Objective To discuss the role of intestinal flora imbalance in the pathogenesis of pouchitis. Methods The pouchitis rat model was established and the faeces sample and the mucous membrane sample were collected regularly, in which the bacterial nucleic acids were extracted for quantitative analysis of the intestinal flora in the samples through using the real-time quantitative PCR technique and high energy sequencing technology. Results The disorder phenomenon of the intestinal flora appeared at the 7th day of the experiment, and the pouchitis was presented at the 21st day of the experiment. At the 31st day of the experiment, compared to control group and non-pouchitis group, the quantity of Bifidobacterium and the Lactobacillus of the pouchitis model rats in the mucous membrane sample and the faeces sample were significantly decreased (P < 0.05), and the Bacteroidetes, Faecalibacterium prausnitzii and XIV Clostridium leptum subgroup in the mucous membrane of pouchitis were significantly decreased (P < 0.05). The IV Clostridium coccoides group was the main flora in the mucous membrane of pouchitis, the bacterial diversity of non-pouchitis group and control group was significantly higher than that of the pouchitis group (P < 0.05). Conclusions The intestinal flora imbalance is one of the factors that cause the incidence of the pouchitis; this study provides a clue of the pathogenesis and treatment direction of the intestinal inflammatory disease.

Objective: To evaluate the prognostic value of neutrophil-to-lymphocyte ratio (NLR) in patients with acute-on-chronic liver failure (ACLF) after glucocorticoid therapy. Methods: Thirty-six patients with acute-on-chronic liver failure (ACLF) were treated with glucocorticoid therapy, of whom 23 patients in the survival group and the other in the deceased group (n=13). The changes of white blood cells, neutrophils, lymphocytes, NLR, total bilirubin (TBil), prothrombin activity (PTA), international normalized ratio (INR) were observed before, during and after treatment, and the relationship between NLR and prognosis was analyzed. Results: NLR after glucocorticoid treatment, the survival group 3.95±2.65, the deceased group 12.79±10.66, there was significant difference between the two groups (P<0.001). According to univariate and multivariate logisitic regression analysis, NLR ratio was one of the independent factor in ACLF. ROC curve showed the AUC of NLR in patients with ACLF 0.868(95%CI: 0.743-0.993). After glucocorticoid treatment, the survival rate of NLR<3.315 patients with acute liver failure was high. Conclusions NLR is one of the important indexes for evaluating the prognosis of ACLF patients with ACLF due to glucocorticoid therapy.

Objective Reports are rarely seen on the clinical studies of pituicytomas. This article discusses the clinical diagnosis, treatment strategies, pathological features and postoperative complications of pituicytomas. Methods This retrospective study included 10 cases of pituicytomas treated in our hospital from July 2008 to July 2018. All the patients underwent microsurgery, gross total resection of the tumor in 6 cases and subtotal resection in the other 4. We analyzed the histopathological features, postoperative complications and follow-up data of the patients. Results The tumors were tightly organized morphologically, consisting of bipolar spindle-shaped cells, arranged like crosswise-woven fiber bundles or in a storiform pattern, the cytoplasm stained red and eosinophilic, the nuclei medium-sized, round, oval or spindle shaped, mildly heterotypical, with visible microencapsulation and abundant interstitial blood vessels. The main postoperative complications included insipidus in 8 cases, hyponatremia in 4, decreased visual acuity in 3, hypopituitarism in 2, and intracranial infection in 1. Of the 9 patients followed up, 1 experienced recurrence at 2 years postoperatively and received another surgery, with no more recurrence hitherto. Conclusion Definite diagnosis of pituicytoma depends on pathological examination, and adequate attention should be paid to the prevention and management of such postoperative complications as insipidus and hyponatremia.

OBJECTIVETo explore the therapeutic method and efficiency of chronic radiation enteritis with intestinal obstruction.

METHODSClinical data of 51 patients of chronic radiation enteritis with intestinal obstruction from Aug. 2001 to Dec. 2006 were analyzed retrospectively.

