Spleen Injury Research Articles

Impact of early arterial-phase multidetector CT in blunt spleen injury: a clinical outcomes-oriented study.

Blunt spleen injuries (BSI) present significant diagnostic and management challenges in trauma care. Current guidelines recommend arterial-phase contrast-enhanced multidetector computed tomography (CT) for a detailed assessment. However, the direct impact of add-on arterial phase CT on clinical outcomes remains unclear. This study investigated the impact of early arterial-phase imaging via multidetector CT on the clinical outcomes of patients with blunt splenic injuries. A retrospective case-control study was conducted to analyze the data of adult patients with BSI treated at a single institution between 2019 and 2022. Patients were divided based on the CT phase performed: portal vein phase only or add-on arterial phase. Management methods were divided according to the initial treatment intent: nonoperative management observation (NOM-Obs), transarterial embolization (TAE), and splenectomy. NOM failure refers to either NOM-Obs or TAE failure leading to splenectomy. NOM-Obs failure refers to cases initially managed with observation only, but later requiring either TAE or splenectomy. Transarterial embolization (TAE) failure refers to cases initially treated with TAE, but subsequently requiring splenectomy. Inverse probability of treatment weighting (IPTW) was used to balance baseline differences and compare outcomes between the two groups. Of 170 patients assessed, 147 met the inclusion criteria and were divided into two groups: those receiving portal vein phasic-only CT (N = 104) and those receiving add-on arterial phasic CT (N = 43). The overall NOM failure rate was 3.0% (4/132), the NOM-OBS failure rate was 6.7% (4/60), and the TAE failure rate was 4.1% (3/73). After adjusting for covariates using inverse probability of treatment weighting (IPTW), the comparison between the add-on arterial phase and portal phase CT groups revealed similar overall NOM failure rates (3.0% vs. 2.2%, p = 0.721), NOM-OBS failure rates (3.8% vs. 6.2%, p = 0.703), and intra-abdominal bleeding-related mortality rates (4.8% vs. 2.1%, p = 0.335). Among the 43 patients who underwent add-on arterial CT, only one was diagnosed with a tiny pseudoaneurysm (0.7cm) attributable to the inclusion of the arterial phase. Dual-phase CT within 24h of presentation offers no added value over single-phase CT in managing blunt splenic injuries in terms of clinical outcomes.

Treatment of children with blunt spleen injury throughout 25-year period in Sevastopol and the Republic of Crimea

This study examines methods of treatment of pediatric patients with blunt splenic injury (BSI) in medical institutions in the city of Sevastopol and the Republic of Crimea. The effectiveness of non-operative management (NOM) in patients with BSI of varying AAST injury grade was assessed and risk factors which could predict the need for operative management (OM) were identified. A two-center retrospective cohort study was performed, in which reviewed the medical records of children diagnosed with BSI between 1996 and 2023. A cohort of patients hospitalized since the start of the active use of NOM of BSI was identified to determine risk factors. The study included 112 patients. The mean age was 9.9±3.6 years, with a predominantly male (72%) population. In 64% of cases, the injury mechanism of BSI was a fall from a height. 26% of patients were hemodynamically unstable. Among the cohort of patients hospitalized since the start of the active use of NOM of BSI, NOM was effective in 94% of patients with low or moderate AAST injury grade, and in 56% of patients with high AAST injury grade. According to the study results, the risk factors that determine the indications for OM in this cohort of patients are BSI of high AAST injury grade (OR 20.0; 95% CI 2.7-53; p<0.01), hemoperitoneum volume >500 ml according to ultrasound and/or CT (OR 15.0; 95% CI 2.3-98; p< 0.01), Hb <92.5 g/l (OR 20.0; 95% CI 1.9-219; p=0.01), hemodynamic instability (OR 5.4; 95% CI 1.4-21; p=0.02). NOM is an effective treatment for BSI of any AAST injury grade. The decision about OM should be based on haemodynamic instability.

Untargeted metabolite profiling reveals metabolic disorders in livers of rats with mepiquat exposure.

