Methodology, safety and applications of colonic transendoscopic enteral tubing (with video) / 中华消化内镜杂志

Objective@#To evaluate the methodology, safety and clinical applications of colonic transendoscopic enteral tubing (TET) as a new method of fecal microbiota transplantation (FMT) and colonic administration.@*Methods@#This prospective study included patients who underwent colonic TET for FMT and(or) colonic administration in the Second Affiliated Hospital of Nanjing Medical University from October 2014 to December 2018. The TET procedure time, success rate, retention time of TET tube, factors influencing TET tube retention, adverse events and satisfaction degree were evaluated.@*Results@#A total of 257 patients underwent TET, among whom 130 patients (50.6%) for microbiota tronsplantation, 8 patients (3.1%) for colon-drip medication, 118 patients (45.9%) for FMT and colon-drip medication, and 1 patient (0.4%) without treatment after TET. The TET procedure time was 10.0±2.8 min. The number of endoscopic clips used was 3.5±1.0. The success rate of the TET procedure was 100.0% (257/257). The retention time of TET tube for 160 patients maintaining the tube for treatment was 9.3±3.8 days. Multivariate analysis indicated that endoscopic clip type (P=0.001) was an independent influencing factor for the retention time of the tube. A total of 9 patients (3.5%) reported adverse events of mild anus discomfort, 4 patients (1.6%) of mobile inconvenience, 3 (1.2%) of anal pain, 2 (0.8%) of mild abdominal pain, 2 (0.8%) of mild bloating, and 1 (0.4%) of mild anal bleeding. No severe adverse events were observed in this study. The total satisfaction degree on colonic TET was 97.3% (250/257) in all patients.@*Conclusion@#The colonic TET, a safe and easy-operating endoscopic interventional technology with a high degree of patients satisfaction, can be used for colonic delivering of FMT and medications for various diseases.

Methodology, safety and applications of colonic transendoscopic enteral tubing (with video) / 中华消化内镜杂志

Objective:To evaluate the methodology, safety and clinical applications of colonic transendoscopic enteral tubing (TET) as a new method of fecal microbiota transplantation (FMT) and colonic administration.Methods:This prospective study included patients who underwent colonic TET for FMT and(or) colonic administration in the Second Affiliated Hospital of Nanjing Medical University from October 2014 to December 2018. The TET procedure time, success rate, retention time of TET tube, factors influencing TET tube retention, adverse events and satisfaction degree were evaluated.Results:A total of 257 patients underwent TET, among whom 130 patients (50.6%) for microbiota tronsplantation, 8 patients (3.1%) for colon-drip medication, 118 patients (45.9%) for FMT and colon-drip medication, and 1 patient (0.4%) without treatment after TET. The TET procedure time was 10.0±2.8 min. The number of endoscopic clips used was 3.5±1.0. The success rate of the TET procedure was 100.0% (257/257). The retention time of TET tube for 160 patients maintaining the tube for treatment was 9.3±3.8 days. Multivariate analysis indicated that endoscopic clip type ( P=0.001) was an independent influencing factor for the retention time of the tube. A total of 9 patients (3.5%) reported adverse events of mild anus discomfort, 4 patients (1.6%) of mobile inconvenience, 3 (1.2%) of anal pain, 2 (0.8%) of mild abdominal pain, 2 (0.8%) of mild bloating, and 1 (0.4%) of mild anal bleeding. No severe adverse events were observed in this study. The total satisfaction degree on colonic TET was 97.3% (250/257) in all patients. Conclusion:The colonic TET, a safe and easy-operating endoscopic interventional technology with a high degree of patients satisfaction, can be used for colonic delivering of FMT and medications for various diseases.