RESULTSThe mean time from the ending of radiation to the occurrence of obstruction was (11.9 +/- 22.6) months. Conservative treatment, intestinal resection-anastomosis, enterostomy, bypass operation and enterolysis were applied and performed in above 51 cases. Two patients could not receive operation because of wild metastasis. One died of peritoneal bleeding after operation. Forty-eight cases were cured and the curative rate was 94.1%.

CONCLUSIONTherapeutic regimen should be chosen according to nutritional status and intestinal impairment in chronic radiation enteritis with intestinal obstruction.

Adult ; Aged ; Chronic Disease ; Enteritis ; complications ; etiology ; Female ; Humans ; Intestinal Obstruction ; etiology ; therapy ; Male ; Middle Aged ; Radiation Injuries ; complications ; Radiotherapy ; adverse effects ; Retrospective Studies

OBJECTIVETo summarize the preliminary experience of laparoscopic surgery in the treatment of radiogenic small bowel damage.

METHODSClinical data of 12 patients with radiogenic small bowel damage undergoing laparoscopic operation in our department from January 2012 to January 2013 were retrospectively reviewed.

RESULTSTwo patients were transferred to laparotomy because of dense adhesion in the entire abdomen and uncertainty of metastatic malignancy, respectively. The laparoscopic surgery was successfully performed in other 10 patients. Three patients received enterostomy or colostomy because of intestinal obstruction or bleeding. Among the other seven patients who underwent intestinal resection and anastomosis, intestinal anastomosis was performed with an small adjunvant incision in the former two cases and performed under laparoscopy in the latter five cases. The post-operative complication included one anastomotic fistula.

CONCLUSIONLaparoscopic surgery can be safely used in radiogenic small bowel damage patients, which can avoid the delayed incision healing.

Colostomy ; Humans ; Intestinal Obstruction ; surgery ; Intestine, Small ; surgery ; Laparoscopy ; Laparotomy

OBJECTIVETo analyze and compare burden of disease caused by malignant tumor in China, 1990 and 2010.

METHODSThe indicators including prevalence, death, years of life lost (YLL), years lived with disability (YLD), and disability adjusted of life years (DALY) of malignant tumor from the results of Global Burden of Disease (GBD) 2010 were used to calculate the standardized prevalence rate, mortality rate, YLL rate, YLD rate and DALY rate with the 2010 national census data. The research described the prevalence, death, and burden of disease caused by malignant tumor and analyze the trend of these indicators in 1990 and 2010 in China.

RESULTSIn China from 1990 to 2010, the standardized prevalence rate of malignant tumor increased from 529.76/100 000 to 749.57/100 000 (increased by 41.49%); the standardized mortality rate decreased from 196.57/100 000 to 169.88/100 000 (decreased by 13.58%); the standardized DALY rate decreased from 5 206.56/100 000 to 4 150.86/100 000. In 2010, the top five standardized DALY rate of malignant tumor were lung cancer, liver cancer, gastric cancer, esophageal cancer, and colorectal cancer. Their standardized DALY rate were 892.21/100 000, 787.40/100 000, 521.36/100 000, 303.95/100 000, and 269.94/100 000, respectively. In all kind of malignant tumors, the burden of disease of lung cancer had the fastest-growing rate. The standardized mortality rate of lung cancer increased from 34.78/100 000 in 1990 to 41.09/100 000 in 2010; the standardized DALY rate increased from 830.77/100 000 in 1990 to 892.21/100 000 in 2010. The burden of disease of gastric cancer had the fastest-falling rate. The standardized mortality rate of gastric cancer decreased from 39.65/100 000 in 1990 to 23.79/100 000 in 2010; the standardized DALY rate decreased from 968.96/100 000 in 1990 to 521.36/100 000 in 2010.

CONCLUSIONThe burden of disease caused by malignant tumor in China remained at high levels in 2010. The top five burden of disease of malignant tumor were lung cancer, liver cancer, gastric cancer, esophageal cancer, and colorectal cancer. The burden of disease of lung cancer had the fastest-growing rate and gastric cancer had the fastest-falling rate from 1990 to 2010 in China. Prevention and control of malignant tumor was still difficult.

