Clinical trial:Lactobacillus plantarum 299v(DSM 9843)improves symptoms of irritable bowel syndrome

AIM:To assess the symptomatic efficacy of Lactobacillus plantarum 299v(L.plantarum 299v)(DSM 9843) for the relief of abdominal symptoms in a large subset of irritable bowel syndrome(IBS) patients fulfilling the Rome Ⅲ criteria.METHODS:In this double blind,placebo-controlled,parallel-designed study,subjects were randomized to daily receive either one capsule of L.plantarum 299v(DSM 9843) or placebo for 4 wk.Frequency and intensity of abdominal pain,bloating and feeling of incomplete rectal emptying were assessed weekly on a visual analogue scale while stool frequency was calculated.RESULTS:Two hundred and fourteen IBS patients were recruited.After 4 wk,both pain severity(0.68 + 0.53 vs 0.92 + 0.57,P < 0.05) and daily frequency(1.01 + 0.77 vs 1.71 + 0.93,P < 0.05) were lower with L.plantarum 299v(DSM 9843) than with placebo.Similar results were obtained for bloating.At week 4,78.1 % of the patients scored the L.plantarum 299v(DSM 9843) symptomatic effect as excellent or good vs only 8.1 % for placebo(P < 0.01).CONCLUSION:A 4-wk treatment with L.plantarum 299v(DSM 9843) provided effective symptom relief,particularly of abdominal pain and bloating,in IBS patients fulfilling the Rome Ⅲ criteria.

Visual pathways involvement in clinically isolated syndrome in children

AIM: To investigate extent and nature of visual pathways involvement in children with clinically isolated syndrome(CIS).METHODS: Forty-seven patients(age 11-17y) with CIS, which later proved to be multiple sclerosis(MS)onset, and 30 controls underwent visual evoked potentials(VEP) investigation within 12 d from the appearance of the first signs of disease. Latency and amplitude of P100 peak were compared with normative data and between groups.RESULTS: In 58% patients, including those without signs of retrobulbar neuritis, significant slowing of conduction along the central visual pathways(P100latency lengthening) is seen. P100 amplitudes drop(signs of axonal damage) are registered less frequently(29% cases).CONCLUSION: The results indicate that visual pathways are often affected in the MS onset; mostly demyelination signs are seen. Despite MRI significance for MS diagnostic, VEPs proved to be still effective in early diagnosis of MS in children.

Advances in post intensive care unit care: A narrative review

As the treatment options,modalities and technology has grown,mortality in intensive care unit(ICU)has been on the decline.More and more patients are being discharged to wards and in the care of their loved ones after at times prolonged treatment,sometimes in isolation.These survivors have a lower life expectancy and a poorer quality of life.They can have substantial familial financial implications and an economic impact on the healthcare system in terms of increased and continued utilisation of services,the so-called post intensive care syndrome(PICS).But it is not only the patient who is the sufferer.The mental health of the loved ones and family members may also be affected,which is termed as PICS-family.In this review,we shall be reviewing the definition,epidemiology,clinical features,diagnosis and evaluation,treatment and follow up of PICS.We shall also focus on measures to prevent,rehabilitate and understand the ICU stay from patients’perspective on how to redesign the ICU,post ICU care needs for a better patient outcome.

Does the ratio of the carpal tunnel inlet and outlet cross-sectional areas in the median nerve reflect carpal tunnel syndrome severity?

Although ultrasound measurements have been used in previous studies on carpal tunnel syndrome to visualize injury to the median nerve, whether such ultrasound data can indicate the severity of carpal tunnel syndrome remains controversial. The cross-sectional areas of the median nerve at the tunnel inlet and outlet can show swelling and compression of the nerve at the carpal. We hypothesized that the ratio of the cross-sectional areas of the median nerve at the carpal tunnel inlet to outlet accurately reflects the severity of carpal tunnel syndrome. To test this, high-resolution ultrasound with a linear array transducer at 5–17 MHz was used to assess 77 patients with carpal tunnel syndrome. The results showed that the cut-off point for the inlet-to-outlet ratio was 1.14. Significant differences in the inlet-to-outlet ratio were found among patients with mild, moderate, and severe carpal tunnel syndrome. The cut-off point in the ratio of cross-sectional areas of the median nerve was 1.29 between mild and more severe（moderate and severe） carpal tunnel syndrome patients with 64.7% sensitivity and 72.7% specificity. The cut-off point in the ratio of cross-sectional areas of the median nerve was 1.52 between the moderate and severe carpal tunnel syndrome patients with 80.0% sensitivity and 64.7% specificity. These results suggest that the inlet-to-outlet ratio reflected the severity of carpal tunnel syndrome.

