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Objective:To evaluate the clinical value of microprobe endoscopic ultrasonography in the diagnosis and treatment of children with protuberant lesions in the upper gastrointestinal tract.Methods:A retrospective study was performed to analyze the clinical data of children who underwent microprobe endoscopic ultrasonography for treating protuberant lesions in the upper gastrointestinal tract in the Department of Gastroenterology, Jinan Children′s Hospital from January 2018 to June 2021.The endoscopic ultrasound characteristics of children with protuberant lesions in the upper gastrointestinal tract were summarized and compared with the pathological results.Results:Microprobe endoscopic ultrasonography was performed in 29 children.Ectopic pancreas was found in 12 cases (41.4%), Brunner gland hyperplasia in 4 cases (13.8%), cysts in 3 cases (10.3%), duodenum accessory nipple in 3 cases (10.3%), extragastric compression in 2 cases (6.9%), lymphoma in 2 cases (6.9%), gastric duplication malformation in 1 case (3.4%), stromal tumor in 1 case (3.4%) and leiomyoma in 1 case (3.4%). According to the results of microprobe endoscopic ultrasonography, 15 cases with protuberant lesions were treated by deep biopsy and handled under endoscope.The tissue was checked by pathological examination.The microprobe endoscopic ultrasonography diagnosis of 14 cases were in accordance with their pathological diagnosis[93.3% (14/15)].Conclusions:Microprobe endoscopic ultrasonography can effectively diagnose and differentiate protuberant lesions in the upper gastroi-ntestinal tract of children, so it can be used to guide the clinical treatment under endoscope.Microprobe endoscopic ultrasonography is a safe and reliable treatment for children.
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Organ transplantation is the primary effective treatment for end-stage organ failure. Donor-derived infection (DDI) is significantly associated with the incidence of infection and mortality of the recipients after organ transplantation. Improvement of donor screening technology and early prevention and treatment can improve the safety of transplantation. In this article, the pathogenic characteristics of DDI bacterial infection, fungal infection, viral infection and parasitic infection were summarized, and the research progress upon the prevention and treatment were briefly introduced, aiming to provide reference for reducing DDI.
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OBJECTIVE@#To explore the clinical characteristics and molecular basis for a Chinese boy affected with jaundiced skin and liver disease.@*METHODS@#The patient was subjected to clinical examination and laboratory tests. Genomic DNA of the patient and his parents was extracted and analyzed by using next generation sequencing (NGS). Suspected mutations were analyzed with bioinformatic software and verified by Sanger sequencing.@*RESULTS@#The patient had jaundice in his eyes and skin. Serum bilirubin was elevated along with hepatomegaly. Next generation sequencing showed that the patient has carried c.18C>A(p.C6X) and c.2556delA mutations in the MRP2 gene, which were respectively inherited from his father and mother.@*CONCLUSION@#The missense mutation c.18C>A and frameshift mutation c.2556delA probably account for the disease. NGS has provided a powerful tool for the diagnosis of rare genetic diseases including Dubin-Johnson syndrome.
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Humanos , Masculino , Povo Asiático , DNA , Sequenciamento de Nucleotídeos em Larga Escala , Icterícia Idiopática Crônica , MutaçãoRESUMO
Children′s esophageal stenosis is mainly benign stenosis. Esophageal foreign bodies and corrosion are common causes of esophageal stenosis in children requiring emergency management. Endoscop￣ic treatment of esophageal stricture includes endoscopic balloon dilatation,endoscopic radial incision,medical treatement,endoscopic stenting and so on. According to the cause of the stenosis,the nature of the lesion and the morphological structure of the lesion,formulating appropriate endoscopic treatment strategy are important for therapeutic effect and reducing the incidence of complications.
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OBJECTIVE To identify potential mutations in five infants with neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD). METHODS The SLC25A13 gene was analyzed by next-generation sequencing. Suspected mutations were confirmed by PCR and Sanger sequencing in the probands and their parents. Impact of novel mutations was predicted with PolyPhen-2 software. RESULTS All neonates have harbored mutations of the SLC25A13 gene. Eight mutations were discovered, which included two novel mutations (c.1357A>G and c.1663dup23). All parents were found to be carriers of the mutations. CONCLUSION Mutations of the SLC25A13 gene probably underlie the NICCD among the five patients, among which 851del4 and 1638-1660dup were the most common ones. This has enriched the spectrum of SLC25A13 mutation in association with NICCD.
