[Chronic non-bacterial osteomyelitis with autoimmune hepatitis: a case report and literature review].

Objective: To summarize the clinical characteristics and treatments of chronic non-bacterial osteomyelitis with autoimmune hepatitis in children. Methods: A child who had chronic non-bacterial osteomyelitis with autoimmune hepatitis was admitted to the Department of Gastroenterology of the Children's Hospital Capital Institute of Pediatrics at April 2022. The clinical data was retrospectively analyzed. Using the keywords of "chronic non-bacterial osteomyelitis""autoimmune hepatitis" in Chinese and English, the literature from database establishment to December 2022 in CNKI, Wanfang, China Biomedical Literature Database and Pubmed was searched. Combined with this case, the clinical characteristics and treatment of chronic non-bacterial osteomyelitis combined with autoimmune hepatitis were analyzed. Results: A 5 years and 3 months girl was admitted to the Department of Gastroenterology of Children's Hospital, Capital Institute of Pediatrics for "transaminase elevated for 1 year and swelling of right maxillofacial area for half a year". The physical examinations at admission found a 4.0 cm × 4.0 cm swelling area with tenderness before the right ear, abdominal distention with visible abdominal wall vein, firm and enlarged liver (10.0 cm below the xiphoid and 4.5 cm below the right ribs), and splenomegaly (Line Ⅰ 10.0 cm, Line Ⅱ 11.5 cm, and Line Ⅲ 25.0 cm). There was no redness, swelling or restriction of the limbs. Laboratory examination found abnormal liver function with alanine aminotransferase 118 U/L, aspartate aminotransferase 227 U/L, γ-glutamyltransferase 360 U/L, and positive direct anti-human globulin test; immunology test found immunoglobulin G 41.60 g/L and a homogeneous type of antinuclear antibody of 1∶1 000; the autoimmune hepatitis antibody test found a positive anti-smooth muscle antibody (1∶100). Liver biopsy showed moderate interfacial inflammation and the patient was diagnosed with autoimmune hepatitis (International Autoimmune Hepatitis Group 19). The imaging findings showed extensive involvement of the bilateral mandible, while the right side was severe. There were expansile bone changes, thinning of the bone cortex, and significant swelling of the surrounding soft tissue in the mandibular body, mandibular angle, and mandibular ramus. After treatment of glucocorticoid, the swelling of the right maxillofacial region disappeared and the transaminase returned to normal. Only one case was reported before in English and none in Chinese. The two cases were both girls whose main clinical features were joint pain and swelling. The previous case started with pain in both knee joints, and developed liver injury during treatment while this case had liver injury as the initial clinical presentation. Besides, the affected sites and degrees of arthritis in the 2 cases were different. After glucocorticoid treatment, the clinical symptoms were alleviated, and transaminases returned to normal. Conclusions: Chronic non bacterial osteomyelitis may involve the liver and manifest as autoimmune hepatitis. Glucocorticoids therapy is effective.

[Diagnostic value and application of 24 h multichannel intraluminal impedance-pH monitoring in children with gastroesophageal reflux disease].

Objective: To evaluate the diagnostic value and application of 24 h multichannel intraluminal impedance-pH (24 h MII-pH) monitoring in children with gastroesophageal reflux disease (GERD). Methods: This is a cross-sectional study. From January 2013 to December, 2020, 417 patients who received 24 h MII-pH monitoring in Department of Gastroenterology of Children's Hospital Capital Institute of Pediatrics were included. According to results, these children were divided into the GERD and non-GERD groups. Furthermore, the 132 children with GERD who had gastroscopy were divided into the reflux esophagitis (RE) and non-erosive reflux disease (NE) groups to investigate the differences in their refluxes. Non-parametric Mann-Whitney U test or indepentent sample t test was used for comparisons between the groups. Results: Among the 417 children, 232 were males and 185 females, aged (7.3±3.9) years. The course of disease was 0.5 (0.1, 2.0) years. The main clinical symptoms included acid reflux (128 cases), vomiting (173 cases), abdominal pain (101 cases), and cough (76 cases). The 24 h MII-pH monitoring were positive in 243 children (58.3%, 243/417), which was higher than that by 24 h esophageal pH monitoring (43.6%, 182/417). The 24 h MII-pH monitoring results demonstrated significant differences in the episodes of acid reflux, weakly acidic reflux, non-acidic reflux, liquid reflux and mixed reflux between GERD and non-GERD groups (10 (4, 19) vs. 4 (1, 9) times/24 h, 14 (6, 32) vs. 7 (3, 13) times/24 h, 0 (0, 0) vs. 0 (0, 0) times/24 h, 19 (10, 34) vs. 8 (3, 14) times/24 h, and 6 (2, 12) vs. 3 (1, 5) times/24 h, Z=-6.96, -7.25, -5.62, -8.75, and -6.48, all P<0.05, respectively). Besides, the results also showed significant differences in Boix-Ochoa score, episodes of long reflux, course of long reflux, and episodes of weakly acidic reflux between the RE and NE groups (51.2 (21.4, 153.2) vs. 20.7 (12.1, 34.7), 5 (2, 10) vs. 1 (0, 4) times/24 h, 19 (7, 87) vs. 8 (3, 22) min, and 5 (2, 15) vs. 15 (6, 33) times/24 h, Z=-3.44, -3.41, -2.65, and -2.27, all P<0.05, respectively). Conclusion: 24 h MII-pH monitoring not only improves the detection rate of GERD in children, but also provides a possibility to early etiological diagnosis.

