Hepatic encephalopathy is a common and serious complication of end-stage liver diseases such as liver cirrhosis， and it is basically a neuropsychiatric syndrome resulting from metabolic disorders caused by severe acute or chronic liver dysfunction or portosystemic shunt. In clinical practice， the onset of hepatic encephalopathy does not completely correlate linearly with the level of blood ammonia and is often triggered by extrahepatic factors， suggesting the presence of complex multiorgan crosstalk in the pathogenesis of hepatic encephalopathy. Based on the four main pathogeneses of ammonia toxicity， inflammation， neurotransmitter imbalance， and oxidative/nitrosative stress， this article systematically elaborates on the mechanism of multiorgan crosstalk in hepatic encephalopathy and discusses the emerging risk factors such as sarcopenia and diabetes mellitus， in order to provide a novel theoretical framework for deepening the understanding of the pathophysiological mechanisms of hepatic encephalopathy and formulating clinical diagnosis and treatment strategies in the future.

Objective To investigate the clinical effect of far lateral approach surgery under unilateral biportal endoscope(UBE)for lumbar foraminal stenosis.Methods From June 2021 to August 2022,39 patients with lumbar foraminal stenosis were treated with far lateral approach surgery under UBE in our department.The patients were placed at the standard prone position,and a longitudinal line was drawn about 2 cm from the lateral edge of the upper and lower pedicles.Transverse incisions were made at the two intersection points of the horizontal line at the midpoint of the lateral edge of the upper and lower pedicles.After inserting the gradually enlarged sleeves to expand the space,the enlargement of the intervertebral foramen and release of the nerve root were completed under the direct view of UBE.The Visual Analogue Scale(VAS)of leg pain and the Oswestry Disability Index(ODI)were compared before and after operation.The effectiveness was evaluated according to the modified MacNab criteria at 12 months after operation.Results The operations were successfully completed in all the 39 cases.The operation time was(105.5±14.8)min,and the blood loss was(26.7±8.8)ml.The tear of adventitial nerve root occurred in 1 case during operation,and there was no nerve injury symptom after operation.One case of suspected infection occurred after operation and recovered after conservative treatment.All the 39 patients got out of bed with waist circumference on the first day after operation.The intervertebral foramen height measured by sagittal CT at 3 d after operation was(1.62±0.26)cm,which was significantly higher than that before operation[(1.51±0.28)cm;t=-4.010,P=0.000].The intervertebral foramen width was significantly greater than preoperation[(1.24±0.17)cm vs.(0.96±0.15)cm;t=-14.811,P=0.000].The area of intervertebral foramen was significantly larger than preoperation[(1.40±0.19)cm2 vs.(1.05±0.22)cm2;t=-12.874,P=0.000].The VAS of leg pain at 1 d,and 1,3,and 6 months after operation were significantly lower than those before operation(all P=0.000),and the VAS scores gradually decreased with the increase of time.The ODI was significantly lower at 1,3,and 6 months after operation than that before operation(all P=0.000),and the ODI decreased gradually with the increase of time.According to the modified MacNab criteria,at 12 months after operation,33 cases were excellent,4 cases were good,and 2 cases were fair,with an excellent and good rate of 94.9％(37/39).Conclusions Far lateral approach surgery under UBE for lumbar foraminal stenosis has significant effect on the relief of lumbago and leg pain and the improvement of lumbar function.It has little damage to lumbar stability and does not need internal fixation,which is worthy of clinical application and promotion.

