Clinical value of the Toronto inflammatory bowel disease global endoscopic reporting score in ulcerative colitis

BACKGROUND Endoscopic evaluation in diagnosing and managing ulcerative colitis(UC)is becoming increasingly important.Several endoscopic scoring systems have been established,including the Ulcerative Colitis Endoscopic Index of Severity(UCEIS)score and Mayo Endoscopic Subscore(MES).Furthermore,the Toronto Inflammatory Bowel Disease Global Endoscopic Reporting(TIGER)score for UC has recently been proposed;however,its clinical value remains unclear.AIM To investigate the clinical value of the TIGER score in UC by comparing it with the UCEIS score and MES.METHODS This retrospective study included 166 patients with UC who underwent total colonoscopy between January 2017 and March 2023 at the Affiliated Hospital of Qingdao University(Qingdao,China).We retrospectively analysed endoscopic scores,laboratory and clinical data,treatment,and readmissions within 1 year.Spearman’s rank correlation coefficient,receiver operating characteristic curve,and univariate and multivariable logistic regression analyses were performed using IBM SPSS Statistics for Windows,version 26.0(IBM Corp.,Armonk,NY,United States)and GraphPad Prism version 9.0.0 for Windows(GraphPad Software,Boston,Massachusetts,United States).RESULTS The TIGER score significantly correlated with the UCEIS score and MES(r=0.721,0.626,both P<0.001),showed good differentiating values for clinical severity among mild,moderate,and severe UC[8(4-112.75)vs 210(109–219)vs 328(219–426),all P<0.001],and exhibited predictive value in diagnosing patients with severe UC[area under the curve(AUC)=0.897,P<0.001].Additionally,the TIGER(r=0.639,0,551,0.488,0.376,all P<0.001)and UCEIS scores(r=0.622,0,540,0.494,and 0.375,all P<0.001)showed stronger correlations with laboratory and clinical parameters,including C-reactive protein,erythrocyte sedimentation rate,length of hospitalisation,and hospitalisation costs,than MES(r=0.509,0,351,0.339,and 0.270,all P<0.001).The TIGER score showed the best predictability for patients'recent advanced treatment,including systemic corticosteroids,biologics,or immunomodulators(AUC=0.848,P<0.001)and 1-year readmission(AUC=0.700,P<0.001)compared with the UCEIS score(AUC=0.762,P<0.001;0.627,P<0.05)and MES(AUC=0.684,P<0.001;0.578,P=0.132).Furthermore,a TIGER score of≥317 was identified as an independent risk factor for advanced UC treatment(P=0.011).CONCLUSION The TIGER score may be superior to the UCIES score and MES in improving the accuracy of clinical disease severity assessment,guiding therapeutic decision-making,and predicting short-term prognosis.

Report on Childhood Obesity in China (6) Evaluation of a Classroom-based Physical Activity Promotion Program

Objectives To evaluate the effect of Happy 10 program on the promotion of physical activity, physical growth and development of primary-school students, and on obesity control and prevention. Methods Two similar primary schools from one district of Beijing, China were selected, one as an intervention school and the other as a control school. Happy 10 program was implemented at least once every school day in the intervention school for two semesters, whereas no intervention was adopted in the control school. The information on energy expenditure and duration of physical activity was collected by a validated 7-day physical activity questionnaire. Height and weight were measured by trained investigators following the standardized procedure. Energy expenditure and intensity of each Happy 10 session was measured by a physical activity monitor. Results The average energy expenditure and duration of total physical activity per day among students in the intervention school increased significantly from 15.0 to 18.2 kcal/kg, and 2.8 to 3.3 h respectively, whereas the figures significantly decreased in the control school. There was a significant difference in change of weight and BMI between girls in the intervention and control school （2.4 kg vs 4.6 kg, -0.47 kg/m^2 vs 0.66 kg/m^2）. The prevalence of overweight and obesity in the intervention school decreased by 0.4%-5.6%, as compared to the increase by 0.6%-4.5% in the control school. The average energy expenditure and intensity per 10-minute session ranged from 25.0-35.1 kcal, 4.8-6.2 kcal/kg/h respectively in grades 1-5. Conclusion Happy 10 program provides a useful strategy to promote physical activity among school children and also plays a positive role in building up physical growth and development of girls.

