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Objective To investigate the application value of magnetic resonance imaging (MRI) examination in the efficacy evaluation of infliximab combined with seton placement for perianal fistulizing Crohn's disease (PFCD) and influencing factors of deep remission.Methods The retrospective case-control study was conducted.The clinicopathological data of 57 patients with PFCD who were admitted to the Affiliated Hospital of Nanjing University of Chinese Medicine from August 2010 to October 2017 were collected.There were 39 males and 18 females,aged (24±9)years,with a range of 14-58 years.Patients underwent MRI examination preoperatively and postoperatively.Observation indicators:(1) follow-up situations;(2) influencing factors analysis of deep remission of PFCD.Follow-up using outpatient and inpatient reexamination was performed to detect clinical recovery of patients up to October 2017.Measurement data with normal distribution were represented as Mean±SD.Measurement data with skewed distribution were described as M (range).Count data were represented as absolute number or percentage.The univariate analysis was performed using the chi-square test.The multivariate analysis was done using the logistic regression model,using P＜0.15 as an inclusion criteria in the univariate analysis.Results (1) Follow-up situations:57 patients with PFCD undergoing inflixmab combined with seton placement were followed up for (40±24)months.During the follow-up,24 of 57 patients had clinical response,33 had long-term clinical healing.The fistulas of 24 patients with clinical response presented as high signal on T2 weighted image (T2WI) of postoperative MRI.Of 33 patients with long-term clinical healing,the fistulas of 16 patients with deep remission presented loss of high signal and replacement of fibrosis tissue on T2WI of postoperative MRI,the fistulas of 17 patients without deep remission presented as high signal on T2WI of postoperative MRI.(2) Influencing factors analysis of deep remission of PFCD:results of univariate analysis showed that extent of fistula was related factors affecting deep remission of PFCD (x2 =4.312,P＜0.05).Results of multivariate analysis showed that a single fistula complicated with branches and times of infliximab maintenance treatment ≤3 were independent risk factors affecting deep remission of PFCD (odds ratio=4.377,4.296,95％ confidence interval:1.124-17.043,1.158-15.940,P＜0.05) and fistula under levator ani muscle was an independent protective factor affecting deep remission of PFCD (odds ratio =0.182,95％ confidence interval:0.041-0.815,P＜ 0.05).Conclusions Partial patients with long-term clinical healing can achieve deep remission after Infliximab combined with seton placement for perianal fistulizing Crohn's disease,requiring MRI examination to further evaluate recovery situations.A single fistula complicated with branches and times of infliximab maintenance treatment ≤ 3 are independent risk factors affecting deep remission of PFCD and fistula under levator ani muscle is an independent protective factor affecting deep remission of PFCD.
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Objective To evaluate the efficacy of infliximab combined with sphincter-sparing surgery in treatment of perianal Crohn's disease.Methods Clinical data of 49 patients with perianal Crohn's disease (3 cases with nonfistulizing perianal Crohn's disease and 46 cases with fistulizing perianal Crohn's disease) receiving infliximab combined with sphincter-sparing surgery in Jiangsu Province Hospital of TCM from May 2010 to June 2014 were analyzed retrospectively.The situation of fistula closure was assessed.C-reactive protein and perianal disease activity index were estimated by Wilcoxon method.Results No patient was failed to respond to primary treatment.patients (26/46) had a complete response to treatment,28.3％ patients (13/46) had a partial response and 15.2％ patients (7/46) had lost response to treatment;2 cases of anal ulcer healing;No other perianal lesion occurred in 1 case of verrucous skin.At final follow-up,CRP was decreased to [4.5 (1.5,15.9)] mg/Lfrom [16.9(6.6,35.6)] mg/L(Z=-3.994,P=0.00);PDAI was decreased to[1(0,4.5)]from [7(4.5,10.5)] (Z=-6.100,P=0.00).Conclusion Infliximab combined with sphincter-sparing surgery is effective for perianal Crohn's disease.
