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Objective:To compare the efficacy of 3D-printed guide plate assisted versus freehand placement of cannulated screws for the treatment of Sanders type II and III calcaneal fractures.Methods:A retrospective cohort study was conducted to analyze the clinical data of 29 patients with Sanders type II and III calcaneal fractures admitted to Chonggang General Hospital from June 2020 to October 2022. Among them, there were 18 males and 11 females, with an age range of 22-69 years [(40.1±11.5)years]. Nineteen patients were treated with individualized 3D-printed guide plate assisted placement of cannulated screws (3D-printed group) and 10 were treated with freehand placement of cannulated screws (freehand group). The surgical time, fluoroscopy times, postoperative 6-month calcaneal morphology (length, width, height, B?hler angle and Gissane angle), and American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Maryland functional score assessed at 3, 6 months after operation and at the final follow-up were compared between the two groups. The incision healing and complications were observed.Results:The patients were followed up for 6-24 months [(11.3±2.5)months]. The surgical time and fluoroscopy times in the 3D-printed group were (53.4±9.1)minutes and (7.3±1.1)times, respectively, which were shorter than (90.2±16.0)minutes and (16.0±3.2)times in the freehand group (all P<0.01). At 6 months after operation, there was no significant difference in calcaneal length between the two groups ( P>0.05); the calcaneal width, height, B?hler angle and Gissane angle in the 3D-printed group [(34.0±1.8)mm, (47.2±1.6)mm, (27.8±1.0)°, (129.2±2.8)°] were superior than those in the freehand group [(37.5±2.0)mm, (43.0±2.7)mm, (25.8±1.5)°, (125.9±2.5)°] (all P<0.01). At 3, 6 months after operation and at the final follow-up, the values of AOFAS ankle-hindfoot score in the 3D-printed group [(72.2±2.3)points, (79.7±2.3)points, (86.5±4.4)points] were higher than those in the freehand group [(64.2±6.9)points, (73.4±4.2)points, (81.8±3.1)points] (all P<0.05); the values of Maryland score in the 3D-printed group [(71.4±7.7)points, (84.7±2.6)points, (91.5±2.5)points] were higher than those in the freehand group [(65.2±5.6)points, (79.1±3.8)points, (87.1±2.9)points] (all P<0.05). All surgical incisions were healed in stage I. In the 3D-printed group, there were no complications regarding infection, iatrogenic vascular or nerve injury, or fixation failure after surgery. In the freehand group, one patient with lateral sural cutaneous nerve injury was resolved spontaneously without specific treatment. Conclusion:Compared with freehand placement of cannulated screws, 3D-printed guide plate assisted placement of percutaneous placement has the advantages of shorter surgical time, fewer fluoroscopy times, lower reduction loss, better ankle joint function recovery, and less complications in treating Sanders type II and III calcaneal fractures.
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Objective:To compare the efficacy of oral sulfate solution (OSS) and polyethylene glycol (PEG) electrolyte powder for colonoscopy bowel preparation.Methods:A total of 283 randomized patients from 9 centers in China taking OSS ( n=143) or PEG ( n=140) using two-day split bowel preparation regimen received colonoscopy and assessment. The primary index was the bowel preparation success rate [global Boston bowel preparation scale (BBPS)≥ 6 by independent assessment center]. Secondary indices included BBPS global and segmental scores, investigator satisfaction (5-point Likert scale) with the quality of bowel preparation, patient satisfaction assessed by questionnaires, and patient tolerance assessed by Sharma scale. Compliance and safety were compared between the two groups. Results:The bowel preparation success rates were 100.0% for OSS and 99.3% for PEG [adjusted difference 0.7% (95% CI: -5.3% - 6.7%), P<0.001 for non-inferiority]. The BBPS global score in OSS group was significantly higher than that in PEG group (8.1 VS 7.7, P<0.001). The segment BBPS scores were also higher in OSS group than those in PEG group for all 3 segments (right colon: 2.4 VS 2.3, P=0.002; transverse colon: 2.8 VS 2.7, P=0.018; left colon: 2.8 VS 2.7, P=0.007). Investigator Likert score in the OSS group was significantly higher than that in the PEG group (2.6 VS 2.3, P<0.001). There was no significant difference in compliance between OSS and PEG, except for the second dose (90.9% VS 82.6%, P=0.039). There was no significant difference in patient satisfaction, Sharma score or proportion of patients with tolerance-related symptoms between the two groups. Safety was comparable between the two groups, and all adverse events were mild to moderate. Conclusion:OSS has comparable efficacy with PEG, with higher BBPS scores in all segments, better investigator satisfaction, better compliance in split dose, and comparable patient tolerance and safety.
