Correlation between age of onset and gastrointestinal stenosis in hospitalized patients with Crohn's disease

BACKGROUND Patients affected by Crohn's disease(CD)are more likely to develop gastrointestinal stenosis and often undergo surgery during the duration of disease.AIM To identify the risk factors for gastrointestinal stenosis in hospitalized CD patients in China.METHODS The clinical data of CD patients hospitalized at the Seventh Medical Center,Chinese People's Liberation Army General Hospital from January 2010 to December 2018 were included.Patients with gastrointestinal stenosis were compared to those without gastrointestinal stenosis for clinical variables.The risk factors for gastrointestinal stenosis were identified using univariate and multivariable logistic regression analyses.The treatments for patients with gastrointestinal stenosis were analyzed,and the characteristics of different treatment methods were discussed.RESULTS The incidence of gastrointestinal stenosis was 59.02%in the 122 hospitalized CD patients.Age of onset of more than 40 years(odds ratio[OR]=3.072,95%confidence interval[CI]:1.298-7.272,P=0.009)and duration of disease of more than 5 years(OR=2.101,95%CI:1.002-4.406,P=0.048)were associated with the occurrence of gastrointestinal stenosis.Fifteen(20.83%)patients did not undergo surgery and received internal medicine and nutrition treatment.Surgical treatments were performed in 72.22%(52)of cases.The rate of postoperative complications was 15.38%(8 cases),and during a median follow-up period of 46 mo,11.54%(6 cases)underwent reoperation.A total of 29.17%(21 cases)were treated with endoscopic therapy,and during a median follow-up period of 32 mo,76.19%(16 cases)had no surgical event,23.81%(5 cases)failed to avoid surgical treatments,and no serious postoperative complications occurred after endoscopic therapy.CONCLUSION Age of onset of more than 40 years and duration of disease of more than 5 years may be strongly correlated with a higher risk of gastrointestinal stenosis in hospitalized CD patients.Endoscopic therapy for gastrointestinal stenosis is relatively safe and effective,and may help to prevent or delay surgery.

Clinical Characteristics and Durations of Hospitalized Patients with COVID-19 in Beijing: A Retrospective Cohort Study

Objective:To provide information on clinical characteristics and different durations of COVID-19 and to identify the potential risk factors for longer hospitalization of patients with COVID-19.Methods:In this retrospective study,we enrolled 77 patients(age 52±20 years;44.2%males)with laboratory-confi rmed COVID-19 admitted to Beijing YouAn Hospital between January 21 and February 8,2020.Epidemiological,clinical,and radiological data on admission were collected;complications and outcomes were followed up until February 26,2020.The end point of the study was discharge alive within 2 weeks.Cox proportional-hazards regression was performed to identify risk factors for longer hospitalization.Results:Of 77 patients,there were 34 males(44.2%),24(31.2%)with comorbidities,22(28.6%)with lymphopenia,20(26.0%)with severe COVID-19,and 28(36.4%)with complications.By the end of follow-up,64 patients(83.1%)were discharged home,eight remained in hospital,and fi ve had died.Thirty-six patients(46.8%)were discharged within 14 days and thus reached the study end point,including 34 of the 57 patients with nonsevere COVID-19(59.6%)and two of the 20 patients with severe COVID-19(10%).The overall cumulative probability of the end point was 48.3%.Hospital length of stay and the duration from exposure to discharge for the 64 discharged patients were 13(10-16.5)days and 23(18-24.5)days,respectively.A multivariable stepwise Cox regression model showed that bilateral pneumonia on CT scan,shorter time from illness onset to admission,severity of disease,and lymphopenia were independently associated with longer hospitalization.Conclusions:COVID-19 has a shorter duration of disease and hospital length of stay than severe acute respiratory syndrome.Bilateral pneumonia on CT scan,shorter period from illness onset to admission,lymphopenia,and severity of disease are the risk factors for longer hospitalization of patients with COVID-19.

Clinical significance of activity of ALT enzyme in patients with hepatitis C virus

AIM: To investigate serum alanine aminotransferase (ALT) levels in relation to the clinical,biochemical,ultrasonographic and histological characteristics of patients with hepatitis C virus. METHODS: Duration of disease,HCV-RNA,liver steatosis,and the hepatitis activity index (HAI) were correlated with serum ALT in 36 patients with HCV. ALT values were also investigated in 16 control subjects without any liver diseases. RESULTS: In bivariate analyses,ALT levels correlated with duration of HCV infection (P < 0.01),HCV-RNA (P < 0.05),and the HAI (P < 0.01). Among the components of the HAI,ALT concentrations were significantly associated with periportal bridging/necrosis (P < 0.01) and fibrosis (P < 0.05). In multivariate analysis,periportal bridging/ necrosis (β = 0.508; P < 0.01),duration of HCV infection (β = 0.413; P < 0.01),and HCV-RNA (β = 0.253; P < 0.05) were independently associated with ALT activity. The normal ALT activity for men and women was < 23 IU/L and < 22 IU/L,respectively. CONCLUSION: In patients with HCV,alterations in the liver tissue as reflected by ALT elevation are mainly associated with periportal bridging/necrosis,viral load and duration of disease. A cut-off value < 23 IU/L distinguished with high diagnostic accuracy healthy controls from patients with HCV.

The role of substantia nigra sonography in the differentiation of Parkinson’s disease and multiple system atrophy

Background:The differential diagnosis of Parkinson’s disease(PD)and multiple system atrophy(MSA)remains a challenge,especially in the early stage.Here,we assessed the value of transcranial sonography(TCS)to discriminate non-tremor dominant(non-TD)PD from MSA with predominant parkinsonism(MSA-P).Methods:Eighty-six MSA-P patients and 147 age and gender-matched non-TD PD patients who had appropriate temporal acoustic bone windows were included in this study.All the patients were followed up for at least 2 years to confirm the initial diagnosis.Patients with at least one substantia nigra(SN)echogenic size≥18 mm^(2) were classified as hyperechogenic,those with at least one SN echogenic size≥25 mm^(2) was defined as markedly hyperechogenic.Results:The frequency of SN hyperechogenicity in non-TD PD patients was significantly higher than that in MSA-P patients(74.1%vs.38.4%,p<0.001).SN hyperechogenicity discriminated non-TD PD from MSA-P with sensitivity of 74.1%,specificity of 61.6%,and positive predictive value of 76.8%.If marked SN hyperechogenicity was used as the cutoff value(≥25 mm^(2)),the sensitivity decreased to 46.3%,but the specificity and positive predictive value increased to 80.2 and 80.0%.Additionally,in those patients with SN hyperechogenicity,positive correlation between SN hyperechogenicity area and disease duration was found in non-TD PD rather than in MSA-P patients.In this context,among early-stage patients with disease duration≤3 years,the sensitivity,specificity and positive predictive value of SN hyperechogenicity further declined to 69.8%,52.2%,and 66.7%,respectively.Conclusions:TCS could help discriminate non-TD PD from MSA-P in a certain extent,but the limitation was also obvious with relatively low specificity,especially in the early stage.