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Efficacy of Tounongsan decoction(透脓散方)on pyogenic liver abscess:network pharmacology and clinical trial validation

Journal of Traditional Chinese Medicine 2024年第1期44卷 145-155页

作者： ZHANG Qi CHEN Dexuan ZHU Guixiang ZHANG Shihu FENG Xiao MA Chaoqun ZHANG Yi Department of General Surgery Affiliated Hospital of Nanjing University of Chinese MedicineJiangsu Provincial Hospital of Traditional Chinese MedicineNanjing 210029China Zhuzhou Orthopaedic Hospital of Traditional Chinese Medicine Zhuzhou 412300China Department of General Surgery Jiangsu Province Hospital on Integration of Chinese and Western MedicineNanjing 210029China

OBJECTIVE:To elucidate the molecular mechanisms governing the effect of Tounongsan decoction(透脓散方,TNS)on the pyogenic liver abscess.METHODS:Based on oral bioavailability and druglikeness,the main active components of TNS were screened using the Traditional Chinese Medicine Systems Pharmacology platform.The Gene Card and Uni Prot databases were used to establish a database of pyogenic liver abscess targets.The interactive network map of drug-ingredients-target-disease was constructed using Cytoscape software(Version 3.7.2).A proteinprotein interaction network was constructed using the STRING database,and the related protein interaction relationships were analyzed.biological process of gene ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analyses were performed for the core targets.Finally,a clinical trial was performed to verify the reliability of the network pharmacology.RESULTS:Forty active components of TNS decoction were obtained,and 61 potential targets and 11 proteins were identified.Pathways involved in the treatment of pyogenic liver abscess include the phosphatidylinositide 3-kinases-protein kinase B(PI3K-AKT),advanced glycation end products-receptor for advanced glycation end products(AGE-RAGE),and tumor necrosis factor(TNF)signaling pathways.The results of network pharmacology analysis combined with clinical trials validated that TNS decoction could alleviate the inflammatory response of pyogenic liver abscesses by decreasing interleukin 6(IL-6)levels.CONCLUSIONS:TNS decoction has the characteristics of being multi-system,multi-component,and multi-target.Active ingredients in TNS,such as quercetin,kaempferol,fisetin,andβ-sitosterol,have strong potential to be candidate drugs for treating pyogenic liver abscesses.The possible mechanism of TSN decoction includes regulating immune and inflammatory responses and reducing IL-6 production to control inflammatory development.

关键词： network pharmacology clinical trial liver abscess pyogenic Tounongsan decoction

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Increased incidence of and microbiologic changes in pyogenic liver abscesses in the Mexican population

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World Journal of Hepatology 2020年第10期12卷 816-828页

作者： Juanita Pérez-Escobar Wagner Ramirez-Quesada Daniel Alejandro Calle-Rodas Luis Alberto Chi-Cervera Nalu Navarro-Alvarez Jorge Aquino-Matus Juan Pablo Ramírez-Hinojosa Carlos Moctezuma-Velázquez Aldo Torre Department of Gastroenterology Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico City 14080Mexico Department of Internal Medicine Hospital General Dr.Manuel Gea GonzálezMexico City 14080Mexico

BACKGROUND pyogenic liver abscess(PLA)is a rare disease with an estimated incidence that varies widely across the globe,being as high as 115.4/100000 habitants in Taiwan and as low as 1.1-1.2/100000 habitants in Europe and Canada.Even though there are multiple microorganisms capable of producing an abscess in the liver,including Entamoeba histolytica,fungi,and viruses,most abscesses are derived from bacterial infections.The epidemiology of PLA in Mexico is currently unknown.AIM To describe the clinical,demographic and microbiologic characteristics of PLA in Mexico.METHODS This is a retrospective study carried out in two centers,and included patients seen between 2006 and 2018 with the diagnosis of pyogenic abscess.We collected demographic,clinical,and microbiological information,treatment,complications,and outcomes.A logistic regression analysis was used to determine the association between different variables and mortality rates.RESULTS A total of 345 patients were included in this study.233(67.5%)had confirmed PLA,133(30%)patients had no positive culture and negative serology and 9(2.5%)had mixed abscesses.The mean age was 50 years(ranging from 16-97 years)and 63%were female.65%of the patients had positive cultures for Extended Spectrum Beta-Lactamases(ESBL)-Escherichia coli and Klebsiella pneumoniae.Cefotaxime was administered in 60%of cases.The most common sources of infection were ascending cholangitis and cholecystitis in 34(10%)and 31(9%),respectively.The median length of hospital stay was 14 d.165 patients underwent percutaneous catheter drainage.The inpatient mortality rate was 63%.Immunocompromised state[OR 3.9,95%CI:1.42-10.46],ESBL-Escherichia coli[OR 6.7,95%CI:2.7-16.2]and Klebsiella pneumoniae[OR 4-8,95%CI:1.6-14.4]predicted inpatient mortality by multivariate analysis.CONCLUSION The prevalence of PLA is increasing in Mexico and has a very high mortality rate.ESBL-Escherichia coli and Klebsiella pneumoniae are the most common microorganisms causing PLA and are independent predictors of inpatient mor

