ABSTRACT
Gastroesophageal reflux disease （GERD） is a frequently and commonly occurring disease in clinic. In recent decades， with the development in pathophysiology and drug researches， modern medicine has achieved remarkable progress and results in diagnosis and treatment. However， the treatments for non-erosive reflux disease， refractory gastroesophageal reflux disease， proton pump inhibitor resistance， overlap of disease symptoms， and extraesophageal symptoms are limited and ineffective. Traditional Chinese medicine （TCM） was widely used in clinical practice， which has been proved effective in relieving symptoms and improving the quality of life. Sponsored by China Association of Chinese Medicine （CACM） and undertaken by the Spleen and Stomach Disease Branch of CACM， "the 12th Youth Salon of Clinical Predominance Disease Series （GERD）" invited 18 authoritative digestive experts of TCM and western medicine to discuss "the difficulties of clinical diagnosis and treatment of GERD and TCM advantages". The focus issues such as modern medical diagnosis and treatment achievements and contributions， improvement and maintenance of symptoms， response to overlapping disease symptoms， reduction and withdrawal of acid suppressors， and treatment of extra-esophageal symptoms were discussed in depth. TCM and western medicine exchanged and complemented each other's strengths， combing the difficulties of modern medical diagnosis and treatment， which clarified the positioning and advantages of TCM and provided guidance for clinical and scientific research.
ABSTRACT
Objective:To analyze the clinicopathological features of de novo early colorectal cancer and to evaluate the efficacy of endoscopic treatment.Methods:Patients with de novo early colorectal cancer who underwent endoscopic resection in Beijing Friendship Hospital, Capital Medical University from June 2020 to May 2022 were enrolled. The baseline data, endoscopic manifestations, treatment methods, postoperative pathological results and prognosis of the patients were collected retrospectively.Results:A total of 33 patients with de novo early colorectal cancer were enrolled with the age of 62.67 ± 8.62 years, and the male to female ratio was 7.25∶1. The long diameter of lesions was 0.96 ± 0.36 cm. The lesion morphology was mainly superficial phenotype (type 0-Ⅱ), accounting for 72.7% (24/33). Endoscopic submucosal dissection (ESD) was performed in 29 cases and endoscopic mucosal resection (EMR) was performed in 4 cases. Postoperative pathology showed that 11 cases (33.3%) were well differentiated tubular adenocarcinoma, of which the superficial submucosal layer was invaded in 2 cases. Twenty cases (60.6%) were moderately differentiated tubular adenocarcinoma, of which the superficial submucosa layer was invaded in 5 cases and the deep submucosa layer in 15 cases. Two cases (6.1%) were moderately-poorly differentiated tubular adenocarcinoma, where the deep submucosa layer was invaded in both. There was significant correlation between the depth of invasion and the degree of differentiation ( P<0.001), and moderately and moderately-poorly differentiated lesions were more likely to invade the deep submucosa layer. The en bloc resection rate was 100.0% (33/33), the complete resection rate was 97.0% (32/33), and the curative resection rate was 42.4% (14/33). Among the 19 patients who did not achieve curative resection, 13 patients received supplementary surgical treatment. No tumor residue or lymph node metastasis was found in the postoperative pathology. All patients were followed up for 3-25 months, and no signs of local recurrence or metastasis were found. Conclusion:Most de novo early colorectal cancers are superficial phenotype under endoscopy. The pathology is mainly moderately differentiated tubular adenocarcinoma. Endoscopic resection of de novo early colorectal cancer shows encouraging short-term efficacy.
ABSTRACT
Objective:To evaluate the application of three-dimensional (3D) imaging device to colonoscopy.Methods:A total of 60 patients who underwent painless colonoscopy in Beijing Friendship Hospital, Capital Medical University from November to December, 2019 were enrolled and divided into 2 groups according to random code. Each patient underwent colonoscopy twice, while 2D colonoscopy was used for cecal intubation. Thirty patients were assigned to the experimental group (primary withdrawal used 3D colonoscopy, and secondary withdrawal used 2D colonoscopy), and 30 others to the control group (primary withdrawal used 2D colonoscopy, and secondary withdrawal used 3D colonoscopy). The detection of polyps, the withdrawal time, operating experience, image quality and complication were evaluated in the two groups.Results:The polyp detection rate at the first colonoscopy in the experimental group was 77.3% (17/22), which was higher than 43.5% (10/23) in the control group ( χ2=5.351, P=0.021). Ten operators in the experimental group had dizziness, while the operators in the control group had no dizziness ( P=0.001). There were no significant differences between the two groups in the polyp diameter [0.50 (0.70) cm VS 0.30 (0.20) cm, U=57.000, P=0.170], withdrawal time (4.6±1.5 min VS 5.2±1.9 min, t=-1.189, P=0.239) or image quality (27 cases with 3 points in the identification of lesion nature, and 28 cases with 3 points in the identification of duct both in the two groups, P=1.000) at the first colonoscopy. No complication occurred in either group. Conclusion:Application of 3D imaging device is feasible for colonoscopic polyp detection, and it can be used in clinical practice.
