A rare form of intoxication: acute methyl ethyl ketone peroxide poisoning

We report two suicidal cases of acute methyl ethyl ketone peroxide (MEKP) poisoning. A woman in her late 60s suffered from oral mucosal erosion, functional impairment of the heart, liver and other organs, pulmonary inflammation, elevated inflammatory markers, pleural effusion, hypoproteinemia and metabolic acidosis after oral administration of approximately 50 mL of MEKP. After admission, the patient was administered hemoperfusion four times, 8 mg of betamethasone for 6 days and symptomatic support. Hemoperfusion had an obvious effect on the treatment of oral MEKP poisoning. After discharge, the patient developed progressive dysphagia and secondary esophageal stenosis. Supplementary feeding was administered with a gastrostomy tube after the patient was completely unable to eat. A man in his mid-40s developed oropharyngeal mucosal erosion, bronchitis and esophageal wall thickening after oral administration of 40 ml MEKP. After receiving total gastrointestinal dispersal, 80 mg of methylprednisolone was administered for 7 days, and symptomatic supportive treatment was provided. Slight dysphagia was observed after discharge, and there was no major effect on the quality of life. Patients with acute oral MEKP poisoning should be followed up regularly to observe its long-term effects on digestive tract corrosion and stenosis.

Research and Nursing Experience of Recombinant Human Epidermal Growth Factor Gel Promoting Oral Mucosal Erosion Lesion Healing

Erosion is a primary clinical manifestation of oral mucosal lesions. Contact between food and the mucosal surface during chewing can easily cause oral mucosal infection and adversely affect the daily lives of patients. Conventional clinical treatment cannot overcome the problems of oral mucosal erosion. This study aimed to analyze the application effect of recombinant human epidermal growth factor (rhEGF) gel on oral mucosal erosion lesions. The subjects of this study were 120 patients with oral mucosal erosion lesions, who were divided, according to random number table method, into a contrast group and rhEGF group with 60 cases in each. The patients in the contrast group were treated with ethacridine lactate, and the rhEGF group patients were treated with rhEGF gel. Patients in both groups received corresponding nursing measures. Compared with the contrast group, the rhEGF group had a lower visual analog scale score, Reticulation/keratosis, erythema, and ulceration score, and inflammatory cytokine levels, as well as a higher total effective rate and faster patient recovery, indicating that the rhEGF gel had significant efficacy and is worthy of promotion.

Bronchitis obliterans after severe pneumonia in children: a review of 34 cases

Background: This study aimed to describe the clinical characteristics, pathogeny and bronchoscopic findings of 34 children with bronchitis obliterans after severe pneumonia. Methods: Thirty-four children diagnosed with bronchitis obliterans were retrospectively studied at the Children’s Hospital of Chongqing Medical University in China between January, 2014 and October, 2020. The clinical manifestations, pathogeny, lung computed tomography imaging and bronchoscopic findings of the 34 children were reported. Results: In children with bronchitis obliterans, repeated coughing, fever, wheezing, tachypnea, and lung rales were common clinical manifestations. Mycoplasma pneumoniae (M. pneumoniae) was the most common etiologic agent, followed by adenovirus. The CT scan images included uneven lung inflation(12/34), lung consolidation( 27/34), pulmonary atelectasis(23/34), and pleural effusion(22/34). All children underwent flexible bronchoscopy, and major types of airway findings were identified: mucosal congestion, luminal longitudinal folds, mucosal erosion or necrosis, hyperplastic changes, sputum emboli, bronchiectasis and obliterative-like lesions. Conclusion: In conclusion, severe M. pneumoniae pneumonia and adenovirus pneumonia appeared to have a higher risk of development of bronchitis obliterans. Bronchoscopy can be used as the main criterion for the diagnosis of bronchitis obliterans. Bronchoscopy interventional treatment is an effective measure to quickly recanalize the occluded lumen, but there is a risk of recurrence after treatment. Children with severe pneumonia should undergo regular follow-up and bronchoscopy to detect possible lumen occlusion in time.

