rui Zhou
- Shaanxi Provincial Clinical Research Center for Hepatic & Splenic Diseases, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Ying Guo
- Shaanxi Provincial Clinical Research Center for Hepatic & Splenic Diseases, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Xi Chen
- Shaanxi Provincial Clinical Research Center for Hepatic & Splenic Diseases, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Aiyu Zhang
- Shaanxi Provincial Clinical Research Center for Hepatic & Splenic Diseases, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Jiayin Wang
- School of Computer Science and Technology, Xi’an Jiaotong University, Xi’an, China
| | - Fanpu Ji
- Shaanxi Provincial Clinical Research Center for Hepatic & Splenic Diseases, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Bowen Qin
- Shaanxi Provincial Clinical Research Center for Hepatic & Splenic Diseases, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Jing Geng
- Shaanxi Provincial Clinical Research Center for Hepatic & Splenic Diseases, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Guangyao Kong
- Shaanxi Provincial Clinical Research Center for Hepatic & Splenic Diseases, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Zongfang Li
- Shaanxi Provincial Clinical Research Center for Hepatic & Splenic Diseases, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
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Carlin M, Elkbuli A, Maka P, McKenney M, Boneva D. A rare case of delayed splenic rupture following initial negative CT scan imaging: A case report and review of the literature. Int J Surg Case Rep 2022; 98:107517. [PMID: 36030762 PMCID: PMC9434024 DOI: 10.1016/j.ijscr.2022.107517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/11/2022] [Accepted: 08/11/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Delayed splenic rupture is an often unpredictable event with high mortality. In this report, we discuss the successful management of delayed splenic rupture, presenting days after index injury, with no commonly associated injuries or blunt abdominal trauma. CASE PRESENTATION A 50 year old male, not on anticoagulants, presented with blunt trauma after driving his motorcycle into a tree. The patient sustained right 3-5 rib fractures, displaced right midclavicular fracture, 25 % right pneumothorax, T5-9 posterior spinous process fractures, left 2nd-5th metatarsal fractures, and scattered abrasions to the left foot, knee and hand. Focused abdominal sonography for trauma (FAST) and admission abdominal multi-detector CT were negative for any intra-abdominal injuries. On hospital day 5, the patient acutely decompensated. FAST was grossly positive and emergent laparotomy revealed a splenic rupture. After a splenectomy, he recovered. DISCUSSION The spleen is the most commonly injured organ in blunt abdominal trauma. Although acute injury often presents with imaging findings or sequelae of hemorrhagic shock, complications of splenic trauma have the potential to result in delayed catastrophe. Bedside ultrasonography is a useful tool to assess acute decompensation in trauma patients along with CT imaging. Prompt identification and hemorrhage control are crucial to survival after trauma. CONCLUSION Repeat CT scans are also important for the identification of delayed splenic rupture and timely intervention. Delayed hemorrhage after blunt trauma should never be ruled out regardless of the injury complexity or length of hospital admission.
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Affiliation(s)
- Margo Carlin
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, FL, USA; Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL, USA
| | - Piueti Maka
- John A. Burns School of Medicine, Honolulu, HI, USA
| | - Mark McKenney
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA; University of South Florida, Tampa, FL, USA
| | - Dessy Boneva
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA; University of South Florida, Tampa, FL, USA.