关键词： Liver abscess pyogenic Mexican population Epidemiology Complications Outcomes Mortality

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Recent upper gastrointestinal panendoscopy increases the risk of pyogenic liver abscess

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World Journal of Gastroenterology 2017年第16期23卷 2948-2956页

作者： Ming-Jen Tsai Chin-Li Lu Ying C Huang Chung Hsien Liu Wan-Ting Huang Kai-Yuan Cheng Solomon Chih-Cheng Chen Department of Emergency Medicine Ditmanson Medical Foundation Chia-Yi Christian HospitalChiayi 60002Taiwan Department of Sports Management Chia Nan University of Pharmacy and ScienceTainan 71710Taiwan Department of Public Health College of MedicineNational Cheng-Kung UniversityTainan 70101Taiwan Department of Emergency Medicine Medical Center and School of MedicineKaohsiung Medical UniversityKaohsiung 807Taiwan Department of Medical Research Ditmanson Medical Foundation Chia-Yi Christian HospitalChiayi 60002Taiwan Heng Chun Christian Hospital Pingtung County 946Taiwan

AIM To investigate the association between a recent gastrointestinal(GI) endoscopy and the subsequent risk of pyogenic liver abscess(PLA).METHODS We designed a nested case control study. Using the Taiwan National Health Insurance Research Database, 2135 patients with a first diagnosis of PLA were identified from 1998 to 2011. Another 10675 patients without PLA matched by age and sex were selected as reference controls. We identified and compared the possible risk factors for PLA and GI endoscopies performed before the index date(when PLA was diagnosed) between the two cohorts. Multivariate analysis was conducted to examine the risk of PLA within the 90 d after the GI endoscopies.RESULTS Patients with a history of diabetes [adjusted odds ratio(a OR) = 4.92, 95%CI: 1.78-13.61], end-stage renal disease(a OR = 3.98, 95%CI: 1.45-10.91), biliary tract infection(a OR = 2.68, 95%CI: 2.11-3.40), liver cirrhosis(a OR = 2.19, 95%CI: 1.39-3.46), GI malignancies(a OR = 5.68, 95%CI: 4.23-7.64), appendicitis(a OR = 3.16, 95%CI: 2.27-4.41), diverticulitis(a OR = 1.64, 95%CI: 1.01-2.64), and recent endoscopic retrograde cholangiopancreatography(a OR = 27.04, 95%CI: 11.65-62.72) were significantly associated with an increased risk of PLA. After adjusting for the above risk factors and the frequency of outpatient department visits and abdominal ultrasounds during 90 d before the index date, an upper GI panendoscopy(a OR = 2.75, 95%CI: 2.05-3.69) but not a lower GI endoscopy(a OR = 1.07, 95%CI: 0.62-1.86) was significantly associated with PLA.CONCLUSION An upper GI panendoscopy performed before 90 d may increase the risk of PLA.

关键词： Appendicitis Colonoscopy Diverticulitis Gastrointestinal endoscopy Panendoscopy pyogenic liver abscess

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A Rare Case of pyogenic Spondylodiscitis after Laparoscopic Sacro-Hysteropexy

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Open Journal of Obstetrics and Gynecology 2022年第6期12卷 510-514页

作者： Adel Mohamed Ismail Haitham Abdel Wahab Said Shaban Gyneoncology Department Ismailia Teaching Oncology Hospital Ismailia Egypt Gyneoncology Department El-Galaa Maternity Teaching Hospital Cairo Egypt

Introduction: pyogenic spondylodiscitis is a rare and severe complication of laparoscopic Sacro-Hysteropexy with a polypropylene mesh. The proper and early diagnosis following by medical treatment, if not responding, so we shift to surgical approach is very important to prevent irreversible complications. Case Presentation: A female patient 32 years old admitted to our Gyne-Oncology unit in El-Galaa Maternity Teaching Hospital, in Jan 2022 with a significant weakness in both lower limbs up to complete paralysis, by history she has done a laparoscopic Hystero-Sacro-Pexy with synthetic polypropylene mesh 2 weeks ago, all investigations were normal except WBCs was 14,000 and CRP was 28, MRI Finding was an Encysted collection likely seroma at sacral promontory 4 × 3 cm, surgical removal of the mesh was done, the mesh related to the sacrum was severely infected and pus formation was noticed, 4 hours after the operation there was a Dramatic response and complete resolution of symptoms within few days. Conclusion: Because of the rarity of this complication in the literature, Spondylodiscitis awareness of symptoms, timely diagnosis, and treatment including surgical removal of synthetic mesh after Sacro-Pexy are fundamental to prevent irreversible complications.

