Auto-brewery syndrome(ABS)is a rare and easily overlooked disease.Overgrowth of certain high-alcohol-producing fungi and bacteria in the intestine leads to the production of endogenous ethanol that ex-ceeds the liver's maximum metabolic capacity,resulting in an elevated ethanol concentration in the patient's peripheral blood.Even without alcohol intake,patients may exhibit symptoms similar to intoxication,causing various social,occupational,and health-related distress.This article provides an overview of the diagnosis and differential diagnosis of ABS,reveals that gut microbiota dysbiosis is the core of ABS,and introduces multiple intervention strategies involving the regulation of the gut microbiota,including dietary intervention,pharmaco-therapy,probiotic therapy,fecal microbiota transplantation,and phage therapy,with the aim of assisting clini-cians in the early identification and treatment of ABS.

Objective:To clarify the current status of mechanical ventilation management in critically ill patients and identify prognostic risk factors in Xinjiang Uygur Autonomous Region, thereby providing evidence for targeted training programs and quality improvement initiatives.Methods:A cohort study was conducted across multiple ICUs in Xinjiang Uygur Autonomous Region from January 31 to February 1, 2024. Patients receiving mechanical ventilation during the study period were enrolled, with clinical outcomes followed up until February 28, 2024. Statistical analyses included demographic characteristics, therapeutic interventions, laboratory parameters, and medication regimens.Results:A total of 77 ICUs and 727 patients were screened in the study, and 253 (34.80%) patients who received mechanical ventilation were ultimately included. Among these patients, 177 patients (69.96%) were treated in tertiary hospitals, and 76 patients (30.04%) in secondary hospitals. Significant differences were observed between tertiary and secondary hospitals regarding ventilator mode selection and mechanical ventilation parameter settings (all P<0.05). No significant differences were found in the 28-day mortality rate between tertiary hospitals and secondary hospitals (33.9% vs. 43.4%, P=0.194). Compared with patients in the survival group, death group patients were older and had more severe disease severity. Multivariate Cox regression analysis demonstrated that body temperature ( HR=1.573, 95% CI: 1.173-2.110, P=0.003), white blood cell count ( HR=1.048, 95% CI: 1.012-1.084, P=0.008), pH ( HR=0.019, 95% CI: 0.001-0.349, P=0.007), age > 65 years ( HR=1.817, 95% CI: 1.086-3.041, P=0.023), and fraction of inspired oxygen ≥ 60% ( HR=2.072, 95% CI: 1.143-3.757, P=0.016) were independent influencing factors for 28-day mortality in mechanically ventilated patients. Conclusions:Mechanically ventilated patients are a major component of the ICU population in Xinjiang Uygur Autonomous Region, with the characteristics of high risk of death. The clinical practice of mechanical ventilation in this region is heterogeneous. In the future, it is urgent to strengthen the improvement of medical quality and related training to improve the success rate of patients with mechanical ventilation.

Auto-brewery syndrome(ABS)is a rare and easily overlooked disease.Overgrowth of certain high-alcohol-producing fungi and bacteria in the intestine leads to the production of endogenous ethanol that ex-ceeds the liver's maximum metabolic capacity,resulting in an elevated ethanol concentration in the patient's peripheral blood.Even without alcohol intake,patients may exhibit symptoms similar to intoxication,causing various social,occupational,and health-related distress.This article provides an overview of the diagnosis and differential diagnosis of ABS,reveals that gut microbiota dysbiosis is the core of ABS,and introduces multiple intervention strategies involving the regulation of the gut microbiota,including dietary intervention,pharmaco-therapy,probiotic therapy,fecal microbiota transplantation,and phage therapy,with the aim of assisting clini-cians in the early identification and treatment of ABS.

