Efficacy of endoscopic therapy for gastrointestinal bleeding from Dieulafoy’s lesion

AIM: To investigate the endoscopic hemostasis for gastrointestinal bleeding due to Dieulafoy's lesion. METHODS: One hundred and seven patients with gastrointestinal bleeding due to Dieulafoy's lesion were treated with three endoscopic hemostasis methods: aethoxysklerol injection (46 cases), endoscopic hemoclip hemostasis (31 cases), and a combination of hemoclip hemostasis with aethoxysklerol injection (30 cases). RESULTS: The rates of successful hemostasis using the three methods were 71.7% (33/46), 77.4% (24/31) and 96.7% (29/30), respectively, with signif icant differences between the methods (P < 0.05). Among those who had unsuccessful treatment with aethoxysklerol injection, 13 were treated with hemoclip hemostasis and 4 underwent surgical operation; 9 cases were successful in the injection therapy. Among the cases with unsuccessful treatment with hemoclip hemostasis,7 were treated with injection of aethoxysklerol and 3 cases underwent surgical operation; 4 cases were successful in the treatment with hemoclip hemostasis. Only 1 case had unsuccessful treatment with a combined therapy of hemoclip hemostasis and aethoxysklerol injection, and surgery was then performed. No serious complications of perforation occurred in the patients whose bleeding was treated with the endoscopic hemostasis, and no re-bleeding was found during a 1-year follow-up. CONCLUSION: The combined therapy of hemoclip hemostasis with aethoxysklerol injection is the most effective method for gastrointestinal bleeding due to Dieulafoy's lesion.

Meckel's diverticulum bleeding diagnosed with magnetic resonance enterography:A case report

Although the introduction of double-balloon enteroscopy has greatly improved the diagnostic rate, definite diagnosis of Meckel's diverticulum far from the ileocecal valve is still impossible in most cases. We explored the role of magnetic resonance (MR) enterography in detecting bleeding from Meckel's diverticulum that can not be confirmed via double-balloon enteroscopy. This study describes a case of male patient with bleeding from Meckel's diverticulum diagnosed with MR enterography of the small intestine. No bleeding lesion was found via colonoscopy, anal enteroscopy, or oral colonoscopy. MR enterography of the small intestine revealed an occupying lesion of 3.0 cm in the lower segment of the ileum. The patient was transferred to the Department of Abdominal Surgery of our hospital for surgical treatment. During surgery, a mass of 3 cm × 2 cm was found 150 cm from the ileocecal valve, in conjunction with congestion and edema of the corresponding mesangium. Intraoperative diagnosis was small bowel diverticulum with bleeding. The patient underwent partial resection of the small intestine. Postopera-tive pathology showed Meckel's diverticulum containing pancreatic tissues. He was cured and discharged 7 d after operation. We conclude that MR enterography of the small intestine has greatly improved the diagnosis rate of Meckel's diverticulum, particularly in those patients with the disease which can not be confirmed via double-balloon enteroscopy.

Small intestinal vascular malformation bleeding:A case report with imaging findings

The small intestine is approximately 5-6 m long and occupies a large area in the abdominal cavity. These factors preclude the use of ordinary endoscopy and X-ray to thoroughly examine the small intestine for bleeding of vascular malformations. Thus,the diagnosis of intestinal bleeding is very difficult. A 47-year-old man presented at the hospital 5 mo ago with dark stool. Several angiomas were detected by oral approach enteroscopy,but no active bleeding was observed. Additionally,no lesions were detected by anal approach enteroscopy;however,gastrointestinal tract bleeding still occurred for an unknown reason. We performed an abdominal vascular enhanced computed tomography examination and detected ileal vascular malformations. Ileum angioma and vascular malformation were detected by a laparoscopic approach,and segmental resection was performed for both lesions,which were confirmed by pathological diagnosis. This report systemically emphasizes the imaging findings of small intestinal vascular malformation bleeding.

