Effective immune-inflammation index for ulcerative colitis and activity assessments

BACKGROUND The inverse association between systemic immune-inammation index(SII)and overall survival in tumors has been studied.AIM To evaluate the hematological indexes for assessing the activity of ulcerative colitis(UC).METHODS In this case-control study,172 UC patients and healthy participants were included.Comparisons were made among groups of white blood cells,hemoglobin,platelets,neutrophils,lymphocytes,monocytes,SII,neutrophil-tolymphocyte ratio(NLR),and platelet-to-lymphocyte ratio(PLR).The relationship with hematological inflammation was verified by Spearman correlation analyses.The efficiency of SII,NLR,and PLR for distinguishing between UC and severe disease status was assessed by the receiver operator curve and logistic regression analyses.RESULTS The values of SII,NLR,and PLR were higher in UC patients than in controls(P<0.001)and were positively correlated with the Mayo endoscopic score,extent,Degree of Ulcerative Colitis Burden of Luminal Inflammation(DUBLIN)score,and Ulcerative Colitis Endoscopic Index of Severity(UCEIS).The cut-off NLR value of 562.22 predicted UC with a sensitivity of 79.65%and a specificity of 76.16%.Logistic regression analysis revealed that patients with SII and NLR levels above the median had a significantly higher risk of UC(P<0.05).Risk factors independently associated with DUBLIN≥3 included SII≥1776.80[odds ratio(OR)=11.53,P=0.027]and NLR value of 2.67-4.23(OR=2.96,P=0.047)on multivariate analysis.Compared with the first quartile,SII≥1776.80 was an independent predictor of UCEIS≥5(OR=18.46,P=0.012).CONCLUSION SII has a certain value in confirming UC and identifying its activity.

Correlation of endoscopic disease severity with pediatric ulcerative colitis activity index score in children and young adults with ulcerative colitis

To investigate of pediatric ulcerative colitis activity index (PUCAI) in ulcerative colitis correlate with mucosal inflammation and endoscopic assessment of disease activity (Mayo endoscopic score).METHODSWe reviewed charts from ulcerative colitis patients who had undergone both colonoscopy over 3 years. Clinical assessment of disease severity within 35 d (either before or after) the colonoscopy were included. Patients were excluded if they had significant therapeutic interventions (such as the start of corticosteroids or immunosuppressive agents) between the colonoscopy and the clinical assessment. Mayo endoscopic score of the rectum and sigmoid were done by two gastroenterologists. Inter-observer variability in Mayo score was assessed.RESULTSWe identified 99 patients (53% female, 74% pancolitis) that met inclusion criteria. The indications for colonoscopy included ongoing disease activity (62%), consideration of medication change (10%), assessment of medication efficacy (14%), and cancer screening (14%). Based on PUCAI scores, 33% of patients were in remission, 39% had mild disease, 23% had moderate disease, and 4% had severe disease. There was “moderate-substantial” agreement between the two reviewers in assessing rectal Mayo scores (kappa = 0.54, 95%CI: 0.41-0.68).CONCLUSIONEndoscopic disease severity (Mayo score) assessed by reviewing photographs of pediatric colonoscopy has moderate inter-rater reliability, and agreement was less robust in assessing patients with mild disease activity. Endoscopic disease severity generally correlates with clinical disease severity as measured by PUCAI score. However, children with inflamed colons can have significant variation in their reported clinical symptoms. Thus, assessment of both clinical symptoms and endoscopic disease severity may be required in future clinical studies.

Are we ready to use new endoscopic scores for ulcerative colitis?

For ulcerative colitis(UC),the variability in inflammatory activity along the colon poses a challenge in management.The focus on achieving endoscopic healing in UC is evident,where the UC Endoscopic Index of Severity and Mayo Endoscopic Subscore are commonly used for evaluation.However,these indices primarily consider the most severely affected region.Liu et al recent study validates the Toronto Inflammatory Bowel Disease Global Endoscopic Reporting(TIGER)score offering a comprehensive assessment of inflammatory activity across diverse segments of the colon and rectum and a reliable index correlating strongly with UC Endoscopic Index of Severity and moderately with Mayo Endoscopic Subscore(MES).Despite recommendation,certain aspects warrant further invest-igation.Fecal calprotectin,an intermediate target,correlates with TIGER and should be explored.Determining TIGER scores defining endoscopic remission and response,evaluating agreement with histological activity,and assessing inter-endoscopist agreement for TIGER require scrutiny.Exploring the correlation between TIGER and intestinal ultrasound,akin to MES,adds value.