Objective:To validate and optimize the interpretation methods and cut-off values of prolonged activated partial thromboplastin time (APTT) mixing test, in order to elevate the clinical applicational value in differentiating single factor deficiency, positive lupus anticoagulant (LA) and FⅧ inhibitors.Methods:This cross-sectional retrospective study involved 130 cases with single APTT prolongation for unknown reasons who underwent mixing tests in the First Hospital of Jilin University from January 1st, 2022 to December 31st, 2023, including 84 males and 46 females. Rosner index (RI), Percentage correction ("Chang") method, Normal reference interval (NRI) method, differential analysis, post-incubation prolongation time and percentage (including mixed immediately and ) were respectively calculated and analyzed for both immediate mixing and 2-hour post-mixing incubation. According to clinical diagnosis, patients were divided into single factor deficiency (51 cases), positive lupus anticoagulant (LA) (56 cases), and positive factor Ⅷ (FⅧ) inhibitor (23 cases). Receiver operation characteristic (ROC) curve analysis was used to determine the cut-off values for APTT mixing test methods in patients with different reasons for prolonged APTT, which were evaluted and adjusted by AUC, sensitivity, and specificity, and compared with the methods currently used for interpretations.Results:For the single factor deficiency cases, the AUCs of immediate RI index <7.5% and incubated RI index <13.9% were 0.87 and 0.90, respectively, with sensitivities at 87.8% and 83.8%, and specificities at 72.0% and 80.0%, whose combination had sensitivity and specificity at 87.3%, and 94.0%, respectively; the judging accuracy increased from 84.6% (110/130) in currently used rule to 93.1% (121/130). For the positive lupus anticoagulant (LA) cases, the combination of immediate RI index >10.3% and prolonged post-incubation clotting time percentage <9.1% showed 88.5% sensitivity and 99.8% specificity; the judging accuracy improved from 80.0% (104/130) in currently used rule to 86.2% (112/130). For positive FⅧ inhibitor cases, the combination of incubated RI index >17.0% and prolonged post-incubation clotting time percentage >9.1% had 99.8% sensitivity and 100.0% specificity; the judging accuracy increased from 89.2% (116/130) in currently used rule to 94.6% (123/130).Conclusion:This study validated and optimized the interpretation methods and cut-off values for the prolonged APTT mixing test in differentiating single factor deficiencies, prositive FⅧ inhibitors and LA positive cases, significantly improving the judging sensitivity and specificity.

Objective:To validate and optimize the interpretation methods and cut-off values of prolonged activated partial thromboplastin time (APTT) mixing test, in order to elevate the clinical applicational value in differentiating single factor deficiency, positive lupus anticoagulant (LA) and FⅧ inhibitors.Methods:This cross-sectional retrospective study involved 130 cases with single APTT prolongation for unknown reasons who underwent mixing tests in the First Hospital of Jilin University from January 1st, 2022 to December 31st, 2023, including 84 males and 46 females. Rosner index (RI), Percentage correction ("Chang") method, Normal reference interval (NRI) method, differential analysis, post-incubation prolongation time and percentage (including mixed immediately and ) were respectively calculated and analyzed for both immediate mixing and 2-hour post-mixing incubation. According to clinical diagnosis, patients were divided into single factor deficiency (51 cases), positive lupus anticoagulant (LA) (56 cases), and positive factor Ⅷ (FⅧ) inhibitor (23 cases). Receiver operation characteristic (ROC) curve analysis was used to determine the cut-off values for APTT mixing test methods in patients with different reasons for prolonged APTT, which were evaluted and adjusted by AUC, sensitivity, and specificity, and compared with the methods currently used for interpretations.Results:For the single factor deficiency cases, the AUCs of immediate RI index <7.5% and incubated RI index <13.9% were 0.87 and 0.90, respectively, with sensitivities at 87.8% and 83.8%, and specificities at 72.0% and 80.0%, whose combination had sensitivity and specificity at 87.3%, and 94.0%, respectively; the judging accuracy increased from 84.6% (110/130) in currently used rule to 93.1% (121/130). For the positive lupus anticoagulant (LA) cases, the combination of immediate RI index >10.3% and prolonged post-incubation clotting time percentage <9.1% showed 88.5% sensitivity and 99.8% specificity; the judging accuracy improved from 80.0% (104/130) in currently used rule to 86.2% (112/130). For positive FⅧ inhibitor cases, the combination of incubated RI index >17.0% and prolonged post-incubation clotting time percentage >9.1% had 99.8% sensitivity and 100.0% specificity; the judging accuracy increased from 89.2% (116/130) in currently used rule to 94.6% (123/130).Conclusion:This study validated and optimized the interpretation methods and cut-off values for the prolonged APTT mixing test in differentiating single factor deficiencies, prositive FⅧ inhibitors and LA positive cases, significantly improving the judging sensitivity and specificity.

