黄芪多糖通过NF-κB/IRF-3/IRF-7轴对自身免疫性炎性肌病大鼠免疫功能及炎性症状作用的研究

目的 探讨黄芪多糖对自身免疫性炎性肌病大鼠免疫功能及炎性症状的作用及其可能的作用机制。方法 构建自身免疫性炎性肌病大鼠模型,随机分为模型组、黄芪多糖低剂量组、黄芪多糖高剂量组(以下简称低剂量组、高剂量组)、阳性对照组,另设正常组。低剂量组、高剂量组分别灌胃黄芪多糖15、30 mL·kg^(-1)·d^(-1),阳性对照组灌胃甲基泼尼松龙5.4 mL·kg^(-1)·d^(-1),模型组和对照组灌胃等体积生理盐水,连续干预1个月。观察大鼠免疫后的一般状态;苏木素-伊红(hematoxylin-eosin,HE)染色观察大鼠骨骼肌的病理变化;酶联免疫吸附试验(enzyme-linked immunosorbent assay,ELISA)检测炎症细胞因子和免疫细胞因子的水平;全自动生化仪检测血清激酶指标;蛋白印记法(Western blotting)检测信号通路蛋白的表达量。结果 模型组大鼠骨骼肌损伤严重,存在明显间质病变,较大量炎症细胞浸润,骨骼肌肌细胞核内移;与模型组比较,低剂量组、高剂量组大鼠病理明显改善,低剂量组仍存在一定程度的间质水肿和炎症细胞浸润,高剂量组和阳性对照组间质水肿、炎症细胞浸润以及细胞核内移明显减轻。模型组、低剂量组、高剂量组、阳性对照组和正常组比较,大鼠血清肌酸激酶(creatine kinase,CK)、乳酸脱氢酶(lactic dehydrogenase,LDH)和羟丁酸转移酶(hydroxybutyric acid dehydrogenase,HBDH)水平逐渐降低,血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)和白细胞介素(interleukin,IL)-6水平逐渐降低,IL-4水平逐渐降低,干扰素-γ(interferon-γ,INF-γ)水平逐渐升高(P<0.05);模型组、低剂量组、高剂量组和正常组比较,大鼠骨骼肌磷酸化核因子κB p65(phosphorylated nuclear factor κB p65,p-NF-κB p65)、干扰素调节因子(interferon regulatory factor,IRF)-3和IRF-7蛋白表达量逐渐降低(P<0.05)。结论 黄芪多糖对自身免疫性炎性肌病大鼠有调节免疫功能、减轻炎性症状的作用,其作用机制可能与抑制NF-κB/IRF-3/IRF-7轴有关。

针灸对颈肩腰腿痛患者疼痛程度、活动功能及炎性症状的影响

目的研究针灸对颈肩腰腿痛患者疼痛程度、活动功能及炎性症状的影响。方法选取2018年3月至2020年3月江苏省灌南县中医院收治的138例颈肩腰腿痛患者,以随机数字表法将其分组,对照组(69例)患者进行按摩、功能性锻炼、止痛等常规对症支持治疗,研究组(69例)患者在对照组的基础上联合针灸治疗,两组患者均治疗4周。比较两组患者治疗后临床疗效;比较两组患者治疗前后视觉模拟疼痛量表(VAS)评分、日常生活活动量表(Barthel)指数评分、肢体运动功能量表(Fugl-Meyer)评分及白介素-6(IL-6)、C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)水平。结果与对照组比,研究组患者临床总有效率升高;与治疗前比,治疗后两组患者Barthel指数、Fugl-Meyer评分均升高,研究组高于对照组;两组患者IL-6、CRP、TNF-α水平及VAS评分均降低,研究组低于对照组(均P<0.05)。结论颈肩腰腿痛患者采用针灸治疗具有良好的临床疗效,可有效缓解患者的疼痛情况与炎性症状,改善患者的活动功能,利于患者康复。

