Association of young age and male sex with primary sclerosing cholangitis in Taiwanese patients with inflammatory bowel disease

Background/Aims@#Primary sclerosing cholangitis (PSC) is associated with inflammatory bowel disease (IBD). We aimed to evaluate the prevalence, clinical manifestation, and outcomes of PSC in Taiwanese patients with IBD. Methods: This retrospective study enrolled patients with IBD admitted from January 1, 1996, to December 31, 2018, to National Taiwan University Hospital. A case-matched analysis was performed comparing patients with IBD with and without PSC according to age, sex, and time of admission, with ratios of 1:4 and 1:2 in the adult and pediatric groups, respectively. @*Results@#In total, 763 patients with IBD were enrolled, 12 of whom were also diagnosed with PSC (1.57%). All these patients had ulcerative colitis (UC). A greater incidence of IBD with PSC was observed in younger patients than in older patients. Male sex was a risk factor for PSC in pediatric patients with IBD (P=0.015); 75% of these patients were diagnosed with PSC along with or after the diagnosis of UC. There was no significant difference in colitis extent and severity between the groups; however, a higher proportion of rectal sparing was observed in patients with PSC (P=0.001). There was no significant difference in cancer development between the groups (P=0.679). Conclusions: A 1.57% prevalence of PSC was observed in Taiwanese patients with IBD. The majority of patients with IBD and PSC were men and were diagnosed at a younger age. Hence, routine evaluation of biliary enzymes and liver imaging is recommended in young male patients with IBD.

Analysis of 13 Cases of Abnormal Death after Drinking / 法医学杂志

Objective To investigate the common causes of death after drinking and the precautions for forensic identification.Methods By reading alarm records, visiting investigations, on-site investigation transcripts, medical examination records and identification documents, the sex, age, corpse examination, toxic (drug) analysis and cause of death in 13 cases of post-drinking death were retrospectively analyzed.Results In 13 cases of post-drinking abnormal death, the causes of death were mainly drowning after drinking and asphyxia induced by stomach contents reflux.However, when accompanied by injury or other toxic poisoning, competition of death causes often occured.Conclusion Combining the case and on-site inspection, a comprehensive systematic corpse examination and toxic (drug) analysis is of great significance for the forensic identification of cadavers of non-acute ethanol poisoning after drinking.

Management of ulcerative colitis in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease

Ulcerative colitis (UC) is an inflammatory bowel disease characterized by chronic mucosal inflammation of the colon, and the prevalence and incidence of UC have been steadily increasing in Taiwan. A steering committee was established by the Taiwan Society of Inflammatory Bowel Disease to formulate statements on the diagnosis and management of UC taking into account currently available evidence and the expert opinion of the committee. Accurate diagnosis of UC requires thorough clinical, endoscopic, and histological assessment and careful exclusion of differential diagnoses, particularly infectious colitis. The goals of UC therapy are to induce and maintain remission, reduce the risk of complications, and improve quality of life. As outlined in the recommended treatment algorithm, choice of treatment is dictated by severity, extent, and course of disease. Patients should be evaluated for hepatitis B virus and tuberculosis infection prior to immunosuppressive treatment, especially with steroids and biologic agents, and should be regularly monitored for reactivation of latent infection. These consensus statements are also based on current local evidence with consideration of factors, and could be serve as concise and practical guidelines for supporting clinicians in the management of UC in Taiwan.

Management of Crohn's disease in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease

Crohn's disease (CD) is a chronic relapsing and remitting inflammatory disease of the gastrointestinal tract. CD is rare in Taiwan and other Asian countries, but its prevalence and incidence have been steadily increasing. A steering committee was established by the Taiwan Society of Inflammatory Bowel Disease to formulate statements on the diagnosis and management of CD taking into account currently available evidence and the expert opinion of the committee. Thorough clinical, endoscopic, and histological assessments are required for accurate diagnosis of CD. Computed tomography and magnetic resonance imaging are complementary to endoscopic evaluation for disease staging and detecting complications. The goals of CD management are to induce and maintain remission, reduce the risk of complications, and improve quality of life. Corticosteroids are the mainstay for inducing re-mission. Immunomodulating and biologic therapies should be used to maintain remission. Patients should be evaluated for hepatitis B virus and tuberculosis infection prior to treatment and receive regular surveillance for cancer. These consensus statements are based on current local evidence with consideration of factors, and could be serve as concise and practical guidelines for supporting clinicians in the management of patients with CD in Taiwan.