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Objective The SEER database was utilized to analyze the prognosis and related factors for patients with locally resectable esophageal cancer undergoing preoperative chemoradiotherapy.A nomogram for predicting survival was established to provide reference for screening patients receiving preoperative chemoradiotherapy.Methods Patients diagnosed with stage T1b-4aN0-3M0(7th version AJCC in 2010) resectable esophageal cancer receiving preoperative chemoradiotherapy between 2010 and 2015 were selected from the SEER database.The survival rate was determined by Kaplan-Meier method.The univariate analysis was performed by log-rank test.The multivariate analysis was conducted by Cox test.The nomogram for survival prediction was established by using R software.The predicting accuracy of the nomogram was evaluated by C-index and calibration curve.Results A total of 1 697 eligible patients were included.Univariate analysis showed that sex,T stage,N stage and tumor differentiation were significantly associated with overall survival (OS) and cancer-specific survival rate (CSS)(all P＜0.001),and age (P=0.027) was significantly correlated with OS.Multivariate analysis demonstrated that age,sex,tumor differentiation and N stage were significantly associated with OS.Sex,tumor differentiation,T stage and N stage were significantly correlated with CSS (all P＜0.05).After the prognostic factors were included into the nomogram,the C-index for 5-year OS and CSS was 0.60 and 0.61.The model for predicting survival of patients with esophageal squamous cell cancer was established by using the same method.The C-index for the OS and CSS was 0.62 and 0.64.Conclusions Sex,clinical stage and tumor differentiation are prognostic factors of CSS in patients with locally resectable esophageal cancer undergoing preoperative chemoradiotherapy followed by surgery.The nomogram established according to the data above can provide certain reference for the selection of preoperative chemoradiotherapy combined with surgery.
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With the updating of the consensus on the diagnosis and treatment of inflammatory bowel disease, ASCA, ANCA and other serological markers are not included as routine examination items , so many related problems need to be recognized .In some special cases , the high specific serological examination still has clinical value in the differential diagnosis for atypical symptom patents .Researches support that ASCA , ANCA and other serological tests have the ability to predict the occurrence of the disease , to evaluate the biological behavior , or to predict clinical response to infliximab and the recurrence after surgery .Finding new methods for combined detection to increase sensitivity and specificity , discovery of new serological antibodies are still research hotspots in the future ."no agreement have been reached about serological detection" in the new consensus is just the expectation of large-scale, multicenter clinical research on serological detection of IBD in China .
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Objective To investigate the prevalence of nutritional risk,undernutrition and nutritional support among elderly inpatients with coronary heart disease in 11 tertiary A hospitals in China.Methods Records of elderly patients under the age of 90 with coronary heart disease were collected between March 2012 and May 2012 from 11 tertiary A hospitals in China following the direction of diagnosis related group of Beijing government.Results A total of 1 279 consecutive cases were recruited with the average age 74 years old (65-89).The total nutritional risk prevalence was 28.14％ (360/1 279).The prevalence of nutritional risk and nutritional risk score ≥ 5 increased with age.The prevalence of nutritional risk (12.88％ vs.30.08％ vs.42.28％) and nutritional risk scored ≥5 (10.86％ vs.18.61％ vs.27.78％)increased with age.Judging from BMI,most patients were overweight or obese (BMI ≥ 24 kg/m2),accounting for 53.0％ of the total,and prevalence of nutritional risk in this subgroup was 15.12％ (96/635).The prevalence of nutritional risk in patients with normal BMI was 34.24％.The prevalence of undernutrition defined as BMI＜ 18.5 kg/m2 was 4.25％ (51/1 279),among which patients with score ≥ 5 account for 64.7％ (33/51).The prevalence of undernutrition defined as nutritional impairment score =3 was 7.58％ (97/1 279).In patients with nutritional risk,57 were administrated nutrition support (16.6％);in patients without nutritional risk,21 received nutrition support,mostly parenteral nutrition (16 cases,76.2％).In patients with nutritional risk [(79.46± 7.19) years vs.(76.40± 6.16) years],there were statistically significant difference between those who received nutrition support and those who did not in terms of age and the ratio of patients with nutritional risk scored≥5 (35.1％ vs.17.1％) (P =0.001,P=0.002).Conclusions The prevalence of nutritional risk in patients with coronary heart disease was high.The prevalence of undernutrition was low.Prevalence of overweight and obese was high,but there was still nutritional risk in this group of patients.The patients who received nutrition support were older and had high nutritional impairment score,but the indication is not rationale.
