Objective To analyze the causal relationship between gut microbiota and tic disorder based on Mendelian randomization (MR). Methods A total of 196 known microbiota (9 phyla, 16 classes, 20 orders, 32 families, and 119 genera) in the human intestinal microbiota dataset downloaded from the MiBioGen database were selected as the exposure factors, and the dataset of tic disorder (finn-b-KRA_PSY_TIC) containing 172 patients and 218620 controls was downloaded from the genome-wide association study database as the outcome variable. Inverse variance weighted was used as the main analysis method, and the causal relationship between gut microbiota and tic disorder was evaluated using odds ratio (OR) and its 95% confidence interval (CI). Horizontal pleiotropy was tested by MR-Egger intercept and MR-PRESSO global test, heterogeneity was assessed by Cochran’s Q test, and sensitivity analysis was performed by leave-one-out method. Results Inverse variance weighted results showed that the Family Rhodospirillaceae [OR=0.398, 95%CI (0.191, 0.831), P=0.014], Order Rhodospirillales [OR=0.349, 95%CI (0.164, 0.743), P=0.006], and Parasutterella [OR=0.392, 95%CI (0.171, 0.898), P=0.027] had negative causal relationships with tic disorder. The Genus Lachnospira [OR=8.784, 95%CI (1.160, 66.496), P=0.035] and Candidatus Soleaferrea [OR=2.572, 95%CI (1.161, 5.695), P=0.020] had positive causal relationships with tic disorder. In addition, MR-Egger intercept and MR-PRESSO global test showed no horizontal pleiotropy, Cochran’s Q test showed no heterogeneity, and leave-one-out sensitivity analysis showed the results were stable. Conclusions A causal relationship exists between gut microbiota and tic disorder. The Family Rhodospirillaceae, Order Rhodospirillales, and Parasutterella are associated with a decreased risk of tic disorder, while the Genus Lachnospira and Candidatus Soleaverea can increase the risk of tic disorder.
摘要:目的:总结十二指肠间质瘤的诊断及外科手术体会。方法:回顾分析1999年~2008年收治的25例十二指肠间质瘤患者的临床资料。结果:临床表现最多见为黑便(14/25)，其次为右上腹不适(11/25)，腹块被(2/25)，无明显症状者(2/25)。术前诊断采用上消化道钡餐造影、CT、B超、胃镜或十二指肠镜、超声内镜检查。25例均手术治疗,其中胰十二指肠切除6例,局部切除18例,组织活检术+胃肠吻合1例。术后随访5~96个月,1、3、5年生存率为95.4%、85.5%和67.3%。结论:综合CT、胃肠道钡餐造影、消化内镜可使大部分十二指肠间质瘤术前得到确诊。手术方式依据肿瘤部位、大小而定,局部切除应选择正确重建方式。Abstract: Objective: To investigate the diagnosis and surgery treatment of duodenal gastrointestinal stromal tumors(GIST).Methods: The clinical data of 25 patients with GIST from 1999 to 2008 were analyzed retrospectively.Results: The most common symptoms of duodenal GIST were melena(14/25), as well as abdominal pain(11/25),abdominal mass, absence of symptoms(2/25). We performed the diagnosis by upper gastrointestinal radiography, gastroscopy, endoscopic ultrasonography and CT scan. All the 25 patients underwent surgical resection, of which 6 with pancreaticoduodenectomy, 18 with local resection, 1 with tissue biopsy and stomach intestinal anastomosis. With 5 to 96 months followup after operation, 1, 3 and 5year survival rates were 95.4%, 85.5% and 67.3%. Conclusion: Preoperative diagnosis of most of GIST was dependent on CT scan, upper gastrointestinal radiography and gastroscopy. The choices of surgical procedures are mainly determined by the location and size of the tumors, local excision should choose the correct way to rebulid alimentary tract.