Objective To investigate the clinical effect of far lateral approach surgery under unilateral biportal endoscope(UBE)for lumbar foraminal stenosis.Methods From June 2021 to August 2022,39 patients with lumbar foraminal stenosis were treated with far lateral approach surgery under UBE in our department.The patients were placed at the standard prone position,and a longitudinal line was drawn about 2 cm from the lateral edge of the upper and lower pedicles.Transverse incisions were made at the two intersection points of the horizontal line at the midpoint of the lateral edge of the upper and lower pedicles.After inserting the gradually enlarged sleeves to expand the space,the enlargement of the intervertebral foramen and release of the nerve root were completed under the direct view of UBE.The Visual Analogue Scale(VAS)of leg pain and the Oswestry Disability Index(ODI)were compared before and after operation.The effectiveness was evaluated according to the modified MacNab criteria at 12 months after operation.Results The operations were successfully completed in all the 39 cases.The operation time was(105.5±14.8)min,and the blood loss was(26.7±8.8)ml.The tear of adventitial nerve root occurred in 1 case during operation,and there was no nerve injury symptom after operation.One case of suspected infection occurred after operation and recovered after conservative treatment.All the 39 patients got out of bed with waist circumference on the first day after operation.The intervertebral foramen height measured by sagittal CT at 3 d after operation was(1.62±0.26)cm,which was significantly higher than that before operation[(1.51±0.28)cm;t=-4.010,P=0.000].The intervertebral foramen width was significantly greater than preoperation[(1.24±0.17)cm vs.(0.96±0.15)cm;t=-14.811,P=0.000].The area of intervertebral foramen was significantly larger than preoperation[(1.40±0.19)cm2 vs.(1.05±0.22)cm2;t=-12.874,P=0.000].The VAS of leg pain at 1 d,and 1,3,and 6 months after operation were significantly lower than those before operation(all P=0.000),and the VAS scores gradually decreased with the increase of time.The ODI was significantly lower at 1,3,and 6 months after operation than that before operation(all P=0.000),and the ODI decreased gradually with the increase of time.According to the modified MacNab criteria,at 12 months after operation,33 cases were excellent,4 cases were good,and 2 cases were fair,with an excellent and good rate of 94.9％(37/39).Conclusions Far lateral approach surgery under UBE for lumbar foraminal stenosis has significant effect on the relief of lumbago and leg pain and the improvement of lumbar function.It has little damage to lumbar stability and does not need internal fixation,which is worthy of clinical application and promotion.

Objective To investigate the effect of early continuous veno-venous hemofiltration (CVVH) on intra-abdominal pressure (IAP) and serum interleukin-6 (IL-6) in severe acute pancreatitis (SAP) patients with abdominal compartment syndrome (ACS).Methods 41 SAP patients with ACS were selected as treatment group and treated with CVVH as well as conventional methods in ICU.The other 12 patients with the same disease were selected as the control group and were only treated with conventional methods because of economic reasons.IAP and blood level of IL-6 in the two groups were measured daily in order to investigate their changes and the correlation between the two parameters.Results The serum IL-6 level and IAP in the two groups were higher on admission day.IAP and serum IL-6 level in the treatment group were significantly decreased on the first day after treatment,and thereafter decreased rapidly.In the control group,IAP and serum IL-6 level were significantly decreased on the 3rd day after treatment.IAP and serum IL-6 level from the 1st day to the 6th day after treatment in the treatment group were significantly lower than those of the control group at the same time point (P＜0.05).There was a significant positive correlation between blood IL-6 level and IAP in SAP patients with ACS(r=0.48,P＜0.01).IL-6 difference before and after treatment was also positively correlated with the difference of IAP(R=0.39,P＜0.05).Conclusions VVH significantly decreased the IAP and the blood level of IL-6 in ACS patients of SAP.The blood level of IL-6 is significantly correlated with IAP,suggesting that IL-6 may play an important role in the pathogenesis of ACS.Therefore early CVVH may clear the cytokines such as IL-6 and lower IAP,thus to prevent multiple organ dysfunction syndrome (MODS),which should be applied in the early stage of ACS.

Objective To explore the value of detection of systemic and local oxidation antioxidation level of ascites in the differential diagnosis of benign and malignant ascites.Methods Thirty-five patients with malignant ascites hospitalized in the Yidu Central Hospital of Weifang from December 2012 to November 2013 as the malignant ascites, and 35 cases of benign ascites as the control group.The ascites of malignant ascites group and plasma total antioxidant capacity (T-AOC) level of two group were detected by ferric ion reduction method.Plasma malonaldehyde (MDA) level of two group were detected by thiobarbituric acid content assay.Peripheral blood mononuclear cell (PBMCs) and tumor associated lymphocytes (TALS) in ascites were isolated by Ficoll density gradient centrifugation,the DNA damage of PBMCs and TALS were detected by single cell gel electrophoresis (SCGE) , expressed in the tailing rate.The value in the diagnosis of benign and malignant ascites was judged according to the analysis of above indexes.Results (1) The difference analysis : the levels of T-AOC in plasma in malignant ascites group was (9.26 ± 1.88)mM, significantly lower than that in benign ascites group((11.26± 1.78) mM, t =16.520,P =0.000);T-AOC levels of malignant ascites group ascites was (6.59± 1.38) mM, significantly lower than the plasma levels of T-AOC ((9.22± 1.86) mM, t =13.869, P =0.000);the MDA level of malignant ascites group was (6.26± 1.83) nM, significantly higher than that of serum benign ascites((3.26±1.12) nM,t=18.267,P=0.000);tailing rate of PBMCS in malignant ascites group was (17.9 ± 6.7) ％, significantly higher than that in benign ascites group ((9.6 ± 5.3) ％, P＜ 0.01);tailing rate of TALS in malignant ascites group was (442.6± 10.8) ％, significantly higher than that of PBMCS ((17.2±6.1)％ ,P＜0.01).(2)The correlation analysis: there was a negative correlation between plasma T-AOC and MDA in malignant ascites group (r =-0.518, P ＜ 0.01), tailing rate of T-AOC and TALS ascites (r =-0.566,P＜0.01) ,tailing rate of plasma T-AOC and PBMCS(t =-0.472,P＜0.01);there was a positive correlation between the tailing rate of plasma MDA and PBMCS (r =0.476, P ＜ 0.05).Conclusion In the malignant ascites group, there is oxidative stress in the whole body and the ascites, and the local oxidative stress in the ascites is more obvious.The sensitivity and accuracy of the diagnosis of malignant ascites can be increases by detected by the detection of the local oxidation resistance of the whole body and the ascites.

