Integrated analysis of metabolomic and transcriptomic profiling reveals the effect of Atractylodes oil on Spleen Yang Deficiency Syndrome in rats

ETHNOPHARMACOLOGICAL RELEVANCE

Spleen Yang Deficiency Syndrome (SYDS), which is a syndrome commonly treated with Traditional Chinese Medicine (TCM), manifests as overall metabolic dysfunction caused mainly by digestive system disorders. Atractylodes lancea (Thunb.) DC. (AL) is a widely used traditional herb with the efficacy of eliminate dampness and strengthen the spleen, Atractylodes oil (AO) is a medicinal component of AL and can be used to treat various gastrointestinal disorders. However, its effects on SYDS and underlying mechanisms have not been clarified to date.

AIM OF THE STUDY

The present study aimed to investigate the efficacy of AO in the improvement of the symptoms of SYDS in rat and the underlying mechanism by integrating transcriptomics, and metabolomics.

MATERIALS AND METHODS

The SYDS rats induced by reserpine were treated with AO. The protective effect of AO on SYDS rats was evaluated by serum biochemical detection, histopathological analyses. Enzyme-linked immunosorbent assay (ELISA), colorimetric assay and immunofluorescence (IF) were performed to determine the levels of relevant indicators of mitochondrial function and energy metabolism in the liver. Liver metabolites and transcript levels were assessed by non-targeted metabolomics and transcriptomics to analyze potential molecular mechanisms and targets. The expression of the corresponding proteins was verified using Western blotting.

RESULTS

AO not only regulated the digestion, absorption function and oxidative stress status of SYDS rats, but also improved mitochondrial function and alleviated energy metabolism disorders in SYDS rats. Metabolomic and transcriptomic analyses demonstrated that AO regulation is mainly exerted in amino acid metabolism, unsaturated fatty acid metabolism, TCA cycle as well as PPAR and AMPK signaling pathways. In addition, The AMPK signaling pathway was verified and AO promoted AMPK phosphorylation and the expression of SIRT1, PGC-1α, and PPARα in SYDS rats.

CONCLUSIONS

The therapeutic effect of AO on SYDS is potentially attributable to activation of the AMPK/SIRT1/PGC-1α signaling pathway, which enhances transport and regulation of energy metabolism.

The compatibility rationality of Sijunzi decoction based on integrated analysis of tissue distribution and excretion characteristics in spleen deficiency syndrome rats

ETHNOPHARMACOLOGICAL RELEVANCE

As a classical prescription for treating spleen deficiency syndrome (SDS), Sijunzi decoction (SJZD) is composed of Ginseng Radix et Rhizoma (RG, Panax ginseng C.A.Mey.), Atractylodes Macrocephalae Rhizoma (AM, Atractylodes macrocephala Koidz.), Poria (Poria cocos (Schw.) Wolf) and Glycyrrhizae Radix et Rhizoma Praeparata Cum Melle (GRP, processed from Glycyrrhiza uralensis Fisch., Glycyrrhiza inflata Bat. or Glycyrrhiza glabra L.). The non-polysaccharides (NPSs) are the pharmacodynamic substance basis of SJZD, whose pharmacokinetics in SDS rats were elaborated previously. Further study on their tissue distribution and excretion properties is of significance for understanding the compatibility laws of SJZD.

AIM OF THE STUDY

The aim was to unravel the tissue distribution and excretion characteristics of NPSs of SJZD in SDS rats, and explore the scientific connotation of SJZD compatibility.

MATERIALS AND METHODS

A validated ultrafast liquid chromatography tandem mass spectrometry method was developed for monitoring the accurate dynamics of sixteen components in the tissues, feces and urine of SDS rats. The four incomplete formulae of SJZD were prepared by randomly deleting one herb to uncover the herb-herb interactions.

RESULTS

All components of NPSs in SJZD were distributed in the tissues, except for ononin in the heart. Among them, glycyrrhetinic acid and atractylenolide III were more abundant in the liver and lung, respectively, while other components were enriched in the ileum, especially saponins. The evaluation of fecal excretion and urinary excretion revealed the low cumulative excretion of all components. The comparative analysis of incomplete formulae indicated that the tissue distribution and excretion became faster after removing Poria from SJZD, while a lack of RG led to slower tissue distribution. The tissue distribution at most time points was reduced when AM was absent. Further comprehensive visualization implied that SJZD compatibility can improve tissue distribution of the NPSs, especially ginsenosides and atractylenolide, at the specific time periods.

CONCLUSION

The tissue distribution and excretion characteristics of NPSs of SJZD were elucidated in current research. Meanwhile, this study proposed new insights into the mechanism of SJZD compatibility rationality.

β-Blockers in Hepatosplenic Schistosomiasis: A Narrative Review

Hepatosplenic schistosomiasis (HSS) is a serious complication of chronic schistosomiasis that can result in portal hypertension and variceal bleeding. β-blockers, a class of medications commonly used to treat hypertension and other cardiovascular conditions, have been investigated for their potential use in preventing variceal bleeding in HSS. Several studies have shown that β-blockers can reduce portal pressure and prevent variceal bleeding effectively in these patients. However, there are limited data on the long-term efficacy and safety of β-blockers in this setting, and further research is needed to determine the optimal use of these medications. This review summarizes the evidence supporting current recommendations of β-blocker use in patients with HSS.

Probiotic-fermented Qushi decoction alleviates reserpine-induced spleen deficiency syndrome by regulating spleen function and gut microbiota dysbiosis

BACKGROUND

Spleen deficiency syndrome (SDS) is associated with elevated inflammatory factors and dysregulation of gastrointestinal motility hormones and intestinal microbiota. Qushi decoction (QD), a traditional formula, has not been reported using modern scientific research methods for changes in its probiotic fermented QD (FQD) composition and its potential mechanisms to alleviate SDS. Therefore, the aim of this study was to investigate the splenic protection of FQD in SDS rats by modulating gastrointestinal motility hormones and intestinal microbiota.

RESULTS

The results showed that FQD increased total polysaccharides, total protein, total flavonoids and the other active ingredients compared to QD, effectively improved splenic inflammation and apoptosis in SDS rats, and modulated gastrointestinal motility hormones to alleviate diarrhea and other symptoms. In addition, the dysregulation of the gut microbiota was reversed by increasing the levels of Bifidobacterium and decreasing the levels of Escherichia-Shigella and Proteobacteria, which may be related to the regulation of bacterial metabolites to alleviate SDS.

CONCLUSION

These results suggest that FQD is an effective formula for improving SDS. Our findings show that FQD beneficial to the implications for the treatment of SDS. © 2023 Society of Chemical Industry.

