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Eosinophilic gastroenteritis (EGE) is a gastrointestinal disorder of unclear etiology that is characterized by eosinophilic infiltration of the stomach and small intestine, and consists of mucosal, muscular, and serosal subtypes. Eosinophilic infiltration of the gastrointestinal tract is a fundamental histopathological characteristic of EGE and is driven by several T-helper type 2 (Th2)-dependent cytokines and induced by food allergy. Due to the lack of a diagnostic gold standard, EGE has a high rate of delayed diagnosis or misdiagnosis. However, several new diagnostic strategies have been developed, such as novel genetic biomarkers and imaging tests. Although dietary therapy and corticosteroids remain the common choices for EGE treatment, recent decades have seen the emergence of novel treatment alternatives, such as biologics that target particular molecules involved in the pathogenic process. Preliminary investigations and clinical trials have demonstrated the efficacy of biologics and provided additional insights for the era of refractory or corticosteroid-dependent EGE biologics.
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Humans , Enteritis/drug therapy , Gastritis/drug therapy , Eosinophilia/therapy , Abdomen , Adrenal Cortex HormonesABSTRACT
Objective:Clinicopathological characteristics of neuroendocrine neoplasms are highly heterogeneous based on variable origins.Our study aims to explore the clinical features of rectal neuroendocrine neoplasm (RNEN).Methods:Patients with histologically diagnosed rectal neuroendocrine neoplasms were retrospectively analyzed between January 2012 and December 2020. Epidemiological characteristics, clinical manifestations, complete blood count, endoscopy findings, and pathological features were recorded and analyzed. T-test was used for measurement data analysis, Chi-square test was performed for classification data analysis, and Binary logistic regression was applied for analyzing risk factors of metastasis.Results:Among 172 patients, the male to female ratio was 107 to 65 with an average age of (52±12) years (16-77 years). Altered bowel habit was the most common initial symptom (58/172, 33.7%), followed by abdominal pain (36/172, 20.9%) and loss of body weight (27/172, 15.7%). One hundred and sixty-one cases were neuroendocrine tumors, 9 were neuroendocrine carcinomas and 2 were mixed neuroendocrine-non-neuroendocrine neoplasms. Most endoscopic presentations were polypoid lesions (147/172, 85.5%), mainly limited to mucosa (48/172, 27.9%) and submucosa (96/172, 55.8%). Twenty-nine patients developed lymph node invasion or distant metastasis at diagnosis. There were statistical difference of neutrophil-to-lymphocyte ratios (NLR) among groups with different tumor size (<10 mm vs. 10-20 mm vs.>20 mm, mean NLR 1.79±0.55 vs. 2.27±1.23 vs. 2.95±0.66, P<0.01. Compared with non-metastatic group, the metastatic group presented higher NLR(2.61±0.81 vs. 1.89±0.80, P<0.01). Tumor size (<10 mm vs. 10-20 mm vs.>20 mm, OR 1.00 vs. 2.10 vs. 5.25×10 9, P =0.001), invasion to bowel wall (mucosa vs. submucosa vs. muscularis vs. serosa invasion, OR 1.00 vs. 3.26 vs. 14.11 vs. 39.42, P=0.008), and NLR (NLR<2.25 vs. NLR≥2.25, OR 1.00 vs. 5.19, P =0.024) were risk factors for metastasis. Conclusion:Metastasis of RNEN is related with tumor size, degree of bowel invasion and NLR. High NLR is a poor prognostic factor of RNEN.
