Progress of Research on Glucagon-like Peptide and Dipeptidyl Peptidase-4 Inhibitor in Treatment of Inflammatory Bowel Disease / 胃肠病学

Inflammatory bowel disease(IBD)is a non-specific and easily recurrent chronic inflammatory disease of the intestine,mainly including ulcerative colitis(UC)and Crohn's disease(CD).Its etiology and pathogenesis have not been fully elucidated,but it is currently believed to be related to environmental,genetic,immune response abnormalities,and other factors.At present,IBD has become a disease of great concern worldwide.According to the epidemiological data and data of inflammatory bowel disease in China,the incidence rate of IBD is on the rise year by year in China,but so far,there has not been a drug that can completely cure the disease.Recently,glucagon-like peptide(GLP)and its degradation enzyme inhibitor dipeptidyl peptidase-4(DPP-4)inhibitors have attracted widespread research and attention in the treatment of IBD.This article reviewed the roles and mechanisms of GLP and DPP-4 inhibitors in the treatment of IBD diseases.

Progress of Research on NAD+ Metabolic Pathway in Treatment of Inflammatory Bowel Disease / 胃肠病学

Inflammatory bowel disease(IBD),including ulcerative colitis(UC)and Crohn's disease(CD),is a systemic inflammatory disease.Nicotinamide adenine dinucleotide(NAD+)is widely used as a cofactor or substrate in biochemical reactions and is closely related to physical health.The close relationship between IBD and NAD+has been widely recognized.Ital homeostasis depends on the balance of NAD+ synthesis and breakdown,and therapeutic approaches designed to target the NAD+ pathway are expected to be used in treating IBD.This article reviews the research progress of NAD+ metabolism in treating IBD and provides directions for applying NAD+-related therapies in the treatment of IBD.

Treatment strategy and mechanical exploration of early lumbar spondylolysis / 中华创伤骨科杂志

Lumbar spondylolysis is one of the common diseases of low back pain caused by spinal surgery. Its treatment options vary depending on different conditions, from early conservative ones to late surgical ones. There are still disputes over various conservative treatments, choice of surgical methods and the biomechanics of different internal fixation techniques to repair spondylolysis. Therefore, this review summarizes the clinical outcomes of previous clinical treatments of lumbar spondylolysis and the biomechanical characteristics of various techniques to find the mechanical and evidence-based clinical data that may facilitate the treatment of lumbar spondylolysis.

Progress of research on Janus kinase inhibitors in treatment of ulcerative colitis / 胃肠病学

Ulcerative colitis (UC) is a chronic inflammatory bowel disease caused by multiple factors, and its etiology and pathogenesis are not fully understood. Janus kinases (JAK) are non‑transmembrane tyrosine kinases that play a key role in many immune‑related cytokine signaling pathways. JAK‑STATs signaling pathway is a cytokine‑mediated signaling pathway, which is involved in many important biological processes such as cell proliferation, differentiation, apoptosis and immune regulation. JAK inhibitors are small molecule drugs that can be administered orally and are relatively inexpensive, therefore, JAK inhibitors may become a new target for the treatment of UC. This article reviewed progress of research on the efficacy and safety of small molecule JAK inhibitors in treatment of UC.

Causal Association Between Unsaturated Fatty Acids and Inflammatory Bowel Disease: A Mendelian Randomization Analysis / 胃肠病学