腹横纹小切口手术对腹股沟疝患儿炎性症状的影响

目的研究腹横纹小切口手术对腹股沟疝患儿炎性症状的影响。方法回顾性分析2018年1月至2020年1月陕健医韩城矿务局总医院接受治疗的60例腹股沟疝患儿的临床资料,按手术方法分为A组和B组,各30例。A组患儿采用腹横纹小切口手术治疗,B组患儿采用传统疝手术治疗。比较两组患儿手术指标;比较两组患儿术前、术后7 d血清肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、C-反应蛋白(CRP)水平;比较两组患儿术前、术后1 d心率、平均动脉压;比较两组患儿术后并发症发生情况。结果A组患儿术中出血量少于B组,手术时间、住院时间短于B组,并发症总发生率低于B组;与术前比,术后7 d两组患儿血清TNF-α、IL-6、CRP水平均降低,A组低于B组;与术前比,术后3 h两组患儿心率、平均动脉压均升高,但A组低于B组(均P<0.05)。结论采用腹横纹小切口手术对腹股沟疝患儿进行治疗,可以减少手术过程中对患儿机体造成的损伤,利于稳定生命体征,减轻炎症反应,缩短手术时间,有效降低术后并发症发生率,提高手术安全性,利于患儿术后恢复。

玉米须总黄酮对改善急性痛风性关节炎炎性症状及镇痛的作用

分析玉米须总黄酮在急性痛风性关节炎炎性中的作用。方法 选取70只,根据试验需要建立急性痛风性关节炎模型和药物干预,建立模型的 12h开始,每间隔12h对大鼠踝关节周长测量,1周后检测IL-1β和UA水平。结果 踝关节肿胀度对比,各组不同时间段均比对A组高(P<0.05);C组均低于模型组(P<0.05);D组、E组踝关节肿胀度24h、36h、48h时低于A组(P<0.05);尿酸水平对比,模型组均高于A组(P<0.05),D组、E组、F组和B组低于模型组(P<0.05); D组、E组、F组和C组IL-1β水平低于模型组(P<0.05)。结论 急性痛风性关节炎通过玉米须总黄酮能降低尿酸水平,减轻炎性症状,达到良好的治疗效果。

雷火灸联合妇炎舒治疗盆腔炎性疾病的疗效及作用机制探讨

目的 探究雷火灸联合妇炎舒治疗盆腔炎性疾病的疗效及作用机制。方法 选取2020年1月至2021年1月于我院收治的PID患者56例随机分成两组,分别为雷火灸联合妇炎舒治疗组(研究组)和单纯妇炎舒治疗组(对照组)。对照组采用单纯妇炎舒治疗,研究组在对照组的治疗基础上加用雷火灸,7天为1个疗程,连续治疗21天,比较并分析两组患者的临床疗效、视觉疼痛模拟评分量表及不良反应发生情况。结果 (1)经雷火灸联合妇炎舒治疗后的PID患者的临床治疗总有效率显著性高于单纯妇炎舒治疗(96.43%vs89.29%)(P<0.05);(2)经雷火灸联合妇炎舒治疗后的PID患者的VAS评分显著性低于单纯妇炎舒治疗(96.43%vs89.29%)(P<0.05);(3)在治疗过程中,共出现2例不良反应,对照组为轻微腹痛、研究组为轻微腹泻,均未特殊处理自行好转,且对临床治疗无影响;未存在肝肾功能等器质性不良反应。结论 雷火灸联合妇炎舒治疗PID,呈现安全性和有效性高的优势,改善盆腔炎性症状,缓解患者不适症状,值得广泛应用于临床。

全麻复合硬膜外麻醉对胃癌根治术的麻醉效果以及对患者术后TNF-α和IL-6水平的影响

目的:对胃癌根治术患者实施全麻复合硬膜外麻醉的效果及对其肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平的影响。方法:将2016年1月~2017年1月接收的114例胃癌患者分作A、B两组各57例,A组行全麻,B组行全麻复合硬膜外麻醉,比较并分析其结果。结果:术后B组T淋巴细胞水平与A组对比有显著差异,且TNF-α、IL-6水平低于A组,有统计学意义(P<0.05)。结论:胃癌根治术中应用全麻复合硬膜外麻醉的效果显著,价值颇高。

