BACKGROUND Depression is a significant psychiatric disorder with particularly high prevalence among adolescents.This mental health condition can have severe consequences,including academic failure,social withdrawal,an...BACKGROUND Depression is a significant psychiatric disorder with particularly high prevalence among adolescents.This mental health condition can have severe consequences,including academic failure,social withdrawal,and suicidal behavior.Given the increasing rate of depression in this age group,understanding the underlying biological mechanisms is essential for early detection and intervention.Recent studies have suggested that immune markers play a role in the pathophysiology of depression,prompting further investigation of their potential association with depressive symptoms in adolescents.AIM To investigate the relationship between immune markers(monocytes,lymphocytes,and direct bilirubin)and the incidence and severity of depression among adolescents.METHODS This cross-sectional study recruited 145 adolescent patients with depression[male(M)/female(F)=38/107]from Jiangbin Hospital in Guangxi,Zhuang and 163 healthy controls(M/F=77/86)from routine health check-ups.Blood samples were collected after an overnight fast.Depression severity was measured using the Zung Self-Rating Depression Scale.The inclusion criteria were age 12-24 years,diagnosis of depressive disorder(ICD-10),and no recent antidepressant use.The exclusion criteria included psychiatric comorbidities and serious somatic diseases.Key statistical methods included group comparisons and correlation analyses.RESULTS There was a higher prevalence of females in the depression group(P<0.001).Significant age differences were observed between the groups(Z=9.43,P<0.001).The depression group had higher monocyte(Z=3.43,P<0.001)and lymphocyte(t=2.29,P<0.05)counts,and higher serum direct bilirubin levels(Z=4.72,P<0.001).Monocyte count varied significantly according to depression severity,with lower counts in the mild group(Z=-2.90,P<0.05).A negative correlation between age and lymphocyte counts was observed(ρ=-0.22,P<0.01).Logistic regression analysis showed that serum direct bilirubin levels significantly predicted depression.CONCLUSION The potential role of elevated levels of immune markers in the early detection of depression in adolescents has been highlighted.Therefore,it is necessary to explore further the relationships between these immune markers and depression.展开更多
Gallbladder stones,a prevalent biliary tract disease,have multifactorial etiologies including metabolic,genetic,and environmental factors.Emerging evidence su-ggests that hematological disorders,particularly those inv...Gallbladder stones,a prevalent biliary tract disease,have multifactorial etiologies including metabolic,genetic,and environmental factors.Emerging evidence su-ggests that hematological disorders,particularly those involving hemolysis or impaired erythropoiesis,may play a significant role in the formation of gallblad-der stones,predominantly pigment stones.This review explores the pathophysio-logical mechanisms linking hematological disorders,such as hemolytic anemias,myeloproliferative disorders,and hematological malignancies,with gallbladder stone development.We also examine the influence of treatments for hemato-logical conditions,such as blood transfusions and chemotherapy,on gallstone risk.Additionally,this article discusses the clinical implications of gallbladder stones in patients with hematological disorders,including diagnostic challenges,management strategies,and surgical considerations.By providing a compre-hensive overview of current knowledge,this review aims to highlight the need for further research into the interplay between hematological disorders and gall-bladder stones,potentially improving preventive and therapeutic strategies in these patient populations.展开更多
Hereditary spherocytosis(HS),a common inherited hemolytic anemia,is characterized by red blood cell membrane protein defects leading to chronic hemolysis.This condition significantly predisposes patients to gallstone ...Hereditary spherocytosis(HS),a common inherited hemolytic anemia,is characterized by red blood cell membrane protein defects leading to chronic hemolysis.This condition significantly predisposes patients to gallstone disease,including both gallbladder and bile duct stones,due to excessive bilirubin production from hemolysis.Gallstones in HS patients,primarily composed of bilirubin,can lead to complications such as cholecystitis,cholangitis,and obstructive jaundice.This review provides a comprehensive landscape of the pathophysiological mechanisms linking HS to gallstone formation,emphasizing the roles of hemolysis,bile composition,and genetic factors.It also discusses the clinical manifestations of gallstone disease in HS,including recurrent jaundice and biliary obstruction,and highlights the diagnostic value of imaging modalities such as ultrasonography and magnetic resonance cholangiopancreatography.Furthermore,current management strategies,including splenectomy,cholecystectomy,and endoscopic approaches for bile duct stones,are examined in the context of HS.By synthesizing existing knowledge,this review aims to provide insights into improving the diagnosis,prevention,and treatment of gallstone disease in patients with HS,while identifying gaps for future research.展开更多
BACKGROUND Sarcopenia is a clinical syndrome presented with progressive and generalized skeletal muscle loss and function dysfunction.Usually,it is considered an agerelated process influenced by genetic,lifestyle fact...BACKGROUND Sarcopenia is a clinical syndrome presented with progressive and generalized skeletal muscle loss and function dysfunction.Usually,it is considered an agerelated process influenced by genetic,lifestyle factors,and diseases.Obstructive jaundice is one of the most common pathophysiological changes in patients needing hepatobiliary or pancreatic operations that can adversely affect the tissue and organ function throughout the human body.However,the effects of obstructive jaundice on the occurrence of sarcopenia remain unclear.AIM To investigate the incidence of sarcopenia in patients with surgical obstructive jaundice and the association of sarcopenia with postoperative outcome.METHODS This cross-sectional study was conducted from December 2019 to January 2024.Data retrieved included patient demographics,disease entities,sarcopenia-related parameters(including grip strength,6-m walking time,and limb skeletal muscle mass index),postoperative complications,and length of hospital stay.Sarcopenia was confirmed using Asian Working Group standards.Logistic regression was used to analyze the relationship between total bilirubin level and sarcopenia.The factors influencing sarcopenia in patients with surgical obstructive jaundice and association of sarcopenia with postoperative complications were also investigated.RESULTS Overall,1708 patients met the inclusion criteria,with a mean age of 60.09±13.52 years(sex:52.28%male).There were 383 patients(22.42%)with obstructive jaundice and 1325(77.58%)without jaundice.Sarcopenia,low walking speed,low grip strength,and low limb skeletal muscle index were more prevalent in patients with obstructive jaundice than nonobstructive jaundice.The odds ratio(OR)for sarcopenia in patients with obstructive jaundice was 1.689[95%confidence interval(CI):1.295-2.203,P<0.001],indicating that jaundice is a significant risk factor for sarcopenia.The occurrence of sarcopenia was higher in patients with severe obstructive jaundice than mild obstructive jaundice(39.3%vs 22.8%,P<0.05).Obstructive jaundice was positively correlated with reduced walking speed(OR=1.627,95%CI:1.185-2.234,P=0.003)and decreased grip strength(OR=1.669,95%CI:1.212-2.300,P=0.002).Age(OR=1.077,95%CI:1.040-1.114,P<0.001)and body mass index(OR=0.703,95%CI:0.630-0.784,P<0.001)were independent risk factors of sarcopenia in patients with obstructive jaundice.Patients with obstructive jaundice and sarcopenia had a higher rate of postoperative complications(46.3%vs 33.1%,P=0.032),longer postoperative hospital stays(11.33±6.75 days vs 9.19±7.32 days,P=0.016),and longer total hospital stays(17.10±7.69 days vs 15.98±8.55 days,P=0.032)than those without sarcopenia.CONCLUSION Sarcopenia is more prevalent in patients with obstructive jaundice and is positively correlated with the degree of jaundice.Sarcopenia prolongs hospital stays and is associate with postoperative complications.展开更多
BACKGROUND Diabetic retinopathy(DR)is a major cause of visual impairment and blindness.However,the current DR biomarkers are insufficient for accurately predicting its onset.AIM To identify a novel marker for predicti...BACKGROUND Diabetic retinopathy(DR)is a major cause of visual impairment and blindness.However,the current DR biomarkers are insufficient for accurately predicting its onset.AIM To identify a novel marker for predicting the risk of developing DR in patients with type 2 diabetes mellitus(T2DM).METHODS We conducted a cross-sectional study involving 6993 hospitalized T2DM patients between 2013 and 2020.Patients were divided into two groups:The DR group and the non-DR group.Data were analyzed using univariate,correlation,multivariate,subgroup,and receiver operating characteristic curve analyses.RESULTS Total bilirubin,indirect bilirubin(IBIL),and direct bilirubin were negatively correlated with the risk of developing DR(P<0.001).Moreover,these three factors were all positively correlated with clinical indicators related to DR,including the estimated glomerular filtration rate,the albumin/creatinine ratio,and the 1,25-dihydroxyvitamin D3 level(P<0.001).After adjusting for multiple variables,greater IBIL levels remained independently associated with a lower risk of developing DR(odds ratio=0.500;95%confidence interval:0.363-0.686;P<0.001).The optimal IBIL cutoff point for predicting the risk of DR in male patients with elevated diastolic blood pressure was 0.655μmol/dL(area under the curve=0.662).CONCLUSION These findings suggest that IBIL could be a valuable biomarker for predicting DR risk,offering a noninvasive,cost-effective,and readily available clinical tool for the early identification of high-risk patients.Future multicenter and longitudinal studies are warranted to validate these findings and further explore the biological mechanisms underlying the protective role of IBIL in DR.展开更多