Background: Inflammatory bowel disease (IBD) is a chronic recurrent inflammatory disease of gastrointestinal tract including ulcerative colitis (UC) and Crohn's disease (CD). It is unclear whether there is a causal association between unsaturated fatty acids and IBD. Aims: A two⁃sample Mendelian randomization analysis was used to explore the causal association between unsaturated fatty acids and IBD. Methods: The data of the genome⁃wide association study (GWAS) of unsaturated fatty acids and IBD were obtained from web⁃based public databases. Two⁃sample Mendelian randomization analysis was performed by using inverse⁃variance weighted analysis, and weight median estimator and MR⁃Egger regression were conducted to validate the association of the causal effect. The causality of unsaturated fatty acids on the risk of IBD was evaluated by OR and 95% CI. Results: No direct causal association was found between ω⁃6 fatty acids and CD, and a direct causal association was found with UC. Inverse⁃variance weighted analysis showed a 16% increase in the risk of UC for each standard deviation increase in ω⁃6 fatty acid gene levels (OR=1.16, 95% CI: 1.00⁃1.36, P=0.04). However, no causal association was found between ω⁃3 fatty acids, monounsaturated fatty acids and IBD. Conclusions: ω⁃6 fatty acids may be only causally associated with UC, and no causal association is found between ω⁃3 fatty acids, monounsaturated fatty acids and IBD.

Using the Padua prediction score and the bleeding risk score for the assessment of venous thromboembolism and hemorrhage risk factors in elderly patients with choledocholithiasis undergoing endoscopic retrograde cholangiopancreatography / 中华老年医学杂志

Objective:To analyze the value of the Padua prediction score and the bleeding risk score in the risk assessment of venous thromboembolism(VTE)and hemorrhage in elderly patients with choledocholithiasis during endoscopic retrograde cholangiopancreatography(ERCP).Methods:Clinical data of 171 elderly patients with choledocholithiasis treated with ERCP at the Affiliated Hospital of Xinjiang Medical University from September 2017 to September 2019 were retrospectively analyzed.The Padua prediction score and bleeding risk score were used to evaluate the occurrence of VTE and hemorrhage risk stratification.Results:Of all patients treated with the procedure, 18 of them had complications after surgery, including postoperative pancreatitis(9 cases), biliary infections(4 cases), hemorrhage(3 cases)and VTE events(2 cases). In addition, complications occurred in elderly patients in different age groups, with no significant difference in incidence(all P>0.05). Evaluation models showed that 32.7%(56/171)were at high risk for VTE, and 15.2%(26/171)were at high risk for hemorrhage.Furthermore, 2 VTE events occurred in the high-risk group and, of 3 hemorrhage events, 2 were occurred in the low-risk group and 1 in the high-risk group.There was no significant difference in the incidence of complications between the high-risk group and the low-risk group( χ2=0.000, 2.867, P=1.000, 0.090). Logistic regression analysis results showed that scores of the two assessment models were not influencing factors for VTE/hemorrhage(Padua prediction score: OR=8.383, 95% CI: 0.926-75.869, P=0.059; bleeding risk score: OR=2.860, 95% CI: 0.250-32.740, P=0.398). Conclusions:For elderly choledocholithiasis patients treated with ERCP, the Padua prediction score and the bleeding risk score have limited ability for risk assessment.More attention needs to be paid to the two VTE risk factors, i.e., malignant tumors and previous VTE history, in addition to previous bleeding risk for antithrombotic therapy.

Correlations between different pH values in tumor microenvironment and bladder cancer / 国际肿瘤学杂志

Compared with normal tissue, interstitial extracellular pH of tumor cells is acidic. The reverse transmembrane pH gradient around tumor cells is closely related to its uncontrolled progression, angiogenesis and metastasis. Changes in urinary pH have an impact on the occurrence, progression and treatment of bladder cancer by regulating the microenvironment of bladder cancer cells. Relevant studies have shown that urinary pH value is an important factor in predicting the final clinical efficacy of bladder cancer patients combined with alkalization agents, which helps to reflect the acid-base balance and immune defense system in the body. Continuous monitoring of urinary pH can provide guidance and decision-making for the prognosis of bladder cancer patients.