Use of the ulcerative colitis endoscopic index of severity and Mayo endoscopic score for predicting the therapeutic effect of mesalazine in patients with ulcerative colitis

Objective:The ulcerative colitis endoscopic index of severity(UCEIS)and the Mayo endoscopic score(MES)are developed as objective methods of evaluating endoscopic severity in patients with ulcerative colitis(UC).The aim of this study is to investigate the diagnostic accuracy of the UCEIS and MES in predicting the patient's response to mesalazine.Methods:Consecutive patients with UC who had undergone colonoscopy within 1 month before starting mesalazine between October 2011 and July 2016 were retrospectively collected at the Department of Gastroenterology,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine.The median follow-up was 81 months,and all the data were analyzed in January 2021.The primary outcome was the need for step-up treatment,which included the use of corticosteroids,immunomodulatory,or surgery during admission and follow-up.Data were analyzed using the c2 or Fisher exact test,Spearman test,t-test,and ManneWhitney U test.Results:Totally,65 patients were enrolled,of whom 12(18.5%)needed step-up treatment due to nonresponse to mesalazine.The UCEIS score,MES,and the ulcerative colitis disease activity index(UCDAI)score were significantly higher in patients who had nonresponse to mesalazine(UCEIS score:6.92±0.69 vs.4.45±1.17,p<0.001;MES:2.67±0.49 vs.2.15±0.69,p=0.024;UCDAI score:9.33±1.87 vs.6.70±2.38,p=0.002).In the multivariate analysis,the UCEIS score(OR=25.65,95%CI:3.048 e45.985,p=0.003),UCDAI score(OR=1.605,95%CI:1.144e2.254,p=0.006),and C-reactive protein level(OR=1.056,95%CI:1.006e1.108,p=0.026)were independent risk factors of nonresponse.The area under the ROC curve of UCEIS was 0.95,with a sensitivity of 100%and specificity of 84.6%,a cut-off value of 6,which outperformed the MES with an area under the ROC curve of 0.70.When the UCEIS score≥6,60%of patients eventually needed step-up treatment.Conclusions:The UCEIS is a useful instrument for predicting the therapeutic effect in patients with UC treated with mesalazine.The high probability of mesalazine treatment failure and benefits of other therapies should be discussed in patients with baseline UCEIS score≥6.

Effect of Kangfuxin solution on inflammatory, immune, oxidative indexes and vascular factors in patients with ulcerative colitis

Objective:To explore the effect of Kangfuxin solution on inflammatory, immune, oxidative indexes and vascular factorsin patients with ulcerative colitis.Methods: 172 cases of ulcerative colitis from August 2015 to February 2017 were selected and divided into control group (n=86) and observation group (n=86) according to random principle, the control group was treated with Mesalazin Enteric-coated Tablets, and the observation group was treated with enema by infusion of rectal drip on the basis of the control group, and the levels of the two groups of inflammatory factors, immune indexes, oxidation indexes and vascular factors were compared.Results: After treatment, the total effective rate of the observation group (88.37%) was significantly higher than that of the control group (73.26%) (P<0.05);the two groups of CRP and TNF-α were significantly lower than those before treatment (P<0.05), and the observation group was significantly lower than that of the control group (P<0.05);the two groups of CD4+, CD4+/CD8+ and SOD increased significantly compared with those before treatment (P<0.05), while CD8+, MDA and LOP were significantly lower than those before treatment (P<0.05), and the CD4+, CD4+/CD8+ and SOD in the observation group were significantly higher than those in the control group (P<0.05), while CD8+, MDA and LOP were significantly lower than those in the control group (P<0.05);The levels of VEGF and PDGF in both groups were significantly higher than those before treatment (P<0.05), and the levels of VEGF and PDG in observation group were significantly higher than those in control group (P<0.05).Conclusions:The combined treatment of Kangfuxin Liquid and mesalazine can significantly improve the clinical efficacy of the patients. The mechanism of its action is related to reducing the inflammatory response and enhancing the immune, antioxidant functionsand vascular factors. It is worthy of further study in clinical.

