Objective To evaluate the clinical value of computed tomography (CT) examination in the etiologic diagnosis of small bowel obstruction.Methods From January 2010 to September 2013,a total of 237 patients with small bowel obstruction confirmed by operation were enrolled.The clinical data of all patients were collected.The diagnostic value of color Doppler ultrasound and abdominal CT examination were compared in estimating site of obstruction,etiology of obstruction and strangulation obstruction.Chi square test was performed for count data comparison.Results Among 237 patients with small bowel obstruction,there were 121 patients with data of both color Doppler ultrasound and abdominal CT examination.After operation,it was comfirmed that the accurate diagnosis rates of abdominal CT scan in the site of obstruction,the etiology of obstruction and strangulation obstruction were 75.2 ％ (91/121),66.1％ (80/121) and 87.2％ (41/47),respectively,and which were higher than those of abdominal color ultrasound (44.6％,54/121; 30.6％,37/121 and 42.6％,20/47).The differences were statistically significant (x2 =23.555,30.595 and 20.593,all P＜0.01).Conclusion The accurate diagnosis rates of abdominal CT scan in estimating the site of obstruction,the etiology of obstruction and strangulation obstruction were higher than those of color Doppler ultrasound,especially with obvious advantage in judging the etiology of obstruction.

Biopsy, Needle ; methods ; Bronchoscopy ; Child ; Humans ; Pediatrics ; methods

Antitubercular Agents ; administration & dosage ; therapeutic use ; Biopsy, Needle ; methods ; Bronchi ; pathology ; Bronchoscopy ; methods ; Child, Preschool ; China ; Diagnosis, Differential ; Humans ; Lymph Nodes ; pathology ; Lymphatic Diseases ; diagnostic imaging ; pathology ; Mediastinum ; diagnostic imaging ; pathology ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary ; diagnostic imaging ; drug therapy ; pathology

AIM: To study the effect of signal transducer and activator of transcription 6 (STAT6) on airway inflammation of rats with asthma. METHODS: Male Sprague-Dawley rats were randomly divided into control group and asthma group. The lung tissue was sampled from the left lung. Bronchoalveolar lavage fluid (BALF) was collected from the right lung. The concentrations of IL-4 in serum and BALF were measured by sandwich ELISA. STAT6 protein and STAT6 mRNA were observed in the epithelial cells of bronchus by the technique of immunohistochemistry and in situ hybridization. RESULTS: (1) The concentrations of IL-4 in BALF and serum of asthma group were significantly higher than those in control group (P

Objective To compare the efficacy of bowel-cleansing,patients′compliance, tolerability and side effects of different doses of polyethylene glycol(PEG)electrolyte solution for colonoscopy preparation.Methods Single-blind prospective randomized trial was performed.A total of 100 inpatients undergoing elective colonoscopy were randomized into three groups to receive 4 L PEG(n =35),2 L PEG (n =31)or 2 +1 L PEG(n =34),respectively,on the day of colonoscopy from May to July 2014.Bowel-cleansing efficacy was separately assessed with the Ottawa Scale for the right,middle,and left colon.Total score was obtained by adding the scores for individual evaluation of the three colon segments with the score of overall fluid in the entire colon.All patients filled in a questionnaire and were interviewed about their com-pliance to the assigned bowel preparation,tolerability,and side effects.Results Patients who did not complete the colonoscopy were excluded.A total of 91 patients were included in the last analysis:31 cases of 4 L group,30 cases of 2 L group and 30 cases of 2 +1 L group.The efficacy of bowel-cleansing of the three groups of patients according to the Ottawa Scale were similar(P >0.05),but the excellent and good rate of cleansing quality of the right colon was higher in 4 L group than in 2 L group(P <0.05).Compared with 4 L group and 2 +1 L group,patients in the 2 L group had higher compliance and tolerability,as well as lower rate of side effects(P <0.05 ).Conclusion The efficacy and safety of taking 2 L polyethylene glycol electrolyte solution in bowel-cleansing on the day of colonoscopy is good and suitable for use.Taking 4 L polyethylene glycol electrolyte solution for bowel preparation on the day of colonoscopy is more suitable for patients who are suspected highly with lesions of the right colon.