Endoscopic therapy for gastric stromal tumors originating from the muscularis propria

AIM:To explore endoscopic therapy methods for gastric stromal tumors originating from the muscularis propria.METHODS:For 69 cases diagnosed as gastric stromal tumors originating from the muscularis propria,three types of endoscopic therapy were selected,based on the size of the tumor.These methods included endoscopic ligation and resection(ELR),endoscopic submucosal excavation(ESE) and endoscopic full-thickness resection(EFR).The wound surface and the perforation of the gastric wall were closed with metal clips.Immunohistostaining for CD34,CD117,Dog-1,S-100 and smooth muscle actin(SMA) was performed on the resected tumors.RESULTS:A total of 38 cases in which the tumor size was less than 1.2 cm were treated with ELR;three cases were complicated by perforation,and the perforations were closed with metal clips.Additionally,18 cases in which the tumor size was more than 1.5 cm were treated with ESE,and no perforation occurred.Finally,13 cases in which the tumor size was more than 2.0 cm were treated with EFR;all of the cases were complicated by artificial perforation,and all of the perforations were closed with metal clips.All of the 69 cases recovered with medical treatment,and none required surgical operation.Immunohistostaining demonstrated that among all of the 69 gastric stromal tumors diagnosed by gastroscopy,12 cases were gastric leiomyomas(SMA-positive),and the other 57 cases were gastric stromal tumors.CONCLUSION:Gastric stromal tumors originating from the muscularis propria can be treated successfully with endoscopic techniques,which could replace certain surgical operations and should be considered for further application.

Endoscopic full-thickness resection for gastric submucosal tumors arising from the muscularis propria layer

AIM:To evaluate the efficacy,safety and feasibility of endoscopic full-thickness resection(EFR) for the treatment of gastric submucosal tumors(SMTs) arising from the muscularis propria.METHODS:A total of 35 gastric SMTs arising from the muscularis propria layer were resected by EFR between January 2010 and September 2013.EFR consists of five major steps:injecting normal saline into the submucosa;pre-cutting the mucosal and submucosal layers around the lesion;making a circumferential incision as deep as the muscularis propria around the lesion using endoscopic submucosal dissection and an incision into the serosal layer around the lesion with a Hook knife;a full-thickness resection of the tumor,including the serosal layer with a Hook or IT knife;and closing the gastric wall with metallic clips.RESULTS:Of the 35 gastric SMTs,14 were located at the fundus,and 21 at the corpus.EFR removed all of the SMTs successfully,and the complete resection rate was 100%.The mean operation time was 90 min(60-155 min),the mean hospitalization time was 6.0 d(4-10 d),and the mean tumor size was 2.8 cm(2.0-4.5cm).Pathological examination confirmed the presence of gastric stromal tumors in 25 patients,leiomyomas in7 and gastric autonomous nerve tumors in 2.No gastric bleeding,peritonitis or abdominal abscess occurred after EFR.Postoperative contrast roentgenography on the third day detected no contrast extravasation into the abdominal cavity.The mean follow-up period was 6mo,with no lesion residue or recurrence noted.CONCLUSION:EFR is efficacious,safe and minimally invasive for patients with gastric SMTs arising from the muscularis propria layer.This technique is able to resect deep gastric lesions while providing precise pathological information about the lesion.With the development of EFR,the indications of endoscopic resection might be extended.

Nerve protective effect of Baicalin on newborn HIBD rats

Objetive:To investigate the nerve protective effect and mechanism of baicalin on newborn rats with hypoxic ischemic brain damage(HIBD).Methods:A total of 64 SD newborn rats were randomlu divided into control group.model group.nerve growth factor group and baicalin group.with 16 in each group.Left carotid artery ligation method was adopted to establish the HIBD model except fou in control group,which was treatde with intraperitoneal injection of salin e10mL/kg for 3 d.After oxygen recovery on hypoxia ischemia rats.intraperitoneal injectionof salin 10mL/kg was adopted in model group for 3 d.Intraperitoneal injection of nerve growth factor injection50μg/kg per day was adopted in nerve growth factor group for 3 d:intraperitoneal injection of radix scutellariae 16mg/kg per day was adopted in baicalin group for 3 d after modeeling.Four rats of each group were sacrificed at Day 1,2,3,7 for microscopic observation of pathological morphological changes in brain tissus aften HE staining,S-P immunohistochemical method was used for observation of Fas and FasL expression in brain cells.Results:Neat structure of cells was observed in control group;edema cells in disordered arrangement was observed in model group,with some cells necrosis and cavity change;tissue injury in nerve growth factor group and baicalin group was significantly lighter than that in model group;Fas and FasL expression in model group,nerve growth factor group and baicalin group were significantiy higher than that in control group at different time points(P<0.05):Fas and FasL expression in nerve growth factor group and baicalin group were significantly lower than that in model group at different time points(P<0.05):There was no statistical diggerence of Fas,FasL expression at each time point between nerve growth factor group and baicalin group(P>0.05).Conclusions:Baicalin can reduce expression of Fas and FasL in HIBD rats,inhibit apoptosis of nerve cells,thus achieve the protective effect on HIBD rat nerves.