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BACKGROUND/AIMS: There is a need for a simple and practical tool adapted for the diagnosis of chronic constipation (CC) in the Asian population. This study compared the Asian Neurogastroenterology and Motility Association (ANMA) CC tool and Rome III criteria for the diagnosis of CC in Asian subjects. METHODS: This multicenter, cross-sectional study included subjects presenting at outpatient gastrointestinal clinics across Asia. Subjects with CC alert symptoms completed a combination Diagnosis Questionnaire to obtain a diagnosis based on 4 different diagnostic methods: self-defined, investigator's judgment, ANMA CC tool, and Rome III criteria. The primary endpoint was the level of agreement/disagreement between the ANMA CC diagnostic tool and Rome III criteria for the diagnosis of CC. RESULTS: The primary analysis comprised of 449 subjects, 414 of whom had a positive diagnosis according to the ANMA CC tool. Rome III positive/ANMA positive and Rome III negative/ANMA negative diagnoses were reported in 76.8% and 7.8% of subjects, respectively, resulting in an overall percentage agreement of 84.6% between the 2 diagnostic methods. The overall percentage disagreement between these 2 diagnostic methods was 15.4%. A higher level of agreement was seen between the ANMA CC tool and self-defined (374 subjects [90.3%]) or investigator’s judgment criteria (388 subjects [93.7%]) compared with the Rome III criteria. CONCLUSION: This study demonstrates that the ANMA CC tool can be a useful for Asian patients with CC.
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Humans , Asia , Asian People , Constipation , Cross-Sectional Studies , Diagnosis , Judgment , OutpatientsABSTRACT
Objective To investigate proliferation and apoptosis of colonic epithelial cells from ulcerative colitis (UC)patients with active new-onset,remission and active recurrent stages,and to study the effects of 5-aminosalicylic acid (5-ASA)on proliferation and apoptosis of colonic epithelial cells during the treatment of inducing remission and maintanence remission. Methods From January 2002 to December 2012,twelve patients with mild-to-moderate UC who received treatment and long-term follow-up and achieved remission with 5-ASA and received long-term maintanence treatment with it were assigned to UC group.At the same period,10 healthy individuals with negative endoscopy results or solitary colonic polyp were assigned to control group.The biopsy tissues from colonoscopy for pathological examination of patients in UC group at new-onset active stage,remission stage and recurrence stage were obtained.Levels of proliferation marker Ki-67 and apoptosis of colonic epithelial cells were determined by immunohistochemistry and terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL)assay,respectively.Data were expressed by median(lower quartile,upper quartile).Kruskal-Wallis test and Mann-Whitney test were performed to compare the differences between groups and Bonferroni method was used for correction.Results The median proliferation indexes (PI)of colonic epithelial cells of UC patients at new-onset active period,remission period and recurrent active period were 31 .65 % (19.14%,39.66%), 12.30% (11 .11 %,14.10%) and 44.15 % (33.65 %,52.45 %), respectively,which were all higher than those of control group (7.89% (6.54%,8.86%))there were statistically significant differentes among four groups (H =30.033,P <0.01 );those of new onset active period and recurrent active period were both higher than remission period,and the differences were statistically significant (all P <0.05/6).The median apoptosis indexes (AI)of colonic epithelial cells in UC patients at new-onset active period,remission period and recurrent active period were 24.18%(17.81 %,27.16%),44.19% (43.41 %,50.55 %),41 .24% (33.78%,46.24%),respectively,which were all higher than those of control group (2.65 %(2.48%,2.98%)),there were statistically significant differences among four groups (H =31 .563,P <0.01);and those of remission and recurrent active period were both higher than new-onset active period (all P <0.05/6).The median apoptosis/proliferation ratios of control group,new onset active period,remission period and recurrent active period were 0.320 0 (0.275 5 ,0.425 0),0.749 9 (0.634 9,1 .115 8 ),3.282 8 (3.133 1 ,4.406 8 )and 1 .008 2 (0.801 9, 1 .099 2),respectively,there were statically significant differences among four groups (H =29.441 ,P <0.01);those of new onset active period and recurrent active period were both lower than that of remission period and the differnces were statistically significant (both P <0.05/6 ).Conclusions Proliferation and apoptosis imbalance in colonic epithelial cells of UC patients is one of the important mechanisms for the pathgensis of UC.5-ASA does not promote the proliferation of epithelial cells during UC remission period.
