Nursing practice for chronic constipation patients with fecal microbiota transplantation: a filed research / 中国实用护理杂志

Objective:To understand the current status of nursing for chronic constipation patients accepted fecal microbiota transplantation and provide reference basis for constructing clinical nursing plan.Methods:From April to August 2021, a field research was conducted in the Tenth People′s Hospital of Tongji University. Data was collected by field observation and informal interview for 13 nurses and analyzed by three-level coding method of qualitative research.Results:The work content of the observation subjects could be divided into 3 items including entrance health education, donor management, bacterial fluid management and clinical nursing. It still needed being improved in donor management, health education, nursing of naso-jejunal tube, intestinal preparation, infusion of bacterial fluid, observation of complications and follow-up.Conclusions:It still needs further development in nursing for chronic constipation with fecal microbiota transplantation. It is urgent to establish donor follow-up team, conduct professional training for nurses, rely on mobile medical platform to improve quality of fecal microbiota transplantation, so as to promote the recovery of patients.

Drug-Coated Balloons for De Novo Coronary Artery Lesions: A Meta-Analysis of Randomized Clinical Trials

Purpose@#Through meta-analysis, we aimed to assess the efficacy and safety of drug-coated balloons (DCB), compared with drugeluting stents (DES) or uncoated devices, in the treatment of de novo coronary lesions. @*Materials and Methods@#Only randomized controlled trials were included. The primary outcomes were late lumen loss (LLL), target lesion revascularization (TLR), and major adverse cardiac events (MACEs). Subgroup analyses were conducted based on clinical indications, whether DCBs were used with a systematic or bailout stent, and types of DESs. @*Results@#The present meta-analysis demonstrated that DCBs elicit significantly lower incidences of TLR, MACE, and LLL, compared with uncoated devices, and similar incidences, compared with DESs, in the treatment of de novo coronary lesions. Subgroup analysis indicated that DCBs used with a bailout stent achieved lower incidences of binary restenosis and myocardial infarction, compared with uncoated devices, and provided less LLL than DESs. DCBs showed similar rates of TLR and MACE, with significantly less LLL, than DESs in treating de novo small-vessel diseases. The clinical efficacy of DCBs was similar to that of secondgeneration DES. @*Conclusion@#Overall, DCB is favored over bare metal stent alone in treating de novo coronary lesions. DCBs appear to be a promising alternative to DESs in the treatment of de novo coronary lesions.

Diagnosis and treatment of superior mesenteric artery compression syndrome secondary to chronic constipation (Lee′s triad syndrome) / 中华胃肠外科杂志

Objective@#To summarize the experience of diagnosis and treatment of superior mesenteric artery compression syndrome (SMACS) secondary to chronic constipation according to the concept of Lee′s triad syndrome.@*Methods@#The concept of Lee′s triad syndrome: (1) clinical symptoms: triad of constipation, malnutrition, upper gastrointestinal obstruction (vomiting, difficulty in eating); (2) anatomical manifestations: with triple anatomy anomaly of transverse colon sagging, elevated spleen flexure, and mesentery arterial compression; (3) treatment: with triple treatment of enteral nutrition support, chest-knee posture and fecal microbiota transplantation. A descriptive cohort study was performed. According to Lee′s triad syndrome criteria, clinical data of 78 patients with superior mesenteric artery compression syndrome secondary to chronic constipation in the Tenth People′s Hospital of Tongji University and General Hospital of Eastern Theater Command from June 2004 to November 2018 were prospectively collected, including basic information, symptoms and signs, imaging findings, nutritional indicators, gastrointestinal quality of life index (GIQLI) and Wexner defecation score. The above parameters based on Lee′s triad syndrome criteria were followed up and recorded at 1, 3, 6, 12 months after comprehensive treatment.@*Results@#All the patients had Lee′s triple symptoms of constipation, malnutrition, upper gastrointestinal obstruction (vomiting, eating difficulties), and triple anatomy anomaly of transverse colon sagging, elevated spleen curvature, and mesentery arterial compression before treatment. After triple treatment of enteral nutrition support, chest-knee posture, and fecal microbiota transplantation, 69 (88.5%) patients had a significant improvement of symptoms, and 9 patients had no significant improvement of symptoms and then eventually received surgery. The 69 cases without operation received follow-up for 12 months. All the patients eventually returned to normal eating, and upper gastrointestinal angiography and superior mesenteric artery imaging showed duodenal compression disappeared. After 1 month, the constipation-related indexes were improved. After 12 months, the number of autonomous defecation per week increased from 1.0±0.8 to 5.0±1.6 (P<0.001). The GIQLI score increased from 52.7±8.5 to 93.2±7.5 (P<0.001), and the Wexner score decreased from 19.1±2.5 to 6.2±2.1 (P<0.001). After 1 month, nutritional indexes were improved gradually. After 12 months, the BMI increased from (17.9±1.8) kg/m2 to (21.0±1.3) kg/m2, total protein increased from (65.2±5.7) g/L to (68.3±4.2) g/L, albumin increased from (32.1±5.1) g/L to (40.4±3.0) g/L, prealbumin increased from (163.2±53.7) mg/L to (259.1±45.6) mg/L, fibrinogen increased from (1.9±0.5) g/L to (2.4±0.5) g/L, whose differences were statistically significant (all P<0.001). Upper gastrointestinal angiography and superior mesenteric artery imaging showed duodenal compression were relieved. The angle between superior mesenteric artery and abdominal aorta increased from (17.4±3.8)° to (37.8±5.8)° (t=-22.26, P<0.001).@*Conclusion@#When patients with SMACS secondary to chronic constipation have Lee′s triple symptoms and triple anatomy anomaly, the triple combination treatment of enteral nutrition support, chest-knee posture and fecal microbiota transplantation should be applied.