Upgrading of by-product from beverage industry through solid-state fermentation with Candida utilis and Bacillus subtilis.

Yellow wine lees (YWL) are the main co-products in yellow wine industry with unbalanced amino acid (AA) profiles. Solid-state fermentation was employed in this study to upgrade the YWL for ruminant animals. A 3 × 3 orthogonal design was conducted to optimize the fermentation condition for optimal crude protein (CP) yield as follows: ratio of water to total solid medium at 50 : 100 (v/w), temperature of 30°C, and ratio of Candida utilis to Bacillus subtilis at 2 : 1. The contents of CP, peptides and AA of fermented products were 14·5, 40·9 and 26·1% higher than those of the unfermented respectively. In particular, the essential AA were highly improved, especially for lysine and methionine. The fermentation increased the in vitro microbial protein synthesis with higher CP digestibility and dramatically enhanced the ability of scavenging free radicals of the YWL. It is concluded that the microbial pretreatment can greatly improve the nutritional value of YWL, making these materials more suitable as feeds for animals, including ruminants. SIGNIFICANCE AND IMPACT OF THE STUDY: Yellow wine lees (YWL) are the main co-products in yellow wine industry with unbalanced amino acid (AA) profiles and are not well utilized. A strain combination of Candida utilis and Bacillus subtilis was employed to upgrade YWL. Contents of crude protein and peptides of YWL were greatly increased by microbial fermentation. Essential AAs of YWL were highly improved after the solid-state fermentation and no negative impact was observed in in vitro digestibility. Fermented YWL may be a good feed source for ruminants.

[Cost-effectiveness analysis on colorectal cancer screening program].

Objective: To evaluate the cost-effectiveness of colorectal cancer screening program in different age groups from the view of health economics. Methods: The screening compliance rates, detection rates in different age groups were calculated by using the data from colorectal cancer screening program in Jiashan county, Zhejiang province. The differences in indicator among age groups were analyzed with χ(2) test or trend χ(2) test. The ratios of cost to the number of case were calculated according to cost statistics. Results: The detection rates of immunochemical fecal occult blood test (iFOBT) positivity, advanced adenoma and colorectal cancer and early stage cancer increased with age, while the early diagnosis rates were negatively associated with age. After exclusion the younger counterpart, the cost-effectiveness of individuals aged >50 years could be reduced by 15%-30%. Conclusion: From health economic perspective, it is beneficial to start colorectal cancer screening at age of 50 years to improve the efficiency of the screening.

Effects of Supplemental Levels of Saccharomyces cerevisiae Fermentation Product on Lactation Performance in Dairy Cows under Heat Stress.

