Objective To compare the diagnostic efficacies of narrow-band imaging (NBI) in distinguishing neoplastic from non-neoplastic colorectal lesions with routine endoscopy and with magnifying endoscopy. Methods Patients with colorectal lesions detected by NBI from September 2008 to February 2010 were enrolled in the study. These lesions were classified by pit pattern and capillary pattern, which was then assessed by reference to histopathology. Results A total of 100 patients with colorectal lesions were enrolled, and the lesions were observed by NBI with ordinary endoscopy (n =64) and NBI with magnifying endoscopy (n =36), respectively, and 7 cases (5 in NBI with ordinary endoscopy and 2 in NBI with magnifying endoscopy) which did not meet the diagnostic criteria were excluded. The overall diagnostic accuracy of NBI endoscopy in distinguishing neoplastic from non-neoplastic colorectal lesions was 91.4% ( 85/93 ), in which NBI with ordinary endoscopy and magnifying endoscopy was 89. 8% (53/59) and 94. 1% (32/34),respectively, with both significantly higher than that of conventional colonoscopy reported in the literature (79. 1% ) (P ＜ 0. 05 ). However, no significant difference was detected between 2 methods ( P ＞ 0. 05 ).Conclusion Similar with NBI magnifying endoscopy, NBI endoscopy without high magnification may also be useful to distinguish neoplastic from non-neoplastic colorectal lesions.

BACKGROUND:Pulmonary infection after kidney transplantation evolves rapidly. There is a high mortality rate in patients with server pulmonary infection. It has the important significance of early diagnosis and treatment of pulmonary infection, but some patients appear to have impaired kidney function because of the adjustment of immunosuppressants. OBJECTIVE:To explore the approaches to applying the immunosuppressants during the treatment of pulmonary infection after kidney transplantation. METHODS:The clinical data of 85 kidney transplantation patients who suffered from pulmonary infection were retrospectively analyzed. There were 43 cases in which the infection occurred within 1-6 months after kidney transplantation, 39 of which within 2-4 months; 7 cases of infection occurring within 6-12 months; 7 cases of infection within 12-24 months; 6 cases of infection within 24-36 months; 22 cases of infection occurring beyond 36 months. The immunosuppressant dose was adjusted based on a per-case basis. As a complement, the smal-dose hormone was used for anti-inflammation. Etiological treatments for resisting infections were also conducted accordingly. Ventilators were utilized for patients with respiratory failures. The body temperature of patients was monitored and controled. Appropriate nutrition support was also provided accordingly. There were 44 cases of decreasing or stopping the use of immunosuppressants during the early period of pulmonary infection; 19 cases of decreasing or stopping the use of immunosuppressants during the treatment of pulmonary infection;5 cases of stopping the use of immunosuppressants during the period of severe pneumonia; 15 cases of gradualy changing the dose of immunosuppressants during the early and progressive period of pneumonia; 2 cases of decreasing the use during the early period of pneumonia and stopping the use during the period of severe pneumonia. The duration of decreasing or stopping the use of immunosuppressants ranged from 3-51 days, with an average of 10.7 days. RESULTS AND CONCLUSION: Among the 85 patients, there were 81 cases cured and 4 cases of death. Among the four death cases, two cases died of acute respiratory failure and two cases died of multiple organ failure. Of the cured 81 cases, acute rejection occurred in 3 cases, while renal alograft dysfunction occurred in 6 cases. Decreasing or temporarily stopping the use of immunosuppressants during the treatment of pulmonary infection caused by the kidney transplantation increases the cure rate and decreases the mortality rate; while timely resuming the usage of immunosuppressants effectively protects the renal graft function, especialy for patients with renal graft dysfunction.

Objective Explore the differences in effectiveness and safety between endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for early esophageal cancer (EEC).Methods Papers published from January 1990 to December 2012 in Medline,Embase,Cochrane library,Wanfang,VIP and CNKI were searched in English and Chinese respectively to identify the studies comparing ESD with EMR for EEC.Meta-analysis for each outcome of the included studies that were identified by the inclusion criteria and the exclusion criteria was conducted using software Revman 5.1.Outcome measures consisted of three effectiveness-relevant measures (rates of en bloc resection,curative resection,local recurrence) and four safety-relevant measures (bleeding,perforation,stenosis and operation time).Results A total of 8 non-randomized retrospective cohort studies (five full-text and three abstracts) were included.Meta-analysis showed significantly higher rates of en bloc resection [98.36％ (360/366) vs.41.79％ (252/603),P ＜ 0.01],curative resection [90.81％ (168/185) vs.50.65 ％ (194/383),P ＜ 0.01] and perforation [4.51％ (21/466) vs.1.25％ (8/640),P =0.03] in ESD group compared with EMR group,and the rate of local recurrence was significantly lower in ESD group [0.55％ (2/366) vs.13.76％ (83/603),P ＜0.01].There were no significant differences in the rates of bleeding [0.21％ (1/466) vs.0.63％(4/640),P =0.41] or stenosis [10.48％ (39/372) vs.10.15％ (41/404),P =0.89].Conclusion Compared with EMR,ESD showed obvious advantages of effectiveness and resemble risks for endoscopic resection of EEC,therefore ESD should be the first choice for endoscopic treatment of EEC.