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Objective To evaluate the efficacy of infliximab combined with sphincter-sparing surgery in treatment of perianal Crohn's disease.Methods Clinical data of 49 patients with perianal Crohn's disease (3 cases with nonfistulizing perianal Crohn's disease and 46 cases with fistulizing perianal Crohn's disease) receiving infliximab combined with sphincter-sparing surgery in Jiangsu Province Hospital of TCM from May 2010 to June 2014 were analyzed retrospectively.The situation of fistula closure was assessed.C-reactive protein and perianal disease activity index were estimated by Wilcoxon method.Results No patient was failed to respond to primary treatment.patients (26/46) had a complete response to treatment,28.3％ patients (13/46) had a partial response and 15.2％ patients (7/46) had lost response to treatment;2 cases of anal ulcer healing;No other perianal lesion occurred in 1 case of verrucous skin.At final follow-up,CRP was decreased to [4.5 (1.5,15.9)] mg/Lfrom [16.9(6.6,35.6)] mg/L(Z=-3.994,P=0.00);PDAI was decreased to[1(0,4.5)]from [7(4.5,10.5)] (Z=-6.100,P=0.00).Conclusion Infliximab combined with sphincter-sparing surgery is effective for perianal Crohn's disease.
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<p><b>OBJECTIVE</b>To discuss the clinical features of perianal Crohn disease (PCD).</p><p><b>METHODS</b>Clinical data of 52 PCD patients who were treated at the Department of Colorectal Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine from June 2011 to October 2014 were analyzed retrospectively. Montreal classification, clinical symptoms, the subtype of perianal lesions, history of perianal surgery and medical treatment, disease active indexes, serum inflammation markers and nutritional indexes were included.</p><p><b>RESULTS</b>Among 52 patients, there were 40 males and 12 females with a mean age of (27.9±9.1) years. According to Montreal classification, 51.9%(27/52) of patients had ileocolic involvement and 75.0%(39/52) had inflammatory disease behavior. Thirteen (25.0%) and 15(28.8%) patients had abdominal pain and diarrhea respectively at admission. With respect to the subtype of perianal lesions, there were 32(61.5%) cases of anal fistula and 16(30.8%) cases of perianal abscess. Thirty-nine(75.0%) and 33(63.5%) patients had a history of perianal surgery and medical treatment before admission resepectively. Laboratory findings revealed high C-reaction protein level in 63.5%(33/52), high erythrocyte sedimentation rate in 61.5%(32/52), elevated platelet in 32.7%(17/52), low body weight in 44.2%(23/52), low albumin in 26.9%(14/52) and anemia in 42.3%(22/52) of patients.</p><p><b>CONCLUSIONS</b>The clinical features of PCD patients include male predominant, early onset disease, high prevalence of ileocolic involvement and inflammation disease behavior. Features prompting underlying PCD diagnosis include characteristic gastrointestinal symptoms, requiring multiple perianal surgery, and abnormality of inflammation markers and nutritional indexes.</p>
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Crohn's disease (CD) is a chronic nonspecific inflammatory disease.CD can affect any location in the digestive tract,and it also affect other organs,including the eyes,skin,liver and joints,which are termed extraintestinal manifestations (EIMs).The cutaneous manifestations of CD are common and occur in about one-third of patients.EIMs of CD have been divided into 3 categories.(1) Specific lesion,cutaneous manifestations of CD were the same as histopathologic findings of underlying gastrointestinal lesion.(2) Reactive lesion,it was also inflammatory lesion which was usually accompanied by underlying gastrointestinal disease while inflammatory injury was different from histopathologic findings of gastrointestinal lesion.(3) Associated lesion,it was caused by sequelae of human leucocyte antigen and chronic inflammation.In the current era of ever-expanding therapeutic options for CD,some investigators have proposed a fourth category of EIMs,namely those that are therapy-related lesion.The therapy-related lesion is closely related to disease-associated conditions in light of certain skin findings,and there is potential overlap between them.