The objectives of this study were to evaluate the effects of different supplemental levels of Saccharomyces cerevisiae fermentation product (SCFP; Original XP; Diamond V) on lactation performance in Holstein dairy cows under heat stress. Eighty-one multiparous Holstein dairy cows were divided into 27 blocks of 3 cows each based on milk yield (23.6±0.20 kg/d), parity (2.88±0.91) and day in milk (204±46 d). The cows were randomly assigned within blocks to one of three treatments: 0 (control), 120, or 240 g/d of SCFP mixed with 240, 120, or 0 g of corn meal, respectively. The experiment was carried out during the summer season of 2014, starting from 14 July 2014 and lasting for 9 weeks with the first week as adaption period. During the experimental period, average daily temperature-humidity index (measured at 08:00, 14:00, and 20:00) was above 68, indicating that cows were exposed to heat stress throughout the study. Rectal temperatures tended to decrease linearly (p = 0.07) for cows supplemented with SCFP compared to the control cows at 14:30, but were not different at 06:30 (p>0.10). Dry matter intake was not affected by SCFP supplementation (p>0.10). Milk yield increased linearly (p<0.05) with increasing levels of SCFP. Feed efficiency (milk yield/dry matter intake) was highest (p<0.05) for cows fed 240 g/d SCFP. Cows supplemented with SCFP gained (p<0.01) body weight, while cows in the control lost body weight. Net energy balance also increased linearly (p<0.01) with increasing levels of SCFP. Concentrations of milk urea nitrogen (p<0.01) decreased linearly with increasing levels of SCFP, while no difference (p>0.10) was observed among the treatments in conversion of dietary crude protein to milk protein yield. In summary, supplementation of SCFP alleviated the negative effect of heat stress in lactating Holstein dairy cows and allowed cows to maintain higher milk production, feed efficiency and net energy balance. Effects of SCFP were dose-dependent and greater effects were observed from higher doses.

Gender disparities in dietary status and its risk factors in underserved populations.

OBJECTIVES: To examine dietary status and its risk factors among adults aged 40-74 years at high risk of colorectal cancer (CRC) in an economically and medically underserved population. STUDY DESIGN: Cross-sectional survey in 2007. METHODS: A survey was conducted among a random sample (n = 1844) nested in a screening cohort of a rural population in Jiashan County, China. Information about diet, family history of CRC and other factors was collected by questionnaire. The primary outcome was dietary status, assessed by consumption (servings/week) of plant-based food and unhealthy food. Linear or multinomial logistic regressions were used to determine risk factors for dietary status. RESULTS: On average, individuals with a family history of CRC ate 2.25 fewer servings of plant-based food each week compared with individuals without a family history of CRC. Individuals who smoked and drank alcohol ate less plant-based food. After stratification by gender, there were multiple determinants for consumption of plant-based food for men, including family history of CRC, smoking, alcohol consumption and income. For women, the only association was found for income. Consumption of unhealthy food was positively associated with high income and high body mass index. Determinants for an unhealthy diet were the same in both genders. CONCLUSIONS: There are gender disparities in the consumption of plant-based food and the risk factors for CRC in medically and economically underserved populations. Men's insufficient consumption of plant-based food and unhealthy lifestyle behaviours, such as smoking and drinking, may explain, in part, why men have a higher risk of CRC than women.

Evidence-based care of Chinese men having transurethral resection of the prostate (TURP).

AIM OF STUDY: To measure the effect of specific preoperative information on postoperative anxiety, satisfaction with information, and demand for analgesia, of Chinese males having transurethral resection of the prostate (TURP). DESIGN: A controlled experimental design. The researchers allocated all patients (n = 30) undergoing TURP in a general hospital in Hong Kong, during a 3-month period, to one of two groups. The experimental group (n = 15) received a specific information pamphlet and a general preoperative counselling video. The control group (n = 15) received a video alone. PROCEDURE AND MEASURES: Following ethical approval, a researcher took baseline measures of state and trait anxiety using the Chinese State-Trait Anxiety Inventory (C -STAI). Five days after surgery the researcher administered the C-STAI (A-State), a patients' satisfaction questionnaire, and, recorded requests for analgesia during the first 5 postoperative days. RESULTS: Experimental subjects reported significantly lower anxiety levels post-operatively and a significantly higher level of satisfaction with the preoperative information, than controls. Postoperative demand for analgesia did not significantly differ between groups. CONCLUSIONS: The findings support the importance of providing patients with specific, written preoperative information about their surgery and its effects to minimize their postoperative anxiety levels, and improve their satisfaction with the care provided.

Diagnostic value of occult fecal blood testing for colorectal cancer screening.

AIM: To evaluate the diagnostic value of occult fecal blood testing in mass colorectal cancer screening. METHODS: A reverse passive hemagglutination reaction fecal occult blood test (RPHA-FOBT) and colorectal cancer risk factor quantitative method were used as preliminary screening for colorectal cancer. A 60-cm fiber optic colonoscopy was used to validate the preliminary screen and was used to detect colorectal cancer in a community of 75813 subjects. RESULTS: Compared to the 60-cm fiber optic colonoscopy as a standard reference, FOBT has a sensitivity of 41.9%, specificity of 95.8%, Youden's index of 0.38, and positive predictive value of 0.68%. These results increased with subject age from the first detection. A 3-year follow up in the target mass showed that all new cases had initially been FOBT-negative. CONCLUSION: The value of FOBT as an indicator of colorectal cancer in mass screening is limited.