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Objectives To explore the clinical features of allergic colitis and the expression of eosinophil cationic protein (ECP) in intestinal mucosa in infant and young children. Methods The clinical data of 24 cases of allergic colitis treated from September 2011 to February 2014 were analyzed retrospectively. Immunohistochemical staining was used to detect expressions of ECP in intestinal mucosa in 24 cases of allergic colitis, gastric and duodenal mucosa in 16 cases of helicobacter pylori infection and proximal normal intestinal mucosa in 18 cases of postoperative resection of congenital megacolon, and the results were compared. Results In the 24 subjects (15 males and 8 females) with allergic colitis,. they were infants except for 1 subject, and 20 subjects were <6 months old. All of them had bloody stool, in which there were 15 cases of diarrhea, 1 case of eczema and 3 cases of drug allergy. The endoscopic lesions were mainly showed in the sigmoid colon (12 cases) and the rectum (11 cases). The most common manifestations were mucosal erythema (21 cases), pox like nodules (18 cases), erosions (3 cases), and ulcers (3 cases). Histopathological findings were eosinophilic infiltration of the mucosa. The number of eosinophils in intestinal mucosa was 42(30~60)in patients with allergic colitis whose ECP was positive,18(15~23)in patients with Helicobacter pylori infection and 25.5 (14~35) in patients with congenital megacolon children, and the differences are statistically significant mong three groups (H=28.14,P<0.001). Conclusions Allergic colitis is more common in infants and young children. The main endoscopic findings are mucosal erythema and eruption like nodules. In addition, the increase of ECP positive eosinophils in intestinal mucosa is the characteristic manifestation of allergic colitis.
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Objectives To explore the clinical features of allergic colitis and the expression of eosinophil cationic protein (ECP) in intestinal mucosa in infant and young children. Methods The clinical data of 24 cases of allergic colitis treated from September 2011 to February 2014 were analyzed retrospectively. Immunohistochemical staining was used to detect expressions of ECP in intestinal mucosa in 24 cases of allergic colitis, gastric and duodenal mucosa in 16 cases of helicobacter pylori infection and proximal normal intestinal mucosa in 18 cases of postoperative resection of congenital megacolon, and the results were compared. Results In the 24 subjects (15 males and 8 females) with allergic colitis,. they were infants except for 1 subject, and 20 subjects were <6 months old. All of them had bloody stool, in which there were 15 cases of diarrhea, 1 case of eczema and 3 cases of drug allergy. The endoscopic lesions were mainly showed in the sigmoid colon (12 cases) and the rectum (11 cases). The most common manifestations were mucosal erythema (21 cases), pox like nodules (18 cases), erosions (3 cases), and ulcers (3 cases). Histopathological findings were eosinophilic infiltration of the mucosa. The number of eosinophils in intestinal mucosa was 42(30~60)in patients with allergic colitis whose ECP was positive,18(15~23)in patients with Helicobacter pylori infection and 25.5 (14~35) in patients with congenital megacolon children, and the differences are statistically significant mong three groups (H=28.14,P<0.001). Conclusions Allergic colitis is more common in infants and young children. The main endoscopic findings are mucosal erythema and eruption like nodules. In addition, the increase of ECP positive eosinophils in intestinal mucosa is the characteristic manifestation of allergic colitis.
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[Objective] To investigate the mesenchymal stem cells (MSC) in treating acute lung injury (ALI) via ALI mouse model.[Methods] By monoclonal antibody Anti-GD2 of specific antigen ganglioside (GD2) only expressed on MSC as a carrier,new fluorescent molecule probe were synthesized through covalently coupling Anti-GD2 and fluorescent group CyDye mono-reactive NHS Esters (Cy7).Synthetic Anti-GD2-Cy7 and MSC were labeled by the specific binding of antigen and antibody in vitro.Total 84 balb/c male mice were selected and randomly selected 48 mice were divided into three groups:sham group (n =16),MSC+ ALI group (n =16),NS + ALI group (n =16).The lung histopathology and scores,lung W/D ratio and permeability of lung microvasculature were examined at 24 h,48 h after ALI mouse model.Other 36 mice were randomly divided into three groups:normal group (n =12),sham group(n =12),MSC +ALI group(n =12).Labeled MSC-GD2-Cy7 were transplanted into MSC+ALI group and sham group mice via tail vein injection.At 30 min,1 d,3 d,and 7 d post-MSC-GD2-Cy7 injection,the mice were sacrificed after anesthesia and then the lung was removed.Excised lung was detected on small animal fluorescent imager.[Results] Contrast to NS+ ALI group,the lung histopathology and scores,lung W/D ratio and permeability of lung microvasculature of MSC +ALI group were more greatly improved at both 24 h and 48 h.Fluorescent results showed that the signal intensity in thc lung of MSC +ALI group was significantly higher than that of sham group at each time point [(3.37 ± 0.02)× 10-4 vs (2.05 ± 0.04) × 10-4 scaled counts/s;(35.54 ± 0.47)× 10-4 vs (25.29 ± 1.48) × 10-4 scaled counts/s;(11.17 ± 0.75)×10-4 vs (6.09 ± 0.62)× 10-4 scaled counts/s;(3.10 ± 0.14) vs (0.00 ± 0.00)× 10-4 scaled counts/s;all P ＜ 0.05].[Conclusion] Our study showed that a proportion of cells migrated into normal and injured lungs 30 min after cell transplantation,and the cells started to recruit and largely gather in injured lungs at day 1 and persisted to day 7,these results suggest that MSC possess the ability to home into injured tissues.