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Schultz BL, Bookbinder LC, Claffey EF, Luedke LK, Delvescovo B, Fubini SL, Radcliffe RM. Treatment and outcomes of two pigs treated for hemoabdomen secondary to splenic disease. Vet Surg 2022; 51:1206-1214. [PMID: 35857027 DOI: 10.1111/vsu.13858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 05/26/2022] [Accepted: 06/18/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To report the management and outcomes of two pigs undergoing emergency surgery for hemoabdomen secondary to splenic disease. STUDY DESIGN Case report. ANIMAL Two adult pigs with hemoabdomen and suspected splenic pathology. METHODS Pigs were admitted for several clinical signs including lethargy, inappetence, vomiting, abdominal distention, hypothermia, and tachycardia. Abdominal ultrasound and abdominocentesis led to a diagnosis of hemoabdomen secondary to splenic disease. RESULTS The spleen was confirmed as the source of hemorrhage during midline exploratory celiotomy in both pigs. Splenic rupture resulted from splenic vein thrombosis in one pig and splenic torsion in the other. Complications included intraoperative hemorrhage and intraabdominal adhesion formation. Four years following splenectomy, one pig was euthanized because of widespread small intestinal adhesions causing luminal obstruction, while the other pig was euthanized following a diagnosis of chronic myeloid leukemia. CONCLUSIONS A ventral midline celiotomy provided adequate exposure for splenectomy. The procedure allowed resolution of signs in both pigs. Splenic pathology, such as vessel thrombosis or torsion, may result in splenic rupture and should be considered as a differential in pigs with hemoabdomen.
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Affiliation(s)
- Brooke L Schultz
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Lauren C Bookbinder
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Elaine F Claffey
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Lauren K Luedke
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Barbara Delvescovo
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Susan L Fubini
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Rolfe M Radcliffe
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
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Bestwick JP, Skelly BJ, Swann JW, Glanemann B, Bexfield N, Gkoka Z, Walker DJ, Silvestrini P, Adamantos S, Seth M, Warland J. Splenectomy in the management of primary immune-mediated hemolytic anemia and primary immune-mediated thrombocytopenia in dogs. J Vet Intern Med 2022; 36:1267-1280. [PMID: 35801263 PMCID: PMC9308443 DOI: 10.1111/jvim.16469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 05/27/2022] [Indexed: 11/27/2022] Open
Abstract
Background Current reports about the use of splenectomy for the management of immune‐mediated hemolytic anemia (IMHA) or immune‐mediated thrombocytopenia (ITP) or both in dogs are limited. Objectives To retrospectively describe the use of splenectomy as part of the management for IMHA, ITP, and concurrent IMHA and severe thrombocytopenia (CIST) in dogs. It was hypothesized that splenectomy would be beneficial in allowing for reduction of dose of immunosuppressive drugs or discontinuation in 1 or more of these groups. Animals Seventeen client‐owned dogs (7 with IMHA, 7 with ITP, and 3 with CIST) were identified across 7 UK‐based referral hospitals from a study period of 2005 to 2016. Methods Data were collected retrospectively via questionnaires and included information about diagnosis, management and treatment response before and after splenectomy. Based on clinical outcome, treatment with splenectomy as part of the management protocol was classified as either successful or unsuccessful. Results Six of 7 dogs with ITP were managed successfully with splenectomy as part of their management protocol (3 complete and 3 partial responses), although 1 subsequently developed suspected IMHA. Of the 7 dogs with IMHA, splenectomy was part of a successful management protocol in 4 dogs (2 complete and 2 partial responses). In the CIST group, 1 case (1/3) responded completely to management with splenectomy as part of the management protocol. Conclusions and Clinical Importance Splenectomy was considered successful and well tolerated in most cases of isolated ITP. Whether there is a benefit of splenectomy in cases of IMHA and CIST could not be determined in the current study.
