Objective To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) with scissors knife in difficult cases.Methods A total of 36 sessions of ESD in 34 patients were performed from May 2010 to May 2012 with application of new scissors knife.The complications and followup outcomes were recorded.Results All lesions were removed successfully with an en bloc resection rate at 91.7％.Delayed bleeding occurred in 2 patients (5.6％),and both of them were cured sucessfully with endoscopy.No perforation happened and the average hospitalization time was 5 days.Follow-up endoscopy performed 6 or 12 months after ESD in 6 patients revealed no recurrence or residual lesions.Other patients are under follow-up now.Conclusion The scissors knife is easy to manipulate,which can ensure the safety and efficiency of ESD.

Intestinal microbial ecosystem is the most complex and the largest micro-ecosystem of the mammals. The use of antibiotics can lead to a lot of major changes of the flora, making the intestinal flora damaged and impacted, even developing Clostridium difficile infection. Fecal microbiota transplantation (FMT) as a special organ transplant therapy, which can rebuild the intestinal flora, has raised the clinical concerns. It has been used in the refractory Clostridium difficile, inflammatory bowel disease, irritable bowel syndrome, chronic fatigue syndrome, and some non-intestinal diseases related to the metabolic disorders. But this method of treatment has not become a normal treatment, and many clinicians and patients can not accept it. This paper reviews relevant literature in terms of origin, indications, mechanism, production process, current situation and future research, and provide a reference for the clinical application of the treatment of fecal microbiota transplantation.
Feces ; Humans ; Inflammatory Bowel Diseases ; Intestines ; Microbiota

Objective To analyze the relationship between the genetic polymorphisms of organic anion transporting polypeptide (SLCO1B1 and SLCO1B3) and mycophenolic acid ( MPA)pharmacokinetics in Chinese kidney transplant recipients. Methods Gene mutations (SLCO1B3T334G, SLCO1B1 A338G) were detected in 68 recipients by PCR-LDR. The plasma samples were collected and blood concentration of MPA was measured on the 28 th day after transplantation. The area under the curve (AUC)0-12 of MPA in different genotype recipients was compared to analyze the correlation between single nucleotide polymorphisms (SNPs) and MPA pharmacokinetics. Results MPA AUC0-12 was higher in SLCO1B3 T334G GG carriers group than in TT carriers [(54. 54 ±14.40)vs(37.30±12.88)mg·h·L-1,(P=0.052)].However,there was no difference in MPA AUC0-12 among each genotype of SLCO1B1 A338G (P>0. 05). Conclusion Genetic polymorphisms of SLCO1B3 affect interindividual variety in plasma MPA concentration in Chinese kidney transplantation recipients.

Objective To investigate the change and implication of plasma osteopontin (OPN) levels in renal allograft rejection.Methods The clinical data and biological samples of 46 renal transplant recipients were analyzed rerrospecnvely,including 16 patiens with stable allograft function and no evidence of biopsy-proved rejection (Non-R),22 patients with biopsy-proved acute cellular rejection (ACR),and 8 paients with biopsy-proved chronic allograft nephropathy (CAN).Six living related donors served as healthy controls (HC).Plasma OPN level was determined by using the human OPN ELISA kit.Type and grade of ACR were diagnosed based on Banff 03 classification criteria of renal allograft pathology.The plasma OPN levels were compared among different groups.The assistant diagnostic value of plasma OPN levels in differentiating rejection patients were also evaloated.Results The plasma OPN level in HC,Non-R,CAN and ACR groups was ( 12.23 ±5.95),(19.38±8.23),(27.77± 12.27) and (41.84± 18.51) μg/L,respectively.There was no significant difference in plasma OPN levels among HC,Non-R and CAN groups (P＞0.05),but the OPN levels in ACR group were decreased significantly as compared with Non-R and CAN groups (P＜0.05 ).OPN levels were positively correlated with Banff grading of ACR (P＜0.05).OPN levels were significantly different between grade Ia and grade IIb (P＜0.05).Conclusion The change in plasma OPN level has a relationship with acute rejection.Besides,the plasma OPN levels were also positively correlated with the severity of ACR.Monitoring plasma OPN levels should be useful in predicting and evaluating the severity of ACR in renal transplant recipients.