Epidemiological Investigation of Actinobacillus Pleuropneumoniae in Western Shandong

[ Objective ] The aim of this study was to investigate the epidemic status of porcine pleuropneumonia in western Shandong and establish the PCR method of actinobacillus pleuropneumoniae （APP）. [ Method] The epidemic status of APP in lesion tissues of 186 death pigs and 545 health pigs without clinical symptoms was analyzed by PCR method. [ Result] APP positive rate in 186 samples accounted for 43.0% （80/186）, while that in 545 porcine serums accounted for 9.4% （51/545）. [ Conclusion] This PCR method can be used as one of the important means for APP clinical diagnosis.

Positions of selective leukocytapheresis in the medical therapy of ulcerative colitis

Ulcerative colitis （UC） and Crohn＇s disease （CD） are the major forms of idiopathic inflammatory bowel disease （IBD）. Both UC and CD are debilitating chronic disorders that afflict millions of individuals throughout the world with symptoms which impair function and quality of life. The etiology of IBD is inadequately understood and therefore, drug therapy has been empirical instead of being based on sound understanding of IBD pathogenesis. This is a major factor for poor drug efficacy and drug related side effects that often add to the disease complexity. The development of biologicals notably infliximab to intercept tumor necrosis factor （TNF）-α reflects some progress, albeit major concern about their side effects and lack of long-term safety and efficacy profiles. However, IBD seems to be perpetuated by inflammatory cytokines like TNF-α, interleukin （IL）-Iβ, IL-6 and IL-8 for which activated peripheral granulocytes and monocytes/macrophages （GH） are major sources. Further, in IBD, peripheral GHs are elevated with activation behavior, increased survival time and are found in vast numbers within the inflamed intestinal mucosa; they are suspected to be major factors in the immunopathogenesis of IBD. Hence, peripheral blood GMs should be appropriate targets of therapy. The Adacolumn is a medical device developed for selective depletion of GH by receptor-mediated adsorption （GHA）. Clinical data show GMA, in patients with steroid dependent or steroid refractory UC, is associated with up to 85% efficacy and tapering or discontinuation of steroids, while in steroid nai＇ve patients （the best responders）, GHA spares patients from exposure to steroids. Likewise, GMA at appropriate intervals in patients at a high risk of clinical relapse suppresses relapse thus sparing the patients from the morbidity associated with IBD relapse. Further, GHA appears to reduce the number of patients being submitted to colectomy or exposure to unsafe immunosupressants. First UC episode, steroid naivety and short disease duration appear good predictors of response to GMA and based on the available data, GMA seems to have an excellent safety profile.

Risk factors for intrahepatic cholangiocarcinoma:A case-control study in China

AIM: To carry out a hospital-based case-control study to investigate risk factors for intrahepatic cholangiocarcinoma (ICC) in China. METHODS: A total of 312 ICC cases and 438 matched controls were included in the study. The presence of diabetes mellitus,hypertention,hepatolithiasis,primary sclerosing cholangitis,liver fluke infection (Clonorchis sinensis ),was investigated through clinical records. Blood from all participants was tested for hepatitis B surface antigen (HBsAg) and anti-HCV antibodies. Odds ratios (OR) and 95% confi dence intervals (95% CI) were estimated using conditional logistic regression. RESULTS: Compared with controls,ICC patients had a higher prevalence of HBsAg seropositivity (48.4% vs 9.6%,P < 0.000),and hepatolithiasis (5.4% vs 1.1%,P = 0.001). By multivariate analysis,the signif icant risk factors for development of ICC were HBsAg seropositivity (adjusted OR,8.876,95% CI,5.973-13.192),and hepatolithiasis (adjusted OR,5.765,95% CI,1.972-16.851). The prevalence of anti-HCV seropositivity,diabetes mellitus,hypertention,cigarette smoking,and alcohol consumption were not significantly different between cases and controls. CONCLUSION: These findings suggest that HBV infection and hepatolithiasis are strong risk factors for development of ICC in China.