Research on the teaching reform of internal medicine for graduate students in colleges and universities based on the concept of OBE / 中华医学教育探索杂志

Objective:To explore the teaching reform of internal medicine graduate students based on the concept of outcomes-based education (OBE).Methods:A total of 86 graduate students who studied in the Teaching and Research Section of Internal Medicine in the First Affiliated Hospital of Xinjiang Medical University from January 2019 to August 2020 were randomly divided into control group ( n=43) and observation group ( n=43). The control group adopted traditional teaching, and the observation group adopted the teaching based on the OBE concept. The evaluation of the academic performance of the two groups of graduate students and the recognition of the teaching mode by the graduate students were compared, and the improvement of the personal ability of the graduate students was evaluated. Meanwhile, the effect of teaching satisfaction and the improvement of learning ability of the graduate students was evaluated. SPSS 22.0 was used for t-test and Chi-square test. Results:The theoretical scores, general head and neck test scores, heart test scores, lung test scores, abdominal test scores, spinal and limb nervous system test scores, operation scores and total scores of graduate students in the observation group were higher than those in the control group ( P<0.05); students in the observation group believed that the teaching could improve their learning interest, improve the self-learning ability, improve communication and expression ability, improve teamwork ability, improve understanding and memory ability, improve internal medicine thinking ability, improve generalization ability, and improve clinical practice ability. All the above aspects were higher in observation group than control group ( P<0.05); the students in the observation group had 97.67% (42/43) recognition of teaching, which was higher than 83.72% (36/43) in the control group. Conclusion:Internal medicine teaching based on the concept of OBE can improve the academic performance and enhance the personal ability of graduate students, and the students are more satisfied with this teaching method.

Relationship between salt-inducible kinase 2 (SIK2) and lymph node metastasis in colorectal cancer patients complicated with chronic schistosomiasis / 浙江大学学报·医学版

To investigate the relationship between salt-inducible kinase 2 (SIK2) and lymph node metastasis in colorectal cancer patients complicated with chronic schistosomiasis. Tissue specimens were collected from 363 patients who were diagnosed as colorectal cancer by clinical and pathological examination in Wuhu Second People's Hospital from June 2015 to June 2020. Fifty-six patients were colorectal cancer complicated with schistosomiasis (CRC-S) and 307 patients were colorectal cancer not complicated with schistosomiasis (CRC-NS). The clinical and pathological data of the patients were analyzed to explore the relationship between chronic schistosomiasis and colorectal cancer. Immunohistochemistry and Western blotting were used to detect the distribution and expression of SIK2 in colorectal cancer specimens. The relationship between SIK2 and lymph node metastasis of CRC-S was analyzed. The rate of lymph node metastasis in CRC-S group was significantly higher than that in CRC-NS group (62.5% vs. 47.2%, <0.05). In CRC-S patients with lymph node metastasis, schistosome eggs were distributed mainly in tumor tissues (25/35, 71.4%), while in patients with CRC-S without lymph node metastasis, schistosome eggs were distributed mainly in paracancerous tissues (17/21, 81.0%) (14.243, <0.01). The SIK2 was mainly located in cytosol, and its expression in tumor tissues was higher than that in paracancerous tissues. Compared with CRC-NS patients, the expression of SIK2 in CRC-S patients was significantly increased; the expression of SIK2 in patients with lymph node metastasis was higher than that in patients without lymph node metastasis; and the expression of SIK2 in patients with schistosome eggs in cancer tissues was higher than that in patients with schistosome eggs in paracancerous tissues (all <0.01). Lymph node metastasis is more likely to be occurred in colorectal cancer patients with schistosomiasis, especially in those with schistosome eggs in tumor tissues. The expression of SIK2 may be correlated with chronic schistosomiasis, egg distribution and lymphatic metastasis.

