Objective: To investigate the incidence of small intestinal bacterial overgrowth (SIBO) and systemic low-grade inflammation in patients with irritable bowel syndrome (IBS). Methods: From June to October in 2017, 50 cases of IBS patients who met Rome Ⅳ criteria were consecutively collected at Outpatient Department of Gastroenterology of Shanghai Huashan Hospital. The incidence of SIBO was detected by hydrogen lactulose breath test (LBT) and methane LBT. The incidence of systemic low-grade inflammation in IBS patients was determined by fractional exhaled nitric oxide(FeNO) breath test. Chi-square test was used for statistical analysis. Results: Among 50 IBS patients, the positive rate of FeNO was 70%(35/50), and the number of FeNO positive cases in diarrhea-predominant (n=28), constipation-predominant (n=14) and mix-type (n=8) IBS paitents was 18, 11 and six, respectively, and the difference was not statistically significant among three groups (χ²=1.020, P=0.600). The incidence rate of SIBO was 60% (30/50), with 20 cases (40%) being only positive for hydrogen LBT, seven cases (14%) being methane LBT, and three cases (6%) being both positive. The numbers of hydrogen LBT and methane LBT in diarrhea-predominant, constipation-predominant, and mix-type IBS patents were 17, three, three and two, six, two, respectively. There were statistically significant differences in positive rates of hydrogen LBT and methane LBT among three groups (χ²=6.076 and 6.392, both P<0.05). The positive rate of FeNO in IBS patients with SIBO was higher than that of IBS patients without SIBO (90%, 27/30 vs. 40%, 8/20), and the difference was statistically significant (χ²=14.286, P<0.01). Conclusions Combination of hydrogen LBT and methane LBT has a higher detection rate of SIBO than traditional single hydrogen LBT. There is a correlation between SIBO and systemic low-grade inflammation in IBS patients.

Objective To explore the influencing factors of different bowel preparation before colonoscopy on the intestinal cleanliness and polyp detection rate .Methods From March to August in 2018, at the Center of Endoscopy of Huashan Hospital Affiliated to Fudan University , the patients who underwent colonoscopy were selected and their general data of bowel preparation regimens were collected .Self-factors of the patients, different bowel preparation regimens , bowel preparation quality and polyp detection rate were observed.The quality of bowel preparation was evaluated by Boston bowel preparation scale (BBPS).T test, and analysis of variance and chi-square test were used for statistical analysis .Results Among 1008 patients who underwent colonoscopy , there were 506 males and 502 females, and average age was (57.3 ±13.7) years. There were statistically significant differences in BBPS score of patients with different body mass index (BMI), Parkinson disease and history of abdominal surgery (F=3.319, t=-2.060 and -2.544;all P<0.05).The BBPS score of patients with three-day low residue diet before examination was higher than that of those without preparation before examination (6.04 ±2.50 vs.5.54 ±2.73), and the difference was statistically significant (t=2.514, P=0.010).The BBPS scores of 2000 mL polyethylene glycol electrolyte lavage solution (PEG) taken once , 2000 mL PEG taken separately , 3000 mL PEG taken once and 3000 mL PEG taken separately were 5.06 ±2.88, 6.11 ±2.44, 5.94 ±2.32 and 6.10 ±2.47, respectively, and the difference was statistically significant (F=7.242,P<0.01).There were significant differences in polyp detection rates among the patients with different age , gender, BMI, and with history of constipation , hypertension and diabetes mellitus (χ2 =33.170, 8.489, 12.024, 4.034, 26.790, 10.381;all P<0.05).The polyp detection rate of patients with oral methyl silicone oil was higher than that of patients without oral methyl silicone oil (52.6％, 30/57 vs.29.7％, 221/744), and the difference was statistically significant (χ2 =12.934, P<0.01).Age (odds ratio (OR)=1.328, 95％confidence interval (CI) 1.162 to 1.517) and BMI (OR=1.412, 95％CI 1.115 to 1.787) were independent risk factors for polyp detection rate .Conclusions Parkinson disease, history of abdominal surgery and BMI are the related factors affecting the quality of bowel preparation before colonoscopy .Age and BMI are independent risk factors for polyp detection rate .

Objective: To investigate the efficacy of low dose and short-term oral rifaximin in patients with small intestinal bacterial overgrowth (SIBO) related irritable bowel syndrome (IBS). Methods: From June 2017 to June 2018, at the Department of Gastroenterology of Huashan Hospital, Fudan University in Shanghai, a total of 37 patients with SIBO related IBS were sequentially enrolled and divided into three groups: diarrhea type, constipation type and mixed type. All the patients received rifaximin 200 mg each time, three times per day for 14 days. The clinical efficacy before and after treatment were compared by the scores of irritable bowel syndrome symptom severity scale (IBS-SSS) and irritable bowel syndrome associated quality of life (IBS-QoL). The efficacy of rifaximin on SIBO clearance and SIBO related chronic low-grade inflammation was evaluated by lactulose breath test (LBT) and exhaled nitric oxide (eNO). T test and variance analysis were used for statistical analysis. Results: Among 39 patients with SIBO related IBS, 24 patients were diarrhea type, seven were constipation type and six were mixed type. Except one patient quitted the study because of chest tightness and palpitation, the IBS-SSS score of the left 36 patients before treatment was (250.83±55.10), and decreased to (151.11±33.96), and the difference was statistically significant (t=13.686, P<0.01). Before treatment the score of IBS-QoL was (28.03±16.16), and decreased to (14.39±9.31) after treatment, and the difference was statistically significant (t=6.867, P<0.01). There was no significant difference in IBS-SSS and IBS-QoL scores among the diarrhea type, constipation type and mixed type groups (all P>0.05). After treated by rifaximin, the negative conversion rate of SIBO was 52.8%(19/36). The negative conversion rate of hydrogen LBT was 54.5%(12/22) and among 11 methane LBT positive patients, six cases turned negative; and one of three patients with both positive hydrogen LBT and methane LBT turned negative. The negative conversion rate of eNO was 41.7%(15/36). Conclusions Low dose and short term rifaximin treatment can improve the severity of clinical symptoms and quality of life in SIBO-related IBS patients, and the efficacy is not related with the subtypes of IBS.

The incidence and prevention of chronic non-communicable respiratory diseases represented by chronic obstructive pulmonary disease, bronchial asthma, and lung cancer, as well asrespiratory communicable diseases such as viral pneumonia and tuberculosis, are becoming increasingly severe and complex.Only by constructing the modern respiratory discipline system of pulmonary and critical care medicine (PCCM) and developing the standardized management of PCCM departments in the hospital, could we achieve the goal of establishing overall specialized capacity for respiratory diseases and improving the ability of disease prevention and treatment in China. This article introducedthe project design and practice exploration based on the standardized construction of PCCM department in hospital, in the context of the new pattern of modern respiratory discipline.It focused on project initiation and management, formulation of evaluation standards, identification process and grading, and phased effectiveness.It also discussed and analyzed the experience, enlightenment, existing problems and suggestions, which could provide reference and advance experience for innovation, governance and improvement of capacity building of respiratory specialty and high-quality development of other medical disciplines and specialties in China.