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Objective To investigate the association between metabolic associated fatty liver disease (MAFLD) and sleep disorders. Methods A total of 222 patients with MALFD who were admitted to Panjin Central Hospital from February 2020 to February 2021 and 270 healthy individuals were enrolled as subjects. According to age, the patients with MALFD were divided into youth group with 93 patients, middle-aged group with 76 patients, and elderly group with 53 patients; according to controlled attenuation parameter (CAP) of liver fat, the patients were divided into non-steatosis group with 23 patients, mild steatosis group with 85 patients, moderate steatosis group with 76 patients, and severe steatosis group with 38 patients; according to liver stiffness measurement (LSM), the patients were divided into non-progressive fibrosis group with 124 patients and progressive fibrosis group with 98 patients. Related data were collected, including general information such as age and sex and laboratory markers such as routine blood test results and biochemistry, and after informed consent was obtained, three sleep scales, i.e., Pittsburgh Sleep Quality Index (PSQI) scale, Epworth Sleepiness Scale (ESS), and Morningness-Eveningness Questionnaire (MEQ), were completed independently. The MAFLD group and the healthy control group were compared in terms of general information and laboratory markers to investigate the association between MAFLD and sleep disorders under different grouping criteria. The chi-square test was used for comparison of categorical data between two groups; the t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U rank sum test was used for comparison of non-normally distributed continuous data between two groups; the Kruskal-Wallis H test was used for comparison between the groups of MAFLD patients with different ages and degrees of hepatic steatosis and pairwise comparison within each group. A logistic regression analysis was used to investigate the independent risk factors for MAFLD, and a Spearman correlation analysis was used to investigate the correlation of hepatic steatosis degree and fibrosis degree with sleep quality, somnolence, and circadian rhythm. Results There were significant differences in age, sex, hypertension, diabetes, and smoking between the MAFLD group and the healthy control group (all P < 0.05). Compared with the healthy control group, the MAFLD group had significantly higher hemoglobin, white blood cell count, lymphocyte percentage, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transpeptidase, serum uric acid, low-density lipoprotein, total bilirubin, total cholesterol, triglyceride, and body mass index and significantly lower albumin and high-density lipoprotein (all P < 0.05). Compared with the healthy control group, the MAFLD group had significantly higher PSQI score ( t =35.529, P < 0.001) and ESS score ( t =24.647, P < 0.001) and significantly lower MEQ score ( t =-22.416, P < 0.001) and sleep time ( t =-8.660, P < 0.001). With the increase in age in the MAFLD group, hepatic steatosis degree, liver fibrosis degree, and PSQI score showed an increasing trend, and pairwise comparison of each scoring factor between groups showed statistical significance (all P < 0.05). Compared with the healthy control group, the MAFLD group had a significantly higher proportion of patients with definitely evening type, moderately evening type, or intermediate type and a significantly lower proportion of patients with moderately morning type or definitely morning type (all P < 0.05), and MEQ score tended to decrease with the increase in hepatic steatosis degree and liver fibrosis degree, with significant differences between two groups (all P < 0.05). The multivariate logistic regression analysis showed that overweight/obesity (odds ratio [ OR ]=3.166, P =0.027), diabetes ( OR =6.811, P =0.045), increase in white blood cell count ( OR =2.301, P < 0.001), increase in lymphocyte percentage ( OR =1.316, P =0.002), poor sleep quality ( OR =8.493, P < 0.001), a high degree of somnolence ( OR =5.420, P < 0.001), and circadian rhythm disturbance ( OR =3.805, P < 0.001) were risk factors for MAFLD. The Spearman correlation analysis showed that in the MAFLD group, hepatic steatosis degree was positively correlated with PSQI score ( r =0.444, P < 0.001) and ESS score ( r =0.339, P < 0.001) and was negatively correlated with MEQ score ( r =-0.195, P =0.004), and liver fibrosis degree was positively correlated with PSQI score ( r =0.518, P < 0.001) and ESS score ( r =0.373, P < 0.001) and was negatively correlated with MEQ score ( r =-0.250, P =0.004). Conclusion Compared with healthy individuals, the patients with MAFLD often have sleep disorders, and the severity of sleep disorders increases with age, hepatic steatosis degree, and liver fibrosis degree. Obesity, diabetes, and sleep disorders are risk factors for the onset of MAFLD.
