Clinical Analysis of Inpatients With Inflammatory Bowel Disease in Last Decade(2008-2017) / 胃肠病学

Background:The clinical characteristics and management approaches of inflammatory bowel disease(IBD)change accordingly with the increasing incidence of the disease. Aims:To investigate the clinical changes of IBD in the last decade(2008-2017)in Anhui Provincial Hospital. Methods:Hospitalization data of patients with newly diagnosed IBD admitted from Jan. 2008 to Nov. 2017 at the Anhui Provincial Hospital were collected,and then the clinical characteristics and management approaches were compared between Group A(2008-2012)and Group B(2013-2017). Results:A total of 515 IBD cases were enrolled in this study. Hospitalized IBD cases increased significantly from 2013 to 2017. Cases of ulcerative colitis(UC)was 3.72 times and cases of Crohn's disease(CD)was 3 times in 2017 as that in 2013. In Group A,UC mainly involved the left colon(47.8%),with mild-to-moderate activity(85.3%);while the majority of UC in Group B presented as pancolitis(54.5%),and mostly with moderate-to-severe disease(83.8%). In group B,the proportion of CD involving ileocolon(65.5%)and with moderate-to-severe disease(58.6%)was significantly increased;complications occurred in 50.9% of the CD patients,predominantly the perianal lesions(44.8%). In the past 5 years, colonoscopy and biopsied pathology were more accessible(>95%),and the detection rate of typical pathological changes, as well as the comprehensive diagnosis based on clinical,colonoscopic and pathological findings were significantly increased. In respect of treatment modalities,steroids and immunosuppressants were more frequently used in UC,and immunosuppressants,biological agents and enteral nutrition were more frequently used in CD in the past 5 years. Conclusions:The number of hospitalized IBD patients admitted in Anhui Provincial Hospital increased significantly in the past 5 years. The clinical characteristics and management approaches of IBD changed as time passed. The diagnosis and treatment were significantly improved.

Impact of Serum 25OHD Level on Disease Activity and Quality of Life in Patients with Ulcerative Colitis / 胃肠病学

Background:It was demonstrated that vitamin D has extensive biological effects,and evidence exists on association between vitamin D and a variety of immune mediated diseases such as inflammatory bowel disease. Aims:To investigate the relationship between serum level of 25-hydroxyvitamin D(25OHD)and disease activity and quality of life in patients with ulcerative colitis( UC). Methods:Serum level of 25OHD was detected by electrochemiluminescence in 50 outpatients/inpatients with UC from Oct. 2015 to Mar. 2016 at the Anhui Provincial Hospital;35 healthy subjects were served as normal controls. CRP,ESR and PLT were determined by routine laboratory tests in UC patients. Disease activity of UC was assessed by improved Mayo score,and Chinese version IBD questionnaire( IBDQ)was employed to assess quality of life. Results:Vitamin D deficiency defined as serum 25OHD ﹤20 ng/mL was detected in 68. 0% of the UC patients. The mean value of serum 25OHD was significantly lower in UC group than in normal control group[(16. 73 ± 8. 83)ng/mL vs.(19. 84 ± 4. 56)ng/mL,P﹤0. 05]. When patients were stratified with disease activity,serum level of 25OHD decreased in the order of remission,mild,moderate and severe active stage(P ﹤0. 05). In UC patients with vitamin D deficiency,the value of CRP,ESR and PLT were significantly increased(P all ﹤0. 05)and the overall score of IBDQ and scores of four dimensions of IBDQ referring to bowel symptom,systemic symptom,emotional function and social function were significantly decreased(P all ﹤0. 05). Spearman and Pearson correlation coefficients analyses showed that serum level of 25OHD was negatively correlated with Mayo score,CRP,ESR and PLT(P all ﹤0. 05),and positively correlated with scores of IBDQ,including overall score and four dimensional scores in UC group( P all ﹤0. 05 ). Conclusions:Vitamin D deficiency occurs frequently in patients with UC and might have a negative impact on disease activity and quality of life.

