non-HP Group Research Articles

The clinical course of hereditary pancreatitis in children – A comprehensive analysis of 41 cases

BackgroundAvailable data from adult patients do not reflect natural course of hereditary pancreatitis (HP) in children. To date, no study has assessed the clinical course of HP in children. ObjectiveTo investigate the clinical course of HP in children and compare it to non-HP group with chronic pancreatitis (CP). MethodsA group of 265 children with CP, hospitalized from 1988 to 2014, were enrolled in the study. Medical records of those patients were reviewed for data on presentation, diagnostic findings and treatment. All children were screened for mutations in major pancreatitis-associated genes, i.e. PRSS1, SPINK1, and CFTR. ResultsHP was diagnosed in 41 children (15.5%). Family history was positive in 88% of children with HP. Mutations of PRSS1 gene were found in 80% (33/41) of HP patients. We detected p.R122H, p.R122C, p.N29I, and p.E79K mutation in 34% (14/41), 27% (11/41), 12% (5/41), and 7% (3/41) of HP patients, respectively. Patients with paternal inheritance had first symptoms earlier than those with maternal inheritance (5.9 vs. 9.1 years; P < 0.05). Children with HP showed more severe changes in ERCP then those from non-HP group (2.05 Cambridge grade, vs. 1.6°; P < 0.05). ESWL was performed more frequently in HP group (12.2% vs. 3.1%; P < 0.05). There was no difference in age of disease onset (7.98 vs. 8.9 years; NS), pancreatic duct stenting (46.3% vs. 33%; NS), or number of surgical interventions (12.2% vs. 14.3%; NS) between both groups. ConclusionsChildren with HP reveal significantly more severe clinical presentation of the disease than non-HP patients, despite the same age of onset.

Hypertensive Phase Following Silicone Plate Ahmed Glaucoma Valve Implantation.

To estimate the incidence of hypertensive phase (HP) following silicone plate Ahmed glaucoma valve implantation and to explore the risk factors for developing HP. A total of 325 eyes from 325 patients who underwent Ahmed glaucoma valve implantation for uncontrolled intraocular pressure (IOP) and were followed for at least 1 year were included. The HP was defined as IOP>21 mm Hg (with or without IOP-lowering medication) during the first 3 months after surgery. Eyes were divided into HP and non-HP development groups. Overall success was defined as reaching an IOP>5 and <22 mm Hg with (qualified success) or without (complete success) use of an IOP-lowering medication. Risk factors associated with HP development were determined by logistic regression analysis. Among 325 eyes, 101 eyes (31.1%) experienced HP. For 24 eyes (23.8%), HP had not resolved by postoperative year 1. The HP group showed a significantly higher mean preoperative IOP than the non-HP group (37.1 ± 11.4 vs. 32.3 ± 11.2 mm Hg, P=0.004). The overall success rate was not significantly different between groups (81.2%, HP group vs. 89.7%, non-HP group; P=0.111); however, the complete success rate was significantly higher in the non-HP group (26.7% vs. 43.3%, P=0.003) at postoperative year 1. HP development was positively associated with preoperative IOP (odds ratio, 1.025; P=0.023). Higher preoperative IOP was associated with the HP development. The non-HP group achieved a higher complete success rate when assessed at postoperative year 1.

Relationship between Th17 cell number and Helicobacter pylori-infected chronic gastritis in children