Endoscopic full-thickness resection and laparoscopic surgery for treatment of gastric stromal tumors

AIM: To assess the effectiveness of endoscopic fullthickness resection(EFR) and laparoscopic surgery in the treatment of gastric stromal tumors arising from the muscularis propria.METHODS: Out of 62 gastric stromal tumors arising from the muscularis propria, each > 1.5 cm in diameter, 32 were removed by EFR, and 30 were removed by laparoscopic surgery. The tumor expression of CD34, CD117, Dog-1, S-100, and SMA was assessed immunohistochemically. The operative time, complete resection rate, length of hospital stay, incidence of complications, and recurrence rate were compared between the two groups. Continuous data were compared using in-dependent samples t-tests, and categorical data were compared using χ2 tests.RESULTS: The 32 gastric stromal tumors treated by EFR and the 30 treated by laparoscopic surgery showed similar operative time [20-155 min(mean, 78.5 ± 30.1 min) vs 50-120 min(mean, 80.9 ± 46.7 min), P > 0.05], complete resection rate(100% vs 93.3%, P > 0.05), and length of hospital stay [4-10 d(mean, 5.9 ± 1.4 d) vs 4-19 d(mean, 8.9 ± 3.2 d), P >0.05]. None of the patients treated by EFR experienced complications, whereas two patients treated by laparoscopy required a conversion to laparotomy, and one patient had postoperative gastroparesis. No recurrences were observed in either group. Immunohistochemical staining showed that of the 62 gastric stromal tumors diagnosed by gastroscopy and endoscopic ultrasound, six were leiomyomas(SMA-positive), one was a schwannoglioma(S-100 positive), and the remaining 55 were stromal tumors.CONCLUSION: Some gastric stromal tumors arising from the muscularis propria can be completely removed by EFR. EFR could likely replace surgical or laparoscopic procedures for the removal of gastric stromal tumors.

Endoscopic mucosal resection for rectal carcinoids under micro-probe ultrasound guidance

AIM: To assess the therapeutic value of endoscopic mucosal resection (EMR) under micro-probe ultrasound guidance for rectal carcinoids less than 1 cm in diameter. METHODS: Twenty-one patients pathologically diagnosed with rectal carcinoids following colonoscopy in our hospital from January 2007 to November 2012 were included in this study. The patients consisted of 14 men and 7 women, with a mean age of 52.3 ± 12.2 years (range: 36-72 years). The patients with submucosal tumors less than 1 cm in diameter arising from the rectal and muscularis mucosa detected by micro-probe ultrasound were treated with EMR and followed up with conventional endoscopy and micro-probe ultrasound. RESULTS: All of the 21 tumors were confirmed by micro-probe ultrasound as uniform hypoechoic masses originating from the rectal and muscularis mucosa, without invasion of muscularis propria and vessels, and less than 1 cm in diameter. EMR was successfully completed without bleeding, perforation or other complications. The resected specimens were immunohistochemically confirmed to be carcinoids. Patients were followed up for one to two years, and no tumor recurrence was reported. CONCLUSION: EMR is a safe and effective treatment for rectal carcinoids less than 1 cm in diameter.