ABSTRACT
Objective:To evaluate the effects of hemoclips on preventing delayed bleeding for early gastric cancer (EGC) after endoscopic submucosal dissection (ESD).Methods:Clinical data of 459 patients who underwent ESD for EGC in Beijing Friendship Hospital from June 2013 to August 2020 were collected retrospectively. Patients were divided into group A (hemoclip group, n=162) and group B (non-hemoclip group, n=297) according to whether preventive hemostatic clip treatment was performed after resection. Delayed bleeding within 2 weeks after ESD was observed. Univariate analysis and subgroup analysis were conducted for the delayed bleeding incidence and clinicopathological features. Results:Delayed bleeding incidences of group A and group B were 3.1% (5/162) and 8.1% (24/297) with significant difference between the two groups ( χ2=4.418, P=0.036). Subgroup analysis showed that there were significant differences in the delayed bleeding incidence between the two groups when the diameter of the tumor >20 mm [3.5% (2/57) VS 15.3% (13/85), χ2=5.016, P=0.025], the tumor located in the lower part of the stomach [1.0% (1/97) VS 10.4% (20/192), χ2=8.425, P=0.004], and the depth of tumor invasion was M/SM1 [3.2% (5/157) VS 8.1% (23/285), χ2=4.072, P=0.044]. There were no significant differences in the delayed bleeding incidence between group A and group B when the diameter of the tumor ≤20 mm, the tumor located in the upper/medial part of the stomach and the depth of tumor invasion was SM2 ( P>0.05). Conclusion:Hemoclips can prevent delayed bleeding after ESD for EGC, which is mainly observed in a tumor of diameter >20 mm, located in the lower part of the stomach and M/SM1 tumor invasion. It has little effect on the prevention when the tumor diameter ≤20 mm and located in the upper/medial part of the stomach.
ABSTRACT
Objective:To investigate the clinicopathological features of missed synchronous multiple early gastric cancer (SMEGC).Methods:Clinical and pathological data of 10 missed SMEGC patients in Beijing Friendship Hospital collected from January 2015 to December 2019 were reviewed for the clinicopathological and endoscopic features.Results:Ten missed SMEGC patients were all over 60 years old, and 6 of them were males. Six patients had family history of tumor and 6 had comorbidity (hypertension, diabetes, dyslipidemia, cardiovascular or cerebrovascular diseases). In terms of endoscopic and pathological manifestations, missed lesions of 6 cases were not smaller than the initial lesions, and more than half of the missed lesions had the same vertical location in the stomach (6/10), infiltration depth (8/10), histological classification (9/10), atrophic (8/10) and intestinal metaplasia (8/10) as the initial lesions.Conclusion:Physicians should be aware of the possibility of missed lesions during the first endoscopic treatment and the follow-up, especially at the same vertical location of the initial lesions in elderly males with family history of tumor and comorbidity.
ABSTRACT
To investigate the clinical and endoscopic characteristics and endoscopic treatment efficacy of cap polyposis, data of 14 patients (56 polyps) who were histologically diagnosed as having cap polyposis after endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) in Beijing Friendship Hospital from June 2017 to February 2021 was retrospectively analyzed. Of the 14 patients, 8 were males and 6 were females. The age ranged from 14 to 74 years, including 7 cases of <60 years old and 7 cases of ≥60 years old. 7 patients (50.0%) had clinical manifestations. Four cases had multiple polyps and 10 cases (71.4%) had single polyps. There were 42 polyps (75.0%) located in the rectum, 13 (23.2%) in the sigmoid colon and 1 in the transverse colon. According to the classification of Yamada, 44 polyps (78.6%) were type Ⅰ, 3 polyps were type Ⅱ, 5 polyps were type Ⅲ and 4 polyps were type Ⅳ. Under endoscopy, there were 41 polyps (73.2%) with obvious white cap-like coverings on the surface and 23 polyps with obvious hyperemia and redness on the mucosa, 8 of which were both visible. Two cases were treated with ESD and 12 cases were treated with EMR, all of which were completely excised. No bleeding, perforation, infection or other complications occurred during and after operation. The clinical symptoms of 7 patients were relieved. During the follow-up period, 11 cases (78.6%) completed colonoscopy, and no polyp recurrence was found. In conclusion, there is no gender or age difference in patients of cap polyposis. It is usually single and located in the rectum and sigmoid colon with Yamada type Ⅰ. The surface of lesions is mostly covered with white cap. Patients may have no obvious clinical symptoms. Treatment of ESD and EMR is safe and effective for cap polyposis.