Objective To explore the relationship between peripheral Th17 cell number and chronic gastritis in Helicobacter pylori(H.pylori)-infected children. Methods Children were diagnosed as chronic gastritis by endoscopy.The degree and activity of inflammation were graded by histopathology examinations.The patients with both 13C urea breath test and urease test positive were diagnosed as H. pylori infection.The peripheral Th17 cell number was measured by flow cytometry and expressed as a ratio to total T cell. Results The Th17 cell number in HP group (chronic gastritis with H. pylori infection, n=33), non-HP group (chronic gastritis without H. pylori infection, n=24) and normal controls (n=15) were (1.55±0.30)%, (1.06±0.33)%, and (1.04±0.35)%, respectively.HP group included a statistically higher Th17 cell number than the other groups (all P 0.05). According to the degree of inflammation, the chronic gastritis with H. pylori infection was categorized into non-apparent (n=10), mild (n=8), moderate (n=9) and severe (n=6) subgroups.The Th17 cell number in each subgroup was (1.64±0.21)%(non-apparent), (1.61±0.23)% (mild), (1.25±0.29)% (moderate) and (1.75±0.20)%(severe), respectively.The moderate group had a lowest Th17 cell number among 4 groups (P 0.05). The HP group patients with different inflammatory activity had a Th17 cell number of (1.23±0.25)% in no-napparent (n=15), (1.53±0.15)% in mild (n=6), (1.55±0.32)% in moderate (n=6) and (1.71±0.35)% in severe (n=6) subgroup, respectively.However, there were no significant differences among 4 subgroups (P>0.05). Conclusions In the progress of chronic gastritis with H. pylori infection, Th17 cells may play a role as a double-edged sword by protecting and fighting against H. pylori infection and immunopathologic insults.This would provide more insights into the treatment of H. pylori infection. Key words: Th17 cell; Helicobacter pylori; Chronic gastritis

High LPS and Inflammatory Factor Levels Decreased After Orthotopic Liver Transplantation in Hepatopulmonary Syndrome Patients.

Objective To investigate the association of Lipopolysaccharides (LPS), Toll like receptor(TLR), TNF-α and ET-1 with the development of HPS. Methods 71 patients were divided into 3 groups: end-stage liver disease with HPS(HPS group, n=31, 26patients were performed liver transplantation), end-stage liver disease without HPS(non-HPS group, n=30) and healthy volunteers(n=10). The written informed consents of all patients were obtained and the ethical committee approval was received. Blood was collected from these 71patients before and 3, 7, 14, 21 and 28days after OLT to detect TLR2mRNA and iNOSmRNA in peripheral blood monocytes and plasma LPS, TNF-α and ET-1 level. Also their changes after OLT were observed. Results TLR2mRNA, iNOSmRNA, LPS, TNF-α and ET-1 before OLT in HPS group were significantly higher than that in control group(P<0.05).They were also higher than those in non-HPS group but without significance(p>0.05). TLR2mRNA, iNOSmRNA, LPS, TLR, TNF-α before OLT was higher in non-HPS group than those in control group without significance(P>0.05 ), except for significantly higher ET-1 in non-HPS group (P=0.001). TLR2mRNA, TNF-αand ET-1 were all decreased in HPS and non-HPS group after OLT compared with those before OLT. Conclusion Higher lipopolysaccharides at the end stage of liver disease with the release of series of inflammatory factors may be associated with the development of HPS.

Hereditary pancreatitis in children

Background: Hereditary Pancreatitis (HP) is a rare inherited condition. We reviewed our experience over the last 20 years. Aims: The aim of our study was to evaluate the clinical course of HP in children. Patients & methods: 240 children with chronic pancreatitis, hospitalized since 1988 to 2013, were enrolled into the study. The medical records of these patients were reviewed for data on the presentation, diagnostic findings and endoscopic treatment. All children were screened for the PRSS1 gene mutations. Results: Hereditary pancreatitis was diagnosed in 31 patients (12.9%). PRSS1 gene mutations were found in 27 patients. We detected R122H/in 13, R122C/in 8, N29I/in 5 and E79K/in 1 patient. Family history was positive in 26 children with HP (84%). In 4 patients without mutations diagnosis was made when patients satisfied the requirements of the family history. In one patient we found SPINK1 mutation. In 2 children CFTR mutation was present. There was no difference in age of the disease onset between HP group and non-HP group (8 vs. 9.1 years; NS). In children with PRSS1 mutation ERCP had mean 2,5o Cambridge grade, vs. 1.6o, p<0.05. 19 patients with HP had calcifications on imaging studies (62% vs. 31%, p<0.05). Therapeutic intervention was more frequent in the HP group (75% vs. 35%; p<0.05). Pancreatic duct stenting was done in 16 children with HP (58% vs. 26%; p<0.05). ESWL was performed more frequent in HP group (20% vs. 3%; p<0.05). Conclusion: Hereditary pancreatitis in children has worse clinical course than CP in children without PRSS1 mutations.