Association of extraintestinal manifestations of inflammatory bowel disease in a province of western Hungary with disease phenotype:Results of a 25-year follow-up study

AIM:IBD is a systemic disease associated with a large number of extraintestinal manifestations (EIMs).Our aim was to determine the prevalence of EIMs in a large IBD cohort in Veszprem Province in a 25-year follow-up study. METHODS:Eight hundred and seventy-three IBD patients were enrolled (ulcerative colitis/UC/:619,m/f:317/302, mean age at presentation:38.3 years,average disease duration:11.2 years;Crohn's disease/CD/:254,m/f:125/129, mean age at presentation:32.5 years,average disease duration:9.2 years).Intestinal,extraintestinal signs and laboratory tests were monitored regularly.Any alteration suggesting an EIMs was investigated by a specialist. RESULTS:A total of 21.3% of patients with IBD had EIM (UC:15.0%,CD:36.6%).Age at presentation did not affect the likelihood of EIM.Prevalence of EIMs was higher in women and in CD,ocular complications and primary sclerosing cholangitis (PSC) were more frequent in UC.In UC there was an increased tendency of EIM in patients with a more extensive disease.Joint complications were more frequent in CD (22.4% vsUC 10.2%,P<0.01).In UC positive family history increased the risk of joint complications (OR:3.63).In CD the frequency of type-1 peripheral arthritis was increased in patients with penetrating disease (P=0.028).PSC was present in 1.6% in UC and 0.8% in CD.Dermatological complications were present in 3.8% in UC and 10.2% in CD,the rate of ocular complications was around 3% in both diseases.Rare complications were glomerulonephritis,autoimmune hemolytic anaemia and celiac disease. CONCLUSION:Prevalence of EIM in Hungarian IBD patients is in concordance with data from Western countries.The high number of EIM supports a role for complex follow-up in these patients.

Protective effects and mechanisms of Baicalin and octreotide on renal injury of rats with severe acute pancreatitis

AIM: To investigate the protective effects and mechanisms of Baicalin and octreotide on renal injury of rats with severe acute pancreatitis (SAP). METHODS: One hundred and eighty SD rats were randomly assigned to the model group, Baicalin-treated group, octreotide-treated group and sham operation group. The mortality, plasma endotoxin level, contents of blood urea nitrogen (BUN), creatinine (CREA), phospholipase A2 (PLA2), nitrogen monoxide (NO), tumor necrosis factor (TNF)-α, IL-6 and endothelin-1 (ET-1) in serum, expression levels of renal Bax and Bcl-2 protein, apoptotic indexes and pathological changes of kidney were observed at 3, 6 and 12 h after operation. RESULTS: The renal pathological changes were milder in treated group than in model group. The survival at 12 h and renal apoptotic indexes at 6 h were significantly (P < 0.05) higher in treated group than in model group [66.67% vs 100%; 0.00 (0.02)% and 0.00 (0.04)% vs 0.00 (0.00)%, respectively]. The serum CREA content was markedly lower in octreotide-treated group than in model group at 3 h and 6 h (P < 0.01, 29.200 ± 5.710 μmol/L vs 38.400 ± 11.344 μmol/L; P < 0.05, 33.533 ± 10.106 μmol/L vs 45.154 ± 17.435 μmol/L, respectively). The expression level of renal Bax protein was not significantly different between model group and treated groups at all time points. The expression level of renal Bcl-2 protein was lower in Baicalin-treated group than in model group at 6 h [P < 0.001, 0.00 (0.00) grade score vs 3.00 (3.00) grade score]. The Bcl-2 expression level was lower in octreotide-treated group than in model group at 6 h and 12 h [P < 0.05, 0.00 (0.00) grade score vs 3.00 (3.00) grade score; 0.00 (0.00) grade score vs 0.00 (1.25) grade score, respectively]. The serum NO contents were lower in treated groups than in model group at 3 h and 12 h [P < 0.05, 57.50 (22.50) and 52.50 (15.00) μmol/L vs 65.00 (7.50) μmol/L; P < 0.01, 57.50 (27.50) and 45.00 (12.50) μmol/L vs 74.10 (26.15) μmol/L, respectively]. The plasma endotoxin content and serum BUN content (at 6 h and 12 h) were lower in treated groups than in model group. The contents of IL-6, ET-1, TNF-α (at 6 h) and PLA2 (at 6 h and 12 h) were lower in treated groups than in model group [P < 0.001, 3.031 (0.870) and 2.646 (1.373) pg/mL vs 5.437 (1.025) pg/mL; 2.882 (1.392) and 3.076 (1.205) pg/mL vs 6.817 (0.810) pg/mL; 2.832 (0.597) and 2.462 (1.353) pg/mL vs 5.356 (0.747) pg/mL; 16.226 (3.174) and 14.855 (5.747) pg/mL vs 25.625 (7.973) pg/mL; 18.625 (5.780) and 15.185 (1.761) pg/mL vs 24.725 (3.759) pg/mL; 65.10 (27.51) and 47.60 (16.50) pg/mL vs 92.15 (23.12) pg/mL; 67.91 ± 20.61 and 66.86 ± 22.10 U/mL, 63.13 ± 26.31 and 53.63 ± 12.28 U/mL vs 101.46 ± 14.67 and 105.33 ± 18.10 U/mL, respectively]. CONCLUSION: Both Baicalin and octreotide can protect the kidney of rats with severe acute pancreatitis. The therapeutic mechanisms of Baicalin and octreotide might be related to their inhibition of inflammatory mediators and induction of apoptosis. Baicalin might be a promising therapeutic tool for severe acute pancreatitis.

