Fecal microbiota transplantation in the treatment of acute intestinal pseudo obstruction secondary to intracerebral hemorrhage: a case report and literature review / 中华危重病急救医学

Objective:To analyze the clinical effects of fecal microbiota transplantation (FMT) on the treatment of acute intestinal pseudo obstruction (AIPO) secondary to intracerebral hemorrhage.Methods:The clinical data of a patient with AIPO secondary to intracerebral hemorrhage who was admitted to Nanfang Hospital of Southern Medical University was analyzed. The flora compositon between donor and patient was compared, finding the changes of intestinal flora before and after FMT (day 0 and day 25).Results:The main clinical findings in the patient were serious bloating, expansion of the intestinal canal and intra-abdominal hypertension. A week of conventional therapy was not effective, and the symptoms became progressively worse, affecting respiratory function.The result of fecal flora suggested the intestinal microbiota dybiosis, so FMT was attempted. After FMT, the patient's gastrointestinal symptoms were significantly relieved, and there were no further episodes within 25 days. The new result of fecal flora showed that the flora colonizing the intestine was dominated by Akkermansia and Bifidobacterium, with a significant decrease in potential pro-inflammatory and gas-producing bacteria and an increased gut microbiota diversity. The results trended to be partly consistent with the donor at 25 days after FMT: at the phylum level, the relative abundance of Bacterioidetes, Vereucomicrobia, Firmicutes and Actinobacteria were increased while Proteobacteria was decreased; at the class level, the relative abundance of Verrucomicrobiae, Bacterioidia, Actinobacteria, Coriobacteriia and Clostridia were increased and Gammaproteobacteria was decreased; at the order level, the relative abundance of Bacterioidales, Verrucomicrobiales, Clostridiale, Coriobacteriales were increased and Betaproteobacteriales, Enterobacteriales were decreased; at the family level, the relative abundance of Bifidobacteriaceae, Akkermansiaceae, Ruminococcaceae were increased and Enterobacteriaceae was decreased; at the genus level, the relative abundance of Akkermansia, Bifidobacterium were increased and Escherichia-Shigella, Klebsiella were decreased. At 1-year follow-up, the patient lived with self-care and scored 5 points in Glasgow outcome scale (GOS). Conclusions:FMT may provide clinical benefit in treated patients with AIPO secondary to intracerebral hemorrhage, probably by regulating the intestinal microflora, and re-establishing proper intestinal barrier, to maintain intestinal homeostasis.

Analysis of correlation between clinical manifestations and immunofluorescence in children with primary IgA nephropathy / 中华实用儿科临床杂志

Objective:To investigate the correlation among clinical manifestations, pathological changes and immunofluorescence in children with primary IgA nephropathy (IgAN).Methods:The data of a total of 222 cases diagnosed with IgAN by the Department of Nephrology, Jiangxi Children′s Hospital in recent 10 years were collected for the analysis of clinical and pathological features and their correlation.Results:(1)Immunofluorescence showed that 115 cases (51.8%) IgA patients had only mesangial deposition, and 107 cases (48.2%) IgA patients had both mesangial deposition and capillary loop deposition.Most IgA patients (122 cases, 55.0%) had immunofluorescence intensity+ + .In IgA patients, IgM deposition was the most common [168 cases (75.7%)], followed by C 3 deposition [160 cases (72.1%)]. Patients with C 4 deposition were the least[7 cases (3.2%)]. (2) Hypertension were positively correlated with IgM, C 3 deposition, IgA deposition intensity and IgA with vascular loop deposition(all P<0.05). Hyperuricemia was positively correlated with IgM deposition, IgG deposition, C 3 deposition and IgA with vascular loop deposition(all P<0.05); hypoalbuminemia was negatively correlated with IgM deposition, C 3 deposition, IgA deposition intensity and IgA with vascular loop deposition(all P<0.05). Hypercholesterolemia were positively correlated with C 3 deposition and IgA with vascular loop deposition(all P<0.05). Urine protein quantification were positively related to IgM, IgG and IgA with vascular loop deposition (all P<0.05). The estimated glomerular filtration rate(eGFR)was negatively related to IgA with vascular loop deposition( P<0.05). (3) Lee′s grade were positively correlated with IgM and C 3 deposition, IgA deposition intensity and IgA with capillary loop deposition(all P<0.05). (4) Oxford type mesangial hypercellularity(M1)were positively correlated with C 3 deposition and IgA deposition intensity(all P<0.001). Endocapillary hypercellularity(E1)lesions were positively correlated with IgA deposition intensity and IgA with capilla-ry loop deposition(all P<0.05). Segmental glomerulosclerosis(S1)lesions had no correlation with immunofluorescence pathology.Tubular atrophy and interstitial fibrosis(T1)was positively correlated with IgG and C 3 deposition(all P<0.05). (5) There was no correlation between glomerulosclerosis and immunofluorescence pathology.Crescent was positively correlated with IgM deposition, IgG deposition, C 3 deposition, IgA deposition intensity and IgA capillary loop deposition(all P<0.05). Renal artery thickening was positively correlated with IgG deposition and IgA capillary loop deposition(all P<0.05). Conclusions:IgA intensity of + + and IgM deposition are most commonly found in immunofluorescence of children with primary IgAN.IgA patients with capillary loops or C 3 deposition have more severe clinical manifestations and light microscopy results.