Effect of TRAIL on Expression of Multidrug Resistance Gene GST-π in Drug-resistant Human Gastric Cancer Cell Line SGC7901/VCR / 胃肠病学

Background:Multidrug resistance of tumor cells is one of the important factors that cause failure of chemotherapy in advanced gastric cancer. Tumor necrosis factor-related apoptosis-inducing ligand(TRAIL)may enhance the killing effect of chemotherapeutics on tumor cells,and reverse drug-resistant cell lines to sensitive cell lines,but its mechanism is not yet clear. Aims:To study the effect of TRAIL on expression of multidrug resistance gene glutathione S-transferase-π(GST-π)in drug-resistant human gastric cancer cell line SGC-7901 / VCR and the potential mechanism of TRAIL in reversing multidrug resistance of gastric cancer cells. Methods:SGC-7901 / VCR cells were treated with TRAIL in different doses (50,100,200 and 400 μg/ L)for 48 hours. After treatment,expression of GST-π mRNA in SGC-7901 / VCR cells and concentration of GST-π in culture supernatant were detected by RT-PCR and ELISA,respectively. Results:TRAIL could inhibit mRNA expression and protein secretion of GST-π in SGC-7901 / VCR cells in a dose-dependent manner within a certain range(≤200 μg/ L). The relative expression levels of GST-π mRNA in 50,100,200 and 400 μg/ L TRAIL groups were 0. 89 ± 0. 04,0. 77 ± 0. 08,0. 65 ± 0. 06 and 0. 61 ± 0. 03,respectively,and the concentrations of GST-π in culture supernatant in these groups were(57. 56 ± 1. 19)ng/ mL,(56. 30 ± 0. 80)ng/ mL,(31. 41 ± 1. 65)ng/ mL and (30. 80 ± 1. 34)ng/ mL,respectively,all were significantly lower than those in control group[1. 01 ± 0. 13 and(58. 62 ± 1. 38)ng/ mL,P all < 0. 05]. Conclusions:TRAIL may play a potential role in reversing multidrug resistance of gastric cancer cells through down-regulating GST-π expression.

Effects of Psychological Abnormalities on Life Quality,Sleep Quality and Symptom Severity in Patients with Irritable Bowel Syndrome / 胃肠病学

Background:Irritable bowel syndrome( IBS)patients are often accompanied by anxiety,depression and other psychological abnormalities,but the effects of psychological abnormalities on daily life have not yet been fully clarified. Aims:To investigate the effects of psychological abnormalities on life quality,sleep quality and symptom severity in IBS patients. Methods:A total of 101 IBS patients admitted from Nov. 2014 to May 2015 at Anhui Provincial Hospital Affiliated to Anhui Medical University were enrolled in this study. Zung self-rating anxiety scale(SAS)and Zung self-rating depression scale(SDS)were used to evaluate the mental state;IBS-quality of life(IBS-QOL)was used to evaluate the life quality;Pittsburgh sleep quality index(PSQI)was used to evaluate the sleep quality;IBS symptom severity score (IBS-SSS)was used to evaluate the symptom severity. Correlations between psychological factors,life quality,sleep quality and symptom severity were analyzed. Results:57. 4%(58 / 101)of IBS patients were accompanied by varying degrees of anxiety and/ or depression. The IBS-QOL score of 101 patients was 73. 28 ± 12. 79,in which anxiety,loss of appetite and health concerns were the most severely affected. 73. 3%(74 / 101)of IBS patients were accompanied by varying degrees of sleep disorders,in which daytime dysfunction,sleep quality and sleep efficiency were the most severely affected. Of the 101 IBS patients,the symptom of 13 cases was mild,63 cases was moderate and 25 cases was severe. IBS-SSS score was 253. 00 ± 72. 58. Correlation analysis showed that anxiety,depression were negatively correlated with life quality(r = - 0. 426,P < 0. 001;r = - 0. 501,P < 0. 001)and positively correlated with sleep quality(r = 0. 556, P = 0. 000;r = 0. 513,P = 0. 000)and symptom severity(r = 0. 231,P = 0. 020;r = 0. 357,P < 0. 001). Life quality was negatively correlated with symptom severity(r = - 0. 417,P < 0. 001). Conclusions:IBS patients have psychological abnormalities and their life and sleep qualities are decreased,the more serious the psychological abnormalities,the more damage on life and sleep qualities and the more severe the IBS symptoms.