Deep-fried Atractylodes lancea rhizome alleviates spleen deficiency diarrhea-induced short-chain fatty acid metabolic disorder in mice by remodeling the intestinal flora

ETHNOPHARMACOLOGICAL RELEVANCE

Atractylodes lancea (Thunb.) DC. is a Chinese herb that has been commonly used to treat spleen-deficiency diarrhea (SDD) in China for over a thousand years. However, the underlying mechanism of its antidiarrheal activity is not fully understood.

AIM OF THE STUDY

The antidiarrheal effects of the ethanol extract of deep-fried A. lancea rhizome (EEDAR) due to spleen deficiency induced by folium sennae (SE) were determined on the regulation of the short-chain fatty acid (SCFA) metabonomics induced by the intestinal flora.

MATERIALS AND METHODS

The effects of EEDAR on a SE-induced mouse model of SDD were evaluated by monitoring the animal weight, fecal water content, diarrhea-grade rating, goblet cell loss, and pathological changes in the colon. The expression of inflammatory factors (tumor necrosis factor [TNF]-α, interleukin [IL]-1β, IL-6, IL-10), aquaporins (AQP3, AQP4, and AQP8), and tight junction markers (ZO-1, occludin, claudin-1) in colon tissues were determined using quantitative polymerase chain reaction and western blotting. SCFA metabonomics in the feces of mice treated with EEDAR was evaluated using gas chromatography-mass spectrometry. Furthermore, 16S rDNA sequencing was used to determine the effect of EEDAR on the intestinal flora of SDD mice, and fecal microbiota transplantation (FMT) was used to confirm whether the intestinal flora was essential for the anti-SDD effect of EEDAR.

RESULTS

Treatment with EEDAR significantly improved the symptoms of mice with SDD by inhibiting the loss of colonic cup cells, alleviating colitis, and promoting the expression of AQPs and tight junction markers. More importantly, the effect of EEDAR on the increase of SCFA content in mice with SDD was closely related to the gut microbiota composition. EEDAR intervention did not significantly improve intestinal inflammation or the barrier of germ-free SDD mice, but FMT was effective.

CONCLUSION

EEDAR alleviated SE-induced SDD in mice, as well as the induced SCFA disorder by regulating the imbalance of the intestinal microbiota.

Hepatosplenic Cat Scratch Disease and Prolonged Fever: When To Add Corticosteroids?

The indications for use of corticosteroids for persistent fever in cat scratch disease are controversial. We report the case of a 5-year-old boy diagnosed with systemic cat scratch disease, who presented with fever for 28 days and focal hepatosplenic lesions. He did not show improvement despite antibiotic treatment for 4 weeks, however, he became afebrile 24 hours after the administration of corticosteroids.

Splenic abscesses in childhood brucellosis: a case-based review

OBJECTIVE

Human brucellosis is a zoonosis with an extremely wide spectrum of clinical manifestations. Focal splenic involvement is very uncommon, particularly in the pediatric age group, during the illness' acute phase.

CASE REPORT

A 4-year-old boy, already receiving third-generation cephalosporin treatment, was transferred from a local hospital to the University Pediatric Department for fever, anemia, increased inflammation index, and multiple, hyper-echogenic splenic lesions on abdominal ultrasound. Initial diagnostic laboratory investigations for Brucella infection, including the Widal-Wright test, were found to be negative. However, further diagnostic laboratory analysis using the chemiluminescent immunoassay was positive for Brucella IgM antibodies. Treatment with rifampicin at a dose of 150 mg/Kg/twice daily and co-trimethoprim at a dose of 80 mg/Kg/twice daily was started and continued for 7 weeks. IgM antibodies were undetectable after 2 weeks of treatment, and after 6 weeks of treatment, abdominal ultrasound documented a reduction of the diameter of the major splenic infiltrate from 1 to 0.5 cm. At 3 and 5 months of follow-up, re-evaluation of the abdominal lesions displayed complete resolution of the splenic lesions and a complete clinical recovery.

CONCLUSIONS

The present case and a literature review are presented in this study since a standard diagnostic laboratory evaluation for brucellosis may miss the diagnosis, and in suspected cases, the laboratory analysis should be extended. Splenic abscesses are known to be rare in brucellosis, but the diagnosis should be considered in children with severe focal lesions, as specific antibiotic treatment may result in complete clinical recovery.

Successful management of a case of intestinal Behçet's disease with a splenic abscess by intensified immunosuppressive therapy without splenectomy

Behçet's disease (BD) is often associated with neutrophilic dermatosis. However, BD is rarely associated with aseptic abscesses in the spleen or liver. A 2-year-old girl presented to our hospital with a 2-week history of fever, abdominal pain, and a skin ulcer on her leg. Each time her skin was punctured with a needle for a blood test or spinal fluid test, she developed intractable aseptic abscesses on her skin. She was diagnosed with intestinal BD based on gastrointestinal endoscopy findings and was treated with prednisolone, mesalazine, and elemental diet therapy. Although these were effective for her colon ulcers, low-grade fever and mild abdominal pain persisted. Abdominal computed tomography revealed a low-density area in the spleen. Although it is recommended to check the contents with puncture drainage, it was difficult due to the risk of bleeding and pathergy. The abscess expanded despite antimicrobial therapy. We discontinued antimicrobial therapy and switched to intensified immunosuppressive therapy for BD [intravenous infliximab (IFX)]. After administration of IFX, the splenic abscess gradually disappeared, and all her symptoms improved. In cases of BD with splenic abscesses resistant to antimicrobial therapy, intensifying immunosuppressive therapy can be expected to shrink the abscesses and avoid splenectomy.

Qihuzha granule attenuated LPS-induced acute spleen injury in mice via Src/MAPK/Stat3 signal pathway

ETHNOPHARMACOLOGICAL RELEVANCE

Qihuzha granule (QHZG), is one of traditional Chinese patent medicines composed of eleven edible medicinal plant, which has been used in the clinic for the treatment of indigestion and anorexia in children caused by deficiency of the spleen and stomach. Yet it is noteworthy that QHZG has therapeutic effect on recurrent respiratory tract infection (RRTI) in children. However, its potential molecular mechanisms remained unclear.

AIM OF THE STUDY

The aim of this study was to investigate the therapeutic effect and potential mechanism of QHZG on lipopolysaccharide (LPS) induced acute spleen injury.

MATERIALS AND METHODS

The acute spleen injury model was induced by intraperitoneal injection of LPS (10 mg/kg) and safe doses of QHZG was administered by gavage once a day for 23 days before LPS treatment. Serum inflammatory cytokines including interleukin-2 (IL-2), IL-1β, IFN-γ, and tumor necrosis factor-α (TNF-α) were tested by ELISA. Related protein levels were detected by Western blotting. Hematoxylin-eosin (HE) staining was employed to observe the histological alterations. The distribution of macrophages and neutrophils in the mouse spleen was examined by immunofluorescence analysis.