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Affiliation(s)
- Jason P Bestwick
- Animal Health Trust, Newmarket, Suffolk, United Kingdom.,Department of Veterinary Medicine, Univeristy of Cambridge, Cambridge, United Kingdom
| | - Barbara J Skelly
- Queen's Veterinary School Hospital, University of Cambridge, Cambridge, United Kingdom
| | - James W Swann
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hertfordshire, United Kingdom.,Columbia Stem Cell Initiative, Columbia University, New York, New York, USA
| | - Barbara Glanemann
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hertfordshire, United Kingdom
| | - Nick Bexfield
- Queen's Veterinary School Hospital, University of Cambridge, Cambridge, United Kingdom.,Pride Veterinary Centre, Derbyshire, United Kingdom
| | - Zeta Gkoka
- Anderson Moores Veterinary Specialists, Winchester, United Kingdom
| | - David J Walker
- Anderson Moores Veterinary Specialists, Winchester, United Kingdom
| | - Paolo Silvestrini
- Small Animal Teaching Hospital, Institute of Veterinary Science, University of Liverpool, Neston, United Kingdom
| | - Sophie Adamantos
- Langford Vets/University of Bristol, Bristol, North Somerset, United Kingdom.,Paragon Veterinary Referrals, Wakefield, West Yorkshire, United Kingdom
| | - Mayank Seth
- Animal Health Trust, Newmarket, Suffolk, United Kingdom.,Dick White Referrals, Cambridge, United Kingdom
| | - James Warland
- Animal Health Trust, Newmarket, Suffolk, United Kingdom.,Southfields Veterinary Specialists, Part of Linnaeus Veterinary Limited, Laindon, Essex, United Kingdom.,Wellcome-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, University of Cambridge, Cambridge, United Kingdom
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41
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Gutama B, Wothe JK, Xiao M, Hackman D, Chu H, Rickard J. Splenectomy versus Imaging-Guided Percutaneous Drainage for Splenic Abscess: A Systematic Review and Meta-Analysis. Surg Infect (Larchmt) 2022; 23:417-429. [PMID: 35612434 DOI: 10.1089/sur.2022.072] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Splenic abscess (SA) is a rare, life-threatening illness that is generally treated with splenectomy. However, this is associated with high mortality and morbidity. Recently, percutaneous drainage (PD) has emerged as an alternative therapy in select patients. In this study, we compare mortality and complications in patients with SA treated with splenectomy versus PD. Patients and Methods: A systematic literature search of 13 databases and online search engines was conducted from 2019 to 2020. A bivariate generalized linear mixed model (BGLMM) was used to conduct a separate meta-analysis for both mortality and complications. We used the risk of bias in non-randomized studies of interventions (ROBINS-I) tool to evaluate risk of bias in non-randomized studies, and the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach for assessing quality of evidence and strength of recommendations. Results were presented according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Results: The review included 46 retrospective studies from 21 countries. For mortality rate, 27 studies compared splenectomy and PD whereas 10 used PD only and nine used splenectomy only. Data for major complications were available in 18 two-arm studies, seven single-arm studies with PD, and seven single-arm studies with splenectomy. Of a total of 589 patients, 288 were treated with splenectomy and 301 underwent PD. Mortality rate was 12% (95% confidence interval [CI], 8%-17%) in patients undergoing splenectomy compared with 8% (95% CI, 4%-13%) with PD. Complication rates were 26% (95% CI, 16%-37%) in the splenectomy group compared with 10% (95% CI, 4%-17%) in the PD group. Conclusions: Percutaneous drainage s associated with a trend toward lower complications and mortality rates compared with splenectomy in the treatment of SA, however, these findings were not statistically significant. Because of the heterogeneity of the data, further prospective studies are needed to draw definitive conclusions.