Diagnosis and Treatment of Patients with Refractory Functional Gastrointestinal Disorders Accompanying with Psychological Disorders / 胃肠病学

Patients who have functional gastrointestinal disorders(FGIDs)often together with psychological disorders and damaged quality of live. Management of FGIDs patients failed to conventional drug therapy,so-called the refractory FGIDs,is a challenge for gastroenterologists. Till now,FGIDs are still not fully recognized and clarified and having only limited therapeutic approaches. In this article,we reviewed the clinical characteristics of refractory FGIDs accompanying with psychological disorders and the progress in research on their diagnosis and treatment for improving the understanding and formularizing the management of this disease.

Molecular mechanism of cisplatin to enhance the ability of TRAIL in reversing multidrug resistance in gastric cancer cells / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the molecular mechanism of cisplatin to enhance the ability of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) in reversing multidrug resistance in vincristine-resistant human gastric cancer SGC7901/VCR cells.</p><p><b>METHODS</b>MTT assay was used to measure the 50% inhibiting concentration (IC₅₀) and cell survival in SGC7901 and SGC7901/VCR cells after different treatments. SGC7901/VCR cells were treated with different concentrations of DDP, different concentrations of TRAIL alone or in combination, and then the mRNA and protein levels of several genes were determined by RT-PCR, RT-qPCR and Western-blot analysis. After targeted silencing with specific siRNA and transfection of recombinant plasmid c-myc into the SGC7901/VCR cells, the mRNA and protein levels of DR4, DR5 and c-myc were determined by RT-PCR and Western-blot analysis.</p><p><b>RESULTS</b>After combined treatment with TRAIL and DDP of the SGC7901/VCR cells, the IC₅₀ of VCR, DDP, ADM, and 5-Fu treatment was significantly decreased compared with the control group or TRAIL-treated group (P < 0.05). After treatment with 0, 10, 50 ng/ml TRAIL in combination with 0.4 µg/ml DDP, the SGC7901/VCR cells showed significantly higher activation of caspase 3, down-regulation of DNA-PKcs/Akt/GSK-3β signaling pathway, and higher inhibition of MDR1(P-gp) and MRP1 than those treated with TRAIL alone (P < 0.01 for all). The mRNA and protein levels of DR4, DR5, c-myc were significantly decreased after silencing c-myc with specific siRNA in the SGC7901/VCR cells (P < 0.01 for all), and were significantly increased after transfection of recombinant plasmid c-myc into the SGC7901/VCR cells (P < 0.01 foe all). After the treatment with 10 ng/ml TRAIL, 0.25 µg/ml DDP + 10 ng/ml TRAIL and 0.5 µg/ml DDP + 10 ng/ml TRAIL, the relative expression level of c-myc protein in the SGC7901/VCR cells was 0.314 ± 0.012, 0.735 ± 0.026, and 0.876 ± 0.028, respectively, and the relative expression of cytochrome C was 0.339 ± 0.036, 0.593 ± 0.020 and 0.735 ± 0.031, respectively, and the relative expression levels of DR4, DR5, active-caspase 3 and active-caspase 9 in the SGC7901/VCR cells were also increased along with increasing DDP concentrations.</p><p><b>CONCLUSIONS</b>The activation of DNA-PKcs/Akt/GSK-3β signaling pathway and high expression of MDR1 and MRP1 play an important role in the multi-drug resistance properties of SGC7901/VCR cells. After combining with TRAIL, DDP can enhance the expression of DR4 and DR5 through up-regulating c-myc and enhancing the activation of caspase 3 and caspase 9 by facilitating mitochondrial release of cytochrome C. It may be an important molecular mechanism of DDP-induced sensitization of TRAIL to reverse the multidrug resistancein SGC7901/VCR cells.</p>