Mepiquat is a contaminant produced in thermal-processed food. It can induce spleen and liver injury. However, the mechanism that mepiquat induced hepatotoxicity remains unclear. In this study, a ultra-performance liquid chromatography-mass spectrometry (UPLC-MS/MS)-based metabolomic analysis of livers in rats was performed to explore metabolic alterations. Our results demonstrated that there were 36 differential metabolites. Eleven major disordered metabolic pathways were found. Network analysis of differential metabolites and metabolic pathways indicated that glutamic acid was a possible key upregulated metabolite. It participated in nine metabolic networks. Glutathione and l-proline may be key downregulated metabolites. They were involved in eight and seven metabolic pathways, respectively. Compared with the control group, serum concentrations of alanine aminotransferase, aspartate aminotransferase, and total bile acid in high dosage group increased significantly. In addition, histopathological analysis showed liver injury in rats with mepiquat exposure. These data were consistent with results of metabolomics. Our results offered new insights for molecular mechanism of liver toxicity induced by mepiquat. PRACTICAL APPLICATION: Mepiquat is a contaminant formed in thermal-processed food. It can induce spleen and liver injury. Our results offered new insights for molecular mechanism of liver toxicity induced by mepiquat. It will provide important information for official limits of mepiquat in foods.

Long-term copper exposure induced pyroptosis and inflammation of rat spleen through intestinal-splenic axis

Copper is an essential micro-element in animal growth. Tribasic copper chloride (TBCC), as an important source of animal feed copper, is widely used in agricultural production. Multiple studies have shown that excessive intake of copper can affect the immune function of animals and lead to disease or death. The intestine-spleen axis, which is the interaction between the spleen, intestines and gut microbiota, is closely linked to immune function in the body. However, the mechanism of intestine-spleen axis affecting TBCC induced immune dysfunction in rats has not been revealed. In this study, we analyzed the impacts of different doses of TBCC on the intestine, gut microbiota and spleen of rats, and investigated their relationship in the process. Our results demonstrated that under copper exposure, the structural integrity of the intestinal epithelium was compromised, resulting in a significant downregulation of genes and proteins expression levels related to the intestinal barrier (Zonula occludens-1, Claudin-1 and Occludin). Additionally, copper perturbed the composition of the rat intestinal microbiota, altered the abundance and diversity of the microbial community. Copper entered the spleen via the intestine-spleen axis, leading to structural damage in the spleen and activation of the NFκB signaling pathway, and increased pro-inflammatory cytokines (IFN-γ, TNF-α, IL-18, and IL-1β), ultimately causing pyroptosis and inflammation in the spleen. These findings offer a novel perspective on how copper may induce spleen injury through the intestine-spleen axis.

Single dose of recombinant baculovirus vaccine expressing sigma B and sigma C genes provides good protection against novel duck reovirus challenge in ducks

The novel duck reovirus (NDRV) disease causes high economic losses, resulting in substantial economic losses in waterfowl industry. However, currently, no commercial vaccines are available to alleviate NDRV infection throughout the world. Here, we developed two subunit vaccine candidates for NDRV based on the insect cell-baculovirus expression system (IC-BEVS). Two recombinant viruses, namely rBac-σB and rBac-σC, were successfully generated based on the consensus sequence of NDRV. Then, the σB and σC subunit vaccine candidates were prepared by directly inactivating the recombinant virus infected-Sf9 cell suspension. The double antibody-sandwich ELISA was used for quantitative of σB or σC protein in the inactivated crude antigen. Protective efficacy results revealed that, compared with the whole virus inactivated vaccine, a single dose of 160 ng σB or σC protein showed advantages in inducing serum antibodies, elevating weight, alleviating liver and spleen injury, restraining viral shedding and viral replication in ducklings. To be noted, the subunit σC or the combination of subunit σB and σC vaccine candidates had better protective efficacies, especially the combined σB and σC vaccine group. Therefore, our study provides useful information for developing effective vaccine against NDRV infection.

Association between nighttime/weekend visits and patient outcomes in children with blunt liver and spleen injuries.

The "out-of-hours effect," which indicates hospital admittance during weekends or nighttime, has poorer outcomes for patients than for those admitted on weekdays and is widely documented in various medical conditions. However, this effect remains understudied in pediatric trauma cases, including blunt liver and spleen injuries (BLSIs). This was a secondary analysis of a nationwide multicenter retrospective study, focusing on pediatric patients with trauma (≤ 16years old) with BLSI admitted from 2008 to 2019. This study evaluated the association between out-of-hour admissions and outcomes. The primary outcome was the intervention rate and secondary outcomes were 30-day mortality and time from hospital arrival to the first intervention. This study identified 1414 pediatric patients with BLSI. In total, 681 events occurred during the daytime and 733 during the nighttime, with 927 weekday and 487 weekend events. Out-of-hour admissions did not significantly associate with a higher rate of intervention. This association remained after adjusting for five potential confounders and patient clustering within the hospital. In addition, Out-of-hour admissions did not significantly associated with 30-day mortality, or time from hospital arrival to the first intervention. The current study showed no significant difference in treatment strategy and outcomes between weekday and out-of-hour among children with BLSI.