Objective:To evaluate the efficacy and safety of Saccharomyces boulardii ( S. boulardii) as an adjuvant therapy for ulcerative colitis (UC). Methods:Databases including PubMed, Embase, Web of Science, Cochrane Library, Chinese Biomedical Literature Database, CNKI, Wanfang Database, and Chongqing VIP Chinese Science and Technology Journal Database were retrieved from their inception to September 1, 2023. Randomized controlled trials (RCTs) about S. boulardii as an adjuvant therapy for UC were included. The intervention method was S. boulardii monotherapy or as an adjunct to other medications ( Saccharomyces group), while the control group received other medications. The risk of bias of the included studies was assessed by the Cochrane risk of bias assessment tool (RoB 2.0). Primary outcome indicators included overall efficacy, clinical remission rate, and endoscopic remission rate. Secondary outcome indicators included Baron score, Sutherland disease activity index, indicators of intestinal mucosal barrier function, levels of inflammatory cytokines, and overall adverse events. RevMan 5.3 software was used for statistical analysis. RR and MD were taken as effect indicators of count data and measurement data, respectively. Results:A total of 26 RCTs were included, all from China. Among them, 22 studies reported the overall efficacy in UC patients. The results indicated that the overall efficacy of Saccharomyces group was higher than that of the control group (93.5%(943/1 009) vs. 76.8%(771/1 004)), and the difference was statistically significant ( RR=1.20, 95% confidence interval (95% CI): 1.16 to 1.25, P<0.001). And 9 studies assessed the efficacy in patients with mild or moderate UC. The results showed that the clinical remission rate and endoscopic remission rate of Saccharomyces group were both higher that those of the control group (68.1%(581/853) vs. 53.1%(455/857); 54.9%(425/774) vs. 35.5%(273/769)), and the differences were statistically significant ( RR=1.21, 95% CI: 1.14 to 1.25, P<0.001; RR=1.49, 95% CI: 1.28 to 1.73, P<0.001). S. boulardii as an adjunctive therapy could significantly lower the Baron score in patients with UC (7 studies) and mild to moderate UC (5 studies) ( MD=-0.51, 95% CI: -0.68 to -0.33; MD=-0.50, 95% CI: -0.75 to -0.26; both P<0.001). Additionally, S. boulardii as an adjunctive therapy could significantly decrease the Sutherland disease activity index in patients with UC (6 studies) and mild to moderate UC (3 studies), and the differences were statistically significant ( MD=-1.50, 95% CI: -2.26 to -0.74; MD=-0.92, 95% CI: -1.16 to -0.69; both P<0.001). Compared with the control group, S. boulardii as an adjunctive therapy significantly improved intestinal mucosal barrier function and decreased inflammatory cytokine levels in patients with UC and patients with mild to moderate UC (all P<0.05), such as D-lactate ( MD=-2.44, 95% CI: -4.43 to -0.45; MD=-1.47, 95% CI: -2.03 to -0.91), Geboes index ( MD=-0.40, 95% CI: -0.46 to -0.35; MD=-0.39, 95% CI: -0.46 to -0.32), C-reactive protein ( MD=-3.70, 95% CI: -5.65 to -1.76; MD=-3.36, 95% CI: -5.07 to -1.64), and tumor necrosis factor-α levels ( MD=-7.64, 95% CI: -11.27 to -4.01; MD=-7.75, 95% CI: -12.25 to -3.25). There was no statistically significant difference in the incidence of adverse events between Saccharomyces group and the control group (13 studies) (7.8%(47/602) vs. 10.9%(65/596)), RR=0.75, 95% CI: 0.52 to 1.09, P=0.130). Conclusions:The additional use of S. boulardii in the treatment of UC. It can improve the clinical remission rate, alleviate intestinal inflammation, promote the recovery is safe of the injury in intestinal mucosal barrier.