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Objective:To investigate the clinical efficacy of middle-preserving pancreatectomy (MPP).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of two patients who underwent MPP in Fujian Provincial Hospital from July 2019 to October 2019 were collected. Case 1 was a 52-year-old woman with multiple serous cystic neoplasms of the pancreatic head and tail. Case 2 was a 20-year-old man with chronic pancreatitis and multiple pancreatic duct stones. After comprehensive evaluation, two patients were performed laparoscopic pancreatic head tumor resection+ pancreatic tail resection+ splenectomy+ pancreaticojejunostomy and duodenum-preserving pancreatic head resection+ pancreatic tail resection+ lithotomy by longitudinal pancreatic duct incision+ side-to-side pancreaticojejunostomy, respectively. Observation indicators: surgery, operation time, volume of intraoperative blood loss, blood transfusion, postoperative fasting blood glucose, postoperative complications, duration of postoperative hospital stay, postoperative pathological examination, and follow-up. Follow-up was performed using outpatient examination and telephone interview to detect new-onset diabetes mellitus, pancreatic enzyme replacement therapy and disease recurrence up to March 2020.Results:Two patients successfully underwent MPP. The operation time of case 1 and case 2 were 470 minutes and 400 minutes, the volume of intraoperative blood loss were 200 mL and 100 mL, respectively. No blood transfusion was performed in either patient. The postoperative fasting blood glucose fluctuated between 5.4 and 11.8 mmol/L in case 1, and fluctuated between 5.9 and 11.3 mmol/L in case 2. Case 1 developed abdominal infection after operation, and was discharged after anti-infective treatment. Case 2 had good recovery with no complication. No pancreatic fistula or perioperative death occurred in two patients. The duration of postoperative hospital stay were 12 days and 8 days of case 1 and case 2, respectively. The pathological examination of case 1 showed serous cystadenoma of the pancreatic head and pancreatic tail. The pathological examination of case 2 showed that slightly dilated pancreatic ducts of the pancreatic head and tail with multiple stones and chronic inflammatory cells infiltration around the pancreatic ducts. The length of pancreas preserved was 8.5 cm and 8.3 cm of case 1 and case 2 on postoperative computed tomography (CT) reexamination. Two patients were followed up for 5 months and 7 months, respectively. During the follow-up, both patients had no new-onset diabetes and they didn′t require pancreatic enzyme replacement therapy. Both patients underwent upper abdominal CT examination at postoperative 5 months, which showed good blood supply in middle pancreas and no signs of recurrence of cystadenoma or stones.Conclusions:MPP is a safe and feasible procedure for the treatment of multifocal pancreatic lesions. The procedure can eradicate the lesions and ensure good control of blood glucose in patients.
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To investigate the therapeutic effect of peroxiredoxin-6(PRDX6)on ultraviolet-induced corneal injury in rats and explore the mechanism.The rat model of corneal injury was established by exposing to ultravio-let.Male wister rats were randomly divided into control groups,dexamethasone (DXM)groups and PRDX6 groups,the rats were administered four times a day and for 12 days.The corneal opacity was observed with a slit-lamp microscope.Histopathologic changes were observed with light microscopy.The content of corneal malonalde-hyde(MDA)was determined by thiobarbituric acid test and the total antioxidative capacity(TAOC)was detected by chemical colorimetric test.P38 MAPK signal pathway was detected with the method of Western blot and the gene expression of cytokines were measured by RT-PCR method.Compared with the control group,PRDX6 treat-ment significantly reduced corneal opacity,improved corneal pathology injury,decreased the MDA content and in-creased the TAOC.In the PRDX6 group the level of phosphorylated p38 protein was significantly lower than that in the control group.The gene expression of cytokine were different between control and PRDX6 groups(P <0.05).PRDX6 showed therapeutic effect in the rat model of ultraviolet-induced corneal injury.This maybe be concerned with that it could alleviated the oxidative damage,suppressed p38 MAPK phosphorylation and regulate the gene expression of cytokine.