Etiology and characteristics and of community-acquired pneumonia among children requiring bronchoalveolar lavage in North China

Objective: To identify the pathogens and compare the clinical characteristics between different type pathogen infection among children with community-acquired pneumonia (CAP) requiring bronchoalveolar lavage. Study design: Children <14 years old hospitalized with CAP requiring bronchoalveolar lavage were enrolled between February 2019 to January 2020. Multiplex reverse transcription polymerase chain reaction (mRT-PCR) and loop-mediated isothermal amplification (LAMP) were used for pathogen detection. The demographic and clinical characteristics were compared between different type pathogen infection groups. Results: Among 1166 children studied, ≥1 pathogen was detected in 1084 (93.0%) children and co-infection was detected in 215 (18.4%) children. Mycoplasma pneumoniae, Streptococcus pneumoniae and adenovirus were the most frequently detected pathogens. Children infected with atypical bacteria alone were older and more likely to display a fever, cough, decreased breath sounds, consolidation, single lobar infiltration, mucosal erosion and/or necrosis and plastic bronchitis. Children with virus-atypical bacteria co-infection were more prone to manifest fatigue, chest pain, tachypnea, chest indrawing, and mucosal erosion and/or necrosis. Those infected with virus alone or co-infected with ≥3 pathogens were liable to display changes in bronchial morphology. Conclusions: Pathogens were detected in 93.0% of enrolled children. M. pneumoniae infection might be the greatest pediatric disease burden due to CAP in North China. Keywords: Children; community-acquired pneumonia; bronchoalveolar lavage fluid; etiology; co-infection.

Bilateral vocal cord paralysis caused by accidental button battery ingestion in children: A case report and literature review

Button battery ingestion in pediatric populations is a common occurrence with severe sequelae. Multiple case reports have established the occurrence of death, fistula formation, mucosal erosion, esophageal perforation, and bleeding post-ingestion of button batteries. However, there is a gap in the literature on the occurrence of bilateral vocal cord paralysis post-lithium battery ingestion. We present a case in which a 12-month-old male developed bilateral vocal cord paralysis following ingestion of a button battery. We compare our case to eleven other reports that exist in the literature based on age, sex, time until removal, clinical presentation, day upon which vocal cord paralysis developed, anatomic location, and post-operative course. We conclude that bilateral vocal cord paralysis is a time-sensitive complication which requires prompt diagnosis. Any child with stridor following button battery ingestion should undergo consultation with pediatric otolaryngology immediately. In addition, long-term follow-up is necessary to evaluate return of normal vocal cord function.

TKT maintains intestinal ATP production and inhibits apoptosis-induced colitis

Inflammatory bowel disease (IBD) has a close association with transketolase (TKT) that links glycolysis and the pentose phosphate pathway (PPP). However, how TKT functions in the intestinal epithelium remains to be elucidated. To address this question, we specifically delete TKT in intestinal epithelial cells (IECs). IEC TKT-deficient mice are growth retarded and suffer from spontaneous colitis. TKT ablation brings about striking alterations of the intestine, including extensive mucosal erosion, aberrant tight junctions, impaired barrier function, and increased inflammatory cell infiltration. Mechanistically, TKT deficiency significantly accumulates PPP metabolites and decreases glycolytic metabolites, thereby reducing ATP production, which results in excessive apoptosis and defective intestinal barrier. Therefore, our data demonstrate that TKT serves as an essential guardian of intestinal integrity and barrier function as well as a potential therapeutic target for intestinal disorders.

Efficient Attenuation of Dextran Sulfate Sodium-Induced Colitis by Oral Administration of 5,6-Dihydroxy-8Z,11Z,14Z,17Z-eicosatetraenoic Acid in Mice

5,6-dihydroxy-8Z,11Z,14Z,17Z-eicosatetraenoic acid (5,6-DiHETE) is an eicosapentaenoic acid-derived newly discovered bioactive anti-inflammatory lipid mediator having diverse functions. Here, we assessed the potential of orally administered 5,6-DiHETE in promoting healing of dextran sulfate sodium (DSS)-induced colitis in mice. We measured the plasma concentrations of 5,6-DiHETE in untreated mice before and 0.5, 1, 3, and 6 h after its oral administration (150 or 600 μg/kg) in mice. Mice developed colitis by DSS (2% in drinking water for 4 days), and 5,6-DiHETE (150 or 600 μg/kg/day) was orally administered from day 9 to 14. Next, the faecal hardness and bleeding were assessed, and the dissected colons on day 14 via H&E staining. The plasma concentration of 5,6-DiHETE reached 25.05 or 44.79 ng/mL 0.5 h after the administration of 150 or 600 μg/kg, respectively, followed by a gradual decrease. The half-life of 5,6-DiHETE was estimated to be 1.25–1.63 h. Diarrhoea deteriorated after day 3 and peaked on day 5, followed by a gradual recovery. Histological assessment on day 14 showed DSS-mediated granulocyte infiltration, mucosal erosion, submucosal edema, and cryptal abscesses in mice. Oral administration of 150 or 600 μg/kg/day of 5,6-DiHETE accelerated the recovery from the DSS-induced diarrhoea and significantly ameliorated colon inflammation. The therapeutic effect of 600 μg/kg/day 5,6-DiHETE was slightly stronger than that by 150 μg/kg/day. Our study reveals attenuation of DSS-induced colitis in mice by the oral administration of 5,6-DiHETE dose-dependently, thereby suggesting a therapeutic potential of 5,6-DiHETE for inflammatory bowel disease.

