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Inflammatory bowel disease (IBD) is a chronic non ‑ specific intestinal inflammatory disease. Spondyloarthritis (SpA) is a chronic inflammatory disease that occurs in the axial skeleton and surrounding joints, and is one of the most common extraintestinal manifestations of IBD. The main pathophysiologic mechanism of IBD accompanied with SpA involves the "gut‑joint axis" hypothesis, and dysbiosis of gut flora plays a key role in explaining the pathologic connection of the "gut‑joint axis" in patients with IBD accompanied with SpA. This article reviewed the progress of research on gut flora and IBD accompanied with SpA.
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【Objective】 To study the incidence and risk factors of bone loss in ulcerative colitis （UC） patients and understand the characteristics of fecal microbiota so as to provide new ideas for the mechanism and new treatment of bone loss in UC patients. 【Methods】 We chose adult UC patients from Department of Gastroenterology in The First Affiliated Hospital of Xi’an Jiaotong University as research subjects. We collected the patients’ related data and divided them into two groups. Then we analyzed the data to understand the incidence of and risk factors for bone loss in the UC patients. Furthermore， we collected the feces of the patients. Based on high-throughput sequencing technology， we analyzed the fecal microbiota’s diversity， species composition and metabolic pathways to understand the differences between the two groups. 【Results】 In the 24 UC patients， the incidence of bone loss was 62.5%. The incidence of bone loss was significantly higher in chronic relapsing UC patients than in initial patients， and the incidence of bone loss increased with the severity of UC. Serum calcium and 25-hydroxyvitamin D concentrations in the normal group were significantly higher than those in the bone loss group. β diversity significantly differed and the species composition of fecal microbiota significantly differed at the levels of phylum， class， order， family and genus between the two groups. Compared with the normal group， the expression abundance of Shigellosis， Geraniol degradation， Steroid hormone biosynthesis pathways was significantly increased in the bone loss group. 【Conclusion】 There is a high incidence of bone loss in UC patients. The clinical type， disease severity， serum calcium and 25-hydroxyvitamin D concentrations are related to bone loss in these patients. In the bone loss group， the diversity of fecal microbiota， especially the proportion of probiotics， is reduced， and the abundance of many disease-related metabolic pathways is significantly upregulated.
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Inflammatory bowel disease (IBD) has been considered gradually as a systemic disease that could affect many extra-intestinal organs or tissues and cause a variety of extra-intestinal manifestations or complications. Bone loss is one of the common extra-intestinal complications of IBD. IBD patients have an increased risk of osteopenia, osteoporosis and fracture than healthy people. The mechanisms of bone loss in IBD patients include deficiency of calcium and vitamin D, immune, inflammation, dysbiosis of gut microbiota, endocrine hormone, and drug effects. In addition to life style adjustment, nutritional therapy and anti-osteoporosis drugs, immunosuppressant, biological agents, probiotics and fecal microbiota transplantation might be expected to become effective treatments for bone loss in IBD patients. This article reviewed the mechanism and treatment prospect of bone loss in patients with IBD.
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Ulcerative colitis (UC) is a chronic, progressive and heterogeneous inflammatory bowel disease. Strategies for management of UC are shifting from simple control of symptoms toward clinical/patient-reported outcome remission (resolution of rectal bleeding and diarrhea/altered bowel habit) and endoscopic remission (mucosal healing), with the final aim of blocking the progression of the disease and promising better long-term outcomes. The therapeutic target for UC is a comprehensive one that combines subjective and objective goals as well as short-term and long-term goals. In order to achieve these goals, it is necessary to assess the severity of the disease first and predict the risk of UC progression, and then provide early intervention and individualized treatment for high-risk patients. The treatment should be timely tailored by close monitoring. Although the clinical implementation of UC treat-to-target (T2T) approach remains challenging, T2T strategy is the key-point for improving the quality of disease management.