Efficacy of Huangma Ding or autologous platelet-rich gel for the diabetic lower extremity arterial disease patients with foot ulcers

BACKGROUND Diabetes foot is one of the most serious complications of diabetes and an important cause of death and disability,traditional treatment has poor efficacy and there is an urgent need to develop a practical treatment method.AIM To investigate whether Huangma Ding or autologous platelet-rich gel(APG)treatment would benefit diabetic lower extremity arterial disease(LEAD)patients with foot ulcers.METHODS A total of 155 diabetic LEAD patients with foot ulcers were enrolled and divided into three groups:Group A(62 patients;basal treatment),Group B(38 patients;basal treatment and APG),and Group C(55 patients;basal treatment and Huangma Ding).All patients underwent routine follow-up visits for six months.After follow-up,we calculated the changes in all variables from baseline and determined the differences between groups and the relationships between parameters.RESULTS The infection status of the three groups before treatment was the same.Procalcitonin(PCT)improved after APG and Huangma Ding treatment more than after traditional treatment and was significantly greater in Group C than in Group B.Logistic regression analysis revealed that PCT was positively correlated with total amputation,primary amputation,and minor amputation rates.The ankle-brachial pressure and the transcutaneous oxygen pressure in Groups B and C were greater than those in Group A.The major amputation rate,minor amputation rate,and total amputation times in Groups B and C were lower than those in Group A.CONCLUSION Our research indicated that diabetic foot ulcers(DFUs)lead to major amputation,minor amputation,and total amputation through local infection and poor microcirculation and macrocirculation.Huangma Ding and APG were effective attreating DFUs.The clinical efficacy of Huangma Ding was better than that of autologous platelet gel,which may be related to the better control of local infection by Huangma Ding.This finding suggested that in patients with DFUs combined with coinfection,controlling infection is as important as improving circulation.

Limited validity of Mayo endoscopic subscore in ulcerative colitis with concomitant primary sclerosing cholangitis

BACKGROUND Ulcerative colitis(UC)with concomitant primary sclerosing cholangitis(PSC)represents a distinct disease entity(PSC-UC).Mayo endoscopic subscore(MES)is a standard tool for assessing disease activity in UC but its relevance in PSC-UC remains unclear.AIM To assess the accuracy of MES in UC and PSC-UC patients,we performed histological scoring using Nancy histological index(NHI).METHODS MES was assessed in 30 PSC-UC and 29 UC adult patients during endoscopy.NHI and inflammation were evaluated in biopsies from the cecum,rectum,and terminal ileum.In addition,perinuclear anti-neutrophil cytoplasmic antibodies,fecal calprotectin,body mass index,and other relevant clinical characteristics were collected.RESULTS The median MES and NHI were similar for UC patients(MES grade 2 and NHI grade 2 in the rectum)but were different for PSC-UC patients(MES grade 0 and NHI grade 2 in the cecum).There was a correlation between MES and NHI for UC patients(Spearman's r=0.40,P=0.029)but not for PSC-UC patients.Histopathological examination revealed persistent microscopic inflammation in 88%of PSC-UC patients with MES grade 0(46%of all PSC-UC patients).Moreover,MES overestimated the severity of active inflammation in an additional 11%of PSCUC patients.CONCLUSION MES insufficiently identifies microscopic inflammation in PSC-UC.This indicates that histological evaluation should become a routine procedure of the diagnostic and grading system in both PSC-UC and PSC.