Objective:To investigate the clinical and endoscopic characteristics of patients with autoimmune gastritis (AIG).Methods:From January 1, 2013 to December 31, 2023, 73 AIG patients who visited Peking Union Medical College Hospital were retrospectively enrolled. The clinical data of all the patients were analyzed, including gender, age, symptoms, laboratory examination results (such as serum hemoglobin, vitamin B 12, serum iron, gastrin, anti-parietal cell antibody (APCA), anti-intrinsic factor antibody (AIFA), Helicobacter pylori ( HP) infection status; the indicators were judged based on the normal reference value), and endoscopic and histopathological examination results. Descriptive statistical methods were used for statistical analysis. Results:Among the 73 AIG patients, there were 27 males (37.0%) and 46 females (63.0%), with a median age of 57 years old (ranged from 25 to 85 years old). Among the 73 AIG patients, 68 patients received APCA test, with a positivity rate of 88.2% (60/68); 67 patients took the AIFA test, with a positivity rate of 52.2%(35/67); 62 patients underwent both APCA and AIFA tests, of which 22 patients (35.5%) showed double positive. Serum level of vitamin B 12 was detected in 59 patients, and decreased in 27 cases (median level: 0.100 ng/L, mean level: 0.102 ng/L). Gastrin level was detected in 58 patients, and increased in 55 cases (median level: 0.930 ng/L, mean level: 1.203 ng/L). The levels of serum iron and ferritin were tested in 52 patients, the level of serum iron of 5 cases decreased, and the level of ferritin of 17 cases decreased (median level: 780.0 and 26.0 μg/L, mean level: 807.8 and 76.0 ng/L, respectively).Among the 73 AIG patients, the urea breath test was performed in 12 patients, and the result was positive in 6 cases. Endoscopic rapid urease test was performed in 69 patients, and the result was positive in 11 cases (15.9%). Regular blood analysis was performed in 71 patients, 24 cases (33.8%) were diagnosed with anemia, the median age of patients with anemia was 55 years old, and male-to-female ratio was 1∶5. There were 6 cases of iron-deficiency anemia and 5 cases of pernicious anemia. The endoscopic examination results of 73 patients indicated that 65 cases (89.0%) with mucosal atrophy under endoscopy, including 47 cases (64.4%) with mucosal atrophy in the gastric fundus and body, and 18 cases (24.7%) with whole gastric atrophy, more obviously in the gastric body. The pathological examination results showed type Ⅰ gastric neuroendocrine tumor(g-NET) in 35 cases (47.9%). Conclusions:The early clinical symptoms of AIG patients are nonspecific, often present with anemia and vitamin B 12 deficiency. Close monitoring of serological markers including APCA, AIFA and gastrin is essential. For patients diagnosed or suspected with AIG, intervals of endoscopic surveillance should be shortened to prevent the genesis and development of neoplasms such as g-NET.

Objective:To evaluate the efficacy and safety of Saccharomyces boulardii ( S. boulardii) as an adjuvant therapy for ulcerative colitis (UC). Methods:Databases including PubMed, Embase, Web of Science, Cochrane Library, Chinese Biomedical Literature Database, CNKI, Wanfang Database, and Chongqing VIP Chinese Science and Technology Journal Database were retrieved from their inception to September 1, 2023. Randomized controlled trials (RCTs) about S. boulardii as an adjuvant therapy for UC were included. The intervention method was S. boulardii monotherapy or as an adjunct to other medications ( Saccharomyces group), while the control group received other medications. The risk of bias of the included studies was assessed by the Cochrane risk of bias assessment tool (RoB 2.0). Primary outcome indicators included overall efficacy, clinical remission rate, and endoscopic remission rate. Secondary outcome indicators included Baron score, Sutherland disease activity index, indicators of intestinal mucosal barrier function, levels of inflammatory cytokines, and overall adverse events. RevMan 5.3 software was used for statistical analysis. RR and MD were taken as effect indicators of count data and measurement data, respectively. Results:A total of 26 RCTs were included, all from China. Among them, 22 studies reported the overall efficacy in UC patients. The results indicated that the overall efficacy of Saccharomyces group was higher than that of the control group (93.5%(943/1 009) vs. 76.8%(771/1 004)), and the difference was statistically significant ( RR=1.20, 95% confidence interval (95% CI): 1.16 to 1.25, P<0.001). And 9 studies assessed the efficacy in patients with mild or moderate UC. The results showed that the clinical remission rate and endoscopic remission rate of Saccharomyces group were both higher that those of the control group (68.1%(581/853) vs. 53.1%(455/857); 54.9%(425/774) vs. 35.5%(273/769)), and the differences were statistically significant ( RR=1.21, 95% CI: 1.14 to 1.25, P<0.001; RR=1.49, 95% CI: 1.28 to 1.73, P<0.001). S. boulardii as an adjunctive therapy could significantly lower the Baron score in patients with UC (7 studies) and mild to moderate UC (5 studies) ( MD=-0.51, 95% CI: -0.68 to -0.33; MD=-0.50, 95% CI: -0.75 to -0.26; both P<0.001). Additionally, S. boulardii as an adjunctive therapy could significantly decrease the Sutherland disease activity index in patients with UC (6 studies) and mild to moderate UC (3 studies), and the differences were statistically significant ( MD=-1.50, 95% CI: -2.26 to -0.74; MD=-0.92, 95% CI: -1.16 to -0.69; both P<0.001). Compared with the control group, S. boulardii as an adjunctive therapy significantly improved intestinal mucosal barrier function and decreased inflammatory cytokine levels in patients with UC and patients with mild to moderate UC (all P<0.05), such as D-lactate ( MD=-2.44, 95% CI: -4.43 to -0.45; MD=-1.47, 95% CI: -2.03 to -0.91), Geboes index ( MD=-0.40, 95% CI: -0.46 to -0.35; MD=-0.39, 95% CI: -0.46 to -0.32), C-reactive protein ( MD=-3.70, 95% CI: -5.65 to -1.76; MD=-3.36, 95% CI: -5.07 to -1.64), and tumor necrosis factor-α levels ( MD=-7.64, 95% CI: -11.27 to -4.01; MD=-7.75, 95% CI: -12.25 to -3.25). There was no statistically significant difference in the incidence of adverse events between Saccharomyces group and the control group (13 studies) (7.8%(47/602) vs. 10.9%(65/596)), RR=0.75, 95% CI: 0.52 to 1.09, P=0.130). Conclusions:The additional use of S. boulardii in the treatment of UC. It can improve the clinical remission rate, alleviate intestinal inflammation, promote the recovery is safe of the injury in intestinal mucosal barrier.