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Objective To investigate the cutaneous manifestations in patients with ulcerative colitis (UC) and related factors.Methods Patients admitted to Department of Gastroenterology Peking University First Hospital from January 1994 to December 2014 and diagnosed as UC were retrospectively enrolled in this study.Skin disorders were confirmed by the dermatologists.Clinical data were collected and compared between patients with and without cutaneous manifestations.Results Among the total 373 UC patients,there were 34 cases (9.1％) with cutaneous manifestations,including 11 pyoderma gangrenosum,8 erythema nodosum,6 eczema,3 psoriasis,2 pemphigus,1 granulomatous cheilitis,1 ichthyosis,1 acne rosacea,and 1 impetigo.The skin manifestations may occur after the diagnosis,simultaneously or even before the diagnosis of UC,which were 24,7 and 3 patients respectively.The mean age in patients with skin lesions was (47.2 ± 12.1) years,male to female ratio 0.79∶ 1.More patients with skin manifestations had severe activity of UC compared with non-skin group [50.0％ (17/34) vs 25.1％ (85/339),P =0.01].In addition,the proportion of extensive colitis in skin lesion group was significantly higher than that in non-skin group [76.5％ (26/34) vs 54.6％ (185/339),P =0.04].Conclusions The cutaneous manifestations associated with UC are polymorphic,erythema nodosums and pyoderma gangrenosums are the most common skin lesions seen in UC patients.Skin lesions occur concurrently,pre or post the diagnosis of UC.Skin lesions in UC patients suggest more severe disease activity.Clinicians need to pay more attention to this group.
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Objective To investigate the clinical characteristics of elderly-onset inflammatory bowel disease (IBD) and its treatment options.Methods Clinical data of IBD in-patients treated in Peking University First Hospital from January 1995 to December 2014 were reviewed and the subsequent information in the follow-up was also collected.Based on the onset age, patients were divided into the elderly-onset group (≥60 years old) and the control group (＜60 years old).The general situation, clinical characteristics and treatment options were retrospectively analyzed and compared between the two groups.Results There were 37 patients (9.3％) with IBD in the elderly-onset group, with 25 cases with ulcerative colitis (UC) and 12 cases with Crohn disease (CD).The ratio of gender, smoking, family history of IBD and colon cancer in the elderly-onset and control groups were 1 : 0.9 and 1 : 1.3, 32.4％ and 21.7％, 0.0％ and 6.1％, 0.0％ and 1.9％, respectively, with no significant differences between the two group (P=0.597, 0.139, 0.247 and 0.840).The attack frequency and the percentages of patients with persistent symptoms and severe disease had no statistical differences between the elderly onset and the control groups.Compared with the control group, the elderly-onset group showed that the percentage of UC patients with extensive colitis (E3) was decreased [16.0％ (4/25) vs.41.2％ (117/289) respectively (x2 =6.123, P=0.013)], and the percentage of CD patients with colonic type (L2) was increased [58.3％ (7/12)vs.21.3％ (16/75) respectively (x2=6.447, P=0.011)].For treatment options, the number of patients receiving 5-Aminosalicylic Acid (5-ASA)/sulfasalazine(SASP) as maintenance treatment for more than 1 years were 274 cases (96.9％) in the control group and 22 cases (86.5％) in the elderlyonset group (x2 =6.382, P=0.011).And the number of patients receiving systemic corticosteroids during induction period were 5 cases (19.4％) in the elderly-onset group and 122 case (43.2％) in the control group (x2 =7.617, P=0.006).There were no statistically significances in the number of patients with immunosuppressant, biologics and operation treatment between the two groups.Conclusions The elderly-onset IBD patients are not rare.The inflammation involvement is more limited in the elderly-onset patients than in the young-onset patients.The treatment option for elderlyonset IBD should be more cautious, especially for the treatment with 5-ASA/SASP long-term maintenance and systemic corticosteroids usage.