4^(th)UI与尿素配施方式对结球白菜生长和部分品质指标的影响

为研究第四类脲酶抑制剂(4^(th) UI)与尿素不同配施方式对结球白菜生长及其部分品质指标的影响,利用室外盆栽方法,以结球白菜的鲜重、株高、叶长、叶宽、叶绿素含量、可溶性糖、根系活力为检测对象,在施肥量相同的情况下,4^(th) UI掺入尿素的3种不同配施方式均能显著提高结球白菜产量、品质指标和养分指标。其中,在B组方式中,1%的抑制剂用量效果最佳,能增产32.82%;在C组方式中,0.2%的抑制剂用量效果最佳,能增产80.49%,株高提高17.34%,结球白菜的总氮和总磷含量分别提高61.36%和78.85%,根系活力提高26.61%;在D组方式中,0.2%的抑制剂用量效果最佳,能增产50.01%。在同一配施方式下,中低浓度的脲酶抑制剂掺量对作物增产效果最佳;在抑制剂浓度相同的3种不同配施方式下,以C组方式及其在此种配施方式下掺入尿素含量0.2%的4^(th) UI分别为最佳抑制剂配施方式和最佳抑制剂用量。

Therapeutic and recurrence-preventing effects of Qi-Replenishing and Blood-Activating Formula in rats with acetic acid-induced gastric ulcer

Objective:To explore the therapeutic and recurrence-preventing effects of Qi-Replenishing and Blood-Activating Formula in rats with acetic acid-induced gastric ulcer.Methods:A total of 138 SD rats were selected to make rat models with gastric ulcer induced by acetic acid(24 rats with sham operation served as sham operation group),and were randomly divided into model group(n=30),western medicine group(n=30),traditional Chinese medicine(TCM) group(n=24) and combination group(combined western medicine and TCM group,n=30).Western medicine group was gavaged with omeprazole in the morning and with iso-volumetric distilled water in the afternoon;TCM group and TCM sham operation group were gavaged with iso-volumetric distilled water in the morning and with Qi-Replenishing and Blood-Activating Formula in the afternoon;combination group was gavaged with omeprazole in the morning and with Qi-Replenishing and Blood-Activating Formula in the afternoon;sham operation group and model group were gavaged with iso-volumetric distilled water both in the morning and afternoon.Ulcer indexes and degree of mucosal degree in rats at different time points after gavage were observed.Twentyeight days after gavage,interleukin(IL)-1β was given to induce ulcer recurrence so as to observe the recurrent severity and rate of ulcer in each group.Results:Compared with model group and western medicine group,treatment in combination group could prominently reduce the ulcer index of rats with peptic ulcer,and increase the healing rate and inhibition rate of peptic ulcer.After IL-1β-induced ulcer recurrence,combination group was significantly superior to model group and western medicine group in ulcer recurrent rate[50%(3/6) vs.100%(6/6)]and severity.Conclusions:Basic acid-suppression therapy combined with Qi-Replenishing and BloodActivating Formula can effectually improve the ulcer healing quality and reduce ulcer recurrence.

Fecal microbiota in pouchitis and ulcerative colitis

AIM To investigate the changes in microbiota in feces of patients with ulcerative colitis(UC) and pouchitis using genomic technology.METHODS Fecal samples were obtained from UC patients with or without an ileal pouch-anal anastomosis(IPAA) procedure, as well as healthy controls. The touchdown polymerase chain reaction technique was used to amplify the whole V3 region of the 16 S r RNA gene, which was transcribed from DNA extracted from fecal samples. Denaturing gradient gel electrophoresis was used to separate the amplicons. The band profiles and similarity indices were analyzed digitally. The predominant microbiota in different groups was confirmed by sequencing the 16 S rR NA gene. RESULTS Microbial biodiversity in the healthy controls was significantly higher compared with the UC groups(P < 0.001) and IPAA groups(P < 0.001). Compared with healthy controls, the UC patients in remission and those in the mildly active stage, the predominant species in patients with moderately and severely active UC changed obviously. In addition, the proportion of the dominant microbiota, which was negatively correlated with the disease activity of UC(r =-6.591, P < 0.01),was decreased in pouchitis patients. The numbers of two types of bacteria, Faecalibacterium prausnitzii and Eubacterium rectale, were reduced in UC. Patients with pouchitis had an altered microbiota composition compared with UC patients. The microbiota from pouchitis patients was less diverse than that from severely active UC patients. Sequencing results showed that similar microbiota, such as Clostridium perfringens, were shared in both UC and pouchitis.CONCLUSION Less diverse fecal microbiota was present in patients with UC and pouchitis. Increased C. perfringens in feces suggest its role in the exacerbation of UC and pouchitis.