SURGICAL MANAGEMENT OF EHLERS-DANLOS SYNDROME:FIRST REPORT OF A PEDIGREE IN CHINA

OBJECTIVE: To describe a case of Ehlers-Danlos syndrome type IV and its pedigree in China. METHODS: Clinical materials of a case of Ehlers-Danlos syndrome type IV and a pedigree of 6 members within 4 generations were analyzed. Dilated internal jugular vein in the proband was removed by operation. The diagnosis, surgical treatment, and postoperative complications were retrospectively reviewed. RESULTS: Vessels of the proband in the pedigree were crisp and easily lacinated during the procedure of removing his internal jugular vein. Repeating postoperative hematomas were found though complete stanching was achieved during the operation. The patient was successfully recovered by promptly debridgement and needle sucking. The other 5 members of the pedigree all had the triads of Ehlers-Danlos syndrome. CONCLUSIONS: Though it was of extremely low morbidity rate, the high mortality rate and complication of Ehlers-Danlos syndrome deserve great attention during surgical management, especially in patients with Ehlers-Danlos syndrome type IV. Surgeons should be aware of the ponderance of its complications and combined diseases to avoid fatal intraoperative vascular lascination and incontrollable hemorrhage.

Magnetic Resonance Imaging in the Acquired Demyelinating Disorders： A Pediatric Cohort Study

Objective： Describing the characteristics of the MRI （magnetic resonance imaging） of patients with ADD （acquired demyelinating disorder） followed in a specialized pediatric clinic. Methods： Descriptive and retrospective study of the MRIs of a pediatric ADD cohort. The included images were acquired in machines with 1.5 or 3T magnets. Low-quality images were excluded. The radiological characteristics of the lesions were described using the 2010 Revised McDonald Diagnostic Criteria regarding localization, contrast enhancement and optic nerve alterations. Results： Twenty-three patients were included （55% female）. The mean age of the first clinical event was 7.7 years. Most common diagnosis was Clinically Isolated Syndrome （35%）, followed by Multiple Sclerosis （30%）, Neuromyelitis Optica （17%） and Acute Disseminated Encephalomyelitis （17%）. Mean time elapsed until diagnosis was 1.8 years. Follow-up MRIs of ADEM patients showed complete or partial resolution of lesions; MS lesions were mostly localized in the brain and four patients had contrast enhancement of lesions in their last available MRI. All NMO （neuromyelitis optica） patients had extensive spinal lesions, and two had optic neuritis. All patients with CIS （clinically isolated syndrome） had focal spinal lesions and evolved with radiologic improvement. Conclusions： ADEM and CIS patients＇ MRIs showed lesion reduction, while MS and NMO patients developed new lesions during follow-up.

Gene mutations and clinical phenotypes in Chinese children with Blau syndrome

The mutations of CARD15 gene and clinical features of Chinese patients with Blau syndrome were analyzed. We identified10 missense mutations, out of which five were new: R334 L, E383 D, R471 C, C495 R and D512 F. The rest of them, R334 W,R334Q, G481 D, M513 T and R587 C, have been reported previously. Among all the mutations, R334 W, R334 Q and C495 R had the highest frequency. Blau syndrome was found at early age after birth. It began with lepidic rash and symmetric polyarthritis and was phenotypically characterized by typical rash, arthritis, iridocyclitis and arteritis. Cardiac involvement was also found in Blau syndrome. In addition to nerve deafness, renal involvement, osteochondroma and central nervous system involvement were also found in our patients. Therefore, Chinese children with Blau syndrome have unique gene mutations and complicated clinical phenotypes. Pathologic examination and CARD15 mutation testing should be considered for diagnosis as early as possible for suspected patients.