Objective To investigate the safety of renal transplantation in patients with idiopathic thrombocytopenic purpura (ITP).Methods Clinical data of two ITP patients undergoing renal transplantation were retrospectively analyzed and pertinent literatures were reviewed.Results Prior to renal transplantation, the platelet count of these two patients was 41 ×109 /L and 34 ×109 /L,respectively.The coagulation function was normal and no active bleeding was observed.They underwent renal transplantation successfully without obvious bleeding intra-or post-operatively.The platelet count of one patient who received hydrocortisone impulse therapy for three days and maintenance treatment with immunosuppressant based on ciclosporin recovered to normal range and kept stable at 7 days after renal transplantation.Though receiving platelet-promoting drugs and platelet infusion,the platelet count of the other patient treated with methylprednisolone impulse therapy for 3 days and maintenance therapy with immunosuppressant based on tacrolimus did not recover to normal range but fluctuated between 10 ×109 /L and 30 ×109 /L after renal transplantation.Renal function was well maintained in both recipients.Conclusions The risk of renal transplantation related bleeding in ITP patients is correlated with whether the preoperative active bleeding or not.Renal transplantation is relatively safe for uremia patients without active bleeding pre-operation.

Objective To summarize the clinical characteristics and treatment experience on vascular complications of transplant renal artery.Methods Of 322 patients undergoing renal transplantation in the 281st Hospital of People's Liberation Army from June 2007 to June 2014,29 patients developed vascular complications of transplant renal artery after transplantation. Clinical data of such 29 patients were retrospectively studied to summarize the clinical characteristics and treatment experience.Results Two patients developed anastomotic haemorrhage of transplant renal artery,23 patients developed transplant intrarenal artery spasm,2 patients developed transplant renal artery thrombosis and 2 patients developed transplant renal artery stenosis.The anastomotic haemorrhage from transplant renal artery was postoperative haemorrhage,and surgical exploration and hemostasis were conducted in time. Patients with transplant intrarenal artery spasm were given antispasmodic treatment during operation.And the dark red and soft renal graft became full and ruddy.Patients with transplant renal artery thrombosis underwent surgical exploration once confirmed.The renal grafts were dark red and did not recover to normal after blood supply recovery,thus the renal grafts were removed.For patients with developed transplant renal artery stenosis,balloon dilatation and stent implantation were adopted.The blood pressure of patients returned to normal and the renal function was normal.Conclusions Vascular complications of transplant renal artery are characterized by quick progression, fast condition changes and serious consequences.In order to reduce the incidence and increase the recovery rate,active prevention and decisive treatment are very important.

Objective To investigate the effect of mycophenolate mofetil (MMF) on the changes of intestinal gamma delta (γδ) T cells and the secretion of plasma IL-6 and TNF-α.Methods Adult male C57BL/6 (C57) mice were randomly divided into two groups by SAS 9.1.3 software:normal saline (NS) group and MMF group.The changes of γδ T cells in each intestinal segment of mice were detected by flow cytometry.ELISA was used to determine the levels of serum IL-6 and TNF-α.Results As compared with the NS group,the ratio of γδ T cells in the epithelial cell to lymphocyte (IEL) of the intestinal tract decreased,and the concentrations of plasma IL-6 and TNF-α increased in MFF group (P＜0.05 for all).Conclusion In mycophenolic acid-related enteritis,the proportion of γδ T cells in intestinal IEL decreased,and the secretion of IL-6 and TNF-α increased.

Objective To investigate the etiology, clinical characteristics, diagnosis and treatment of intestinal complications after renal transplantation. Methods Clinical data of 47 patients presenting with intestinal complications following renal transplantation were retrospectively analyzed. The etiology, clinical characteristics and treatment experience of intestinal complications were summarized. Results Forty-seven patients with intestinal complications after renal transplantation were followed up for 3-36 months with the median time of 18 months. Intestinal complications included the upper gastrointestinal bleeding in 4 cases, the lower gastrointestinal bleeding in 1 case, acute enteritis in 25 cases, chronic enteritis in 12 cases, intestinal tuberculosis in 1 case, colon cancer in 1 case, and intestinal obstruction in 3 cases, respectively. Among patients with gastrointestinal bleeding, the symptoms occurred after the use of high-dose adrenal cortex hormone in 4 cases and 2 patients developed hemorrhagic shock. In patients with acute enteritis, 7 cases received immunosuppressants for the first time during the perioperative period of renal transplantation, the remaining18 patients had dirty diet or catched cold and 4 were positive for pathogens. Among patients with chronic enteritis,plasma concentrations of mycophenolic acid or tacrolimus were elevated in 12 patients, water, electrolyte, and acidbase imbalance was detected, 2 were positive for pathogens, and 8 were accompanied with severe anemia. One case of intestinal obstruction occurred during the perioperative period of renal transplantation, and 2 cases experienced toxic shock. According to the type and severity of disease, symptomatic and etiological treatments were actively implemented.In the 47 patients, 45 were cured and 2 died from the lower gastrointestinal bleeding and respiratory failure caused by lung metastasis of colon cancer. Three patients suffered from transplanted renal insufficiency. Conclusions The intestinal complications after renal transplantation are diverse, which are correlated with the imbalance of intestinal homeostasis.Both the acute and chronic diseases can cause various degrees of damage to the function of transplanted kidneys. Clinical prognosis is poor at the presence of severe complications. Active prevention and management should be implemented to reduce the risk of postoperative complications and enhance the cure rate.