Acute Bilirubin Encephalopathy(ABE)is a significant threat to neonates and it leads to disability and high mortality rates.Detecting and treating ABE promptly is important to prevent further complications and long-ter...Acute Bilirubin Encephalopathy(ABE)is a significant threat to neonates and it leads to disability and high mortality rates.Detecting and treating ABE promptly is important to prevent further complications and long-term issues.Recent studies have explored ABE diagnosis.However,they often face limitations in classification due to reliance on a single modality of Magnetic Resonance Imaging(MRI).To tackle this problem,the authors propose a Tri-M2MT model for precise ABE detection by using tri-modality MRI scans.The scans include T1-weighted imaging(T1WI),T2-weighted imaging(T2WI),and apparent diffusion coefficient maps to get indepth information.Initially,the tri-modality MRI scans are collected and preprocessesed by using an Advanced Gaussian Filter for noise reduction and Z-score normalisation for data standardisation.An Advanced Capsule Network was utilised to extract relevant features by using Snake Optimization Algorithm to select optimal features based on feature correlation with the aim of minimising complexity and enhancing detection accuracy.Furthermore,a multi-transformer approach was used for feature fusion and identify feature correlations effectively.Finally,accurate ABE diagnosis is achieved through the utilisation of a SoftMax layer.The performance of the proposed Tri-M2MT model is evaluated across various metrics,including accuracy,specificity,sensitivity,F1-score,and ROC curve analysis,and the proposed methodology provides better performance compared to existing methodologies.展开更多
BACKGROUND Gastric cancer is the most common malignancy of the digestive system and surgical resection is the primary treatment.Advances in surgical technology have reduced the risk of complications after radical gast...BACKGROUND Gastric cancer is the most common malignancy of the digestive system and surgical resection is the primary treatment.Advances in surgical technology have reduced the risk of complications after radical gastrectomy;however,post-surgical pancreatic fistula remain a serious issue.These fistulas can lead to abdominal infections,anastomotic leakage,increased costs,and pain;thus,early diagnosis and prevention are crucial for a better prognosis.Currently,C-reactive protein(CRP),procalcitonin(PCT),and total bilirubin(TBil)levels are used to predict post-operative infections and anastomotic leakage.However,their predictive value for pancreatic fistula after radical gastrectomy for gastric cancer remains unclear.The present study was conducted to determine their predictive value.AIM To determine the predictive value of CRP,PCT,and TBil levels for pancreatic fistula after gastric cancer surgery.METHODS In total,158 patients who underwent radical gastrectomy for gastric cancer at our hospital between January 2019 and January 2023 were included.The patients were assigned to a pancreatic fistula group or a non-pancreatic fistula group.Multivariate logistic analysis was conducted to assess the factors influencing development of a fistula.Receiver operating characteristic(ROC)curves were used to determine the predictive value of serum CRP,PCT,and TBil levels on day 1 postsurgery.RESULTS On day 1 post-surgery,the CRP,PCT,and TBil levels were significantly higher in the pancreatic fistula group than in the non-pancreatic fistula group(P<0.05).A higher fistula grade was associated with higher levels of the indices.Univariate analysis revealed significant differences in the presence of diabetes,hyperlipidemia,pancreatic injury,splenectomy,and the biomarker levels(P<0.05).Logistic multivariate analysis identified diabetes,hyperlipidemia,pancreatic injury,CRP level,and PCT level as independent risk factors.ROC curves yielded predictive values for CRP,PCT,and TBil levels,with the PCT level having the highest area under the curve(AUC)of 0.80[95%confidence interval(CI):0.72-0.90].Combined indicators improved the predictive value,with an AUC of 0.86(95%CI:0.78-0.93).CONCLUSION Elevated CRP,PCT,and TBil levels predict risk of pancreatic fistula post-gastrectomy for gastric cancer.展开更多
BACKGROUND Helicobacter pylori(H.pylori)is a prevalent pathogen associated with various diseases.Cholelithiasis is also a common condition.H.pylori infection has been identified in the biliary system,suggesting its po...BACKGROUND Helicobacter pylori(H.pylori)is a prevalent pathogen associated with various diseases.Cholelithiasis is also a common condition.H.pylori infection has been identified in the biliary system,suggesting its potential involvement in biliary diseases.However,the specific role of H.pylori in the development of cholelithiasis remains inconclusive.AIM To investigate the potential association between H.pylori infection and the development of cholelithiasis.METHODS We performed a retrospective study in more than 70000 subjects in health examination center from 3 institutions in the middle,northern and eastern China,from October 2018 to December 2021,to explore the potential association between H.pylori and cholelithiasis through univariate and multivariate analysis.Meanwhile,the influence of H.pylori on biliary-related parameters was investigated.A comprehensive analysis of previous studies concerned about H.pylori and cholelithiasis was also executed.RESULTS In our multi-center study,H.pylori was positively associated with cholelithiasis[odds ratio(OR)=1.103,95%confidence interval(CI):1.001-1.216,P=0.049].Furthermore,H.pylori patients had less total and direct bilirubin than uninfected patients,while the total cholesterol and low-density lipoprotein cholesterol were more in H.pyloripositive participants(P<0.05).In the published articles,the cohort studies indicated H.pylori was a risk factor of cholelithiasis(hazard ratio=1.3280,95%CI:1.1810-1.4933,P<0.0001).The pooled results of case-control and crosssectional studies showed positive association between H.pylori and cholelithiasis in Asia(OR=1.5993,95%CI:1.0353-2.4706,P=0.034)but not in Europe(OR=1.2770,95%CI:0.8446-1.9308,P=0.246).Besides,H.pylori was related to a higher choledocholithiasis/cholecystolithiasis ratio(OR=3.3215,95%CI:1.1034-9.9986,P=0.033).CONCLUSION H.pylori is positively correlated with cholelithiasis,choledocholithiasis phenotype particularly,especially in Asia,which may be relevant to bilirubin/cholesterol metabolism.Cohort studies confirm an increased risk of cholelithiasis in H.pylori patients.展开更多
This editorial synthesizes insights from a series of studies examining the interplay between metabolic and oxidative stress biomarkers in cardiovascular disease(CVD),focusing particularly on type-2 diabetes mellitus(T...This editorial synthesizes insights from a series of studies examining the interplay between metabolic and oxidative stress biomarkers in cardiovascular disease(CVD),focusing particularly on type-2 diabetes mellitus(T2DM)and acute coronary syndrome(ACS).The central piece of this synthesis is a study that investigates the balance between oxidative stress and antioxidant systems in the body through the analysis of serum bilirubin andγ-glutamyltranspeptidase(γ-GGT)levels in T2DM patients with ACS.This study highlights serum bilirubin as a protective antioxidant factor,while elevatedγ-GGT levels indicate increased oxidative stress and correlate with major adverse cardiovascular events.Complementary to this,other research contributions revealγ-GGT’s role as a risk factor in ACS,its association with cardiovascular mortality in broader populations,and its link to metabolic syndrome,further elucidating the metabolic dysregulation in CVDs.The collective findings from these studies underscore the critical roles ofγ-GGT and serum bilirubin in cardiovascular health,especially in the context of T2DM and ACS.By providing a balanced view of the body’s oxidative and antioxidative mechanisms,these insights suggest potential pathways for targeted interventions and improved prognostic assessments in patients with T2DM and ACS.This synthesis not only corroborates the pivotal role ofγ-GGT in cardiovascular pathology but also introduces the protective potential of antioxidants like bilirubin,illuminating the complex interplay between T2DM and heart disease.These studies collectively underscore the critical roles of serum bilirubin andγ-GGT as biomarkers in cardiovascular health,particularly in T2DM and ACS contexts,offering insights into the body’s oxidative and antioxidative mechanisms.This synthesis of research supports the potential of these biomarkers in guiding therapeutic strategies and improving prognostic assessments for patients with T2DM and some CVD.展开更多