Presurgical Orthopedic Treatment Ameliorates Postoperative Nasal Deformity After Cheiloplasty

We assessed the postoperative nasal form and symmetry after presurgical use of a Hotz plate (HP) in patients with unilateral complete cleft lip and palate (UCLP). The subjects were 28 infants with UCLP who underwent cheiloplasty. Of these subjects, 14 underwent presurgical orthopedic treatment using the HP (HP group) and 14 underwent the same treatment without the HP (non-HP group). Photographic records were obtained 1 and 6 months after cheiloplasty, and the results of anthropometric analysis were compared between the 2 groups. The nasal inclination and the ratio of the width of the nasal base to the total width of the nose were significantly improved in the HP group compared with the non-HP group at both postoperative time points. Thus, presurgical use of the HP significantly improved the nasal asymmetry and deformity in UCLP patients after primary cheiloplasty and nasal repair.

Analysis of clinic efficacy on early repeated hemoperfusion in patients with acute paraquat poisoning

Objective To explore the clinic efficacy on early repeated hemoperfusion in patients with acute paraquat (PQ) poisoning by analyzing the clinical data of 168 patients.Methods A total of 168 patients with acute paraquat poisoning,admitted to our emergency intensive care unit (EICU) from January 2008 to February 2011 were retrospectively analyzed.The PQ poisoning patients were divided into HP group (n =81,group A) and non-HP group (n =87,group B).The early repeated HP was carried out for at least 2 times within 24 hours after poisoning.The chi-square test and t test were used to detect the difference in outcome between groups.Results There were 52 patients (64.2％) in group A died and 68 fatalities (78.2％) in group B (x2 =4.01,P =0.042).The first HP was carried out in patients of group A within (3.6 ± 3.3) h after poisoning,and the patients in the group A received HP for (2.9 ± 1.4) times.On the second day after poisoning,sequential organ failure assessment (SOFA) scores of 168 patients were higher than those at admission (P ＜ 0.05).SOFA scores of patients in the group A were higher than that in the group B on the third day and on the forth day (P ＜ 0.05).In the group B,alanine aminotransferase (ALT)＞ 80 U/L and total bilirubin (TBIL) ＞ 34.2 μmol/L occurred earlier than those in group A (P ＜ 0.05)and there were more patients with abnormal creatinine and arterial oxygen and those abnormalities occurred earlier than those in group A (P ＜0.05).The maximum value of ALT,TBIL,creatinine,amylase (AMS)and CK-MB in the group B were higher than those in group A (P ＜ 0.05),the lowest value of PaO2 (＜ 60mm Hg) in group B were lower than that in group A (P ＜ 0.05).Conclusions The early repeated HP can delay organ injury after acute paraquat poisoning and reduce the extent of injure,giving ample time to get advanced treatment measures to improve the prognosis of patients. Key words: Hemoperfusion; Paraquat; Poisoning

Clinical significance of hemophagocytosis in BM clot sections during the peri-engraftment period following allogeneic hematopoietic SCT

The effects of macrophage activation on the outcome of allogeneic hematopoietic SCT (allo-HSCT) have yet to be fully examined. A total of 70 adult patients who received a first allo-HSCT for hematological diseases were studied. We counted the number of hemophagocytic cells in BM clot sections on day +14±7, and analyzed its impact on subsequent outcome. In all, 23 patients were diagnosed as having increased numbers of hemophagocytic cells (HP group), whereas 47 were not (non-HP group). The HP group was not associated with an increased incidence of acute or chronic GVHD, but was associated with worse hematopoietic recovery than the non-HP group. The 2-year OS for the HP group and the non-HP group was 30 and 65% (P<0.01), respectively, and 2-year non-relapse mortality was 48% and 27% (P<0.01), respectively. Multivariate analysis confirmed that the HP group was associated with a lower OS (hazard ratio (HR)=2.3; 95% confidence interval (CI), 1.0-5.4; P=0.048) and higher non-relapse mortality (HR=4.0; 95% CI, 1.6-9.9; P<0.01). The HP group had higher incidences of death due to graft failure (P<0.01) and endothelial complications, such as sinusoidal obstruction syndrome and transplant-associated microangiopathy (P=0.01). Macrophage activation is a previously unrecognized complication with negative impact on outcome of allo-HSCT.