ORGAN-SPARING AND ORGAN- REMOVING SURGICAL PROCEDURES FOR PATHOLOGICAL CONDITIONS OF THE SPLEEN IN CHILDREN. QUESTIONS AND ANSWERS.

Introduction. Nowadays splenic surgery is a rather urgent problem in pediatric surgery. There are diseases where only splenectomy allows a child to live a full life. These are: sickle cell anemia (SCA), idiopathic thrombocytopenic purpura, hereditary spherocytosis (Minkowski- Chauff ard disease), thalassemia, and autoimmune hemolytic anemia. The spleen is involved in 25-30 % of cases of blunt abdominal trauma in children. The loss of more than 45 % of the circulating blood volume leads to an unstable hemodynamic state in the child. The question of surgical treatment and preservation of the spleen in hemoperitoneum due to its injury is of vital importance. Aim: To study the possibilities of surgical treatment of diseases and injuries of the spleen in children. Materials and methods. An analysis of surgical interventions for diseases and injuries of the spleen in children aged 2 to 17 years from 2019 to 2024 was performed. The study was conducted in the surgical departments of the «Clinical Center of Pediatric Medicine» of the «Okhmatdyt Hospital» of the «Western Ukrainian Specialized Center» (Lviv) and the «Chernivtsi City Children’s Clinical Hospital» (Chernivtsi). 27 children (17 girls, 10 boys) had spleen diseases and 43 children (23 girls, 20 boys) had spleen injuries. Splenectomy was performed for the following splenic diseases: sickle cell anemia (9 children), idiopathic thrombocytopenic purpura (4 children), hereditary spherocytosis (Minkowski- Chauff ard disease) (6 children), thalassemia (1 child), and autoimmune hemolytic anemia (1 child). Six children had splenic cysts: 3 children had posttraumatic cysts and 3 children had parasitic cysts. Twenty children underwent surgery for splenic injuries. The following surgical procedures were performed: laparoscopic abdominal cavity repair with spleen preservation followed by conservative therapy (13 children); laparoscopic splenectomy (2 children); laparotomy, splenic suture (2 children); and open splenectomy (3 children).Results. Conservative management of splenic injuries of varying degrees according to the American Association for the Surgery of Trauma (AAST) was performed in 23 (53.49 %) children. Resorption of hemoperitoneum in cases of conservative treatment of splenic injuries occurred 11-14 days after the start of treatment. Safe, full physical activity was resumed after 6 weeks of conservative treatment of splenic injury. Surgical procedures were performed in 20 (46.51 %) children using various techniques. 17 patients underwent laparoscopy. 2 children underwent laparoscopic splenectomy for grade IV AAST injury and hemodynamic instability. In 15 cases, treatment was started with conservative therapy, but during monitoring an increase in hemoperitoneum was observed, indicating the need for laparoscopy. Laparoscopy was performed in 13 children. A minimum of 100 ml and a maximum of 400 ml of blood was collected laparoscopically in the children. The abdominal cavity was examined and hemostasis was confi rmed. In cases where the spleen was «wrapped» with the omentum, the omentum was not separated from the spleen. The operation was completed by placing a drainage tube in the perisplenic space. In 2 children, grade IV AAST injuries were converted to an open procedure in which the spleen was sutured to stop bleeding and a drain was left near the splenic bed. Grade V AAST splenic injury in 3 children was an indication for left subcostal laparotomy and splenectomy. For splenic disease, laparoscopic splenectomy was performed in 12 (44.44 %) children, with high effi cacy in Minkowski- Chauff ard disease combined with gallstones (3 children) where simultaneous cholecystectomy was possible. Laparoscopic removal of splenic cysts was also justifi ed in 3 (11.11 %) children. However, removal of parasitic cysts required open splenectomy in 3 patients. Open splenectomy was performed in 9 children with splenic disease. In 5 children the inappropriateness of laparoscopy was due to severe perisplenitis, large spleen weight and young age of the children.Conclusions1. The morpho- functional structure of the spleen promotes spontaneous hemostasis, which is the basis for conservative treatment of spleen injuries in 53.49 % of children.2. The AAST classifi cation of splenic injuries from grade I to V, hemodynamic indicators and ultrasound monitoring of blood in the abdominal cavity can be used as a basis for choosing the method of treatment of closed blunt splenic injuries in children.3. Ineff ectiveness of conservative treatment, hemodynamic instability and increase of blood in the abdominal cavity in a child with splenic injury within 4 hours is an indication for laparoscopy.4. Splenic suturing and laparoscopic monitoring should be the preferred methods for treating closed splenic injuries in children to preserve the organ.5. The choice of surgical intervention for splenic diseases in children should be individualized and depend on the disease, the child’s age, the size of the spleen, and the presence of complications of the disease.