ABSTRACT
Objective:To evaluate the efficacy and safety of SPOT (GI Supply, USA), a new carbon-based permanent marker approved by the Food and Drug Administration (FDA), in the endoscopic marking for gastrointestinal lesions.Methods:A total of 115 patients with gastrointestinal lesions who underwent endoscopic treatment or surgery in Beijing Friendship Hospital or Beijing Chao-Yang Hospital from April 2019 to November 2019 were enrolled in the study. SPOT was used to mark the lesions, and marking points were found during endoscopic treatment or surgery to calculate the effective marking rate by single-group target value method. Adverse events after marking were recorded, and the changes of blood routine test, liver and kidney functions before and after marking were compared.Results:The effective rate of endoscopic marking with SPOT was 99.13% (114/115). The longest marking time was 57 days. There was no puncture of intestinal wall or injection into abdominal cavity during the marking process. One patient developed mild fever after marking. The incidence of adverse events was 23.48% (27/115), which were all unrelated to the test equipment. There was no significant difference in blood routine tests or liver and kidney functions before and after marking ( P>0.05). Conclusion:SPOT produced by GI Supply can effectively mark gastrointestinal lesions without serious adverse events, which meets the requirements of clinical use.
ABSTRACT
Objective:To determine the accuracy and influencing factors for endoscopic ultrasound (EUS) in predicting the invasive depth of early gastric cancer (EGC).Methods:A retrospective analysis was conducted on data of patients with EGC who were staged T1 with EUS and were treated at Beijing Friendship Hospital from January 2014 to August 2020. The consistency between the invasive depth determined by EUS and postoperative pathology were compared, and the accuracy, the sensitivity and the specificity of EUS were calculated. Logistic regression model was used for univariate and multivariate analysis to explore the relevant factors that affected the accuracy of EUS.Results:A total of 380 lesions were included. While 301 intramucosal (T1a) lesions and 79 submucosal (T1b) lesions were detected with EUS, postoperative pathology diagnosed 320 T1a lesions and 60 T1b lesions. The accuracy of EUS in predicting the invasive depth of EGC was 77.1% (293/380), the sensitivity and the specificity were 83.4% (267/320) and 43.3% (26/60) respectively. Multivariate analysis indicated that the lesions located in the upper 1/3 of the stomach ( OR=2.272, 95% CI: 1.266-4.080, P=0.006), ≥20 mm in size ( OR=2.013, 95% CI: 1.200-3.377, P=0.008) and poorly differentiated cancer ( OR=2.090, 95% CI: 1.018-4.294, P=0.045) were the independent risk factors affecting the accuracy of EUS. Poorly differentiated EGC ( OR=4.046, 95% CI: 1.737-9.425, P=0.001) was the risk factor for over-staging of EUS. Conclusion:EUS is useful in predicting the invasive depth of EGC. Factors affecting the accuracy of EUS include location in the upper 1/3 of the stomach, ≥20 mm in size and poorly differentiated EGC. Additionally, poor differentiation is the risk factor for over-staging of EUS.
ABSTRACT
Objective:To explore the value of ex- vivo porcine stomach model for endoscopic submucosal dissection (ESD) training for international trainees. Methods:Fifteen international students received ESD training and learning for twenty days. Firstly, students learned basic theory of ESD and completed a questionnaire. Then they were randomized to receive endoscopic training either on the vitro animal (group A) or on training experience (group B) of the clinical observation. At last, one case was assessed by an experienced endoscopist. The total and step-by-step operating time, complete resection, size of specimen and complications were recorded. All students completed the questionnaire once again. SPSS 20.0 was used for t test and chi-square test. Results:There was significant difference in total ESD operation time between group A and group B ( P<0.05). There were significant differences between the two groups on cutting time and dissection time, but there was no difference on marking time, injection time and operating speed. There was only one case of block resection and perforation in each group. For group A, their mastery and clinic confidence of ESD had been obviously increased after the animal training course. Compared with the operation before the training in group A, it was found that the total time and cutting time of the ESD after the training were also significantly improved. Conclusion:Theory combined with endoscopic training on vitro animal model can make the trainees familiar with the basic theory and master the operational skills, which is helpful and valuable for them to perform ESD in further clinic practice.
