Crohn′s disease complicated with mesenteric fibromatosis is rare in clinical practice. We report a case that the patient with Crohn′s disease developed mesenteric fibromatosis after 1.5 years of infliximab treatment, hoping to enrich clinicians′ experience.

Objective:To investigate the diagnosis and clinical characteristics of five elderly patients with Chlamydia psittaci-caused severe pneumonia.Methods:Through retrospective analysis, diagnosis and treatment process and clinical characteristics of five elderly inpatients with severe pneumonia caused by Chlamydia psittaci were summarized in the Department of Critical Care Medicine, Quanzhou First Hospital East Street Branch Area, affiliated to Fujian Medical University between January to June 2021.Results:Five patients with severe pneumonia caused by Chlamydia psittaci were aged from 64 to 74 years, with various underlying diseases such as coronary heart disease, chronic heart failure, chronic obstructive pulmonary disease, etc.All patients had an established history of poultry exposure.These cases had high fever, cough, spitting, and dyspnea as the main clinical manifestations.Some of them also had systemic symptoms or weakness of the limbs as the prodromal symptoms.The disease progressed rapidly, with severe respiratory failure, acute kidney injury, and shock appearing soon, accompanied by different degrees of muscle injury, and damage to the heart, liver, blood coagulation, and immune systems at the same time.Laboratory examination showed that levels of inflammatory indicators were increased: at 3, 5, 7 d after admission, the level of C reactive protein was 214.6(153.9-256.3)mg/L, 199.2(115.8-333.8)mg/L, 151.0(11.19-173.7)mg/L, respectively; and interleukin 6 level was 1 241.0(912.1-6822.0)ng/L, 779.1(451.2-7122.0)ng/L, 631.2(7.0-4 321.0)ng/L, respectively.And monitoring results of nutritional index indicated a high metabolic state.The imaging examinations showed that consolidation and ground-glass shadows spreaded to both lungs, may accompany the miliary and nodular shadows, and may also involve pleural which caused pleural effusion.After the clinical use of metagenomic next-generation sequencing(mNGS), mNGS has been confirmed as an important method for the diagnosis of Chlamydia psittaci infection.The disease course and prognosis were related to the severity of the disease, advanced age, underlying diseases, and timely diagnosis and effective treatment.Conclusions:The progression of Chlamydia psittaci pneumonia to severe disease may be related to advanced age, more basic diseases such as chronic cardiopulmonary disease, smoking, and timely diagnosis and treatment.Generally, laboratory and imaging examinations have no diagnostic specificity, but mNGS is of great significance for early diagnosis, transition to target treatment and improvement of prognosis.

Crohn′s disease complicated with mesenteric fibromatosis is rare in clinical practice. We report a case that the patient with Crohn′s disease developed mesenteric fibromatosis after 1.5 years of infliximab treatment, hoping to enrich clinicians′ experience.

Objective:To clarify the distribution and composition of drug-resistant genes of carbapenem-resistant Klebsiella pneumoniae (CRKP) in Qingdao City and to provide rationale for clinical application of antibacterial treatment by screening for carbapenemase phenotype and detecting resistance genes of CRKP. Methods:Fifty-four clinically isolated non-repeating CRKP from five Third Grade & Class A Hospitals in Qingdao City from October 2016 to September 2019 were collected. Kirby-Bauer method was used for drug sensitivity tests of commonly used antibacterial drugs; modified Hodge test was used for carbapenemase phenotypic screening; and polymerase chain reaction (PCR) was used to amplify blaKPC-2, blaNDM-1, blaOXA-48, blaIMP, blaVIM target genes. The amplified products were subjected to agarose gel electrophoresis. Results:Drug susceptibility tests showed that CRKP had the lowest resistance rate to amikacin (35.2%), followed by compound sinomine (53.7%), gentamicin (55.6%), levofloxacin (75.9%), and imipenem-cilastatin (88.9%); piperacillin-tazobactam, meropenem, cefotaxime, and cefoperazone-sulbactam were all higher than 90%. There were 43 positive strains in the modified Hodge test (the positive rate was 79.63%) and 11 negative strains. A total of 40 strains with carbapenemase resistance were detected by PCR resistance gene detection. The detection rate of target drug-resistant genes was 74.07%. Among them, 35 strains carry the KPC-2 gene, 7 strains carry the OXA-48 gene, 4 strains carry the NDM-1 gene, and 1 strain carries the IMP gene. All strains carrying the OXA-48 gene also carried the KPC-2 gene, which was not detected. Strains carrying the VIM gene were identified, and the remaining 14 strains did not detect the target carbapenem gene.Conclusion:The carbapenem-producing genes carried by CRKP in five hospitals in Qingdao City are mainly KPC-2, followed by OXA-48 and NDM-1.

