A case of hemolytic disease of the newborn caused by IgG anti-E / 中华检验医学杂志

A case of hemolytic disease of the newborn (HDFN) caused by immunoglobulin (Ig) G anti-E was analyzed in this study. The ABO and Rh blood group of the newborn was O and CcDEe, respectively. The ABO and Rh blood group of her mother was A and CCDee, respectively. Thus, the reason of ABO and RhD hemolysis were impossible. The incompatible antibodies were found in the newborn serum by three serological tests. The antibody screening and identification test using the plasma and the red blood cell eluate from the newborn and the plasma from her mother showed that the HDFN was caused by the IgG anti-E antibodies. The case was caused by failing to prenatal screening for irregular antibodies. Therefore, the prenatal screening for irregular antibodies seems necessary for pregnant women to prevent, diagnose or manage the HDFN at an early time, reducing the occurrence of perinatal complications.

Role of Intestinal Microecology in Crohn's Disease and Prospect of Treatment / 胃肠病学

Crohn's disease (CD) is a chronic inflammatory granulomatous disease of gastrointestinal tract. The global incidence of CD increased in recent years, yet its pathogenesis has not yet been clarified, and it is of great significance to reveal the exact pathogenesis. It has been confirmed that changes of the intestinal microecology caused by environmental factors are correlated with the occurrence of CD; meanwhile, the changes of body's internal environment caused by CD can cause changes in intestinal microecology. Regulation of intestinal microecology has therapeutic effect on CD. This article reviewed the role of intestinal microecology in CD and the prospect of treatment.

Transumbilical endoscopic surgery in the diagnosis of ascites of unknown origin / 中南大学学报(医学版)

To explore whether transumbilical endoscopic surgery (TUES) can effectively and safely elucidate the causes of ascites of unknown origin.
 Methods: A total of 23 consecutive patients with ascites of unknown origin who undertook TUES procedures in the Department of Gastroenterology of The Third Xiangya Hospital of Central South University between January 2014 and January 2016 were retrospectively investigated. Clinical manifestations, laboratory examinations and findings from radiological examinations and endoscopic investigations were noted before the procedure. Conditions of the abdominal cavity under endoscope, final diagnosis and outcome of patients were carefully recorded.
 Results: TUES procedure was successfully performed in all 23 patients with an operation time of (58.2±13.9) min. Twenty-two patients were undertaken biopsy on the nodules or masses that found in the abdominal cavity. Definite diagnoses were established in the overwhelming majority of patients (22/23). The most common causes of ascites for the 23 cases was tuberculosis (8 cases), followed by peritoneal carcinomatosis (6 cases), and pseudomyxoma peritonei (5 cases). Operation-related complications, such as postoperative bleeding, perforation, peritonitis, intraabdominal chronic abscesses, were not observed, except one case showed a transient moderate fever in 24 hours after operation. No mortality related to TUES occurred. We concluded that TUES was a feasible, economic and minimally invasive approach to access the peritoneal cavity.
 Conclusion: TUES combinated with biopsy can effectively elucidate the causes of ascites of unknown origin.

Experience in transumbilical endoscopic surgery diagnosis for 3 cases of pseudomyxoma peritonei / 中南大学学报(医学版)

Three patients of pseudomyxoma peritonei who were diagnozed by transumbilical endoscopic surgery (TUES) were reviewed retrospectively from September 2014 to November 2014. Three cases of ascites patients underwent TUES were diagnozed as pseudomyxoma peritonei. All operations were successful. No open surgery or laparoscopic surgery was required. The mean operative time was (45±16) min; the mean intraoperative blood loss was 510 mL; the mean hospital stay time was 3 days. During the follow up of 911 months, no obvious scar was observed. Cosmetic results appear to be excellent. All patients were treated with intraperitoneal hyperthermia and chemotherapy. The survival rate was 100%. As a novel scarless endoscopic invasive abdominal surgery, TUES has high clinical value with the advantages such as small trauma, no scars, small risk and low cost in the diagnosis of unexplained ascites.