Role of moxibustion in inflammatory responses during treatment of rat ulcerative colitis

AIM: To investigate the efficacy of moxibustion in ulcerative colitis (UC) rats from morphological, immunological and molecular biological perspectives. METHODS: Thirty-two Sprague-Dawley rats were randomly assigned to a blank control group (normal rats, n = 6) and a model replication (MR) group (UC rats, n = 26). A UC model was established by 2,4,6-trinitrobenzenesulfonic acid/dextran sulfate sodium enema. Rats in the MR group were further randomly assigned to a 9-min moxibustion (9M) group (9 moxa-cone, n = 6), 6-min moxibustion (6M) group (6 moxa-cone, n = 6), 3-min moxibustion (3M) group (3 moxa-cone, n = 6), and a waiting list control (WLC) group (no moxibustion treatment, n = 6). Rats in the moxibustion treatment group were treated in 14 sessions over 28 d. Disease activity, local tissue morphology, serum level of interleukin (IL)-8 and IL-10, and expression of Toll-like receptor (TLR)9 as well as nuclear factor (NF)-kappa B p65 in colonic tissue were determined by disease activity index (DAI), hematoxylin and eosin staining, electron microscopy, enzyme-linked immunosorbent assay and Western blotting, respectively. RESULTS: DAI was lowest in the 9M group and highest in the WLC group. The differences in DAI between the moxibustion treatment (3M, 6M, 9M) and no treatment groups were significant for all one-to-one comparisons (0.60 +/- 0.54 vs 1.20 +/- 0.44, 0.60 +/- 0.54 vs 1.80 +/- 0.45, 0.60 +/- 0.54 vs 3.0 +/- 0.45, respectively, P < 0.05). Light and electron microscopy showed that the neatness of the glandular arrangement in colonic mucosal epithelia gradually increased in the WLC, 3M, 6M to 9M groups. IL-8 level successively decreased while IL-10 level increased from the WLC to 3M, 6M and 9M groups. The differences among these groups were significant for all comparisons (105.46 +/- 8.75 vs 76.61 +/- 3.58, 105.46 +/- 8.75 vs 69.78 +/- 1.87, 105.46 +/- 8.75 vs 67.41 +/- 1.84, respectively, P < 0.01 for IL-8; and 30.83 +/- 1.29 vs 75.64 +/- 1.90, 30.83 +/- 1.29 vs 80.90 +/- 3.16, 30.83 +/- 1.29 vs 83.46 +/- 2.37, respectively, P < 0.01 for IL-10), except comparison of 6M vs 9M. Expression of TLR9 and NF-kappa B p65 decreased in order: highest in the WLC group and lowest in the 9M group. In addition, the differences among the WLC, 3M, 6M and 9M groups were significant for all comparisons (0.492 +/- 0.026 vs 0.380 +/- 0.022, 0.492 +/- 0.026 vs 0.355 +/- 0.005, 0.492 +/- 0.026 vs 0.327 +/- 0.015, respectively, P < 0.05 for TLR9; and 0.436 +/- 0.041 vs 0.326 +/- 0.022, 0.436 +/- 0.041 vs 0.293 +/- 0.006, 0.436 +/- 0.041 vs 0.265 +/- 0.017, respectively, P < 0.05 for NF-kappa B p65). CONCLUSION: Moxibustion repairs damaged colonic mucosa, suppresses serum IL-8, activates serum IL-10 level, and decreases expression of TLR-9 and NF-kappa B p65 in UC rats. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.

Epidemiology of perforating peptic ulcer:A population-based retrospective study over 40 years