Application value of non-invasive disturbance coefficient measurement on brain edema in patients with cerebral injury / 重庆医学

Objective To explore the application disturbance coefficient (DC) value of noninvasive brain edema monitoring in patients after traumatic brain injury.Methods A total of 54 cerebral injury patients were performed by non-invasive brain edema monitoring from June to November 2016.The essential information,DC,intracranial pressure (ICP),and 6-month-later glasgow outcome score (GOS) were collected.Results DC was negatively correlated with ICP (r=-0.779 5,P＜0.01),and it was positively correlated with glasgow coma scale (GCS) and GOS (r=0.667 5,P＜0.01;r=0.630 6,P＜0.01).The mean of DC with good prognosis patients was 106.99±4.09,and that of the poor prognosis patients was85.26±4.45,the difference was statistically significant (P＜0.05).Conclusion DC has a good clinical application value.

Clinicopathological characteristics and prognosis analysis of colorectal neuroendocrine neoplasms based on the data from domestic six medical centers / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the clinicopathological characteristics and their relationship with prognosis of colorectal neuroendocrine neoplasms (NEN).</p><p><b>METHODS</b>Medical records of 329 patients with colorectal NEN between June 2001 and July 2016 from 6 large scale centers in China were reviewed to investigate the clinicopathological characteristics and their relationship with prognosis of colorectal NEN.</p><p><b>RESULTS</b>(1) Colonic NEN: A total of 41 patients with colonic NEN were enrolled from The First Affiliated Hospital of Sun Yat-sen University(n=11), Sun Yat-sen University Cancer Center (n=15), Guangdong General Hospital (n=10), Sun Yet-san Memorial Hospital of Sun Yat-sen University (n=3) and Fudan University Shanghai Cancer Center (n=2). 41 cases, including 20 males and 21 females with a mean age of (58.7±4.7) years. Twenty-three colonic NEN originated in hindgut (23/41, 56.1%), and 20 patients were stage IIII( (20/41, 48.8%). Nine cases (22.0%) were neuroendocrine tumor(NET), 25(61.0%) were neuroendocrine carcinoma (NEC) and 7(17.1%) were mixed adenoendocrine carcinoma (MANEC). Six cases (14.6%) were G1 grade, 3(7.3%) were G2 grade and 32(78.1%) were G3 grade. Ulcerative or cauliflower-like tumors were the most common appearance under endoscopy (both 9/41, 22.0%). Thirty-three patients (80.5%) underwent surgery. During follow-up, 19 cases died and the 3-year survival rate was 46.1%. Multivariate analysis revealed that stage IIII( was an independent risk factor of poor prognosis (HR=3.871, 95%CI:1.342 to 11.167, P=0.012) in colonic NEN patients. (2) Rectal NEN: A total of 288 patients with rectal NEN were enrolled from The First Affiliated Hospital of Sun Yat-sen University(n=130), Nanfang Hospital of Southern Medical University (n=115) and Fudan University Shanghai Cancer Center (n=43). Two hundred and eighty-eight cases, including 181 males and 107 females with a mean age of (47.7±1.5) years. One hundred and ninety-seven patients were stage I((197/288, 68.4%). Of 288 rectal NEN cases, 267(92.7%) were NET, 20(7.0%) were NEC and 1(0.3%) was MANEC; 214(74.3%) were G1 grade, 53(18.4%) were G2 grade and 21(7.3%) were G3 grade. Submucosal tumor was the most common appearance under endoscopy(164/288, 56.9%). Most of the rectal NET G1/G2 tumors were submucosal(146/214, 68.2%;18/53,34.0% respectively) while most of G3 tumors were cauliflower-like (14/21,66.7%). A total of 175 patients (60.8%) underwent endoscopic therapy, while 96 patients(33.3%) underwent surgery. During follow-up, 12 cases died and 3-year survival rate was 94.0%. Multivariate analysis revealed that poor differentiation as NEC or MANEC(HR=8.919, 95% CI:1.911 to 41.637, P=0.005) and stage III( to IIII((HR=10.304, 95%CI:1.772 to 59.916, P=0.009) were independent risk factors of poor prognosis in rectal NEN patients.</p><p><b>CONCLUSIONS</b>The clinicopathological manifestations of rectal NEN and colonic NEN are quite different. Rectal NEN are more common with better differentiation and has better prognosis than colonic NEN.</p>