A five-year follow-up analysis of efficacy and complications of 3 932 cases of fecal microbiota transplantation treatment / 中华消化杂志

Objective:To observe the long-term efficacy and complication rate of fecal microbiota transplantation (FMT) and the effects of different ways of transplantation and treatment courses on the efficacy of FMT.Methods:From April 2012 to April 2020, the data of 3 932 patients (804 cases of Nanjing General Hospital of Nanjing Military Command and 3 128 cases of Tenth People′s Hospital of Tongji University) who voluntarily received FMT treatment were prospectively collected. After the first course of transplantation, the follow-up rate and efficacy and complications in 5 years were observed at the 1st, 12th, 24th, 36th, 48th and 60th month. According to the different ways of the first transplantation, 3 932 patients were divided into nasointestinal tube group (2 604 cases), capsule group (873 cases), colonoscopy group (268 cases) and enema group (187 cases). One month after transplantation, the effective rate and complication were observed. At the same time, the 1 813 patients with FMT less than four courses were divided into 1 treatment course group (369 cases), 2 treatment courses group (568 cases), 3 treatment courses group (497 cases) and 4 treatment courses group (379 cases). The effective rates of patients in four groups with different treatment courses were observed 6 months after finishing the treatment. Chi square test was used for statistical analysis.Results:Among 3 932 patients, the follow-up rates at 1st, 12th, 24th, 36th, 48th and 60th month after the first course of FMT were 93.67%(3 683/3 932), 82.30%(2 307/2 803), 82.17%(1 825/2 221), 62.41%(978/1 567), 59.85%(559/934) and 60.84%(289/475), respectively. The total effective rates at 1st, 12th, 24th, 36th, 48th and 60th month were 67.23%(2 476/3 683), 64.20%(1 481/2 307), 59.29%(1 082/1 825), 59.71%(584/978), 55.81%(312/559) and 59.17%(171/289), respectively. During FMT period, the total incidence of different complications was 34.49%(1 356/3 932). During follow-up period, the total rate of complication was 4.22%(166/3 932). There were no serious adverse events such as gastrointestinal perforation, multi-drug resistant bacterial infection, organ failure and death. One month after FMT, the effective rates of nasojejunal tube group, capsule group, colonoscopy group, and enema group were 67.18%(1 668/2 483), 68.63%(549/800), 67.23%(158/235), 61.21%(101/165), respectively. There was no significant difference among the four groups ( P>0.05). The effective rates of patients with chronic constipation in nasal jejunal tube group, capsule group and colonoscopy group were all higher than that of enema group (67.82%, 1 043/1 538; 67.98%, 138/203 and 62.96%, 17/27 vs. 26.67%, 8/30), and the differences were statistically significant ( χ2=22.55, 19.07 and 7.60, all P<0.01). During the period of FMT, the total incidence of complications of nasojejunal tube group, capsule group, colonoscopy group and enema group were 35.22%(917/2 604), 30.24%(264/873), 42.54%(114/268) and 32.62%(61/187), respectively. The difference was statistically significant among four groups ( χ2 =18.84, P<0.01). Among nasojejunal tube group, capsule group, colonoscopy group and enema group, there were significant differences in the incidence of diarrhea (4.49%, 117/2 604; 4.58%, 40/873; 7.83%, 21/268 and 5.35%, 10/187, respectively), throat pain (5.30%, 138/2 604; 0.69%, 6/873; 2.99%, 8/268 and 1.07%, 2/187, respectively), gastrointestinal bleeding (0; 0; 1.87%, 5/268 and 0.53%, 1/187, respectively) and enterogenous infection (0; 0; 1.49%, 4/268 and 0.53%, 1/187, respectively) ( χ2 =8.24, 39.24, 63.13 and 49.68, all P<0.05). At the 6th month after treatment, the effective rates of 1 treatment course group, 2 treatment courses group, 3 treatment courses group and 4 treatment courses group were 63.94%(211/330), 61.93%(301/486), 65.75%(286/435) and 72.54%(251/346), respectively. There were statistically significant differences among groups with different treatment courses ( χ2 =10.70, P =0.01). The effective rate of the four treatment courses group was significantly higher than those of the one treatment course group, two treatment courses group and three treatment courses group, and the differences were statistically significant ( χ2=5.78, 10.18 and 4.14, all P<0.05). The effective rates of in chronic constipation and autism in 4 treatment courses group were significantly higher than those in 1 treatment course group and 2 treatment courses group (72.73%(136/187) vs.55.47%(71/128) and 58.71%(155/264), 72.73%(40/55) vs.6/15 and 47.83%(11/23)), the effective rate of autism in 3 treatment courses group was higher than that in 1 treatment course group (69.05%(29/42) vs. 6/15), and the differences were statistically significant ( χ2=10.05, 9.39, 5.60, 4.44 and 3.94, all P<0.05). Conclusions:The long-time efficacy of FMT is definite in the treatment of intestinal flora derangement related intestinal diseases and extraintestinal diseases complicated with intestinal disfunction and there are no serious adverse events. The efficacy of FMT is related to the way of transplantation and treatment. The incidence of complications of FMT is related to the way of transplantation. Different ways of transplantation and treatment courses should be formulated for different diseases.