Association among lifestyle, clinical examination, polymorphisms in CDH1 gene and Traditional Chinese Medicine syndrome differentiation of gastric cancer

OBJECTIVE:To explore the association among lifestyle,clinical examination,polymorphisms in CDH1 gene and Traditional Chinese Medicine(TCM)syndrome differentiation of gastric cancer(GC). METHODS:A hospital-based population of 387 GC patients was investigated in Jiangsu province.Relevant information regarding lifestyle and clinical examination were collected by a standard questionnaire.Four known single nucleotide polymorphisms(SNPs)in CDH1 were investigated by polymerase chain reaction-ligation detection reaction methods.Statistical analysis was conducted by SPSS 16.0 software.RESULTS:The results showed that meal duration and the status of glutamic pyruvic transaminase were significantly associated with TCM syndrome differentiation of GC(both P<0.05).None of the four SNPs in the E-cadherin(CDH1)gene achieved significant differences in their distributions among the nine syndrome types of GC(both P>0.05).However,significant differences were observed in rs13689 genotype distributions between several pairs of syndrome types of GC,suggesting that rs13689 is correlated with the syndrome differentiation of GC.CONCLUSION:Integrated analysis of lifestyle,clinical examination and CDH1 gene polymorphisms can contribute to a better understanding of the GC syndrome types and may improve the efficacy of interventions by stratifying disease according to TCM criteria.

Traditional Chinese Medicine Clinical Experience of the Treatment for Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a functional bowel disorder that includes abdominal pain or discomfort associated with defecation or a change in bowel habits with features of disordered defecation.This disease lacks morphological changes and biochemical abnormalities to explain the symptoms.

To Explore the Chinese Medicine Syndrome Types and Integrative Therapy from Clinical Relative Factors of Patients with Advanced Prostate Cancer

Current Situation and Problems of the Treatment in Advanced Prostate Cancer In recent years,the incidence of prostate cancer shows a rising trend in China with an increase of 70%and has been the first place in the growth rate of malignant tumor in the male reproductive system. Prostate cancer has become a serious threat to male senior’s health.Because of the application of

Clinical Profile and Significance of Mucocutaneous Lesions of Primary Sjogren＇s Syndrome： A Large Cross-sectional Study with 874 Patients

Background： Mucocutaneous lesions are common features of primary Sjogren＇s syndrome （pSS）, but only a few studies have focused on them. To demonstrate the profile ofmucocutaneous lesions ofpSS and further explore their potential clinical significance, we perfermed a cross-sectional study on 874 patients. Methods： Demographic data, clinical manifestations, and laboratory results of 874 pSS patients were collected. Patients were divided into two groups according to the presence of mucocutaneous lesions. Differences in primary symptoms and systemic impairments between the two groups were analyzed. Results of laboratory tests were also compared alter excluding those who had taken corticosteroid from both groups. One-year follow-up was done, and occurrences of various new complications were compared. Results： Among the 874 pSS patients, 181 patients had mucocutaneous lesions, accounting for 20.7%. Multiple mucocutaneous manifestations were displayed, and the top four most common types of lesions were purpuric eruptions （39.8%）, urticaria （23.8%）, Raynaud＇s phenomenon （14.9%）, and angular stomatitis （9.9%）. Incidences of pulmonary interstitial fibrosis, pulmonary bullae, leukopenia, and anemia were significantly higher among patients with mucocutaneous lesions （P 〈 0.05）. Increase in lgG and decrease in C4 among patients with mucocutaneous lesions displayed statistical significance after excluding patients from both groups who had taken corticosteroid （P 〈 0.05）. Alter one-year follow-up, patients with mucocutaneous lesions presented a slightly higher incidence of new complications compared to those without. Conclusions： Mucocutaneous manifestations ofpSS patients were common and diverse. Patients with mucocutaneous manifestations had more systemic damages, higher level of IgG, and lower level of serum C4, suggesting a higher activity of the primary disease.

Comparison of clinical course of patients with severe acute respiratory syndrome among the multiple generations of nosocomial transmission

Background Severe acute respiratory syndrome (SARS) is characterized by both an atypical pneumonia and efficient nosocomial transmissin. However,it remains unknown whether the infectivity and the virulence of the pathogen will change throughout the successive transmission. This study was conducted to compare the clinical features and management regimens of patients with SARS among the multiple generations from nosocomial transmission initiated by a super-spreader. Methods The clinical data of 84 epidemiologically-linked SARS patients from a hospital outbreak were retrospectively studied. All patients,in whom a clear-cut transmission generation could be noted,had a direct or indirect exposure to the index patient and the epidemic successively propagated through the multiple generations of cases within a short period of time. Results There were 66 women and 18 men with mean age of (29.2 ± 10.3) years in this cluster;and 96.4% of whom were health care workers. Detailed contact tracing identified 35 (41.7%) first-generation cases,34 (40.5%) second-generation cases,and 15 (17.8%) third-generation cases. No statistical differences among the multiple generations of transmission were found in terms of age,gender,incubation period and length of hospital stay. With the advanced transmission generations,the initial temperature lowered,the number of cases with dry cough decreased. There were no statistical differences in the peak temperature and duration of fever,other accompanying symptoms,leucopenia;however,the time from initial pulmonary infiltrates to radiographic recovery shortened ( P <0.05). No differences were found in maximum number of lung fields involved,duration from the onset of fever to the occurrence of pulmonary infiltrates and time from the initial pulmonary infiltrate to its peak among the multiple transmission generations ( P >0.05). No statistical differences were found in modes of oxygen therapy and sorts of antibiotics prescribed among the various transmission generations ( P >0.05);however, as with the advanced transmission generations,the number of cases prescribed with methylprednisolone,human γ-globulin,interferon-α,antiviral drugs (oral ribavirin or oseltamivir) increased ( P <0.05) and time from admission to starting these medication shortened ( P <0.05). Conclusions There is no evidence that SARS infection will evolve or transmit within a fashion that permits it to become less powerful throughout the successive transmission within a short time.