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BACKGROUND:Artificial tissue-engineered bone combined with acel ular bone matrix has been shown to be favorable for bone repair. OBJECTIVE:To explore the safety and biocompatibility of the stromal vascular fraction of the adipose tissue combined with the acel ular bone matrix-chitosan scaffold in the repair of rabbit radial defects. METHODS:A total of 38 New Zealand rabbits were selected, 3 rabbits were used to extract stromal vascular fraction of adipose tissue, 3 used to prepare acel ular bone matrix and 32 divided into experimental and control groups. Models of rabbit radial defects were established using Brownlow method. The rabbits in the experimental group were treated with the SVF of adipose tissue combined with the acel ular bone matrix-chitosan scaffold, while those controls received no treatment. General situation, gross observation, X-ray examination, histological observation and Lane-Sandhu scores were performed at 2 and 4 months postoperatively. RESULTS AND CONCLUSION:No infections occurred in both two groups at 2 and 4 months postoperatively, but the activity level and degree of healing in the experimental group were significantly better than those in the control group. In the experimental group, there were high-density shadows at 2 months postoperatively and the X-ray image of the bone defect site was the same as that of the normal one at 4 months, while bone nonunion occurred in the control group. The bone tissues in the experimental group grew significantly better than that in the control group at 2 and 4 months postoperatively, and the Lane-Sandhu histological scores in the experimental group were significantly higher than those in the control group at 2 and 4 months postoperatively (P<0.05). These results indicate that the stromal vascular fraction combined with the acel ular bone matrix-chitosan scaffold exhibits safety and biocompatibility in the repair of rabbit radical defects.
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Objective To explore the clinical features of gastric neuroendocrine neoplasms (GNENs). Methods A total of 36 patients with GNENs who were diagnosed between October 2005 and October 2015 at Peking Union Medical College Hospital were retrospectively analyzed. The demographic characteristics,clinical manifestations,endoscopic findings,and pathologic features as well as the treatments of GNENs were collected and analyzed. Results The average age of 36 patients was (55.8±11.1) years and the male to female ratio was 0.89:1. The clinical manifestations varied,in which abdominal pain was as high as 42.9%. Also,63.9% of the lesions were distributed in the gastric body. The endoscopic appearance of GNENs included polypoid lesions,ulcerative lesions,and mucosal depression. Polypoid lesions were most common,and 73.9% of these polyps were single,with an average diameter of less than 10 mm. Pathological grading included G1-G3 level,while G1 level accounted for 55.6%. Up to 65.2% of patients who undergone gastric body biopsy had pathologic evidence of mucosa atrophy or metaplasia. Therapeutic modalities included endoscopic intervention and surgical resection. Conclusion Patients with GNENs lack specific symptoms. The most common endoscopic appearance is polypoid lesions,mainly in gastric body. Clinicians should be aware of the possibility of GNENs in the polypoid lesions,particularly for those accompanied with gastric body atrophy.
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Objective To discuss the clinical outcomes of C1-C2 pedicle screw fixation in treatment of Jefferson fracture combined with aflantoaxial instability.Methods Eleven adult patients with Jefferson fracture combined with atlantoaxial instability were treated with C1-C2 pedicle screw fixation in our department from January 2006 to December 2009.There were eight males and three females at age range of 20-52 years(mean 36 years).There were eight patients with fresh fractures,three with old fracture and three complicated with odontoid process fracture.The main preoperative clinical symptoms were the limitation of head torsion and pain in the occiput and neck,with no spinal dysfunction in all patients.X-ray,CT scan,three-dimensional reconstruction,MRI scan and skull traction were performed in all patients before operation.Then,the patients were treated with C1-C2 pedicle screw fixation without fusion between C1-C2 under general anesthesia.Results The atlantoaxial dislocation was reduced completely and the patients could move from bed,wearing the neck collar.There was no injury of vertebral artery,spinal cord or nerve roots during operation,but one patient suffered the venous plexus bleeding which was packed with the hemostatic gauze.Eleven patients were followed up for 6-24 months(average 15 months),which showed bone union,with no internal fixation breakage,loosening or dislocation.The internal fixation was removed from seven patients 15 months after operation,with mild limitation of the cervical vertebra torsion(90°-135°,average 115°)but with no limitation of obvious extension-flexion motion.Conclusion C1-C2 pedicle screw fixation has features of simple operation,short segment fixation,solid fixation and high rate of bone healing for treatment of Jefferson fracture combined with atlantoaxial instability.