Objective To investigate the effect of Glycyrrhizin combined with puerarin on serum Leptin and insulin resistance in non-alcoholic fatty liver disease(NAFLD) patients.Methods One hundred and twenty patients with NAFLD were randomized into 4 groups,which were control group,compound Glycyrrhizin group,puerarin group,combined group,and each group was 30 cases.Patients in control group were received the regular liver protecting therapy including vitamins,amino acids,glucurolactone,in compound Glycyrrhizin group were given 60 ml compound glycyrrhizin solution (iv),in puerarin group were given puerarin at dose of 400 mg by intravenous infusion,and in combined group were given both compound glycyrrhizin and puerarin combination.All treatment period was 4 weeks.The levels of serum serum alanine aminotransferase (ALT),aspartate aminotransferase (AST),total cholesterol (TC),triglyceride (TG),leptin (LP),fasting blood glucose (FBG) and insulin(INS) were measured,and the insulin resistance index(IRI) was calculated.The liver CT image of patients were performed by Germany Siemens dual source CT instrument.Results The levels of serum ALT,AST,TC,TG,LP and IRI in control group at before and after treatment were ((83.08 ± 115.68) U/L vs.(43.32 ±11.72) U/L,(52.12±15.62) U/Lvs.(36.08 ±7.28) U/L,(6.20±1.30) mmol/Lvs.(5.60 ±0.70) mmol/L,(2.70 ±0.50) mmol/L vs.(2.10 ±0.40) mmol/L,(14.63 ±3.26) μg/L vs.(7.61 ± 2.46) μg/L,(7.9 ± 1.8) vs.(7.0 ± 1.2)),and the difference were statistically significant (t =12.828,4.244,16.648,21.442,3.341,16.152 respectively,P ＜ 0.01).The levels of serum ALT,AST,TC,TG,LP and IRI in compound glycyrrhizin group after treatment were ((43.28 ± 11.06) U/L,(37.28 ± 7.22) U/L,(5.70± 0.80) mmol/L,(2.20 ± 0.50) mmol/L,(7.89 ± 2.26) μg/L,(7.1 ± 1.6) respectively,significant different from before treatment ((83.06 ± 14.38) U/L,(51.68 ± 15.48) U/L,(6.30 ± 1.50) mmol/L,(2.60 ± 0.40) mmol/L,(15.13 ± 3.87) μg/L,(7.8 ± 2.2) respectively,t =8.893,4.225,16.520,24.708,6.353,21.137 respectively,P ＜ 0.01).The levels of serum ALT,AST,TC,TG,LP and ISI in puerarin group after treatment were (44.26 ± 9.68) U/L,(36.86 ± 6.88) U/L,(5.60 ± 0.70) mmol/L,(2.26 ± 0.48) mmol/L,(6.89 ± 2.18) μg/L,(7.0 ± 1.8) respectively,significant different from that before treatment ((82.68±14.36) U/L,(50.06±15.23) U/L,(6.20±1.60) mmol/L,(2.70±0.52) mmol/L,(15.68 ±3.26)μg/L,(7.7 ±2.8) respectively,t =7.087,8.138,18.159,7.244,7.470,32.283 respectively,P ＜ 0.01).The levels of serum ALT,AST,TC,TG,LP and ISI in combined treatment group after treatment were (22.28 ± 9.38)U/L,(28.48 ± 9.06) U/L,(5.00 ± 0.60) mmol/L,(1.70 ± 0.40) mmol/L,(4.63 ± 2.36) μg/L,(6.20± 1.6) respectively,significantly different from that before treatment ((84.62 ± 14.88) U/L,(49.12 ± 16.56)U/L,(5.70 ± 1.60) mmol/L,(2.78 ± 0.50) mmol/L,(14.78 ± 3.68) μg/L,(7.6 ± 2.1),t =14.255,11.272,8.371,9.941,8.102,37.626,P ＜ 0.01).The levels of serum ALT,AST,TC,TG,LP and ISI of patient were no significant difference before treatment,but after treatment,these indexes in combined therapy group were the lowest among 4 groups (P ＜ 0.05).And there were no significant difference among control group,compound glycyrrhizin group,puerarin group (P ＞ 0.05).Conclusion Compound glycyrrhizin combined with puerarin is proved to be an effect treatment method for NAFLD through decreasing serum leptin,improving insulin resistance.