Probiotic effects on intestinal fermentation patterns in patients with irritable bowel syndrome

AIM： To determine whether Lactobacillus casei strain Shirota （Yakult） can alter small intestinal bacterial overgrowth （SIBO）, as tested by the lactulose breath test, and whether this is associated with changes in symptoms in irritable bowel syndrome （IBS）. METHODS： 18 patients with IBS （Rome Ⅱ criteria）, who showed an early rise in breath hydrogen with lactulose （ERBHAL）, consumed 65 mL of Yakult daily for 6 wk. Lactulose breath test was repeated at the end of the treatment period. Symptoms were recorded daily using a 10 cm visual analogue scale. RESULTS： 14 patients completed the study, 9 （64%） had reversal of ERBHAL, with the median time of first rise in breath hydrogen increasing from 45 to 75 min （P = 0.03）. There was no significant improvement in the symptom score with probiotic therapy, except for wind （P = 0.04）. Patients commencing with at least moderate symptoms and who no longer had ERBHAL at the end of treatment, showed improvement in the overall symptoms scores [median final score 5.3 （IQR 3.9-5.9）, 55% reduction; n = 6] to a greater extent than those who had had persisting ERBHAL [final score 6.9 （5.0-7.0）, 12% reduction; n = 5; P = 0.18]. CONCLUSION： Yakult is effective in altering fermentation patterns in the small bowel, consistent with reducing SIBO. The loss of ERBHAL was associated with reduced symptoms. The true interpretation of these findings awaits a randornised, controlled trial.

Outcome of patients with acute, necrotizing pancreatitis requiring drainage-does drainage size matter?

AIM:To assess the outcome of patients with acute necrotizing pancreatitis treated by percutaneous drainage with special focus on the influence of drainage size and number. METHODS:We performed a retrospective analysis of 80 patients with acute pancreatitis requiring percutaneous drainage therapy for infected necroses. Endpoints were mortality and length of hospital stay. The influence of drainage characteristics such as the median drainage size, the largest drainage size per patient and the total drainage plane per patient on patient outcome was evaluated. RESULTS:Total hospital survival was 66%. Thirty-four patients out of all 80 patients (43%) survived acute necrotizing pancreatitis with percutaneous drainage therapy only. Eighteen patients out of all 80 patients needed additional percutaneous necrosectomy (23%). Ten out of these patients required surgical necrosectomy in addition, 6 patients received open necrosectomy without prior percutaneous necrosectomy. Elective surgery was performed in 3 patients receiving cholecystectomy and one patient receiving resection of the parathyroid gland. The number of drainages ranged from one to fourteen per patient. The drainage diameter ranged from 8 French catheters to 24 French catheters. The median drainage size as well as the largest drainage size used per patient and the total drainage area used per patient did not show statistically significant influence on mortality. CONCLUSION:Percutaneous drainage therapy is an effective tool for treatment of necrotizing pancreatitis.Large bore drainages did not prove to be more effective in controlling the septic focus.

