Text, photo/ Yangcheng Evening News all-media reporter Chen Hui Liu Xinyu
In 2015, the Chinese manure mushroom bank was established. Since then, the emerging treatment method of fecal bacteria transplantation has been carried out in many hospitals such as Nanjing and Guangzhou, and clinical surprises have been continuously obtained, and patients with intestinal diseases, autism, depression and Parkinson's have flocked to it.
"Fecal bacteria transplantation" once rushed to the hot search, but the focus of netizens is more on the subsidies of fecal bacteria donors: "500 yuan at a time, donate feces to earn 80,000 yuan a year!" ”
So, how do you become a qualified fecal fungus donor? What secret do they have to pull out "gold-containing rice dumplings"? What is the actual efficacy of fecal transplantation? What is the current status of the fecal bacteria transplant industry? How secure is it? With many questions, the Yangcheng Evening News reporter recently conducted a multi-party interview.
How is it donated?
To donate rice dumplings, you have to pass five levels
The reporter came to the First Affiliated Hospital of Guangdong Pharmaceutical University, which has been carrying out fecal bacteria transplantation for 5 years.
He Xingxiang is the party secretary of the hospital and the head of the fecal bacteria transplant project. He introduced that the gastroenterology department of the hospital established a standardized laboratory in 2016 to officially carry out the clinical treatment of fecal bacteria transplantation and the recruitment of fecal bacteria donors.
He introduced that the so-called "fecal bacteria transplantation" is to transplant the functional bacteria in the feces of healthy people into the gastrointestinal tract of patients to improve their imbalanced microecology, rebuild the intestinal flora with normal functions, and realize the treatment of intestinal and extraintestinal diseases.
Professor He said that fecal bacteria transplantation has high requirements for the health status of fecal bacteria donors' bodies and feces, and few finally meet the requirements. Taking the recruitment of the hospital in 2018 as an example, 700 people participated in the initial screening, and only 13 people really qualified in the end. The hospital currently has 27 stable fecal bacteria donors, the oldest is 25 years old, the youngest is 4 years old, mainly college students.
Professor Ho said that fecal bacteria donation must pass the "five levels".
The first is genetic disease. If the parents develop cancer, diabetes, etc. before the age of 40, the student is genetically at risk and is not eligible for donation. If a student's BMI (Body Mass Index) value is too high, indicating a risk of metabolic disease, they will be eliminated.
The second is appearance. The size and appearance of the donor are also to be considered. "There was a young man who was eliminated as soon as he walked in," Professor Ho said, "because he had a 'general's belly.'" Having a big belly at such a young age indicates that there is a problem with his fat metabolism. ”
The third is the integrity of the pass. Ho said that if a classmate walks in and immediately asks how much money he can give for a donation, he/she will also be eliminated because he/she may hide the situation in order to successfully donate in the future.
The fourth is psychological barriers. Students who pass the interview will also fill out the Depression, Anxiety and Equal Scale.
Fifth, the physical examination. The scale shows that students without psychological problems are about to attend a detailed medical examination provided by the hospital. In addition to routine physical examinations, there are also examinations that specifically assess the health of the gut flora. Once all are qualified, the donor can start donating for the first time. Thereafter, about every six months, donors are re-examined for important indicators to ensure that their gut flora is healthy.
Preparation of fecal bacteria by Liu Xinyu
The donation process takes 5-10 minutes
On August 19 last year, Assistant Researcher Xu Jiating of the Engineering Research Center for Microecological Therapy of the First Hospital of Guangzhou Pharmaceutical University first called the digestive center ward to ask about the number of patients who needed to receive fecal bacteria transplants the next day, and then opened the donor roster and began to contact one by one. On the phone, she asked them about their health these days, what medications they had taken, whether they had taken any taboo foods, and other questions, and donors who were eligible and available the next day could come.
At 8:20 the next day, 25-year-old Xiao Kuang was the first to come to the fecal bacteria preparation laboratory. He can be said to be the elder of the donors. In 2016, he participated in the fecal bacteria transplant project of the First Affiliated Hospital of Guangzhou Pharmaceutical University, when he was still a student, he saw a recruitment message in the QQ group and signed up, he did not expect that this donation was 5 years, and there was no interruption after work, from the beginning of one or two times a week, to now five times a week, witnessing the rapid development of fecal bacteria transplantation.