ABSTRACT
Objective@#To analyze the characteristics of early gastric cancer (EGC) with submucosal infiltration under conventional white light endoscopy (C-WLE) and magnifying endoscopy with narrow band imaging (ME-NBI), and to improve the diagnostic accuracy of EGC infiltration by combining C-WLE and ME-NBI findings.@*Methods@#Data of patients who received endoscopic submucosal dissection or surgical treatment for EGC at Beijing Friendship Hospital from January 2015 to December 2017 were retrospectively analyzed. The basic information, lesion characteristics, and postoperative pathology of patients were collected. The characteristics of EGC with submucosal infiltration were analyzed, and a model for predicting the depth of EGC invasion was constructed by combining independent risk factors of submucosal infiltration.@*Results@#A total of 207 lesions in 195 patients were included in the study, divided into the modeling group (138 lesions) and the testing group (69 lesions) in the ratio 2∶1. In the modeling group, the lesions located in the upper third of the stomach (OR=12.949, 95%CI: 2.148-78.070, P=0.005), middle third of the stomach (OR=7.534, 95%CI: 1.044-54.360, P=0.045), >2 cm in size (OR=6.828, 95%CI: 1.657-28.136, P=0.008) and presence of dilated blood vessel (OR=6.856, 95%CI: 1.577-29.805, P=0.010) were independent risk factors for submucosal infiltration. Based on the above independent risk factors, the infiltration depth predicting scoring system (DPSS) was constructed (5 points for the lesion located in upper third of the stomach, 4 points for the lesions located in the middle third of stomach, 4 points for lesions >2 cm in size, and 4 points for the presence of dilated vessels). The areas under the receiver operating characteristic curve for predicting the infiltration depth of DPSS were 0.884 (95%CI: 0.809-0.960) in the modeling group and 0.799 (95%CI: 0.684-0.914) in the testing group. The sensitivities of the modeling group and the testing group were 83.3% and 71.4% respectively; and the specificities were 76.2% and 74.5%, respectively in the two groups at 8 as the cut-off score.@*Conclusion@#The DPSS based on C-WLE and ME-NBI findings can predict the invasion depth of EGC.
ABSTRACT
Objective:To analyze the characteristics of early gastric cancer (EGC) with submucosal infiltration under conventional white light endoscopy (C-WLE) and magnifying endoscopy with narrow band imaging (ME-NBI), and to improve the diagnostic accuracy of EGC infiltration by combining C-WLE and ME-NBI findings.Methods:Data of patients who received endoscopic submucosal dissection or surgical treatment for EGC at Beijing Friendship Hospital from January 2015 to December 2017 were retrospectively analyzed. The basic information, lesion characteristics, and postoperative pathology of patients were collected. The characteristics of EGC with submucosal infiltration were analyzed, and a model for predicting the depth of EGC invasion was constructed by combining independent risk factors of submucosal infiltration.Results:A total of 207 lesions in 195 patients were included in the study, divided into the modeling group (138 lesions) and the testing group (69 lesions) in the ratio 2∶1. In the modeling group, the lesions located in the upper third of the stomach ( OR=12.949, 95% CI: 2.148-78.070, P=0.005), middle third of the stomach ( OR=7.534, 95% CI: 1.044-54.360, P=0.045), >2 cm in size ( OR=6.828, 95% CI: 1.657-28.136, P=0.008) and presence of dilated blood vessel ( OR=6.856, 95% CI: 1.577-29.805, P=0.010) were independent risk factors for submucosal infiltration. Based on the above independent risk factors, the infiltration depth predicting scoring system (DPSS) was constructed (5 points for the lesion located in upper third of the stomach, 4 points for the lesions located in the middle third of stomach, 4 points for lesions >2 cm in size, and 4 points for the presence of dilated vessels). The areas under the receiver operating characteristic curve for predicting the infiltration depth of DPSS were 0.884 (95% CI: 0.809-0.960) in the modeling group and 0.799 (95% CI: 0.684-0.914) in the testing group. The sensitivities of the modeling group and the testing group were 83.3% and 71.4% respectively; and the specificities were 76.2% and 74.5%, respectively in the two groups at 8 as the cut-off score. Conclusion:The DPSS based on C-WLE and ME-NBI findings can predict the invasion depth of EGC.