Clinical analysis of fecal microbiota transplantation for the treatment of radiation intestinal injury / 国际外科学杂志

Objective@#To evaluate the efficacy and safety of fecal microbiota transplantation for radiation intestinal injury.@*Methods@#Retrospective analysis of the clinical data of 32 radiation intestinal injury patients including 6 males and 26 females, aged (59.4±9.5) years, with an age range of 51-86 years who underwent fecal microbiota transplantation from August 2017 to August 2018 in the Intestinal Microenvironment Treatment Centre, Tenth People′s Hospital of Tongji University was performed. The efficacy (cure rate, improvement rate), nutritional indicators (body weight, albumin, hemoglobin), inflammation index (C-reactive protein), gastrointestinal quality of life index score and adverse events were compared after 1 year of fecal microbiota transplantation. The patients were followed up for 1 year by telephone, outpatient and network. The follow-up was carried out in combination with the above-mentioned effectiveness and safety indicators. The time was until August 2019. The measurement data were expressed as mean±standard deviation (Mean±SD), the count data were expressed as percentage. The paired t test was used for comparison between groups.@*Results@#The clinical cure rate and clinical improvement rate of patients who received fecal microbiota transplantation for 1 year were 56.3% and 15.6%, respectively. Body weight increased from pre-treatment (53.7 ± 9.6) kg to (60.8 ± 2.1) kg after 1 year of fecal microbiota transplantation, albumin increased from pre-treatment (30.7±4.6) g/L to (37.5±3.8) g/L after 1 year of fecal microbiota transplantation, and hemoglobin increased from pre-treatment (108.5±13.1) g/L to (123.3±13.4) g/L after 1 year of fecal microbiota transplantation. C-reactive protein decreased from pre-treatment (24.1±4.5) mg/L to (3.2±4.5) mg/L after 1 year of fecal microbiota transplantation. Gastrointestinal quality of life index scores were significantly increased after fecal microbiota transplantation, from (88.4±7.1) scores to (112.2±3.2) scores after 1 year of fecal microbiota transplantation. No serious adverse events occurred during the whole follow-up. The difference was statistically significant (P<0.05).@*Conclusions@#Fecal microbiota transplantation techndogy is effective and safe for radiation intestinal injury patients, which is worthy of clinical research.

Efficacy analysis of fecal microbiota transplantation in the treatment of 2010 patients with intestinal disorders / 中华胃肠外科杂志