Expression of TRPV1 and Electrophysiological Characteristics of Colon-specific Dorsal Root Ganglion Neurons in Rat Model of Visceral Hypersensitivity / 胃肠病学

Background:Visceral hypersensitivity is considered to be one of the major pathophysiological mechanisms of irritable bowel syndrome. Aims:To investigate the expression of TRPV1 and electrophysiological characteristics of colon-specific dorsal root ganglion( DRG)neurons in rat model of visceral hypersensitivity. Methods:Twenty 10-day-old rats were randomly divided into two groups. In model group,visceral hypersensitivity was induced by colorectal administration of acetic acid;while in control group the same amount of saline was administered. Colon-specific DRG neurons were labeled retrogradely by injection of DiI,a fluorochrome,into the colon wall. Expression of TRPV1 in DRG neurons was detected by immunofluorescence and the electrophysiological characteristics of DRG neurons was detected by using patch-clamp technique. Results:In model group,the expression rate of TRPV1 in colon-specific DRG neurons was significantly higher than that in controls(46. 1% vs. 36. 6% ,P <0. 01),the average rheobase was significantly decreased[(57. 80 ±1. 32)pA vs.(73. 45 ± 4. 51)pA,P < 0. 05],while the frequency of action potentials(APs)in response to doubling rheobase stimulation was significantly increased[(8. 20 ± 1. 10)Hz vs. (4. 54 ± 0. 66)Hz,P < 0. 05]. Score of abdominal withdrawal reflex(AWR)under a 60 mm Hg colorectal distention was positively correlated with the expression rate of TRPV1 and the frequency of APs in response to doubling rheobase stimulation(r = 0. 87 and r = 0. 73,P < 0. 01),but was negatively correlated with the rheobase(r = - 0. 81,P < 0. 01)in model group. Conclusions:Increased expression of TRPV1 and excitability in colon-specific DRG neurons might be a crucial step in formation of visceral hypersensitivity.

Analysis of bacterial flora in faeces and mucosa of sigmoid colon in patients with ulcerative colitis / 中华消化杂志

