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24 h) and from 4.54 3.20 to 0.42 0.11 nmol/mg protein (control vs

Additionally, rare deficiencies of glutathione cycle enzymes (gamma-glutamylcysteine ligase, glutathione synthetase, 5-oxoprolinase, and gamma-glutamyl transferase) have all been associated with neuropsychiatric and cognitive impairments, although detailed phenomenological characterization has not been reported (9, 61, 62)

These include: Paraesthesia (pins and needles) in hands and feet Peripheral neuropathy with numbness or altered sensation Difficulty walking or balance problems (ataxia) Memory problems and cognitive difficulties Mood changes, including depression or irritability In severe cases, confusion or dementia-like symptoms Other manifestations may include: Loss of appetite and unintentional weight loss Constipation Visual disturbances (rare, but can occur with optic neuropathy) Important: The neurological complications of B12 deficiency can progress even in the absence of anaemia, making early detection crucial

331 Notably, 12 months after splenectomy plus pericardial devascularization in chronic hepatitis B cirrhosis patients, gut flora composition restored to near healthy control levels, and liver function, intestinal permeability, and inflammation levels improved compared to pre-surgery, indicating that the improvement in liver function and intestinal permeability after splenectomy plus pericardial devascularization may be related to gut flora recovery