ABSTRACT
Objective@#To investigate the risk factors of operation time of endoscopic submucosal dissection (ESD) for superficial gastric lesions.@*Methods@#Clinicopathologic data of 193 patients (195 lesions) diagnosed with early gastric cancer preoperatively who received ESD in Beijing Friendship Hospital from January 2015 to December 2017 were retrospectively collected, including basic information (age, gender, body mass index, comorbidities), lesion characteristics (size, location, morphology), the operators′ experience of ESD, operation time, and postoperative pathology, etc. Univariate analysis was performed to find the risk factors of ESD operation time, and logistic regression analysis was performed on the factors with statistical differences in univariate analysis to find the independent risk factors of ESD operation time over 120 min.@*Results@#The mean age of the patients was 63.34±9.11 years. The median time of ESD operation was 120.00 (95.00, 165.00) min and the median size of the lesions was 1.50 (1.00, 2.38) cm. Early gastric cancer was diagnosed by postoperative pathology in 164 lesions (84.10%), among which 162 lesions (98.78%) achieved en bloc resection, and 148 lesions (90.24%) achieved curative resection. The gender (P=0.018), location(P<0.001) and size (r=0.209, P=0.007) were risk factors of the operation time by univariate analysis, while age, body mass index, American Society of Anesthesiologists (ASA) grade, roughness of lesion surface, presence or absence of white moss and ulcer, depth of lesion invasion, operative period, gross shape of lesion, degree of differentiation, and experience of operator were not associated with operation time (all P>0.05). Multivariate analysis showed that the lesion located in cardia/fundus of stomach (OR=5.656, 95%CI: 2.291-13.964, P<0.001), body of stomach (OR=2.667, 95%CI: 1.048-6.785, P=0.040) and >2 cm in size (OR=2.761, 95%CI: 1.229-6.205, P=0.014) were independent risk factors for the operation time longer than 120 min.@*Conclusion@#Lesions located in the cardia/fundus, body of stomach and >2 cm in size are independent risk factors for long operation time of ESD.
ABSTRACT
Objective@#To compare the efficacy and safety of endoscopic submucosal dissection(ESD) and surgery in the treatment of early gastric cancer.@*Methods@#Clinical data of patients with early gastric cancer who received ESD or surgery in Beijing Friendship Hospital from June 2012 to May 2018 were collected. Complete resection rate, complication incidence, hospital stay and expenses between the two groups were compared.@*Results@#There was no significant difference between two groups in complete resection rate[95.7%(245/256) VS 99.0%(97/98), P=0.191], or the complication incidence [5.9%(15/256) VS 8.2%(8/98), P=0.471]. Hospital stay was shorter in the ESD group than that in the surgery group(11.5±3.7 d VS 19.4±13.0 d, P=0.000). Expenses were less in the ESD group than those in the surgery group (27 383.1±10 143.0 yuan VS 78 004.3±79 027.8 yuan, P=0.000).@*Conclusion@#The efficacy and safety of ESD are comparable with surgery in the treatment of early gastric cancer, but ESD is superior to surgery in hospital stay and expenses.
ABSTRACT
Objective To analyze the clinical and endoscopic characteristics of pneumatosis cystoides intestinalis ( PCI) in colon. Methods Data of 116 patients with colonic PCI admitted at Beijing Friendship Hospital from January 2005 to June 2018 were retrospectively collected, including age, gender, clinical manifestations, lesion size, location, and morphology. The clinical and endoscopic characteristics of colonic PCI were analyzed. Results The 116 patients included 54 males and 62 females, with age of 59. 11±13. 13 years (ranged, 17-91 years). Fifty cases (43. 10％) had a single lesion, and 66 cases (56. 90％) had multiple lesions. The detection rate of colonic PCI was 0. 40‰ ( 1/2524) to 2. 03‰(8/3945). Clinical manifestations included no symptom (24. 14％, 28/116), abdominal pain (18. 97％,22/116) , and elevated tumor markers ( 17. 24％, 20/116 ) . A total of 168 lesions were found under colonoscopy, and were single or multiple submucosal hemispherical or spherical cystic eminence of different sizes with soft surface, and some had hyperemia and erosion on the mucosal surface. The size of lesions was clearly recorded in 66 cases among the 116 patients, with 1. 61±0. 87 cm (ranged, 0. 3-5. 0 cm). The diameter of lesions was 1. 0-<2. 0 cm in 30 cases ( 45. 45％) . The single PCI was mostly located in ascending (38. 00％, 19/50) and transverse ( 28. 00％, 14/50) colon, and multiple PCIs were mostly located in ascending ( 28. 81％, 34/118 ) , sigmoid ( 22. 03％, 26/118 ) and descending ( 17. 80％, 21/118) colon. Conclusion Colonic PCI is a rare disease in clinic with non-specific clinical manifestations, and colonoscopy is an effective diagnostic method. It is apt to happen in elder patients and often found in ascending colon.