Clinical characteristics of macrophage activation syndrome secondary to systemic lupus erythematosus

Objective To investigate the clinical features of macrophage activation syndrome(MAS)associated with systemic lupus erythematosus(SLE).Methods The clinical data of 15 patients with SLE-induced MAS diagnosed in Peking Union Medical College Hospital from July

A retrospective clinical study of sixty-three cases with persistent inflammation immunosuppression and catabolism syndrome

Objective To study the clinical characteristics and prognosis of patients with persistent inflammation immunosuppression and catabolism syndrome(PICS)in ICU.Methods A total of 126 patients admitted to ICU(ICU stay of more than 10 days,age≥18 years)between January 2014 and December 2014 were retrospectively studied.Data were collected from electronic medical records including demographics,underlying disease。

Cultural drivers and health-seeking behaviours that impact on the transmission of pig-associated zoonoses in Lao People’s Democratic Republic

Pig rearing is an important income source in the Lao People’s Democratic Republic(PDR),with many smallholder farmers using traditional free-range pig production systems.Despite the potentially significant health risks posed by pig production regarding pig-associated zoonoses,information on the sociocultural drivers of these zoonoses is significantly lacking.This review summarises the existing sociocultural knowledge on eight pig-associated zoonoses suspected to be endemic in Southeast Asia:brucellosis,Q fever(Coxiella burnetii),trichinellosis,hepatitis E virus,leptospirosis,Japanese encephalitis,Streptococcus suis and Taenia solium taeniasis-cysticercosis.It summarises current knowledge on these diseases grouped according to their clinical manifestations in humans to highlight the propensity for underreporting.A literature search was conducted across multiple databases for publications from 1990 to the present day related to the eight pig-associated zoonoses and the risk and impact connected with them,with Lao PDR as a case study.Many of these pig-associated zoonoses have similar presentations and are often diagnosed as clinical syndromes.Misdiagnosis and underreporting are,therefore,substantial and emphasise the need for more robust diagnostics and appropriate surveillance systems.While some reports exist in other countries in the region,information is significantly lacking in Lao PDR with existing information coming mainly from the capital,Vientiane.The disease burden imposed by these zoonoses is not only characterised by morbidity and mortality,but directly impacts on livelihoods through income reduction and production losses,and indirectly through treatment costs and lost work opportunities.Other factors crucial to understanding and controlling these diseases are the influence of ethnicity and culture on food-consumption practices,pig rearing and slaughter practices,hygiene and sanitation,health-seeking behaviours and,therefore,risk factors for disease transmission.Published information on the knowledge,attitudes and beliefs of people regarding pig zoonoses and their risk factors is also extremely limited in Lao PDR and the broader Southeast Asian region.The need for more transdisciplinary research,using a One Health approach,in order to understand the underlining social determinants of health and their impacts on health-seeking behaviours,disease transmission and,ultimately,disease reporting,cannot be more emphasized.