RESULTS

QHZG pretreatment significantly abolished the increased secretion of cytokines such as interleukin-2 (IL-2), IL-1β, IFN-γ, and tumor necrosis factor-α (TNF-α), which were attributable to LPS treatment. Immunofluorescence staining and Histological analysis of spleen tissue revealed the protective effect of QHZG against LPS-induced acute spleen injury in mice. Further study indicated that pretreatment with QHZG significantly inhibited LPS-induced phosphorylation of Src. Accordingly, the increased phosphorylation of Src downstream components (JNK, ERK, P38 and STAT3) induced by LPS was remarkably diminished by QHZG, suggesting the involvement of Src/MAPK/STAT3 pathway in the inhibitory effects of QHZG on spleen injury in mice.

CONCLUSION

Our study demonstrated that QHZG protected mice from LPS-induced acute spleen injury via inhibition of Src/MAPK/Stat3 signal pathway. These results suggested that QHZG might serve as a new drug for the treatment of LPS-stimulated spleen injury.

Metabolomics of Spleen-Yang deficiency syndrome and the therapeutic effect of Fuzi Lizhong pill on regulating endogenous metabolism

ETHNOPHARMACOLOGICAL RELEVANCE

Spleen-Yang deficiency (SYD) is one of the primary causes of many digestive diseases, such as ulcerative colitis (UC), and irritable bowel syndrome (IBS), but its endogenous metabolic characteristics are still unclear. Fuzi Lizhong pill (FLZP) is well-known for its powerful capacity for treating SYD; however, its mechanisms require further study.

AIM OF THE STUDY

Herein, our present study aimed to investigate the essence of SYD from the perspective of metabolomics, and tried to reveal the anti-SYD action mechanisms of FLZP.

MATERIALS AND METHODS

Firstly, the compound factor modeling method with the principle of "indiscipline in diet + excessive fatigue + intragastric administration of Senna water extracts" was used to establish Sprague Dawley (SD) rats as SYD model. Then, the visceral index, motilin (MTL), malonaldehyde (MDA), Interleukin 1 alpha (IL-1α), and Interleukin 6 (IL-6) levels were used to verify the anti-SYD effect of FLZP. In addition, serum samples were analyzed by UPLC-QE/MS metabolomics technique. Finally, the metabolic pathways associated with specific biomarkers were analyzed to research the possible mechanism underlying the action of FLZP.

RESULTS

The expression of MTL, MDA, IL-1α, and IL-6 were regulated by FLZP, which suggested that it has relieved diarrhea and gastrointestinal motility disorder caused by SYD and had an anti-peroxidation, anti-inflammatory, and immune regulation effect. A total of 75 metabolites were found to be the potential biomarkers of SYD. Moreover, FLZP regulates 21 metabolites and 10 vital pathways including the tricarboxylic acid (TCA) cycle, sphingolipid metabolism, and histidine metabolism.

CONCLUSION

SYD primarily causes disorders of amino acid metabolism, lipid metabolism, carbohydrate metabolism, metabolism of cofactors and vitamins, nucleotide metabolism, and translation. In addition, FLZP regulated carbohydrate, lipid, and amino acid metabolisms, gastrointestinal motility, digestive juice secretion, immune regulation, as well as antioxidant effects. Hence, FLZP had a good therapeutic effect on treatment of SYD. It might be a promising therapeutic agent for the treatment of SYD-related diseases.

Isolated hepatosplenic tuberculosis: a rare presentation with persistent fever in a 2-year-old female child

A 2-year-old female child from South India presented with persistent fever for 3 weeks, pallor and hepatosplenomegaly. There was no history of contact with tuberculosis (TB) and BCG scar was absent. Tests for TB (Mantoux and gastric aspirate) were negative. Blood and bone marrow tests for other infections, inflammation and infiltration were inconclusive. Chest X-ray was normal. Ultrasound study (USS) of abdomen showed multiple microabscesses in the liver and spleen. USS-guided fine needle aspiration cytology from splenic lesion demonstrated epithelioid granuloma while bacteriology was negative. Commencement of anti-tubercular therapy (ATT) resulted in remarkable clinical improvement in a week with resolution of lesions on follow-up USS in 2 months. Isolated hepatosplenic TB in children, though rare, has a wide, non-specific clinical spectrum and potential of delaying diagnosis. Probability diagnosis and therapeutic trials of ATT are accepted approaches, using treatment response as indirect confirmation of the likely cause.

Challenges in the Management of Multiple Splenic Abscesses caused by Extensively Drug-resistant (XDR) Salmonella Typhi

Extensively drug-resistant (XDR) typhoid emerged in Hyderabad, Pakistan in 2016. It spread regionally and globally due to fast travelling. An immuno-competent young male referred by general practitioner, was diagnosed and managed as XDR salmonella typhi with multiple splenic abscesses. We faced challenges in its management, like little suspicion of potentially lethal disease; non-availability of evidence-based medicine and further delay in diagnosis as he was already on antibiotics therapy. Patient was diagnosed by radiology and blood cultures. In our case, option of conservative treatment with sensitive antibiotics (azithromycin and meropenem) was successful, though with increased hospital stay. There is no data on treatment duration and choice between two sensitive antibiotics or both in combination. In the present situation, sensitisation of clinicians to salmonella drug resistance, rational use of antibiotics and prompt public health awareness is the need of the day, especially in endemic areas. KEY WORDS: Extensively drug-resistant (XDR) typhoid,Splenic abscesses, Azithromycin, Meropenem.

Disseminated Melioidosis with Spinal Intraosseous Abscess

Melioidosis is endemic in the State of Sabah, Malaysia. We report a case of a 34-year-old man with one-week history of fever and cough, three days history of diarrhoea and vomiting, which was associated with a loss of appetite and loss of weight for one-month. Clinically, he had hepatosplenomegaly and crepitation over his right lower zone of lung. Chest radiograph showed right lower lobe consolidation. Ultrasound abdomen showed liver and splenic abscesses. Ultrasound guided drainage of splenic abscess yielded Burkholderia pseudomallei. Magnetic resonance imaging (MRI) lumbosacral confirmed right sacral intraosseous abscess after he developed back pain a week later. He received 6 weeks of intravenous antibiotics and oral co-trimoxazole, followed by 6 months oral co-trimoxazole and had full recovery.

[A 19-year-old woman with fever and high blood pressure]

A 19-year-old female patient was admitted to hospital for further diagnostics and treatment of a febrile infection. The cause was found to be a bronchopulmonary infection due to methicillin-sensitive Staphylococcus aureus (MSSA), which led to an infective endocarditis with mitral valve infestation and two splenic abscesses. Under treatment according to the antibiogram and laparoscopic excision of the splenic abscesses, the infection-related complications could be successfully resolved. Even during the physical examination there was a suspicion of Cushing's syndrome, which was confirmed by laboratory and radiological investigations and is associated with a general immune deficiency. Remarkable was that the initially difficult to adjust high blood pressure became normalized after transsphenoidal resection of the pituitary adenoma.