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Objective To investigate the clinical characteristics of perianal Crohn's disease (CD) with or without proctitis and compare the treatment effect of surgery combined with biological preparation.Methods The retrospective cohort study was conducted.The clinical data of 52 patients with perianal CD who were admitted to the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from June 2011 to October 2014 were collected.Thirty patients with inflammation involvement of the rectum and 22 patients without inflammation involvement of the rectum were respectively divided into the proctitis group and non-proctitis group.All the 52 patients underwent surgery combined with infliximab therapy.Observation indicators included:(1) clinical characteristics:gender,age,body mass index (BMI),lesion location,disease behavior,type of perianal lesions,history of perianal surgeries,CD activity index (CDAI),perianal disease activity index (PDAI),C-reactive protein (CRP),erythrocyte sedimentation rate (ESR),white blood cell (WBC),platelet (PLT) and albumin (Alb),(2) treatment and follow-up.Follow-up using outpatient examination was performed to evaluate the perianal lesions up to December 2015.Measurement data with normal distribution were described as-x ± s and comparison between groups was analyzed by the t test.Count data were described as the percentage,and comparison between groups was analyzed by the chi-square test and Fisher's exact probability.Results (1)Clinical characteristics:number of patients with BMI ＜ 18.5 kg/m2 and with normal BMI were respectively 17,13 in the proctitis group and 6,16 in the non-proctitis group.Lesions located at ileum,colon and ileocolon were respectively detected in 3,9,18 patients in the proctitis group and 9,4,9 patients in the non-proctitis group.CDAI≥ 150 and ＜ 150,CRP≥8 mg/L and ＜ 8 mg/L,ESR ＞ normal level and =normal level,Alb ＜ 35 g/L and between 35 g/L and 50 g/L were respectively detected in 23,7,25,5,24,6,12,18 patients in the proctitis group and 8,14,8,14,8,14,2,20 in the non-proctitis group,with statistically significant differences between the 2 groups (x2 =4.446,6.855,8.563,12.076,10.211,6.163,P ＜ 0.05).(2) Treatment and follow-up:all the 52 patients underwent more than 3 times infliximab therapies and perianal surgeries within 1 week after infliximab therapy.All the patients were followed up for a median time of 28 months (range,8-52 months).Thirty-four patients still underwent maintenance therapy of immunosuppressive agents and 18 didn't undergo maintenance therapy up to the end of follow-up.Twenty-two patients in the proctitis group and 12 patients in the non-proctitis group underwent maintenance therapy,with no statistically significant difference between the 2 groups (x2 =1.979,P ＞ 0.05).The total healed rate,improvement rate and unhealed rate of perianal lesion were 55.8％ (29/52),34.6％ (18/52) and 9.6％ (5/52),respectively.The number of patients with healed,improved and unhealed perianal lesions were 16,11,3 in the proctitis group and 13,7,2 in the non-proctitis group,respectively,showing no significant difference in treatment effects between the 2 groups (x2 =O.173,P ＞ 0.05).Conclusions Patients with perianal CD combined with proctitis have higher activity of intestinal inflammation and worse nutritional status compared with patients without proctitis.However,there is no significant difference in the type and activity of perianal lesion between patients with or without proctitis.Surgery combined with biological preparation could render better clinical outcomes in treatment of perianal CD with proctitis.
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<p><b>OBJECTIVE</b>To evaluate the efficacy of ligation of intersphincteric fistula tract (LIFT) in the treatment of complex fistula-in-ano.</p><p><b>METHODS</b>Clinical data of 24 patients with complex fistula-in-ano who treated with LIFT in the Affiliated Hospital of Nanjing University of Chinese Medicine from September 2009 to February 2012 were analyzed retrospectively. The operative efficacy and postoperative continence were evaluated.</p><p><b>RESULTS</b>The prime success rate of fistula healing was 66.7% (16/24) after the LIFT procedure. Two patients presented with intersphincteric incision infection which was successfully treated with topical of silver nitrate. Four patients had intersphincteric fistula with infection and managed with the complete laying open approach. The total clinical healing rate was 91.7% (22/24). Another 2 patients had persistent external opening with discharge. During follow-up of 6 to 44 (median 16) months, The Cleveland Clinic Florida Fecal Incontinence score revealed that no patient developed decreased continence.</p><p><b>CONCLUSION</b>LIFT is a safe and effective sphincter-preserve procedure for complex fistula-in-ano.</p>
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Humans , Anus Diseases , General Surgery , Fecal Incontinence , Ligation , Rectal Fistula , General Surgery , Retrospective Studies , Wound HealingABSTRACT
Objective To establish a stable orthotopic model with high green fluorescent protein (GFP) expression in nude mice and observe its biological features.Methods Human HCT116 colon cancer cells transfected with GFP pLPCX retroviral plasmid were used to build a subcutaneous tumor model in nude mice.Fifteen BALB/C nude mice were selected to underwent orthotopic transplantation of colon when the GFP-labeled tumor grew to 10 mm × 10 mm as observed by in vivo fluorescent microscopy.The growth and metastasis of orthotopically implanted colon cancer cells were observed with fluorescent imaging system at different time points.The differences of the tumor size measured by peripheral vernier caliper and fluorescent imaging system were analyzed using the t test,and the differences in different groups were analyzed using the analysis of variance.Results GFP-labeled colon cancer models were successfully established in all the 15 nude mice,and there was no surgery-related complications or death.Tumors marked by GFP were observed under fluoroscope in week 3.The size of the tumors progressively increased with time.The volumes of the orthotopically transplanted tumors obtained from global measurement using fluorescent imaging system were greater than those measured by peripheral vernier calipers at postoperative week 3,4,5,6,7,while no statistically significant difference was observed (t =-1.280,-1.115,-0.718,-0.199,-0.386,P ＞0.05).There was a significant difference in the interation of measure method and different time points (F =29.546,P ＜ 0.05).Eight nude mice survived at the end of the experiment,and tumor metastasis was observed in 6 mice.Conclusions It is technically feasible to construct GFP-labeled colon cancer orthotopic transplantation model.The mice model could be used for real-time,in vivo,non-invasive and dynamic observation and analysis of the growth and metastasis of tumor cells.