Establishment of risk model for predicting the progression within 1 year of patients with gastric neuroendocrine neoplasms and its value of prediction / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To establish the risk model for predicting the progression within 1 year of patients with gastric neuroendocrine neoplasms(gNEN) and to evaluate its value of prediction.</p><p><b>METHODS</b>Clinical data of 127 gENE patients with histologically comfirmed sporadic gNEN from January 1999 to February 2015 in Nanfang Hospital of Southern Medical University(n=63) and The First Affiliated Hospital of Sun Yat-sen University(n=64) were collected retrospectively. Twenty-five patients without follow-up were excluded, so a total of 102 cases were enrolled in the analysis. Tumor size enlargement, lesion number increase, recurrence after resection of primary tumor and emergence of tumor metastasis were defined as tumor progression. Patients were divided into progression group (above definitions occurred within 1 year, n=56) and non-progression group (above definitions did not occur within 1 year, n=46). Logistic regression analysis was used to identify the influencing factors of progression within 1 year and the regression equation was acquired, then the probability of progression within 1 year of gNEN patients was obtained to predict the grading: grade I(: the probability of tumor progression within 1 year was < 25.0%; grade II(: this probability was from ≥25.0% to <50.0%; grade III(: this probability was from ≥50.0% to <75.0%; grade IIII(:this probability was ≥75.0%. Spearman correlation analysis was used to study the correlation between predictive grading and the occurrence of disease progression in patients with gNEN NET within 1 years. The ROC curve of different prediction methods was drawn, then the area under the curve(AUC), sensitivity and specificity were calculated and compared.</p><p><b>RESULTS</b>Multivariate regression analysis showed that tumor size(OR=1.048, 95%CI:1.014-1.083, P=0.005), Ki-67 index(OR=2.045, 95%CI:1.261-3.316, P=0.004), and surgical resection of the primary lesion(OR=0.074, 95%CI:0.011-0.497, P=0.070) were independent influencing factors of the progression of gNET within 1 year. The regression equation was as below: P(Y)=1/[1+ e -(-0.934+0.047a+0.715b-2.597c)]. (a: tumor size, b: Ki-67 grading, c: undergoing the surgical resection of the primary lesion). Prediction grading was based on regression equation: 28 cases (29.2%) belonged to grade I(, 9 cases (9.4%) to grade II(, 24 cases (25.0%) to grade III(, and 35 cases (36.5%) to grade IIII(. The probability of progression within 1 year of patients in grade I(, II(, III( and IIII( was 10.7% (3/28),5/9, 58.3%(14/24), and 91.4%(32/35) respectively, with significant difference (χ=41.236, P=0.000). Prediction grading was positively correlated with the occurrence of tumor progression in gNEN patients within 1 year(r=0.644, P=0.000). The AUC of prediction grading to predict the progression of gNEN within 1 year was 0.857, while the sensitivity was 85.2% and the specificity was 69.0%. DeLong method was used to compare the AUC values of prediction grading, Ki-67 grading and TNM staging. Comparison result revealed that the predictive value of prediction grading was not significantly different with that of TNM staging (P=0.303), but was better than that of Ki-67 grading (P=0.006).</p><p><b>CONCLUSIONS</b>Our grading standard can objectively and accurately reflect the probability of progression within one year in gNEN patients. The later the grading, the higher the probability of progression within 1 year is for gNEN patients.</p>