Clinical significance of a myeloperoxidase gene polymorphism and inducible nitric oxide synthase expression in cirrhotic patients with hepatopulmonary syndrome

The clinical significance of a myeloperoxidase (MPO) gene polymorphism and inducible nitric oxide synthase (iNOS) expression in cirrhotic patients with hepatopulmonary syndrome (HPS) was explored. Enrolled subjects were divided into three groups according to their disease/health conditions: the HPS group (cirrhotic patients with HPS; n=63), the non-HPS group (cirrhotic patients without HPS; n=182), and the control group (healthy subjects without liver disease; n=35). The distribution of the MPO -463 G/A genotype and its relationship with iNOS expression in a typical cell block from ascitic fluid were detected by immunohistochemistry and polymerase chain reaction-restricted fragment length polymorphism analysis (PCR-RFLP). In the HPS group, the partial pressure of oxygen in blood and ascitic fluid was significantly decreased (8.95+/-1.58 kPa and 6.81+/-0.95 kPa, respectively; both P<0.01), while the partial pressure of carbon dioxide significantly increased (4.62+/-0.20 kPa and 5.92+/-0.45 kPa, respectively; P<0.01). MPO and iNOS levels were significantly increased in the HPS group as compared with the non-HPS group. These increases were even more remarkable in ascitic fluid (41.36+/-11.62 and 13.23+/-4.81 microg/L; 10.27+/- 3.20 and 4.95+/-1.12 microg/L) than in blood (16.66+/-5.24 and 4.87+/-1.73 microg/L; 5.79+/-2.31 and 2.35+/-0.84 microg/L). The distribution of the MPO genotypes GG, GA, and AA were 76.2%, 22.2% and 1.6% in the HPS group, and 57.7%, 37.9% and 4.4% in the non-HPS group (P<0.05). The expression of iNOS was significantly higher in patients with the G alleles (G/G and G/A) (61.54%, 48/78) than in patients with A alleles (G/A and A/A) (38.46%, 30/78) (P<0.01). It was suggested that the expression levels of iNOS and MPO were correlated with HPS-induced hypoxemia. The MPO-463 G/A mutation might be a protective factor that prevents the development of HPS. The MPO might be involved in the regulation of iNOS expression. In humans, MPO pathways, the iNOS/NO system, and their interaction might have an impact on the occurrence and development of HPS.

Can a Short Course of Prophylactic Low-dose Proton Pump Inhibitor Therapy Prevent Stomal Ulceration After Laparoscopic Roux-en-Y Gastric Bypass?

The purpose of this retrospective analysis was to determine if a short course of prophylactic proton pump inhibitor (PPI) therapy can prevent stomal ulceration after laparoscopic Roux-en-Y gastric bypass (LRYGBP). Four hundred forty-nine consecutive patients who underwent LRYGBP and had a minimum of 6 months follow-up were included. Patients were categorized in two groups: patients with Helicobacter pylori at preoperative endoscopy (HP group) and patients without H. pylori (non-HP group). All patients in the HP group were medically treated prior to surgery. In both groups, almost half of the patients received low-dose proton pump inhibitors (omeprazole 20 mg daily) for 1 month following LRYGBP. The incidence of stomal ulceration in the HP group was not statistically different from the incidence in the non-HP group (7/86, 8.14% vs. 41/363, 11.29%; p = 0.559). When comparing the patients who did receive PPI therapy with the patients who did not receive PPI therapy within the non-HP group, there was no significant reduction in development of stomal ulceration (18/169, 10.65% vs. 23/194, 11.86%; p = 0.743). When comparing the patients who did receive PPI therapy with the patients who did not receive PPI therapy within the HP group, there is a significant reduction in development of stomal ulceration (0/41, 0% vs. 7/45, 15.56%; p = 0.0123). Development of stomal ulceration in patients tested positive for H. pylori prior to LRYGBP can be prevented by prophylactic low-dose PPI therapy following surgery.