Objective To explore the difference in bacterial flora between faeces and mucosa of sigmoid colon,the possible role and significance of microbiota alteration in the genesis of ulcerative colitis (UC).Methods Fusobacterium, Enterococcus, Lactobacillus, Bifidobacterium, Bacteroides and Escherichia were selected as target bacteria colonies.The content of six target bacteria colonies in faeces and mucosa of sigmoid colon of 35 UC patients (20 active UC, and 15 UC in remission) and 20 health controls were detected by real-time fluorescent quantitative polymerase chain reaction (RT-PCR).Two independent samples t-test was performed to compare the differences in bacterial flora between faeces and mucosa of sigmoid colon.Variance analysis was used to compare the differences in bacterial flora among health controls group,active stage group and remission stage group.Results In health control group, the contents of Fusobacterium, Bacteroides, Enterococcus and Lactobacillus in faeces ((10.94 ± 0.29),(12.42±0.39), (8.73±0.84), (9.05±0.35), respectively) were higher than those in the mucosa of sigmoid colon ((9.36±0.66), (9.88±0.82), (7.70±1.17) and (7.96±0.68), respectively, t=9.83, 12.51, 3.20 and 6.35, all P＜0.05).However, the content of Escherichia was lower in faeces than that in the mucosa of sigmoid colon ((8.03±1.02) lg copy/g vs (8.91±0.52) lg copy/g, t=-3.44, P＜0.05).There was no difference in the content of Bifidobacterium between faeces and mucosa of sigmoid colon ((9.54±0.79) lg copy/g vs (9.42±0.98) lg copy/g, P＞0.05).For UC patients, the contents of Fusobacterium, Bacteroides, Enterococcus, Lactobacillus and Bifidobacterium in faeces ((9.62 ±± 1.13),(11.31±0.71), (9.33±0.65), (8.42±0.80) and (8.85±0.73) lg copy/g, respectively) were higher than those in the mucosa of sigmoid colon ((9.00±0.79), (8.80±0.66), (7.46±0.82), (6.82±1.07) and (8.40±0.72) lg copy/g, respectively, t=2.66, 15.28, 10.58, 7.12 and 2.56, all P＜0.05).The content of Escherichia was lower in faeces than that in the mucosa of sigmoid colon ((8.50 ± 0.52) lg copy/g vs (9.26±0.87) lg copy/g, t=-4.45, P＜0.05).Compared with health control group, the content of Fusobacterium, Lactobacillus, Bifidobacterium and Bacteroides ((8.83 ± 0.81), (7.48 ± 1.59), (8.55±0.79) and (11.11±0.88) lg copy/g) all decreased (F=84.45, 14.58, 10.43 and 24.91, all P＜0.05), while the contents of Enterococcus and Escherichia increased ((9.63 ± 0.39) and (8.74 ±0.53) lg copy/g, F=9.87 and 5.55,both P＜0.05).For remission stage group, only the content of Bacteroides decreased ((11.56±0.21) lg copy/g, P＜0.05).Compared with health control group, the contents of Fusobacterium, Bacteroides, Lactobacillus, Bifidobacterium ((8.52 ± 0.30), (8.34 ±0.29), (6.29±0.52) and (8.06±0.21) lg copy/g) all decreased in active stage group (F=16.99,35.98,22.28 and 16.08, all P＜0.05);the content of Escherichia increased ((9.68±0.56) lg copy/g, F=11.19,P＜0.05);there was no difference in the content of Enterococcus ((7.19±0.32) lg copy/g, P＞0.05).In remission stage group, the contents of Bacteroides fragilis and Bifidobacterium decreased ((9.42±0.48) lg copy/g and (8.87±0.89) lg copy/g, both P＜0.05), there was no difference in other bacterias (all P＞0.05).In both faeces and mucosa of sigmoid colon, the ratios of Bifidobacterium and Enterobacteriaceae (B/E value) in active stage group were less than 1 (0.98±0.13 and 0.84±0.05),which significantly decreased compared with health control group (1.21 ± 0.19, 1.06 ± 0.08;F=12.64,76.20, both P＜0.05).In remission stage group, B/E values were higher than 1 both in faeces and mucosa (1.14±0.08 and 1.02±0.04), and there was no difference compared with those of control group (P＞0.05).Conclusions The distribution of target bacteria in feces and sigmoid colonis differed between health controls and UC patients.There are obvious changes in fecal and mucosa associated bacterial flora in UC patients especially in active stage compared with healthy controls.

Changes of mucosa associated bacterial flora in patients with ulcerative colitis at different stages and its significance / 安徽医科大学学报