Relationship Between Vitamin D Receptor Gene Polymorphisms and Risk of Ulcerative Colitis: A Meta-analysis / 胃肠病学

Background: Vitamin D receptor (VDR) is associated with the occurrence and development of ulcerative colitis (UC). The expression and function of VDR may be affected by its gene polymorphisms, and thus affecting the occurrence of UC. However, results of studies are still in controversary. Aims: To explore the relationship between VDR gene polymorphisms and UC. Methods: Studies on correlation of VDR gene (Apa, Bsm, Fok, Taq) polymorphisms with UC were retrieved from SinoMed, CNKI, Wanfang, VIP, Embase, PubMed, The Cochrane Library databases. Literatures were enrolled according to the inclusion and exclusion criteria, and the data were extracted. RevMan 5.3 was used to conducted meta-analysis. Results: A total of 11 studies involving 1 811 UC patients were included. Meta-analysis showed that VDR gene Fok polymorphism (FF + Ff vs. ff: OR=0.67, 95% CI: 0.49-0.92, P=0.01), allele (F vs. f: OR=0.81, 95% CI: 0.68-0.96, P=0.02) were significantly correlated with the susceptibility of UC. Among which, Fok polymorphism (FF+Ff vs. ff: OR=0.59, 95% CI: 0.37-0.94, P=0.03), allele (F vs. f: OR=0.76, 95% CI: 0.60-0.97, P=0.03) were significantly correlated with the susceptibility of UC in Asian, but not in Caucasian population (P>0.05). No significant association was observed between Apa, Bsm, or Taq polymorphisms and UC (P>0.05). Conclusions: Existing evidence shows that VDR gene Fok polymorphism might contribute to UC susceptibility, however, Apa, Bsm, and Taq polymorphisms might not be significantly correlated with UC.

Association Between TLR2, TLR4 and NOD2/CARD15 Gene Polymorphisms and Ulcerative Colitis: A Meta-analysis / 胃肠病学

Background: The prevalence rate of ulcerative colitis (UC) in China has increased significantly in recent years, and Toll-like receptor 2 (TLR2), TLR4 and NOD2/CARD15 may be closely related to the development of UC. Aims: To explore the influence of TLR2, TLR4 and NOD2/CARD15 gene polymorphisms on the pathogenesis of UC. Methods: Studies on correlation of TLR2, TLR4 and NOD2/CARD15 gene polymorphisms with UC were retrieved from PubMed, CBM, CNKI, Wanfang, VIP databases. Literatures were enrolled according to the inclusion and exclusion criteria, and the quality was evaluated and data were extracted. RevMan 5.3 software was used to conducted meta-analysis. Results: Fifteen eligible articles were included. Meta-analysis showed that TLR2 Arg753Gln gene polymorphism was not associated with risk of UC (P>0.05). Except the recessive model, TLR4 Asp299Gly gene polymorphism could increase the risk of UC (P0.05). No significant association between NOD2/CARD15 (Arg702Trp, Gly908Arg and Leu1007fsinsC) gene polymorphism and UC was found (P>0.05). Conclusions: Existing evidence shows that TLR4 (Asp299Gly, Thr399Ile) gene polymorphisms are associated with an increased risk of UC, however, NOD2/CARD15 (Arg702Trp, Gly908Arg and Leu1007fsinsC) and TLR2 (Arg753Gln) gene polymorphisms are not associated with UC.

Clinical Study on Effect of Vitamin D3 Combined With Mesalazine in Reparation of Intestinal Mucosal Oxidative Stress Injury in Patients With Ulcerative Colitis / 胃肠病学

Background: The prevalence of ulcerative colitis (UC) in China increased significantly in recent years. Vitamin D3 might be closely correlated with the development and progress of UC. Aims: To investigate the role of vitamin D3 combined with mesalazine in reparation of oxidative stress injury of intestinal mucosa in patients with UC. Methods: A total of 120 patients with mild or moderate UC from January 2019 to January 2020 at the First Affiliated Hospital of Xinjiang Medical University were enrolled, and were randomly divided into treatment group (n=60) and control group (n=60). Patients in the treatment group were treated with vitamin D3 combined with mesalazine, and patients in the control group were treated with mesalazine alone. Eight weeks after treatment, the clinical manifestations were observed. Serum oxidative stress [oxidized low density lipoprotein (ox-LDL) and lipid peroxidase (LPO)], intestinal mucosal barrier injury [serum procalcitonin (PCT) and diamine oxidase (DAO)] and Mayo score in the two groups were compared. Results: After 8 weeks treatment, the total effective rate was significantly higher in treatment group than in control group (93.3% vs. 78.3%; χ