"At the beginning, the road to hold back the stool, now has formed a new biological clock, as soon as you go to the experimental building, the stool will come unexpectedly", Xiao Kuang first walked into the air shower room for full body disinfection, and then entered a strictly disinfected sampling room, unpacked the sampling box, put it on the toilet in the sampling room, unwrapped the stool in the sampling box, and then handed the sampling box to the doctor in the fecal preparation laboratory through the transmission window. The whole process takes 5-10 minutes.
Xu Jiating will conduct a final "naked eye" test on the donor's rice dumplings, and only those that weigh more than 100 grams and are golden in color and shape like bananas, curved and shaped are qualified.
Five times a week, four thousand a month
If the donor can donate more than 5 times a week, the monthly transportation subsidy can reach more than 4,000 yuan.
"When I first started donating, I didn't know there was this subsidy, but I was surprised when I got it a few months later." Xiao Lei, who is also a donor, said.
Xu Jiating said: "These donors have common characteristics, mostly belong to the dedication personality, many of them donate blood every year, and have an optimistic personality, self-discipline in life, and their motivation for donation is good-faith." It is not simply to make money with subsidies, so they often do not hide their identity as fecal fungus donors from their relatives and friends, and even willingly mobilize people around them to participate. ”
Guangdong's climate is humid and hot, many people have weak spleens, and stool is not easy to form, so how do these donors produce healthy rice dumplings?
He Xingxiang said that stool can be said to be a barometer of human health, and in addition to their own physical health, donors also need to continue to maintain a healthy and temperate life in order to have healthy stools.
The gospel of healing?
From the rice to the fecal bacteria, it is filtered layer by layer
After the advent of fecal bacteria transplant treatment, it has been on the cusp of public opinion. Not to mention the general public, even medical staff are not easy to accept.
"Isn't this the 'eating shit' of Cantonese?! Can it work? This was the first reaction of the head nurse of the Department of Gastroenterology of the First Hospital of Guangzhou Pharmaceutical University when she heard that her department was going to carry out this therapy, and when she visited and studied, she changed her opinion after contacting several patients.
Yangcheng Evening News reporter recently saw in the Microecological Treatment Engineering Technology Research Center of the First Affiliated Hospital of Guangdong Pharmaceutical University that after the staff has initially examined the stool with the naked eye, it can be put into the intelligent machine for fecal bacteria separation. The machine will automatically add water, stir, separate the stool, the separation is through the multi-level layer filtration to remove the coarse extraction, remove the harmful substances, get the liquid containing fecal bacteria.
Xu Jiating introduced, at this time the obtained liquid in addition to fecal bacteria, there will be organic matter produced by human metabolism, considering that the proportion of fecal bacteria is relatively high, then the bacterial liquid after several water injection, centrifugal "washing" treatment, synchronous deodorization, the last collection is the washing of clean bacteria mud. After this treatment, the fecal bacteria are transplanted into the patient's body, and the probability of adverse reactions will be significantly reduced, and the safety will be significantly improved.
Dr. Xu Jiating is professionally treating the stool
Transplant patients find their own home for fecal bacteria
After the fecal bacteria are isolated, they will be sent to the gastroenterology ward immediately and transplanted into the patient's body immediately.
"It is generally recommended that the time interval between the feces leaving the donor and the fecal bacteria entering the patient's body is not more than two hours, and it is necessary to 'steam hot and sell', because the intestinal flora is mostly anaerobic bacteria, and if it is in contact with oxygen in the air for a long time, its activity will be affected, and it is bound to affect the efficacy," Professor He Xingxiang said.
Yangcheng Evening News reporter saw in the ward that the nurse will prepare the fecal bacteria through the syringe, injected into the thin tube placed in the patient's intestine in advance, and the doctor will put the thin tube through the anus into the patient's intestine through the colonoscopy, all the way to the junction of the large intestine and the small intestine. Fecal bacteria have "homing", they land at the junction of the patient's large and small intestines, and then different bacteria will find their own home, such as the original rectal flora, it will roam all the way back to the rectum.