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Objective@#To evaluate combined robotic and endoscopic surgery in the third space for gastric submucosal tumors(SMTs).@*Methods@#Combined surgery in 4 patients were compared with 19 patients who underwent laparoscopic wedge resection between Aug 2017 and Feb 2018.@*Results@#R0 resection was achieved in all combined surgery patients. The operation time was longer (112±29 )min vs. (93±11 ) min (t=2.338, P<0.05), but less blood loss, (11±6)ml vs.(59±6)ml (t=15.102, P<0.01). In combined surgery group, there was a larger tumor over resected tissue percentage, 65.4%±28.2% vs.22.8%±19.6% ( t=3.680, P<0.05). Combined surgery group patients were with earlier first breaking wind (3±1.4) d vs.(4.1±0.9) d (t=2.026, P>0.05), and shorter hospital stay (6.5±1.3) d vs.( 8.5±0.6) d (t=4.902, P<0.01), but a little higher hospitalization costs(57 651±10 097)rmb vs.(42 620±5 086)rmb (t=4.508, P<0.01). There were no major postoperative complications occurred in neither groups, nor tumor recurrences after 3-month follow-up.@*Conclusion@#Combined robotic and endoscopic surgery in the third space for submucosal gastric tumors is a novel operation with short operation time, less blood loss and good result.
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Objective To evaluate combined robotic and endoscopic surgery in the third space for gastric submucosal tumors (SMTs).Methods Combined surgery in 4 patients were compared with 19 patients who underwent laparoscopic wedge resection between Aug 2017 and Feb 2018.Results R0 resection was achieved in all combined surgery patients.The operation time was longer (112 ±29)min vs.(93 ±11) min (t =2.338,P＜0.05),but less blood loss,(11 ±6)ml vs.(59 ±6)ml (t =15.102,P＜ 0.01).In combined surgery group,there was a larger tumor over resected tissue percentage,65.4％ ± 28.2％ vs.22.8％ ± 19.6％ (t =3.680,P ＜ 0.05).Combined surgery group patients were with earlier first breaking wind (3 ± 1.4) d vs.(4.1 ± 0.9) d (t =2.026,P ＞ 0.05),and shorter hospital stay (6.5 ± 1.3) d vs.(8.5 ±0.6) d (t =4.902,P＜0.01),but a little higher hospitalization costs(57 651 ± 10 097) rmb vs.(42 620 ± 5 086) rmb (t =4.508,P ＜ 0.01).There were no major postoperative complications occurred in neither groups,nor tumor recurrences after 3-month follow-up.Conclusion Combined robotic and endoscopic surgery in the third space for submucosal gastric tumors is a novel operation with short operation time,less blood loss and good result.
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Objective To study the skills and effects of endoscopic retrograde appendicitis therapy (ERAT) in treating patients with uncomplicated acute appendicitis .Methods We enrolled 21 patients with suspected acute appendicitis who then underwent emergent ERAT between October 2014 and January 2015 .The data of treatment were collected and the operative skills and effects of ERAT were analyzed . Results ERAT was completed successfully in all the patients ,resulting in a success rate of 100% .Mean operation time of ERAT was (49 .7 ± 18 .2) min and mean hospital stay was (3 .3 ± 1 .6)d .Cannulation of the appendix lumen was the most critical step of ERAT ,and cannulation time [(5 .7 ± 4 .9)min , P< 0 .05] was shortened significantly by the use of LoopTip guidewire . Fourteen patients with intraluminal appendicoliths (7 of massive appendicoliths , 4 of sand‐like appendicoliths and 3 of sand‐like appendicoliths with luminal stenosis ) underwent endoscopic lithotomy successfully with balloon or basket ,with the success rate of 100% .One patient who presented perforation after appendicolith removal by basket was cured with conservative treatment .Appendix stent was inserted ,then pulled out after 1 week in 9 patients ,while no complaint or complication of the stent was observed .Operation time of ERAT shortened with the increase of case number .Conclusion ERAT is an effective and safe therapy for treating patients with uncomplicated acute appendicitis .The high success rate and safety of ERAT will be achieved by selecting suitable instruments for cannulation and appendicolith removal ,deciding suitable indications for stenting ,and accumulating of operative cases .