OBJECTIVE To investigate the mechanism of nicotinamide mononucleotide (NMN) on inflammation and fibrosis between endogenous nicotinamide phosphoribosyltransferase (NAMPT) and bone morphogenetic protein 7 (BMP-7) in diabetic glomerular cells.METHODS ① In vivo,spontaneous diabetic C57/BL6 mice and wild C57/BL6 mice were divided into two groups.When blood glucose was above (34.2±1.9) mmol· L-1,renal histology of diabetic mice became obvious.The protein expressions of Nampt and nuclear transcription factors-kappa B p65 (NF-κB p65),silent mating type information regulation 2 homolog 1 (SIRT1) and BMP7 were analyzed by lengths of immunofluorescence.② In vitro,rats' glomerular cells HBZY-1 were incubated with glucose 200 mmol· L-1 for different lengths of time (0,24,48 and 72 h) and at different concentrations of NMN (0,50,100 and 200 iμmol· L-1).The protein levels of Nampt and BMP7 were detected by Western blotting and the protein expressions of NF-κB p65 and α-SMA were measured by immunofluorescence assay.The protein levels of Nampt,BMP7 and NF-κB p65 were detected by Western blotting after HBZY-1 cells were treated with NMN 100 μmol· L-1 and FK866 10 μmol· L-1 for 24 h.RESULTS ① In vivo,the glomeruli of diabetic C57/BL6 mice showed obvious atrophy.Fluorescence intensity of Nampt was increased (P＜0.05),but that of BMP7 and SIRT1 in renal glomeruli cells was decreased compared with the wild type (P＜0.01).② In vitro,HBZY-1 cells were cultured in glucose 200 mmol· L-1 for 48 and 72 h.The protein expression of NAMPT was increased,but that of BMP7 was decreased (P＜0.05,P＜0.01).Expressions of NF-κB p65 and α-SMA were increased (P＜0.01) by immunofluorescence.The expression of BMP7 was increased after treatment with glucose 200 mmol· L-1,followed by NMN 50,100 and 200 μmol · L-1 for 24 h (P＜0.01).The expressions of NAMPT and NF-κB p65 were decreased (P＜0.01).The expressions of Nampt and NF-κB p65 in glucose 5.6 mmol· L1 +FK866 and glucose 5.6 mmol· L-1+ NMN groups were increased (P＜0.01),but the expression of BMP7 did not change.CONCLUSION Upregulation of endogenous Nampt obviously intervenes in BMP7 expression in the process of glomerular inflammatory fibrosis in severe diabetes.NMN can affect the protein expression of BMP7 via a special Nampt signaling pathway.

AIM: To investigate the effect of hypercapnia on hypoxia-induced pulmonary hypertension and the changes of lysyl oxidase (LOX) and extracellular matrix collagen cross-links in the rat.METHODS: Sprague-Dawley rats were randomly divided into 4 groups: normoxia group, hypoxia group, hypercapnia group and hypoxia+hypercapnia group.LOX activity was detected by fluorescence spectrophotometry.LOX protein expression was detected by immunohistochemistry and Western blot.The mRNA expression of LOX in the pulmonary artery was detected by real-time PCR.RESULTS: The levels of mean pulmonary artery pressure (mPAP), RV/(LV+S) and WA/TA in hypoxia group were significantly higher than those in normoxia group (P<0.01).Moreover, the levels of mPAP and RV/(LV+S) in hypoxia+hypercapnia group were significantly lower than those in hypoxia group (P<0.01).However, no significant difference of mPAP and RV/(LV+S) between hypercapnia group and normoxia group was observed.In hypoxia group, the collagen cross-links in the lung tissue was significantly higher than that in normoxia group and hypercapnia group (P<0.01).Importantly, collagen cross-links in the lung tissue of hypoxia+hypercapnia group was significantly lower than that in hypoxia group (P<0.01).There was no significant difference in collagen cross-links between hypercapnia group and normoxia group.The expression of LOX at mRNA and protein levels and its activity in the pulmonary arteries of hypoxia group were significantly increased as compared with normoxia group (P<0.01).Furthermore, the expression of LOX at mRNA and protein levels and its activity in the pulmonary arteries in hypoxia+hypercapnia group were lower than those in hypoxia group (P<0.01).CONCLUSION: Hypoxia not only up-regulates LOX but also promotes collagen cross-linking in the rat lung, which contributes to the development of pulmonary hypertension.Hypercapnia inhibits hypoxia-induced LOX expression and collagen cross-linking, therefore impairing the progress in hypoxia-induced pulmonary hypertension.

The clinical manifestations of inherited metabolic diseases are diverse.If not treated in time, they often cause damage to multiple systems and multiple organs, including the lung, which is one of the common target organs of inherited metabolic diseases.Some patients present with recurrent respiratory infections and/or dyspnea and respiratory failure, and long-term lung damage, which increase the rate of hospitalization and mortality of inherited metabolic diseases.Because patients lack specific symptoms and signs, early identification is difficult, and they are easily misdiagnosed as children′s respiratory diseases.Therefore, now, the lung involvement of inherited metabolic diseases was explored, and the symptoms, signs, chest imaging manifestations, biochemical and genetic analysis, etc., were differentiated in order to help clinicians to increase vigilance and conduct timely intervention to improve lung function and the quality of life of the patients.