Objective@#To evaluate the efficacy and safety of fecal microbiota transplantation (FMT) for intestinal disorders.@*Methods@#A retrospectively descriptive cohort study was carried out. Clinical data of 2010 patients who underwent FMT and received follow-up for more than 3 months from May 2014 to November 2018 were collected, including 1,206 cases from Tongji University Shanghai Tenth People′s Hospital and 804 cases from Nanjing Eastern Military General Hospital. Of the 2,010 patients, 797 were male and 1,213 were female, with a mean age of (49.4±16.5) years old. Inclusion criteria were those with indications for FMT and voluntary treatment of FMT. Pregnant or lactating women, patients with end-stage disease, cases who were participating or participated in other clinical trials within 3 months, and patients with previous bowel history of pathogen infection, oral antibiotics or proton pump inhibitors (PPI) for the recent2 weeks, and those at immunosuppressive state were excluded. Informed consent was obtained from the enrolled patients and their families. There were 1,356 cases of constipation, 175 cases of inflammatory bowel disease, 148 cases of chronic diarrhea, 127 cases of radiation enteritis, 119 cases of irritable bowel syndrome, and 85 cases of autism (complicating with intestinal disorders). FMT donor requirements: (1) 18 to 30 years old non-relatives, non-pregnant healthy adults with healthy lifestyle and good eating habits as volunteers to participate in fecal donation; (2) no administration of antibiotics within 3 months; (3) no chronic diseases such as constipation, irritable bowel syndrome, inflammatory bowel disease, etc., no autoimmune disease, not in immunosuppressive state, no history of malignant disease; (4) negative pathogen examination of infectious diseases (hepatitis B virus, hepatitis C virus, syphilis, HIV, etc.); (5) negative fecal examination (C.difficile, dysentery bacillus, Shigella, Campylobacter, parasites, etc.). The donor requirements after enrollment: (1) physical examination was reviewed once every two months, and the result still met the above requirements; (2) 16S rRNA sequencing was performed for every fecal donation in order to ensure that the composition and diversity of the fecal flora was stable and reliable. The preparation of the stool suspension referred to the Amsterdam criteria and the preparation process was less than 1 hour. The preparation of the FMT capsule was processed by pre-freezing the stool suspension after the preparation of the above suspension, and the frozen sample was transferred into a freeze dryer for freezing. The dried and lyophilized powder was encapsulated in capsules, and the capsule shell was made of acid-resistant hypromellose capsule (No.0) and pediatric-specific capsule (No.3), sealed and packaged in a-20℃ refrigerator. Three ways of accepting FMT treatment pathways included 6-day transplantation after the placement of the nasointestinal tube, 6-day oral FMT capsule transplantation and one-time transplantation through colonoscopy. Intestinal preparation (nasointestinal tube feeding of polyethylene glycol until watery stool) was carried out before transplantation. Other treatments were stopped during treatment and follow-up, and any medication was not recommended when necessary.@*Results@#Of the 2010 patients, 1,497 cases received nasointestinal tube transplantation (nasointestinal tube group), 452 cases oral capsule transplantation (oral capsule group) and 61 cases colonoscopy (colonoscopy group). At 3 time points of 3, 12, and 36 months after FMT, the clinical cure rates and the clinical improvement rates were 41.3% (560/1 356), 35.2% (320/909), 31.4% (69/220), and 29.0% (393/1 356), 27.8% (253/909), 29.1% (64/220), respectively in constipation patients; 33.1% (58/175), 29.9% (35/117), 24.5% (12/49), and 31.4% (55/175), 27.4% (32/117), 57.1% (28/49), respectively in inflammatory bowel disease patients; 87.8% (130/148), 81.8% (81/99), 78.3% (36/46), and 8.1% (12/148), 7.1% (7/99), 4.3% (2/46), respectively in chronic diarrhea patients; 61.4% (78/127), 56.5% (48/85), 47.6% (20/42), and 21.2% (27/127), 15.3% (13/85), 14.3% (6/42), respectively in radiation enteritis patients; 53.8% (64/119), 45.0% (36/80), 6/15, and 21.0% (25/119), 26.2% (21/80), 4/15, respectively in irritable bowel syndrome patients; 23.5% (20/85), 22.8% (13/57), 20.0%(5/25), and 55.3% (47/85), 49.1% (28/57), 40.0% (10/25), respectively in autism patients. Meanwhile the clinical cure rates and the clinical improvement rates at 3, 12, and 36 months were 47.7% (714/1 497), 42.8% (425/994), 39.1% (128/327), and 29.1% (436/1 497), 27.0% (268/994), 28.1% (92/327), respectively in the nasointestinal tube group; 38.7% (175/452), 30.2% (91/301), 33.3% (16/48), and 24.3% (110/452), 26.2% (79/301), 25.0% (12/48), respectively in the oral capsule group; 34.4% (21/61), 32.7% (17/52), 18.2% (4/22), and 21.3% (13/61), 13.5% (7/52), 45.5% (10/22), respectively in colonoscopy group. No serious adverse events occurred during treatment and follow-up period. The adverse event of nasointestinal tube group presented higher ratio of discomfort in respiratorytract accounting for 13.1% (196/1497); the oral capsule group had a higher proportion of nausea and vomiting when swallowing capsules accounting for 7.1% (32/452); the colonoscopy group was mainly diarrhea, accounting for 37.7% (23/61). The above symptoms disappeared after the nasointestinal tube was removed, or after treatment ended, or within 1 to 3 days after hospitalization.@*Conclusion@#FMT is a safe and effective method for the treatment of intestinal dysfunction.