Objective:To investigate the clinical and endoscopic characteristics of patients with autoimmune gastritis (AIG).Methods:From January 1, 2013 to December 31, 2023, 73 AIG patients who visited Peking Union Medical College Hospital were retrospectively enrolled. The clinical data of all the patients were analyzed, including gender, age, symptoms, laboratory examination results (such as serum hemoglobin, vitamin B 12, serum iron, gastrin, anti-parietal cell antibody (APCA), anti-intrinsic factor antibody (AIFA), Helicobacter pylori ( HP) infection status; the indicators were judged based on the normal reference value), and endoscopic and histopathological examination results. Descriptive statistical methods were used for statistical analysis. Results:Among the 73 AIG patients, there were 27 males (37.0%) and 46 females (63.0%), with a median age of 57 years old (ranged from 25 to 85 years old). Among the 73 AIG patients, 68 patients received APCA test, with a positivity rate of 88.2% (60/68); 67 patients took the AIFA test, with a positivity rate of 52.2%(35/67); 62 patients underwent both APCA and AIFA tests, of which 22 patients (35.5%) showed double positive. Serum level of vitamin B 12 was detected in 59 patients, and decreased in 27 cases (median level: 0.100 ng/L, mean level: 0.102 ng/L). Gastrin level was detected in 58 patients, and increased in 55 cases (median level: 0.930 ng/L, mean level: 1.203 ng/L). The levels of serum iron and ferritin were tested in 52 patients, the level of serum iron of 5 cases decreased, and the level of ferritin of 17 cases decreased (median level: 780.0 and 26.0 μg/L, mean level: 807.8 and 76.0 ng/L, respectively).Among the 73 AIG patients, the urea breath test was performed in 12 patients, and the result was positive in 6 cases. Endoscopic rapid urease test was performed in 69 patients, and the result was positive in 11 cases (15.9%). Regular blood analysis was performed in 71 patients, 24 cases (33.8%) were diagnosed with anemia, the median age of patients with anemia was 55 years old, and male-to-female ratio was 1∶5. There were 6 cases of iron-deficiency anemia and 5 cases of pernicious anemia. The endoscopic examination results of 73 patients indicated that 65 cases (89.0%) with mucosal atrophy under endoscopy, including 47 cases (64.4%) with mucosal atrophy in the gastric fundus and body, and 18 cases (24.7%) with whole gastric atrophy, more obviously in the gastric body. The pathological examination results showed type Ⅰ gastric neuroendocrine tumor(g-NET) in 35 cases (47.9%). Conclusions:The early clinical symptoms of AIG patients are nonspecific, often present with anemia and vitamin B 12 deficiency. Close monitoring of serological markers including APCA, AIFA and gastrin is essential. For patients diagnosed or suspected with AIG, intervals of endoscopic surveillance should be shortened to prevent the genesis and development of neoplasms such as g-NET.

Objective To evaluate the safety and early-stage efficacy of transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS) using a new generation balloon-expandable (BE) valve by collecting the baseline and follow-up data. Methods We retrospectively reviewed the clinical data of severe AS patients who received TAVR with BE valve (Sapien 3) in Fuwai Hospital from September 2020 to June 2022. We collected the echocardiographic data as well as follow-up results at post-procedure, 1, 3, 6 and 12 months. According to the Sievers classification criteria, the patients were divided into a normal group and a bicuspid aortic valve group. Results Finally 62 patients were collected, including 31 females and 31 males with an average age of 71.44±9.17 years. There was 61 patients implanted successfully with BE valve and only 1 was transferred to surgical replacement. There was no mortality or severe complications. Echocardiographic assessment showed significant reduction of the pressure gradient (P＜0.001) and the effect was consistent to postoperative 12 months. After the treatment of patients with different aortic valve morphology using balloon dilation, the condition of valve stenosis improved. Conclusion The use of BE valves has good safety and early efficacy in patients with severe AS of different valve morphology.