Objective To systematically evaluate the efficacy of partial splenic artery embolization(PSE)and splenectomy in the treatment of secondary hypersplenism in liver cirrhosis.Methods PubMed,Cochrane Library,Embase,CNKI,Wan Fang were searched to collect randomized controlled trials and cohort studies about the efficacy of PSE versus splenectomy in the treatment of hyper-splenism secondary to liver cirrhosis from inception to October 30,2021.Two reviewers screened the literature,extracted data,and as-sessed the risk of bias of included studies.Meta-analysis was then conducted.Results A total of 14studies were included with 1092 patients.The results of the meta-analysis showed that there was no significant difference in postoperative leukocyte levels at 1 week,1 month,and 1 year after surgery between the PSE group and the splenectomy group.However,6months after surgery,the level of postop-erative leukocyte in the splenectomy group was significantly higher than that in the PSE group.For postoperative platelet counts,there was no significant difference at 1 month and 1 year after surgery between the two groups.However,1 week(MD=-65.46,95％CI:-116.39--14.52,P=0.01)and 6months(MD=-117.99,95％CI:-229.71--6.27,P=0.04)after surgery,the level of postoperative platelet in splenectomy group was significantly higher than that in PSE group.There was no significant difference in postoperative erythro-cyte levels at 1 week,1 month,and 1 year after surgery between the two groups.The level of postoperative natural killer cells in the PSE group was significantly higher than that in the splenectomy group at 1 month(MD=6.02,95％CI:4.27-7.77,P＜0.001)and 1 year(MD=3.53,95％CI:1.68-5.37,P=0.0002)after surgery.Compared with splenectomy group,PSE group exhibited less intraopera-tive bleeding(MD=-73.92,95％CI:-89.39--58.45,P＜0.001),less hospitalization costs(MD=-0.80,95％CI:-1.27--0.34,P=0.0008)and shorter length of stay(MD=-4.08,95％CI:-5.22--2.95,P＜0.001).Conclusion The current evi-dence shows that PSE has certain short-term and long-term effects on hypersplenism.Compared with splenectomy,it has less surgical trauma,less hospital stay and less cost,easy to control complications,and retains some immune function,which is worth spreading in the clinic.Limited by the quantity and quality of the included literature,more high-quality studies are needed to confirm the above conclu-sions.

Objective To investigate clinical features and risk factors of obstructive sleep apnea(OSA)complicated with metabolic associated fatty liver disease(MAFLD),and to construct a prediction model,so as to provide reference for clinical diagnosis and treat-ment.Methods A total of 228 OSA patients admitted to Xiangyang No.1 People's Hospital Affiliate to Hubei University of Medicine from January 2020 to December 2022 were selected.According to whether complicated with MAFLD,the patients were divided into OSA+MAFLD group(n=94)and OSA group(n=134).According to the liver/spleen CT values,OSA+MAFLD group was further di-vided into OSA+mild MAFLD group(n=56)and OSA+moderate-severe MAFLD group(n=38).General clinical data,polysomnog-raphy(PSG),serological examination and other related indicators and parameters of all patients were collected for statistical analysis.Results Univariate analysis showed that there were significant differences between the OSA group and the OSA+MAFLD group in age,hypertension,diabetes,hyperlipidemia,body mass index(BMI),apnea hypopnea index(AHI),oxygen reduction index(ODI),lon-gest apnea time(LAT),snore frequency,lowest saturation oxygen(LSpO2),mean oxygen saturation(MSpO2),CT90％,fasting plasma glucose(FPG),alanine aminotransferase(ALT),aspartate aminotransferase(AST),γ-glutamyltransferase(GGT)(P＜0.05);and there were significant differences between the OSA+mild MAFLD group and the OSA+moderate-severe MAFLD group in age,hyperlip-idemia,BMI,AHI,ODI,LAT,snore frequency,LSpO2,MSpO2,CT90％and ALT(P＜0.05).Multivariate Logistic regression analy-sis showed that age,BMI,AHI,snore frequency were independent risk factors for OSA and MAFLD(P＜0.05);Age,BMI,AHI and ALT were independent risk factors for OSA with moderate-severe MAFLD(P＜0.05).The Logistic regression model was established:Y1=-13.183+0.083age+0.205BMI+0.039AHI+0.002snore frequency,the area under the receiver operating characteristic curve was 0.915,and the sensitivity and specificity of the regression model were 87.2％and 82.8％.Y2=-44.956+0.146age+0.510BMI+0.056AHI+0.022ALT,the area under the receiver operating characteristic curve was 0.924,and the sensitivity and specificity of the regression model were 78.9％and 91.1％.Conclusion In clinical work,the occurrence of MAFLD should be considered for OSA pa-tients with older age,higher BMI,higher AHI,and more snoring frequency.OSA patients with MAFLD with older age,higher BMI,higher AHI,and higher ALT are more serious.Moreover,the combined prediction model constructed in this study has better diagnostic value,and can provide reference for early diagnosis of OSA complicated with MAFLD.