Clinical analysis of fecal microbiota transplantation for the treatment of radiation intestinal injury / 国际外科学杂志

Objective To evaluate the efficacy and safety of fecal microbiota transplantation for radiation intestinal injury.Methods Retrospective analysis of the clinical data of 32 radiation intestinal injury patients including 6 males and 26 females,aged (59.4 ± 9.5) years,with an age range of 51-86 years who underwent fecal microbiota transplantation from August 2017 to August 2018 in the Intestinal Microenvironment Treatment Centre,Tenth People's Hospital of Tongji University was performed.The efficacy (cure rate,improvement rate),nutritional indicators (body weight,albumin,hemoglobin),inflammation index (C-reactive protein),gastrointestinal quality of life index score and adverse events were compared after 1 year of fecal microbiota transplantation.The patients were followed up for 1 year by telephone,outpatient and network.The follow-up was carried out in combination with the above-mentioned effectiveness and safety indicators.The time was until August 2019.The measurement data were expressed as mean ± standard deviation (Mean ± SD),the count data were expressed as percentage.The paired t test was used for comparison between groups.Results The clinical cure rate and clinical improvement rate of patients who received fecal microbiota transplantation for 1 year were 56.3％ and 15.6％,respectively.Body weight increased from pre-treatment (53.7 ± 9.6) kg to (60.8 ± 2.1) kg after 1 year of fecal microbiota transplantation,albumin increased from pre-treatment (30.7 ± 4.6) g/L to (37.5 ± 3.8) g/L after 1 year of fecal microbiota transplantation,and hemoglobin increased from pre-treatment (108.5 ± 13.1) g/L to (123.3 ± 13.4) g/L after 1 year of fecal microbiota transplantation.C-reactive protein decreased from pre-treatment (24.1 ±4.5) mg/L to (3.2 ±4.5) mg/L after 1 year of fecal microbiota transplantation.Gastrointestinal quality of life index scores were significantly increased after fecal microbiota transplantation,from (88.4 ± 7.1) scores to (112.2 ± 3.2) scores after 1 year of fecal microbiota transplantation.No serious adverse events occurred during the whole follow-up.The difference was statistically significant (P ＜ 0.05).Conclusions Fecal microbiota transplantation techndogy is effective and safe for radiation intestinal injury patients,which is worthy of clinical research.

Current research progress and thinking of fecal microbiota transplantation for the treatment of gastrointestinal disorders / 中华胃肠外科杂志

Fecal microbiota transplantation (FMT), also known as fecal bacteriotherapy or fecal infusion, consists of injection of a liquid filtrate of feces from a healthy donor into the gastrointestinal tract of a recipient individual. FMT has been proposed as a therapeutic approach for functional diseases of the gastrointestinal tract by reestablishment of a wide diversity of intestinal flora. Clostridium difficile infection (CDI) treatment guideline from American Gastroenterology Association (AGA) recommends that FMT can be used as the treatment protocols of relapse CDI. Numerous case reports, retrospective case series, and randomized controlled trials have shown the benefit of FMT in patients with functional bowel disorders, including inflammatory bowel disease, irritable bowel syndrome and constipation, etc. Evidence regarding the safety of FMT is relatively limited because the very rapid adoption of FMT as a therapeutic modality for CDI occurred before the performance of large, long prospective trials that are typically conducted to assess the safety of new interventions. Potential adverse events can be categorized as short-term and long-term, and short-term events can further be divided into those related to the method of FMT delivery (colonoscopy, sedation) and those related to the FMT itself. Due to the recent emergence of FMT, little data exist regarding long-term events and many safety concerns are speculative. Capsulized FMT therapy solves the clinical problems associated with the use of fresh FMT suspensions for long-term maintenance i.e. repeat transplantation and invasive procedures, which is of great significance to optimize the traditional FMT clinical strategy. Future work will focus on establishing best practices and more robust safety data than exist currently, as well as refining FMT beyond current "whole-stool" transplants to increase safety and tolerability. Encapsulated formulations, full-spectrum stool-based products, and defined microbial consortia are all in the immediate future. Although challenges exist, regulatory agencies have been willing to work with stakeholders and will continue to evolve and adapt policy as therapeutics based on human gut microbiota research emerge.