Report on Childhood Obesity in China(8):Effects and Sustainability of Physical Activity Intervention on Body Composition of Chinese Youth

Objectives To determine whether a large-scale physical activity intervention could affect body composition in primary school students in Beijing, China. Methods The study design was one-year cluster randomized controlled trial of physical activity intervention （20 rain of daily exercise in the classroom） with an additional year of follow-up among 4 700 students aged 8-11 years at baseline. Results After the one-year intervention, BMI increased by 0.56 kg/m2 （SD 1.15） in the intervention group and by 0.72 kg/m^2 （SD 1.20） in the control group, with a mean difference of-0.15 kg/m^2 （95% CI： -0.28 to -0.02）. BMI z score decreased by -0.05 （SD 0.44） in the intervention group, but increased by 0.01 （SD 0.46） in the control group, with a mean difference of-0.07 （-0.13 to -0.01）. After another year of follow up, compared to the control group, children in the intervention group had significantly lower BMI （-0.13, -0.25 to -0.01 ）, BMI z score （-0.05, -0.10 to -0.01）, fat mass （-0.27 kg, -0.53 to -0.02） and percent body fat （-0.53, -1.00 to -0.05）. The intervention had a more pronounced effect on weight, height, BMI, BMI z score, and body composition among obese children than among normal weight or overweight children. Compared to the control group, the intervention group had a significantly higher percentage of children who maintained or reduced their BMI z score at year 1 （P-0.008） and year 2 （P=-0.04）. Conclusions These findings suggest that 20 min of daily moderate to vigorous physical activity during the school year is a feasible and effective way to prevent excessive gain of body weight, BMI, and body fatness in primary school students.

COVID-19 with asthma:A case report

BACKGROUND Coronavirus disease 2019(COVID-19)is a public health emergency of international concern.The global population lacks immunity to COVID-19 and is generally susceptible.Underlying conditions,especially chronic respiratory diseases,may affect progression,treatment and prognosis of COVID-19.CASE SUMMARY We report a patient with confirmed COVID-19 combined with asthma.It took 41 d from disease onset to discharge to obtain two negative tests for this coronavirus.CONCLUSION This case indicates the dynamic clinical characteristics,laboratory and computed tomography findings and adjustment of treatment,and the possible relationship between glucocorticoid therapy and coronavirus clearance.

Gastrointestinal amyloidosis in a patient with smoldering multiple myeloma:A case report

BACKGROUND Smoldering multiple myeloma(SMM)is an asymptomatic plasma cell proliferative disorder that can progress to multiple myeloma(MM).Amyloidosis(light chain)(AL)is the most common form of systemic amyloidosis.There are few reports of SMM coexisting with AL involving the digestive tract.CASE SUMMARY A 63-year-old woman presented with lower limb edema,abdominal distension,abdominal pain,and hematochezia.Gastroscopy showed gastric retention,gastric angler mucosal coarseness,hyperemia,and mild oozing of blood.Colonoscopy showed hyperemic and edematous mucosa of the distal ascending colon and sigmoid colon with the presence of multiple round and irregular ulcers,submucosal ecchymosis,and hematoma.Gastric and colonic tissue biopsy confirmed the diagnosis of AL by positive Congo red staining.MM was confirmed by bone marrow biopsy and immunohistochemistry.The patient had no hypercalcemia,renal dysfunction,anemia,bone lesions or biomarkers of malignancy defined as plasma cells>60%in bone marrow.Additionally,no elevated serum free light chain ratio,or presence of bone marrow lesions by magnetic resonance imaging(SLiM criteria)were detected.The patient was finally diagnosed with SMM coexisting with AL.She received chemotherapy and was discharged when the symptoms were relieved.She is doing well at nearly five years of follow up.CONCLUSION This case highlights that high index of suspicion is required to diagnose gastrointestinal AL.It should be suspected in elderly patients with endoscopic findings of granular-appearing mucosa,ecchymosis,and submucosal hematoma.Timely diagnosis and appropriate therapy can help to improve the prognosis of these patients.