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ObjectiveTo unify the definitions of colonoscopic characteristics of Crohn disease (CD) and intestinal tuberculosis ( ITB),and to evaluate colonoscopic and clinical features in the differential diagnosis of CD and ITB.MethodsA collaborative group composed of 10 experts from 5 hospitals voted to identify and confirm the colonoscopic characteristics.Clinical and colonoscopic characteristics were analyzed,thereafter,characteristics were scored based on different diagnostic specificity.ROC curve was used for determining the cutoff point to differentiate CD from ITB.ResultsFirstly,standard endoscopic images and descriptions were determined.Secondly,colonoscopic parameters which were significantly different between the CD and ITB patients included the follows:involvement of more than four intestinal segments,anorectal involvement,longitudinal ulcers,cobblestone appearance and transverse ulcers.Clinical findings which were significantly different between the CD and ITB patients included active pulmonary tuberculosis,PPD-test strong positive,anal fistula/perianal abscess and extra-intestinal manifestations in CD.4.4％(6/136) patients were confirmed by histological evidence of caseating granulomas.By using our scoring system,39.7％ (54/136) confirmed diagnoses and 18.4％ (25/136) suspected diagnoses were made in patients without histological evidence.ConclusionIdentification of colonoscopic characteristics and unification of the colonscopic diagnostic criteria were helpful in the differential diagnosis between CD and ITB.The differential diagnosis rate could he improved by using the scoring system.Half cases could not be confirmed even with combined pathology and the scoring system,so a more comprhensive scoring system would be warranted.
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@#Objective To investigate the effects of total glucosides of paeony (TGP) on mice with experimental ulcerative colitis and the underlying mechanisms. Methods Forty-eight mice were equally randomized into 6 groups ( n = 8): normal control group, model group, salicylazosulfapyridine (SASP) group, low-dose TGP group one day after enama, the mice were treated with corresponding agent by oral gavage for3 days. The disease activity index (DAI) score was evaluated every day. After all the mice were scarified, the macroscopic and histological scores were evaluated. The tumor necrosis factor-α (TNF-α) level of the colon mucosa was measured by ELISA and the colonic expression of nuclear factor-κB (NF-κB) p65 was detected by immunohistochemistry. Results Compared with the normal control group, the DAI score was significantly higher in the model group (P ＜0. 01 ),but was similar to that in low-dose TGP group ( P ＞ 0.05 ). Compared with the model group, the DAI score was significantly decreased in SASP group, medium-dose TGP group, and high-dose TGP group (all P ＜ 0. 05). The macroscopic score, histological score, TNF-α level, and expression of NF-κB p65 were significantly higher in model group than in normal control group, SASP group, medium-dose TGP group, and high-dose TGP group ( all P ＜0. 01 ), but was similar to that in low-dose TGP group (P ＞ 0. 05). The efficacy of TGP was higher in high-dose TGP group than in SASP group. Conclusions TGP has certain therapeutic effects on experimental ulcerative colitis,which may be achieved by its inhibitory effect on the activation of NF-κB and the production of TNF-α.