State-of-the-art of irritable bowel syndrome and inflammatory bowel disease research in 2008

Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) are two of the leading causes of chronic intestinal conditions in the world. This issue of World Journal of Gastroenterology (WJG ) presents a series of papers from world experts who discuss the current knowledge and opinions on these important conditions. Although great strides have been made in the diagnosis, treatment and pathology of IBS and IBD; much has yet to be explained. The etiologies and risk factors of these multifactorial conditions remain elusive. Specific diagnostic biomarkers need to be developed and safer treatments developed. The burden of IBS and IBD on the healthcare system is felt with repeated medical care visits and high costs. IBS and IBD patients can account for 30%-50% of office visits at gastroenterology services/clinics. Over one million people have IBD in the United States, with 30 000 new cases being diagnosed every year. One-quarter million people in the UK are afflicted with IBD. The cost of medical care in the United States for IBD is estimated to be $1.8 billion/year.

Primary sclerosing cholangitis, autoimmune hepatitis and overlap syndromes in inflammatory bowel disease

Primary sclerosing cholangitis （PSC） is a chronic progressive disorder of unknown aetiology characterised by chronic inflammation and stricture formation of the biliary tree. Symptoms include itch and lethargy and in advanced cases cholangitis and end-stage liver disease, however increasing numbers of asymptomatic individuals are being identified. The disease is rare in the general population but is strongly associated with inflammatory bowel disease （IBD） affecting up to 5% of patients with Ulcerative Colitis, with a slightly lower prevalence （up to 3.6%） in Crohns disease. The strength of this association means that the vast majority （ 〉 90%） of patients with PSC also have IBD, although many may have only mild gastro-intestinal symptoms. Usually IBD presents before PSC, although vice-versa can occur and the onset of both conditions can be separated in some cases by many years. Mean age of diagnosis of PSC is in the fitch decade of life with a strong male predominance. Risk is increased in those with a family history of PSC, suggesting a genetic predisposition and the disease is almost exclusive to non-smokers. The ulcerative colitis associated with PSC is characteristically mild, runs a quiescent course, is associated with rectal sparing, more severe right sided disease, backwash ilieitis and has a high risk of pouchitis post-colectomy. Most worrisome is the high risk of colorectal malignancy which necessitates routine colonoscopic surveillance. Cholangiocarcinoma is also a frequent complication of PSC with a 10%-15% lifetime risk of developing this condition. Treatment with high dose ursodeoxycholic acid offers some chemoprotective effects against colorectal malignancy and may decrease symptoms, biochemical and histological progression of liver disease. Small duct PSC patients characteristically have normal cholangiography, and liver biopsy is required for diagnosis, it appears to have a more favourable prognosis. Autoimmune Hepatitis （AIH） is also more prevalent in patients with IBD, with up to 16% of patients with Autoimmune Hepatitis also having ulcerative colitis. A small subgroup of patients have a AIH-PSC overlap syndrome and the management of these patients depends on liver histology, serum IgM levels, autoantibodies, degree of biochemical cholestasis and cholangiography as some of these patients may respond to immunosupression.

Genetic epidemiology of primary sclerosing cholangitis

The aetiology of primary sclerosing cholangitis (PSC) is not known. A more than 80-fold increased risk of PSC among first-degree relatives emphasizes the importance of genetic factors. Genetic associations within the human leukocyte antigen (HLA) complex on chromosome 6p21 were detected in PSC 25 years ago. Subsequent studies have substantiated beyond doubt that one or more genetic variants located within this genetic region are important. The true identities of these variants,however,remain to be identified. Several candidate genes at other chromosomal loci have also been investigated. However,according to strict criteria for what may be denominated a susceptibility gene in complex diseases,no such gene exists for PSC today. This review summarises present knowledge on the genetic susceptibility to PSC,as well as genetic associations with disease progression and clinical subsets of particular interest (inflammatory bowel disease and cholangiocarcinoma).