ABSTRACT
Objective To analyze the possible influencing factors of postoperative bleeding after endoscopic submucosal dissection and endoscopic mucosal resection ( ESD/EMR) for early gastric cancer. Methods Clinical data of patients receiving ESD/EMR for the diagnosis of early gastric cancer at the Endoscopy Center of Beijing Friendship Hospital from January 2013 to May 2018, including demographic information ( age, gender and history ) , endoscopic lesion characteristics ( tumor size, location and morphology) and postoperative pathological features ( differentiated types and invasive depth) were collected to analyze the effects of these factors on bleeding after ESD/EMR. Results A total of 195 patients with early gastric cancer were included in the study and 9 cases ( 4. 6％) had postoperative bleeding. The medication history of clopidogrel and main lesion sizes were statistically different between postoperative bleeding group and non-bleeding group ( P=0. 018 and P=0. 034 ) . Multivariate analysis showed a history of clopidogrel ( OR=10. 223, 95％CI:1. 143-91. 468, P= 0. 038 ) , multiple lesions ( OR= 6. 412, 95％CI:1. 123-36. 616, P=0. 037) and lesions sizes of larger than 2 cm ( OR=6. 718, 95％CI:1. 130-39. 935, P=0. 036) were possible risk factors for postoperative bleeding. Survival analysis showed of higher postoperative bleeding risks in patients with the history of clopidogrel ( P<0. 001) and lesions sizes of more than 2 cm ( P=0. 022) . Conclusion More attention should be paid to the risk of ESD/EMR postoperative bleeding in early gastric cancer patients with medication history of clopidogrel and multiple large lesions.
ABSTRACT
Objective To study the clinical features,diagnosis and treatment of polycystic liver disease (PLD)complicated with portal hypertension (PHT).Methods The clinical data of one patient with PLD and PHT was retrospectively analyzed,and relevant literature was reviewed.Results The patient presented fatigue,dyspepsia, abdominal distension and lower limb edema.Laboratory examination showed mild liver dysfunction(Alkaline phospha-tase 291.2U/L,gamma glutamyl transpeptidase 168.1U/L,59.9g/L,total protein,albumin 32.2g/L,21.0μmol /L, total bilirubin,direct bilirubin 11.5μmol /L).Abdominal ultrasound (US)and computerized tomography (CT) showed multiple noncommunicating cysts of varying size in both liver and kidney.Antioxidant supplements and diuretic were introduced,and the therapy was approved to be effective.Conclusion The case in this report illustrates that PLD could occasionally present with PHT.Physician should be alert to prevent misdiagnosis.