TREATMENT OF MIGRAINE WITH MODIFIED CHUANXIONG POWDER——A Report of 30 Cases

The formula of Chuanxiong Powder(Chuan Xiong San) is recorded in "PreciousMinor from Oriental Medicine (东医宝鉴)"compiled by Xu Jun (许俊) in 1611 A.D. Bymainly adopting this formula, the authorstreated 30 migraine cases on the basis ofsyndrome differentiation, the total effectiverate being 90%. Described below is a briefintroduction.

The feasibility of an internet-based intervention for Chinese people with mental illness: A survey of willingness and attitude

Background:The easy accessibility,increasing usage,and low cost of internet make it a desirable way of providing health information and delivering interventions for health consumers.Studies in other countries have verified and confirmed the effectiveness of internet-based interventions among people with mental health problems.Similar programs have yet to commence in China.Purpose:This study investigated the willingness for,and attitude toward internet-based intervention in Chinese mental health service users and explored the feasibility of such an intervention.Methods:A cross-sectional survey utilizing a self-developed questionnaire was administered to 186 mental health service users in Beijing,between April and May 2011.Results:Most participants held a positive attitude toward online information and expressed interest in getting assistance from the internet.Some advice and suggestions were provided such as more ways of getting assistance,setting up more professional websites,increasing interaction,as well as having government funding and guidance.Conclusion:Internet-based programs are feasible and applicable,and worth implementing with Chinese people with mental illness.

An international guideline with six personalised titration schedules for preventing myocarditis and pneumonia associated with clozapine

White blood cell(WBC)monitoring has reduced clozapinetreated patient deaths associated with agranulocytosis to a rarity.However,clozapine protocols and package inserts worldwide provide no instructions for preventing myocarditis or pneumonia during clozapine titrations.Prescribers worldwide are largely unaware of that.Meanwhile,as they worry about agranulocytosis,their clozapine-treated patients are at risk of dying from pneumonia or myocarditis.Consequently,an international guideline with 104 authors from 50 countries/regions was recently published to provide personalised clozapine titration schedules for adult inpatients.This forum article reviews pneumonia and myocarditis occurring during clozapine titration,as well as the three most innovative aspects of this new guideline:(1)personalised titration,(2)C reactive protein(CRP)measures,and(3)dose predictions based on blood levels.Clozapine metabolism is influenced by 3 levels of complexity:(1)ancestry groups,(2)sex-smoking subgroups,and(3)presence/absence of poor metabolizer status.These 3 groups of variables should determine the maintenance dose and speed of clozapine titration;they are summarised in a table in the full-text.The international clozapine titration guideline recommends measuring CRP levels simultaneously with WBC,at baseline and weekly at least for the first 4 weeks of titration,the highest risk period for clozapine-induced myocarditis.

Expert consensus on the prevention and treatment of substance use and addictive behaviour-related disorders during the COVID-19 pandemic

In early 2020,the COVID-19 outbreak complicated the diagnosis,treatm ent and rehabilitation of patients with substance use disorders and increased the risks of substance abuse and addictive behaviours,such as online gaming disorders,in the general public.Substance use disorder is a chronic recurrent brain disease characterised by strong cravings,high recurrence rates,and a high proportion of comorbidity of mental and physical disorders.1 Therefore,regular long-term therapeutic interventions are critical to preventing dm g relapses while maintaining withdrawal.

Using eye movements in the dot-probe paradigm to investigate attention bias in illness anxiety disorder

BACKGROUND Illness anxiety disorder(IAD)is a common,distressing,and debilitating condition with the key feature being a persistent conviction of the possibility of having one or more serious or progressive physical disorders.Because eye movements are guided by visual-spatial attention,eye-tracking technology is a comparatively direct,continuous measure of attention direction and speed when stimuli are oriented.Researchers have tried to identify selective visual attention biases by tracking eye movements within dot-probe paradigms because dot-probe paradigm can distinguish these attentional biases more clearly.AIM To examine the association between IAD and biased processing of illness-related information.METHODS A case-control study design was used to record eye movements of individuals with IAD and healthy controls while participants viewed a set of pictures from four categories(illness-related,socially threatening,positive,and neutral images).Biases in initial orienting were assessed from the location of the initial shift in gaze,and biases in the maintenance of attention were assessed from the duration of gaze that was initially fixated on the picture per image category.RESULTS The eye movement of the participants in the IAD group was characterized by an avoidance bias in initial orienting to illness-related pictures.There was no evidence of individuals with IAD spending significantly more time viewing illness-related images compared with other images.Patients with IAD had an attention bias at the early stage and overall attentional avoidance.In addition,this study found that patients with significant anxiety symptoms showed attention bias in the late stages of attention processing.CONCLUSION Illness-related information processing biases appear to be a robust feature of IAD and may have an important role in explaining the etiology and maintenance of the disorder.