Objective Sigmoid mucosa specimens of the patients with ulcerative colitis ( UC ) at active stage and remission stage were respectively detected by real-time PCR for the contents of the six kinds of bacterial floras inclu-ding fusobacterium, enterococcus, lactobacillus, bifidobacterium, bacteroides, and escherichia coli. So the possi-ble roles and significance of the changes of intestinal mucosa associated bacterial flora in the pathogenesis of UC were discussed. Methods Sigmoid biopsy tissues were collected from 35 UC patients ( 20 cases were activities group while 15 cases were remission group) and 20 healthy cases( control group) . Specific primers were set accord-ing to the bacterial 16 SrDNA sequences. Bacterial DNA of the intestinal mucosa specimens was extracted, and re-al-time PCR was used to detect the numbers of different bacterial colonies. Results In sigmoid mucosa specimens of the UC group at activities group, escherichia coli colony was increased, while bifidobacterium, bacteroides, lac-tobacillus and fusobacterium, were reduced compared to the control group(P0.05). And in remission group, bacteroides and bifidobacterium were reduced com-pared with the control group(P0.05 ) . The ration of bifidobacterium to escherichia coli ( B/E ) in UC pa-tients at active stage was less than 1, which was lower than the control group. While B/E values in UC patients at remission stage and the control group were both larger than 1 , with no statistically significant difference between them. Conclusion There were obvious changes of intestinal bacterial flora in UC patients, and the change is more obvious in the UC patients at active stage, showing that there is a close relationship between intestinal mucosa asso-ciated bacterial flora and the development of UC.

Risk Factors and Hygiene Hypothesis of Inflammatory Bowel Disease / 胃肠病学

Till now,the etiology of inflammatory bowel disease( IBD)is still not very clear. Some genetic risk loci have been identified that predispose people to IBD,however,they increase the risk of IBD by only a small magnitude. Therefore,environmental risk factors have been the focus of recent researches. This article reviewed the association of environmental factors( hygiene and dietary factors etc. ),especially childhood hygiene with IBD,and concluded that rural environment,higher number of siblings and having pets decreased the risk of IBD,while urban environment and small household size/sibship were risk factors for IBD. Currently,population-based study focusing on hygiene and IBD is deficient domestically,further epidemiological surveys are warranted to confirm their associations.

Clinical efficacy of biofeedback therapy on constipation-predominant irritable bowel syndrome / 中华行为医学与脑科学杂志

Objective To investigate the clinical effects of biofeedback therapy on constipation-predominant irritable bowel syndrome(IBS-C).Methods 30 patients with IBS-C were given to biofeedback therapy,5 times every treatment course.and then their clinical symptoms,mental state and quality of life before the treatment and at the end of treatment with biofeedback therapy were respectively evaluated by symptom scores,self-rating anxiety scale (SAS),self-rating depression scale (SDS),and short form 36 health survey questionnaire (SF-36).Results Post-treatment with biofeedback therapy,there were very significant decrease in total and subscales scores of bowel symptom including abdominal pain/discomfort,abdominal distension,abnormal appearance of defecation,abnormal process of defecation((12.31±2.01) vs (19.16±2.17),(2.95±0.57) vs (5.04±1.04),(2.64±0.92) vs (4.25±1.09),(3.66±1.09) vs (5.10±0.57),(3.06±1.08) vs (4.77±0.95) respectively,P＜0.01).The integration of SAS and SDS were obviously decreased after treatment((39.53±6.39) vs (44.43±7.89),P＜0.05;(40.70±8.38) vs (46.46±8.74),P＜0.05),the SF-36 scores were also improved in five dimensions including rolephysical,social-functioning,vitality,role-emotional and mental health((74.16±21.25) vs (57.0±39.40),(86.21±13.54) vs (75.54±20.96),(75.16±13.42) vs (64.66±20.54),(78.87±28.36) vs (57.76±46.26),(81.60±16.08) vs (71.20±22.04) respectively,P＜0.05).Conclusion Biofeedback therapy can improve the clinical symptoms,alleviate the moods of anxiety and depression,and improve the quality of life in patients with IBS-C.