Objective:To investigate the clinical efficacy of Omalizumab in the treatment of moderate-to-severe allergic asthma with allergic comorbidities in children.Methods:The clinical data of 50 children with moderate-to-severe allergic asthma and allergic comorbidities, who were treated with Omalizumab and completed 12-month follow-up in the Department of Pediatrics of Peking University First Hospital from July 2018 to March 2022, were retrospectively analyzed.A comparison was performed on the scale scores of childhood allergic asthma and allergic comorbidities including allergic rhinitis (AR) and chronic spontaneous urticaria (CSU), pulmonary function test indices and fractional exhaled nitric oxide (FeNO) concentration before and after treating with Omalizumab.The data were compared by ANOVA, paired t-test, chi- square test and rank sum test. Results:(1)Improvement of clinical symptoms: after 12 months of Omalizumab treatment, the childhood asthma control test score of 42 children aged ≤11 years increased from (20.98±5.03) points to (26.95±0.22) points ( F=18.189, P<0.001). The asthma control questionnaire 7 score of 50 children decreased from (0.89±0.11) points to (0.10±0.02) points ( F=5.662, P=0.006). The score of visual analogue scale of 47 children with AR decreased from (11.00±1.65) points to (0.2±0.14) points ( F=14.901, P<0.001), and the urticaria control test score of 13 children with CSU decreased from (4.82±0.88) points to (1.87±0.61) points ( F=4.329, P=0.018). (2)Improvement of quality of life: compared with those before treatment, the pediatric asthma quality of life questionnaire score in 50 children increased from (124.50±32.13) points to (159.40±6.21) points ( F=12.052, P<0.001), and global evaluation of asthma treatment effectiveness decreased from (2.23±0.70) points to (1.07±0.26) points ( F=68.865, P<0.001) after Omalizumab treatment for 12 months.(3)Improvement of pulmonary function results: after 12 months of Omalizumab treatment, the number of children with forced expiratory volume in one second/forced vital capacity< 80% decreased from 13 cases (26%) to 1 case (2%), and the values increased from (91.39±12.88)% to (96.96±8.54)%( χ2=11.960; t=2.486, all P<0.05). The peak expiratory flow of predicted value increased from (86.73±16.05)% to (94.01±13.11)% ( t=2.445, P<0.05). The number of children with two indicators among the forced expiratory flow at 50% of forced vital capacity exhaled, forced expiratory flow at 75% of forced vital capacity exhaled and maximal mid-expiratory flow lower than 65% decreased from 31 cases (62%) to 7 cases (14%) ( χ2=24.450, P<0.001). There was no significant difference in FeNO concentration before and after treatment ( P>0.05). Safety of Omalizumab: no obvious adverse reactions were found during treatment and follow-up. Conclusions:Omalizumab can significantly improve the clinical symptoms, small airway function and quality of life of children with allergic asthma and concomitant AR or CSU.It is a potential targeted drug for treating a variety of allergic diseases in children.

Objective:To explore the clinical utility of bronchoscopy and transbronchial cryotherapy in children with tracheobronchial tuberculosis (TBTB).Methods:Retrospective study was conducted to collect the clinical data of 10 hospitalized children who underwent bronchoscopy and were diagnosed as TBTB and in the Department of Pediatrics of Peking University First Hospital and the Department of Pediatric Respiratory Medicine of the Second Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University from January 2011 to October 2019. The clinical characteristics of TBTB in children, and the efficacy and safety of bronchoscopy and transbronchial cryotherapy were summarized through descriptive analysis.Results:The onset age of 10 children (6 males and 4 females) ranged from 1-14 years. The clinical manifestations included fever (8/10), cough (7/10) and hemoptysis (2/10). Purified protein derivative test and interferon-γ release assay were performed in 9 and 10 patients respectively, the results were all positive. Chest CT examination was performed in all patients, and 8 patients had hilar and mediastinal lymphadenopathy. All patients underwent pediatric bronchoscopy in time, in 9 patients bronchus was found to be blocked in varying degrees by granulation tissue and caseous necrosis and in the remaining patient, obvious congestion and edema in bronchial mucosa. The bronchoscopic manifestations included 8 cases of lymph node fistula type, 1 case of granulation proliferative type and 1 case of inflammatory infiltration type. Pathological biopsies were performed in 7 cases, the findings were consistent with the pathological characteristics of tuberculosis. Nine patients were treated by pediatric bronchoscopic intervention, with 8 transbronchial cryotherapy by flexible bronchoscopy, and among them, 2 patients were treated by simultaneous rigid bronchoscopy. After 1-3 times of transbronchial cryotherapy, the blocked bronchial lumina in 8 cases were all recanalized, and the curative effect was significant without any serious complications.Conclusions:Bronchoscopy plays an important role in the diagnosis of TBTB in children and is helpful for its classification. Also, transbronchial cryotherapy has good efficacy and safety for TBTB in children, especially for the granuloproliferative type or lymph node fistula type.