Objective To investigate the clinical and pathologic features of patients with gastric neuroendocrine neoplasms (g-NENs).Methods A total of 50 cases of g-NENs diagnosed by pathology in the First Hospital of Jilin University from May 2012 to January 2016 were retrospective analyzed to summarize the clinical manifestations and pathological features.The location of lesion,gross morphology,maximum diameter,lymph node metastasis rate,distant metastasis rate,and survival time between patients with neuroendocrine tumors and neuroendocrine carcinomas were compared.Results Among the 50 patients,34 were males and 16 were females with a male to female ratio of 2.125 ∶ 1.Their age ranged from 33 to 77 years with an mean age of 60± 11 years.There were 13 cases (26％) of neuroendocrine tumors,31 (62％) neuroendocrine carcinomas,and 6 (12％) mixed adenoneuroendocrine carcinomas.The maximum diameter of lesion was less than 2 cm in 8 cases (16％),and equal or greater than 2 cm in 42 cases (84％).There was single lesion in 48 cases (96％) and multiple lesions in 2 cases (4％).There were 19 cases (38％) located in gastric antrum,16 (32％) in gastric body,11 (22％) in gastric fundus or cardia,3 (6％) in gastric angle,and 1 (2％) in the junction of gastric antrum and body.Thirty-two patients (64％) had metastasis,including 20 cases of lymph node metastasis and 12 cases of distant metastasis.The clinical symptoms of the patients were different,mainly were digestive system symptoms and tumor occupying symptoms,and no carcinoid syndrome was reported.The gross morphology (x2 =24.446.P =0.000).maximum diameter (t =-4.044,P =0.001),lymph node metastasis rate (x2=4.435,P =0.035),and survival time (t =2.925,P =0.000) were significantly differences between 13 cases of neuroendocrine tumors and 37 cases of neuroendocrine carcinoma.But the location of lesion (x2 =6.921,P=0.082) and distant metastasis rate (x2 =0.715,P =0.389) were no statistically different between the two groups.Conclusion Gastric neuroendocrine neoplasms can occur in any part of stomach,majority of tumor is single lesion and lack of specific clinical manifestations.The mostly gross morphology of gastric neuroendocrine carcinoma and mixed adenoneuro-endocrine carcinoma are ulcer type with a large diameter and poor prognosis.

As one of the complications of liver cirrhosis, esophageal and gastric varices will seriously threaten patient’s life once it ruptures and causes bleeding. At present, endoscopic treatment has become the first-line treatment for this disease. As for gastroesophageal varices, conventional esophageal ligation cannot deal with the varicose veins under the cardia and has a high risk of postoperative recurrence. In recent years, reverse ligation, as an effective method for the treatment of gastroesophageal varices, is safe and effective in the treatment of varices and has a similar clinical effect as other endoscopic techniques. This article elaborates on the clinical features and treatment of gastroesophageal varices and advantages, limitations, and improvements of reverse ligation.

Intestinal microbial ecosystem is the most complex and the largest micro-ecosystem of the mammals. The use of antibiotics can lead to a lot of major changes of the flora, making the intestinal flora damaged and impacted, even developing Clostridium difficile infection. Fecal microbiota transplantation (FMT) as a special organ transplant therapy, which can rebuild the intestinal flora, has raised the clinical concerns. It has been used in the refractory Clostridium difficile, inflammatory bowel disease, irritable bowel syndrome, chronic fatigue syndrome, and some non-intestinal diseases related to the metabolic disorders. But this method of treatment has not become a normal treatment, and many clinicians and patients can not accept it. This paper reviews relevant literature in terms of origin, indications, mechanism, production process, current situation and future research, and provide a reference for the clinical application of the treatment of fecal microbiota transplantation.

Intestinal microbial ecosystem is the most complex and the largest micro-ecosystem of the mammals. The use of antibiotics can lead to a lot of major changes of the flora, making the intestinal flora damaged and impacted, even developing Clostridium difficile infection. Fecal microbiota transplantation (FMT) as a special organ transplant therapy, which can rebuild the intestinal flora, has raised the clinical concerns. It has been used in the refractory Clostridium difficile, inflammatory bowel disease, irritable bowel syndrome, chronic fatigue syndrome, and some non-intestinal diseases related to the metabolic disorders. But this method of treatment has not become a normal treatment, and many clinicians and patients can not accept it. This paper reviews relevant literature in terms of origin, indications, mechanism, production process, current situation and future research, and provide a reference for the clinical application of the treatment of fecal microbiota transplantation.