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Affiliation(s)
- Barite Gutama
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Jillian K Wothe
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Mengli Xiao
- University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Dawn Hackman
- University of Minnesota Health Sciences Library, Minneapolis, Minnesota, USA
| | - Haitao Chu
- University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Jennifer Rickard
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
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Pancreatic Fistula and Biochemical Leak after Splenectomy: Incidence and Risk Factors-A Retrospective Single-Center Analysis. Langenbecks Arch Surg 2022; 407:2517-2525. [PMID: 35508768 PMCID: PMC9468060 DOI: 10.1007/s00423-022-02531-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 04/21/2022] [Indexed: 11/24/2022]
Abstract
Purpose Postoperative pancreatic fistula (POPF) is a complication discussed in the context of pancreatic surgery, but may also result from splenectomy; a relationship that has not been investigated extensively yet. Methods This retrospective single-center study aimed to analyze incidence of and risk factors for POPF after splenectomy. Patient characteristics included demographic data, surgical procedure, and intra- and postoperative complications. POPF was defined according to the International Study Group on Pancreatic Surgery as POPF of grade B and C or biochemical leak (BL). Results Over ten years, 247 patients were identified, of whom 163 underwent primary (spleen-associated pathologies) and 84 secondary (extrasplenic oncological or technical reasons) splenectomy. Thirty-six patients (14.6%) developed POPF of grade B/C or BL, of which 13 occurred after primary (7.9%) and 23 after secondary splenectomy (27.3%). Of these, 25 (69.4%) were BL, 7 (19.4%) POPF of grade B and 4 (11.1%) POPF of grade C. BL were treated conservatively while three patients with POPF of grade B required interventional procedures and 4 with POPF of grade C required surgery. POPF and BL was noted significantly more often after secondary splenectomy and longer procedures. Multivariate analysis confirmed secondary splenectomy and use of energy-based devices as independent risk factors for development of POPF/BL after splenectomy. Conclusion With an incidence of 4.5%, POPF is a relevant complication after splenectomy. The main risk factor identified was secondary splenectomy. Although POPF and BL can usually be treated conservatively, it should be emphasized when obtaining patients’ informed consent and treated at centers with experience in pancreatic surgery. Supplementary Information The online version contains supplementary material available at 10.1007/s00423-022-02531-7.
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Kaplan HJ, Leitman IM. Race and insurance status outcome disparities following splenectomy in trauma patients are reduced in larger hospitals. A cross-sectional study. Ann Med Surg (Lond) 2022; 77:103516. [PMID: 35638010 PMCID: PMC9142383 DOI: 10.1016/j.amsu.2022.103516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/14/2022] [Accepted: 03/26/2022] [Indexed: 11/24/2022] Open
Abstract
Background Splenectomy, still a commonly performed treatment for splenic injury in trauma patients, has been shown to have a high rate of complications. The purpose of this study was to identify predictors, including race and insurance status, associated with adverse outcomes post-splenectomy in trauma patients. We discuss possible explanations and methods for reducing these disparities. Methods The American College of Surgeons – Trauma Quality Improvement Program (ACS-TQIP) participant user database was queried from 2010 to 2015 and patients who underwent total splenectomy were identified. All mechanisms of injury, including both blunt and penetrating trauma, were included. Patients with advance directives limiting care or aged under 18 were excluded. Propensity score matching was used to control for age, preexisting medical conditions, and the severity of the traumatic injury. A chi-squared test was used to find significant associations between available predictors and outcomes for this cross-sectional study. Results The post-splenectomy mortality rate was 9.2% (n = 1047), 8.0% (n = 918) of patients had three or more complications, and 20.3% (n = 2315) had major complications. A primary race of white (OR 0.7, 95% Confidence Interval (CI) 0.6–0.9, p < 0.01) and private insurance (OR 0.5, 95%CI 0.4–0.6, p < 0.01) were associated with lower risks of mortality A primary race of neither Black nor white (OR 1.3, 95%CI 1.03–1.7, p = 0.03) and a lack of health insurance (“self-pay”) (OR 1.6, 95%CI 1.3–1.9, p < 0.01) were both correlated with mortality. When limited to hospitals of 600+ beds, there were no associations between race and mortality. Conclusion The post-splenectomy mortality rate after trauma remains high. In U.S. trauma centers, a primary race of Black and payment status of “self-pay” are associated with adverse outcomes after splenectomy following a traumatic injury. These disparities are reduced when limiting analysis to larger hospitals. Efforts to reduce disparities in outcomes among trauma patients requiring a splenectomy should focus on improving resource availability and quality in smaller hospitals.
The post-splenectomy mortality rate in trauma patients remains high. Mortality is less frequent in white patients, and more frequent in uninsured patients. Black patients were more likely to experience major complications following splenectomy. In hospitals with greater than 600 beds, there were no associations between race and mortality following splenectomy.