Efficacy and safety of peroral endoscopic myotomy in the treatment of achalasia cardia / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the efficacy and safety of peroral endoscopic myotomy (POEM) for achalasia cardia (AC).
@*METHODS@#A total of 62 patients with AC were enrolled and treated with POEM in the Third Xiangya Hospital, Central South University from April 2012 to October 2014. The symptoms and complications were retrospectively analyzed.
@*RESULTS@#The ages of patients, including 32 males and 30 females, were 14-68 (43.2±5.6) years old. Eckardt scores were 4-6 or ≥7 for 25 patients or 37 patients (including 20 patients were at a score of 12). Thirteen patients suffered balloon expansion for 2-3 times. Sixty-one patients had completed POEM treatment, 1 patient were given Heller surgery instead of POEM because of extensive submucosal adhesion during POEM. The operative time for POEM was (60.8±15.1) min. Fourteen patients had mild subcutaneous emphysema. Among them, 5 suffered pneumoperitoneum and felt better after abdominal puncture exhaust; 2 patients suffered bronchospasm hypoxemia and were relieved after treatment by positive pressure oxygen for 1 h. The hospital stay was (4.3±1.2) d. The postoperative follow-up period was (11.4±5.4) months. Swallowing obstruction, vomiting and chest pain in patients was relieved at different degrees. The treatment effective rate was 100%. 
@*CONCLUSION@#POEM is a safe, effective and minimally invasive approach for AC.

Application of endoscopic full-thickness resection in the treatment of gastric tumors originated from the muscularis propria / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the curative effect and safety of endoscopic full-thickness resection (EFR) in the treatment of gastric tumor originated from the muscularis propria.
@*METHODS@#Clinical data were collected from 34 patients, who underwent EFR of gastric tumor originated from muscularis propria, to observe the resection rate and complications from November 2012 to August 2014.
@*RESULTS@#Of the 34 patients, 15 were male, 19 were female, with the age of 38.3-70.6 (52.3±4.3) years old. The lesions of 25 patients located in the fundus of stomach and the rest was in the gastric body. EFR was successfully performed in the 34 patients with no need for surgery. The complete resection rate was 100%. Lesion diameter ranged from 1.0 to 5.0 (2.8±1.2) centimeters. The operation time was 50-100 (76.5±18.2) min. Patients with pneumoperitoneum were relieved after abdominal puncture exhaust, without post-operation bleeding and perforation. The hospitalization duration was 3-5 (3.6±0.8) days. Except 1 case, the remaining 33 cases were spindle cell tumors, consistent with the results of immunohistochemistry. The risk for two lesions with 4.5 cm and 5.0 cm was moderate. The risk of invasion was low or very low in the remaining 31 cases. Among them, 2 stromal tumors near the cardia showed a differentiation tendency toward smooth muscle. No lesion residual or recurrence happened during the follow-up period (range 5-23 months) in 34 cases. 
@*CONCLUSION@#EFR is a safe and effective method for gastric tumor originated from muscularis propria.

A case of complex Crohn's disease with severe complication / 中南大学学报(医学版)

Crohn's disease (CD) is a nonspecific chronic intestinal inflammatory disease with unknown etiology. The course of CD is persistent and recurrent. In the progress, CD can come with many complications such as obstruction, fistula formation, perforation, and hemorrhage. The early diagnosis, treatment, and the time of the surgery for CD pose a big controversy and challenge. There was a female patient diagnosed as Crohn's disease with severe complication in department of Gastroenterology of the Third Xiangya Hospital, Central South University.  We reported the diagnosis and treatment on this patient. The choice for the medicine and surgury was discussed.

Effect of Feridex-GFP double-labeled BMSC transplant on the damaged liver under the condition of constant magnetic field / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the effect of the bone marrow mesenchymal stem cells (BMSCs) transplant through peripheral vein, portal vein and hepatic artery into liver under the condition of constant magnetic field and to analyze the therapeutic effect on liver function recovery.@*METHODS@#BMSCs were isolated, purified and induced to differentiate into liver-like cells, which were double labeled by Feridex-GFP. The double-labeled BMSCs were transplanted into liver through different ways including peripheral vein, portal vein and hepatic artery with or without constant magnetic field in vitro. The rats were sacrificed at the 1st, 2nd, 3rd and 4th week after the transplant. ALB, ALT, AST were tested. The liver tissue biopsy was collected. GFP-positive cells in liver were observed by fluorescence microscopy.@*RESULTS@#Double-labeled BMSCs could be transplanted into liver through all ways. GFP expression was found in liver in all groups at the 4th week and the liver functions were improved. Based on the long term efficacy, the liver functions recovered more rapidly in the portal vein + constant magnetic field group and the hepatic artery + constant magnetic field group.@*CONCLUSION@#BMSCs transplantation can reduce acute liver damage. The first choice for BMSCs transplantation was via portal vein or hepatic artery under the condition of constant magnetic field. The second choice was via peripheral vein alone or under the condition of constant magnetic field.