BACKGROUND The incidence of peptic ulcer disease has decreased during the last few decades,but the incidence of reported peptic ulcer complications has not decreased.Perforating peptic ulcer(PPU)is a severe form of the disease.AIM To assess trends in the incidence,presentation,and outcome of PPU over a period of 40 years.METHODS This was a single-centre,retrospective,cohort study of all patients admitted to Levanger Hospital,Norway,with PPU from 1978 to 2017.The patients were identified in the Patient Administrative System of the hospital using International Classification of Diseases(ICD),revision 8,ICD-9,and ICD-10 codes for perforated gastric and duodenal ulcers.We reviewed the medical records of the patients to retrieve data.Vital statistics were available for all patients.The incidence of PPU was analysed using Poisson regression with perforated ulcer as the dependent variable,and sex,age,and calendar year from 1978 to 2017 as covariates.Relative survival analysis was performed to compare long-term survival over the four decades.RESULTS Two hundred and nine patients were evaluated,including 113(54%)men.Fortysix(22%)patients were older than 80 years.Median age increased from the first to the last decade(from 63 to 72 years).The incidence rate increased with increasing age,but we measured a decline in recent decades for both sexes.A significant increase in the use of acetylsalicylic acid,from 5%(2/38)to 18%(8/45),was observed during the study period.Comorbidity increased significantly over the 40 years of the study,with 22%(10/45)of the patients having an American Society of Anaesthesiologists(ASA)score 4-5 in the last decade,compared to 5%(2/38)in the first decade.Thirty-nine percent(81/209)of the patients had one or more postoperative complications.Both 100-day mortality and long-term survival were associated with ASA score,without significant variations between the decades.CONCLUSION Declining incidence rates occurred in recent years,but the patients were older and had more comorbidity.The ASA score was associated with both short-term mortality and long-term survival.

Protective effect of Polyalthia longifolia var.pendula leaves on ethanol and ethanol/HCl induced ulcer in rats and its antimicrobial potency

Objective:To explore antiulcer and antimicrobial properties of methanolic extract of Polyalthia longifolia var.pendula.Methods:Gastroprotective potential of Polyalthia longifolia was studied on ethanol and ethanol/HCl induced ulcers at 2 different doses(270 and 540 mg/kg/body weight). Antimicrobial efficacy of Polyalthia longifolia(25 mg/mL) was also studied against six gram positive,seven gram negative bacteria and five fungi by agar well diffusion method.Minimum inhibitory concentration was determined by agar well diffusion method in two fold serial dilution, in the range of 97-25 000μg/mL.Results:The reduction of ulcer index in Polyalthia longifolia treated animals was found to be statistically significant with respect to control animals.The Polyalthia longifolia exhibited ulcer protection activity in dose dependent manner and was also better than the standard.In antimicrobial activity,gram positive bacteria were more susceptible to Polyalthia longifolia than gram negative bacteria and fungal strains.Conclusions:Results obtained confirm the antiulcer and antimicrobial potential of the Polyalthia longifolia.

Low dose oral curcumin is not effective in induction of remission in mild to moderate ulcerative colitis: Results from a randomized double blind placebo controlled trial

AIM To evaluate the role of oral curcumin in inducing clinical remission in patients with mild to moderate ulcerative colitis(UC).METHODS A prospective randomized double-blind placebo-controlled trial comparing the remission inducing effect of oral curcumin and mesalamine 2.4 g with placebo and mesalamine 2.4 g in patients of ulcerative colitis with mild to moderate severity was conducted from January 2003 to March 2005. The included patients received 1 capsule thrice a day of placebo or curcumin(150 mg) for 8 wk. Patients were evaluated clinically and endoscopically at 0,4 and 8 wk. The primary outcome was clinical remission at 8 wk and secondary outcomes were clinical response, mucosal healing and treatment failure at 8 wk. The primary analysis was intention to treat worst case scenario(ITT-WCS).RESULTS Of 300 patients with UC, 62 patients(curcumin: 29, placebo: 33) fulfilled the inclusion criteria and were randomized at baseline. Of these, 21 patients did not complete the trial, 41 patients(curcumin: 16, placebo: 25) finally completed 8 wk. There was no significant difference in rates of clinical remission(31.3% vs 27.3%, P = 0.75), clinical response(20.7% vs 36.4%, P = 0.18), mucosal healing(34.5% vs 30.3%, P = 0.72), and treatment failure(25% vs 18.5%, P = 0.59) between curcumin and placebo at 8 wk.CONCLUSION Low dose oral curcumin at a dose of 450 mg/d was ineffective in inducing remission in mild to moderate cases of UC.