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Objective To study the effect and safety of endoscopic retrograde appendicitis therapy (ERAT) in treating patients with uncomplicated acute appendicitis. Methods Patients with uncomplicated acute appendicitis were enrolled and divided into ERAT group and LA group received laparoscopic appendectomy. Then compare treat-ment condition, complications and follow-up of the two groups. Results ERAT were completed successfully in all the patients in ERAT group, while one patient underwent a reversion to open appendectomy for technical difficulties in LA group. Mean operative time was (49.7 ± 18.2) min for ERAT group and (68.9 ± 25.9) min for LA group (P <0.05). Fever relief time (1.3 ± 0.5) d, WBC normalization time (2.0 ± 0.9) d, mean bed time (0.1 ± 0.2) d and mean hospital stay (3.3 ± 1.6) d for ERAT group were significantly lower than LA group (P <0.05). 14 patients with intra-luminal appendicoliths (7 of massive appendicoliths, 4 of broken appendicoliths and 3 of broken appendicoliths with luminal stenosis) underwent endoscopic lithotomy successfully in ERAT group, resulting in a success rate of 100.00%. One patient presented perforation after ERAT was cured with conservative treatment. During the follow-up of at least 1/2 year, the rate of recurrence was 10.00% in ERAT group. 1 patient (5.00%) underwent LA at the 5th month after ERAT during the follow-up. Conclusion ERAT is an effective and safe therapy in treating patients with uncomplicated acute appendicitis with advantages of minimal invasiveness and quick recovery. Uncomplicated acute appendicitis with appendicoliths and/or luminal stenosis are the most suitable indications for ERAT.
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This study was aimed to clone the GGPS (geranylgeranyl pyrophosphate synthase) gene from Lepidium apetalum, to analyze its sequence, and to express the protein in E.coli expression system. Specific PCR cloning primers were designed for GGPS gene from Lepidium apetalum according to the full-length sequence from a previous transcriptome sequencing project. PCR amplification was performed with this primer pair on a leaf cDNA template. TA cloning, sequencing and sequence analysis were performed.GGPS gene from Lepidium apetalum was expressed in the E.coli expression system. The results showed that the full-lengthGGPS cDNA from Lepidium apetalum was 1 146 bp coding a protein of 381 amino acids. The LaGGPS protein had an isoprenoid synthase domain. According to a phylogenetic tree constructed with multiple alignment of GGPS protein sequences from various plant species, GGPS protein from Lepidium apetalum was the closest to Arabidopsis thaliana and Sinapis alba. The prokaryotic expression vectorpET-32a-LaGGPS was also constructed successfully. The protein was expressed in E.coli BL21 strain. It was concluded that the cloning and prokaryotic expression of LaGGPS gene provided a foundation for a follow-up research of its function with protein purification and activity analysis.
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<p><b>OBJECTIVE</b>To observe the changes in subgingival microflora before and after Er:YAG laser treatment on diabetic patients with periodontitis, and to compare with the subgingival microflora of chronic periodontitis.</p><p><b>METHODS</b>Subgingival plaque of 13 pairs of teeth (26 sites) was selected from type 2 diabetic patients at pretreatment, one month post-treatment, and three months post-treatment. Subgingival plaque was also obtained from 11 cases of moderate to severe chronic periodontitis with similar severity of periodontitis. The DNA of the subgingival plaque samples was extracted. Whole bacterial 16S rDNA gene fragments separated by denaturing gradient gel electrophoresis. Specific DNA bands were then chosen for retrieval and sequencing.</p><p><b>RESULTS</b>The gene sequencing results of the special DNA bands of subgingival plaque samples show that the pathogenic bacteria of both diabetic periodontitis and simple chronic periodontitis were Prevotella intermedia and Tannerella forsythia, respectively. The composition of the subgingival microflora before and after laser treatment changed. Some DNA bands, including that of Tannerella forsythia, disappeared or weakened one month after treatment. A new strip appeared, which belonged to Actinomyces sp.</p><p><b>CONCLUSION</b>The profiles of the subgingival microflora changed after treatment, and one month was indicated as an important stage. Er:YAG laser may have an important function in delaying microflora recolonization.</p>