Establishment of a mouse model of cancer cachexia with spleen deficiency syndrome and the effects of atractylenolide I

Cancer cachexia is a multifactorial metabolic syndrome that affects ∼50%-80% of cancer patients, and no effective therapy for cancer cachexia is presently available. In traditional Chinese medicine, a large portion of patients with cancer cachexia was diagnosed as spleen deficiency syndrome and treated with tonifying TCMs that produce clinic benefits. In this study we established a new animal model of spleen deficiency and cancer cachexia in mice and evaluated the therapeutic effects of atractylenolide I, an active component of tonifying TCM BaiZhu, in the mouse model. Cancer cachexia was induced in male BALB/c mice by inoculation of mouse C26 colon adenocarcinoma cells, whereas spleen deficiency syndrome was induced by treating the mice with spleen deficiency-inducing factors, including limited feeding, fatigue, and purging. The mouse model was characterized by both cachexia and spleen deficiency characteristics, including significant body weight loss, cancer growth, muscle atrophy, fat lipolysis, spleen, and thymus atrophy as compared with healthy control mice, cancer cachexia mice, and spleen deficiency mice. Oral administration of atractylenolide I (20 mg· kg-1per day, for 30 days) significantly ameliorated the reduction in body weight and atrophy of muscle, fat, spleen, and thymus in mice with spleen deficiency and cachexia. The established model of spleen deficiency and cancer cachexia might be useful in the future for screening possible anticachexia TCMs and clarifying their mechanisms.

Efficacy and safety of oral traditional Chinese patent medicine in treatment of liver stagnation and spleen deficiency of depression: A protocol for systematic review

BACKGROUND

Depression is a kind of chronic and recurrent mental disorder, the main clinical characteristics of the patients are marked and persistent depression. At the same time, it is often accompanied by chronic physical disease, cognitive impairment, and functional damage, which is one of the common diseases that seriously threaten human health. At present, 3 kinds of oral Chinese patent medicine have clinical comparability in the treatment of depression of liver stagnation and spleen deficiency, but there is no evidence for clinical efficacy and safety. Therefore, this study aims to integrate the clinical related syndromes of direct and indirect comparison by using systematic evaluation and network meta-analysis (NMA). According to the data, the different Chinese patent medicines with the same evidence body for the treatment of the disease are collected, analyzed, and sequenced in a quantitative and comprehensive way, and then the advantages and disadvantages of the efficacy and safety between different Chinese patent medicines are screened out to get the best choice scheme, thus providing reference value and evidence-based theoretical evidence for the clinical optimization of drug selection.

METHODS

Comprehensive retrieval of China National Knowledge Infrastructure, Chinese scientific journal database (VIP), China biological feature database (CBM) and WANFANG Data Chinese electronic database and the Cochrane Library, PubMed, Web of Science, and EMBASE foreign database. Search and publish the clinical randomized controlled trials of these 3 Chinese patent medicines combined with fluoxetine compared with fluoxetine. The retrieval time is from the establishment of the database to October 31, 2019. The 2 first authors will screen the literatures that meet the inclusion criteria, extract the data independently according to the predesigned rules, and evaluate the literature quality and bias risk of the included research according to the Cochrane 5.1 manual standard. R and Aggregate Data Drug Information System software were used for data consolidation and NMA to evaluate the ranking probability of all interventions.

RESULTS

This result will show that the best oral Chinese patent medicine to assist the treatment of liver stagnation and spleen deficiency depression provides reliable evidence.

CONCLUSION

This study will provide systematic evidence-based medicine evidence for TCM assisted treatment of depression of liver stagnation and spleen deficiency type, and help clinicians, patients with depression and decision-makers to make more effective, safer, and economic optimal treatment plan in the decision-making process.

PROSPERO REGISTRATION NUMBER

CRD42019115695.

Splenic Abscess of an Unknown Etiology

Splenic abscess is a rare condition, detected in individuals with certain predisposing factors that lead to abscess formation. This is a case report of a 20-year female presenting with high grade fever, weight loss, and left hypochondrial pain. She had an abdominal mass, that was reported as enlarged spleen with multiple abscesses on CT scan. Her laboratory analysis revealed neutrophil leukocytosis with a raised erythrocyte sedimentation rate (ESR) and normal peripheral smear, while her blood culture, brucella and viral serologies, transesophageal echo, antinuclear antibody (ANA) profile and hypercoagulability work up, were negative. Hence, no predisposing factor could be found as the cause of splenic abscess. She was successfully treated with intravenous antibiotics and recovered.

A case report: Splenic abscess caused by Burkholderia pseudomallei

RATIONALE

Melioidosis is an emerging infectious disease caused by Burkholderia pseudomallei. To our knowledge, there have been very few cases of splenic abscesses due to melioidosis in Hainan, China.

PATIENT CONCERNS

The patient was a 55-year-old male farmer, who was admitted in our hospital with persistent left epigastric dull pain accompanied by chills and febrile. One month before, the patient presented with persistent abdominal pain. After received anti-infection therapy, the subjective symptoms eased slightly, but recently he suffered from intermittent abdominal pain again.

DIAGNOSES

Bacteria isolated from splenic pus were identified as B. pseudomallei by the Phoenix-100 system and indirect immunofluorescence.

INTERVENTIONS

The patient was treated by surgical excision and anti-infection therapy.

OUTCOMES

The patient was then treated with intravenous ceftazidime and oral trimethoprim-sulfamethoxazole for 2 weeks and his clinical symptoms improved.

LESSONS

In endemic areas, B. pseudomallei should be considered as a causative organism of splenic abscess in patients with established risk factors. The isolation of B. pseudomallei from abscess sites is crucial to improve clinical outcomes by appropriate antimicrobial therapy coupled with surgical drainage.

Effect of Zhizhu Kuanzhong capsule on functional dyspepsia: Protocol for a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Functional dyspepsia (FD) is a gastrointestinal disorder affecting people in the globe. Spleen-deficiency syndrome is one of its basic syndromes. Zhizhu Kuanzhong capsule was the most frequent Chinese herbal formula used in the spleen-deficiency researches. We aim to assess the effectiveness and safety of Zhizhu Kuanzhong capsule on FD.

METHODS

A systematic literature search for randomized controlled trials (RCTs) from their inception until December 31, 2017 will be conducted using 7 databases: PubMed, Cochrane Library, Embase, VIP Database, Chinese National Knowledge Infrastructure, Wanfang Data, and Chinese BioMedical Database. Inclusion the trials of Zhizhu Kuanzhong capsule which evaluate motilin level, clinical syndrome, and side effect in people with FD. The primary outcome measures will be motilin level, clinical syndrome integral, and clinical total effective rate. Data extraction and risk of bias assessments will be performed by 2 reviewers independently. Methodological and reporting quality of included studies will be assessed by the consolidated standards of reporting trials for Chinese herbal medicine formulas. All statistical analyses will be conducted using RevMan V.5.3 software. Funnel plots, Begg's test, and Egger's test will be developed to evaluate reporting bias.

