OBJECTIVETo study different effects of Herba Lycopodii (HL) Alcohol Extracted Granule combined methylprednisolone on behavioral changes, brain derived neurotrophic factor (BDNF) expression levels, and N-methyl-D-aspartate (NMDA) receptor levels in rats with spinal cord injury (SCI).

METHODSMale adult SD rats were randomly divided into five groups, i.e., the sham-operation group, the model group, the HL treatment group, the methylprednisolone treatment group, the HL + methylprednisolone treatment group. Rats in the HL treatment group were intragastrically administered with HL at the daily dose of 50 mg/kg for 5 successive days. Rats in the methylprednisolone treatment group were intramuscularly injected with 50 mg/kg methylprednisolone within 8 h after spinal cord contusion, and then the dose of methylprednisolone was reduced for 10 mg/kg for 5 successive days. Rats in the HL + methylprednisolone treatment group received the two methods used for the aforesaid two groups. Basso Beattie and Bresnahan (BBB) score (for hindlimb motor functions) were assessed at day 0, 3, 7, and 28 after operation. At day 13 after SCI, injured spinal T8-10 was taken from 8 rats of each group and stored in liquid nitrogen. The N-methyl-D-aspartate (NMDA) receptor affinity (Kd) and the maximal binding capacity (Bmax) were determined using [3H]MK-801 radioactive ligand assay. Rats' injured spinal cords were taken for immunohistochemical assay at day 28 after SCI. Expression levels of BDNF in the ventral and dorsal horn of the spinal cord were observed.

RESULTSCompared with the sham-operation group, the number of BDNF positive neurons in the ventral and dorsal horn of the spinal cord increased in the model group, Bmax increased (470 ± 34), Kd decreased, and BBB scores decreased at day 3 -28 (all P <0. 05). Compared with the SCI model group, the number of BDNF positive neurons and Kd increased, BBB scores at day 3 -28 increased (P <0. 05) in each medicated group. Bmax was (660 ± 15) in the methylprednisolone treatment group, (646 ± 25) in the HL treatment group, and (510 ± 21) in the HL +methylprednisolone treatment group (P <0. 05). Compared with the methylprednisolone treatment group, the number of BDNF positive neurons and Kd increased, BBB scores at day 7 -28 increased, and Bmax decreased in the HL treatment group and the HL + methylprednisolone treatment group (all P <0. 05). Compard with the HL treatment group, the number of BDNF positive neurons and Kd increased, and Bmax decreased (all P < 0.05).

CONCLUSIONSHL could effectively improve motor functions of handlimbs, increase expression levels of BDNF in the spinal cord, and lessen secondary injury by affecting spinal levels of NMDA receptors. It showed certain therapeutic and protective roles in treating SCI. Its effect was better than that of methylprednisolone with synergism.

Animals ; Brain-Derived Neurotrophic Factor ; metabolism ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Ethanol ; Male ; Methylprednisolone ; pharmacology ; therapeutic use ; Models, Animal ; N-Methylaspartate ; metabolism ; Neurons ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Receptors, N-Methyl-D-Aspartate ; Spinal Cord Injuries ; drug therapy ; metabolism

Objective:To explore the postoperative biliary leakage and severe complication rate and its related risk factors of hepaticojejunostomy (HJ) for biliary disease.Methods:The clinical data of patients undergoing HJ for benign biliary diseases at the First Affiliated Hospital of Anhui Medical University from Jan 2003 to Dec 2017 were retrospectively analyzed. Multi-factor analysis was used to find a risk factor for postoperative bile leakage and severe complications.Results:Two hundred and eighty-three patients received HJ. The median age was 39 years.The short-term complication rate after surgery was 19.1% ( n=54), and the biliary leakage rate was 11.7% ( n=33), and the severe complication rate was 15.2% ( n=43). By multi-factor analysis: preoperative sepsis[ OR=3.875, 95% CI (1.583, 9.485), P=0.003], liver cirrhosis [ OR=3.212, 95% CI (1.001, 10.307), P=0.050], intraoperative blood loss≥400 ml [ OR=6.054, 95% CI (1.231, 29.781), P=0.027],postoperative hospitalization ≥9 days [ OR=6.738, 95% CI (2.287, 19.855), P=0.001] are the independent risk factors for postoperative bile leakage. Main bile duct stone[ OR=2.764, 95% CI (1.174, 6.510), P=0.020], preoperative sepsis [ OR=4.310, 95% CI (1.666, 11.149), P=0.003], intraoperative bleeding ≥400 ml [ OR=5.944, 95% CI (1.231, 29.781), P=0.022] and postoperative hospitalization ≥ 9 days [ OR=11.422, 95% CI (1.317, 49.859), P=0.001] are the independent risk factors for serious complications. Conclusions:HJ should be conducted when the sepsis was under control and sufficient bile drainage.The patients' condition should be comprehensively and accurately assessed before operation. The indications for partial hepatectomy need to be strictly defined.

Objective:To investigate the incidence and related risk factors related to early postoperative complications after hepaticojejunostomy surgery for iatrogenic bile duct injury.Methods:A retrospective analysis was made on the data of 110 cases undergoing a hepaticojejunostomy at the First Affiliated Hospital of Anhui Medical University and Anhui Provincial Hospital from January 2001 to December 2018. The univariate and multivariate analyses were performed to explore the impact risk factors on the short-term complications.Results:Patients′ median age was 44 years old. The short-term postoperative complication rate was 35.5% and the serious complication rate was 17.3%. Univariate analysis showed that male, a failed repair was attempted before referral, intraoperative bleeding>400 ml, and duration of surgery were significantly related to the occurrence of early postoperative complications (all P<0.05). Multivariate analysis showed that male, pre-referral failed surgical repair, preoperative bile leakage, initially combined with hepatectomy, and intraoperative bleeding>400 ml were independent risk factors for postoperative short term complications (all P<0.05). Univariate and multivariate analysis of early postoperative severe complications(Clavien-Dindo≥Ⅲ) revealed that pre-referral surgical repair, combined liver resection, and intraoperative bleeding>400 ml can significantly affect the occurrence of early postoperative severe complications (all P<0.05) . There was no significant correlation between the timing of biliary repair and the occurrence of complications ( P>0.05). Conclusions:Upon the occurrence of iatrogenic bile duct injury, the surgeon is advised to refrain from doing a repair instead sending the patient to a referral hospital. If bile leakage persists before surgery, sufficient bile drainage should be given priority to control infection.