BACKGROUND Cardiovascular disease is a major complication of diabetes mellitus(DM).Type-2 DM(T2DM)is associated with an increased risk of cardiovascular events and mortality,while serum biomarkers may facilitate the p...BACKGROUND Cardiovascular disease is a major complication of diabetes mellitus(DM).Type-2 DM(T2DM)is associated with an increased risk of cardiovascular events and mortality,while serum biomarkers may facilitate the prediction of these outcomes.Early differential diagnosis of T2DM complicated with acute coronary syndrome(ACS)plays an important role in controlling disease progression and improving safety.AIM To investigate the correlation of serum bilirubin andγ-glutamyltranspeptidase(γ-GGT)with major adverse cardiovascular events(MACEs)in T2DM patients with ACS.METHODS The clinical data of inpatients from January 2022 to December 2022 were analyzed retrospectively.According to different conditions,they were divided into the T2DM complicated with ACS group(T2DM+ACS,n=96),simple T2DM group(T2DM,n=85),and simple ACS group(ACS,n=90).The clinical data and laboratory indices were compared among the three groups,and the correlations of serum total bilirubin(TBIL)levels and serumγ-GGT levels with other indices were discussed.T2DM+ACS patients received a 90-day follow-up after discharge and were divided into event(n=15)and nonevent(n=81)groups according to the occurrence of MACEs;Univariate and multivariate analyses were further used to screen the independent influencing factors of MACEs in patients.RESULTS The T2DM+ACS group showed higherγ-GGT,total cholesterol,low-density lipoprotein cholesterol(LDL-C)and glycosylated hemoglobin(HbA1c)and lower TBIL and high-density lipoprotein cholesterol levels than the T2DM and ACS groups(P<0.05).Based on univariate analysis,the event and nonevent groups were significantly different in age(t=3.3612,P=0.0011),TBIL level(t=3.0742,P=0.0028),γ-GGT level(t=2.6887,P=0.0085),LDL-C level(t=2.0816,P=0.0401),HbA1c level(t=2.7862,P=0.0065)and left ventricular ejection fraction(LEVF)levels(t=3.2047,P=0.0018).Multivariate logistic regression analysis further identified that TBIL level and LEVF level were protective factor for MACEs,and age andγ-GGT level were risk factors(P<0.05).CONCLUSION Serum TBIL levels are decreased andγ-GGT levels are increased in T2DM+ACS patients,and the two indices are significantly negatively correlated.TBIL andγ-GGT are independent influencing factors for MACEs in such patients.展开更多
Surgical resection is a pivotal therapeutic approach for addressing hepatic space-occupying lesions,with liver volume restoration and hepatic functional recovery being crucial for assessing surgical prognosis.The preo...Surgical resection is a pivotal therapeutic approach for addressing hepatic space-occupying lesions,with liver volume restoration and hepatic functional recovery being crucial for assessing surgical prognosis.The preoperative albumin-bilirubin(ALBI)score,encompassing serum albumin and bilirubin levels,can be determined via blood analysis,effectively mitigating human error and providing an accurate depiction of liver function.The hepatectomy ratio,which is the proportion of the liver volume removed to the total liver volume,is critical in preserving an adequate liver tissue volume to ensure postoperative hepatic functional compensation,minimize surgical complications,and reduce mortality rates.Incorporating the preoperative ALBI score and hepatectomy ratio aids surgeons in assessing the optimal timing and extent of partial hepatectomy.The introduction of preoperative albumin bilirubin score and hepatectomy percentage is beneficial for the surgeons to evaluate the timing and magnitude of partial liver resection.展开更多
BACKGROUND Individuals with diabetes mellitus are more likely to experience depression,although most patients remain undiagnosed.The relation between total bilirubin and depression has been increasingly discussed,but ...BACKGROUND Individuals with diabetes mellitus are more likely to experience depression,although most patients remain undiagnosed.The relation between total bilirubin and depression has been increasingly discussed,but limited studies have examined the association of total bilirubin with depression risk in adults with diabetes,which warrants attention.AIM To investigate the association between total bilirubin levels and the risk of depression in adults with diabetes.METHODS The study included adults with diabetes from the National Health and Nutrition Examination Survey 2007-2018.Depression was determined using the Patient Health Questionnaire-9.Multivariable logistic regression,propensity scorematched analysis and restricted cubic spline models were utilized to investigate the association between total bilirubin levels and depression risk in adults with diabetes.RESULTS The study included 4758 adults with diabetes,of whom 602(12.7%)were diagnosed with depression.After adjusting for covariates,we found that diabetic adults with lower total bilirubin levels had a higher risk of depression(OR=1.230,95%CI:1.006-1.503,P=0.043).This association was further confirmed after propensity score matching(OR=1.303,95%CI:1.034-1.641,P=0.025).Subgroup analyses showed no significant dependence of age,body mass index,sex,race or hypertension on this association.Restricted cubic spline models displayed an inverted U-shaped association of total bilirubin levels with depression risk within the lower range of total bilirubin levels.The depression risk heightened with the increasing levels of total bilirubin,reaching the highest risk at 6.81μmol/L and decreasing thereafter.CONCLUSION In adults with diabetes,those with lower levels of total bilirubin were more likely to have depressive symptoms.Serum total bilirubin levels may be used as an additional indicator to assess depression risk in adults with diabetes.展开更多
Background: Exclusive breastfeeding is globally promoted as a preventive health measure. However, an increasing incidence of jaundice among exclusively breastfed neonates has been observed. In Jos, Nigeria, anecdotal ...Background: Exclusive breastfeeding is globally promoted as a preventive health measure. However, an increasing incidence of jaundice among exclusively breastfed neonates has been observed. In Jos, Nigeria, anecdotal evidence suggests a rise in jaundice cases among breastfed infants during their first week of life. This study investigates the relationship between neonatal jaundice and the biochemical composition of maternal breast milk in Jos, Nigeria. Objective: To evaluate the role of maternal milk protein status and other milk constituents in the development of neonatal jaundice among exclusively breastfed full-term infants. Methods: This cross-sectional study involved 152 participants, comprising of 76 neonates (38 jaundiced and 38 healthy controls) and their corresponding 76 mothers at Jos University Teaching Hospital. Biochemical analyses were conducted on maternal breast milk (albumin, proteins, casein, fat, lactose, enzymes) and infant serum (bilirubin, albumin, proteins, enzymes). Statistical analysis was performed using Mann-Whitney tests with significance set at p ≤ 0.05. Results: Maternal breast milk from mothers of jaundiced infants showed significantly lower protein (0.73 ± 0.07 g/100ml), albumin (0.62 ± 0.04 g/100ml), and casein (1.6 ± 0.12 g/100ml) levels compared to controls (p Conclusion: The study highlights a potential link between lower maternal milk protein levels and the occurrence of neonatal jaundice. Interventions aimed at enhancing maternal nutrition and promoting more frequent breastfeeding may mitigate the risk. Further research should explore additional maternal and neonatal factors contributing to this condition.展开更多
Objective:To analyze the therapeutic efficacy of Yinzhihuang granules in treating neonatal jaundice.Methods:A total of 62 neonates with jaundice,admitted from September 2021 to September 2023,were randomly divided int...Objective:To analyze the therapeutic efficacy of Yinzhihuang granules in treating neonatal jaundice.Methods:A total of 62 neonates with jaundice,admitted from September 2021 to September 2023,were randomly divided into two groups.The observation group received Yinzhihuang granules,while the control group received conventional blue light therapy.The overall efficacy rate and other indicators were compared.Results:The observation group showed a higher overall efficacy rate and superior clinical indicators compared to the control group(P<0.05).Before treatment,there was no significant difference between the two groups in bilirubin,liver function,or immune function indicators(P>0.05).After one week of treatment,the observation group had lower bilirubin and liver function indicators and higher immune function indicators than the control group(P<0.05).Conclusion:Yinzhihuang granules can improve the efficacy of neonatal jaundice treatment,accelerate recovery,reduce bilirubin levels,protect liver function,and enhance immune function in neonates.展开更多
Forty-four different animal biles obtained from both invertebrates and vertebrates (including human bile) have been used for centuries for a host of maladies in traditional Chinese medicine (TCM) beginning with dog, o...Forty-four different animal biles obtained from both invertebrates and vertebrates (including human bile) have been used for centuries for a host of maladies in traditional Chinese medicine (TCM) beginning with dog, ox and common carp biles approximately in the Zhou dynasty (c. 1046-256 BCE). Overall, different animal biles were prescribed principally for the treatment of liver, biliary, skin (including burns), gynecological and heart diseases, as well as diseases of the eyes, ears, nose, mouth and throat. We present an informed opinion of the clinical efficacy of the medicinal uses of the different animal biles based on their presently known principal chemical components which are mostly steroidal detergent-like molecules and the membrane lipids such as unesterified cholesterol and mixed phosphatidylcholines and sometimes sphingomyelin, as well as containing lipopigments derived from heme principally bilirubin glucuronides. All of the available information on the ethnopharmacological uses of biles in TCM were collated from the rich collection of ancient Chinese books on materia medica held in libraries in China and United States and the composition of various animal biles was based on rigorous separatory and advanced chemical identification techniques published since the mid-20<sup>th</sup> century collected via library (Harvard’s Countway Library) and electronic searches (PubMed and Google Scholar). Our analysis of ethnomedical data and information on biliary chemistry shows that specific bile salts, as well as the common bile pigment bilirubin and its glucuronides plus the minor components of bile such as vitamins A, D, E, K, as well as melatonin (N-acetyl-5-methoxytryptamine) are salutary in improving liver function, dissolving gallstones, inhibiting bacterial and viral multiplication, promoting cardiac chronotropsim, as well as exhibiting anti-inflammatory, anti-pyretic, anti-oxidant, sedative, anti-convulsive, anti-allergic, anti-congestive, anti-diabetic and anti-spasmodic effects. Pig, wild boar and human biles diluted with alcohol were shown to form an artificial skin for burns and wounds one thousand years ago in the Tang dynasty (618-907 CE). Although various animal biles exhibit several generic effects in common, a number of biles appear to be advantageous for specific therapeutic indications. We attempt to understand these effects based on the pharmacology of individual components of bile as well as attempting to identify a variety of future research needs.展开更多