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Objective To investigate the relationship among the activity of diseases , the alteration of intestinal flora and the serum immuoglobulin (Ig) in patients with ulcerative colitis (UC) and to further evaluate the clinical value of fecal cue ratio in assessing humoral immune abnormalities. Methods Clinical data of 401 UC patients admitted in Peking University First Hospital from January 2013 to May 2015 were analyzed. According to Mayo index , patients were divided into inactive and active groups , and the active group was further divided into the mild, moderate and severe group. Serum immunoglobulin (IgG, IgM, IgA, C3 and C4) and fresh fecal bacteria cue proportion were measured. Statistical analysis was made to find the relevance among the above indexes. Results With the increase of disease activity , the intestinal flora imbalance aggravated (Spearmann correlation coefficient equals 0.295, P < 0.05) and serum IgM decreased significantly. However, serum C3 increased obviously. Serum C4 increased in mild to moderate group but decreased significantly in severe group. With the aggravation of intestinal flora imbalance , serum IgM and IgA decreased but C3 increased (P < 0.05). Conclusions The measurement of intestinal flora cue proportion, Ig, C3 and C4 may contribute to better determining the severity of diseases and provide beneficial information for therapy.
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Objective To investigate the change of the distribution of peripheral blood lymphocyte subsets,before and after treated by infliximab (IFX) in patients with inflammatory bowel disease (IBD).Methods From September 2008 to January 2013,a total of 20 patients with IBD accepted more than three times of IFX treatment and on time follow-up were collected,11 cases of ulcerative colitis (UC) and nine of Crohn's disease (CD).At same time,20 healthy individuals were enrolled as healthy control group.The efficacy of IFX on patients with UC or CD was evaluated according to Mayo score and simplified Crohn's disease active index (CDAI) before and after treatment.Fasting blood of healthy control group,one day before IFX treatment and in 24 to 72 hours after the third time of IFX injection of IBD patients was collected.The percentage of total T lymphocyte,total B lymphocyte,CD4+ T lymphocyte,CD8+ T lymphocyte and natural killer (NK) cell in lymphocyte was determined by fluorescent labeled monoclonal antibodies and flow cytometry.Independent sample t-test was performed for comparison between two groups.Analysis of variance was for comparison among three groups.Results Three of 11 patients with UC achieved clinical remission,three cases were clinical improved and five cases were ineffectiveness.Among nine CD patients,one achieved clinical remission,six cases were clinical improved and two cases were ineffectiveness.Of UC patients,the percentage of total T lymphocyte before and after treatment ((84.2±8.1) ％ and (82.1±6.2)％),the percentage of CD8+ T lymphocyte before treatment ((40.0± 13.2)％) were all higher than that of healthy control group ((74.7±10.7)％ and (30.5±11.9) ％),while the percentage of NK cell before and after treatment ((5.1±2.8)％ and (7.8±4.3)％) were all lower than that of healthy control group ((13.7 ±7.8)％) and the differences were statistically significant (t=2.540,2.074,2.251,3.464 and 2.063,all P＜0.05).Compared with healthy controls,there were no significant differences in the percentage of total B lymphocyte and CD4+ T lymphocyte of UC patients before and after treatment,the percentage of total T lymphocyte,total B lymphocyte,CD4+ T lymphocyte,CD8+T lymphocyte and NK cell of CD patients before and after treatment (all P＞0.05).Before treatment,there were significant differences among effective treatment group,ineffective treatment group and healthy control group in the percentage of total T lymphocyte,CD8+ T lymphocyte and NK cell (F=4.095,4.571 and 7.432,all P＜0.05),of those there were significant differences between ineffective treatment group ((88.3 ± 8.2) ％,(44.4 ± 11.5) ％ and (4.6 ± 3.2) ％) and healthy control group (t=2.902,2.105 and 3.647,all P＜0.05).Conclusion The percentage of peripheral blood total T lymphocyte and CD8+T lymphocyte increase in active IBD patients with ineffective IFX treatment,however the percentage of NK cell decreases.