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Adulto , Humanos , Bactérias , Periodontite Crônica , Placa Dentária , Diabetes Mellitus Tipo 2 , Lasers de Estado Sólido , PeriodontiteRESUMO
Objective To summarize our experience of laparoscopic surgery for complex choledochal cysts (type Ⅳ-A). Methods The clinical data of 65 children of choledochal cyst undergoing laparoscopic choledochal cyst resection were retrospectively reviewed from 2002 to 2009 in our institute.Among those type Ⅳ-A cyst was found in 16 patients. Hepaticojejunostomy was performed using a Roux-en-Y jejunal loop after extrahepatic cyst excision and ductoplasty. Results Laparoscopic procedures were successfully performed in 16 patients with type Ⅳ-A cysts. The stenotic segment was splited or excised and a wide hepaticojejunostomy was completed at the porta hepatis in 8 patients with a stricture extending to the level of common hepatic duct. The constrictive confluence of the bilateral hepatic duct was incised and the bi-ductal cystojejunostomy was achieved at the bifurcation in 4 cases. A septum was found at the orifice of right hepatic duct and was excised through the hilar stoma in 2 cases. A downstream stricture of the left hepatic duct was incised from the hilum to the dilated segment along the lateral wall in 2 patients, so that a long intrahepatic cystojejunostomy was completed in an oblique course. Postoperative complications developed in 2 cases including temporary bile leakage in one case and anastomotic stricture in another. The intrahepatic cysts were remarkably reduced in size during the follow-up. Conclusions With the magnified laparoscopic view, the radical resection of extrahepatic cyst and correction of the intrahepatic bile ductal stenosis can be easily performed. Laparoscopic hepaticojejunostomy and/or intrahepatic cystojejunostomy is effective and safe for children with type Ⅳ-A choledochal cysts.
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Objective To assess whether the G870A polymorphism of cyclin D1 (CCND1)was associated with individual susceptibility to gastric cancer in China. Methods Case-control study of 214 individuals was conducted, including 108 controls (non ulcerative dyspepsia) and 106 cases of gastric cancer. The polymorphism analysis of CCND1 A/G was performed in blood samples by PCR-RFLP method. Results The frequency of GG genotype was 19.8% and 7.4% in patients with gastric cancer and controls, respectively. The risk for gastric cancer in patients homozygous (GG) for CCND1 genotypes was 3.5 times higher in comparison with patients carrying AA genotypes (P＜0.05, OR =0.281). Furthermore, the stratification analyses showed that the male, elderly (≥60 years) or H. pylori infected gastric cancer patients who carrying GG genotype were more susceptible to gastric cancer compared with those carrying AA or GA genotype. Conclusion GG genotype is associated with increased susceptibility to gastric cancer in high risk area of Xi'an.
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Objective To explore the method, safety, and efficacy of laparoscopic intracorporeal sutured gastrojejunostomy.Methods Three children with gastric outlet obstruction underwent laparoscopic sutured gastrojejunostomy from May to September 2005. Of them, two patients with pyloric stenosis secondary to peptic ulceration received a concomitant highly selective vagotomy. A suitable segment of jejunum was lifted over the transverse colon and apposed to the gastric antrum. A continuous 4/0 suture was conducted at the seromuscular layer making the two organs together. Then the stomach and adjacent jejunum were incised with an ultrasonic scalpel. A side-to-side gastrojejunostomy was performed with full-thickness continuous suture of gastric and jejunal wall followed by anterior interrupted suture of seromuscular layers. Results All the intracorporeal sutured gastrojejunostomies were completed successfully under laparoscope. The operating time was 135, 150, and 180 min, respectively. The postoperative hospital stay was 6 d. There was no surgical complications. Postoperative follow-up at 8, 10, and 12 months, respectively, showed that all patients had normal diet and nutriture. Conclusions Laparoscopic sutured gastrojejunostomy is a safe and feasible technique, with advantages of minimal invasion, rapid recovery, and good cosmetic outcomes.