Effect of hemoperfusion on clearance of organophosphorus in rabbits poisoned by methamidophos.

Objective To evaluate the clearance efficacy of resin hemoperfusion(HP) on the removal of organophosphorus in the rabbits poisoned by methamidophos(MAP) and its effects on organ injury. Method Six-teen healthy Japanese white rabbits were randomly divided into HP group and non-HP group. MAP was given through gastric tube in a dosage of 20 mg/kg to rabbits of both groups. Rabbits of liP group received resin hemop-ersion plus conventional treatment including early gastric lavage, atropine and pralidoxime. Rabbits of non-HP group received only conventional treatment. The plasma concentration of MAP was determined by using gas chro-matography before and after rabbits were poisoned at different intervals. Serum choline esterase (ChE),lactic de-hydrogenase (LDH), alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatine kinase (CK) and creatine kinase isoenzyme (CK-MB) of rabbits of both groups were assayed 6 hours after rabbits poisoned. Pathological changes in lung, liver, kidney and muscle were investigated simutaneously. SPSS 10.0 software was used for statistical analysis. The comparison between groups was carried out by using t -test. Results ① The typical symptoms of organophospborus poisoning were occurred in rabbits within 5 - 10 minutes after ingestion of MAP. In HP group, the plasma levels of rabbits before,and 30 min,60 min,90 min and 120 min after hemoperfu-sion were (11.43±1.56),(7.82±1.54),(4.97±1.58),(5.66±1.75) ,(5.49±1.68) μg/mL, respectively (P <0.01). After hemoperfusion, the plasma MAP levels of rabbits in HP group were lower than those in non-HP groups (P < 0.01). The improveme, nt of clinical presentation of rabbits was observed shortly after HP. ② The blood choline esterase activity of rabbits were depressed in hoth groups without significant difference. In contrast, the blood levels of ALT, AST,LDH,CK and CK-MB of rabbits in non-HP group elevated significantly than in HP group (P < 0.01). ③ The more severe injury of muscle, liver, kidnet and lung of rabbits can could be seen in non-HP group. Conclusions ① HP can effectively eliminate the plasma MAP and has the potential to improve the clinical presentation of intoxication in rabbits. ② Early intervention of Hp exerts a protection from organ dam-age of organophosphorus pesticide. Key words: Hemoperfusion; Poisoning; Methamidophos; Clearance; Organ injury

A comparative study on resilience level between WHO health promoting schools and other schools among a Chinese population

The WHO health promoting school (HPS) approach covers key areas including school-based programmes improving students' psychological health, but there have been few studies evaluating the resilience performance of these schools. This study compared the resilience scores between schools within the healthy school award (HSA) scheme (HPS group) and those not (non-HPS group). We conducted a cross-sectional survey of grade-one students (aged 12), all teachers and parents of mainstream secondary schools recruited by stratified random sampling in one large Territory of Hong Kong using validated resilience questionnaires during November-December 2005. Four non-HPS and four HPS secondary schools were recruited, respectively, involving 1408 students, 891 parents and 91 teachers, with similar baseline characteristics. The HPS students were found to have better scores than non-HPS students (average age 12.4 year-old in both groups) in all dimensions with significantly higher scores in 'Peer Support' (p = 0.013), 'Making a Difference' (p = 0.011), 'About Me' (p = 0.027) and 'Generally Happy' (p = 0.011). There was no difference in the scores between non-HPS and HPS parents. The HPS teachers reported significantly higher scores in 'Health Policies' (p = 0.023), 'Social Environment' (p = 0.049), 'School Community Relations' (p = 0.048), 'Personal Skills Building' (p = 0.008) and 'Partnership & Health Services' (p = 0.047). The secondary HPS students and teachers reported significantly higher resilience scores than those of non-HPS. This study shows that the HSA scheme under WHO has the potential to exert positive changes in students and teachers and the concept of HPS is effective in building resilience among major school stakeholders.

The impact of a newly designed resilience-enhancing programme on parent- and teacher-perceived resilience environment among Health Promoting Schools in Hong Kong

Background:The Health Promoting School (HPS) approach provides a strong foundation to improve students’ overall health, including psychological well-being, which has its roots in resilience. The present study evaluates the effectiveness...