Objective To investigate the effect of mesenteric lymphatic duct liagtion and glutamine enteral nutrition on intestine and distant organs in intestinal ischemia/reperfusion injury. Methods Forty male SD rats undergoing gastrostomy were randomly assigned into 5 groups (n=8): sham operation group, normal enteral nutrition group, normal enteral nutrition+lymphatic duct ligation group, glutamine group and glutamine+lymphatic duct ligation group. Sham operation group only received laparotomy after 7 days of full diet, the other four groups were subjected to 60 min of intestinal ischemia after 7 days of enteral nutrition, and the two lymphatic duct ligation groups were plus mesenteric lymphatic duct ligation. The original nutrition continued 3 days after reperfusion. Intestinal permeability was detected on day 1 before reperfusion, day 1 and 3 after reperfusion. Intestinal morphology was observed, endotoxin, D-lactate and diamine oxidase levels in serum, and apoptotic index in lung tissue were detected on day 3 after reperfusion. Results The intestinal permeability in each group was significantly increased on day 1 after reperfusion (Plt;0.05), and which in normal enteral nutrition+lymphatic duct ligation group and glutamine+lymphatic duct ligation group were significantly decreased on day 3 after reperfusion (Plt;0.05). The mucosal thickness and villus height of ileum and mucosal thickness of jejunium in glutamine+lymphatic duct ligation group were significantly higher than those in other groups (Plt;0.05), and villus height of ileum in glutamine group was higher than that in normal enteral nutrition group (Plt;0.05); those morphology indexes in normal enteral nutrition+lymphatic duct ligation group were higher than those in normal enteral nutrition group, but there was no statistical signification (Pgt;0.05). Apoptosis index of lung tissue in lymphatic duct ligation groups was significant lower than that in no-ligation groups (Plt;0.05). Levels of endotoxin, D-lactate, and diamine oxidase in lymphatic duct ligation groups had downward trends compared with no-ligation groups, but there was no statistical signification (Pgt;0.05). Conclusions Intestinal ischemia/reperfusion injury of rats can cause intestinal permeability increase, bacterial endotoxin translocation and systemic inflammatory response. Mesenteric lymphatic duct ligation and glutamine enteral nutrition intervention can weak lung tissue damage, increase thickness of intestinal mucosa, maintain intestinal barrier function, reduce endotoxin translocation and attenuate systemic inflammatory response. Enteral nutrition with glutamine was better than normal enteral nutrition.
【摘要】目的比较胃肠机械吻合与传统手工吻合对术后并发症的影响，探讨机械吻合的安全性问题。 方法对我院1999年1月至2003年12月期间收治的932例行Billroth Ⅱ式胃肠吻合术患者的资料进行回顾性分析，了解其术后并发症的发生情况。 结果行机械吻合的392例中出现术后并发症8例（吻合口漏7例，梗阻1例），其发生率为2.04%； 而使用传统手工吻合的540例中出现术后并发症44例（吻合口漏28例，出血4例，梗阻12例），其发生率为8.15%，明显高于前者（P＜0.01）。 结论胃肠机械吻合较传统手工吻合更为安全。
Objective To observe the effect of glutamine （Gln） on intestinal permeability after surgery of children, also its influence on the plama level of interleukin-2（IL-2）, endotoxin and synthesize of protein through a random nutrition trial. Methods Twenty children suffered from congenital heart disease were divided into Gln group and control group with random number table, 10 cases in each group. They were all given isonitrogenous and isocaloric total paraenteral nutrition after 24 h postoperatively. In Gln group the Dipeptiven [-N （2）-L-alanyl-Lglutamine] was used with 2 ml/kg · 24h additionly. Before operation, 24h and 96 h after operation, intestinal permeability, serum level of endotoxin, IL-2, C-reaction protein, prealbumine were measured. Results Intestinal permeability increased in 24 h after cardiac surgery in two groups, while the concentration of endotoxin also increased, 96 h after surgery the intestinal permeability recovered, but the endotoxin level did not decrease in control group （P〈0. 01）. Conclusion Utilization of Gln can improve immune suppression, elevate the IL-2 level, decrease the endotoxin concentration, alleviate the infection, but has no effect on the protein synthesis after congenital cardiac operation of children.
ObjectiveTo investigate the specific CT findings of high-risk gastrointestinal stromal tumors (GISTs). MethodsCT findings of 24 patients with high-risk GISTs from August 2009 to March 2014 proved by surgery and pathology were retrospectively reviewed. ResultsTwelve of the high-risk GISTs were from the stomach, 11 from the small intestine (5 from duodenum, 4 from jejunum, and 2 from ileum), and 1 from the rectum. The biggest transverse diameter of the tumor was between 2.5 and 15.0 cm, and 2 were less than 5 cm and 22 of them were over 5 cm. The tumors appeared as irregular in 20 cases, and with indefinite boundary in 21 cases. Twenty-four tumors showed different levels of necrosis and cystic change, 15 showed ulcer, 2 showed perforation with effusion and pneumatosis, and 3 showed calcification. The enhancement of lesion was mostly moderately to markedly inhomogeneous. High-risk small intestinal stromal tumors had more significant enhancement and vessels. Hepatic metastasis in 3 cases was detected. ConclusionCT features of HRGISTs can be found with certain characteristics, which may contribute to the diagnosis.