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Silwal S, Koirala DP, Islam KD, Kharel S, Thapa S, Neupane S. Evaluation of portal venous system in post splenectomised beta-thalassemic children: A prospective study in a tertiary care hospital. Ann Med Surg (Lond) 2022; 77:103565. [PMID: 35638066 PMCID: PMC9142395 DOI: 10.1016/j.amsu.2022.103565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 11/29/2022] Open
Abstract
Background Splenectomy is a palliative management technique in children with β-thalassemia. Portal thrombosis is the most dreaded complication after splenectomy that requires fast diagnosis, effective therapy, and good follow-up to prevent protal hypertension. Thus, there is the importance of constant evaluation of portal venous system through Color Doppler Ultrasound. This cohort study aimed to observe the changes in the portal venous system in post-splenectomised β-thalassemic children. Material and methods This is a prospective observational cohort study carried out on all the pediatric patients who have undergone splenectomy in Bangabandhu Sheikh Mujib Medical University, Dhaka Bangladesh from 2017 to 2019 for β-thalassemia. The color doppler of the portal venous system was done within the 7th to 10th post-operative day and after 3 months. Outcomes like mean the caliber of the portal vein, mean velocity within the portal vein, and color Doppler findings like Portal Vein Thrombosis (PVT) and Pathological change in Mean Volume (PMV) were calculated and compared in two headings: pre-operative period and postoperative period (7–10 POD and 3 months) with the help of paired t-test. Results Twenty-Eight β-thalassemia patients with a mean age of 10.43 ± 3.91 years planned to undergo splenectomy were included in our study. The pre-operative mean caliber and mean velocity of the portal vein were not statistically significant when compared after the postoperative period (7–10 POD and 3 months). But, continuous changes in portal vein were seen that could lead to normalization or pathological changes. Conclusion There are physiological and pathological changes in portal vein following splenectomy that could lead to varied complications like portal vein thrombosis and portal hypertension. Color Doppler Ultrasound findings along with close follow-up help in minimizing the pathological changes and complications.
Splenectomy is a palliative management technique in children with β-thalassemia. Portal vein thrombosis and portal hypertension are dreaded complications.
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Affiliation(s)
- Shirish Silwal
- Department of Pediatric Surgery, Kanti Children's Hospital, Kathmandu, Nepal
| | - Dinesh Prasad Koirala
- Department of General Surgery, Pediatric Surgery Unit, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
- Corresponding author. Department of General Surgery, Pediatric Surgery Unit, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, 44600, Nepal.
| | - K.M. Didarul Islam
- Department of Pediatric Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka Bangladesh
| | - Sanjeev Kharel
- Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
| | - Sita Thapa
- Kathmandu Medical College, Kathmandu University, Kathmandu, Nepal
| | - Subita Neupane
- Department of General Practice and Emergency Medicine, National Academy of Health Science, Kathmandu, Nepal
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Sclerosing Angiomatoid Nodular Transformation of the Spleen: A Diagnostic Conundrum. J Belg Soc Radiol 2022; 106:12. [PMID: 35480339 PMCID: PMC8992766 DOI: 10.5334/jbsr.2689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/28/2022] [Indexed: 11/23/2022] Open
Abstract
A splenic lesion often represents a diagnostic challenge due to relative scarcity and the broad differential diagnosis. Sclerosing Angiomatoid Nodular Transformation (SANT) of the spleen is usually encountered only incidentally. Although benign, patients with SANT often receive splenectomy, due to its rarity, diagnostic uncertainty and sometimes intimidating imaging morphology and size. Imaging features on computed tomography, magnetic resonance and positron emission tomography have a high diagnostic value for SANT and help differentiate this entity from other splenic lesions. When the imaging parameters are matched with core needle biopsy tissue analysis, further watchful waiting can be recommended in order to avoid splenectomy.