ABSTRACT
Objective To evaluate the levels of ghrelin, adiponectin, leptin and true insulin in human milk from mothers with and without gestational diabetes mellitus (GDM), and to assess the effects of these parameters on infant growth. Methods Fifty-two GDM mothers and their healthy infants (GDM group) and 49 non-GDM mothers and their healthy infants (control group) were enrolled from Beijing Obstetrics and Gynecology Hospital and Peking Union Medical College Hospital from January 2010 to August 2010. The levels of ghrelin, adiponectin, leptin and true insulin in colostrum and human milk 90 days postpartum (mature milk) were determined by enzyme-linked immunosorbent assay. Infant weight, length and head circumference at birth and at 90 days old were measured. The two-sample t-test, sum-rank test and Spearman correlation analysis were used for statistical analysis. Results Compared with the control group, ghrelin was significantly lower in human milk from GDM mothers both in colostrum [136.7 (102.7-181.4) vs 175.4 (137.5-235.0) ng/L, t= -2.737] and mature milk [111.8 (77.5-184.2) vs 210.9 (147.3-381.9) ng/L, t= -3.268]. Adiponectin was also significantly lower in human milk from GDM mothers both in colostrum [21.7 (14.6-51.8) vs 57.0 (23.1-113.9)μg/L, t=-2.858] and mature milk [11.7 (8.4-14.4) vs 15.1 (11.9-18.5)μg/L, t=-2.625], however, true insulin level was higher in colostrum [22.8 (13.4-50.2) vs 20.4 (7.8-30.8) mU/L, t=-2.007] and mature milk [33.6 (22.5-54.1) vs 23.5 (13.5-31.6) mU/L, t=-2.009]. The differences were statistically significant (all P < 0.05). (2) In the colostrums of the GDM group, true insulin level was negatively associated with ghrelin (r=-0.342), but positively associated with adiponectin (r=0.305). In the control group, the level of true insulin in mature milk was positive associated with leptin in colostrums( r=0.456)and mature milk(r=0.629). The differences were statistically significant (all P < 0.05). (3) In the GDM group, adiponectin level in colostrum was negatively associated with neonatal birth weight (r= - 0.323, P=0.025); the leptin/adiponectin ratio was negatively associated with neonatal birth weight (r= -0.403, P=0.005) and head circumference (r= -0.327, P=0.039) at birth. Adiponectin level in mature milk was negatively associated with infant length 90 days postpartum (r=-0.406, P=0.040). In the control group, the leptin/adiponectin ratio in colostrum was negatively associated with neonatal head circumference at birth (r= -0.370, P=0.024). Adiponectin level in mature milk was positively associated with infant weight 90 days postpartum (r=0.432, P=0.007). Conclusion Women with GDM have different levels of ghrelin, adiponectin and true insulin in their milk from the normal controls, which may affect infant growth.
ABSTRACT
<p><b>OBJECTIVE</b>To understand adiponectin, leptin, insulin and ghrelin levels in preterm colostrum and mature milk and their influence on the growth and development of the premature infant.</p><p><b>METHOD</b>The study subjects were divided into two groups: preterm group and control group. Specimens of colostrum and mature milk on 42nd day after delivery were collected, the general situation of maternal and infants growth parameters at birth and at postnatal 42 days were recorded. Leptin, adiponectin, insulin and ghrelin levels in colustrum and mature milk were determined and compared.</p><p><b>RESULT</b>A total of 128 mother-infant pairs were involved. There were 128 specimens of colostrums (80 from preterm group, 48 from control group) and 94 specimens of mature milk(50 from premature group, 44 from control group). The levels of colostrum, mature milk adiponectin, leptin, and insulin were not significantly different between the 2 groups; ghrelin levels in colostrum and mature milk of premature group were significantly lower than those in control group (P = 0.038), adiponectin and leptin levels in colostrum were higher than those of the mature milk (P < 0.05), colostrum ghrelin levels were lower than those of mature milk (P < 0.05). Adiponectin, leptin, and ghrelin showed no significant difference between different gestational age groups ( ≤ 34 weeks group vs. > 34 weeks group). True insulin level of mature milk in 34 weeks group was higher than that of > 34 weeks group (29.3 vs. 21.6 mU/L, P = 0.045); true insulin level in colostrums in ≤ 34 weeks group was lower than that in mature milk (21.7 vs. 29.3 mU/L, P = 0.000). Adiponectin levels in colostrum and 42 days weight gain were negatively correlated (r = -0.362, P = 0.025) . Insulin level in mature milk had a negative correlation with birth weight (r = -0.319, P = 0.029) . Ghrelin levels in colostrum and birth weight, length, head circumference, head circumference on 42(nd) day were positively correlated (r = 0.271,0.261,0.360, P < 0.05); weight, length at 42(nd) day and ghrelin levels showed borderline positive correlation (P = 0.050, 0.058).</p><p><b>CONCLUSION</b>Many bioactive hormones in milk might participate in the regulation of suitable growth after birth. Premature birth affects hormone levels in breast milk. Breast feeding is very important in preterm infants.</p>