Microbiota transplantation: concept, methodology and strategy for its modernization

Fecal microbiota transplantation (FMT) has become a research focus of biomedicine and clinical medicine in recent years. The clinical response from FMT for different diseases provided evidence for microbiota-host interactions associated with various disorders, including Clostridium difficile infection, inflammatory bowel disease, diabetes mellitus, cancer, liver cirrhosis, gut-brain disease and others. To discuss the experiences of using microbes to treat human diseases from ancient China to current era should be important in moving standardized FMT forward and achieving a better future. Here, we review the changing concept of microbiota transplantation from FMT to selective microbiota transplantation, methodology development of FMT and step-up FMT strategy based on literature and state experts' perspectives.

Brain activities in patients with inflammatory bowel disease on resting-state functional MRI with amplitude of low-frequency fluctuation algorithm / 医学研究生学报

Objective Visceral pain in patients with inflammatory bowel disease (IBD) may be associated with the abnormal processing of pain in the central nervous system.The aim of the study is to investigate the characteristic changes of brain functions in the IBD patients using resting-state functional magnetic resonance imaging (rs-fMRI) with the amplitude of low-frequency fluctuation (ALFF) algorithm.Methods This study included 27 cases of IBD treated in our hospital from December 2015 to August of 2016 and 21 healthy volunteers as normal controls.We recorded the high-resolution structure imaging and rs-fMRI data, compared the brain activities of the two groups patients by ALFF analysis, and evaluated the correlation of the ALFF values with the clinical parameters of the IBD patients.Results Compared with the normal control group, the IBD patients showed significantly decreased ALFF values in the medial frontal gyrus, right putamen, right insula, left middle cingulate gyrus (MCC), and bilateral supplementary motor region (P<0.05), increased ALFF values in the middle frontal gyrus, left superior frontal gyrus, and medial prefrontal lobe region (P<0.05).The ALFF values in the inferior parietal lobule, precuneus and MCC of the IBD patients were correlated negatively with the blood sedimentation rate (r=-0.537,-0.588, and-0.588, P<0.05), disease course (P<0.05), and C-reactive protein (CRP) level (P<0.05), while that in the medial frontal gyrus positively with the CRP level (r=-0.623, P<0.001).Conclusion IBD patients have abnormal ALFF values in various brain regions, mainly in those involved in the processing of visceral pain and emotion.

Principle, Protocol and Risk Management of Chinese Fecal Microbiota Bank / 胃肠病学

Fecal microbiota transplantation (FMT) has become a key treatment for Clostridium difficile infection (CDI).The Chinese fecal microbiota bank rescue plan is a non-profit central platform for the treatment of refractory CDI using FMT.This article reviewed and analyzed the principle,protocol and risk management of the Chinese fecal microbiota bank rescue plan.

Application value of quantitative parameter in assessing the activity of Crohn’s disease by using DCE-MRI / 实用放射学杂志

Objective To assess the activity of Crohn’s disease (CD)by using the quantitative parameter of dynamic contrast-enhanced MRI (DCE-MRI).Methods 50 CD patients with ileocecal solitary lesion were recruited in this study.All of patients underwent con-ventional and DCE-MRI.The quantitative parameter of volume transfer constant (Ktrans )and the clinical data including Harvey-Brad-show index (HBI)and C-reactive protein (CRP)were recorded.(1)the reliability and repeatability of Ktrans measurement were analyzed. (2)the correlation between Ktrans value and clinical data was analyzed by using Pearson analysis.(3)according to HBI,all of the CD patients were divided into severe group,mild-moderate group,and static group.The differences of Ktrans values among the three groups were compared by using Mann-Whitney U test.Results (1)the reliability of Ktrans measurement was high (Cronbach’s Alpha=0.993).(2)there was positive correlation between HBI and Ktrans(r=0.635,P<0.001),and between CRP and Ktrans(r= 0.764,P<0.001).(3)there was significant difference of Ktrans value between the static group and the mild-moderate group (P<0.001),be-tween the static group and the severe group (P<0.001),and.between the mild-moderate group and the severe group (P<0.001). Conclusion Quantitative parameter of DCE-MRI (Ktrans )had a high reliability and can be used to assess the inflammation activity of CD.