Assessment of the protective effect of vitamin E supplementation on oxidative damage of diabetic rat spleen induced by streptozotocin

AimsIncreased oxidative stress in diabetes mellitus may lead to splenic damage, contributing to decreased immunity. This study aims to evaluate the potential of vitamin E supplements as a protective agent against spleen injury by examining physiological, hematological, biochemical, and histological changes in diabetic rat model. MethodsDiabetes was induced in male wistar albino rats through an intraperitoneal injection of 50 mg/kg Streptozotocin, and the rats were randomly divided into five groups. The rats were then administered varying doses of vitamin E for 14 consecutive days. Assessments included renal function tests, blood glucose levels, complete blood counts, lipid profiles, tissue oxidative stress and spleen histology. An acute toxicity study was also conducted on normal rats. ResultsVitamin E supplementation did not result in any mortality up to 5000 mg/kg body weight. The treated diabetic group showed improved metabolic characteristics, such as normal body weight, food and water intake and a reduced spleen index compared to the untreated diabetic group. Significant improvements were observed in hematological parameters like packed cell volume (PCV), hemoglobin concentration, RBC (red blood cells) and WBC (white blood cells) counts. HCA (Hierarchical Cluster Analysis) of these parameters indicated that doses of 100 mg/kg and 150 mg/kg were most similar to normal condition. Catalase and MDA (Malondialdehyde) assays showed a substantial reduction in oxidative stress in spleen tissue and histopathological examination revealed significant regenerative effects. ConclusionThis study demonstrated that vitamin E supplementation significantly enhanced various metabolic, hematological, biochemical, and histological parameters in the diabetic group compared to those who did not receive the treatment. Among the doses tested, 100 mg/kg and 150 mg/kg body weight were found to yield the most favorable outcomes.

Deciphering the transcriptional regulatory networks of FOX genes in nitrite-induced spleen injury in largemouth bass

Deciphering the transcriptional regulatory networks of FOX genes in nitrite-induced spleen injury in largemouth bass

Quercetin Protects against Silicon dioxide Particles-induced spleen ZBP1-Mediated PANoptosis by regulating the Nrf2/Drp1/mtDNA axis

Silicon dioxide particles (SiO2) are a widely used novel material, and SiO2 that enter the body can accumulate in the spleen and cause spleen injury. Quercetin (Que) has a strong antioxidant activity and can also regulate and improve immune function, but whether Que can improve SiO2-induced spleen injury and its underlying mechanism remain to be explored. Herein, we established a C57BL/6 mice model with SiO2 exposure (10 mg/kg) and treated with Que (25 mg/kg). We also cultured CTLL-2 cells for in vitro experiments. Studies in vivo and in vitro showed that SiO2 exposure caused oxidative stress and mitochondrial dynamics disorder, which led to decrease of mitochondrial membrane potential (ΔΨm) and mitochondrial DNA (mtDNA) leakage. mtDNA was recognized by Z-DNA binding protein 1 (ZBP1) in the cytoplasm and increased the expression of ZBP1. This process further promoted the assembly of the ZBP1-mediated PANoptosome, which subsequently induced PANoptosis. Interestingly, supplementation with Que significantly reversed these changes. Specifically, Que mitigated spleen ZBP-1 mediated PANoptosis through preventing mtDNA leakage via regulating nuclear factor erythroid 2-related factor 2/reactive oxygen species/dynamin-related protein 1 (Nrf2/ROS/Drp1) axis. This study enriches the understanding of the toxicological mechanisms of SiO2 and provides evidence for the protective effects of Que against SiO2-induced splenic toxicity.

Follow-up strategy for early detection of delayed pseudoaneurysms in patients with blunt traumatic spleen injury: A single-center retrospective study.