Gastric metastasis from pancreatic cancer characterized by mucosal erosion: a case report and literature review

Pancreatic cancer with gastrointestinal tract metastasis is a fairly rare occurrence, and gastric metastasis in such cases has been seldom reported. We herein present a case of gastric involvement secondary to pancreatic cancer in a 74-year-old woman in whom the metastatic lesion only presented as mucosal erosion in the stomach. The patient had a 1-month history of progressive right upper quadrant pain before admission. Computed tomography and endoscopic examinations revealed a solid and hypo-enhancing mass in the head of the pancreas. The patient underwent conventional upper endoscopy before pancreatic biopsy, and mucosal erosion was observed in the gastric pylorus. We obtained gastric and pancreatic biopsies by gastroscopy and endoscopic ultrasound-guided fine needle aspiration, respectively. Pathologically, the biopsies taken from the area of gastric erosion showed poorly differentiated invasive adenocarcinoma that was morphologically consistent with the pancreatic specimens. Moreover, the gastric section showed tumor thrombi within the vessels. Hence, the suspected diagnosis was unresectable pancreatic cancer with gastric metastasis. The patient immediately underwent two courses of chemotherapy, but her condition rapidly deteriorated and she died 2 months later.

Histopathologic Manifestations of Crohn Disease in Duodenal Endoscopy Biopsy: The Value of Different Patterns of Involvement of Brunner Glands

Crohn disease (CD) not uncommonly involves the upper gastrointestinal tract, usually gastric antrum and proximal duodenum. The most consistent histopathologic manifestations of CD in duodenal biopsies are mucosal erosion, focal active inflammation, and granulomas. Since CD is a transmural inflammation and since duodenal biopsy may include submucosal Brunner glands, we aimed to find if CD has any specific histopathologic manifestations in Brunner gland lobules and their ducts compared to other duodenal inflammatory lesions. We carried out a retrospective review study over 6 years retrieving duodenal biopsy specimens in CD patients. We compared duodenal specimens involved by CD with other inflammatory lesions, for example, ulcerative colitis (UC), Helicobacter pylori-associated gastritis, non-Helicobacter gastritis, Celiac sprue, infections, and drugs. We found focal active duodenitis and erosion in CD cases and non-CD cases. Granulomas were found in CD cases. Five cases of CD showed inflammatory and degenerative changes of Brunner glands. Focal patchy active inflammation of only portion of submucosal Brunner gland lobule, mucosal Brunner glands, and their ducts was solely found in CD cases. This focally enhanced inflammation of Brunner glands was not found in other lesions. Whether this phenomenon of focal active “lobulitis” and “ductitis” is a specific sign of duodenal CD compared to UC and other inflammatory lesions warrants verification. We encourage endoscopists to include submucosal Brunner lobules in their duodenal biopsy samples and pathologists to look for these patterns of involvement particularly in patients suspected of CD.

Effects of dietary copper supplementation on serum and biochemical and histopathology of pubertal boars

The effects of dietary copper on some biochemistry and histopathology of organs of pubertal pigs were assessed using 32 large white male weanling pigs of 8-9 weeks of age in a 6-months feeding trial. The animals were randomly assigned to four diets containing 0, 100, 200 and 300ppm Cu/kg as the control diet (diet 1), diets 2, 3 and 4 respectively. The feeding trial was divided into 3 growth phases (weanling, pre-pubertal and pubertal) corresponding to 8, 18 and 24 weeks of life respectively. At the end of the feeding trial, all the animals were sacrificed by stunning, bled, decapacitated followed by blood collection and careful evisceration to obtain the kidney, liver, spleen and testes and samples of the small intestine. Selected organs and tissues collected from sacrificed animals were processed for histology. Results showed that dietary copper did not significantly (P>0.05) influence the blood serum biochemical composition and the histomorphology of the organs and tissues examined. The boars exposed to the diet containing the highest copper supplementation (diet 4) did not have severe splenic atrophy and/or lymphoid depletion, liver necrosis and/or lesions, intestinal mucosal erosion and testicular necrosis and/or sertoli cells degeneration as compared to those fed the control. There was no intestinal mucosal erosion with increased dietary copper in this study because the maximum level of copper that was used in this study was not above 500ppm; hence all the tissues studied did not show degeneration of any form.