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Objective To investigate the effects of trimebutine maleate (TM) on the expression of large conductance calcium-activated potassium channel (BKCa) and ryanodine receptors (RyR)channels at mRNA and protein level in colonic smooth muscle cell of cold restraint stress(CRS)induced rats.Methods A total of 24 Wistar rats were divided into CRS group,CRS with TM group and control group equally.The rats of CRS group were gavaged with 0.9％NaCl (6 ml/kg) daily; the rats of CRS with TM group were gavaged with 15 g/L TM (6 ml/kg) daily and activity was restricted in wire cage at 4 ℃ for two hours,continuously for five days.The rats of control group were gavaged with 0.9 ％ NaCl (6 ml/kg) once without CRS.The amount and characteristics of stool of rats in each group were observed.The colonic smooth muscle was isolated to detect the expression of BKCa and RyR at mRNA and protein level by reverse transcription-polymerase chain reaction (RT-PCR) and Western Blot.Results The median of rats defecation particles of CRS group was six,control group was one and CRS with TM group was five.Compared with control group,the defecation appearance of CRS group and CRS with TM group was looser and wetter observed by naked eyes.Compared with control group,there was no obvious pathological changes in CRS and CRS with TM group.There was no significant difference in the mRNA expression of BKCa and RyR channels between control group and CRS group.Compared with control group,the BKCa expression at mRNA level of CRS with TM group increased 1.45 fold.Compared with control group,the RyR2 expression at mRNA level of CRS with TM group increased 1.32 fold.Compared with control group,the BKCa expression at protein level of CRS with TM group increased 1.39 fold,and there was no RyR2 expression band at protein level.Conclusion TM might affect colonic smooth muscle contraction through the upregulation of BKCa expression at mRNA and protein level and RyR expression at mRNA level.
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Objective To assess the expression of TNFα, IL-1β and the serotonin transporter (SERT) in adult rats of chronic visceral hypersensitivity induced by colon irritation during postnatal development, and to provide evidence to clarify the complex relationship between inflammatory cytokines and SERT among visceral hypersensitivity. Methods Sixteen neonatal male Sprague-Dawley rats were randomly separated into two groups undergoing different treatments. The irritated group ( n = 8 ) was received intracolonic injections of acetic acid(0.5%) between postnatal days 8 and 21 and another group ( n = 8 )was received colonic infusion with 0. 9% saline served as control. When they became adults( ages 7 weeks),the threshold intensity for a visually identifiable contraction of the abdominal wall and body arching were recorded during rectal distention (RD) to evaluate visceral hypersensitivity. Histological evaluation and MPO activity assay were performed to quantify the inflammation. The expression of cytokine of colon was assessed through immunohistochemistry. The expression of SERT was examined by Western blot. Results Histological examination of the tissues showed no significant structural damage or loss of crypts. The MPO levels in both groups were similar[(0. 497 ±0. 570) unit/g vs (0. 623 ±0. 739) unit/g, P =0.724]. The threshold to elicit a distinctive abdominal muscle contraction in response to RD decreased from (0.40 ±0. 14) ml in the control group to (0. 19 ±0.06)ml in the irritated group. And the threshold for bodying arching decreased from (0.91 ± 0. 26 ) ml in the control group to ( 0. 47 ± 0. 13 ) ml in the irritated group (P ＜ 0. 01 ). Cytokine immunoreactivity was increased in the irritated group when compared to the control group (TNFα: 0. 194 ±0. 001 vs 0. 182 ±0. 001, P ＜0. 01; IL-1β: 0. 196 ±0. 002 vs 0. 185 ±0.001, P＜0. 01 ), while SERT expression were reduced in the irritated group (0. 298 ±0. 038 vs 0. 634 ±0. 200, P＜0. 05). Conclusion There is an increase in the proinflammatory cytokines and a decrease in the SERT expression associated with the presence of chronic visceral hypersensitivity, both of them may play an important role in the pathogenesis of visceral hypersensitivity.