Evaluation of glucocorticoid-induced osteoporosis in childhood kidney diseases by quantitative ultrasound / 中华实用儿科临床杂志

Objective To observe the glucocorticoid-induced osteoporosis (GIOP) in children with kidney diseases by quantitative ultrasound (QUS), and to analyze its influencing factors.Methods The tibia/radius bone mineral density(BMD) was checked obtained in 67 cases with childhood kidney diseases treated with glucocorticoid by QUS,BMD was measured in children over the age of 12 by dual-energy X-ray absorptiometry(DXEA) ,and BMD was measured with QUS consistency and different stages of osteoporsis were compared.The clinical data of gender, age,body mass index(BMI) ,administration duration and daily dosage of glucocorticoid were analyzed.The association between the duration of glucocorticoid use,and daily dosage of glucocorticoid and the different degrees of BMD was analyzed by Logistic regression analysis.Results Sixty-seven patients(male 45 ,female 22) were divided into 4 groups according to the reference standard of Asian children BMD data provided by Sunlight Company:the normal BMD group(41 cases), the mild osteoporosis group (18 cases), moderate osteoporosis group (5 cases), and severe osteoporosis group (3 cases).Both QUS and DEXA were highly correlated with BMD in patients measured (P ＞ 0.05).The duration of glucocorticoid treatment and daily dosage of glucocorticoid in 3 abnormal BMD groups were all significantly longer and larger than those of the normal BMD group (all P ＜ 0.05).Correlation analysis showed that BMI was positively correlated with the bone mass of the tibia(r =0.395 ,P ＜ 0.01).The duration of glucocorticoid treatment and daily dosage of glucocorticoid were negatively correlated with those of radius BMD(r =-0.474,-0.381 ,all P ＜ 0.01).Analysis showed that both the duration of glucocorticoid,and the daily dosage of glucocorticoid were the risk factors for GIOP.Conclusions QUS is a better method for evaluating of BMD and diagnosing of GIOP compared with DEXA in children.The daily dosage of glucocorticoid and the duration of glucocorticoid treatment are both the risk factors for GIOP.

Podocalyxin expression in renal tissues and correlation with the number of urinary podocytes in children with Henoch-Sch(o)nlein purpura nephritis / 中南大学学报(医学版)

Objective:To analyze the podocalyxin (PCX) expression in the kidney and the number of urinary podocytes in different pathological grades of Henoch-Sch(o)nlein purpura nephritis (HSPN),and to determine whether the number of urinary podocytes reflects the renal damage in HSPN.Methods:Fifty-six children diagnosed with HSPN in our hospital were enrolled in the study and classified into 4 groups by renal pathology:grade Ⅱ (Ⅱa+Ⅱb) (n=10),grade Ⅲ (Ⅲa+Ⅲb) (n=21),grade Ⅳ (n=16),and grade Ⅴ (n=9).Four kidney autopsy specimens without histomorphologic lesions and 8 urine samples from healthy children served as controls.With immunofluorescence assay,the PCX expression in 4 normal renal tissues and in the renal tissues of the 56 HSPN children was detected and quantitatively analyzed.Positive rate and the number of urinary podocytes were detected in the 8 healthy children and 56 HSPN children.Results:In the renal tissues of the normal control group and grade Ⅱ (Ⅱa+Ⅱb) HSPN group,the PCX expression was complete.The percentage of the PCX positive area out of the total glomerular area in the renal tissues of 2 groups had no significant difference (P＞0.05).In the renal tissues of grade Ⅲ (Ⅲa+Ⅲb),Ⅳ,and Ⅴ HSPN groups,the PCX expression showed various degrees of loss,decreasing in turn from grade Ⅱ (Ⅱa+Ⅱb),Ⅲ (Ⅲa+Ⅲb),Ⅳ to Ⅴ,with significant differences between each group (P＜0.01).For HSPN with grade Ⅲ (Ⅲa+Ⅲb) or higher,positive PCX expression was found in the urine,suggesting the presence of enough podocytes in the urine.The percentage of fluorescence positive area out of the total glomerular area of PCX in the renal tissues was negatively correlated with the total number of urinary podocytes (r=-0.637,P＜0.01).Conclusion:Podocyte injury plays a certain role in the pathological progression of HSPN.The urinary detection ofpodocytes can reflect the degrees of pathological damage in HSPN.