RESULTS

This review will assess the effect of Zhizhu Kuanzhong capsule on clinical total effective rate, symptom remission rate, plasma motilin level, and safety of FD in patients.

CONCLUSION

The conclusion of our study will provide updated evidence to judge whether Zhizhu Kuanzhong capsule is an effective intervention for patients with FD.

Java brucea and Chinese herbal medicine for the treatment of cholesterol granuloma in the suprasellar and sellar regions: A case report and literature review

RATIONALE

A cholesterol granuloma (CG) is usually found in the middle ear, papilla, orbits, petrous apex, and choroid plexus, but is highly uncommon in the skull. In spite of benign clinicopathological lesions, bone erosion can be seen occasionally in the patient with CG. The optimal treatment strategy is radical surgery, but complete excision is usually impossible due to anatomical restrictions and a risk of injury to the key structures located nearby. Here, we report a patient with CGs in the suprasellar and sellar regions who was successfully treated with Java brucea and Chinese herbal medicine.

PATIENT CONCERNS

A 31-year-old man presenting with progressive decreased vision in both eyes was analyzed.

DIAGNOSES

A skull magnetic resonance imaging (MRI) scan showed a low-density tumor in the uprasellar and sellar regions and histopathological examination revealed a CG.

INTERVENTIONS

The patient was referred the surgery and radiotherapy. In the meantime, brucea soft capsules and herbal medicine combined were administered to him.

OUTCOMES

The related clinical symptoms and signs resolved significantly after several months, as his therapy progressed. The patient showed no sign of recurrence during the treatment period. Furthermore, he was still alive and disease-free at 37 months of follow-up visit.

LESSONS

Overall, brucea soft capsules and a Chinese herbal formula treatment combined could be beneficial in improving the patient's quality of life with CG in the skull.

Acute Bilateral Renal and Splenic Infarctions Occurring during Chemotherapy for Lung Cancer

We herein report a rare case of acute bilateral renal and splenic infarctions occurring during chemotherapy for lung cancer. A 60-year-old man presented with acute and intensive upper abdominal and back pain during chemotherapy with cisplatin and etoposide for lung cancer. Contrast-enhanced computed tomography (CT) revealed bilateral renal and splenic infarctions. After the administration of unfractionated heparin his pain was relieved with a clearance of the infarctions in the CT findings and a recovery of renal dysfunction. Enhanced coagulation by lung cancer and arterial ischemia by chemotherapy may therefore contribute to the development of these infarctions.

[Effect of Jingui Shenqi pill combined with nifedipine for the treatment of elderly hypertensive patients with spleen-kidney Yang deficiency syndrome]

Totally 96 elderly patients with spleen-kidney Yang deficiency type hypertension were selected in this study. Patients were randomly divided into study and control group. It was treated with the Jingui Shenqi pill combined nifedipine sustained-release tablets in the study group and only nifedipine sustained-release tablets for the control group. Meanwhile, the clinical features including reducing blood pressure, blood lipid and traditional Chinese medicine (TCM) syndromes of the two groups were observed pre and post treatment. Finally, the results showed that it could significantly reduce the hypertensive, hyperlipidemia and TCM syndromes in the study group compared with the control group (P < 0.05), which indicated that the combination of the Jingui Shenqi pill with nifedipine sustained-release tablets was effective for the patients with hypertension with spleen-kidney Yang deficiency type, especially for decreasing TCM syndromes and the blood lipid.

Splenic abscess in cancer chemotherapy

BACKGROUND

Splenic abcess is an uncommon complication for cancer treatment. It occurs more frequently in immunocompromised patients. They are characterized by high mortality. The classic triad (fever, pain of the left hypochondrium, and sensitive mass left) is only present in one-third of cases the clinical spectrum ranging from no symptoms to events such as fever, nausea, vomiting, weight loss, abdominal pain left, splenomegaly. Treatment options are limited, but must be discussed and adapted to the patient profile.

CASE PRESENTATION

We report the case of a 62-year-old Arabic male, diagnosed with metastatic lung adenocarcinoma, who, after several cycles of chemotherapy, presented symptoms and signs of splenic abcess.

CONCLUSION

Splenic abcess is rare situation, which must be actively researched, to have access to an optimal therapeutic approach.

[Study on interference effect of Sijunzi decoction on brain-gut CaM/CaMK II of spleen Qi deficiency syndrome rats]

OBJECTIVE

To observe the dynamic time-phase expressions of key genes of brain-gut CaM signal pathway of spleen Qi deficiency rats and the intervention effect of Sijunzi decoction.

METHOD

Male Wistar rats were randomly divided into the normal control group, model 14 d, 21 d, 28 d groups, and Sijunzi decoction 14 d, 21 d, 28 d groups. Except for the normal control group, the remaining groups were included into the spleen Qi deficiency model with the bitter cold breaking Qi method (ig 7.5 g · kg⁻¹ · d⁻¹ of Rheum officinale, Fructus aurantii immaturus, Magnolia officinalis preparation) and the exhaustive swimming method. On the 7th day after the modeling, the Sijunzi decoction groups were orally administered with Sijunzi decoction 20 g · kg⁻¹ · d⁻¹. The expressions of key genes CaM/CaMK II of CaM signaling pathway in hippocampus and intestine at different time points by immunohistochemical method and Western blot. At the same time, the intervention effect of Sijunzi decoction on spleen Qi deficiency rats and its mechanism were analyzed.

RESULT

Spleen Qi deficiency rats showed higher intestinal CaM/CaMK II expression and lower hippocampus CaM/CaMK II expression than normal rats (P < 0.05, P < 0.01). After the treatment of Sijunzi decoction, spleen Qi deficiency rats showed reduction in intestinal CaM/CaMK II expression and increase in hippocampus CaM/CaMK II expression (P < 0.05, P < 0.01).

CONCLUSION

The formation of spleen Qi deficiency syndrome may be related to the high expression of CaM/CaMK II in small intestine tissues and its low expression in hippocampus tissues. Sijunzi decoction may achieve the therapeutic effect in spleen Qi deficiency syndrome by reducing the CaM/CaMK II expression in intestinal tissues and increasing it in hippocampus tissues.

Epidemiologic, clinical, diagnostic and therapeutic aspects of visceral leishmaniasis in renal transplant recipients: experience from thirty cases

BACKGROUND

Visceral leishmaniasis is a disease caused by the protozoan Leishmania sp. and is transmitted by Lutzomyia longipalpis (sand fly). In renal transplant recipients, visceral leishmaniasis causes severe damage to the liver, spleen, and hematopoietic system, as well as poor outcomes for patients with transplanted kidneys. This study describes the largest series of cases of visceral leishmaniasis in renal transplant recipients, providing important information about the diagnostic routines and therapeutic strategies in this patient population.