Frequent surprises in curative effects Children come to their own doorstep
Professor He Xingxiang introduced that as of April 30 last year, 4321 people received fecal bacteria transplants in their hospitals, mainly patients with digestive tract diseases. These patients are constantly pleasantly surprised during treatment. Some patients were originally treated for intestinal diseases, and after the treatment, they found that their hyperlipidemia was better, and some of them lowered their blood pressure by the way.
As the number of cases increased, doctors wrote papers on the universal laws they found, which have been published in international professional journals.
Walking into the hospital's gastroenterology ward, children of all ages were running around in the corridors, and these were autistic children who were being treated with fecal bacteria.
"The use of fecal bacteria transplantation to treat autism is not our initiative to carry out, but the patients themselves to find the door," He Xingxiang recalled, the first parent of autistic children is a doctor in a third-class hospital in Guangzhou, he took the child around to seek medical treatment without results, inquired about foreign literature reports, said that fecal bacteria transplantation is helpful for autism treatment, so he took the child to the door. After a few courses of treatment, the child's symptoms have improved, so word of mouth has spread, and more and more children with autism have poured in, resulting in a bed that is difficult to find.
Fecal bacteria and autism seem to be indistinguishable, why can they have such a wonderful effect?
Wu Lihao, director of the Department of Gastroenterology of the First Affiliated Hospital of Guangzhou Pharmaceutical University, explained that in medicine, the intestine is closely related to the brain, which has been recognized, and there is a brain-intestinal axis in the human body, and the intestine is also known as the second brain. Children with autism generally have gastrointestinal symptoms such as constipation and abdominal pain. From the clinical observation, the gastrointestinal symptoms and sleep of children with autism will be significantly improved after receiving fecal bacteria transplantation; in addition, the willingness to actively communicate with people, emotional control, response to instructions, and attention and concentration time will be improved to varying degrees from person to person.
Some parents have proposed that the flora in children and adults is different, can the fecal bacteria of healthy children be transplanted to children with autism? It is precisely because of this request that children have emerged among fecal fungus donors.
Wu Lihao said that some of the patients who are currently undergoing fecal bacteria transplant treatment are anxiety, depression, Parkinson's and other non-intestinal diseases, and have also achieved good results.
【Zhiduo D】
How safe is fecal transplantation?
As an emerging medicine, how can the safety of fecal bacteria transplantation be guaranteed? How to regulate fecal donation and transplantation? Just in 2019, after two patients in the United States transplanted feces that had not been tested for drug-resistant bacteria, they caused a serious infection and caused the death of one person, which also attracted close attention in China.
The Yangcheng Evening News reporter learned that medical institutions with the ability to prepare fecal bacteria will leave samples from each donated stool, and this sample will be stored in the refrigerator at minus 80 degrees Celsius for 2 to 5 years in case of disputes in the future, which will help protect practitioners, patients, and help the healthy development of the entire industry.
On December 12, 2019, experts from Chinese mainland, Hong Kong, And Taiwan jointly formulated the Nanjing Consensus on The Transplantation Methodology of Washing Flora. On August 31, 2021, the Shanghai Municipal Health Commission issued the "Shanghai Microbial Transplantation Technology Management Specification", which is the first management specification formulated by the local health administrative department in China, which will play a role in the orderliness of fecal bacteria transplantation.
The first person to transplant fecal bacteria in China
Known by the outside world as "the first person in China's modern fecal bacteria transplantation", Professor Zhang Fangfang of the Bowel Disease Center of the Second Affiliated Hospital of Nanjing Medical University did postdoctoral research in the United States in 2012, accidentally came into contact with fecal bacteria transplantation and became interested, after returning to China, he quickly began his own research, and brought this technology to the world's leading level, invented the world's first set of intelligent isolation system for fecal bacteria, and also invented a new full colon implant to meet non-invasive repeated transplantation, proposing to wash microbiota transplantation. To date, the evidence he led his team has been recommended by 8 international medical guidelines or expert consensus.
Photo by Professor Zhang Tianjie Lin Tianjie
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Source | Yangcheng Evening News Yangcheng Pie
Editor-in-charge | Fu Mingtu Wang Junjie