Recent trends in the surgical management of inflammatory bowel disease

Surgery is required in the vast majority of patients with Crohn’s disease (CD) and in approximately one-third of patients with ulcerative colitis (UC). Similar to medical treatments for IBD, significant advances have occurred in surgery. Advances in CD include an emphasis upon conservatism as exemplified by more limited resections, strictureplasties, and laparoscopic resections. The use of probiotics in selected patients has improved the outcome in patients with pouchitis following restorative proctocolectomy for UC. It is anticipated that ongoing discoveries in the molecular basis of IBD will in turn identify those patients who will best respond to surgery.

Ileal pouch surgery for ulcerative colitis

Ulcerative colitis (UC) is a relapsing and remitting disease characterised by chronic mucosal and submucosal inflammation of the colon and rectum. Treatment may vary depending upon the extent and severity of inflammation. Broadly speaking medical treatments aim to induce and then maintain remission. Surgery is indicated for inflammatory disease that is refractory to medical treatment or in cases of neoplastic transformation. Approximately 25% of patients with UC ultimately require colectomy. Ileal pouch-anal anastomosis (IPAA) has become the standard of care for patients with ulcerative colitis who ultimately require colectomy. This review will examine indications for IPAA, patient selection, technical aspects of surgery, management of complications and long term outcome following this procedure.

Immunopathogenesis of inflammatory bowel disease

Crohn＇s disease and ulcerative colitis are chronic relapsing immune mediated disorders that results from an aberrant response to gut luminal antigen in genetically susceptible host. The adaptive immune response that is then triggered was widely considered to be a T-helper-1 mediated condition in Crohn＇s disease and T-helpero2 mediated condition in ulcerative colitis. Recent studies in animal models, genome wide association, and basic science has provided important insights in in the immunopathogenesis of inflammatory bowel disease, one of which was the characterization of the interleukin-23/Th-17 axis.

Impact of alanyl-glutamine dipeptide on severe acute pancreatitis in early stage

AIM:To evaluate the therapeutic effect of alanyl- glutamine dipeptide (AGD) in the treatment of severe acute pancreatitis (SAP) in early and advanced stage. METHODS: Eighty patients with SAP were randomized and received 100 mL/d of 20% AGD intravenously for 10 d starting either on the day of (early treatment group) or 5 d after (late treatment group) admission. Groups had similar demographics, underlying diseases, Ranson score, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score, and Balthazar’s computed tomography (CT) score at the beginning of the study and underwent similar other medical and nutritional management. RESULTS: The duration of acute respiratory distress syndrome (2.7 ± 3.3 d vs 12.7 ± 21.0 d, P < 0.01), renal failure (1.3 ± 0.5 d vs 5.3 ± 7.3 d, P < 0.01), acute hepatitis (3.2 ± 2.3 d vs 7.0 ± 7.1 d, P < 0.01), shock (1.7 ± 0.4 d vs 4.8 ± 3.1 d, P < 0.05), encephalopathy (2.3 ± 1.9 d vs 9.5 ± 11.0 d, P < 0.01) and enteroparalysis (2.2 ± 1.4 d vs 3.5 ± 2.2 d, P < 0.01) and hospital stay (28.8 ± 9.4 d vs 45.2 ± 27.1 d, P < 0.01) were shorter in the early treatment group than in the late treatment group. The 15-d APACHE Ⅱ score was lower in the early treatment group than in the late treatment group (5.0 ± 2.4 vs 8.6 ± 3.6, P < 0.01). The infection rate (7.9% vs 26.3%, P < 0.05), operation rate (13.2% vs 34.2%, P < 0.05) and mortality (5.3% vs 21.1%, P < 0.05) in the early treatment group were lower than in the late treatment group.CONCLUSION: Early treatment with AGD achieved a better clinical outcome in SAP patients.