METHODS

A retrospective, descriptive study was performed to analyze the distribution and evaluate the extent of the epidemiologic, clinical, diagnostic and therapeutic aspects of 30 renal transplant recipients from endemic regions who presented with visceral leishmaniasis in the post-transplantation period.

RESULTS

In this study, visceral leishmaniasis was more frequent in men (80%). The mean age of presentation was 40 ± 10.5 years. The majority of patients worked in urban areas (66.7%), cohabitated with domestic animals (90%), and were from low-income households. In 73.3% of cases, diagnosis was made by direct isolation of Leishmania forms. Patients were treated with liposomal amphotericin, resulting in a high degree of disease remission (80%).

CONCLUSIONS

This study describes the largest series of visceral leishmaniasis in renal transplant recipients and expands clinical-epidemiological knowledge for transplantation teams to perform adequate disease management for this specific patient population.

Effects of dietary selenium on histopathological changes and T cells of spleen in broilers exposed to aflatoxin B1

Aflatoxin B1 (AFB1), which causes hepatocellular carcinoma and immune-suppression, is commonly found in feedstuffs. To evaluate the ability of selenium (Se) to counteract the deleterious effects of AFB1, two hundred 1-day-old male avian broilers, divided into five groups, were fed with basal diet (control group), 0.3 mg/kg AFB1 (AFB1 group), 0.3 mg/kg AFB1+0.2 mg/kg Se (+Se group I), 0.3 mg/kg AFB1+0.4 mg/kg Se (+Se group II) and 0.3 mg/kg AFB1+0.6 mg/kg Se (+Se group III), respectively. Compared with control group, the relative weight of spleen in the AFB1 group was decreased at 21 days of age. The relative weight of spleen in the three +Se groups was higher than that in the AFB1 group. By pathological observation, the major spleen lesions included congestion in red pulp and vacuoles appeared in the lymphatic nodules and periarterial lymphatic sheath in the AFB1 group. In +Se groups II and III, the incidence of major splenic lesions was decreased. The percentages of CD3+, CD3+CD4+ and CD3+CD8+ T cells in the AFB1 group were lower than those in control group from 7 to 21 days of age, while there was a marked increase in the three +Se groups compared to the AFB1 group. The results indicated that sodium selenite could improve the cellular immune function impaired by AFB1 through increasing the relative weight of spleen and percentages of splenic T cell subsets, and alleviating histopathological spleen damage.

Surgical approach to splenic hydatid cyst: single center experience

The benefits and risks of surgery for splenic hydatid cyst (SHC) remain controversial. We aimed to share our experience about a surgical approach for SHC. Sixteen consecutive patients with SHC disease who underwent open splenectomy at our hospital between January 2006 and July 2012 were retrospectively evaluated. Data on the patients' demographic features, clinical findings, radiological and serological diagnostic methods, and surgical and medicinal treatment options were collected and used to generate descriptive profiles of diagnosis, treatment course, and outcome. The patient population was composed of 6 females and 10 males, with an age range of 18 to 79 years (mean age: 47.0 ± 18.0). Radiological examinations detected hydatid cysts in spleen alone (n = 7) or both spleen and liver (n = 9). Preoperative serological testing identified 13 of the patients as IHA positive. All except 1 patient received a 10- to 21-day preoperative course of albendazole therapy and all patients received vaccination 1 week prior to surgery. Seven patients underwent splenectomy. The remaining patients underwent splenectomy with partial cystectomy and omentopexy (n = 6), partial cystectomy and unroofing (n = 1), pericystectomy (n = 1), or pericystectomy with partial nephrectomy (n = 1). All except one patient received a 10- to 45-day postoperative course of albendazole. No patients developed serious complications or signs of recurrence during the follow-up. The clinical profile of SHC disease at our hospital includes diagnosis by radiological methods, splenectomy treatment by simple or concomitant procedures according to the patient's symptoms, cyst size, number and localization, and compression of adjacent organs, and adjunct vaccination to decrease risk of postoperative septic complications. This profile is associated with low risk of complications and high therapeutic efficacy.

Splenic abscess due to acute brucellosis

Splenic abscess due to acute brucellosis is a rare event. We report a case of splenic abscess caused by Brucella spp. in a 21-year-old man. The MRI revealed sharply demarcated lesions measuring 20 and 30 mm in diameter at the superior pole of spleen. Positive Wright agglutination test and positive blood culture confirmed the diagnosis. Antibiotic therapy, without surgical intervention, was successful.

[Effect of sijunzi decoction on salivary amylase secretion disorder and VIP-cAMP signaling pathway in splenasthenic rats]

OBJECTIVE

To observe the effect of Sijunzi Decoction on secretion disorder of salivary amylase in splenasthenic rat and its mechanism.

METHODS

The model group rats received reserpine 0.5 mg/kg through subcutaneous injection while the control group rats received the same volume of saline for 8 days. After being modeled, the model group were divided into treatment group and model control group, treatment group were given orally Sijunzi Decoction, model control group and normal group were fed the same amount of distilled water for 4 weeks. The animal were anaesthetized and the left parotid was removed, the wounds were sutured. When the animals were awake but drowsy, 20 microL 10% glacial acetic acid was applied on the apex of the tongue once a minute for 30 minutes, removed the right parotid gland of the animals. The samples were frozen and amylase activity and VIP, cyclic adenosine monophosphate (cAMP) content and VAMP-8, SNAP-23 protein expression in the parotid glands were detected.

RESULTS

Change of sAA in parotid acinar was not significantly different between treatment group and normal groups, but higher in model control groups after acid stimulation. The VIP and PKA contents were not significantly different among three groups. VIP, cAMP content and PKA activity increased significantly in normal group while VIP increased slightly, cAMP and PKA activity decreased in model control groups, which returned to some degrees in treatment group after acid stimulation. Expression of VAMP-8 protein was not significantly different between treatment group and model control groups, while expression of SNAP-23 was lower in model control groups, expression of VAMP-8 and SNAP-23 was higher in treatment group than which in model control groups.

CONCLUSION

Sijunzi Decoction has a certain effect on secretion disorder of salivary amylase in splenasthenic rat, which mechanism may be related to recover changes of VIP-cAMP signal pathway in the splenasthenic rat's parotid gland cells,including increase VIP content and expression of VAMP-8 and SNAP-23.

[Clinical study on intervention of spleen-restoring decoction integrating with dormancy hygiene education on subhealthy insomnia of deficiency of both heart and spleen pattern]

OBJECTIVE

To appraise the clinical efficacy, safety and compliance of the intervention of spleen-restoring decoction combined with dormancy hygiene education and the intervention of spleen-restoring decoction alone on sub-healthy insomnia of deficiency of both the heart and spleen pattern.