China ; Colorectal Neoplasms ; Cost of Illness ; Esophageal Neoplasms ; Humans ; Liver Neoplasms ; Lung Neoplasms ; Mortality ; Neoplasms ; Prevalence ; Quality-Adjusted Life Years ; Stomach Neoplasms

Objective: To assess the disease burden attributable to household air pollution in 1990 and 2013 in China. Methods: Based on data from the Global Burden of Disease Study 2013 in China (GBD 2013), we used population attributable fractions (PAF) to analyze the burden of different diseases attributable to solid-fuel household pollution in 2013 in China(not inclnding HongKang, Macao, Taiwan). We compared PAF, mortality, and disability-adjusted life years (DALY) for diseases attributable to solid-fuel household pollution in 31 provinces in mainland China in 1990 and 2013, and stratified the burden by age group. The estimated world average population during 2000- 2025 was used to calculate age-standardized mortality and DALY rates. Results: In 2013, 14.9% of lower respiratory infections in children <5, 32.5% of chronic obstructive pulmonary disease (COPD), 12.0% of ischemic stroke, 14.2% of hemorrhagic stroke, 10.9% of ischemic heart disease, and 13.7% of lung cancer were attributable to solid-fuel household pollution. In addition, 807 000 deaths were attributable to solid-fuel household pollution, including 296 000 from COPD, 169 000 from hemorrhagic stroke, 152 000 from ischemic heart disease, 88 000 from ischemic stroke, 75 000 from lung cancer, and 28 000 from lower respiratory infections in children <5. The age-standardized mortality rate from solid-fuel household pollution decreased by 59.3% from 158.8/100 000 in 1990 to 64.6/100 000 in 2013. The age-standardized mortality rate from solid-fuel household pollution decreased in all 31 provinces, with the highest decline observed in Shanghai (96.3%), and lowest in Xinjiang (39.9%). In 2013, the age-standardized DALY rate from solid-fuel household pollution was highest in Guizhou (2 233.0/100 000) and lowest in Shanghai (27.0/100 000). The DALY rate was the highest for the >70 age group (7 006.0/100 000). Compared with 1990, the 2013 mortality rate and DALY rate from solid-fuel household pollution decreased in all age groups, with the highest decline observed in the <5 age group (91.9% and 91.8% , respectively). Conclusion Although the disease burden attributable to household air pollution decreased notably between 1990 and 2013, household pollution caused a high number of deaths and DALY loss in certain western provinces.

Objective: To analyze the burden of disease attributable to low fruit intake among Chinese population aged ≥15 years old between 1990 and 2013. Methods: We used data from the 2013 Global Burden of Disease Burden of Disease Study to study the situation in China. The population attributable fraction was calculated to estimate and compare the death and disability-adjusted life years (DALY) attributed to low fruit intake between 1990 and 2013 in China (excluded Taiwan, China). An average world population age structure of the period 2000-2025 was adopted to calculate age-standardized rates. Results: Deaths attributable to low fruit intake accounted for 11.02% of all death in 2013, which were higher than it in 1990 (10.38%). In 2013, the number of deaths attributed to low fruit intake in China increased to 1 046 500 from 793 800 in 1990. From 1990-2013, the age-standardized death rate attributable to low fruit intake decreased from 113.04/100 000 to 79.80/100 000. DALYs caused by low fruit intake increased from 18.346 5 million in 1990 to 21.296 7 million in 2013. Compared with 1990, the age-standardized DALY rate attributed to low fruit intake decreased by 34.67%. In 2013, the top three provinces with the highest burden of disease attributed to low fruits intake were Tibet, Guizhou and Xinjiang provinces, with standardized DALY rate at 2 612.53/100 000, 2 281.85/100 000 and 2 198.22/100 000, respectively. Compared with the results in 1990, the standardized DALY attributed to low fruits intake decreased, especially in Tianjin, where decreased by 63.61%; followed by Aomen, Zhejiang, Shanghai and Beijing, where decreased by 59.74%, 59.53%, 56.64% and 53.88%, respectively. Conclusion Compared with the situation in 1990, the burden of disease attributable to low fruit intake decreased in 2013, but the situation is still serious, especially in Tibet, Guizhou and Xinjiang provinces, where the burden decreased comparatively slowly.