With the popularization of digestive endoscopy in children, colonoscopy has been widely used. As the basis of digestive endoscopy, bowel preparation directly affects the diagnosis and treatment results of colonoscopy. Compared with adults, the functioning of important organs of children is immature, and their ability of cognition, communication and tolerance are weak. Their structure of the digestive tract is also significantly different in different ages. However, there have been no existing evidence-based guidelines on bowel preparation for digestive endoscopy of Chinese children. Therefore, it is important to develop evidence-based guidelines for bowel preparation combined with the clinical practice in China. In order to provide guidance and decision-making basis for Chinese pediatricians, we collaborated with multidisciplinary experts, based on existing evidence, adopted the grading of recommendations assessment, development and evaluation (GRADE) approach, followed the Reporting Items for Practice Guidelines in Healthcare (RIGHT) to develop this guideline for bowel preparation related to the diagnosis and treatment of children's digestive endoscopy.
ObjectiveThe aim of this current meta-analysis is to evaluate the efficacy and safety of selective surgery after colonic stenting versus emergency surgery for acute obstructive colorectal cancer.MethodsThe studies published from January 1, 2000 to July 31, 2018 were searched from Pubmed, Embase, Cochrane Library, CNKI, Wanfang database, and VIP database. RevMan 5.3 software was used for data analysis.ResultsA total of 21 studies were included in this meta-analysis. Compared to emergency surgery, selective surgery after colonic stenting had significant lower mortality rate [OR=0.44, 95% CI was (0.26, 0.73), P<0.05], permanent stoma rate [OR=0.46, 95% CI was (0.23, 0.94), P<0.05], complication rate [OR=0.47, 95% CI was (0.35, 0.63), P<0.05], and wound infection rate [OR=0.40, 95% CI was (0.25, 0.65), P<0.05）], but had significant higher primary anastomosis rate [OR=3.30, 95% CI was (2.47, 4.41), P<0.05] and laparoscopic surgery rate [OR=12.55, 95% CI was (3.64, 43.25), P<0.05]. But there was no significant differences between the two groups as to anastomotic leak rate [OR=0.86, 95% CI was (0.48, 1.55), P>0.05].ConclusionsSelective surgery after colonic stenting can be identified in a reduced incidence of mortality rate, complication rate, permanent stoma rate, and wound infection rate, and also can increase primary anastomosis rate and laparoscopic surgery rate. Thus, for acute obstructive colorectal cancer, selective surgery after colonic stenting is better than emergency surgery.
目的 推荐在胃底贲门癌和直肠上段癌切除的病例，如果无条件使用胃肠吻合器，在胃肠道重建吻合时应用三翼钳。方法 我科自1990年7月至1998年11月在胃底贲门癌和直肠上段癌切除术中，应用三翼钳进行胃肠道重建吻合共40例。其中全胃切除12例，近侧胃切除7例，直肠上段及部分乙状结肠切除21例。重建术式有： 食管空肠Roux-Y吻合5例，食管空肠袢式吻合2例，食管十二指肠吻合3例，横结肠间置代胃2例，食管胃吻合7例，乙状结肠、直肠盆内吻合21例。结果 全部手术除1例术后死于呼吸衰竭外均恢复顺利出院，无1例发生吻合口瘘。术后病理证实仅1例远侧直肠端可见癌细胞浸润，其它均证实两断端已切干净。随访半年内发生吻合口狭窄4例。结论 对胃底贲门癌或直肠上段癌切除的病例应用三翼钳技术有如下优点： ①食管或直肠切除长度符合肿瘤切除标准； ②吻合时两端对合整齐，且无张力； ③吻合端不出血，视野清晰； ④吻合操作时从容稳定； ⑤全层吻合确实，可靠； ⑥结肠吻合时可避免粪便污染。