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Objective To study the effect of baicalin on the apoptosis and cell cycle of colorectal cancer cells in orthotopic transplantation mice model with mismatch repair gene hMLH1 deficient.Methods Sixty orthotopic transplantation mice models of human colorectal cancer cell line HCT1 16 expressing green fluorescent protein (GFP) were established,and were randomly divided into the control group and the 50,100,200 mg/kg baicalin groups according to the random number table.Mice in the 50,100,200 mg/kg baicalin groups received intragastric infusion of baicalin at the corresponding dosages twice a day,while mice in the control group received intragastric infusion of 5％ NaHCO3.Cell cycles and apoptotic rates of the HCT116-GFP cells were detected by flow cytometry and TUNEL method respectively.Differences between the 2 groups were analyzed using the analysis of variance or chi-square test,and differences within each group were analyzed using the LSD-t test.Results The orthotopic transplantation mice models of human colorecta] cancer were successfully constructed,and there was no significant difference in the body weight of the mice and tumor size among the 4 groups (F =0.343,0.107,P ＞0.05).The proportion of HCT116-GFP cells in the G2/M phase in the 50,100,200 mg/kg baicalin groups were 22％±6％,18％±7％ and 19％±6％,which were significantly higher than 7％ ±5％ of the control group (t =5.421,3.483,3.575,P ＜0.05).There were no significant differences in the proportion of HCT116-GFP cells in the G2/M phase among the 50,100,200 mg/kg baicalin groups (F =1.291,P ＞ 0.05).The apoptotic rates of HCT116-GFP cells in the 50,100,200 mg/kg baicalin groups were significantly higher than the control group (t =7.163,3.703,2.688,P ＜0.05).The apoptotic rate of the 50 mg/kg baicalin group was significantly higher than that of the 200 mg/kg baicalin group (t =2.259,P ＜ 0.05).Conclusions Baicalin significantly inhibits tumor growth in the orthotopic transplantation mice model with mismatch repair gene hMLH1 deficient.After treated with baicalin,the cell cycle is arrested at the G2/M phase,thus the tumor growth is inhibited.
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Objective Extrapolate the relationships between the width of circumferential rectal mucosa re-sected and the method of either performing single purse-string or performing double purse-string during per-forming the procedure for prolapse and hemorrhoids (PPH), and to assess the impact of both the level of sta-ple line and the width of rectal mucosa resected on clinical outcomes after stapled hemorrhoidpexy. Meth-ods Twenty-eight adult patients with Ⅲ-Ⅳ hemorrhoids were assigned to two groups: 15 patients using sin-gle pursestring and the remaining 13 patients using double purse-string. The mucosal width of doughtnuts of both groups were measured and the data recorded. The doughtnuts resected were sent to pathology examina-tion after stapled hemorrhoids pexy to identify whether or not the specimens involved the smoth muscles. The demographic complications (bleeding, postoperative pain, urinary retention, fecal urgency) were compared and statistically analysed between the two groups, respectively. Results There were no statistical differ-ences between the two groups in terms of postoperative short-term results and complication rates, as well as the proportion of involving smooth muscle in specimens(P >0.05). However, when compared the width of doughtnuts resected in single-pursestring group was smaller than that in double-parse-string group (P < 0. 01). Conclusion The single or double-purse-string suture in PPH can control the width of resected rectal mucosa.