METHOD

Study design took multi-centers, blind and randomized control trial, 107 participants with sub-healthy insomnia of deficiency of both the heart and spleen pattern were assigned to A group (52 cases) which was treated with the intervention of spleen-restoring decoction combined with dormancy hygiene education and B group (55 cases) which was treated with the intervention of spleen-restoring decoction single, compared by efficacy, PSQI score, CGI score, WHOQOL-BREF score and security.

RESULT

The efficacy of two group was 79.58%. There was no significant different between them. The PSQI scores before treatment was (11.80 +/- 2.08) and which afer treatment was (6.78 +/- 2.84) of A group. The PSQI scores before treatment was (11.61 +/- 2.00) and which afer treatment was (6.73 +/- 2.27) of B group. There was significant difference in PSQI scores both A group and B group after treatment (P < 0.01); the results of CGI score and WHOQOL-BREF score before and after measurement showed the same as PSQI. There were no significant difference between two groups in all scores after treatment and there was no interaction between time pots and treatment factors . Withdrawal reaction analysis: comparing CGI after withdraw 2 weeks and at the end of treatment course, there was no significant difference between two groups. The same result was in comparison among groups.

CONCLUSION

Both the intervention of spleen-restoring decoction integrating with dormancy hygiene education and spleen-restoring decoction had obvious clinical efficacy on treating subhealthy insomnia of deficiency of both the heart and spleen pattern, and had high compliance and safety. The intervention of spleen-restoring decoction integrating with dormancy hygiene education showed no better clinical efficacy than spleen-restoring decoction did.

To compare the efficacy of two kinds of Zhizhu pills in the treatment of functional dyspepsia of spleen-deficiency and qi-stagnation syndrome: a randomized group sequential comparative trial

BACKGROUND

In Traditional Chinese Medicine (TCM) theory, functional dyspepsia (FD) can be divided into different syndromes according to different clinical symptoms and signs, and the most common one is spleen-deficiency and qi-stagnation syndrome that can be treated by Chinese traditional patent medicine--two kinds of Zhizhu pills, between which the primary difference in ingredients is that one contains immature orange fruit of Citrus aurantium L.(IFCA) and the other contains that of Citrus sinensis Osbeck (IFCS). The trial's objective was to compare the efficacy of two kinds of Zhizhu pills on symptom changes in patients with FD of spleen-deficiency and qi-stagnation syndrome.

METHODS

A randomized, group sequential, double-blinded, multicenter trial was conducted in patients with FD of spleen-deficiency and qi-stagnation syndrome at 3 hospitals in Beijing between June 2003 and May 2005. Participants were randomly allocated into two groups (IFCA group and IFCS group) in a 1:1 ratio, and respectively took one of the two kinds of Zhizhu pills orally, 6 g each time, 3 times a day, for 4 weeks. Statistical analysis was performed with use of a group sequential method, the triangular test (TT).

RESULTS

A total of 163 patients were randomized, and 3 patients were excluded from analysis because of early dropouts, leaving 160 patients (IFCA group: n = 82; IFCS group: n = 78) for statistical analysis. Three interim analyses were done after 62, 116, and 160 patients had completed their 4-week treatment, respectively. At the third interim analysis, the sample path crossed the upper boundary and the trial was stopped, the cure-markedly effective rates were 45% for IFCS group and 67% for IFCA group, respectively, the one-sided p-value was 0.0036, the median unbiased estimate of the odds ratio (OR) for the benefit of IFCA relative to IFCS was 2.91 with 95%CI: 1.40 to 6.06.No adverse events were observed in the two groups.

CONCLUSIONS

Zhizhu pills containing IFCA was superior to Zhizhu pills containing IFCS in the treatment of FD of spleen-deficiency and qi-stagnation syndrome. The application of group sequential analysis in clinical trials of TCM may offer some financial and ethical benefits.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (ChiCTR): ChiCTR-TRC-00000485.

Splenic abscess: a single institution study and review of the literature

PURPOSE

The aim of this study was to review our experience with splenic abscesses, with respect to the relevant aspects of splenic abscesses and treatment outcomes.

MATERIALS AND METHODS

We reviewed the cases of 18 patients who had splenic abscesses and who were treated at our hospital from November 1993 to December 2008.

RESULTS

The most common symptom at presentation was abdominal pain in 12 patients (66.7%). The median duration from symptom onset until establishment of a diagnosis was 22 days. Streptococcus viridans was the most common pathogen (27.8%), follow by Klebsiella pneumoniae (22.2%). The mortality rate during the inpatient period and the previous 90 days was 16.6%. Three of four patients with Klebsiella pneumoniae showed a single abscess pocket. Four patients (22.2%) underwent percutaneous drainage, eight (44.5%) received antibiotic treatment only and six (33.3%) underwent splenectomy.

CONCLUSION

There is no gold standard for treating splenic abscesses. Treatment should be customized for each patient.

[Effects of acupoint-injection of Lentinan on the immunologic funtion in rabbits with spleen-qi deficiency]

To observe the effect of Spleen-Meridian-acupoint injection of Lentinan on the immunologic function in spleen-deficiency rabbits.

METHODS

A total of 54 Newzealand rabbits were randomly divided into normal (n = 10), model (n = 8), intramuscular injection (n = 10), Sanyinjiao (SP6, n = 10), Diji (SP8, n = 8) and Xuehai (SP 12, n = 8) groups. Spleen-qi deficiency model was established by intragastric administration of 100% crude Radix et Rhizoma Rhei decoction (15 mL/kg/day x 10 d), and then Lentinan (LNT, 0.025 mg/kg/2 day x 5) was injected into the aforementioned acupoints of the Spleen Meridian. The erythrocyte immunologic function (RBC-C3 bR, RBC-IC), hemolysin (lgM) and changes of physical signs of the rabbits were observed.

RESULTS

In comparison with the control group, the rabbits' body weight, rectal temperature, RBC-C3 bR% and serum IgM level were decreased significantly in model group (P < 0.05); while in comparison with the model group, the body weight in SP 8 group,retal temperature in SP 9 and SP 8 groups, RBC-C3 bR% in SP 9 and SP 12 groups, and serum IgM levels in SP 9, SP 8 and SP 12 groups increased considerably (P < 0.05, P < 0.01). Comparison among the 4 treatment groups showed that the effect of SP 12 was superior to that of intramuscular injection group in upregulaing RBC-C3 bR%, and the effects of SP 9, SP 8 and SP 12 groups were significantly superior to those of intramuscular injection group in upregulating serum IgM level (P < 0.05).

CONCLUSION

The Spleen-Meridian-acupoint injection of LNT is superior to that of intramuscular injection of LNT in improving the spleen-qi deficiency rabbits' symptoms and immunologic function.

A Case of Pasteurella haemolytica Sepsis in a Patient with Mitral Valve Disease who Developed a Splenic Abscess

We report a patient with sepsis caused by Pasteurella haemolytica, an extremely rare etiologic agent of human infection, who had mitral valve disease and developed a splenic abscess.