Endoscopic submucosal excavation for the treatment of gastric submucosal tumor originated from the muscularis propria layer / 中国医师进修杂志

Objective To evaluate surgical approach,safety and efficacy of endoscopic submucosal excavation (ESE) for the treatment of gastric submucosal tumors originated from the muscularis propria layer.Methods Fifty-three patients with submucosal tumors of the stomach diagnosed by gastroscope,were examined using endoscopic ultrasonography (EUS) from February 2012 to April 2013.The patients were completed ESE at general anesthesia.Results The diameter of the tumor was from 5 to 35 mm (median 13.2 mm).The tumors of 48 patients were complete resection,the complete resection rate was 90.6％(48/53).The operation time was from 30 to 150 min (median 45 min).Three patients (5.7％,3/53) had impulsivity hemorrhage during ESE,no patients had unmanageable hemorrhea under the gastroscope.Perforation occurred in 6 patients during ESE,perforation rate was 11.3％ (6/53),the perforation was closed by endoclip in 5 patients.Five patients with inability resection and 1 patient with perforation inability closed were treated with surgical operation.None was developed perforation postoperative and hemorrhea.Conclusion ESE is a safety and efficacy method for treating gastric submucosal tumors originating from the muscularis propria layer.

Analysis of 108 cases of submucosal tumor treated by endoscopic submucosal excavation / 中华消化杂志

Objective To evaluate the efficacy and safety of endoscopic submucosal excavation in the treatment of suhmucosal tumor.Methods From 2010 to 2013,a total of 108 cases of suhmucosal tumor detected by endoscopic,endoscopic ultrasonography and computed tomography (CT) scan,most of which grew toward the lumen,were treated by endoscopic suhmucosal excavation.After the lesions were completely excavated,pathological examination were performed.All the cases were followed up with endoscopic examination at one,three,six,12 and 24 months after operation.Results Among 108 cases of lesions,27 cases were located in esophagus,eight in cardia,59 in stomach,two in duodenum and 12 cases in rectum.The diameters of the lesions ranged from 0.5 to 5.5 cm (median 2.1 cm).Operation time was between 18 and 240 minutes (median 105 minutes).The endoscopic treatment was converted to laparoscopic operation in three cases because the submucosal tumors of gastric body growing towards outside the lumen,or adhesive to muscular layer tightly and or perforation too big to be sutured.Three cases of submucosal tumor of fundus were failed to excavate,the other 102 cases (94.44％) of lesions were completely removed.Perforation occurred in 19 cases (17.59％).The procedure was converted to laparoscopic operation in one case.Effective endoscopic suture was complered in 18 cases.The volume of haemorrhage during operation was about 0 to 50 mL and no post-operational bleeding was found.Eight cases had cervical subcutaneous emphysema.Nine cases had pneumoperitoneum.Left parotid gland swollen was found in one case.Nine cases were lost to follow up.The left 99 cases were followed up for one to 24 months and no recurrence.Conclusion ndoscopic submucosal excavation safety and effectively achieve once complete removed of the big submucosal tumor which grows towards inside the lumen,and provide complete pathologic data.

Effect of insulin on small intestinal smooth muscle in diabetic mice / 中华消化杂志

Objective To investigate the effects of regular insulin (RI)on duodenal smooth muscle in diabetic mice. Methods Diabetes mellitus (DM) model was established by intraperitoneal injection of 150 mg/kg streptozotocin (STZ) in male BALB/c mice. The model mice were divided into DM group and DM treated with RI group with 6 each. Meanwhile, 6 normal mice were served as controls. The mice in treatment group were intraperitoneally injected with 40 U/kg of RI daily.Whereas the mice in DM and control groups were intraperitoneally injected with phosphate buffer solution (pH = 7. 40). After 6 weeks, the small intestinal transit rate of mice was determined by lavage of Indian ink. Interstitial cells of cajal (ICC) in duodenal myenteric plexus were counted using immunohistochemical staining. Slow waves of duodenal smooth muscle cells were recorded with intracellular recordings. Data were analysed by SPSS 17.0 software, and comparisons among three groups were done using LSD test. Results After intervention for 6 months, the clinical presentations,such as more water and food intake and polyuria, were improved in treatment group. The body weight was increased in treatment group [(23.33±3.13) g] compared with DM group [(15.42±1.40) g,P＜0.01] ,but dereased compared with control group [(26.78 ± 2.09) g, P＜0.05]. The level of blood glucose in DM group was significantly higher than that in control and treatment groups(P＜0.01). Small intestine transmission rate was significantly reduced in DM group than that in control and treatment groups (P＜0.01), but it was slower in treatment group than that in control group (P＜ 0. 01 ). Immunohistochemical study showed that the number of c-kit positive cells reduced obviously in DM group than that in control group and treatment group (P＜0.05), whereas it was lower in treatment group than that in control group (P ＜ 0.05). The slow wave frequency and amplitude of duodenal smooth muscle cells in DM group were reduced when compared with control and treatment groups (P＜0.01) and both were lower in treatment group than that in control group (P＜0. 01 ). Conclusion The findings indicate that DM mice have gastrointestinal dysmotility and exogenous insulin may improve small intestinal dysmotility in DM mice.