Hypersensitivity pneumonitis caused by Penicillium citrinum, not enoki spores

Flammulina velutipes is called the Enoki mushroom in Japanese and is cultivated indoors. Mushroom workers face occupational exposure to a tremendous number of fungi and organic antigens capable of causing hypersensitivity pneumonitis (HP). One worker employed at an Enoki farm developed HP due to Penicillium citrinum. This study investigated new cases of HP among the workers cultivating Enoki. Serum Krebs von der Lungen-6 (KL-6), surfactant protein (SP)-A and SP-D were measured. Lymphocyte stimulation tests (LST) and double immunodiffusion tests (DIT) were performed to identify P. citrinum. Workers showing high levels of KL-6, SP-A, or SP-D and a high LST value or positive DIT were identified and then were further examined by chest computed tomography, bronchoalveolar lavage and transbronchial lung biopsy. The initial patient and new HP patients were defined as the HP group and the other participants were defined as the non-HP group. Forty-eight Enoki workers participated in the study. Four of nine workers who met the criteria for further examinations were diagnosed as having HP due to P. citrinum. In comparison between non-HP group and HP group, KL-6, SP-D and LST values were significantly higher in HP group. There was a strong correlation between KL-6 and SP-D. DIT had high sensitivity and high specificity. KL-6, SP-D, LST, and DIT were useful for detecting HP patients. KL-6 was the most useful predictor of HP in this study. DIT was useful not only as a predictor of HP but also as a detector of the causative antigen.

Hypophosphataemia in old patients is associated with the refeeding syndrome and reduced survival

Previous studies found that hypophosphataemia (HP) a common finding in hospitalised patients associated with unfavourable outcome, but they did not focus on old patients. The aim of the current study was to determine the prevalence, associated risk factors and potential clinical consequences of HP detected during hospitalisation in a geriatric medical centre. Case-control study. A total of 312-bed geriatric division. We compared 325 patients aged >or=65 years with at least one episode of HP-group defined by serum phosphate <or=0.77 mmol L(-1) with 326 patients without HP (non-HP group). Evaluation included baseline anamnesis, demographic and laboratory data. Patients in both groups were followed up to 2.7 years and clinical outcome recorded included length of hospitalisation, in-hospital and long-term survival. About 14.1% of 2307 elderly had HP. Patients in the HP-group compared with the non-HP group had significantly more weight loss, lower albumin levels, more sepsis and received threefold more glucose-containing infusions and twofold more food supplementations (P < 0.0001). HP was detected on average on the 10.9 +/- 21.5 days of hospitalisation. Patients in the HP-group compared with the non-HP group, had significantly longer hospitalisation period (P < 0.0001) and reduced long-term survival (P = 0.003) with threefold increased mortality rates. In a multivariate analysis, HP was not found to be an independent predictor of mortality. The HP was common among old hospitalised patients. Clinical characteristics of the HP-group, the time-course and strong association with glucose and food supplementation, are compatible with the refeeding syndrome, described previously in malnourished patients. HP was associated with significantly reduced survival.

Does Hearing Preservation Surgery for Acoustic Neuromas Affect Tinnitus?

Questionnaires returned from 202 patients who had undergone acoustic neuroma resection were analyzed with special reference to the effect on tinnitus of surgery that attempted to preserve hearing versus surgery that did not. We also examined the relationship between postoperative hearing and tinnitus following surgery to preserve hearing (103 patients, HP group). The incidence of preoperative tinnitus in the HP group was 78.6%; postoperatively it increased to 89.3% (p = 0.0367). The remaining 99 patients (non-HP) underwent labyrinthectomy during tumor resection. In this group tinnitus occurred in 72.7% preoperatively and in 67.3% postoperatively (p = 0.4097). Our findings show that when tinnitus was absent preoperatively, 85% of the HP group developed it postoperatively compared to 31% of patients in the non-HP group. The outcome of surgery to preserve hearing had no bearing on the loudness or annoyance of postoperative tinnitus. Although postoperative tinnitus is tolerable to most patients, they must be informed prior to surgery about its possible occurrence or worsening, especially if the goal is to preserve hearing.