Efficacy observation of periodic fecal microbiota transplantation in the treatment of refractory constipation / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of periodic fecal microbiota transplantation (FMT) for refractory constipation.</p><p><b>METHODS</b>Clinical data of 49 patients with refractory constipation undergoing FMT through standard transplantation path of nasojejunal tube between April 2015 and April 2016 in Intestinal Microenvironment Treatment Centre of Nanjing General Hospital were analyzed retrospectively. Of 49 patients, 25 received single FMT for only 6 days (single group), and 24 received periodic FMT with another 6 days FMT 1 month after the first 6 days FMT (periodic group). The follow up was at 12 weeks after treatment. Autonomous defecation frequency, Wexner constipation score, gastrointestinal quality of life index and related adverse reaction were evaluated and compared at 4-, 8- and 12-week after treatment. Statistical analysis was performed on the difference after treatment at each time point, and the greater difference indicated the better improvement.</p><p><b>RESULTS</b>There were no statistically significant differences in general characteristics between the two groups (all P<0.05). Before treatment, Wexner constipation score was 17.32±2.66 and 16.25±2.47, gastrointestinal quality of life index was 81.84±8.73 and 83.25±7.87, autonomous defecation frequency was (1.64±0.57) time/week and (1.42±0.65) time/week in single group and periodic group respectively, whose differences were not significant (all P>0.05). Compared with before FMT treatment, the autonomous defecation frequency, Wexner constipation score, gastrointestinal quality of life index were obviously improved at the 4-, 8-, 12-week (all P=0.000). At the 4-week after FMT treatment, the improvement degree of autonomous defecation frequency, Wexner constipation score, gastrointestinal quality of life index was compared between two groups, and no statistically significant differences were found (all P>0.05). While at 8-week and 12-week after FMT treatment, as compared to single group, periodic group had greater Wexner constipation score (at 8-week: 7.29±2.05 vs. 5.96±2.30, t=2.135, P=0.038; at 12-week: 7.21±1.98 vs. 5.80±2.43, t=2.218, P=0.031), greater gastrointestinal quality of life index (at 8-week: 25.71±8.91 vs. 20.20±8.53, t=2.211, P=0.032; at 12-week: 24.16±8.99 vs. 18.92±8.28, t=2.127, P=0.039) and better autonomous defecation frequency [at 8-week: (2.42±0.93) time/week vs. (1.72±0.61) time/week, t=3.110, P=0.003; at 12-week: (1.37±0.88) time/week vs. (0.84±0.62) time/week, t=2.454, P=0.018].</p><p><b>CONCLUSION</b>Periodic FMT has better efficacy than single FMT in the treatment of refractory constipation.</p>

Effects of perioperative intestinal microecological treatment on postoperative complications and gastrointestinal function in patients with refractory functional constipation / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effects of perioperative intestinal microecological treatment on postoperative complications and gastrointestinal function in patients with refractory functional constipation by nonrandomized controlled trial.</p><p><b>METHODS</b>A total of 198 patients with refractory functional constipation who underwent Jinling procedure in our department from 2014 to 2015 were prospectively enrolled, and were divided into conventional treatment group (n=100, routine intestinal preparation was used before operation; probiotics and prebiotics were applied if diarrhea or abdominal distention occurred after operation) and microecological treatment group (n=98, routine perioperative management was applied; probiotics, prebiotics and enteral nutrition were administered since 2 weeks before operation; probiotics and prebiotics were given again when exhaust and defecation recovered after operation). The general clinical data, postoperative complications, gastrointestinal quality of life index (GIQLI), Wexner constipation score, the incidence of abdominal distension and diarrhea during follow-up were collected.</p><p><b>RESULTS</b>The baseline information was not significantly different between two groups (all P>0.05) as well as the morbidity of postoperative complication [27.6% (27/98) vs 37.0% (37/100), P=0.155]. Compared with conventional treatment group, microecological treatment group had obviously lower incidence of enteritis [2.0%(2/98) vs. 9.0% (9/100), P=0.034] and shorter postoperative hospital stay [(7.2±3.1) d vs. (9.8±3.6) d, P=0.040]. The incidences of diarrhea and abdominal distension in microecological treatment group were obviously lower than those in conventional treatment group [30.9% (29/94) vs. 46.9% (45/96), P=0.024; 44.7%(42/94) vs. 60.4%(58/96), P=0.030] at postoperative 1-month. Compared with conventional treatment group, microecological treatment group had obviously higher GIQLI (52.36 vs. 43.55, P=0.026) at postoperative 1-month. At postoperative 12-month, the incidences of diarrhea and abdominal distension decreased obviously in both two groups but without significant differences [diarrhea: 3.4% (3/89) vs. 3.3%(3/90), P=0.989; abdominal distention: 6.7% (6/89) vs. 5.6% (5/90), P=0.742]. GIQLI and Wexner score were improved but without significant differences as well (all P>0.05).</p><p><b>CONCLUSION</b>Perioperative intestinal microecological treatment can obviously reduce the incidences of postoperative enteritis, early abdominal distension and early diarrhea, improve the postoperative early GIQLI, and shorten postoperative hospital stay.</p>