Objective To review and analyze the clinical and pathological data of children with autoimmune hepatitis (AIH).Methods Medical records of 46 patients hospitalized in Pediatric Liver Diseases Treatment and Research Center,Fifth Medical Center,General Hospital of People's Liberation Army(PLA) from April 2012 to April 2018 were extracted.Medical data included type of AIH,clinical manifestations,biochemical parameters,liver biopsy results,and outcomes of treatment were analyzed retrospectively.Among 46 children,19 were males and 27 were females.The age of onset was 10.1 (1.4-18.0) years old.Chi-Square test,Rank sum test or t test were used for inter-group comparison.Results There were 32 (70％)AIH-Ⅰ cases and 14 (30％)AIH-Ⅱ cases (x2=12.565,P=0.000).Among the 46 patients,there were 5 modes of onest:17 cases (37％) had acute viral hepatitis-like presentation,2 cases (4％)had fulminant hepatic failure,9 cases (20％) had insidious onset,5 cases (11％) showed cirrhosis and portal hypertension,and 13 cases (28％) were incidentally found to be due to elevated hepatic aminotransferases.Comorbidities including primary sclerotic cholangitis (n=3),primary biliary cholangitis (n=1),systemic lupus erythematosus (n=1) and inflammatory bowel disease (n=2),were all seen in AIH-Ⅰ cases.The elevated biochemical parameters of these patients were as follows:alanine aminotransferase (n=46),aspartate transminase (n=46),total bilirubin (n=35) γ-glutamyl transpeptadase (n=39),γ-globulin (n=32) and IgG (n=33).The γ-globulin and IgG levels were significantly higher in AIH-Ⅰ patients than those with AIH-Ⅱ ((32±9)％ vs.(23±8)％,t=3.217,P=0.002,(27± 10) vs.(18±8)g/L,t=3.193,P=0.003,respectively).Thirty-nine patients received liver biopsy,among whom 22 (56％) with inflammation grade (G)≥3,26(67％) with fibrosis stage (S) ≥3,and 7 with hepatic cirrhosis (S4) according to pathological analysis.Typical histopathological changes of AIH included:36 cases of interfacial hepatitis (92％),23 cases of lymphocyte/plasma cell infiltration (59％),3 cases of rosette (8％).Forty patients received prednisolone monotherapy or combined with azathioprine after diagnosis.Complete remission was seen in 29 (72％) patients,partial remission in 10 (25％) patients and no response in 1 (3％) patient.Among complete remission patients,15 (52％) had relapse in the process of prednisolone reduction.Repeated liver biopsy performed in 8 patients after treatment showed that hepatic inflammation and fibrosis were both improved in 6 patients,only inflammation was alleviated without fibrosis improvement in 1 patient,and neither inflammation nor fibrosis was improved in 1 case.The length of follow-up was 3.3 (0.3-10.5) years,and none of the 39 prednisolone-responded cases discontinued treatment successfully.Adverse effect of long-term prednisolone therapy included bilateral cataract (n=6),spinal fracture accompanied with delayed bone age development (n=1).Conclusions AIH-Ⅰ is more common than AIH-Ⅱ in children,with diverse clinical characteristics.Most cases have progressive liver inflammation and fibrosis when diagnosed.Prednisolone monotherapy or combined with azathioprine could achieve both biochemical and pathological improvement,but relapse is inevitable during drug tapering,hence long-term treatment is essential.