Research Advances in NLRP3 Inflammasome-related Regulatory Mechanisms / 中国医学科学院学报

Inflammasome is one of the pattern recognition receptors whose activation directly relates to the maturity and secretion of proinflammatory cytokines interleukin (IL)-1Β and IL-18. Thus, it plays an important role in the humoral immunity. A growing number of studies have found that inflammasome has a close relationship with the pathogenesis of various diseases including atherosclerosis,diabetes, and gout. However,the activation of the inflammasome and its specific regulatory mechanisms remain not clear. This article reviews the possible regulatory mechanisms of the inflammasome NLRP3 in terms of oxidative stress, endoplasmic reticulum stress,and autophagy reaction.

Seminar Report From the 2014 Taiwan Society of Inflammatory Bowel Disease (TSIBD) Spring Forum (May 24th, 2014): Crohn's Disease Versus Intestinal Tuberculosis Infection

Since Taiwan is an endemic area for tuberculosis (TB), differential diagnosis between the intestinal TB and Crohn's disease is an important issue. The steering committee of Taiwan Society of Inflammatory Bowel Disease (TSIBD) has arranged a seminar accordingly on May 24th, 2014 and the different point of views by gastroenterologist, radiologist, pathologist and infectious disease specialist were suggested to help the proper diagnosis and management of these two diseases.

Safety and Efficacy of Adalimumab for Patients With Moderate to Severe Crohn's Disease: The Taiwan Society of Inflammatory Bowel Disease (TSIBD) Study

BACKGROUND/AIMS: Only moderate to severe Crohn's Disease (CD) patients without a satisfactory conventional therapy effect are eligible to get reimbursement from the National Health Insurance of Taiwan for using adalimumab. These are more stringent criteria than in many Western countries and Japan and Korea. We aim to explore the efficacy of using adalimumab in CD patients under such stringent criteria. METHODS: A retrospective analysis was conducted in nine medical centers in Taiwan and we collected the results of CD patients receiving adalimumab from Sep 2009 to Mar 2014. The clinical characteristics, response measured by CDAI (Crohn's Disease Activity Index), adverse events and survival status were recorded and analyzed. CR-70, CR-100, and CR-150 were defined as attaining a CDAI decrease of 70, 100 or 150 points compared with baseline. RESULTS: A total of 103 CD patient records were used in this study. Sixty percent of these patients received combination therapy of adalimumab together with immunomodulators. CR-70 was 68.7%, 74.5% and 88.4% after week 4, 8 and 12 of treatment, respectively. The steroid-free rate, complications and survival were 47.6%, 9.7% and 99% of patients, respectively. In considering the mucosal healing, only 25% patients achieve mucosal healing after treatment for 6 to12 months. Surgery was still needed in 16.5% of patients. Combination treatment of adalimumab with immunomodulators further decreased the level of CDAI at week 8 when compared with the monotherapy. CONCLUSIONS: Even under the stringent criteria for using adalimumab, the response rate was comparable to those without stringent criteria.

Forensic investigation of 127 unidentified corpses in Shaoxing City / 法医学杂志

OBJECTIVE@#To explore the unidentified corpses in Shaoxing city in recent years to provide the experience for these types of corpse examination and forensic identification.@*METHODS@#One hundred and twenty-seven unidentified corpses were collected and analyzed in the period from January 2009 to June 2011. The scene investigation, clothing examination and information of forensic investigation were collected and analyzed.@*RESULTS@#Most of the unidentified corpses are the young male. Of them, there are 3 homicide cases. There are 92 cases (72.44%) of the corpses was found with all clothes and 72 cases (56.69%) with the belongings. There are 63 cases (49.61%) of the cases was died from downing and 15 cases (11.81%) was died from hypothermia and starvation. Cause of death in 25 cases (19.69%) was undetermined.@*CONCLUSION@#The most of unidentified corpses in Shaoxing are found in water and died from accidents. The degree of corpse putrefaction is the principal factor to analyze the cause of death.