The spleen is the most commonly injured solid organ in blunt abdominal trauma, and splenic pseudoaneurysm rupture is associated with a high risk of mortality. Nonoperative management has become the standard treatment for hemodynamically stable patients with splenic injuries. On the other hand, delayed splenic pseudoaneurysms can develop in any patient, and at present, there are no known risk factors that may reliably predict their occurrence. Furthermore, there is a lack of consensus regarding the most appropriate strategies for monitoring and managing splenic injuries, especially lower-grade (I-III). To determine the predictors of pseudo-aneurysm formation following splenic injury and develop follow-up strategies for early detection of pseudoaneurysms. We retrospectively analyzed patients who visited the Level I Trauma Center between January 2013 and December 2022 and were diagnosed with spleen injuries after blunt abdominal trauma. Using the American Association for the Surgery of Trauma spleen injury scale, the splenic injuries were categorized into the following order based on severity: Grade I (n = 57, 17.6%), grade II (n = 114, 35.3%), grade III (n = 89, 27.6%), grade IV (n = 50, 15.5%), and grade V (n = 13, 4.0%). Of a total of 323 patients, 35 underwent splenectomy and 126 underwent angioembolization. 19 underwent delayed angioembolization, and 5 under-went both initial and delayed angioembolization. In 14 patients who had undergone delayed angioembolization, no extravasation or pseudoaneurysm was observed on the initial computed tomography scan. There are no particular patient-related risk factors for the formation of a delayed splenic pseudoaneurysm, which can occur even in a grade I spleen injury or even 21 days after the injury. The mean detection time for a delayed pseudoaneurysm was 6.26 ± 5.4 (1-21, median: 6, interquartile range: 2-9) days. We recommend regular follow-up computed tomography scans, including an arterial and portal venous phase, at least 1 week and 1 month after injury in any grade of blunt traumatic spleen injury for the timely detection of delayed pseudoaneurysms.

Milk fat globule membrane attenuates acute Salmonella typhimurium infection induced mouse model of colitis and ameliorates intestinal immunity

Research investigating the effects of milk fat globule membranes (MFGM) on Salmonella typhimurium-induced colitis, intestinal barrier integrity, and gut-associated immune responses remains scarce. This study aimed to investigate the potential of dietary MFGM to alleviate S. typhimurium-induced colitis in mice. Male C57BL/6J mice were administered S. typhimurium to induce colitis and were then subjected to dietary interventions with either bovine MFGM (BMFGM) or goat MFGM (GMFGM). Both BMFGM and GMFGM mitigated S. typhimurium-induced colitis, as evidenced by increased body weight, decreased mRNA levels of pro-inflammatory cytokines (TNF-α, IFN-γ, IL-1β, and IL-6) in the colon, reduced intestinal permeability, and increased mRNA expression of tight junction-associated genes (Claudin-1 and ZO-1). Additionally, there was a reduction in the number of S. typhimurium in the mesenteric lymph nodes and an improvement in CD4 T cell activation status. Furthermore, liver and spleen injury was reduced, and serum levels of pro-inflammatory cytokines (IFN-γ, IL-1β, IL-4, IL-2, IL-6, and TNF-α) were decreased by both type of MFGM. Overall, BMFGM and GMFGM effectively alleviated S. typhimurium-induced colitis and associated hepatic and splenic injuries.

Impact of splenectomy on long-term outcomes after gastrectomy for gastric cancer: a population-based study

BackgroundNo national studies comparing long-term survival after total or partial gastrectomy with splenectomy due to injury or oncologic reasons or spleen preservation exist. This study aimed to examine the 5-year overall survival (OS) of patients with gastric adenocarcinoma who underwent total or partial gastrectomy with splenectomy due to injury or oncologic reasons or spleen preservation in a population-based nationwide setting. MethodsThis study included all patients undergoing total or partial gastrectomy with splenectomy or spleen preservation for gastric adenocarcinoma in Finland from 2005 to 2016, with follow-up until December 31, 2019. A total of 2196 patients with gastric cancer diagnosis and total or partial gastrectomy were identified in the registries. Of these patients, 2118 were applicable for this study. Cox proportional hazard models provided hazard ratios (HRs) with 95% CIs of 5-year OS. The results were adjusted for age, sex, year of operation, comorbidities, tumor location, pathologic stage, and neoadjuvant therapy. ResultsThe observed 5-year OS rates were 38.7% in patients with no or minor spleen injury, 39.7% in patients with splenectomy due to injury, and 30.8% in patients with splenectomy due to oncologic reasons (P = .032). Patients who underwent R0 gastrectomy with splenectomy due to oncologic reasons had higher 5-year mortality (the adjusted model HR, 1.26; 95% CI, 1.01–1.56) than patients who underwent spleen preservation. ConclusionThe OS was worst in patients who underwent gastrectomy with splenectomy due to oncologic reasons, highlighting the poor prognosis in patients with advanced gastric cancer. Splenectomy due to injury does not compromise the prognosis.