Efficacy analysis of fecal microbiota transplantation in the treatment of 406 cases with gastrointestinal disorders / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of fecal microbiota transplantation (FMT) for gastrointestinal disorders.</p><p><b>METHODS</b>Retrospective analysis of the clinical data of 406 patients who underwent FMT from May 2014 to April 2016 in the Intestinal Microenvironment Treatment Centre of Nanjing General Hospital was performed, including patients with constipation(276 cases), recurrent Clostridium Difficile infection (RCDI, 61 cases), ulcerative colitis(44 cases), irritable bowel syndrome (15 cases) and Crohn's disease(10 cases). Donors were completely unrelated, 18- to 50-year-old non-pregnant healthy adult, with healthy lifestyle and habits, without taking antibiotics, probiotics and other probiotics history within 3 months. There were three routes of FMT administration: patients received 6 days of frozen FMT by nasointestinal tube placed in the proximal jejunum under gastroscope (319 cases); patients received capsules FMT per day for 6 consecutive days (46 cases) or once 600 ml of treated fecal liquid infusion into colon and terminal ileum by colonoscopy(41 cases).</p><p><b>RESULTS</b>Clinical cure rate and improvement rate of different diseases receiving FMT were respectively as follows: RCDI was 85.2% (52/61) and 95.1%(58/61); constipation was 40.2%(111/276) and 67.4%(186/276); ulcerative colitis was 34.1%(15/44) and 68.2% (30/44); irritable bowel syndrome was 46.7% (7/15) and 73.3% (11/15) and Crohn disease was 30.0%(3/10) and 60.0%(6/10). RCDI had the best efficacy among these diseases(P<0.01). There was no significant difference between the three routes of FMT administration(P=0.829). The clinical cure rate and improvement rate of different routes were 43.3%(138/319) and 58.6% (187/319) respectively in nasogastric transplantation group, 41.5%(17/41) and 61.0%(25/41) in colonoscopy group, 37.0%(17/46) and 63.0% (29/46) in the capsule transplantation group. There was no serious adverse event during the follow-up. The most common side effects were respiratory discomfort (27.3%, 87/319) and increased venting (51.7%, 165/319) in nasogastric transplantation group. Diarrhea was the most common complication in colonoscopy group (36.6%, 15/41). The main symptoms were increased venting (50.0%, 23/46) and nausea(34.8%, 16/46) in oral capsule group. Side effect symptoms disappeared after the withdraw of nasogastric tube, or at the end of treatment, or during hospitalization for 1-3 days.</p><p><b>CONCLUSIONS</b>FMT is effective for many gastrointestinal disorders. No significant adverse event is found, while the associated mechanism should be further explored.</p>

Serial Frozen Fecal Microbiota Transplantation in the Treatment of Chronic Intestinal Pseudo-obstruction: A Preliminary Study

BACKGROUND/AIMS: Chronic intestinal pseudo-obstruction (CIPO) is a serious, life-threatening motility disorder that is often related to bacterial overgrowth. Fecal microbiota transplantation (FMT) results in restoration of the normal intestinal microbial community structure. We investigated the efficacy of FMT in the treatment of CIPO patients. METHODS: Nine patients (age 18–53 years) with CIPO were enrolled in this prospective, open-label study. Patients received FMT for 6 consecutive days through nasojejunal (NJ) tubes and were followed up for 8 weeks after treatment. We evaluated the rate of clinical improvement and remission, feeding tolerance of enteral nutrition, and CT imaging scores of intestinal obstructions. Lactulose hydrogen breath tests were performed before FMT and 8 weeks after FMT to evaluate for the presence small intestinal bacterial overgrowth (SIBO). RESULTS: FMT significantly alleviated bloating symptoms, and symptoms of pain were relieved 2 weeks after FMT. Enteral nutrition administered through a NJ tube after FMT was well-tolerated by 66.7% (6/9) of patients. CT scores of intestinal obstructions were significantly reduced after FMT (P = 0.014). SIBO was eliminated in 71.0% (5/7) of patients. CONCLUSIONS: This pilot study demonstrated the safety of using FMT. FMT may relieve symptoms in selected patients with CIPO. FMT may also improve patient tolerance of enteral nutrition delivered via a NJ tube.

Structural basis of Zika virus helicase in recognizing its substrates

The recent explosive outbreak of Zika virus (ZIKV) infection has been reported in South and Central America and the Caribbean. Neonatal microcephaly associated with ZIKV infection has already caused a public health emergency of international concern. No specific vaccines or drugs are currently available to treat ZIKV infection. The ZIKV helicase, which plays a pivotal role in viral RNA replication, is an attractive target for therapy. We determined the crystal structures of ZIKV helicase-ATP-Mn(2+) and ZIKV helicase-RNA. This is the first structure of any flavivirus helicase bound to ATP. Comparisons with related flavivirus helicases have shown that although the critical P-loop in the active site has variable conformations among different species, it adopts an identical mode to recognize ATP/Mn(2+). The structure of ZIKV helicase-RNA has revealed that upon RNA binding, rotations of the motor domains can cause significant conformational changes. Strikingly, although ZIKV and dengue virus (DENV) apo-helicases share conserved residues for RNA binding, their different manners of motor domain rotations result in distinct individual modes for RNA recognition. It suggests that flavivirus helicases could have evolved a conserved engine to convert chemical energy from nucleoside triphosphate to mechanical energy for RNA unwinding, but different motor domain rotations result in variable RNA recognition modes to adapt to individual viral replication.