Significance of soluble P-selectin in diagnosis of pre-disseminated intravascular coagulation state in children with severe pneumonia / 中华儿科杂志

<p><b>OBJECTIVE</b>Inflammation and coagulation occur concomitantly in severe pneumonia. The term non-overt disseminated intravascular coagulation (DIC) (pre-DIC state) refers to a state prevalent before the occurrence of overt DIC. It is suggested that initiation of treatment in non-overt DIC leads to better outcome than in overt DIC. The present study aimed at evaluating potential use of soluble P-selectin in diagnosis of pre-DIC state of children with severe pneumonia.</p><p><b>METHOD</b>The laboratory findings (including soluble P-selectin, D-Dimer, platelet count, activated partial prothrombin time, prothrombin time and fibrinogen) of 226 children with severe pneumonia from Jan. 2010 to Jul. 2011 in pediatric intensive care unit (PICU), were analyzed in this prospective cohort study, and the ROC curve was plotted to evaluate the potential role of soluble P-selectin in diagnosis of pre-DIC state.</p><p><b>RESULT</b>A total of 226 patients with severe pneumonia comprised of 75 positive and 151 negative pre-DIC state cases were enrolled. The mean value of soluble P-selectin, D-Dimer, and platelet count were 124.8 (26.9 - 608.3) µg/L, 1.3(0.7 - 16.0) mg/L and 91 (56 - 196)×10(9) for the positive cases, and 63.3 (2.8 - 302.1) µg/L, 0.5 (0.2 - 1.0) mg/L and 231 (120 - 680)×10(9) for the negative cases, respectively. There was a significant difference between the two groups. Coagulatory function in the positive cases, including activated partial prothrombin time, prothrombin time and fibrinogen which were (39.1 ± 3.5) sec, (14.8 ± 2.1) sec and (3.8 ± 0.5) g/L, respectively, were significantly higher than those in the negative cases [(37.2 ± 2.4) sec, (13.0 ± 0.5) sec and (3.3 ± 0.2) g/L] (P < 0.001). The area under ROC curve showed that D-dimer, soluble P-selectin for pre-DIC state had higher diagnostic value. The Optimal Operating Point of soluble P-selectin was determined and interpreted at 94.0 µg/L with a sensitivity of 0.824, a specificity of 0.887, and the Optimal Operating Point of D-dimer was determined and interpreted at 0.7 mg/L with a sensitivity of 0.905, a specificity of 0.867, systematic test of soluble P-selectin and D-dimer had a higher specificity of 0.920, determined at the same time.</p><p><b>CONCLUSION</b>To improve the outcome of patients with DIC, there is a need to establish more useful and easily operative diagnostic criteria for pre-DIC state. Plasma levels of soluble P-selectin will be helpful in this respect. Systematic test of soluble P-selectin and D-dimer may be helpful in reducing misdiagnosis rate.</p>

The mast cell and trauma / 法医学杂志

Mast cell(MC) takes an important role in trauma and the process of wound healing, and the pathophysiology reaction has a relationship to the time since trauma, which is helpful to determine the post-trauma and postmortem interval, and to distinguish the wound shaped whether before or after death. In this paper, the role of MC and its chemic medium in the process of wound healing, scar shaping, postburns inflammatory response, healing of bone fracture, as well as the signification for forensic medicine and the progress of researching in this field were reviewed.

The applying and foreground of quantifying DNA content by image analysis technique in determining postmortem interval / 法医学杂志

Image Analysis Technique(IAT) was developed at 1950's, which quantifies the changing all the part of image by sampling, processing, quantifying, computing, analyzing the information of image. And now it has become a normal quantifying technique in biology and medicine research. In the present paper, we reviewed briefly the principium of quantifying the DNA content by IAT, the law of degradation of DNA in nucleus and the foreground of this method in determining PMI in forensic pathology.