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Objective To investigate the role of Th cells in dextran sulfate sodium (DSS) induced murine colitis. Methods The ratios of Th1/Th2 cells intestinal mucosa and splenic monocytes (SMC) of mouse with DSS induced murine colitis were detected by FCM with two color intracellular cytokine staining. Results (1) In lamina propria mucosa cell (LPMC) of murine colonic mucosa from the acute model, Th1 cell was (8.90?1.23)%, significantly higher than that in the control( P 0.05). The ratio of Th1/Th2 was 3.09?1.18, significantly higher than that in the controls( P
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Objective To observe the expression of TGF?RⅠ,TGF?RⅡ and Smad7 in oxazolone-induced colitis of mice and to investigate the role of the TGF? signal transduction on pathogenesis of colitis. Methods Balb/c mice were pre-sensitized by skin painting with 0.2 ml 3% oxazolone on day 0 and 1 followed by intrarectal administration of 0.15 ml 1% oxazolone on day 7. The mice were sacrificed after 3 days. Colitis was evaluated by macroscopic and microscopic examination. The expressions of TGF?RⅠ, TGF?RⅡ and Smad 7 were examined by immunohistochemical study and Western blot respectively. All the results were compared with the controls. Results Twenty-four hours after intrarectal administration of oxazolone, the mice presented anorexia, less moving, loose stool, hematochezia or occult blood(+) and weight loss. The macroscopic and microscopic scores in two groups were 0.17?0.41, 2.67?1.03 and 2.33?0.52, 8.17?0.75, respectively. In the normal intestine, TGF?RⅠ, TGF?Ⅱ and Smad7 were mainly co-localized on the upper part of the villus. However, their expression was not only throughout the villus including fundus of crypts, but also in the mononuclear cells of the lamina propria and submucosa in the experimental intestine. The amounts of TGF?RⅠ, TGF?Ⅱ, Smad7 and the ratio of TGF?RⅠ/Ⅱ in control and colitis groups were 3.40?1.25, 21.71?6.97, 8.95?2.12, 0.16?0.01 and 6.49?3.18, 4.40?3.34, 17.92?6.80, 2.14?1.61, respectively. Conclusions Decreased TGF?RⅡ and increased Smad7 expressions indicate the abnormality of TGF? signal transduction in oxazolone-induced colitis. These pathologic and immunologic characteristics may resemble human ulcerative colitis.
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Objective To investigate the effect of bifidobacterium (Bif) supplementation on acute inflammatory response in murine dextran sulfate sodium(DSS)-induced colitis, and its possible mechanism. Methods Mice were divided into four groups: control,DSS, salfasalazine (SASP) and Bif. The mice in groups DSS, SASP and Bif were fed with 5% DSS(w/v) solution for 7 days to induce colitis, and disease activity index (DAI) was calculated every day. The mice in group SASP were fed with SASP every day during inducing colitis, and the mice in Bif group were given Bif by oral gavage from 7 days before the experiment to the end of experiment. The expression of TNF-?、NF-?B P65 and myeloperoxidase (MPO) in inflamed colon of each group was measured at the end of experiment. Results The mice in groups SASP and Bif showed a lower DAI than those in group DSS since the forth day to the end of experiment. There were lower level of TNF-? and MPO in murine inflammatory colon, and lower NF-?B P65 expression in nuclei of inflammatory cells in groups SASP and Bif than those in control at the end of experiment. Conclusions Treatment with Bif can effectively inhibit proinflammatory cytokine secretion and NF-?B activation in inflammatory cells, and decrease colonic inflammatory response in DSS induced colitis.
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Objective In order to improve the diagnostic level of Crohn's disease( CD),the relevant literatures with CD in China were reviewed and the causes of misdiagnosis about CD were analyzed. Methods Papers on CD published in medical journals from 1989 to 2003 in CMCC and VIP are collected and reviewed one by one, and then the characteristics of the misdiagnosed and missed CD were recorded and the causes of these cases were analyzed. Results From 1989 to 2003, there are 428 papers about CD, of which 261 papers are about clinical studies(60.9%); In these papers, total of 3397 CD cases were reported. In these cases there are 2357 cases missed, clinical symptoms are various and complex including abdomen pain (62.5%),diarrhea(51.5%), abdomenal lumps(16.6%) and so on. The most commonly involved sites of CD are terminal ileum (62.5%), colon (26.9%) and ileum combining with colon (38.9%). Cranulomas were identified in 61.2% of operative specimens and in 27.6% of biopsy specimens. The most common missed diagnosed diseases are intestinal tuberculosis(32. 2% ), simplex intestinal block (23.2%) and intestinal block caused by tumor(6.4%) and acute appenditis(27. 9% ). There are 389 cases misdiagnosed as CD, the most common diseases are tuberculosis(53.5%), small intestinal lymphoma(14.4%) and colonal cancer (17.0%). Conclusion Papers on CD are increased gradually during the periods from 1989 to 2003 with rather high missed or misdiagnosis. As a result, it is necessary for us to improve the cognitzability on CD and to improve the accuracy of diagnosis.