Ultrastructure of colonic mucosa in post infectious irritable bowel syndrome / 中华消化内镜杂志

se,instead of simply a functional disease,wtth biochemical basis.

Quantity and functional alterations of lower esophageal mucosal mast cells in elderly patients with reflux esophagitis / 中华老年医学杂志

Objective To investigate the alteration of mast cell(MC)in elderly patients with reflux esophagitis(RE). Methods Twenty eight elderly and 15 non-elderly patients with RE were recruited.Lower esophageal mucosal mast cells and the percentage of degranulated mast cells were countered after immunohistochemieal staining.The ultrastrueture of mast cells was observed by eleetromieroscope. Results The number of mast cells in lower esophageal mucosa in elderly patients with RE was significantly more than that in non-elderly patients with RE(10.24±2.56 VS.5.07±0.18,P＜0.01),and the percentage of degranulated mast cells in lower esophageal mucosa was also significantly higher in elderly patients with RE than in non-elderly patients with RE[(24.7±4.6)%vs.(13.5±5.5)%,P＜0.01].The more severe the esophageal mucosallesions,the more the numberof mast cells. Under the electromicroscopy, more Golgi apparatus, mitochondria and endoplasm-reticulum were found in mast cells.Special secreting particles were also found in cytoplasm,more vacuole were left behind after mast cells degranulation in elderly patients with RE.Conclusions Increased numbers of mast cells and mast cell activation may be involved in the pathogenesis of elderly RE.

The study for colonoscopic manifestations and epidemiology in elderly patients with vascular malformation / 中华老年医学杂志

ObjectiveTo investigate the colonoscopic manifestations, the prevalence and natural history of vascular malformation (VM) in elderly patients .MethodsTotally 2917 elderly patients were examined by colonoscopy and the colonoscopic apperances and prevalence were studied. A 3 years follow-up for VM patients was carried to assess bleeding risk. ResultsPrevalence in elderly group was 2.4%, while 0.8% for the non-elderly(P

Colonscopie therapy and follow-up study of colonic angiodysplasia / 中华消化内镜杂志

Objective To report on the clinical presentations of patients with colonic angiodysplasia and the results of electrocoagulation under the guide of colonoscopy. Methods Study on the clinical and endoscopic manifestation of patient with colonic angiodysplasia and follow-up study for the risk of bleeding in asymptomatic AD and in those after electrocoagulation. Results Totally 10 200 cases were involved in colonoscopy, among them 126(1. 24%) cases of CAD were found. Prevalence rate in asymptomatic group was 0. 89%, in bleeding group 2. 62%, and in nonbleeding group 0. 82%. In 9 asymptomatic AD cases no bleeding occurred in a period of 3-year follow-up. However, most of the bleeding AD patients have bleeding relapsed within 3 years. The curative effect of electrocoagulation during 1 year is significant the relapse rate of bleeding, 18% as compared to 54% in patients with bleeding without electrocoagilation P