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Objective To investigate the cause,prevention and treatment of intra-abdominal hemorrhage after liver transplantation. Methods Clinical data of 82 patients undergoing liver transplantation were retrospectively analyzed. All participants were divided into the intra-abdominal hemorrhage (n =12)and control groups (n =70). Preoperative parameters including age,model for end-stage liver disease (MELD)score,prothrombin time (PT),prothrombin time international normalized ratio (PT-INR),fibrinogen (FIB),activated partial thromboplastin time (APTT),platelet (Plt) were statistically compared between two groups. Intraoperative hemorrhage volume,cold ischemia time of donor liver, anhepatic phase time and operation time were also compared between two groups. Postoperatively,the mortality rate was compared between two groups. Results Among 82 patients,1 2 (1 5%)presented with intra-abdominal hemorrhage and required twice surgical hemostasis. In the intra-abdominal hemorrhage group,4 cases (33%)died,and 8 (1 1%)died in the control group. No statistical significance was documented between two groups (P>0. 05 ). Age,MELD score,PT-INR, FIB,APTT and PLT did not significantly differ between two groups (all P>0. 05 ). Compared with patients in the control group,those in the intra-abdominal hemorrhage group yielded significantly more blood loss intraoperatively,longer operation time and longer cold ischemia time of donor liver (all P<0. 05 ). Anhepatic phase time did not significantly differ between two groups (P>0. 05 ). Conclusions After liver transplantation,intra-abdominal hemorrhage is associated with longer cold ischemia time of donor liver,more intraoperative blood loss and longer operation time. In order to decrease the incidence of postoperative intra-abdominal hemorrhage,coagulation function should be completely corrected prior to surgery and the surgical skills should also be enhanced.
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Objective To investigate the application effect of nasojejunal feeding tube nutrition in patients with severe traumatic brain injury. Methods The clinical data of 54 patients with severe traumatic brain injury admitted to the Department of Surgical Critical Care Medicine,the Third Affiliated Hospital,Sun Yatsen University between June 2012 and December 2014 were analyzed retrospectively. They were divided into either a nasojejunal feeding tube nutrition support group (nasojejunal group,n = 26)or an asogastric feeding tube nutrition support group (asogastric group,n = 28)according to the different ways of enteral nutrition. All patients began to receive nasal feeding whole protein preparations (enteral nutritional emulsion,TPF-D)from the second day after admission to intensive care unit (ICU). The time to reach the enteral nutrition support target,the time of parenteral nutritional support,nutritional index (albumin and hemoglobin),the time admission to ICU,and the incidences of infection and gastrointestinal complications in both groups were observed. Results (1)According to the body weight to calculate calorie demand, the nasojejunal group reaching the time of enteral nutrition support target was faster than that of the asogastric group (3. 0 ± 0. 8 d vs. 7. 7 ± 2. 5 d). There was significant difference between the 2 groups (P 0. 05). Conclusion Nasojejunal feeding tube nutrition support may be faster to achieve the target of enteral nutrition supports and shorten the time in ICU.
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Objective To summarize the treatment experience of sepsis after liver transplantation.Methods The clinical features and treatment methods of 1 patient developing sepsis after liver transplantation, who was admitted and treated in the Surgical Intensive Care Unit of the Third Affiliated Hospital of Sun Yat-sen University in September 201 4,were retrospectively studied.The interpretation of International Guidelines for Management of Severe Sepsis and Septic Shock (SSC Guidelines)and relevant literature were reviewed.Results One male patient at the age of 50 years old developed high fever and decrease of blood pressure at 1 d after liver transplantation,and was diagnosed as septic shock.The symptoms were relieved after the appropriate treatment like goal-directed fluid resuscitation,anti-infection and blood purification,etc.And the patient was discharged in stable conditions.Conclusions It is easy to develop infection after liver transplantation and the fatality rate of sepsis caused by infection is high.Once the sepsis occurs,clinicians must perform early goal-directed therapy and bundle therapy according to the SSC Guidelines positively,and select the appropriate drugs according to the pathogen culture results in order to reduce the fatality rate.
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Objective To explore the clinical characteristics of eosinophilic gastroenteritis. Methods The clinical data of 2 children with eosinophilic gastroenteritis was retrospectively analyzed. Results Eosinophilia was found in both cases and path-ological examination indicated eosinophil infiltration in intestinal mucosa. The clinical symptoms were improved after hypoaller-genic diet, amino acid formula and anti-allergy treatment. Conclusions Eosinophilic gastroenteritis is characterized by eosino-phil infiltration with unknown pathogenic factor leading the treatment of eosinophilic gastroenteritis lacking of sound evidence.