Emergency cesarean section in pregnant trauma patients presenting after motor vehicle collision

BackgroundMost pregnant trauma patients (PTPs) present after motor vehicle collision (MVC). The national rate and risk factors for emergency cesarean section (ECS) during the index hospitalization for pregnant trauma patients (PTPs) are unknown. We sought to investigate the national rate of ECS in PTPs presenting after MVC, hypothesizing a higher risk of ECS among those with severe injuries or elevated shock index (SI). MethodsThe 2020–2021 TQIP was queried for PTPs presenting after MVC. PTPs that underwent ECS were compared to patients that did not undergo ECS. Elevated SI was defined as ≥1. Severe injury was defined by abbreviated injury scale grade ≥3. Bivariate and multivariable logistic regression analyses were performed. ResultsFrom 1183 PTPs, 95 (8.0 %) underwent ECS. The median time to ECS was 115 min. The ECS group had higher rates of lung (27.4 % vs. 12.2 %, p < 0.001) injury, spleen (18.9 % vs. 5.5 %, p < 0.001) injury, and elevated SI (22.1 % vs. 9.8 %, p < 0.001). ECS patients had higher rates of complication (9.5 % vs. 2.1 %, p < 0.001) and death (4.2 % vs. 1.1 %, p = 0.012). Independently associated risk factors for ECS included severe head (OR 2.65, CI 1.14–6.17, p = 0.023) or abdominal (OR 2.07, CI 1.08–3.97, p = 0.028) injuries and elevated SI (OR 2.17 CI 1.25–3.79, p = 0.006). ConclusionThe national rate of ECS among PTPs presenting after MVC is 8 % with most occurring within the first 2 hours of arrival. Severe head and abdominal injuries as well as elevated SI are risk factors for ECS.

Rib Fractures in Trauma Patients: Prevalence, Associated Injuries, and Mortality Trends.

Introduction Rib fractures are a common consequence of thoracic trauma, often signaling the presence of additional injuries and increasing the risk of mortality. This study aimed to elucidate the frequency, patterns, and mortality rates associated with rib fractures in multitrauma patients and to explore the association between rib fractures and other systemic injuries. Methods In a retrospective observational study at a tertiary care hospital, electronic medical records of multi-trauma patients over a four-year period were examined. Inclusion criteria encompassed adult patients who had undergone whole-body or chest and abdomen CT imaging. The study evaluated the incidence and location of rib fractures, associated thoracic and intra-abdominal injuries, and the in-hospital mortality rate. Results Among the 1,338 patients analyzed, rib fractures were identified in 273 (20.4%), with a median age of 33 years and 199 (72.9%) were male. Motor vehicle accidents were the most common trauma mechanism with a rate of 52% (n=142). Patients with rib fractures had significantly higher occurrences of pneumothorax (25.3%), hemothorax (20.9%), and intra-abdominal injuries (17.5%) (p<0.001). Notably, patients with six or more rib fractures exhibited a higher frequency of liver, spleen, and kidney injuries (p=0.003, p=0.011, p=0.001, respectively). The in-hospital mortality rate was 5.9% (n=17) for patients with rib fractures, significantly higher than those without (p<0.001). Conclusion Rib fractures in multi-trauma patients are an important indicator of severe concurrent injuries and are associated with a higher mortality rate. These findings advocate for a systemic and immediate evaluation of patients with rib fractures upon presentation in emergency departments to improve survival outcomes.

Immunomodulatory effects and mechanisms research of deer antler water extract (DAWE) on cyclophosphamide-induced immunosuppressive mice based on metabolomics and microbiomics

Deer antler has been a staple food for millennia, yet its precise immunomodulatory mechanisms remain unexplored. In our study, we systematically investigated the effects and mechanisms of deer antler water extract (DAWE) on cyclophosphamide-induced immunosuppressive mice. We identified various bioactive components in DAWE, including monosaccharides, nucleosides, phospholipids, amino acids, lipids, and organic acids. Following 14 days of administration of DAWE (260 mg/kg) significantly enhanced immunity in immunosuppressed mice, alleviating spleen injury, boosting immune cell proliferation, and increasing immunoactive substances production. Moreover, DAWE effectively mitigated intestinal barrier damage by promoting goblet cell and IgA-secreting cell proliferation and upregulating the expression of occludin-1 and claudin-1. Additionally, DAWE modulated gut microbiota diversity, composition, and metabolic activity. The metabonomic analysis highlighted the pivotal role of glutamine and glutamate metabolic pathways in DAWE's immune regulatory effects. These findings provide valuable insights into DAWE as a potential immunomodulator and functional food, warranting further exploration in clinical applications.