BACKGROUND Unconjugated bilirubin(UCB)is generally considered toxic but has gained recent prominence for its anti-inflammatory properties.However,the effects of it on the interaction between intestinal flora and organ...BACKGROUND Unconjugated bilirubin(UCB)is generally considered toxic but has gained recent prominence for its anti-inflammatory properties.However,the effects of it on the interaction between intestinal flora and organisms and how it influences immune responses remain unresolved.AIM To investigate the role of UCB in intestinal barrier function and immune inflammation in mice with dextran-sulfate-sodium-induced colitis.METHODS Acute colitis was induced by 3%(w/v)dextran sulfate sodium salt in drinking water for 6 d followed by untreated water for 2 d.Concurrently,mice with colitis were administered 0.2 mL UCB(400μmol/L)by intra-gastric gavage for 7 d.Disease activity index(DAI)was monitored daily.Mice were sacrificed at the end of the experiment.The length of the colon and weight of the spleen were recorded.Serum level of D-lactate,intestinal digestive proteases activity,and changes to the gut flora were analyzed.In addition,colonic specimens were analyzed by histology and for expression of inflammatory markers and proteins.RESULTS Mice treated with UCB had significantly relieved severity of colitis,including lower DAI,longer colon length,and lower spleen weight(colon length:4.92±0.09 cm vs 3.9±0.15 cm;spleen weight:0.33±0.04 vs 0.74±0.04,P<0.001).UCB administration inactivated digestive proteases(chymotrypsin:18.70±0.69 U/g vs44.81±8.60 U/g;trypsin:1.52±0.23 U/g vs 9.05±1.77 U/g,P<0.01),increased expression of tight junction(0.99±0.05 vs 0.57±0.03,P<0.001),decreased serum level of D-lactate(31.76±3.37μmol/L vs 54.25±1.45μmol/L,P<0.001),and lowered histopathological score(4±0.57 vs 7±0.57,P<0.001)and activity of myeloperoxidase(46.79±2.57 U/g vs 110.32±19.19 U/g,P<0.001).UCB also regulated the intestinal microbiota,inhibited expression of tumor necrosis factor(TNF)αand interleukin 1β(TNF-α:52.61±7.81 pg/mg vs 105.04±11.92 pg/mg,interleukin 1β:13.43±1.68 vs 32.41±4.62 pg/mg,P<0.001),decreased expression of Toll-like receptor 4(0.61±0.09 vs 1.07±0.03,P<0.001)and myeloid differentiation primary response gene 88(0.73±0.08 vs 1.01±0.07,P<0.05),and increased expression of TNF-receptor-associated factor 6(0.79±0.02 vs0.43±0.09 P<0.05)and inhibitor of kappa Bα(0.93±0.07 vs 0.72±0.07,P<0.05)in the colon.CONCLUSION UCB can protect intestinal barrier function,regulate normal intestinal homeostasis,and suppress inflammation via the Toll-like receptor 4/nuclear factor-κB signaling pathway.展开更多
AIM： To evaluate the long-term outcome and prognostic factors of patients with hilar cholangiocarinoma. METHODS： Ninety-six consecutive patients underwent treatment for malignant hilar bile duct tumors during 1995-2...AIM： To evaluate the long-term outcome and prognostic factors of patients with hilar cholangiocarinoma. METHODS： Ninety-six consecutive patients underwent treatment for malignant hilar bile duct tumors during 1995-2005. Of the 96 patients, 20 were initially treated with surgery （n = 2 R0 / n = 18 R1）. In non-operated patients, data analysis was performed retrospectively. RESULTS： Among the 96 patients, 76 were treated with endoscopic transpapillary （ERC, n = 45） and/or percutaneous transhepatic biliary drainage （PTBD, n = 31）. The mean survival time of these 76 patients undergoing palliative endoscopic and/or percutaneous drainage was 359 ± 296 d. The mean survival time of patients with initial bilirubin levels 〉 10 mg/dL was significantly lower （P 〈 0.001） than patients with bilirubin levels 〈 10 mg/dL. The mean survival time of patients with Bismuth stage Ⅱ （n = 8）, Ⅲ （n = 28） and Ⅳ （n = 40） was 496 =1= 300 d, 441 ± 385 d and 274 ± 218 d, respectively. Thus, patients with advanced Bismuth stage showed a reduced mean survival time, but the difference was not significant. The type of biliary drainage had no significant benefidal effect on the mean survival time （ERC vs PTBD, P = 0.806）. CONCLUSION： Initial bilirubin level is a significant prognostic factor for survival of patients. In contrast, age, tumor stage according to the Bismuth-Corlette classification, and types of intervention are not significant prognostic parameters for survival. Palliative treatment with endoscopic or percutaneous biliary drainage is still suboptimal, new diagnostic and therapeutic tools need to be evaluated.展开更多
AIM:To find a possible relationship between inflammation and CA19-9 tumor marker by analyzing data from patients with benign jaundice(BJ) and malignant jaundice(MJ).METHODS:All patients admitted for obstructive jaundi...AIM:To find a possible relationship between inflammation and CA19-9 tumor marker by analyzing data from patients with benign jaundice(BJ) and malignant jaundice(MJ).METHODS:All patients admitted for obstructive jaundice,in the period 2005-2009,were prospectively enrolled in the study,obtaining a total of 102 patients.On admission,all patients underwent complete standard blood test examinations including C-reactive protein(CRP),bilirubin,CA19-9.Patients were considered eligible for the study when they presented obstructive jaundice confirmed by instrumental examinations and increased serum bilirubin levels(total bilirubin > 2.0 mg/dL).The standard cut-off level for CA19-9 was 32 U/mL,whereas for CRP this was 1.5 mg/L.The CA19-9 level was adjusted by dividing it by the value of serum bilirubin or by the CRP value.The patients were divided into 2 groups,MJ and BJ,and after the adjustment a comparison between the 2 groups of patients was performed.Sensitivity,specificity and positive predictive values were calculated before and after the adjustment.RESULTS:Of the 102 patients,51 were affected by BJ and 51 by MJ.Pathologic CA19-9 levels were found in 71.7% of the patients.In the group of 51 BJ patients there were 29(56.9%) males and 22(43.1%) females with a median age of 66 years(range 24-96 years),whereas in the MJ group there were 24(47%) males and 27(53%) females,with a mean age of 70 years(range 30-92 years).Pathologic CA19-9 serum level was found in 82.3% of MJ.CRP levels were pathologic in 66.6% of the patients with BJ and in 49% with MJ.Bilirubin and CA19-9 average levels were significantly higher in MJ compared with BJ(P = 0.000 and P = 0.02),while the CRP level was significantly higher in BJ(P = 0.000).Considering a CA19-9 cut-off level of 32 U/mL,82.3% in the MJ group and 54.9% in the BJ group were positive for CA19-9(P = 0.002).A CA19-9 cut-off of 100 U/mL increases the difference between the two groups:35.3% in BJ and 68.6% in MJ(P = 0.0007).Adjusting the CA19-9 value by dividing it by serum bilirubin level meant that 21.5% in the BJ and 49% in the MJ group remained with a positive CA19-9 value(P = 0.003),while adjusting the CA19-9 value by dividing it by serum CRP value meant that 31.4% in the BJ group and 76.5% in the MJ group still had a positive CA19-9 value(P = 0.000004).Sensitivity,specificity,positive predictive values of CA19-9 > 32 U/mL were 82.3%,45% and 59.1%;when the cutoff was CA19-9 > 100 U/mL they were,respectively,68.6%,64.7% and 66%.When the CA19-9 value was adjusted by dividing it by the bilirubin or CRP values,these became 49%,78.4%,69.4% and 76.5%,68.6%,70.9%,respectively.CONCLUSION:The present study proposes CRP as a new and useful correction factor to improve the diag-nostic value of the CA19-9 tumor marker in patients with cholestatic jaundice.展开更多
The activation of heme oxygenase-1(HO-1) appears to be an endogenous defensive mechanism used by cells to reduce inflammation and tissue damage in a number of injury models. HO-1, a stress-responsive enzyme that catab...The activation of heme oxygenase-1(HO-1) appears to be an endogenous defensive mechanism used by cells to reduce inflammation and tissue damage in a number of injury models. HO-1, a stress-responsive enzyme that catabolizes heme into carbon monoxide(CO), biliverdin and iron, has previously been shown to protect grafts from ischemia/reperfusion and rejection.In addition, the products of the HO-catalyzed reaction, particularly CO and biliverdin/bilirubin, have been shown to exert protective effects in the liver against a number of stimuli, as in chronic hepatitis C and in transplanted liver grafts. Furthermore, the induction of HO-1 expression can protect the liver against damage caused by a number of chemical compounds. More specifically, the CO derived from HO-1-mediated heme catabolism has been shown to be involved in the regulation of inflammation; furthermore, administration of low concentrations of exogenous CO has a protective effect against inflammation. Both murine and human HO-1 deficiencies have systemic manifestations associated with iron metabolism, such as hepatic overload(with signs of a chronic hepatitis) and iron deficiency anemia(with paradoxical increased levels of ferritin).Hypoxia induces HO-1 expression in multiple rodent,bovine and monkey cell lines, but interestingly, hypoxia represses expression of the human HO-1 gene in a variety of human cell types(endothelial cells, epithelial cells, T cells). These data suggest that HO-1 and CO are promising novel therapeutic molecules for patients with inflammatory diseases. In this review, we present what is currently known regarding the role of HO-1 in liver injuries and in particular, we focus on the implications of targeted induction of HO-1 as a potential therapeutic strategy to protect the liver against chemically induced injury.展开更多
基金Supported by the Medical Discipline Construction Project of Pudong Health Committee of Shanghai,No.PWZzb2022-09Nanning City Science Research and Technology Development Program,No.ZC20233017and Guangxi Medical and Health Appropriate Technology Development and Promotion Project,No.S2021061.