Objective:To investigate the role of ineffective esophageal motility (IEM) in the diagnosis of non-erosive reflux disease (NERD) and its relationship with acid exposure.Methods:From March 2013 to May 2019, in First Hospital Affiliated to Jilin University, patients who underwent gastroendoscopy exam, esophageal high-resolution manometry (HRM), 24-h pH monitoring and had gastroesophageal reflux symptoms, and without mucosal or structural abnormal changes under gastroendoscopy were retrospectively selected. Based on Rome Ⅳ criteria, the patients were reevaluated and the diagnostic types were NERD, reflux hypersensitivity (RH) and functional heartburn (FH). The changes of esophageal HRM metrics and acid reflux-related parameters of patients with IEM were analyzed and compared. Independent sample t-test, nonparametric test and chi-square test were used for statistical analysis. Results:The data of 228 patients were collected. Thirty-seven cases with esophageal gastric junction (EGJ) outflow obstruction and severe esophageal motility disorder (8 cases of achalasia, 9 cases of EGJ outflow obstruction, 4 cases of distal esophageal spasm, 14 cases of absent contractility and 2 cases of hypercontractile esophagus) and fifty-three cases with endoscopic reflux esophagitis under endoscopy (20 cases of Los Angeles grade A, 15 cases of grade B, 13 cases of grade C, and 5 cases of grade D) were excluded. In the end 138 patients were enrolled, including 60 males and 78 females, with a mean age of (50.1±14.1) years, including 36 cases of NERD, 44 cases of RH and 58 cases of FH. According to esophageal HRM Chicago classification standard, 138 patients with gastroesophageal reflux symptoms were divided into IEM group (46 cases, including 15 cases of NERD, 12 cases of RH, and 19 cases of FH) and normal manometry group (92 cases, including 21 cases of NERD, 32 cases of RH, and 39 cases of FH). There was no statistically significant difference in the proportion of patients diagnosed as NERD, RH and FH between the two groups ( P> 0.05). The length of lower esophageal sphincter (LES) (2.70 cm, 2.40 to 3.00 cm vs. 3.00 cm, 2.70 to 3.20 cm), the average value of LES resting breathing pressure (16.55 mmHg, 7.98 to 22.95 mmHg vs. 19.10 mmHg, 14.15 to 25.68 mmHg, 1 mmHg=0.133 kPa), the distal contractile integral (DCI)(417.90 mmHg·s·cm, 279.08 to 584.45 mmHg·s·cm vs. 1 429.40 mmHg·s·cm , 994.38 to 1 852.80 mmHg·s·cm) and EGJ contractile integral (37.86 mmHg·cm, 26.97 to 46.78 mmHg·cm vs. 45.19 mmHg·cm, 35.39 to 58.20 mmHg·cm) of IEM group were all lower than those of normal manometry group, ( Z=3.33, 2.09, 8.09, and 2.90, all P<0.05). There were no statistically significant differences in LES resting pressure at the end of the breath, 4 s-intergrated reloxation pressure, distal latency, upper esophageal sphincter (UES) resting pressure (UESP), UES residual pressure, UES baseline relaxation time, UES recovery time, EGJ type, acid reflux related parameters (total acid exposure time (AET), AET in upright position, AET in supine position, and Demeester score) between the two groups (all P>0.05). The 36 NERD patients were divided into IEM group (15 cases) and normal manometry group (21 cases). The distal contractile integral was lower in IEM group than that in normal manometry group (401.10 mmHg·s·cm, 276.60 to 555.60 mmHg·s·cm vs. 1 135.00 mmHg·s·cm, 903.20 to 1 537.65 mmHg·s·cm), the difference was statistically significant ( Z=3.93, P<0.01). There was no statistically significant difference in EGJ type, other HRM parameters or acid reflux-related parameters between IEM group and normal manometry group (all P>0.05). Conclusions:IEM is not related with the diagnosis of NERD. In patients with gastroscopy-negative gastroesophageal reflux symptoms or NERD with IEM, except for weakened peristaltic function, the EGJ morphological evaluation of the anti-reflux barrier function has nothing to do with IEM. In NERD patients, the relationship between IEM and acid exposure needs further study.

Objective:To evaluate the clinical value of renal artery Doppler ultrasonography in the diagnosis of renal transplant dysfunction by detecting blood perfusion in transplanted kidney with ultrasound .Methods:A total of 107 renal transplantation patients ,aged (38 .8 ± 1 .6) years in average ,including 68 new cases and 39 follow‐ups ,were recruited .Peak systolic velocity (PSV) ,end‐diastolic velocity (EDV) and resistance index (RI) ,in main renal artery ,renal segmental arteries and interlobar arteries of transplanted kidneys ,were examined by color Doppler ultrasonography .Results:Hemorheologic alterations in renal segmental arteries and interlobar arteries were closely correlated with renal function .Correlation indexes between PSV and clearance of creatinine (Ccr) were r=0 .072(P>0 .05) ,r=0 .224 (P=0 .014) and r=0 .250 (P=0 .006) ,respectively ,in main renal artery ,renal segmental arteries and interlobar arteries .Correlation indexes between RI and Ccr were r= -0 .398 (P<0 .001) ,r= -0 .400(P<0 .001) and r= -0 .436(P<0 .001) ,respectively ,in main renal artery ,renal segmental arteries and interlobar arteries .Correlation indexes between EDV and Ccr were r=0 .446(P<0 .001) ,r=0 .659(P<0 .001) and r=0 .529(P< 0 .001) ,respectively ,in main renal artery ,renal segmental arteries and interlobar arteries .The above results indicated that ,the maintenance of diastolic blood flow in renal arteries was important for renal function .The increase of RI and decrease of EDV in arteries of transplanted kidney was characteristic manifestation of chronic allograft nephropathy and vasculitic rejection .Conclusions:Renal artery Doppler ultrasonography can effectively measure the hemorheologic alterations of transplanted kidney ,thus it is an important adjuvant diagnostic tool for clinical renal transplantation .