Degos disease is a rare multi-system necrotic vasculitis disease. Autoimmune abnormality, heredity, infection and coagulation abnormality may be involved in the disease. Usually skin manifestations would be the first manifestation of this disease. However, intestinal perforation and hemorrhage are the main causes of death, which are not easy to be recognized or diagnosed by gastroenterologist. A case of this rare disease with intestinal microperforation is reported for reference.

Objective:To analyze the association between NUDT15 gene polymorphism and adverse reactions induced by azathioprine (AZA) myelosuppression in patients with inflammatory bowel disease (IBD) , and to provide reference for clinical treatment of IBD. Methods:Literatures of randomized controlled trials of NUDT15 gene mutation and AZA in the treatment of IBD were searched with computer from China Knowledge Network, Wanfang database, VIP database, PubMed, Cochrane Library and Web of Science. The quality evaluation and data of studies meeting the inclusion criteria were screened and retrieved to perform meta analysis. Results:Ten literatures were enrolled including 3095 patients. Meta analysis showed that the mutation rate of NUDT15 gene in Asian IBD population was significantly higher than that of TPMT gene (21.5% vs. 2.8%, OR = 0.10, 95% CI: 0.07-0.15, P<0.001) with significant difference. NUDT15 gene mutation was significantly associated with AZA-related leukopenia ( OR = 0.40, 95% CI: 0.34-0.47, P<0.001) . IBD patients with NUDT15 mutation were more likely to develop leukopenia in the early stage of AZA application ( OR = 2.69, 95% CI: 1.67-4.33, P<0.001) . Besides, homozygous mutants of NUDT15 gene (TT type) were more likely to have grade Ⅲ-Ⅳ bone marrow suppression ( OR = 0.09, 95% CI: 0.04-0.18, P<0.001) . Conclusions:In Asian IBD population, bone marrow suppression caused by AZA is significantly associated with NUDT15 gene mutation, which is more closely associated than TPMT gene mutation and usually occurs within 8 weeks of AZA application. At the same time, homozygous mutations of NUDT15 gene (TT) increase the risk of severe myelosuppression.

Degos disease is a rare multi-system necrotic vasculitis disease. Autoimmune abnormality, heredity, infection and coagulation abnormality may be involved in the disease. Usually skin manifestations would be the first manifestation of this disease. However, intestinal perforation and hemorrhage are the main causes of death, which are not easy to be recognized or diagnosed by gastroenterologist. A case of this rare disease with intestinal microperforation is reported for reference.

Objective:To analyze the association between NUDT15 gene polymorphism and adverse reactions induced by azathioprine (AZA) myelosuppression in patients with inflammatory bowel disease (IBD) , and to provide reference for clinical treatment of IBD. Methods:Literatures of randomized controlled trials of NUDT15 gene mutation and AZA in the treatment of IBD were searched with computer from China Knowledge Network, Wanfang database, VIP database, PubMed, Cochrane Library and Web of Science. The quality evaluation and data of studies meeting the inclusion criteria were screened and retrieved to perform meta analysis. Results:Ten literatures were enrolled including 3095 patients. Meta analysis showed that the mutation rate of NUDT15 gene in Asian IBD population was significantly higher than that of TPMT gene (21.5% vs. 2.8%, OR = 0.10, 95% CI: 0.07-0.15, P<0.001) with significant difference. NUDT15 gene mutation was significantly associated with AZA-related leukopenia ( OR = 0.40, 95% CI: 0.34-0.47, P<0.001) . IBD patients with NUDT15 mutation were more likely to develop leukopenia in the early stage of AZA application ( OR = 2.69, 95% CI: 1.67-4.33, P<0.001) . Besides, homozygous mutants of NUDT15 gene (TT type) were more likely to have grade Ⅲ-Ⅳ bone marrow suppression ( OR = 0.09, 95% CI: 0.04-0.18, P<0.001) . Conclusions:In Asian IBD population, bone marrow suppression caused by AZA is significantly associated with NUDT15 gene mutation, which is more closely associated than TPMT gene mutation and usually occurs within 8 weeks of AZA application. At the same time, homozygous mutations of NUDT15 gene (TT) increase the risk of severe myelosuppression.