Rapid reconstitution of NK1 cells after allogeneic transplantation is associated with a reduced incidence of graft-versus-host disease

The balance between immunostimulation and immunoregulation in T cell immunity is achieved by maintaining specific ratios of Th1, Th2, Th3 and Tr1 cells. Here, we investigate levels of type 1(IFN-gamma; NK1), type 2(IL-13; NK2), type 3(TGF-beta;NK3) and regulatory(IL-10; NKr) cytokines in peripheral blood to assess the cytokine profiles of natural killer(NK) cells following human allogeneic hematopoietic stem cell transplantation(allo-HSCT). NK2 and NK3 cell expansion was observed after allo-HSCT; levels of NKr cells reached donor levels at day 15, though levels of NK1 cells were consistently lower than donor levels until day 60 after allo-HSCT. Multivariate analysis showed that a higher level of NK1 cells by day 15 was associated with a lower overall risk of acute graft-versus-host disease(GVHD)(HR 0.157, P=0.010) as well as II-IV acute GVHD(HR0.260, P=0.059). Furthermore, higher levels of NK1 cells by day 15 were correlated with lower rates of cytomegalovirus(CMV)reactivation(HR 0.040, 0.005–0.348, P=0.003). These results indicate that rapid reconstitution of NK cells, especially NK1 cells,can help prevent the development of GVHD as well as CMV reactivation after allogeneic transplantation.

Association between painful physical symptoms and clinical outcomes in Chinese patients with major depressive disorder：a three-month observational study

Background Painful physical symptoms （PPS） may present as a component of major depressive disorder （MDD）.Their effect in Chinese patients has not been investigated.This analysis reports the changes in disease severity,treatment patterns, quality of life and outcomes in a Chinese cohort according to the presence （PPS＋） or absence （PPS-）of painful physical symptoms.Methods A subgroup of Chinese patients from a large observational 3-month study of patients from Asian countries and regions of China were classified using the modified Somatic Symptom Inventory （SSI） as PPS＋（mean score≥2） or PPS（mean score 〈2）.Depression severity was assessed with the Clinical Global Impression of Severity （CGI-S） scale and 17-item Hamilton depression rating scale （HAMD17）.Pain severity was measured using a visual analogue scale （VAS）,while the EuroQoL （EQ-5D） assessed patient well-being.Antidepressants were compared with regard to their efficacy.Results Of the 299 Chinese patients enrolled in the study, 105 were classified as PPS＋ （73/105, 70% women）.At baseline, PPS＋ patients reported greater pain severity （VAS, mean （SD）： 49.56 （26.49） vs.16.60 （20.99） for PPS-, P 〈0.01）, were more depressed （HAMD17, mean （SD）： 25.32 （5.47） vs.23.33 （5.24） for PPS-, P=0.002） and had poorer quality of life （EQ-5D Health State, mean （SD）： 38.48 （22.38） vs.49.57 （18.54） for PPS-, P 〈0.001）.PPS＋ patients showed less overall improvement in depressive symptom severity （HAMD17, change from baseline （95% CI）：-17.38（-18.65, -16.12） vs.-19.20 （-20.05,-18.35） for PPS-,P=-0.032; CGI-S, change from baseline （95% CI）： -2.85（-3.11, -2.58） vs.-3.20 （-3.38, -3.02） for PPS-, P=0.044）.Conclusions PPS were less frequent than expected compared with previous studies of Asian populations.PPS＋were associated with greater MDD severity and less improvement than PPS- when antidepressants were given.