文摘BACKGROUND Depression is a significant psychiatric disorder with particularly high prevalence among adolescents.This mental health condition can have severe consequences,including academic failure,social withdrawal,and suicidal behavior.Given the increasing rate of depression in this age group,understanding the underlying biological mechanisms is essential for early detection and intervention.Recent studies have suggested that immune markers play a role in the pathophysiology of depression,prompting further investigation of their potential association with depressive symptoms in adolescents.AIM To investigate the relationship between immune markers(monocytes,lymphocytes,and direct bilirubin)and the incidence and severity of depression among adolescents.METHODS This cross-sectional study recruited 145 adolescent patients with depression[male(M)/female(F)=38/107]from Jiangbin Hospital in Guangxi,Zhuang and 163 healthy controls(M/F=77/86)from routine health check-ups.Blood samples were collected after an overnight fast.Depression severity was measured using the Zung Self-Rating Depression Scale.The inclusion criteria were age 12-24 years,diagnosis of depressive disorder(ICD-10),and no recent antidepressant use.The exclusion criteria included psychiatric comorbidities and serious somatic diseases.Key statistical methods included group comparisons and correlation analyses.RESULTS There was a higher prevalence of females in the depression group(P<0.001).Significant age differences were observed between the groups(Z=9.43,P<0.001).The depression group had higher monocyte(Z=3.43,P<0.001)and lymphocyte(t=2.29,P<0.05)counts,and higher serum direct bilirubin levels(Z=4.72,P<0.001).Monocyte count varied significantly according to depression severity,with lower counts in the mild group(Z=-2.90,P<0.05).A negative correlation between age and lymphocyte counts was observed(ρ=-0.22,P<0.01).Logistic regression analysis showed that serum direct bilirubin levels significantly predicted depression.CONCLUSION The potential role of elevated levels of immune markers in the early detection of depression in adolescents has been highlighted.Therefore,it is necessary to explore further the relationships between these immune markers and depression.
文摘Gallbladder stones,a prevalent biliary tract disease,have multifactorial etiologies including metabolic,genetic,and environmental factors.Emerging evidence su-ggests that hematological disorders,particularly those involving hemolysis or impaired erythropoiesis,may play a significant role in the formation of gallblad-der stones,predominantly pigment stones.This review explores the pathophysio-logical mechanisms linking hematological disorders,such as hemolytic anemias,myeloproliferative disorders,and hematological malignancies,with gallbladder stone development.We also examine the influence of treatments for hemato-logical conditions,such as blood transfusions and chemotherapy,on gallstone risk.Additionally,this article discusses the clinical implications of gallbladder stones in patients with hematological disorders,including diagnostic challenges,management strategies,and surgical considerations.By providing a compre-hensive overview of current knowledge,this review aims to highlight the need for further research into the interplay between hematological disorders and gall-bladder stones,potentially improving preventive and therapeutic strategies in these patient populations.
文摘Hereditary spherocytosis(HS),a common inherited hemolytic anemia,is characterized by red blood cell membrane protein defects leading to chronic hemolysis.This condition significantly predisposes patients to gallstone disease,including both gallbladder and bile duct stones,due to excessive bilirubin production from hemolysis.Gallstones in HS patients,primarily composed of bilirubin,can lead to complications such as cholecystitis,cholangitis,and obstructive jaundice.This review provides a comprehensive landscape of the pathophysiological mechanisms linking HS to gallstone formation,emphasizing the roles of hemolysis,bile composition,and genetic factors.It also discusses the clinical manifestations of gallstone disease in HS,including recurrent jaundice and biliary obstruction,and highlights the diagnostic value of imaging modalities such as ultrasonography and magnetic resonance cholangiopancreatography.Furthermore,current management strategies,including splenectomy,cholecystectomy,and endoscopic approaches for bile duct stones,are examined in the context of HS.By synthesizing existing knowledge,this review aims to provide insights into improving the diagnosis,prevention,and treatment of gallstone disease in patients with HS,while identifying gaps for future research.
基金Supported by Shandong Province Biliary Pancreatic Cancer Clinical Quality Specialty Construction Fund,No.SLCZDZK-2401.
文摘BACKGROUND Sarcopenia is a clinical syndrome presented with progressive and generalized skeletal muscle loss and function dysfunction.Usually,it is considered an agerelated process influenced by genetic,lifestyle factors,and diseases.Obstructive jaundice is one of the most common pathophysiological changes in patients needing hepatobiliary or pancreatic operations that can adversely affect the tissue and organ function throughout the human body.However,the effects of obstructive jaundice on the occurrence of sarcopenia remain unclear.AIM To investigate the incidence of sarcopenia in patients with surgical obstructive jaundice and the association of sarcopenia with postoperative outcome.METHODS This cross-sectional study was conducted from December 2019 to January 2024.Data retrieved included patient demographics,disease entities,sarcopenia-related parameters(including grip strength,6-m walking time,and limb skeletal muscle mass index),postoperative complications,and length of hospital stay.Sarcopenia was confirmed using Asian Working Group standards.Logistic regression was used to analyze the relationship between total bilirubin level and sarcopenia.The factors influencing sarcopenia in patients with surgical obstructive jaundice and association of sarcopenia with postoperative complications were also investigated.RESULTS Overall,1708 patients met the inclusion criteria,with a mean age of 60.09±13.52 years(sex:52.28%male).There were 383 patients(22.42%)with obstructive jaundice and 1325(77.58%)without jaundice.Sarcopenia,low walking speed,low grip strength,and low limb skeletal muscle index were more prevalent in patients with obstructive jaundice than nonobstructive jaundice.The odds ratio(OR)for sarcopenia in patients with obstructive jaundice was 1.689[95%confidence interval(CI):1.295-2.203,P<0.001],indicating that jaundice is a significant risk factor for sarcopenia.The occurrence of sarcopenia was higher in patients with severe obstructive jaundice than mild obstructive jaundice(39.3%vs 22.8%,P<0.05).Obstructive jaundice was positively correlated with reduced walking speed(OR=1.627,95%CI:1.185-2.234,P=0.003)and decreased grip strength(OR=1.669,95%CI:1.212-2.300,P=0.002).Age(OR=1.077,95%CI:1.040-1.114,P<0.001)and body mass index(OR=0.703,95%CI:0.630-0.784,P<0.001)were independent risk factors of sarcopenia in patients with obstructive jaundice.Patients with obstructive jaundice and sarcopenia had a higher rate of postoperative complications(46.3%vs 33.1%,P=0.032),longer postoperative hospital stays(11.33±6.75 days vs 9.19±7.32 days,P=0.016),and longer total hospital stays(17.10±7.69 days vs 15.98±8.55 days,P=0.032)than those without sarcopenia.CONCLUSION Sarcopenia is more prevalent in patients with obstructive jaundice and is positively correlated with the degree of jaundice.Sarcopenia prolongs hospital stays and is associate with postoperative complications.
基金Supported by Natural Science Foundation of Shaanxi Province,No.2024JC-YBQN-0828 and No.2024JC-YBMS-765Clinical Research Award of the First Affiliated Hospital of Xi'an Jiaotong University,No.XJTU1AF-CRF-2022-036National Innovation Center for Advanced Medical Devices,No.NMED2023AGP-013.