Cap-assisted endoscopic sclerotherapy for hemorrhoids: a prospective study(with video) / 中华消化内镜杂志

Objective To evaluate the methodology, feasibility, safety and efficacy of cap-assisted endoscopic sclerotherapy(CAES)for hemorrhoids. Methods Patients with grade Ⅰ to Ⅲ internal hemorrhoids underwent CAES from September 2014 to May 2016. According to the methodology of CAES, reasons for blooding were identified and polypectomy and excision of anal papilla fibroma was performed. Efficacy,intraoperative and postoperative complications and patient satisfaction were evaluated during and after CAES. The follow-up was more than three months. Results A total of 48 patients with gradeⅠ toⅢinternal hemorrhoids underwent CAES,including 25(52.1%)patients with grade Ⅰ,21(43.8%)patients with grade Ⅱ,and 2(4.2%)grade Ⅲ. During the whole procedure of CAES, colon and terminal ileum examination was performed in 48(100.0%)patients, polypectomy was performed in 14(29.2%)patients, excision of anal papilla fibroma was performed in 1(2.1%)patient, excision of external hemorrhoids was performed in 1(2.1%)patient,biopsy for the polyps on dentate line was performed in 2(4.2%)patients, and sclerotherapy for rectal mucosal prolapse was performed in 2(4.2%)patients. No bleeding was observed during and after CAES. Infection occurred in one(2.1%)patient, who recovered with a one-week anti-infective therapy. One(2.1%)patient claimed mild tenesmus within four days after CAES.No complications were observed within the three-month follow-up. All patients(100.0%)were satisfied with this novel procedure. Conclusion CAES, as a novel endoscopic sclerotherapy, is a safe and effective endoscopic therapy with high patient satisfaction for internal hemorrhoids.

Advances in Methodology of Fecal Microbiota Transplantation and its Application in Treatment of Inflammatory Bowel Disease / 胃肠病学

Inflammatory bowel disease(IBD)is a group of chronic and nonspecific intestinal inflammatory diseases of unknown etiology. A growing body of evidence indicated that the intestinal microflora might play an important role in the pathogenesis of IBD. As a microecological therapy,fecal microbiota transplantation(FMT)has been used in various of gastrointestinal and metabolic diseases for reconstruction of intestinal flora and achieved favorable results. This article mainly reviewed the progress of technical innovation in FMT and its application in the treatment of IBD.

Identifying secondary bowel stenosis:MRI diffusion-weighted imaging in Crohn′s disease / 医学研究生学报

[Abstract ] Objective Stenosis is a common complication of Crohn′s disease (CD), different treatments for different cau-ses.The article aimed to investigate bowel stenosis by the application of MRI diffusion-weighted imaging(DWI) and explore its value of identifying CD. Methods From Jan 2014 to Jun 2014, 31 patients with histologically proven CD (18 males and 13 females;mean age:38.90 ±13.65 years) were recruited in this approved retrospective study .All patients underwent conventional 3.0T MRI and DWI sequences .According to the most serious stenosis part identified by MRI , DWI sequence examination was added and the apparent diffusion coefficient (ADC) of the lesion was measured.All patients would undergo colonoscopy in 24 hours.According to the endo-scopic manifestations and pathological results , the patients were divided into inflammatory group (n=21) and fibrotic group (n=10). We observed the difference of ADC between two groups and worked out the cutoff points . Results In the inflammatory group , the ADC value andthe mean ADC value of stenosis bowel wall were (1.01 ±1.83) ×103 mm2/s and (1.40 ±0.23) ×103 mm2/s, whereas (0.53 ±1.03) ×103 mm2/s and (0.80 ±0.16) ×103 mm2/s in the fibrotic group(P<0.05).The area under receiver operating characteristic curve was 0.981 (95%confidence interval 0.943-1.000), taking 1.11 ×103mm2/s as the cutoff point.The sensitivity of low ADC values in detecting inflammatory bowels was 90.5%, and the specificity of high ADC values in excluding inflammatory bowels was 100%. Conclusion Different pathological components limit the movement of water molecular at different degrees , therefore quantitative parameters can be acquired by measuring ADCs , which contributes to the identification and diagnosis of CD secondary bowel stenosis.