Subject(s)
Female , Humans , Infant , Infant, Newborn , Male , Adiponectin , Birth Weight , Physiology , Breast Feeding , Colostrum , Chemistry , Gestational Age , Ghrelin , Infant Nutritional Physiological Phenomena , Infant, Premature , Insulin , Leptin , Milk, Human , Chemistry , Weight Gain , PhysiologyABSTRACT
Objective To determine the clinical characteristics of neonatal asymmetric crying facies and to review the latest progress in clinical research of this condition. Methods Clinical and laboratory data of a case of neonatal asymmetric crying facies syndrome admitted to Peking Union Medical College Hospital in March, 2013 was reported. Clinical charateristics, chromosome abnormalities, treatment and prognosis of neonatal asymmetric crying facies reported in China were analyzed, and pertinent literatures in China Knowledge Resource Integrated Database and CQVIP Database were reviewed. Results Eighteen Chinese reports on this syndrome were retrieved and 48 patients, 31 males and 17 females including our patient, were analyzed. Twelve patients had neonatal asymmetric crying facies and 36 patients had neonatal asymmetric crying facies syndrome. Anomalies in these children included malformations of the heart (26 cases, 72.2%), ear (11 cases, 30.6%), gastrointestinal tract (4 cases, 11.1%), cleft palate (2 cases, 5.6%) and fingers (2 cases, 5.6%). Standard chromosome analysis in three studies was normal. In one case, chromosome 22q11.2 microdeletion was not found using flucrescence in situ hyloridization analysis. There were few studies with long-term follow-up in China. Conclusions Neonatal asymmetric crying facies are complicated with a high rate of other malformations. Identification of associated malformations and close follow-up are required, and intervention should be carried out earlier so as to ensure a good outcome.
ABSTRACT
Objective To explore the effect of fortified human milk feeding on growth,metabolism and complications of premature infants during hospital stay.Methods Totally,148 premature infants of gestational age ≤36 weeks and birth weight ≤1800 g,admitted to NICU of Peking Union Medical College Hospital between January 1st,2009 and December 31st,2012,were retrospectively enrolled and divided into two groups.Infants fed predominantly (＞50％) with human breast milk,combined with human milk fortification (HMF) formula when breast milk was insufficient during hospital stay,were named HMF group (n =73),and those fed exclusively with premature formula were called premature formula feeding group (PF group,n =75).Data of infants on growth,metabolism and incidence of various complications were compared between the two groups.Clinical data were expressed with mean± standard deviation or median and quartiles [M(P25,P75)].Statistical analysis was performed with t-test,x2 test or non-parameter test.Results Among the 148 infants included,there was no significant difference in gestational age,birth weight,head circumference,length at birth,time for regaining birth weight,SGA at birth,neonatal respiratory distress symdrome,intraventricular hemorrhage (over grade Ⅲ) and asphyxia rate between HMF and PF group(all P＞0.05).Infants of the HMF group showed shorter duration of parenteral nutrition [18 d(14 d,25 d) vs 24 d (18 d,31 d),Z=-2.950,P=0.003],smaller age to achieve 120 ml/(kg · d) through enteral feeding [16 d(12 d,23 d) vs 22 d (16 d,30 d),Z=-2.895,P=0.004],smaller age to achieve total energy intake of 120 kcal/(kg · d) [11 d(8 d,15 d) vs 14 d (10 d,18 d),Z=-2.392,P=0.017] than those of the PF group.Medical cost during hospital stay in the HMF group was significantly less than in the PF group [RMB:47 078 yuan(30 802 yuan,67 039 yuan) vs 58 400 yuan (38 166 yuan,82 737 yuan),Z=-1.970,P=0.049].The time for initial feeding,rate of feeding intolerance,daily weight gain after regaining birth weight,weekly increase of body length and head circumference,weight,body length and head circumference at discharge,proportion of small for gestational age infants at discharge,z scores of both birth weight and weight at discharge showed no significant difference (all P＞ 0.05).The level of blood alkaline phosphates before discharge in HMF group was significantly higher than that of the PF group [(347.7±149.4) U/L vs (288.6±108.8) U/L,t=2.570,P=0.011].None of the other biochemical indicator showed any statistical difference.The incidence of sepsis in the HMF group was slightly lower than that in the PF group [11.0％ (8/73) vs 20.0％ (15/75)] without significant difference (x2 =2.30,P＞ 0.05),neither the morbidity of retinopathy of premature,chronic lung disease,necrotizing enterocditis of newborns (all P＞0.05).Conclusions HMF for premature infants may ensure the same growth pattern as those fed by premature formula,and it also can accelerate the enteral feeding process,reduce the incidence of sepsis and decrease the medical cost during hospital stay.