文摘BACKGROUND Diabetic retinopathy(DR)is a major cause of visual impairment and blindness.However,the current DR biomarkers are insufficient for accurately predicting its onset.AIM To identify a novel marker for predicting the risk of developing DR in patients with type 2 diabetes mellitus(T2DM).METHODS We conducted a cross-sectional study involving 6993 hospitalized T2DM patients between 2013 and 2020.Patients were divided into two groups:The DR group and the non-DR group.Data were analyzed using univariate,correlation,multivariate,subgroup,and receiver operating characteristic curve analyses.RESULTS Total bilirubin,indirect bilirubin(IBIL),and direct bilirubin were negatively correlated with the risk of developing DR(P<0.001).Moreover,these three factors were all positively correlated with clinical indicators related to DR,including the estimated glomerular filtration rate,the albumin/creatinine ratio,and the 1,25-dihydroxyvitamin D3 level(P<0.001).After adjusting for multiple variables,greater IBIL levels remained independently associated with a lower risk of developing DR(odds ratio=0.500;95%confidence interval:0.363-0.686;P<0.001).The optimal IBIL cutoff point for predicting the risk of DR in male patients with elevated diastolic blood pressure was 0.655μmol/dL(area under the curve=0.662).CONCLUSION These findings suggest that IBIL could be a valuable biomarker for predicting DR risk,offering a noninvasive,cost-effective,and readily available clinical tool for the early identification of high-risk patients.Future multicenter and longitudinal studies are warranted to validate these findings and further explore the biological mechanisms underlying the protective role of IBIL in DR.
文摘Acute Bilirubin Encephalopathy(ABE)is a significant threat to neonates and it leads to disability and high mortality rates.Detecting and treating ABE promptly is important to prevent further complications and long-term issues.Recent studies have explored ABE diagnosis.However,they often face limitations in classification due to reliance on a single modality of Magnetic Resonance Imaging(MRI).To tackle this problem,the authors propose a Tri-M2MT model for precise ABE detection by using tri-modality MRI scans.The scans include T1-weighted imaging(T1WI),T2-weighted imaging(T2WI),and apparent diffusion coefficient maps to get indepth information.Initially,the tri-modality MRI scans are collected and preprocessesed by using an Advanced Gaussian Filter for noise reduction and Z-score normalisation for data standardisation.An Advanced Capsule Network was utilised to extract relevant features by using Snake Optimization Algorithm to select optimal features based on feature correlation with the aim of minimising complexity and enhancing detection accuracy.Furthermore,a multi-transformer approach was used for feature fusion and identify feature correlations effectively.Finally,accurate ABE diagnosis is achieved through the utilisation of a SoftMax layer.The performance of the proposed Tri-M2MT model is evaluated across various metrics,including accuracy,specificity,sensitivity,F1-score,and ROC curve analysis,and the proposed methodology provides better performance compared to existing methodologies.
文摘BACKGROUND Gastric cancer is the most common malignancy of the digestive system and surgical resection is the primary treatment.Advances in surgical technology have reduced the risk of complications after radical gastrectomy;however,post-surgical pancreatic fistula remain a serious issue.These fistulas can lead to abdominal infections,anastomotic leakage,increased costs,and pain;thus,early diagnosis and prevention are crucial for a better prognosis.Currently,C-reactive protein(CRP),procalcitonin(PCT),and total bilirubin(TBil)levels are used to predict post-operative infections and anastomotic leakage.However,their predictive value for pancreatic fistula after radical gastrectomy for gastric cancer remains unclear.The present study was conducted to determine their predictive value.AIM To determine the predictive value of CRP,PCT,and TBil levels for pancreatic fistula after gastric cancer surgery.METHODS In total,158 patients who underwent radical gastrectomy for gastric cancer at our hospital between January 2019 and January 2023 were included.The patients were assigned to a pancreatic fistula group or a non-pancreatic fistula group.Multivariate logistic analysis was conducted to assess the factors influencing development of a fistula.Receiver operating characteristic(ROC)curves were used to determine the predictive value of serum CRP,PCT,and TBil levels on day 1 postsurgery.RESULTS On day 1 post-surgery,the CRP,PCT,and TBil levels were significantly higher in the pancreatic fistula group than in the non-pancreatic fistula group(P<0.05).A higher fistula grade was associated with higher levels of the indices.Univariate analysis revealed significant differences in the presence of diabetes,hyperlipidemia,pancreatic injury,splenectomy,and the biomarker levels(P<0.05).Logistic multivariate analysis identified diabetes,hyperlipidemia,pancreatic injury,CRP level,and PCT level as independent risk factors.ROC curves yielded predictive values for CRP,PCT,and TBil levels,with the PCT level having the highest area under the curve(AUC)of 0.80[95%confidence interval(CI):0.72-0.90].Combined indicators improved the predictive value,with an AUC of 0.86(95%CI:0.78-0.93).CONCLUSION Elevated CRP,PCT,and TBil levels predict risk of pancreatic fistula post-gastrectomy for gastric cancer.
基金Supported by the National Natural Science Foundation of China,No.82270594the National Natural Science Foundation for Youths of China,No.82103151+1 种基金the Outstanding Youth Foundation of Hunan Province,No.2022JJ20092the Wisdom Accumulation and Talent Cultivation Project of Third Xiangya Hospital of Central South University,No.YX202103.
文摘BACKGROUND Helicobacter pylori(H.pylori)is a prevalent pathogen associated with various diseases.Cholelithiasis is also a common condition.H.pylori infection has been identified in the biliary system,suggesting its potential involvement in biliary diseases.However,the specific role of H.pylori in the development of cholelithiasis remains inconclusive.AIM To investigate the potential association between H.pylori infection and the development of cholelithiasis.METHODS We performed a retrospective study in more than 70000 subjects in health examination center from 3 institutions in the middle,northern and eastern China,from October 2018 to December 2021,to explore the potential association between H.pylori and cholelithiasis through univariate and multivariate analysis.Meanwhile,the influence of H.pylori on biliary-related parameters was investigated.A comprehensive analysis of previous studies concerned about H.pylori and cholelithiasis was also executed.RESULTS In our multi-center study,H.pylori was positively associated with cholelithiasis[odds ratio(OR)=1.103,95%confidence interval(CI):1.001-1.216,P=0.049].Furthermore,H.pylori patients had less total and direct bilirubin than uninfected patients,while the total cholesterol and low-density lipoprotein cholesterol were more in H.pyloripositive participants(P<0.05).In the published articles,the cohort studies indicated H.pylori was a risk factor of cholelithiasis(hazard ratio=1.3280,95%CI:1.1810-1.4933,P<0.0001).The pooled results of case-control and crosssectional studies showed positive association between H.pylori and cholelithiasis in Asia(OR=1.5993,95%CI:1.0353-2.4706,P=0.034)but not in Europe(OR=1.2770,95%CI:0.8446-1.9308,P=0.246).Besides,H.pylori was related to a higher choledocholithiasis/cholecystolithiasis ratio(OR=3.3215,95%CI:1.1034-9.9986,P=0.033).CONCLUSION H.pylori is positively correlated with cholelithiasis,choledocholithiasis phenotype particularly,especially in Asia,which may be relevant to bilirubin/cholesterol metabolism.Cohort studies confirm an increased risk of cholelithiasis in H.pylori patients.
文摘This editorial synthesizes insights from a series of studies examining the interplay between metabolic and oxidative stress biomarkers in cardiovascular disease(CVD),focusing particularly on type-2 diabetes mellitus(T2DM)and acute coronary syndrome(ACS).The central piece of this synthesis is a study that investigates the balance between oxidative stress and antioxidant systems in the body through the analysis of serum bilirubin andγ-glutamyltranspeptidase(γ-GGT)levels in T2DM patients with ACS.This study highlights serum bilirubin as a protective antioxidant factor,while elevatedγ-GGT levels indicate increased oxidative stress and correlate with major adverse cardiovascular events.Complementary to this,other research contributions revealγ-GGT’s role as a risk factor in ACS,its association with cardiovascular mortality in broader populations,and its link to metabolic syndrome,further elucidating the metabolic dysregulation in CVDs.The collective findings from these studies underscore the critical roles ofγ-GGT and serum bilirubin in cardiovascular health,especially in the context of T2DM and ACS.By providing a balanced view of the body’s oxidative and antioxidative mechanisms,these insights suggest potential pathways for targeted interventions and improved prognostic assessments in patients with T2DM and ACS.This synthesis not only corroborates the pivotal role ofγ-GGT in cardiovascular pathology but also introduces the protective potential of antioxidants like bilirubin,illuminating the complex interplay between T2DM and heart disease.These studies collectively underscore the critical roles of serum bilirubin andγ-GGT as biomarkers in cardiovascular health,particularly in T2DM and ACS contexts,offering insights into the body’s oxidative and antioxidative mechanisms.This synthesis of research supports the potential of these biomarkers in guiding therapeutic strategies and improving prognostic assessments for patients with T2DM and some CVD.
基金Supported by Science and Technology Major Project of Changzhou Science and Technology Bureau,No.CE20205047Natural Science Foundation of Xinjiang Uygur Autonomo us Region,No.ZD202220Changzhou A major scientific research project of the Municipal Health Commission,No.2022D01F52.