Rectal administration of d-alpha tocopherol for active ulcerative colitis:A preliminary report

AIM: To investigate the anti-oxidant and anti-neutrophil recruitment effects of rectal d-alpha (d-α) tocopherol administration on mild and moderately active ulcerative colitis (UC). METHODS: Fifteen patients with mild and moderately active ulcerative colitis were enrolled in an open-label study of d-α tocopherol enema (8000 U/d) for 12 wk. All patients were receiving concomitant therapy with 5-aminosalicylic acid derivatives (5-ASA) and/or immunomodulator medications. Endoscopic evaluation was performed at baseline and after 4th and 12th weeks. Disease activity was measured with the Mayo disease activity index (DAI) and remission was defined as DAI of ≤ 2 with no blood in stool. Clinical response was defined as a DAI reduction of ≥ 2. RESULTS: At the end of 12th week,the average DAI score significantly decreased compared to the beginning of the study (2.3 ± 0.37 vs 8 ± 0.48,P < 0.0001). One patient was withdrawn after 3 wk for being unavailable to follow-up. On the 4th week of therapy,12 patients showed clinical response,3 of whom (21.4%) achieving remission. After 12 wk,all 14 patients responded clinically to the therapy and remission was induced in 9 of them (64%). No patient reported adverse events or was hospitalized due to worsened disease activity. CONCLUSION: This preliminary report suggests that rectal d-α tocopherol may represent a novel therapy for mild and moderately active UC. The observed results might be due to the anti-inflammatory and anti-oxidative properties of vitamin E.

Endoscopic ultrasonography in the evaluation of condition and prognosis of ulcerative colitis

BACKGROUND Ulcerative colitis(UC)is usually diagnosed through histopathology,enteroscopy,clinical symptoms,and physical findings;however,it is difficult to accurately evaluate disease severity.AIM To investigate the value of endoscopic ultrasonography(EUS)in the evaluation of the severity and prognosis of UC.METHODS Patients with UC who were seen in our hospital from March 2019 to December 2020 were eligible,and disease severity was evaluated according to the modified Truelove and Witts and Mayo scores.We performed EUS,calculated the UC endoscopic index of severity(UCEIS)and EUS-UC scores,and administered appropriate treatment.The UCEIS and EUS-UC scores of patients were assessed in relation to disease severity,and the correlations between UCEIS and EUS-UC scores and disease severity was also analyzed.The UCEIS and EUS-UC scores before and after treatment were also compared.RESULTS A total of 79 patients were included in this study.According to the Mayo Index,23,32,and 24 patients had mild,moderate and severe UC,respectively.The UCEIS and EUS-UC scores were higher in moderate cases(4.98±1.04 and 5.01±0.99,respectively)than in mild cases(1.56±0.82 and 1.64±0.91,respectively,P<0.05).Furthermore,the UCEIS and EUS-UC scores(7.31±1.10 and 7.59±1.02,respectively)were higher in severe cases than in moderate cases(P<0.05).According to the modified Truelove and Witts scores,21,36,and 22 patients were classified as having mild,moderate and severe disease,respectively.The UCEIS and EUS-UC scores were significantly higher in moderate disease(4.79±1.11 and 4.96±1.23,respectively)than in mild disease(1.71±0.78 and 1.69±0.88,respectively,P<0.05).Additionally,the UCEIS and EUS-UC scores in severe disease(7.68±1.22 and 7.81±0.90,respectively)were significantly higher than in moderate disease(P<0.05).The UCEIS and EUSUC scores were significantly and positively correlated with disease severity according to the modified Truelove and Witts score and Mayo score(P<0.05).The UCEIS and EUS-UC scores after 2 mo of treatment(3.88±0.95 and 4.01±1.14,respectively)and after 6 mo of treatment(1.59±0.63 and 1.64±0.59,respectively)were lower than the respective scores before treatment(5.93±1.79 and 6.04±2.01)(P<0.05).CONCLUSION EUS can clarify the status of UC and accurately evaluate the treatment response,providing an objective basis for formulation and adjustment of the treatment plan.

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.