ObjectiveTo study the changes of the plasma thrombomodulin(TM) and von Willebrand factor (vWF) levels and their clinical significance associated with the extent and severity of acute ischemie colitis.MethodsThe plasma TM and vWF levels were determined by enzyme linked immunosorbent assay in 46 patients with acute ischemic colitis (acute ischemic colitis group),42 patients with ulcerative colitis (ulcerative colitis group) and 40 healthy subjects (control group).ResultsThe plasma TM was (49.6 ±2.3) μg/L,and vWF was(198.8 ±8.9)％ in acute ischemic colitis group.The plasma TM was (38.2 ± 3.8) μ g/L,and vWF was ( 162.6 ± 7.6)％ in ulcerative colitis group.The plasma TM was (23.8 ±2.3) μg/L,and vWF was ( 116.7 ± 6.2)％ in control group.The plasma TM and vWF levels in acute ischemic colitis group were higher than those in ulcerative colitis group and control group (P ＜ 0.05 or ＜ 0.01 ).The plasma TM and vWF levels in ulcerative colitis group were higher than those in control group (P＜ 0.05).The plasma TM levels[(49.9 ± 0.3 ) μg/L] and vWF [(210.6 ± 8.2 ) ％] in all colon disease were higher than those in partial colon disease (P ＜ 0.05 ).ConclusionThe changes of plasma TM and vWF levels can be used as one of the indicators for assessment of the development and the prognosis of acute ischemic colitis.

ObjectiveTo study changes of molecular markers of prothrombotic state:Platelet granule membrane protein ( GMP-140 ),Von Willebrand factor ( vWF:Ag),thrombomodulin (TM),Two-D dimer ( DD),antithrombin Ⅲ ( AT- Ⅲ ) in plasma and puerarin for treatment functions of acute pancreatitis (AP).MethodsIn 78 patients with AP [ severe acute pancreatitis (SAP):26 cases,mild acute pancreatitis (MAP):52 cases ],using a random number table,the patients were given puerarin treated base (n =40) and conventional treated base group (n =38 ).The two groups were given fast,continuous gastrointestinal decompression,correction of electrolyte and acid-base balance disorders,vein support,antisecretory drugs,antibiotics inhibit pancreatic secretion and inhibition of trypsin activity of drug treatment.Puerarin group:Puerarin injection 0.5 g in 5％glucose injection intravenous infusion of 500 ml,1 time a day.GMP-140 vWF:Ag,TM,DD were measured by the methods of analysis of enzyme-linked immunosorbent assay and AT-Ⅲ was measured by the methods of analysis of chromogenic substrate method preformed in all patients,plasma amylase and uric amylase were determined by the method of somogyi and after the treatment.And 22 healthy people were selected as normal controls ( NC,Group C,n =22).ResultsCompared with the Group C and MAP,the plasma GMP-140 [ ( 86.26 ± 15.28 )ng/Lvs (32.56 ± 18.17) ng/L and (58.68 ± 15.86)ng/L],vWF[(236.22 ±31.78)％vs (95.12 ±31.68)％ and (126.68 ± 17.06)％ ],TM [(65.70 ± 12.27) μg/L vs (4.26 ±0.92) μg/L and (9.80 ± 6.98) μg,/L],DD [ (0.87 ±0.04) mg/L vs (0.36 ±0.06) mg/L and (0.56 ±0.05) mg/L] were significantly elevated,however the AT-Ⅲ [ (56.13 ± 15.78) U/ml vs (98.76 ±22.68) U/ml and (80.38 ± 18.29)U/ml )was significantly decreased SAP ( P ＜ 0.01 ).There were significant differences on the levels of GMP-140 [ (31.52 ± 15.81 ) ng/L vs (59.62 ± 13.73 ) ng/L,t =- 23.283 ],vWF [ ( 93.32 ± 28.62) ％ vs ( 128.81 ±16.23)％,t=-28.205,P＜0.01 ],TM[ (4.36 ± 0.82) μg,/L vs (11.23 ± 7.62)μg/L,t =-43.419,P ＜0.001],DD[ (0.32 ±0.05) mg/L vs (0.68 ±0.04) mg/L,t =- 15.642,P ＜0.001],AT-Ⅲ ((97.68 ±21.69) U/ml vs (76.86 ± 17.92) U/m,t =14.967,P ＜ 0.01 ) between puerarin treated base group and conventional treated base group.Comparing with treated base,the group given puerarin obviously shortened the increased of plasma [ ( 81.26 ± 17.12) U/L vs ( 119.63 ± 51.87 ) U/L,t =- 7.618,P ＜ 0.001 ],uric amylase [ (416.37 ± 116.50) U/L vs (576.32 ± 126.58) U/L,t =- 36.659,P ＜ 0.001 ],the time of abdominal pain relief and therapy to spend [ ( 2.18 ± 0.76 ) d vs ( 5.26 ± 0.58 ) d,t =- 13.619,P ＜ 0.001 ].Conclusion The molecular markers of prothrombotic state:GMP-140,vWF:Ag,TM,DD,AT- Ⅲ might all play key roles in the development of AP.Puerarin can improve the pancreatic microcirculation and adjust molecular markers of prothrombotic state,and had certain treatment functions with AP.