文摘BACKGROUND Cardiovascular disease is a major complication of diabetes mellitus(DM).Type-2 DM(T2DM)is associated with an increased risk of cardiovascular events and mortality,while serum biomarkers may facilitate the prediction of these outcomes.Early differential diagnosis of T2DM complicated with acute coronary syndrome(ACS)plays an important role in controlling disease progression and improving safety.AIM To investigate the correlation of serum bilirubin andγ-glutamyltranspeptidase(γ-GGT)with major adverse cardiovascular events(MACEs)in T2DM patients with ACS.METHODS The clinical data of inpatients from January 2022 to December 2022 were analyzed retrospectively.According to different conditions,they were divided into the T2DM complicated with ACS group(T2DM+ACS,n=96),simple T2DM group(T2DM,n=85),and simple ACS group(ACS,n=90).The clinical data and laboratory indices were compared among the three groups,and the correlations of serum total bilirubin(TBIL)levels and serumγ-GGT levels with other indices were discussed.T2DM+ACS patients received a 90-day follow-up after discharge and were divided into event(n=15)and nonevent(n=81)groups according to the occurrence of MACEs;Univariate and multivariate analyses were further used to screen the independent influencing factors of MACEs in patients.RESULTS The T2DM+ACS group showed higherγ-GGT,total cholesterol,low-density lipoprotein cholesterol(LDL-C)and glycosylated hemoglobin(HbA1c)and lower TBIL and high-density lipoprotein cholesterol levels than the T2DM and ACS groups(P<0.05).Based on univariate analysis,the event and nonevent groups were significantly different in age(t=3.3612,P=0.0011),TBIL level(t=3.0742,P=0.0028),γ-GGT level(t=2.6887,P=0.0085),LDL-C level(t=2.0816,P=0.0401),HbA1c level(t=2.7862,P=0.0065)and left ventricular ejection fraction(LEVF)levels(t=3.2047,P=0.0018).Multivariate logistic regression analysis further identified that TBIL level and LEVF level were protective factor for MACEs,and age andγ-GGT level were risk factors(P<0.05).CONCLUSION Serum TBIL levels are decreased andγ-GGT levels are increased in T2DM+ACS patients,and the two indices are significantly negatively correlated.TBIL andγ-GGT are independent influencing factors for MACEs in such patients.
文摘Surgical resection is a pivotal therapeutic approach for addressing hepatic space-occupying lesions,with liver volume restoration and hepatic functional recovery being crucial for assessing surgical prognosis.The preoperative albumin-bilirubin(ALBI)score,encompassing serum albumin and bilirubin levels,can be determined via blood analysis,effectively mitigating human error and providing an accurate depiction of liver function.The hepatectomy ratio,which is the proportion of the liver volume removed to the total liver volume,is critical in preserving an adequate liver tissue volume to ensure postoperative hepatic functional compensation,minimize surgical complications,and reduce mortality rates.Incorporating the preoperative ALBI score and hepatectomy ratio aids surgeons in assessing the optimal timing and extent of partial hepatectomy.The introduction of preoperative albumin bilirubin score and hepatectomy percentage is beneficial for the surgeons to evaluate the timing and magnitude of partial liver resection.
文摘BACKGROUND Individuals with diabetes mellitus are more likely to experience depression,although most patients remain undiagnosed.The relation between total bilirubin and depression has been increasingly discussed,but limited studies have examined the association of total bilirubin with depression risk in adults with diabetes,which warrants attention.AIM To investigate the association between total bilirubin levels and the risk of depression in adults with diabetes.METHODS The study included adults with diabetes from the National Health and Nutrition Examination Survey 2007-2018.Depression was determined using the Patient Health Questionnaire-9.Multivariable logistic regression,propensity scorematched analysis and restricted cubic spline models were utilized to investigate the association between total bilirubin levels and depression risk in adults with diabetes.RESULTS The study included 4758 adults with diabetes,of whom 602(12.7%)were diagnosed with depression.After adjusting for covariates,we found that diabetic adults with lower total bilirubin levels had a higher risk of depression(OR=1.230,95%CI:1.006-1.503,P=0.043).This association was further confirmed after propensity score matching(OR=1.303,95%CI:1.034-1.641,P=0.025).Subgroup analyses showed no significant dependence of age,body mass index,sex,race or hypertension on this association.Restricted cubic spline models displayed an inverted U-shaped association of total bilirubin levels with depression risk within the lower range of total bilirubin levels.The depression risk heightened with the increasing levels of total bilirubin,reaching the highest risk at 6.81μmol/L and decreasing thereafter.CONCLUSION In adults with diabetes,those with lower levels of total bilirubin were more likely to have depressive symptoms.Serum total bilirubin levels may be used as an additional indicator to assess depression risk in adults with diabetes.
文摘Background: Exclusive breastfeeding is globally promoted as a preventive health measure. However, an increasing incidence of jaundice among exclusively breastfed neonates has been observed. In Jos, Nigeria, anecdotal evidence suggests a rise in jaundice cases among breastfed infants during their first week of life. This study investigates the relationship between neonatal jaundice and the biochemical composition of maternal breast milk in Jos, Nigeria. Objective: To evaluate the role of maternal milk protein status and other milk constituents in the development of neonatal jaundice among exclusively breastfed full-term infants. Methods: This cross-sectional study involved 152 participants, comprising of 76 neonates (38 jaundiced and 38 healthy controls) and their corresponding 76 mothers at Jos University Teaching Hospital. Biochemical analyses were conducted on maternal breast milk (albumin, proteins, casein, fat, lactose, enzymes) and infant serum (bilirubin, albumin, proteins, enzymes). Statistical analysis was performed using Mann-Whitney tests with significance set at p ≤ 0.05. Results: Maternal breast milk from mothers of jaundiced infants showed significantly lower protein (0.73 ± 0.07 g/100ml), albumin (0.62 ± 0.04 g/100ml), and casein (1.6 ± 0.12 g/100ml) levels compared to controls (p Conclusion: The study highlights a potential link between lower maternal milk protein levels and the occurrence of neonatal jaundice. Interventions aimed at enhancing maternal nutrition and promoting more frequent breastfeeding may mitigate the risk. Further research should explore additional maternal and neonatal factors contributing to this condition.
基金2023 Innovation Fund Project for College Teachers of Gansu Provincial Department of Education(Project No.2023B-004)The Foundation of the First Hospital of Lanzhou University(Grant No.Idyyyn 2021-92)。
文摘Objective:To analyze the therapeutic efficacy of Yinzhihuang granules in treating neonatal jaundice.Methods:A total of 62 neonates with jaundice,admitted from September 2021 to September 2023,were randomly divided into two groups.The observation group received Yinzhihuang granules,while the control group received conventional blue light therapy.The overall efficacy rate and other indicators were compared.Results:The observation group showed a higher overall efficacy rate and superior clinical indicators compared to the control group(P<0.05).Before treatment,there was no significant difference between the two groups in bilirubin,liver function,or immune function indicators(P>0.05).After one week of treatment,the observation group had lower bilirubin and liver function indicators and higher immune function indicators than the control group(P<0.05).Conclusion:Yinzhihuang granules can improve the efficacy of neonatal jaundice treatment,accelerate recovery,reduce bilirubin levels,protect liver function,and enhance immune function in neonates.
基金Supported by Grants DK54012,DK73917,to Wang DQ-HDK36588,DK34854,and DK73687,to Carey MCall from the National Institutes of Health(US Public Health Service)
文摘Forty-four different animal biles obtained from both invertebrates and vertebrates (including human bile) have been used for centuries for a host of maladies in traditional Chinese medicine (TCM) beginning with dog, ox and common carp biles approximately in the Zhou dynasty (c. 1046-256 BCE). Overall, different animal biles were prescribed principally for the treatment of liver, biliary, skin (including burns), gynecological and heart diseases, as well as diseases of the eyes, ears, nose, mouth and throat. We present an informed opinion of the clinical efficacy of the medicinal uses of the different animal biles based on their presently known principal chemical components which are mostly steroidal detergent-like molecules and the membrane lipids such as unesterified cholesterol and mixed phosphatidylcholines and sometimes sphingomyelin, as well as containing lipopigments derived from heme principally bilirubin glucuronides. All of the available information on the ethnopharmacological uses of biles in TCM were collated from the rich collection of ancient Chinese books on materia medica held in libraries in China and United States and the composition of various animal biles was based on rigorous separatory and advanced chemical identification techniques published since the mid-20<sup>th</sup> century collected via library (Harvard’s Countway Library) and electronic searches (PubMed and Google Scholar). Our analysis of ethnomedical data and information on biliary chemistry shows that specific bile salts, as well as the common bile pigment bilirubin and its glucuronides plus the minor components of bile such as vitamins A, D, E, K, as well as melatonin (N-acetyl-5-methoxytryptamine) are salutary in improving liver function, dissolving gallstones, inhibiting bacterial and viral multiplication, promoting cardiac chronotropsim, as well as exhibiting anti-inflammatory, anti-pyretic, anti-oxidant, sedative, anti-convulsive, anti-allergic, anti-congestive, anti-diabetic and anti-spasmodic effects. Pig, wild boar and human biles diluted with alcohol were shown to form an artificial skin for burns and wounds one thousand years ago in the Tang dynasty (618-907 CE). Although various animal biles exhibit several generic effects in common, a number of biles appear to be advantageous for specific therapeutic indications. We attempt to understand these effects based on the pharmacology of individual components of bile as well as attempting to identify a variety of future research needs.