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Objective To evaluate the effectiveness of laparoscopic sutured anastomosis of the duodenum for children with congenital duodenal obstruction (CDO). Methods From February 2003 to July 2008,13 patients (aged 2 days to 12 years) with CDO underwent laparoscopic sutured anastomosis of the duodenum in our hospital. Among the cases,7 were newborns,3 were infants,and 3 were children. Laparoscopy showed duodenal atresia or stenosis in 7 cases,annular pancreas in 2 cases,superior mesenteric artery syndrome (SMAS) in 3 cases,and preduodenal portal vein in 1 case. Results Excepting the patient with preduodenal portal vein,who was converted to mini-laparotomy for duodenojejunostomy,all the cases were treated by laparoscopy. In 5 cases,the diaphragm was excised partially after a vertical incision was made at the anterior part of the duodenum,and then a transverse suture was completed; the 2 patients with duodenal atresia and the 2 with annular pancreas received diamond-shaped side-to-side duodenoduodenal anastomosis under a laparoscope; and the 3 cases of SMAS were treated by Roux-en-Y duodenojejunostomy. The mean operation time in this series was (97.0?18.2) min (range,75 to 180 min). No intraoperative complications occurred. The patients started oral intake in 2 to 5 days after the surgery,and resume a normal diet in 7 to 9 days. Before being discharged from the hospital,upper gastrointestinal tract imaging showed no evidence of obstruction in the patients.A follow-up up to 6 months to 4 years were available in 11 patients,among which 8 were followed for more than 1 year. During the period,the patient developed well. Conclusions The laparoscopic sutured anastomosis of the duodenum is feasible and effective for children. It can be performed in neonates securely as an excellent minimally invasive treatment for congenital duodenal obstruction.
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Objective To explore the feasibility and efficacy of laparoscopic rectopexy with peritoneal strips for severe complete rectal prolapse (SCRP) in children. Methods From August 2004 to October 2008,6 patients (aged 2 to 6 years with a mean of 3.5) with SCRP were treated in our hospital. The clinical data of the patients were reviewed. Under the laparoscope,two L-shaped peritoneal strips with the pedicle were cut from the incrassated and slack peritoneum of the pelvic cavity on bilateral sites of the rectum,and then were folded and sutured with the lateral wall of the free rectum with the ends being stitched on the fascia in front of the sacral promontory to suspend the rectum. Afterwards,the incisal margin of the peritoneum was sutured together with the anterior wall of the rectum in order to embed the peritoneal strips and reconstruct the pelvic peritoneum. Results All of the 6 cases of laparoscopy were completed successfully with a mean operation time of (120?24) min (ranged from 95 to 210 min). The blood loss was less than 10 ml in all of the cases. The patients received a mean of 28-month follow-up (range,6 to 54 months),during the period,none of them had recurrence or abnormal bowel movement. Conclusions Laparoscopic rectopexy with peritoneal strips is an effective and satisfactory treatment for SCRP with minimal invasion,quick recovery and a low-recurrence rate.
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0.05).Compared to OA group,the patients in the LA group had shorters periods of absolute diet and hospital stay(P=0.000,P=0.000).Conclusions LA has less influence on the humoral immunity and protein metabolism in children.Meanwhile the procedure is minimally invasive,patients recover quickly and are discharged earlier after the operation.
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Objective To investigate the preventive effect of spironolactone on hepatic fibrosis. Methods Ninety SD rats were randomly divided into three groups. Control group consisted of 8 rats that , fed by normal food, were injected with peanut oil subcutaneously. Model group consisted of 42 rats whose liver fibrosis was induced by compound factors. Spiro nolactone-prevention group consisted of 40 rats that were given 100 mg?kg -1 spironolactone per day, by the same methods of making models as those of the model group. At the end of weeks 2, 4, 6 and 8, 8 rats were randomly taken out of model group and spironol actone group and then were sacrificed. The expressions of TGF- ? 1 , PDGF- BB and ? -SMA in hepatic tissues were detected with immunohistochemical met hods. Results The expressions of TGF- ? 1 , PDGF-BB a nd ? -SMA in spironolactone group decreased greatly than those in model gro up ( P