关键词： Spondylodiscitis pyogenic Sacro-Pexy Pecto-Pexy Mesh

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Huge pyogenic liver abscess(PLA)in an elderly patient with dia-betes following the pancreaticoduodenectomy

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中华内分泌外科杂志 2019年第3期13卷 256-258页

作者： Liu Yunfeng Li Linhui Zhang Yi Xu Linxin Yin Jianhong Sun Li Yang Jing Department of Endocrinology the First Hospital of Shanxi Medical UniversityTaiyuan 030001China Department of Pharmacology Shanxi Medical UniversityTaiyuan 030001China

We described an elderly female with type 2 diabetes referred to our hospital with fever, nausea and upper abdominal pain. The patient had got duodenal tumor and received the pancreaticoduodenectomy(PD)12 years ago. The laboratory examinations revealed white blood cells(WBC)increasing and severe hypocalcemia. Abdominal computed tomography(CT)revealed a huge gas-forming pyogenic liver abscess(PLA)in left lobe of the liver. The patient got cured after correction of calcium metabolism disorders, treatment with antibiotic and receiving percutaneous tube drainage. We concluded that we should remain on high alert of those patients with DM and the history of cancer, when he or she gets fever of unknown origin and abdominal tenderness. PLA should be considered.

关键词： Diabetes mellitus(DM) Pancreaticoduodenectomy pyogenic liver abscesses(PLA) Klebsiella pneumoniae Hypocalcemia Percutaneous transhepatic abscess drainage

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pyogenic liver abscess caused by Fusobacterium in a 21-year-old immunocompetent male

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World Journal of Gastroenterology 2015年第12期21卷 3731-3735页

作者： Zohair Ahmed Saurabh K Bansal Sonu Dhillon Department of Internal Medicine University of Illinois Peoria Campus OSF Saint Francis Medical Center Department of Gastroenterology and Hepatology University of Illinois Peoria Campus OSF Saint Francis Medical Center

A 21-year-old male with no significant past medical history, presented with right upper quadrant(RUQ) abdominal pain along with fevers and chills. Lab work revealed leukocytosis, anemia, and slightly elevated alkaline phosphatase. Viral serology for hepatitis B virus, hepatitis C virus, and human immunodeficiency virus were negative and he was immunocompetent.Computed tomography imaging revealed hepatic abscesses, the largest measuring 9.5 cm. Empiric antibiotics were started and percutaneous drains were placed in the abscesses. Anaerobic cultures from the abscesses grew Fusobacterium nucleatum. This is a gram negative anaerobic bacteria; a normal flora of the oral cavity. Fusobacterium is most commonly seen in Lemiere's disease, which is translocation of oral bacteria to the internal jugular vein causing a thrombophlebitis and subsequent spread of abscesses. Our patient did not have Lemiere's, and is the first case described of fusobacterium pyogenic liver abscess in a young immunocompetent male with good oral hygiene. This case was complicated by sepsis, empyema, and subsequent abscesses located outside the liver. These abscesses' have the propensity to flare abruptly and can be fatal. This case not only illustrates fusobacterium as a rare entity for pyogenic liver abscess, but also the need for urgent diagnosis and treatment. It is incumbent on physicians to diagnose and drain any suspicious hepatic lesions. While uncommon, such infections may develop without any overt source and can progress rapidly. Prompt drainage with antibiotic therapy remains the cornerstone of therapy.

关键词： Hepatic abscess pyogenic Fusobacterium Liver Immun

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pyogenic liver abscess in children: Diagnosis and treatment at the teaching hospital Gabriel Touré, Bamako, Mali

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Open Journal of Pediatrics 2013年第2期3卷 45-48页

作者： Coulibaly Yacaria Amadou Issa Keita Mamby Diaby Souleymane Gaoussou Konaté Madiassa Diallo Gangaly Department of Pediatric Surgeon University Hospital of Gabriel Touré Bamako Mali