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46
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Weledji EP, Zouna F. A rare presentation of a splenic abscess. Clin Case Rep 2022; 10:e05493. [PMID: 35228887 PMCID: PMC8864576 DOI: 10.1002/ccr3.5493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/07/2022] [Accepted: 02/14/2022] [Indexed: 12/03/2022] Open
Abstract
Although the spleen is frequently enlarged in association with systemic infection, splenic abscesses are rare. They result from direct or hematogenous spread, or when a hematoma becomes infected. We present a case of the rare splenic abscess in a low-resource setting.
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Affiliation(s)
| | - Frank Zouna
- Department of MedicineRegional Hospital LimbeLimbeCameroon
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47
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Sheng X, Yang Y, Liu J, Yu J, Guo Q, Guan W, Liu F. Down-regulation of miR-18b-5p protects against splenic hemorrhagic shock by directly targeting HIF-1α/iNOS pathway. Immunobiology 2022; 227:152188. [DOI: 10.1016/j.imbio.2022.152188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/14/2022] [Accepted: 02/05/2022] [Indexed: 01/15/2023]
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48
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Ogbuanya AUO, Ajuluchuku UE, Nnadozie UU, Otuu O, Umezurike DA, Kwento N. Splenic injuries in native Africans: Presentation, limitations of management, and treatment outcomes in a civilian trauma service in Southeast Nigeria. Ann Afr Med 2022; 21:327-338. [PMID: 36412331 PMCID: PMC9850893 DOI: 10.4103/aam.aam_53_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Splenic trauma has emerged as a major global health burden, especially in developing nations with limited diagnostic and therapeutic facilities. The current trend toward nonoperative management (NOM) and adoption of splenic salvage whenever feasible calls for local evaluation of our current practice. The aim of this study was to document the epidemiology and outcomes of management of splenic injuries in our setting. Patients and Methods This was a multicenter, prospective study of epidemiology and outcomes of patients with splenic injuries recruited over 10 years in southeast Nigeria. Results Approximately 66% of all patients with abdominal injuries sustained splenic trauma. A total of 313 patients with splenic trauma were recruited; 226 (72.2%) were managed operatively (OM) and 87 (27.8%) conservatively (NOM). Majority (75.7%) had blunt abdominal trauma (BAT), while 24.3% sustained penetrating injuries. Sonographic grading showed that 46 (14.7%), 58 (18.5%), 79 (25.2%), 106 (33.9%), and 24 (7.7%) patients had grades I, II, III, IV, and V injuries, respectively. Isolated splenic injuries occurred in 172 (55%) patients, and the rest (141, 45%) had associated intra-abdominal injuries. Two-thirds (67.1%) were aged 16-45 years. In the OM group, 178 (78.7%) had total splenectomy, while 48 (21.3%) had splenic salvage. There was a statistically significant difference (P = 0.022) in the rate of postoperative complications between the splenectomy and splenorrhaphy groups. The overall mortality rate was 4.5%. Major predictors of morbidity and mortality were high-grade splenic injuries, total splenectomy, multiple injuries, advanced age, and comorbidities. Conclusion Splenic injuries complicate approximately two-thirds of all abdominal injuries in our environment and majority of these injuries were due to BAT. In this study, majority had OM and splenic salvage rate was relatively low.