Objective To investigate the effectiveness of simple peritoneal lavage combined with venous-venous hemofiltration therapy for severe acute pancreatitis (SAP). Methods Needles were inserted into abdominal cavity and tee was connected, then normal saline was administrated and discharged, followed by lidocaine, dexamethasone and antibiotics once daily until bloody peritoneal drainage became clear. At the same time venous-venous hemofiltration was used. Results 61 SAP patients were randomly divided into peritoneal lavage + hemofiltration group (treatment group, n =31) and control group (n = 31). The time to abdominal pain relief, abdominal distention relief, nausea and vomiting disappearance, peritoneal irritation disappearance was (1.5 ±0.3)d,(2.7 ±0.3)d, (1.9 ±0.3)d, (1.5 ±0.2)d, and the time to cure was (11.0 ±2.0)d in the treatment group, which was significantly shorter than that in the control group [(3.9 ± 0. 3) d, (4.5 ±0.6)d, (3.7 ±0.2)d, (5.3 ±0.4)d, (18.0 ±2.5)d, P＜0.05]. At the 1st day of treatment, serum ALT,AST was significantly lower than that in the control group; at the 3rd day of treatment, the serum and urine amylase and serum levels of TNF-α, IL-6 and IL-8 level were significantly lower, but the serum level of IL-10,HCO3-was significantly higher than that in the control group (P ＜ 0.05 or ＜ 0. 01); at the 5th day of treatment, the serum Bun and Cr level were significantly lower than those in the control group (P ＜ 0. 05).Conclusions Simple peritoneal lavage combined with venous-venous hemofiltration therapy can effectively eliminate the inflammatory factors, which is more rational and effective for the treatment of severe acute pancreatitis.

Objective To investigate the clinical effect and pathogenesis of tiopronin in treating acute pancreatitis complicated with liver damages. Methods Eighty-one patients with acute pancreatitis complicated with liver damages were randomly divided into two groups. The control group (40 cases) received routine treatment, and the treatment group (41 cases ) received routine treatment and tiopronin. The liver function, pancreatic enzyme indexes and C-reactive protein (CRP), the length of hospital stay was recorded. Results After 8 days' treatment, the liver function improved, and the levels of pancreatic enzyme indexes and CRP were decreased significanfly in both groups, and these changes were more obvious in treatment group (P <0.05). The length of hospital stay of mild acute pancreatitis in treatment group was significantly shorter than that in control group [ (8.6 ± 2.7 ) d vs. ( 13.8 ± 3.5 ) d ] (P < 0.05 ). Conclusions Tiopronin has beneficial effects in treating acute pancreatitis complicated with liver damages,and it has a therapeutic effect in acute pancreatitis at the same time. The mechanism may be related with the inhibition of inflammatory mediators, oxygen free radicals scavenging and other effects.