Clinical analysis of 122 patients with inflammatory bowel disease / 中国医师进修杂志

Objective To investigate the clinical situation of inflammatory bowel disease (IBD).Methods The clinical features and treatment features of 122 patients with IBD were investigated.Results In 122 IBD patients,54 cases had ulcerative colitis (UC),the lesion was in colon,hospital number visited was median 3,the ratios of using amino salicylic acid salts,hormones,immunosuppressive agents,biological agents and antibiotics was 100.0％ (54/54),55.6％ (30/54),24.1％ (13/54),7.4％ (4/54) and 75.9％ (41/54); 68 cases had Crohn disease (CD),the lesion was in the ileocolic,hospital number visited was median 4,the ratios of using amino salicylic acid salts,hormones,immunosuppressive agents,biological agents and antibiotics was 95.6％ (65/68),58.8％ (40/68),47.1％ (32/68),11.8％ (8/68) and 79.4％ (54/68).The uses of CD in patients with immunosuppression,quinolone antibiotics in patients of CD were higher than those of patients with UC,the use of herbal medicine in patients of CD was lower than that in patients of UC,the difference was statistically significant (P ＜ 0.05).Conclusion The main drugs currently used to treat IBD are amino salicylic acid preparation,corticosteroids,immunosuppressive agents,biological agents.

Association of serum uric acid with body mass index: a cross- sectional study from Jiangsu Province, China

Body mass index [BMI] has been demonstrated to be associated with serum uric acid [SUA] level in many developed countries, however, there is still a lack of large sample study in Jiangsu Province, one of the most economically developed regions in China, where fat-rich diet is common. Through retrospective analysis in healthy subjects, we determined the association of BMI with hyperuricemia risk. Data of 39,736 participants from January 2011 to June 2013 in China were analyzed for parameters including physical examinations and biochemical blood analysis. On univariate analysis, SUA was positively correlated with age, SBP, DBP, BMI, FPG, red blood cell count, hemoglobin, white blood cell count, platelet, cholesterol, triglyceride, HDL-cholesterol, LDL-cholesterol, ALT, AST, bilirubin, albumin, BUN and creatinine. SUA was significantly elevated in a linear fashion as BMI increased, and SUA in obesity was significantly higher than underweight. The prevalence of hyperuricemia remained approximately 2.98 times greater among individuals with overweight, and 5.96 times greater among obesity, compared to individuals with underweight. There is a positive relationship between BMI and SUA among healthy subjects in Jiangsu province, China

A 10-Year Retrospective Analysis of Clinical Profiles, Laboratory Characteristics and Management of Pyogenic Liver Abscesses in a Chinese Hospital

BACKGROUND/AIMS: Pyogenic liver abscess (PLA) is a serious, life threatening condition with a high mortality rate that represents a diagnostic and therapeutic challenge. The aim of this study was to collect demographic data and clinical, laboratory and microbiological characteristics of PLA patients treated between 2000 and 2010. We also aimed to collect information regarding our management experience of these cases. METHODS: As a retrospective review, 47 patients with PLA in a tertiary referral center were examined to determine their demographic characteristics, clinical features, and laboratory, imaging, and microbiologic findings as well as the treatment outcome. RESULTS: Cryptogenic PLA was the most frequently identified type of PLA, while benign biliary tract disease was the most frequently identifiable cause of PLA (18/47 patients; 38.3%). Leukocytosis and elevated alanine transaminase were common laboratory findings and were observed in 35 (74.5%) and 22 (46.8%) patients, respectively. Increased fibrinogen was also detected in 11 of 15 investigated cases (73.3%). Notably, infection-induced thrombocytopenia occurred in 8 patients (17%). Diabetes mellitus was associated with the occurrence of infection induced shock when compared to the non-diabetic group (p<0.05). Patients with two or more comorbid diseases had longer hospitalizations when compared to patients with one comorbid disease or those without comorbidities (p<0.001). The number of days needed to establish diagnosis was correlated with the length of hospitalization (p<0.001). The overall hospital mortality rate was 2.1% (1/47). CONCLUSIONS: Characteristics of PLA patients from the past 10 years are presented. The number of days needed to establish a PLA diagnosis was correlated with the length of the hospital stay. The hospital stay of PLA patients can be further improved by early diagnosis and effective treatments during the early stages of PLA progression.