Objective Few studies have paid attention to time-zero renal biopsy in living kidney transplantation so far. This article aimed to investigate the risk factors of latent pathologic changes in living donors by time-zero renal biopsy (TO-RBx) and the predictive value in the allograft function of recipients early after living kidney transplantation.Methods We retrospectively analysed the clinical data of 89 renal transplant recipients and living donors who received TO-RBx at Nanjing General Hospital from January 2008 to December 2016. According to the 2007 Banff criteria, the common pathologic changes in living donors such as latent glomeruloscerosis (GS), tubular atrophy (CT), interstitial fibrosis (CI), arteriolar hyaline thickening (AH) and vascular fibrous intimal thickening (CV) were scored. To analyze the influencing factors for different pathological changes and evaluate its predictive value in the allograft function of recipients in 1, 3, 6 months after living renal transplantation.Results Of all the TO-RBx specimens, 23 cases (25.84%) with GS (21 were mild change, 1 was moderate change and 1 was severe change), 33 cases (37.08%) with CT/CI changes (30 were mild change and 3 were moderate change) and 37 cases (41.57%) with AH/CV changes (36 were mild change and 1 was moderate change). GS was related to the donor age (P=0.042); CT/CI changes were related to donor age, gender and systolic pressure (P=0.019；0.006；0.01); arterial changes were related to donor gender and blood triglyceride level (P=0.029；0.049). Within 3 and 6 months after living donor renal transplantation, the eGFR of renal transplant recipients with GS lesions \[(65.96±17.17), (69.52±19.1)mL/min·1.73m2\] were significantly lower than the groups without lesions \[(76.91±18.98), (79.52±18.91)mL/min·1.73m2\] (P＜0.05).Conclusion Time-zero renal biopsy has significance in terms of predicting the allograft function in 6 months after transplantation. It can guide the formulation and adjustment of postoperative immunosuppressive regimens for recipients. Besides, it can also detect the latent pathologic changes in living donors and is one of the important evidence for establishing a personalized follow-up plan for donors after surgery. This method is practical in clinical.

Objective To explore the effect of fime particulate matters with an aerodynamic diameter less than 2.5 μtm (PM2.5) on daily cardiovascular disease mortality in seven cities of China.Methods Daily average concentrations of PM2.5,cardiovascular disease mortality data and environmental data were collected from January 1,2013 to December 31,2015 in seven cities of China,including Shijiazhuang,Haerbin,Shanghai,Wuhan,Guangzhou,Chengdu and Xi'an.We linked generalized additive model with Quasi-Poisson distribution to evaluate the association between daily concentrations of PM2.5 and cardiovascular disease mortality at single-city level and multi-city level,after adjusting for the long-term and seasonal trend,as well as meteorological factors and the effect of "days of week".Results The single-pollutant model indicated that there were marked differences in association strength in these cities,among which the effect in Guangzhou was strongest.At multi-city level,a 10 μg/m3 increase of PM2.5 was associated with an increase of 0.315％ (95％CI:0.133％-0.497％) of daily cardiovascular disease mortality.From lag0 to lag2,the effect of PM2.5 on cardiovascular disease mortality decreased,while it was strongest on lag01.In the two-pollutant model,the estimated effect decreased in all the cities with the adjustments of SO2 or NO2.The insignificant combined results suggested that PM2.5 might have combined effect with other pollutants.Each 10 μg/m3 increase of PM2.5 was associated with increases of 0.371％ (95％CI:0.141％-0.600％) and 0.199％ (95％ CI:0.077％-0.321％) of cardiovascular disease mortality in males and females,respectively.The effect of PM2.5 on cardiovascular disease mortality increased with age and decreased with educational level,although the differences between different subgroups were insignificant.The dose-response relationship between PM2.5 and cardiovascular disease mortality was non-linear and non-threshold,with a steeper curve at lower concentrations.Conclusion The increases of PM2.5 concentration can result in the increase of daily cardiovascular mortality.