Objective To improve the quality standard of Taohong Tongmai granule.Methods TLC was used to make qualitative identification of Paeoniae Radix Rubra,Rehmanniae Radix,Glycyrrhizae Radix;The effective components of the main walnut kernel were identified by HPLC;and HPLC was used to do quantitative determination of Paeoniflorin,the determination was performed on Agilent HC-C18(250mm×4.6mm,5μm)column with mobile phase consisted of Acetonitrile-water(13:87) at the flow rate of 1.0 ml/min,the column temperature was 30 ℃ and the detection wavelength was set at 230 nm.Results These TLC spots were fairly clear,and the blank test showed no interference;The paeoniflorin at the range of 1·79-57.28 μg/ml was linear with peak area(r= 0.999 9),its average recovery rate was 99.99% and RSD was 2.05%(n= 9). Conclusion The quality standard of Taohong Tongmai granule had been improved,identification method was better reproduc-ibility,the determination method of paeoniflorin content had enhanced the controllability of product quality.

Objective To improve quality standard of Fufang Shenghua granules.Methods TLC was used to identify chief components in the preparation, Radix et Rhizoma Glycyrrhizae and Salvia Miltiorrhiza.HPLC was applied to identify Amarogentin and to determine the content of Salvianolic acid B.Salvianolic acid B assay was performed on Agilent HC-C18(4.6 mm×250 mm, 5 μm) column with Acetonitrile-0.1% phosphoric acid (23∶77)as mobile phase.The flow rate was 1.0 ml/min.The column temperature was 30 ℃.The detection wavelength was set at 286 nm.Results The spots on TLC were fairly clear with good separation.There was no interference from the negative control samples.However, HPLC was a more accurate, reliable and objective method for qualitative identification.Salvianolic acid B showed a good linear correlation in the range of 1.56~49.92 μg/ml (r=0.999 9).The average recovery was 100.07%, RSD 1.61% (n=9).Conclusion A simple, accurate and reliable method was developed for the quality control of Fufang Shenghua granules.

Objective To explore the clinical effect of ultrasound-guided ilioinguinal/iliohypo-gastric nerve blocks marked by arteriae circumflexa ilium profunda in elderly hernia surgery. Methods Forty ASA Ⅰ-Ⅲ grade patients (33 males and 7 females)of 65-90 years old scheduled for elective hernia surgery were randomly divided into two groups (n =20).In group T,patients received ilioinguinal/iliohypogastric nerve blocks bytraditional anatomical positioning;in group V,patients re-ceived ultrasound-guided ilioinguinal/iliohypogastric nerve blocks marked by arteriae circumflexa ilium profunda.The comparison was made between the two groups in term of onset time of anesthe-sia,VAS score of intraoperative and postoperative 6 h.Anesthesia satisfaction,incidence of uros-chesis,misplacement local anesthetics into blood-vessels were recorded.Results The onset time of anesthesia in group V was significantly shorter than that in group T [(6.1 ± 1.8)min vs (12.1 ± 2.0)min,P <0.05].The VAS score of intraoperative in group T was significantly higher than that of group V [(4.5 ± 1.1 )scores vs (2.1 ± 0.9 )scores,P < 0.05 ].The anesthesia satisfaction of group V was higher than that of group T (P <0.05).There was one misplacement local anesthetics into blood-vessels in group T.Conclusion Ultrasound-guided ilioinguinal/iliohypogastric nerve blocks marked by arteriae circumflexa ilium profunda can provide safe,effective and reliable anesthesia in elderly hernia surgery.