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Objective To observe the change of peripheral blood lymphocytes subsets in patients with active ulcerative colitis (UC) and explore its clinical significance. Methods The clinical data and lymphocyte subsets of 40 active UC patients who admitted to the Department of Gastroenterology, Peking University First Hospital,from June 2007 to January 2010 were retrospectively analyzed. Patients who had previously used immunosuppressants or tumor necrosis factor monoclonal antibody were excluded. Seventy-nine subjects with health examination served as controls. Peripheral blood lymphocyte subsets detected included total T cells, CD4 + T cells, CD8 + T cells, B cells, and NK cells. Only the first detection results of UC patients were used for analysis. Results The proportion of total T cells for UC patients (73.60% ± 8.35% ) was significantly higher than the controls (69. 76% ±7.37%) (P =0.012). CD8+T cell ratio (35.53% ± 10.99%) was significantly higher than the controls ( 30. 56% ± 6. 75 % ) ( P = 0. 011 ). When the UC patients were stratified according to inflammatory involvement,the total T cells, CD8 +T cell, and NK cell ratio were significantly different among pancolitis, non-pancolitis, and the controls ( all P ＜ 0. 05 ). When the UC patients were stratified according to the disease course, the total T cells and CD8 + T cell ratio were significantly different among chronic recurrent/persistent, onset, and the controls ( both P ＜ 0.05 ). When the UC patients were stratified according to the extraintestinal manifestations, the total T cells and CD8 + T cell ratio were significantly different among those with extraintestinal manifestations, those without extraintestinal manifestations, and the controls ( both P ＜ 0.05 ). Conclusions The proportion of total T cells and CD8 + T cells increase in UC patients. Such immune abnormalities are even more distinctive in those UC patients who suffer from pancolitis or chronic recurrent/persistent type or those with extraintestinal manifestations.
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Objective To determine the effect of proinflammatory cytokines including interleukin-lbeta (IL-1β) and tumor necrosis factor-Alpha (TNF-α) on human serotonin transporter (SERT) in human enterocyte-like cell line Caco-2.Methods Caco2 cells were cultured for 5 days,then were divided into control group.IL-1β treated group (50 ng/ml) and TNF-α treated group (50ng/ml) for 2.24,48 and 72 hours.The expression of SERT mRNA was detected by RT-PCR at 2,24 and 48 hours and its protein expression was measured by Western blotting at 24,48 and 72 hours.Results The expression of SERT mRNA at 2,24 and 48 hours was lower both in IL-1β treated group (1.393±1.184,1.064±0.625 and 1.013±0.415,respectively) and TNF-α treated group (1.000±0.000,0.829±0.162and 0.945±0.147,respectively) in comparison with control group (2.282±1.367,1.586±0.421 and 1.86 ±O.496,respectively).There was significant difference among three groups (P<0.01).The expression of SERT protein at 24,48 and 72 hours was lower in IL-1β treated group and TNF-α treated group than in control group.Conclusions The IL-1β and TNF-α can inhibit the expressions of SERT mRNA and protein in Caco-2 cells,which indicates that IL-1β and TNF-α may change visceral sensitivity by influencing peripheral 5-hydroxytryptamine levels.
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Objective To observe the effect of atropine and N-nitro-L-arginine methyl ester (L-NAME) on the pressure of lower esophageal sphincter (LESP) regulated by electro-acupuncturing (EA) at Zusanli acupoint (He-Sea, st 36) of stomach meridian and explore the neural mechanism of EA. Methods Forty-eight rats were divided into six groups:control group, EA group, atropine group, atropine+EA group, L-NAME group and L-NAME+EA group. LESP was observed and recorded by using three-channel perfusion manometric measurement system. Results LESP increased significantly under or after EA at Zusanli acupoint. Cholinergic M receptor blocker partly abolished the influence of EA on LESP, but EA could restore the decreased pressure of cholinergic M receptor blocked rats. Nitric oxide synthase (NOS) inhibitor increased LESP, and EA could make it higher. Conclusions The main efferent pathway of regulating effect of EA at Zusanli acupoint on LESP is via the chlinergic nerve of vagus, and other mechanism possibly exits.