Effect of Vitamin D3 on Expression of Toll-like Receptor 4 in Intestinal Mucosa in Colitis Model in Rats / 胃肠病学

Background: The prevalence of ulcerative colitis (UC) in China has significantly increased in recent years,and Toll-like receptor 4 (TLR4) may be closely related to the development of UC.Aims: To study the effect of vitamin D3 on expression of TLR4 in the intestinal mucosa in colitis model in rats.Methods: Thirty Sprague-Dawley rats were randomly divided into normal control group,model group and vitamin D3 group.Rats in model group and vitamin D3 group were given trinitro-benzene-sulfonic acid (TNBS) to induce colitis model.Rats in vitamin D3 group were given vitamin D3.HE staining was performed,and disease activity index (DAI) and colon histopathological score were evaluated,the expression of TLR4 was measured by immunohistochemistry.Results: Compared with normal control group,DAI and histopathological score in model group were significantly increased (P＜0.05),and expression of TLR4 was significantly increased (P＜0.05).After giving vitamin D3,DAI and histopathological score were significantly decreased (P＜0.05),and expression of TLR4 was significantly decreased (P＜0.05).Conclusions: The expression of TLR4 is increased in colon tissue in colitis model in rats,which may be involved in the pathogenesis of UC.Vitamin D3 can alleviate intestinal inflammation via inhibiting expression of TLR4,thereby playing a role in the adjunctive therapy of UC.

Clinical analysis of endoscopic treatment for patients with gastric submucosal tumors (61 cases) / 中国内镜杂志

Objectives To analyze the clinical and pathological characteristics of gastric submucosal tumors (GSMTs), and evaluate the safety and efficacy of endoscopic treatment for GSMTs. Methods 61 patients with GSMTs were selected from June 2014 to September 2012 by endoscopy and ultrasonography;they were all treated by endoscopic therapy; pathological examination was took in all removed tumors, the tumors which could be the gastric stromal tumor were furtherly examined by molecular biology technique of immunohistochemistry. Result In 61 cas-es, 39 cases are female patients, accounting for 63.93%;the tumors located at the stomach fund accounted for 52.46%(32/61), at the gastric corpus for 21.31%(13/61), at the gastric antrum for 11.48 %(7/61), at cardia for 14.75%(9/61); 10 cases were treated by Endoscopic submucosal dissection, 21 by endoscopic submucosal excavation, 27 by Endoscopic full-thickness resection, 3 by Submucosal tunnelling endoscopic resection; in all 61 cases, 2 were changed to laparoscopic treatment because one tumor was too big and broke the Serous and another was located at mucus Lake of gastric fund, 1 occurred postoperative bleeding and was treated by laparoscopy successfully, 1 oc-curred postoperative perforation and was treated by endoscopy successfully; after pathological and immunohisto-chemical analysis, 34 tumors were identified as gastric stromal tumor and all of them in risk classification were at very low risk, 11 were leiomyoma, 5 were lipoma, 3 were heterotopic pancreas, 5 were calcifying fibrous pseudotu-mor, 2 were inflammatory fibroid polyps, and 1 was angiomatous proliferation; gastric stromal tumor at gastric fundus account for 73.53 % (25/34), at gastric corpus for 11.76 % (4/34), at gastric antrum for 5.88 % (2/34) and at cardia for 8.82 %(3/34). Conclusion Most GSMTs are found in female and commonly lack of specific clinical symptoms;GMSTs are commonly located at gastric fund and most of them are gastric stromal tumors, vast majority of gastric stromal tumors in the risk classification are at very low risk;the endoscopic resection is a mini-invasive, safe and ef-fective treatment for GSMTs.