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Affiliation(s)
- Aloysius Ugwu-Olisa Ogbuanya
- Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Nigeria,Department of Surgery, Bishop Shanahan Specialist Hospital, Nsukka, Enugu State, Nigeria,Department of Surgery, Mater Misericordie Hospital, Afikpo, Ebonyi State, Nigeria,Department of Surgery, Ebonyi State University, Abakaliki, Nigeria,Address for correspondence: Dr. Aloysius Ugwu-Olisa Ogbuanya, Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, PMB 102, Abakaliki, Ebonyi State, Nigeria. E-mail:
| | - Uzoamaka Esther Ajuluchuku
- Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Nigeria,Department of Surgery, Ebonyi State University, Abakaliki, Nigeria
| | - Ugochukwu Uzodimma Nnadozie
- Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Nigeria,Department of Surgery, Ebonyi State University, Abakaliki, Nigeria
| | - Onyeyirichi Otuu
- Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Nigeria,Department of Surgery, Ebonyi State University, Abakaliki, Nigeria
| | - Daniel Akuma Umezurike
- Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Nigeria,Department of Surgery, Ebonyi State University, Abakaliki, Nigeria
| | - Nwanneka Kwento
- Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Nigeria,Department of Surgery, Ebonyi State University, Abakaliki, Nigeria
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49
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Zhu S, Liu Y, Li Y, Yi J, Yang B, Li Y, Ouyang Z, Liu B, Shang P, Mehmood K, Abbas RZ, Ahmed S, Chang YF, Guo J, Pan J, Hu L, Tang Z, Li Y, Zhang H. The potential risks of herbicide butachlor to immunotoxicity via induction of autophagy and apoptosis in the spleen. CHEMOSPHERE 2022; 286:131683. [PMID: 34351278 DOI: 10.1016/j.chemosphere.2021.131683] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/22/2021] [Accepted: 07/25/2021] [Indexed: 06/13/2023]
Abstract
Butachlor being an important member of chloroacetanilide herbicides, is frequently used in agriculture to control unwanted weeds. Exposure to butachlor can induce cancer, human lymphocyte aberration, and immunotoxic effects in animals. The current experimental trial was executed to determine the potential risks of herbicide butachlor to immunotoxicity and its mechanism of adverse effects on the spleen. For this purpose, mice were exposed to 8 mg/kg butachlor for 28 days, and the toxicity of butachlor on the spleen of mice was evaluated. We found that butachlor exposure led to an increase in serum ALB, GLU, TC, TG, and TP and changes in the morphological structure of the spleen of mice. More importantly, results showed that butachlor significantly increased the expression level of ATG-5, decreased the protein expression of LC3B and M-TOR, and significantly decreased the mRNA content of M-TOR and p62. Results revealed that the mRNA contents of APAF-1, CYTC, and CASP-9 related genes were significantly decreased after butachlor treatment. Subsequently, the mRNA levels of inflammatory cytokines (IL-1β, TNF-α, IL-10) were reduced in the spleen of treated mice. This study suggested that butachlor induce spleen toxicity and activate the immune response of spleen tissue by targeting the CYTC/BCL2/M-TOR pathway and caspase cascading activation of spleen autophagy and apoptosis pathways which may ultimately lead to immune system disorders.
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Affiliation(s)
- Shanshan Zhu
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China
| | - Yingwei Liu
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China
| | - Yangwei Li
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China
| | - Jiangnan Yi
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China
| | - Bijing Yang
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China
| | - Yuanliang Li
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China
| | - Zhuanxu Ouyang
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China
| | - Bingxian Liu
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China
| | - Peng Shang
- College of Animal Science, Tibet Agriculture and Animal Husbandry College, Linzhi, Tibet, China.
| | - Khalid Mehmood
- Department of Clinical Medicine and Surgery, Faculty of Veterinary and Animal Sciences, The Islamia University of Bahawalpur, 63100, Pakistan
| | - Rao Zahid Abbas
- Department of Parasitology, Faculty of Veterinary Science, University of Agriculture Faisalabad, Pakistan
| | - Shakeel Ahmed
- Instituto de Farmacia, Facultad de Ciencias, Universidad Austral de Chile, Campus Isla Teja, Valdivia, 5090000, Chile
| | - Yung-Fu Chang
- College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Jianying Guo
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China
| | - Jiaqiang Pan
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China
| | - Lianmei Hu
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China
| | - Zhaoxin Tang
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China
| | - Ying Li
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China.
| | - Hui Zhang
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China.