Effects of different Helicobacter pylori phenotype on gastric mucosal pathogenesis / 医学研究生学报

Objective:To explore the effects of different Helicobacter pylori (Hp) phenotype on expression of ki-67 in gastric mucosa. Methods:137 patients (with Hp infection) with chronic gastritis(CG), peptic ulcer or gastric cancer and 34 patients without Hp infection were observed. All patients with gastroduodenal diseases were diagnosed by endoscopy and histology. Western blotting was used to detect phenotypes of Hp Cytotoxin-associated protein (CagA), vacuolating cytotoxin (VacA), Urease and their sub-phenotypes. In Hp associated gastritis, histological grade of chronic inflammation (CI), polymorphonuclear neutrophil activity(PA) and density of Hp (DH) were scored according to the Updated Sydney System. Immunohistochemistry was used to exam the expression of ki-67. Results:①Expression rates of Hp128000CagA, 116000CagA, 95000VacA, 91000VacA and 30000UreA in the group of mild grade of CI were lower than those in the moderate-marked group (P(0.05,)respectively).③In Hp(+) CG, (ki-67LI) in the group with expression of (128000)CagA, 95000VacA or 30000UreA were higher than that in groups without their expression. In Hp(+) gastric cancer, (ki-67LI) in the group with expression of 128000CagA was higher than that in the group without its expression((P=)0.02). Conclusion:Many virulent factors of Hp may cause increased grade of CI and play an important role in the occurrence and development of PA. Hp infection and density of Hp seem to cause increased epithelial cell proliferation in gastric mucosa with chronic gastritis. But they may exert different influences on malignant and benign gastric mucosa, and more virulent factors probably increase epithelial cell proliferation in gastric mucosa with chronic gastritis rather than gastric cancer.

The clinical analysis of 23 patients with Wegener granulomatosis / 中华风湿病学杂志

Objective To investigate the clinical and pathological features of Wegener granulomatosis to improve the management of it. Methods Twenty-three patients with Wegener granulomatosis were analyzed retrospectively. Results The average age at onset was 37.2 years (range from 20~57 years). The average interval from clinical symptoms presentation to diagnosis was 5.8 months. The initial symptom of 23 cases was the upper respiratory tract involvement (48%). The patients had multiple system and organ involvement. 87% patients with WG had lung involvement and 78% patients had glucocorticoids. Seventeen out of 23 were cANCA (74%) positive. The pathological manifestations included necrotizing granulomatosis and vasculitis. Conclusion Clinical manifestation of WG is complicate, including multiple system and organ involvement. The upper and lower respiratory tract and kidney are the most commonly involved organs. Necrotizing granulomatosis and vasculitis are the pathological features of WG.

Clinical application of double stapling technique in anus-preserving operation of low and middle rectal cancer / 中国现代普通外科进展

Objective:To study the clinical application and postoperative complication of double stapling technique (DST) in anus-preserving operation of low and middle rectal cancer. Method:From April 2002 to April 2006, clinical data of 75 cases with low and middle rectal cancer were analyzed retrospectively. Of those 32 cases used DST underwent sphincter-reserving operation(SPO),regard as study group;and 43 cases used SST received SPO, as control group. Clinical pathologic parameters、 postoperative complication and tumor recurrence were compared between the two groups. Results:Operation of all the 75 patients was successful without operative mortality. In DST group patients, defecation function was different from SST group after postoperative 3 and 6 months (P