Association of intestinal epithelial tight junctions, E.coli, intestinal mucosa Toll-like receptor-4 and tumor necrosis factor-alpha in rabbit with non-alcoholic fatty liver disease / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To explore the variation and association of intestinal epithelial tight junctions, E.coli, and expression of Toll-like receptor-4 (TLR-4) and tumor necrosis factor-alpha (TNFα) in a rabbit model of non-alcoholic fatty liver disease (NAFLD).</p><p><b>METHODS</b>Fourteen male New Zealand rabbits were randomly divided into two groups. The control group was given a normal diet, while the NAFLD group was given a high-fat diet. After 12 weeks, the two groups were sacrificed. Both length and width of the tight junctions of ileum epithelial cells were measured by electron microscopy. Enzyme-linked immunosorbent assay was used to detect the concentration of TNFα in venous blood serum. Location and expression of TLR-4 were observed by immunohistochemical staining. Copies of E.coli genes were measured by RT-PCR. The relationship between TNFα and tight junctions, TLR-4, and E.coli were respectively analyzed by stepwise multiple linear regression.</p><p><b>RESULTS</b>Compared with the control group, the NAFLD group has significantly shortened ileum epithelial fight junctions (t=5.031, P<0.01), increased copies of E. coli genes (t=-3.492, P<0.01), and increased ileal expression of TLR-4 (t=-44.089, P<0.01). A significant increase of TNFα was also observed in the NAFLD group (t=-17.768, P<0.01). Regression analysis showed that E.coli and intestinal epithelial tight junctions were correlated (standardized beta=-0.385), and showed a positive correlation between E. coli and TLR-4 (standardized beta=0.332 and 0.427).</p><p><b>CONCLUSION</b>Damage to the intestine as a physical barrier, biological barrier and immune barrier is closely related to TNFα expression, and the relation between the immune barrier and TNFα is more significant.</p>

Relationship between delirium and dementia in elderly patients undergoing hip fracture surgery / 中华老年医学杂志

Objective To explore the correlation between delirium and dementia in elderly patients undergoing hip fracture surgery.Methods A prospective study was conducted on 118 elderly patients with hip fracture who were free from prefracture dementia.Caregivers or the relatives described the patients' prefracture cognition by the Informant Questionnaire on Cognitive Decline in the Elderly-short form (IQCODE SF).Delirium was assessed by the Confusion Assessment Method (CAM).After 6 months,cognition was reassessed by using 5 cognitive tests,taking DSM-Ⅳ as the diagnostic criteria.Results Among 32 cases (27％) suffered from delirium in the acute phase,12 cases (38％) reached to the diagnostic criteria of dementia after 6 months follow up,while there were 6 cases (7％) reached to the diagnostic criteria of dementia after 6 months follow-up in the group without delirium in the acute phase (x2 =16.81,P＜0.001).IQCODE-SF score had no statistically significant difference in the prediction of dementia.Conclusions In elderly patients without the history of dementia,delirium after hip fracture surgery is the major predictor of dementia within half years.

ISOLATION AND IDENDTIFICATION OF CYCLIC ?-(1,2)-GLUCANS / 微生物学通报

Rhizobium leguminosarum biov.trifolii H954 has been fermented for eight days on the GMS medium.Culture supernatant is extracted by ethanol precipitation,sample is purified by Sephadex G\|50,Sephadex G\|10 and DEAE\|Cellulose chromatoraphy.Gas chromatography(GC), 13 C nuclear magnetic resonance spectroscopy(NMR)and mass spectrometry(MS) analysis indicated that the sample is cyclic,neutral glucan,and composes of glucose linked solely by 1→2 glucosidic bonds.Cyclic glucan has degrees of polymerization ranging form 17 to 22,with a degree of ploymerization of 19 as the major glucan cycles.