Complicated typhoid fever

Acute typhoid fever, caused by the gram negative bacterium Salmonella typhi may have a wide spectrum of clinical presentation. We report a young boy with typhoid fever, who developed myocarditis and splenic abscess, two of the unusual complications in the course of the disease. Judicious use of corticosteroid and antibiotic helped in achieving a favourable outcome.

Sepsis and gas-forming splenic abscess by Clostridium septicum in a patient with type 2 diabetes

Clostridium infections are rare but frequently associated with malignancy, and mortality approaches 100% if care is not rendered within 12 to 24 h. These infections are associated with various medical problems including diabetes mellitus. In this report, we describe a unique case of sepsis and a gas-forming splenic abscess caused by Clostridium septicum in a type 2 diabetes patient which was treatable solely with antibiotics.

[Multiple abdominal hydatid disease. Case report]

Hydatid disease, a parasitic infection caused by Echinococcus granulosus is relatively frequent in our country. Imaging techniques like ultrasound and CT made possible an early and accurate diagnosis prior to serious complications. Hydatid cysts can be ruptured spontaneously or following trauma. The authors report a case of multiple abdominal hydatid disease (hepatic, splenic and peritoneal) in a 11-year-old boy admitted into the Bacau County Hospital with severe abdominal pain and history of abdominal trauma 7 months ago in the right hypochondriac region. The case was managed surgically being performed pericystectomy, splenectomy and omentectomy. Albendazole was administered before and after surgery. The recovery course was uneventful and the evolution favorable. Although ruptured hydatid cyst of liver and multiple abdominal hydatid disease are rare clinic entities, in an endemic region as Romania, they should be taken into account when making the differential diagnosis of abdominal pain.

Bullous Sweet syndrome associated with an aseptic splenic abscess

Sweet syndrome is a rare disorder characterized by fever and painful erythematous plaques containing dense dermal neutrophilic infiltrates. Extracutaneous manifestations include alveolitis, sterile osteomyelitis, and arthritis. We present a patient with a bullous presentation of Sweet syndrome who developed an aseptic splenic abscess.

Splenic abscess due to Brucella infection: Is the splenectomy necessary? Case report and literature review

The case of a woman with splenic abscess due to Brucella is reported. There was no response with antibiotics and surgical treatment was required. On the basis of this case and the literature review we consider that surgical treatment must be considered in patients with splenic abscess due to Brucella infection.

Idiopathic thrombocytopenic purpura with isolated tuberculous splenic abscess

We present a 14-year-old boy, a known case of idiopathic thrombocytopenic purpura (ITP) for five years, and was treated with intermittent oral steroids. He presented with left upper abdominal pain of three months' duration. The pain was dull, aching and non-radiating. There were no other associated features. Before this presentation, he was receiving oral steroids for a month. The patient had been hospitalised in the past for ITP-related bleeding. The patient was managed with anti-tuberculous therapy alone, and after nine months, his splenic abscess regressed significantly in size. Tuberculous splenic abscesses are rare, and in particular, isolated tuberculous splenic abscesses are extremely rare with only three cases reported to date. This may be the first case report of tuberculous splenic abscess in ITP. It is noteworthy that this abscess was minimally symptomatic, with no fever or constitutional symptoms.

[Influence of Qingxiang San on substance P, somatostatin in rats model with the spleen and stomach wet heat syndrome]

OBJECTIVE

To observe the influence of Qingxiang San (QS) on substance P (SP), somatostatin (SS) in rats model of spleen and stomach wet heat syndrome.

METHODS

24 rats were divided into 3 groups (each group 8 rats) randomly: the normal control group (NCG), wet heat group (WHG), QS group (QSG). We set up the spleen and stomach wet heat syndrome of rats model by the composite factors such as greasy and sweet food, wet and hot environment, pathogen and so on. Then the contents of SP, SS were detected by radioimmuno assay.

RESULTS

The content of SP, SS in WHG were obviously lower than NCG (P<0.01); QSG compared with WHG, the content of SP, SS increased (P<0.01); The content of SP obviously increased when QSG compared with NCG (P<0.01); About the content of SS, there was no significant difference between QSG and NCG (P>0.05), illustrating that QS can increase the content of SP, SS which had decreased.

CONCLUSION

QS can regulate the content of SP and SS and increase them which had decreased.

Ten-year series of splenic abscesses in a general hospital in Singapore

INTRODUCTION

Splenic abscess is an uncommon clinical problem. Traditionally, the "gold standard" treatment has been splenectomy. However, there is increasing use of non-operative treatments worldwide.

MATERIALS AND METHODS

A 10-year (1996-2005) retrospective review of case records from a single centre (an 800-bed general hospital) was performed. Information regarding demographics, clinical presentation, aetiological agents and management was gathered and analysed.

RESULTS

There were 21 cases from 1996 to 2005. Nineteen (90%) had multiple abscesses. Disseminated melioidosis was the most common aetiological agent (15 cases, 71%). Only 3 patients underwent splenectomy. The remainder were treated conservatively with antibiotics. Almost all the patients (19, 90%) also suffered from diabetes mellitus.

CONCLUSIONS

The most common aetiological agent encountered was Burkholderia pseudomallei. Diabetes mellitus may be an important co-factor in the pathogenesis of splenic abscesses. The majority of our patients were managed conservatively and splenectomy was only occasionally required.

A singular case of granulomatous lesions of unknown significance

The acronym used for granulomatous lesion of unknown significance, (GLUS), was first employed in 1990, to describe epithelioid-cell granulomas occasionally observed in biopsies from liver, lymph-nodes and other tissues without any apparent cause than thorough diagnostic examinations. Authors describe a case of a 51-year-old woman who was admitted to hospital because of fever, nodules in the liver and spleen, skin ulcerative lesions on the legs. The patient had a very long medical history; recurrent fever, liver and spleen enlargement have been lasting since 1975. Laboratory data showed erythrocyte sedimentation rate increase (125 mm 1 hour), anemia, (Hb=8.1 g/dL), an increase of alkaline phosphatase activity (328.4 mU/mL NV=80-275) and also an increase of policlonal gamma-globulins; patient's total proteins was 6.8 g/dL while their gamma-globulins were 29.5%; IgG=2 260 mg/dL (NV=751-1 560 mg/dL), IgM=277 mg/dL (NV=46-230 mg/dL), IgA=405 mg/dL (NV=70-400 mg/dL). One culture of the blood and a needle aspiration specimen of liver nodule was positive for Staphylococcus coagulase negative. This case cannot be regarded as GLUS-syndrome because of the long time duration of the disease and other clinical features. The dramatic, even if transient, liver nodules improvement obtained by Linezolid therapy, and the well-being obtained by prolonged monociclin use, make the authors hypothesize that Staphylococcus coagulase negative could be the etiological agent of this granulomatous clinical picture.