基金Supported by grants from the National Natural Foundation of China,No.81703232
文摘BACKGROUND Unconjugated bilirubin(UCB)is generally considered toxic but has gained recent prominence for its anti-inflammatory properties.However,the effects of it on the interaction between intestinal flora and organisms and how it influences immune responses remain unresolved.AIM To investigate the role of UCB in intestinal barrier function and immune inflammation in mice with dextran-sulfate-sodium-induced colitis.METHODS Acute colitis was induced by 3%(w/v)dextran sulfate sodium salt in drinking water for 6 d followed by untreated water for 2 d.Concurrently,mice with colitis were administered 0.2 mL UCB(400μmol/L)by intra-gastric gavage for 7 d.Disease activity index(DAI)was monitored daily.Mice were sacrificed at the end of the experiment.The length of the colon and weight of the spleen were recorded.Serum level of D-lactate,intestinal digestive proteases activity,and changes to the gut flora were analyzed.In addition,colonic specimens were analyzed by histology and for expression of inflammatory markers and proteins.RESULTS Mice treated with UCB had significantly relieved severity of colitis,including lower DAI,longer colon length,and lower spleen weight(colon length:4.92±0.09 cm vs 3.9±0.15 cm;spleen weight:0.33±0.04 vs 0.74±0.04,P<0.001).UCB administration inactivated digestive proteases(chymotrypsin:18.70±0.69 U/g vs44.81±8.60 U/g;trypsin:1.52±0.23 U/g vs 9.05±1.77 U/g,P<0.01),increased expression of tight junction(0.99±0.05 vs 0.57±0.03,P<0.001),decreased serum level of D-lactate(31.76±3.37μmol/L vs 54.25±1.45μmol/L,P<0.001),and lowered histopathological score(4±0.57 vs 7±0.57,P<0.001)and activity of myeloperoxidase(46.79±2.57 U/g vs 110.32±19.19 U/g,P<0.001).UCB also regulated the intestinal microbiota,inhibited expression of tumor necrosis factor(TNF)αand interleukin 1β(TNF-α:52.61±7.81 pg/mg vs 105.04±11.92 pg/mg,interleukin 1β:13.43±1.68 vs 32.41±4.62 pg/mg,P<0.001),decreased expression of Toll-like receptor 4(0.61±0.09 vs 1.07±0.03,P<0.001)and myeloid differentiation primary response gene 88(0.73±0.08 vs 1.01±0.07,P<0.05),and increased expression of TNF-receptor-associated factor 6(0.79±0.02 vs0.43±0.09 P<0.05)and inhibitor of kappa Bα(0.93±0.07 vs 0.72±0.07,P<0.05)in the colon.CONCLUSION UCB can protect intestinal barrier function,regulate normal intestinal homeostasis,and suppress inflammation via the Toll-like receptor 4/nuclear factor-κB signaling pathway.
文摘AIM： To evaluate the long-term outcome and prognostic factors of patients with hilar cholangiocarinoma. METHODS： Ninety-six consecutive patients underwent treatment for malignant hilar bile duct tumors during 1995-2005. Of the 96 patients, 20 were initially treated with surgery （n = 2 R0 / n = 18 R1）. In non-operated patients, data analysis was performed retrospectively. RESULTS： Among the 96 patients, 76 were treated with endoscopic transpapillary （ERC, n = 45） and/or percutaneous transhepatic biliary drainage （PTBD, n = 31）. The mean survival time of these 76 patients undergoing palliative endoscopic and/or percutaneous drainage was 359 ± 296 d. The mean survival time of patients with initial bilirubin levels 〉 10 mg/dL was significantly lower （P 〈 0.001） than patients with bilirubin levels 〈 10 mg/dL. The mean survival time of patients with Bismuth stage Ⅱ （n = 8）, Ⅲ （n = 28） and Ⅳ （n = 40） was 496 =1= 300 d, 441 ± 385 d and 274 ± 218 d, respectively. Thus, patients with advanced Bismuth stage showed a reduced mean survival time, but the difference was not significant. The type of biliary drainage had no significant benefidal effect on the mean survival time （ERC vs PTBD, P = 0.806）. CONCLUSION： Initial bilirubin level is a significant prognostic factor for survival of patients. In contrast, age, tumor stage according to the Bismuth-Corlette classification, and types of intervention are not significant prognostic parameters for survival. Palliative treatment with endoscopic or percutaneous biliary drainage is still suboptimal, new diagnostic and therapeutic tools need to be evaluated.
文摘AIM:To find a possible relationship between inflammation and CA19-9 tumor marker by analyzing data from patients with benign jaundice(BJ) and malignant jaundice(MJ).METHODS:All patients admitted for obstructive jaundice,in the period 2005-2009,were prospectively enrolled in the study,obtaining a total of 102 patients.On admission,all patients underwent complete standard blood test examinations including C-reactive protein(CRP),bilirubin,CA19-9.Patients were considered eligible for the study when they presented obstructive jaundice confirmed by instrumental examinations and increased serum bilirubin levels(total bilirubin > 2.0 mg/dL).The standard cut-off level for CA19-9 was 32 U/mL,whereas for CRP this was 1.5 mg/L.The CA19-9 level was adjusted by dividing it by the value of serum bilirubin or by the CRP value.The patients were divided into 2 groups,MJ and BJ,and after the adjustment a comparison between the 2 groups of patients was performed.Sensitivity,specificity and positive predictive values were calculated before and after the adjustment.RESULTS:Of the 102 patients,51 were affected by BJ and 51 by MJ.Pathologic CA19-9 levels were found in 71.7% of the patients.In the group of 51 BJ patients there were 29(56.9%) males and 22(43.1%) females with a median age of 66 years(range 24-96 years),whereas in the MJ group there were 24(47%) males and 27(53%) females,with a mean age of 70 years(range 30-92 years).Pathologic CA19-9 serum level was found in 82.3% of MJ.CRP levels were pathologic in 66.6% of the patients with BJ and in 49% with MJ.Bilirubin and CA19-9 average levels were significantly higher in MJ compared with BJ(P = 0.000 and P = 0.02),while the CRP level was significantly higher in BJ(P = 0.000).Considering a CA19-9 cut-off level of 32 U/mL,82.3% in the MJ group and 54.9% in the BJ group were positive for CA19-9(P = 0.002).A CA19-9 cut-off of 100 U/mL increases the difference between the two groups:35.3% in BJ and 68.6% in MJ(P = 0.0007).Adjusting the CA19-9 value by dividing it by serum bilirubin level meant that 21.5% in the BJ and 49% in the MJ group remained with a positive CA19-9 value(P = 0.003),while adjusting the CA19-9 value by dividing it by serum CRP value meant that 31.4% in the BJ group and 76.5% in the MJ group still had a positive CA19-9 value(P = 0.000004).Sensitivity,specificity,positive predictive values of CA19-9 > 32 U/mL were 82.3%,45% and 59.1%;when the cutoff was CA19-9 > 100 U/mL they were,respectively,68.6%,64.7% and 66%.When the CA19-9 value was adjusted by dividing it by the bilirubin or CRP values,these became 49%,78.4%,69.4% and 76.5%,68.6%,70.9%,respectively.CONCLUSION:The present study proposes CRP as a new and useful correction factor to improve the diag-nostic value of the CA19-9 tumor marker in patients with cholestatic jaundice.
基金Supported by Brazilian Foundation-FAPESP(Fundao deapoio à pesquisa do Estado de So Paulo),No.07/07139-3,10/02024-6 and CNPq
文摘The activation of heme oxygenase-1(HO-1) appears to be an endogenous defensive mechanism used by cells to reduce inflammation and tissue damage in a number of injury models. HO-1, a stress-responsive enzyme that catabolizes heme into carbon monoxide(CO), biliverdin and iron, has previously been shown to protect grafts from ischemia/reperfusion and rejection.In addition, the products of the HO-catalyzed reaction, particularly CO and biliverdin/bilirubin, have been shown to exert protective effects in the liver against a number of stimuli, as in chronic hepatitis C and in transplanted liver grafts. Furthermore, the induction of HO-1 expression can protect the liver against damage caused by a number of chemical compounds. More specifically, the CO derived from HO-1-mediated heme catabolism has been shown to be involved in the regulation of inflammation; furthermore, administration of low concentrations of exogenous CO has a protective effect against inflammation. Both murine and human HO-1 deficiencies have systemic manifestations associated with iron metabolism, such as hepatic overload(with signs of a chronic hepatitis) and iron deficiency anemia(with paradoxical increased levels of ferritin).Hypoxia induces HO-1 expression in multiple rodent,bovine and monkey cell lines, but interestingly, hypoxia represses expression of the human HO-1 gene in a variety of human cell types(endothelial cells, epithelial cells, T cells). These data suggest that HO-1 and CO are promising novel therapeutic molecules for patients with inflammatory diseases. In this review, we present what is currently known regarding the role of HO-1 in liver injuries and in particular, we focus on the implications of targeted induction of HO-1 as a potential therapeutic strategy to protect the liver against chemically induced injury.