Comparison of fecal calprotectin levels and endoscopic scores for predicting relapse in patients with ulcerative colitis in remission

BACKGROUND Although the usefulness of endoscopic scores,such as the Mayo Endoscopic Subscore(MES),Ulcerative Colitis Endoscopic Index of Severity(UCEIS),and Ulcerative Colitis Colonoscopic Index of Severity(UCCIS),and biomarkers such as fecal calprotectin(FC)for predicting relapse in ulcerative colitis(UC)has been reported,few studies have included endoscopic scores for evaluating the entire colon.AIM To compare the usefulness of FC value and MES,UCEIS,and UCCIS for predicting relapse in patients with UC in clinical remission.METHODS In total,75 patients with UC in clinical and endoscopic remission who visited our institution between February 2019 and March 2022 were enrolled.The diagnosis of UC was confirmed based on the clinical presentation,endoscopic findings,and histology,according to the current established criteria for UC.Fecal samples were collected the day before or after the colonoscopy for measurement of FC.Endoscopic evaluations were performed using MES,UCEIS,and UCCIS.The primary outcome measure of this study was the assessment of the association between relapse within 12 mo and MES,UCEIS,UCCIS,and FC.The secondary outcome was the comparison between endoscopic scores and biomarkers in en-rolled patients with UC with mucosal healing.RESULTSFC and UCCIS showed a significant correlation with UCEIS (r = 0.537, P < 0.001 and r = 0.957, P < 0.001, respectively).Receiver-operating characteristic analysis for predicting MES 0 showed that the area under the curve ofUCCIS was significantly higher than that of FC (P < 0.01). During the 1-year observation period, 18 (24%) patientsexperienced a relapse, and both the FC and UCCIS of the relapse group were significantly higher than that of theremission group. The cut-off values for predicting relapse were set at FC = 323 mg/kg and UCCIS = 10.2. The areaunder the curve of the receiver-operating characteristic analysis for predicting relapse did not show a significantdifference between FC and UCCIS. The accuracy of the endoscopic scores and biomarkers in predicting relapse was86.7% for UCCIS, 85.3% for UCEIS, 76.0% for FC, and 73.3% for MES.CONCLUSIONThe three endoscopic scores and FC may predict UC relapse during clinical remission. Among these scores, UCEISmay be the most useful in terms of ease of evaluation and accuracy.

Quantitative index calculated by ^(99m)Tc-GSA scintigraphy

99mTc-galactosyl human serum albumin（GSA） scintigraphy is useful to evaluate hepatic function and hepatic functional reserve. A reliable SPECT and CT integrated system is now commercially available. Using this system, we can obtain 99mTc-GSA SPECT/CT fused imaging with a small registration error. Therefore, the 99mTc-GSA scintigraphy techniques prove more useful in clinical practice than have been previously reported. In the latest Annals of Surgical Oncology on Oct 2014, the uptake index（UI） values calculated from 99mTc-GSA scintigraphy are reported to be useful for predicting the functional reserve of the future remnant liver. In this paper, we describe the usefulness of 99mTc-GSA scintigraphy as well as some cautions that are necessary as regards using the system.

Evaluating mucosal healing using colon capsule endoscopy predicts outcome in patients with ulcerative colitis in clinical remission

AIM To examine whether second generation of colon capsule endoscopy(CCE-2) is acceptable for assessing the severity of mucosal inflammation and evaluating mucosal healing using CCE-2 is able to predict outcome in ulcerative colitis(UC) patients, especially in clinical remission.METHODS A total of 30 consecutive UC patients in clinical remission were enrolled to undergo CCE-2. Clinical remission was defined as clinical activity index(CAI) ≤ 4 according to Rachmilewitz index. The rate of total colon observation and colon cleansing level were evaluated. Severity of mucosal inflammation in UC was assessed according to the Mayo endoscopic subscore(MES) and Ulcerative Colitis Endoscopic Index of Severity(UCEIS). Relapsefree survival was assessed. Acceptability of CCE-2 was assessed using a questionnaire survey.RESULTS The rate of total colon observation within its battery life was 93.3%. The proportion of "excellent" plus "good" cleansing level was 73.3%. The rate of mucosal healing(MES 0, 1) assessed by CCE-2 was 77.0%. The relapse-free survival rate was significantly higher in MES 0, 1 than in MES 2, 3(P = 0.0435), and in UCEIS 0-3 than in UCEIS 4-8(P = 0.0211), whereas there was no significant difference between CAI 0 and CAI 1-4 groups. A questionnaire survey revealed an overall acceptability of CCE.CONCLUSION CCE-2 is acceptable for assessing the severity of mucosal inflammation in UC patients, especially in clinical remission. Evaluating mucosal healing using CCE-2 was able to predict outcome.