A hospital outbreak of severe acute respiratory syndrome in Guangzhou,China

Objective To describe a hospital outbreak of severe acute respiratory syndrome (SARS) and summarize its clinical features and therapeutic approaches.Methods The outbreak started with a SARS patient from the community, and a total of 96 people (76 women and 20 men, mean age (29. 5±10. 3) years, 93. 8% of whom were health care workers) who had exposure to this source patient became infected in a short time. Clinical data in this cohort were collected prospectively as they were identified.Results (1) The incubation period ranged from 1 to 20 (mean: 5. 9±3. 5) days. The duration of hospitalization was (17. 2±8. 0) days. (2) The initial temperature was (38. 3±0. 6)℃, while the highest was (39. 2 ±0. 6)℃( P<0. 001), with fever duration of (9. 0±4. 2) days. (3) Other most common symptoms included fatigue (93. 8%), cough (85. 4%), mild sputum production (66. 7%), chills (55.2%), headache (39.6%), general malaise (35.4%) and myalgia (21.9%). (4) The radiographic changes were predominantly bilateral in the middle or lower lung zones. The number of affected lung fields was 1. 2±0. 8 on presentation, which increased to 2. 9 ?1. 4 after admission (P<0. 001). The interval from the beginning of fever to the onset of abnormal chest radiographs was (3. 5±2. 3) days, which increased in size, extent, and severity to the maximum (6. 7±3. 5) days later. The time before the lung opacities were basically absorbed was (14.9±7.8) days. (5) Leukopenia was observed in 67. 7% of this cohort. The time between the onset of fever and leukopenia was (4. 4±2. 3) days, with the lowest white blood cell count of (2. 80±0. 72)×10~9/L (6) The lowest arterial oxygen saturation was (94.8±3.1 )% with supplementary oxygen. (7) Antibiotical therapies included tetracyclines ( 91. 0%), aminoglycosides ( 83. 3%), quinolones (79. 2%); 18. 8% of the patients received a combination of tetracyclines and aminoglycosides, while 11. 5% received a combination of tetracyclines and quinolones, and 63. 5% received a combination of tetracyclines, aminoglycosides and quinolones. Vancomycin was used in 13. 5% of the patients. (8) 68. 8% of the patients were treated with methylprednisolones for a mean interval of (4. 9±2. 4) days. The initial dose was (67. 3±28. 2) mg/d and the maximal dose was (82. 4 ±30. 5) mg/d. (9) Human y-globulin, interferon-α, antiviral drugs (oral ribavirin or oseltamivir) were used respectively in 68.6%, 46.9% and 92.7% of the patients. (10) Ninety-five patients (99.0%) had a complete clinical recovery, and only 1 patient (1.0%) died. Conclusions SARS appears to be quickly infectious and potentially lethal among health care workers, characterized by acute onset and rapid progression, and mostly bilateral lung involvement on chest radiographs. Proper administration of glucocorticosteroids seems to be of some benefits. Antibiotics, human y-globulin, interferon-α, and antiviral drugs, although empirically, might be useful to shorten the clinical course.

Acquired immunodeficiency syndrome associated disseminated Penicillium Marneffei infection: report of 8 cases

Penicillinosis Marneffei （PSM） is a rare fungal disease caused by systemic infection of Penicillium Mameffei （PM）. Disseminated PSM is one of the most common opportunistic infections in patients with acquired immunodeficiency syndrome （AIDS） living in Southeastern region during the endstage of disease. Sporadic and individual cases have been reported recently in China and there appeared a tendency of increase of PM infections because of the increase of AIDS cases. To improve our understanding of this disease, we report here 8 cases of AIDS associated PSM.

Neurofilament light chain in demyelinating conditions of the central nervous system: a promising biomarker

Neurofilaments are the major structural proteins of the neuronal cytoskeleton and are classified according to molecular weight into heavy,intermediate,and light chains.They are released into the interstitial fluid and cerebrospinal fluid(CSF)as a consequence of axonal damage.In particular,the light chain(NfL)represents the most abundant and soluble subunit and has been demonstrated to be increased in the CSF of patients with inflammatory,degenerative,vascular,or traumatic injuries in correlation with clinical and radiological activity.Similar results have been obtained measuring serum NfL with high-sensitivity single-molecule array,which enables reliable and repeatable measurement of the low NfL concentrations in serum.In particular,CSF and serum NfL values are strongly correlated in patients with multiple sclerosis(MS)and have been demonstrated to be increased in patients with MS and clinically isolated syndromes(CIS)in accordance with clinical and radiological activity.NfL levels increase in patients with a recent relapse and seem to predict cognitive impairment,long-term outcome,and conversion of CIS to MS.The few available data on patients with other demyelinating diseases suggest that NfL levels are also increased in neuromyelitis optica spectrum disorders and related conditions in correlation with attack severity,suggesting that axonal damage may occur in these disorders.We herein report and discuss published data on the role of NfL as a possible predictor of disease activity,clinical outcome and treatment response in patients with demyelinating conditions of the central nervous system.