Objective: To investigate whether rapid weight gain in the first year of life was associated with incidence of overweight and higher blood pressure in small for gestational age (SGA) and appropriate for gestational age (AGA) infants at preschool age. Methods: From March 1, 2017 to June 30, 2018, a total of 12 150 children aged six years from 50 municipal kindergartens in Tianjin were enrolled in a cross-sectional survey. Their body weight, height and blood pressure were measured. Body length and weight at birth and one year of age were retrospectively collected. Rapid catch-up growth was defined as the difference of weight-for-height Z-score between one year old and at birth >0.67. The relationship between rapid growth with overweight and blood pressure in SGA and AGA infants at preschool age were analyzed using t test, analysis of variance and Chi-square test. Results: At the age of six, children with rapid growth had a higher rate of overweight [28.6% (2 095/7 328) vs 17.5% (842/4 822), t=196.457, P<0.001], and higher systolic blood pressure [(99.4±10.0) vs (98.4±10.1) mmHg (1 mmHg=0.133 kPa), t=29.260, P<0.001] and diastolic blood pressure [(60.0±7.7) vs (59.4±7.8) mmHg, t=16.079, P<0.001] compared with children without rapid growth. SGA children with rapid growth had higher body weight [(21.5±4.4) vs (19.2±3.7) kg, t=3.747, P<0.001], height [(117.4±5.5) vs (114.8±5.4) cm, t=3.557, P<0.001] and systolic blood pressure [(98.4±9.9) vs (95.6±11.2) mmHg, t=2.080, P=0.038] compared with those without. Comparing to AGA children, SGA children had lower overweight rate [17.5% (144/824) vs 24.7% (2 793/11 326), t=21.630, P<0.001] and systolic blood pressure [(98.2±10.0) vs (99.0±10.1) mmHg, t=2.431, P=0.015]. Among the AGA children with rapid growth, 29.8% (1 958/6 564) were overweight. Conclusions Rapid growth in infancy is associated with overweight and higher systolic blood pressure at preschool age. A proper weight gain should be emphasized for both SGA and AGA infants.

Objective To observe the dynamic changes of heme oxygenase 1,NAD(P)H:quinine oxidoreductase 1 and Nuclear factor-E2-related factor 2 in the lung tissue of acute H2S-intoxicated rats and intervention effects of ulinastratin(UTI).Methods A total of 96 SD rats of clean grade were divided randomly(random number)into four groups:normal control group(NS group,n =8),UTI control group(UTI group,n =8),H2S-intoxicated model group(H2S group,n =40,rats were exposed to H2S(200 × 10-6)for 1 h to establish the H2S-intoxicated model)and UTI treatment group(H2S +UTI group,n =40,rats were intraperitoneal injected with the dose of UTI 105 U/kg).H2S group and H2S + UTI group were sacrificed 2,6,12,24 and 48 h after modeling.The activity and mRNA expression of HO-1 and NQO-1 in the lung tissue were measured by ELISA and RT-PCR methods,and the expression of Nrf2 mRNA and protein in the lung tissue was detected by RT-PCR and Western Blot methods.Pathological changes of lung tissue were observed by lightmicroscope and the lung injury score was used to evaluate inhalation injury.Results The pulmonary HO-1 activity and mRNA expression in rats of H2S group at 2,6,12 h(P ＜ 0.01)after intoxication were markedly increased than that in NS group:In comparison with H2S group,the pulmonary HO-1 activity and mRNA expression increased at 6,12,24,48 h(P ＜0.01).The pulmonary NQO-1 activity and mRNA expression in rats of H2S group at 2,6,12,24 h(P＜ 0.01)after intoxication were markedly increased than that in NS group; In comparison with H2S group,the pulmonary NQO-1 activity and mRNA expression increased at 6,12,24,48 h(P ＜ 0.01).The pulmonary Nrf2 mRNA and protein expression in rats of H2S group at 2,6,12 h(P ＜0.01 or P ＜0.05)after modeling were markedly increased than that in NS group and reached peak 2 hour after modeling; In comparison with H2S group,the pulmonary Nrf2 mRNA and protein expression increased at 6,12,24,48 h(P ＜0.01).At 24 h after modeling,the degree of lung damage were also decreased in H2S group compared with H2S + UTI group in the lightmicroscope.Histopathological examination showed that the degree of lung injury in H2S + UTI group was less severe than that in H2S group especially in the 12,24 and 48 h (P ＜0.01).Conclusions HO-1,NQO-1 and Nrf2 are involved in the pathogenesis of acute lung injury induced by H2S-intoxicated in rats.UTI may improve the imbalance in redox and activate HO-1,NQO-1 and Nrf2 can reduce lung injury and protect the lung injury induced by H2S in rats.