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SUMMARY The patient, an 18-year-old girl, was found to have strong positive purified protein derivative of tuberculin (PPD) test and calcified focus in her liver 2 years ago. She denied fever, cough, sputum, weight loss, night sweats, fatigue, and anorexia. After admission, physical examination, laboratory tests, CXR, abdominal CT, colonoscopy and gynecological examination were all normal except for the liver lesions. Percutaneous needle biopsy was performed under sonographic guidance and pathological examination showed caseous granuloma. She was diagnosed as primary liver tuberculosis and the lesions decreased after 2 months’ therapy of isoniazid, rifampicin and ethambutol. Primary liver tuberculosis could be asymptomatic and manifestated as calcified focus; percutaneous needle biopsy and pathological examination is helpful for the diagnosis. The asymptomatic liver lesions are still an indication for anti-tuberculosis therapy.
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Objective Effects of melatonin and serotonin on ethanol induced ulceration in the rat stomach were investigated. Methods Serotonin was injected subcutaneously, then melatonin solution and finally ethanol was put into the ex vivo gastric lumen to prepare the experimental models. Glandular mucosal blood flow (GMBF) and the gastric mucosal injury were observed. Results Melatonin and serotonin administration did not induce observable gastric mucosal of damage in the ex vivo stomach, but the serotonin reduced glandular mucosal blood flow (GMBF) with dose dependence in this organ. Ethanol reduced GMBF and induced visible glandular mucosal damage. The latter effect was prevented by melatonin pretreatment. Serotonin pretreatment aggravated the gastric mucosal injury and GMBF changes induced by ethanol, but these effects were partially reversed by melatonin. Conclusion The findings indicate that the GMBF and gastric injury are related, the reduction in GMBF, however, may not be the sole factor responsible for ulceration. The antagonistic effects of melatonin on serotonin action on the stomach suggest that melatonin may play a modulator role for serotonin action on the gastrointestinal tract.
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Objective To determine the function and clinical significance of OMOM capsule endos-copy. Methods To review the history and outcomes of 65 patients underwent capsule endoscopy from Oct. to Dec. 2004. Results OMOM capsule endoscopy failed to pass the pylorus within the effective working time in one case. The significant pathological findings were revealed in 47 patients among 64 patients (73. 4% ). Inflammatory small bowel diseases in 21 patients including Crohn's disease in 3 patients, small intestinal pol-yps in 8 patients including one Peutz-Jeghers syndrome, angiodysplasia in 9, diverticula in 3, hookworm in 3, submucosal tumor in 3 including one myosarcoma finally diagnosed by operation. OMOM capsule endosco-pies have working time 473 min (360-630) averagely. The duration from oral to anus was 1723 min (690-2370 min) averagely. Conclusion The capsule endoscopy is a highly useful technique in detecting small in-testinal diseases. It can be recommended as part of the routine work-up in patients with obscure bleeding.
ABSTRACT
Objective To investigate the clinical features of adult inpatients with abdominal type Henoch-Schonlein purpura(HSP)and to compare them with those without gastrointestinal symptoms.Methods The adult inpatients with HSP during January 2000 and December 2005 were reviewed retrospectively,and the clinical features of those with or without abdominal pain were compared.Results Sixty-three patients were included.Thirty-two patients(50.8%)complained of abdominal pain.Of these patients,43.8% had peri-umbilical colicky pain,40.6% middle-upper abdominal pain and 15.6% lower abdominal pain.The other clinical manifestations included nausea/vomiting(15.6%),positive feces occult blood test(50.0%)and elevated blood/urine amylase(25.0%).EGD showed mucosal congestion,red macula,erosion and ulceration mainly in the descending duodenum.Colonscopy showed inflammatory and ulcerative lesions at distal ileum and rectosigmoid.The biopsy pathology showed non-specific inflammatory cell infiltration.There were no differences in age,gender,allergic history and predisposing infection between those with abdominal pain and those without abdominal symptoms.The patients with abdominal pain had more mixed-type HSP(78.1% vs 22.6%,P