Integration of proteomics and metabolomics analysis investigate mechanism of As-induced immune injury in rat spleen

Arsenic (As) is a widespread metalloid and human carcinogen found in the natural environment, and multiple toxic effects have been shown to be associated with As exposure. As can be accumulated in the spleen, the largest peripheral lymphatic organ, and long-term exposure to As can lead to splenic injury. In this study, a Sprague-Dawley (SD) rat model of As-poisoned was established, aiming to explore the molecular mechanism of As-induced immune injury through the combined analysis of proteomics and metabolomics of rats’ spleen. After feeding the rats with As diet (50 mg/kg) for 90 days, the spleen tissue of the rats in the As-poisoned group was damaged, the level of As was significantly higher than that of the control group (P < 0.001), and the level of inflammatory cytokine interleukin-6 (IL-6) was decreased (P < 0.01). Proteomics and metabolomics results showed that a total of 134 differentially expressed proteins (DEPs) (P < 0.05 and fold change > 1.2) and 182 differentially expressed metabolites (DEMs) (VIP >1 and P < 0.05) were identified in the spleens of the As poisoned group compared to the control group (As/Ctrl). The proteomic results highlight the role of hypoxia-inducible factors (HIF), natural killer cell mediated cytotoxicity, and ribosomes. The major pathways of metabolic disruption included arachidonic acid (AA) metabolism, glycerophospholipid metabolism and folate single-carbon pool. The integrated analysis of these two omics suggested that Hmox1, Stat3, arachidonic acid, phosphatidylcholine and leukotriene B4 may play key roles in the mechanism of immune injury to the spleen by As exposure. The results indicate that As exposure can cause spleen damage in rats. Through proteomic and metabolomic analysis, the key proteins and metabolites and their associated mechanisms were obtained, which provided a basis for further understanding of the molecular mechanism of spleen immune damage caused by As exposure.

Adrenal gland injury in trauma patients and its impact on clinical outcomes.

Adrenal gland injury (AGI) associated with trauma is an uncommon and often overlooked condition. This study aimed to evaluate the frequency of AGI in individuals with severe trauma injuries and investigate the outcomes of patients with AGI. All patients admitted to a tertiary trauma referral center under the trauma protocol who had a computed tomography (CT) scan between January 2012 and January 2023 were analyzed retrospectively. Patients who were dead on arrival and patients with incomplete data were excluded. They were classified into two main groups, adult and pediatric, and further subcategorized by the presence or absence of radiologically evident AGI. Demographic data, mechanism of injury, injury severity scores (ISS), presence of concurrent abdominal injury, and 30-day mortality rates were compared. A separate analysis was performed for factors affecting mortality rates. A total of 1,253 patients were included: 950 adults and 303 pediatric patients. In the adult group, AGI was detected in 45 (4.7%) patients and was more commonly associated with the following mechanisms of injury: motor vehicle accidents (26.7% vs. 14.3%) and pedestrian accidents (37.8% vs. 15.5%). Injury to the right side was more common (55.6%). Patients with AGI had higher rates of concurrent liver (17.8% vs. 3.9%), spleen (11.1% vs. 3.6%), and kidney injuries (15.6% vs. 1.3%). In the pediatric population, AGI was detected in 30 patients (14.8%), a significantly higher rate compared to the adult group. Similar to the adult group, AGI was more commonly associated with concurrent abdominal injuries and had a right-sided dominance (60%), but the rate of concurrent abdominal injuries was higher in the pediatric group (80% vs. 46%). The 30-day mortality was significantly higher in both adult and pediatric AGI groups compared to patients without AGI (adult: 15.6% vs. 2.9%, pediatric: 10% vs. 1.8%). In patients with AGI, major head and neck injuries and chest injuries were associated with mortality. Adrenal gland injuries due to trauma are not uncommon. They are usually associated with blunt trauma and other concurrent abdominal organ injuries. The major contributors to mortality in patients with AGI were major head and neck injuries and chest injuries.