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50
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Roussotte M, Gerfaud-Valentin M, Hot A, Audia S, Bonnotte B, Thibault T, Lobbes H, Le Guenno G, Goulabchand R, Cathebras P, Varron L, Dufour JF, Deroux A, Compain C, Baudet A, Karkowski L, Pérard L, Ebbo M, Lega JC, Sève P. Immune thrombocytopenia with clinical significance in systemic lupus erythematosus: a retrospective cohort study of 90 patients. Rheumatology (Oxford) 2021; 61:3627-3639. [PMID: 34918048 DOI: 10.1093/rheumatology/keab925] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/07/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To describe the characteristics, treatment, and outcome of patients with immune thrombocytopenia with clinical significance (ITPCS) associated with systemic lupus erythematosus (SLE). METHODS This retrospective multicentre study included SLE patients who experienced ≥1 ITPCS (defined as ITP with attributable bleeding disorders and/or a platelet count <30 x109/L). Other causes of secondary thrombocytopenia were excluded. Major bleeding event (MBG) was defined as Khellaf score>8 and/or WHO score>2. RESULTS A total of 90 patients were included, the median (range) follow-up duration was 80 (6-446) months. ITP was diagnosed before SLE in 25 patients. They presented high rate of autoimmune haemolytic anaemia (15%), antiphospholipid antibody (62%), and antiphospholipid syndrome (19%). The 25 (28%) patients who experienced MBG had significantly more bleedings at ITP diagnosis and higher bleeding scores, and serositis and thrombosis during follow-up. They required significantly more treatment lines, transfusions, and hospitalizations. The 11 (12%) patients who experienced no bleeding event presented a significantly more restricted SLE phenotype (cutaneous and/or articular). Patients received a mean (range) of 4.2 (1-11) treatment lines. Corticosteroids and hydroxychloroquine allowed ITPCS overall response in one third of patients. The median relapse-free survival of rituximab (n = 34), azathioprine (n = 19), mycophenolate mofetil (n = 8), thrombopoietin-receptor agonists (n = 16), and splenectomy (n = 19) were 53, 31.5, 61, 24.5, and 78 months, respectively. Four patients experienced thrombotic events after splenectomy and one occurred under thrombopoietin-receptor agonist treatment. CONCLUSION SLE-ITCS patients displayed a high rate of haematological abnormalities and MBG patients exhibited higher morbidity. Management of thrombocytopenia was highly heterogeneous and many options seem viable.
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Affiliation(s)
| | | | - Arnaud Hot
- Department of Internal Medicine, Hospices Civils de Lyon, France
| | - Sylvain Audia
- Department of Internal Medicine, Centre Hospitalier Universitaire de Dijon, France
| | - Bernard Bonnotte
- Department of Internal Medicine, Centre Hospitalier Universitaire de Dijon, France
| | - Thomas Thibault
- Department of Internal Medicine, Centre Hospitalier Universitaire de Dijon, France
| | - Hervé Lobbes
- Department of Internal Medicine, Centre Hospitalier Universitaire de Clermont-Ferrand, France
| | - Guillaume Le Guenno
- Department of Internal Medicine, Centre Hospitalier Universitaire de Clermont-Ferrand, France
| | - Radjiv Goulabchand
- Department of Internal Medicine, Centre Hospitalier Universitaire de Montpellier, France
| | - Pascal Cathebras
- Department of Internal Medicine, Centre Hospitalier Universitaire de Saint Etienne, France
| | - Loig Varron
- Department of Internal Medicine, Centre Hospitalier de Montélimar, France
| | | | - Alban Deroux
- Department of Internal Medicine, Centre Hospitalier Universitaire de Grenoble, France
| | - Caroline Compain
- Department of Internal Medicine, Centre Hospitalier de Chambéry, France
| | - Antoine Baudet
- Department of Internal Medicine, Centre Hospitalier d'Annecy, France
| | - Ludovic Karkowski
- Department of Internal Medicine, Centre Hospitalier Militaire de Desgenettes, Lyon, France
| | - Laurent Pérard
- Department of Internal Medicine, Centre Hospitalier de St. Joseph St. Luc, Lyon, France
| | - Mikael Ebbo
- Department of Internal Medicine, Centre Hospitalier de La Timone, Marseille, France
| | | | - Pascal Sève
- Department of Internal Medicine, Hospices Civils de Lyon, France.,Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
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