Short-term efficacy on fecal microbiota transplantation combined with soluble dietary fiber and probiotics in the treatment of slow transit constipation / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of fecal microbiota transplantation (FMT) combined with soluble dietary fiber and probiotics for slow transit constipation(STC).</p><p><b>METHODS</b>Twenty-three patients with STC from Jinling Hospital, Medical School of Nanjing University were prospectively enrolled between April 2015 and January 2016. STC patients received FMT combined with soluble dietary fiber and probiotics. Fresh stool(100 g) was immediately mixed in a blender with 500 ml of 0.9% sterile saline for several seconds, which was then filtered through a gauze pad and a decreasing number of gauze screen (2.0 to 0.5 mm). The fecal bacteria suspension was stored frozen at -20centi-degree. The preparation time of FMT material was less than 1 hour. Total time of treatment was 9 days. An initial oral antibiotics(vancomycin 500 mg orally twice per day) was given for 3 consecutive days. Then the fecal microbiota(100 ml) was infused slowly(5 min) through nasojejunal tube for 6 consecutive days. After FMT, patients were recommended to receive soluble dietary fiber (pectin, 8 g/d) and probiotics (bifid triple viable capsules, twice per day) for 4 weeks. Rates of clinical improvement and remission, adverse events, constipation-related symptoms (PAC-SYM scores), bowel movements per week and gastrointestinal quality-of-life index (GIQLI) were recorded during the 12-week follow-up. This study was registered in the Clinical Trials.gov (NCT02016469).</p><p><b>RESULTS</b>Among 23 patients, 7 were male, 16 were female, the mean age was (49.6±14.7) years, the body mass index was (21.2±2.2) kg/m, the duration of constipation was (8.3±5.9) years, and the defecation frequency was 1.8±0.7 per week. Compared with pre-treatment, PAC-SYM scores decreased significantly from 2.3±0.5 to 1.3±0.4 at week 12 (P<0.01), defecation frequency increased from 1.8±0.7 per week to 4.8±2.0 per week at week 12 (P<0.01), and patients felt satisfied with improved GIQLI score (from 78.5±15.5 to 120.8±21.3, P<0.01). During the follow-up, the clinical improvement and remission of STC patients reached 69.6%(16/23) and 52.2%(12/23), respectively. No serious adverse events were observed.</p><p><b>CONCLUSION</b>FMT combined with soluble dietary fiber and probiotics is safe and effective in treating slow transit constipation, which can improve the symptom and quality of life significantly.</p>

Research competence of authors in papers on Kashin-Beck disease and characteristics of their cooperation / 中华医学图书情报杂志

Objective To provide the evidence for cooperation in research on Kashin-Beck disease in China by ana-lyzing the research competence of authors in papers on Kashin-Beck disease and their cooperation .Methods Papers on Kashin-Beck disease were retrieved from 4 commonly used Chinese perodical databases .Key words Information was collected and organized using BICOMS to produce a co-words matrix,atlas of co-words was plotted using NetDraw, the data were analyzed using SPSS 17.0.Results Of the 3454 authors engaged in research of Kashin-Beck disease from 1957 to 2012,81 published 15 or more than 15 papers.Cluster analysis showed that these 81 authors were from Institute of Endemic Diseases,Xi'an Jiaotong University Medical School; Institute of Kashin-Beck Disease,Chinese Center for Endemic Disease Prevention and Control;Jilin No.2 Center for Endemic Disease Prevention and Control;Centers for Disease Prevention and Control of China Academy of Sciences , Henan Province and Gansu Province .Conclusion A large number of researchers are engaged in research of Kashin-Beck disease .Their research interest and charac-teristics are clear.However, the cooperation between different institutions is weak and should be strengthened.

Key words-based analysis of subjects in Chinese papers on Kashin-Beck disease / 中华医学图书情报杂志

Objective To reveal the main interests in studies of Kashin-Beck disease by analyzing the key words in Chinese papers on Kashin-Beck disease .Methods Chinese papers on Kashin-Beck disease were retrieved from CNKI, CBM, VIP, and Wanfang digital journal full-text database.A co-word matrix was generated by abstracting their key words which were analyzed by gCLUTO clustering .Results The studies on Kashin-Beck disease were centered on the role of fusarium metabolic toxins and fulvic acid in pathology of Kashin-Beck disease, etiology of Kashin-Beck disease, functional change in Kashin-Beck disease patients, relation between Kashin-Beck disease and geological envi-ronment, monitoring and X-ray diagnosis of Kashin-Beck disease, surgical treatment of Kashin-Beck disease, preven-tion and treatment efficiency analysis of Kashin-Beck disease.Social network figure showed that etiology of Kashin-Beck disease, relation between Kashin-Beck disease and geological environment, monitoring and X-ray diagnosis of Kashin-Beck disease, surgical treatment of Kashin-Beck disease, prevention and treatment efficiency analysis of Kashin-Beck disease were the hot spots in studies of Kashin-Beck disease at present.Conclusion The research subjects determined by co-word clustering analysis are consistent with the interests in studies of Kashin-Beck disease in China at present.