Cadmium causes spleen toxicity in chickens by regulating mitochondrial unfolded protein response and nuclear receptors response

Cadmium (Cd) is a heavy metal that pollutes the environment and threatens human and animal health via the food chain. The spleen is one of the target organs affected by Cd toxicity. However, the mechanism of Cd toxicity is not fully understood. In this study, 80 chicks were allocated into 4 groups (n = 20) and exposed to different doses of CdCl2 (0 mg/kg, 35 mg/kg, 70 mg/kg and 140 mg/kg) for 90 d. The pathological changes in the spleen, mitochondrial dynamics-related factors, cytochrome P450 (CYP450) enzyme system contents, activities, transcription levels, nuclear receptors (NRs) response molecule levels, and mitochondrial unfolded protein-related factors were detected. The findings indicate that exposure to Cd significantly leads to spleen injury. In Cd groups, the total contents of CYP450 and cytochrome b5 (Cyt b5) increased, and the activities of the CYP450 enzyme system (APND, ERND, AH, and NCR) changed. The NRs response was induced, and the gene levels of AHR/CAR and corresponding CYP450 isoforms (CYP1B1, CYP1A5, CYP1A1, CYP2C18, CYP2D6 and CYP3A4) were found altered. The study found that Cd exposure altered the mRNA expression levels of mitochondrial dynamics-related factors, such as OPA1, Fis1, MFF, Mfn1, and Mfn2, breaking mitochondrial fusion and cleavage and ultimately leading to mitochondrial dysfunction. Changes were detected in the gene levels of several mitochondrial unfolded protein response (mtUPR)-related factors, namely (SIRT1, PGC-1α, NRF1, TFAM, SOD2, and HtrA2). Cd also altered the gene levels of mitochondrial function-related factors (VDAC1, Cyt-C, COA6, PRDX3, RAF and SIRT3). It is showed that Cd can initiate the NRs response, influence the homeostasis of the CPY450 enzyme system, trigger the mtUPR, impair mitochondrial function, and ultimately lead to Cd toxicity in the spleen of chickens.

Surgical Repair vs Splenectomy in Patients With Severe Traumatic Spleen Injuries

The spleen is often removed in laparotomy after traumatic abdominal injury, with little effort made to preserve the spleen. To explore the association of surgical management (splenic repair vs splenectomy) with outcomes in patients with traumatic splenic injuries undergoing laparotomy and to determine whether splenic repair is associated with lower mortality compared with splenectomy. This is a trauma registry-based cohort study using the American College of Surgeons Trauma Quality Improvement Program database from January 2013 to December 2019. Participants included adult patients with severe splenic injuries (Abbreviated Injury Scale [AIS] grades 3-5) undergoing laparotomy after traumatic injury within 6 hours of admission. Data analysis was performed from April to August 2023. Splenic repair vs splenectomy in patients with severe traumatic splenic injury. The primary outcome was in-hospital mortality. Outcomes were compared using different statistical approaches, including 1:1 exact matching with consecutive conditional logistic regression analysis as the primary analysis and multivariable logistic regression, propensity score matching, and inverse-probability weighting as sensitivity analyses. A total of 11 247 patients (median [IQR] age, 35 [24-52] years; 8179 men [72.7%]) with a severe traumatic splenic injury undergoing laparotomy were identified. Of these, 10 820 patients (96.2%) underwent splenectomy, and 427 (3.8%) underwent splenic repair. Among patients who underwent an initial splenic salvage procedure, 23 (5.3%) required a splenectomy during the subsequent hospital stay; 400 patients with splenic preservation were matched with 400 patients who underwent splenectomy (matched for age, sex, hypotension, trauma mechanism, AIS spleen grade, and AIS groups [0-2, 3, and 4-5] for head, face, neck, thorax, spine, and lower and upper extremity). Mortality was significantly lower in the splenic repair group vs the splenectomy group (26 patients [6.5%] vs 51 patients [12.8%]). The association of splenic repair with lower mortality was subsequently verified by conditional regression analysis (adjusted odds ratio, 0.4; 95% CI, 0.2-0.9; P = .03). Multivariable logistic regression, propensity score matching, and inverse-probability weighting confirmed this association. In this retrospective cohort study, splenic repair was independently associated with lower mortality compared with splenectomy during laparotomy after traumatic splenic injury. These findings suggest that efforts to preserve the spleen might be indicated in selected cases of severe splenic injuries.