Objective To compare two methods in the determination of mannatide for injection .Methods The contents were determined by spectrophotometry and HPLC method .Results In the samples determined by Spectrophotometric Determi‐nation ,soluble in phenol solution and sulfuric acid ,was detected at wavelength 490 nm ,D‐mannose derivatives linear concen‐tration range is 10 .2‐51 μg/ml (r=0 .999 1) ,the average content was 92 .14% ,the average RSD value was 1 .17% .In the HPLC determination , with color spectrum column : Gemini C18 (250 mm × 4 .6 mm , 5 μm ) , mobile phase acetonitrile -0 .02 mol/L ammonium acetate solution (20∶80) ,flow rate:1 ml/min ,the detection wavelength was at 250 nm , column temperature:30 ℃ ,sample size:10 μl detection .The average content ws 83 .47% ,the average RSD value was 0 .65% ,the content of two kinds of methods could effectively determine the D‐mannose .Conclusion The average content for spectrophotometry was higher ,but the phenol was used in detection of special odor ,poisonous ,corrosive ,would cause a cer‐tain risk .HPLC was exclusive ,chromatogram was more intuitive ,on the operator harmfulness and less irritating .A new meth‐od for the determination of D‐mannose was established at the same time .

Objective To establish a quality standard for Ganmao granules of hospital preparations .Methods Radix Scutellariae ,cortex phellodendri and radix bupleuri were identified by thin layer chromatography (TLC) qualitatively .High performance liquid chromatography (HPLC) was used for the content of baicalin .The determination was performed on Agilent HC-C18 column (250 mm × 4 .6 mm ,5 μm) at 30 ℃ with mobile phase composed of methanol-0 .2% phosphoric acid (43∶57) at the flow rate of 1 .0 ml/min .The detection wavelength was set at 280 nm .Results In TLC chromatograms ,the spectra of different test products had spots of the same color at corresponding sites ,with no interference from negative control .A good linearity range of baicalin was 1 .81~72 .40 μg/ml (r=0 .999 9) .The average recovery rate was 98 .55% (RSD=1 .91% ,n=9) .Conclusion The quality standard was established and the method of identification has good reproducibility .The method of determination of baicalin content improved the controllability of formulated quality of Ganmao granules .

OBJECTIVE:To establish the quality standards for Shenshuaikang granule. METHODS:TLC was used for the quali-tative identification of Astragali Radix and Rhei Radix et Rhizoma in the preparation. HPLC was used for the contents determina-tion of emodin and chrysophanol ,the column was Agilent HC-C18 with mobile phase of methanol-0.1% phosphoric acid (85:15 , V/V)at a flow rate of 1.0 ml/min,the detection wavelength was 254 nm,the column temperature was 30 ℃ and the injection vol-ume was 10 μl. RESULTS:TLC showed clear spots and good separation. The linear range was 1.9-60.8 μg/ml for emodin(r=0.999 9, n=6) and 1.6-51.2 μg/ml for chrysophanol (r=0.999 9),RSDs of precision,stability and reproducibility tests were lower than 3%,recoveries were 95.76%-103.66%(RSD=2.83%,n=9)and 97.24%-104.34%(RSD=2.65%,n=9),respectively. CONCLU-SIONS:The standard can be used for the quality control of Shenshuaikang granule.

Objective:To establish the quality standard for Tangzhixiao capsules. Methods: The qualitative identification of Salvia miltiorrhiza,Atractylodes and Hawthorn was detected by TLC, and the quantitative determination of salvianolic acid B was determined by HPLC. The HPLC determination was performed on a YMC-Triart C18 (250 mm × 4. 6 mm, 5μm ) column with the mobile phase consisted of acetonitrile-0. 1% phosphoric acid (24∶ 76) at the flow rate of 1. 0 ml·min-1 , the column temperature was 30℃ and the detection wavelength was set at 286 nm. Results: The TLC spots were fairly clear, and the negative samples showed no interference. The concentration of salvianolic acid B within the range of 0. 012-0. 120 mg·ml -1 was linear with peak area(r = 0. 999 5), the average recovery was 100. 06% and RSD was 0. 83%(n = 6). Conclusion: The method is accurate, reliable and reproducible, which can be used in the quality control of Tangzhixiao capsules.