The clinical value of multimodal ultrasound for the evaluation of disease activity and complications in inflammatory bowel disease.

BACKGROUND: Inflammatory bowel disease (IBD) has the characteristics of chronic relapse and remission, which makes early diagnosis and effective evaluation of disease activity especially crucial. With the development of ultrasound technology, its role in the diagnosis and treatment of IBD is increasing. This study aimed to explore the value of multimodal ultrasound in the assessment of disease activity and complications in IBD. METHODS: Patients with clinically confirmed IBD were selected and examined with two-dimensional ultrasound, Doppler ultrasound, contrast-enhanced ultrasound (CEUS), elastography, endoscopy with biopsies, and whole-abdominal enhanced computed tomography (CT). Collect relevant laboratory data, including C-reactive protein, erythrocyte sedimentation rate, etc. Endoscopy is used as the gold standard for disease activity assessment, and the diagnostic value of each ultrasound parameter is compared separately, and correlation analysis is made. RESULTS: Intestinal maximum wall thickness in patients in the disease activity group (active group) was significantly thicker than that in patients in remission group (7.93±2.65 vs. 4.16±1.08 mm, P<0.001). The mean values of Peak Enhancement (PE) and the area under the receiver operating characteristic (ROC) curve (AUC) were higher in the active stage than in remission, with a significant difference (-40.66±4.81 vs. -50.47±5.03 db, 356.44±170.67 vs. 194.42±92.09 dBsec, both P<0.05). Time To Peak (TTP) showed no significant difference between the active stage and remission (20.04±8.74 vs. 20.09±11.13 s, P>0.05). Twenty cases of intestinal stricture were detected by ultrasound, and no fistula or abscesses were detected. CEUS and elastography could distinguish inflammatory bowel stenosis and fibrous bowel stenosis in patients with IBD. In the fibrosis group and inflammation group, the mean shear wave velocity, Young's modulus, TTP, PE, and AUC were statistically significantly different (P<0.05). The mean maximum wall thickness and disease extent assessed by ultrasound and CT were strongly correlated (r=0.799, 0.831). Wall thickness showed a moderate positive correlation with CRP and ESR and a strong positive correlation with Mayo score (P<0.05), but no significant correlation with CDAI (P>0.05). CONCLUSIONS: Multimodal ultrasound provides more detailed clinical reference values for the comprehensive evaluation of IBD.

Treatment for thoracoabdominal aortic aneurysm by fenestrated endovascular aortic repair with physician-modified stent graft.

Despite being widely used for several years, the endovascular aortic repair (EVAR) of a thoracoabdominal aneurysm (TAAA) remains challenging, particularly the revascularization of the abdominal aortic visceral branches. A 66-year-old male was admitted to hospital with abdominal bloating and pain. Computed tomographic angiography (CTA) confirmed a Crawford type III TAAA from the distal descending aorta to the suprarenal abdominal aorta that involved the celiac axis, accompanied with an occlusion of the left subclavian artery. Fenestrated-EVAR was performed successfully and 1 week later CTA showed a type III endoleak, which had resolved 3 months later, without stent migration or visceral artery occlusion. In this present case, the surgeons preferred to perform the procedure in three surgical stages, postponing the deployment of a covered stent in the CA fenestration to provide additional time for the development of collateral circulation to the spinal cord as a possible means of preventing postoperative paraplegia.

IDO expressing dendritic cells suppress allograft rejection of small bowel transplantation in mice by expansion of Foxp3+ regulatory T cells.

BACKGROUND: Indoleamine 2,3-dioxygenase (IDO), the enzyme that catalyzes the first and rate-limiting step of tryptophan catabolism, suppresses T-cell responses by tryptophan depletion and accumulation of kynurenine metabolites. IDO prevents allograft rejection in various transplantations. METHODS: Dendritic cells (DC) highly expressing IDO (IDO(+) DC) were cultured through transduction of adenovirus vectors carrying the IDO sequence. IDO(+) DC were incubated with CD4(+) CD25(-) T cells to detect T cell proliferation. The effects of IDO(+) DC and 3-Hydroxyanthranilic acid (3-HAA) were verified in an allogeneic murine small bowel transplantation (SBT) model. Foxp3(+) Treg cells of recipient mice were detected by flow cytometry and cytokines in plasma were determined by ELISA. RESULTS: IDO(+) DC effectively suppressed proliferation of CD4(+) CD25(-) T cells in vitro, and this effect could be enhanced by adding 3-HAA. In the SBT transplantation model, both 3-HAA (P < 0.05) and IDO(+) DC (P < 0.01) prolonged the survival time of transplanted mice. Mice treated with IDO(+) DC achieved longer mean survival time than 3-HAA administrated mice (11.5d vs. 18.5d). Grafts from IDO(+) DC, 3-HAA and combination treatment group showed reduced inflammation and minimal architectural distortion. IFN-γ production was significantly inhibited by IDO(+) DC and 3-HAA (P<0.05). The expression of IL-2 was slightly lower with 3-HAA or IDO(+) DC treatment. However, IL-10 was higher in 3-HAA, IDO(+) DC and combination treatment groups, while TGF-ß was elevated in all non-control groups. CONCLUSIONS: IDO(+) DC plus 3-HAA has an immunoprotective role and represents a potential strategy to suppress acute rejection and prolong survival of grafts in SBT.