Purpose: To determine diagnostic and therapeutic problems of pyogenic liver abscess in our hospital. Method and material: We conducted a retrospective study from January 2006 to December 2010 of all children aged from 0 - 15 years admitted and treated for pyogenic liver abscesses. Amoebic liver abscesses and other hepatobiliary disorders were not considered. Results: pyogenic abscesses accounted for 50 cases. The mean age of patients at presentation was 2.4 ± 0.78 years (range from 6 months to 15 years). Sex ratio was 2.8 for boys. Abdominal pain was the primary reason for consultation in 27 cases (54%). Fever has been noted in 42 patients (84%) and the patient general state was altered in 13 patients (26%). Escherishia coli was the most frequent bacteria found at pus. The pus was sterile in 25 cases (50%). The ultrasonographic percutaneous drainage was performed in 33 patients (66%), open surgery in 6 (12%) and antibiotics alone in 11 others (22%). The short outcomes were simple in 36 patients (72%) while pain and fever persisted in 12 others (24%). Two patients (4%) died from sepsis soon after the operating room. Improving the frequency of early diagnosis will depend on education of clinicians about the need for clinical suspicion aided by ultrasound.

关键词： pyogenic Liver Abscess Children Diagnosis Treatment Mali

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pyogenic Granuloma of Nasal Septum: A Case Report and Review of Literature

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International Journal of Otolaryngology and Head & Neck Surgery 2014年第4期3卷 190-194页

作者： Ramabhadraiah Anil Kumar Myle Mahesh Babu Palegar Rayadurga Venkatarajamma Urvashi Mishra Department of ENT Bangalore Medical College & Research Institute Bangalore India

pyogenic granuloma is a rapidly growing hyperplastic, vascular proliferation of the skin or mucous membrane. A benign lesion of unknown aetiology commonly associated with pregnancy, oral contraceptives and trauma. While lesions occur frequently in oral cavity, occurrence in the nasal septum is rarely reported. We report a case of 38-year-old male (known case of active pulmonary tuberculosis on anti-tubercular therapy) who presented with unilateral pyogenic granuloma of the anterior nasal septum with unilateral nasal obstruction. We emphasize that the rarely seen lobular capillary hemangioma (pyogenic granuloma) must be kept in mind in the differential diagnosis of a rapidly growing mass of the nasal cavity, even without history of epistaxis. Here we report an uncommon case and review current literature regarding aetiology, site and role of rifampicin in pyogenic granuloma.

关键词： pyogenic Granuloma Nasal Obstruction Vestibule

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A middle-aged lady with a pyogenic liver abscess caused by Clostridium perfringens

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World Journal of Hepatology 2012年第8期4卷 252-255页

作者： Siu-Tong Law Ming Kai Lee Division of Gastroenterology and Hepatology Department of Medicine and GeriatricsTuen Mun HospitalTuen MunHong KongChina

The pyogenic liver abscess caused by Clostridium perfringens (C. perfringens ) is a rare, but rapidly fatal infection. It is usually associated with malignancy and immunosuppression. We report the case of 50-year-old lady with the secondary liver metastases from rectal cancer presented with fever and epigastric pain. The identification of Grampositive bacilli septicaemia, the presence of gas-forming liver abscess and massive intravascular hemolysis should lead to the suspicion of C. perfringens infection. Here we review twenty cases published since 1990 and their clinical features are discussed. The importance of "an aggressive treatment policy" with multidisciplinary team approach is emphasized.

关键词： pyogenic liver abscess Clostridium perfringens Infected hepatic metastases Liver abscess Gram-positive bacilli septicaemia

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Successful Treatment of Suborbital pyogenic Granuloma with Topical Imiquimod

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Case Reports in Clinical Medicine 2018年第1期7卷 1-6页

作者： George Badavanis Efstathia Pasmatzi Alexandra Monastirli Dionysios Tsambaos Center for Dermatologic Diseases Limassol Cyprus Department of Dermatology University of Patras Patras Greece

pyogenic granuloma (PG) is a benign vascular proliferation of the skin and mucosae, that has been treated with different regimens with variable success and recurrence rates;however, the management of PG still remains a challenging issue, particularly in children and in adult cases with lesions localized at sites difficult to access. Imiquimod, a member of the imidazoquinoline family of immune response modifiers, is a topically applicable TLR-7/8 agonist that reveals potent antiviral, antitumor, immunoregulatory and antiangiogenic properties. In the present paper we report the case of a 9-year old boy with suborbital pyogenic granuloma, successfully treated with topical daily application of imiquimod 5% cream without occlusion. 8 weeks after onset of topical imiquimod treatment a complete resolution of the lesion without any scarring was observed. No systemic side effects were seen and the patient remained well throughout the course of therapy. He is presently completing a 15-month follow-up and has revealed no relapse. The findings of the present study suggest that topical imiquimod is a safe, effective and well-tolerated treatment for PG in children, even at difficult to treat areas like the suborbital region.

关键词： pyogenic Granuloma Imiquimod Children Angiogenesis

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