Repair of finger pulp defect with free second toe pulp flap anastomosed with palmar vein / 中华显微外科杂志

Objective:To explore a surgical procedure of reconstruction finger pulp defect with free toes plantar flap with vascular anastomosis of toe-finger artery and plantar-palmar vein of finger.Methods:From April, 2018 to November, 2019, 15 patients with finger pulp defect were repaired by transplantation of the second toe pulp. In the procedure, the plantar vein of the toe and palmar vein of the finger were anastomosed. The artery and nerve of the toe and finger were anastomosed. The flap size was 0.8 cm×0.5 cm-1.0 cm×1.2 cm. The donor site was primary closed without deformity and other complication.Results:All flaps survived without vascular crisis. The mean followed-up period was 5.7 (range 3-9) months. The flaps had good blood flow, soft texture and good elasticity. Three months after surgery, touch sensation was partly recovered in some patients, and while pain was partly recovered in some patients 4-6 months after surgery. There was no deformity and other complication in the donor site. The donor sites of the foot had good appearance and normal walking function.Conclusion:The free toe plantar flap anastomosed with palmar vein can repair the digital pulp defect without dissecting the dorsal vein of digital (toe), and the donor sites can be primary sutured without deformity and other complications. The surgery operation is simple with satisfactory clinical effect.

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.

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>

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>

Using the Tabu-search-algorithm-based Bayesian network to analyze the risk factors of coronary heart diseases / 中华流行病学杂志

Under the available data gathered from a coronary study questionnaires with 10 792 cases,this article constructs a Bayesian network model based on the tabu search algorithm and calculates the conditional probability of each node,using the Maximum-likelihood.Pros and cons of the Bayesian network model are evaluated to compare against the logistic regression model in the analysis of coronary factors.Applicability of this network model in clinical study is also investigated.Results show that Bayesian network model can reveal the complex correlations among influencing factors on the coronary and the relationship with coronary heart diseases.Bayesian network model seems promising and more practical than the logistic regression model in analyzing the influencing factors of coronary heart disease.

Using the Tabu-search-algorithm-based Bayesian network to analyze the risk factors of coronary heart diseases / 中华流行病学杂志

Under the available data gathered from a coronary study questionnaires with 10 792 cases,this article constructs a Bayesian network model based on the tabu search algorithm and calculates the conditional probability of each node,using the Maximum-likelihood.Pros and cons of the Bayesian network model are evaluated to compare against the logistic regression model in the analysis of coronary factors.Applicability of this network model in clinical study is also investigated.Results show that Bayesian network model can reveal the complex correlations among influencing factors on the coronary and the relationship with coronary heart diseases.Bayesian network model seems promising and more practical than the logistic regression model in analyzing the influencing factors of coronary heart disease.

Clinical Observation of the Effects of Yinxing Damo Injection on Recovery of Neural Function after Hyper-tension Intracerebral Hemorrhage Minimally Invasive Surgery / 中国药房

OBJECTIVE:To observe therapeutic efficacy and safety of Yinxing damo injection for neural function recovery af-ter hypertensive intracerebral hemorrhage (HICH) minimally invasive surgery. METHODS:84 HICH patients were randomly di-vided into control group and observation group with 42 patients in each group. Both groups received CT guiding minimally inva-sive aspiration. Control group was given western medicine baseline therapy,such as dehydration and intracranial decompression, controlling blood pressure,preventing infection,alimenting never,symptomatic treatment. Observation group was additionally giv-en Yinxing damo injection 20 ml,ivgtt,bid. Treatment course lasted for 14 d. NIHSS score,GCS score and Fugl-Meyer motor function assessment scale score were comducted before and after treatment. The serum levels of NSE,serum C3,C4 and hs-CRP were determined in 2 groups before and after treatment. RESULTS:After treatment,the effective rate of observation group (85.71%)was better than that of control group(66.67%),with statistical significance(P<0.05);after treatment,NIHSS score, Fugl-Meyer score and GCS score of 2 groups were all better than before,the observation group was better than the control group, the levels of C3 and C4 in observation group were lower than in control group,with statistical significance(P<0.01). There was one case of allergic reaction that the patient can tolerate. Magnesium sulfate for external use was given,which did not affect the treatment. CONCLUSIONS:Yinxing damo injection could improve neurologic impairment,promote the recovery of patients and have good safety.

Clinical Efficacy of Edaravone Combined with Xingnaojing in the Treatment of Acute Severe Brain Injury / 中国药房

OBJECTIVE:To analyze the clinical efficacy of edaravone combined with Xingnaojing in the treatment of acute severe head injury.METHODS:72 patients with acute severe brain injury were collected from Nov.2008 to Nov.2009 and randomly divided into 2 groups.Treatment group were treated with edaravone and Xingnaojing and control group received edaravone alone.14 days after treatment,APACHE-Ⅱ and GCS score were collected.The overall efficacies of 2 groups were evaluated three months after suffering from injury.RESULTS:The GCS score of treatment group was increased while APACHE-Ⅱ score was decreased,there was statistical significance in difference between 2 groups(P