Global, regional, and national burden of inflammatory bowel disease, 1990-2021: Insights from the global burden of disease 2021.

PURPOSE: The prevalence of inflammatory bowel disease (IBD) is on the rise worldwide. We utilizes data from the Global Burden of Diseases (GBD) 2021 to analyze the national-level burden of IBD, trends in disease incidence, and epidemiological characteristics. METHODS: Detailed information on IBD was gathered from 204 countries and territories spanning 1990 to 2021, sourced from the GBD 2021. Calculations were performed for incidence rates, mortality rates, disease-adjusted life years (DALYs), and estimated annual percentage changes (EAPCs). These trends were analyzed based on region, nationality, age, gender, and World Bank income level stratifications. RESULTS: The global age-standardised incident rate (ASIR) of IBD increased from 4.22 per 100000 in 1990 to 4.45 per 100000 in 2021. However, the age-standardised mortality rate (ASMR) decreased from 0.60 per 100000 in 1990 to 0.52 per 100000 in 2021. Similarly, the age-standardised DALYs rate decreased from 21.55 per 100000 in 1990 to 18.07 per 100000 in 2021. Gender comparisons showed negligible differences in disease burden. The greatest increase in IBD-associated ASIR and ASMR occurred in World Bank upper-middle income region (EAPCs, 1.25) and World Bank high-income region (EAPCs, 1.00), respectively. Regionally, East Asia experienced the largest increase in ASIR (EAPCs, 2.89). Among 204 countries, China had the greatest increases in ASIR (EAPCs, 2.93), Netherlands had the highest ASMR in 2021 (2.21 per 100000). CONCLUSIONS: Global incidence rate of IBD have been increasing from 1990 to 2021, while the DALYs and mortality have been decreasing. The escalating incident rates in select Asian regions deserves further attention.

Causal relationship between inflammatory bowel disease and erythema nodosum: A two-sample bidirectional Mendelian randomization study.

BACKGROUND: Previous studies have demonstrated the coexistence of erythema nodosum (EN) and inflammatory bowel disease (IBD), while the exact etiology of the co-occurrence of the two disorders remains uncertain. METHODS: A bidirectional two-sample Mendelian randomization (MR) design was employed to determine the causal link between EN and IBD. Genetic variations associated with Crohn's disease (CD) and ulcerative colitis (UC) were derived from accessible genome-wide association studies pertaining to European ancestry. The FinnGen database was used to find the genetic variations containing EN. In the forward model, IBD was identified as the exposure, whereas in the reverse model, EN was identified as the exposure. The causal link between IBD and EN was examined using a range of different analysis techniques, the primary one being the inverse variance weighted (IVW) method, including inverse variance weighted-fixed effects (IVW-FE) and inverse-variance weighted-multiplicative random effects (IVW-MRE). To strengthen the results, assessments of sensitivity, heterogeneity, and pleiotropy were also conducted. RESULTS: MR results showed that IBD increased the risk of EN (IVW-MRE: OR = 1.242, 95% CI = 1.068-1.443, p = 0.005). Furthermore, there was a strong correlation found between CD and a higher risk of EN (IVW-FE: OR = 1.250, 95% CI = 1.119-1.396, p = 8.036 × 10-5 ). However, UC did not appear to be linked to EN (IVW-FE: OR = 1.104, 95% CI = 0.868-1.405, p = 0.421). The reverse MR analysis findings did not imply that EN was linked to IBD. Horizontal pleiotropy did not appear to exist, and the robustness of these findings was confirmed. CONCLUSION: The current investigation found that in European populations, IBD and its subtype CD could raise the incidence of EN.

Research on an Enhanced Detuned-Loading Effect in Integrated Two-Section DFB Lasers with High Modulation Bandwidths.

A novel high-speed directly modulated two-section distributed-feedback (TS-DFB) semiconductor laser based on the detuned-loading effect is proposed and simulated. A grating structure is designed by the reconstruction-equivalent-chirp (REC) technique. A π phase shift is introduced into the reflection grating, which can provide a narrow-band reflection region with a sharp falling slope on both sides of the reflection spectrum, thus enhancing the detuned-loading effect. Owing to its unique dual-falling-edges structure, the bandwidth can be improved even when the lasing wavelength shifts beyond the left falling edge due to a thermal effect in the actual test, in which condition the detuned-loading effect can be used twice, which greatly improves the yield. The modulation bandwidth is increased from 17.5 GHz for a single DFB laser to around 24 GHz when the lasing wavelength is located on the left falling edge of the TS-DFB laser based on the detuned-loading effect, and it can be increased to 22 GHz for the right side. An eight-channel laser array with precise wavelength spacing is investigated, with a side-mode suppression ratio (SMSR) >36 dB. In addition, TS-DFB lasers with uniform reflection gratings are studied, and simulated results show that the modulation characteristic is far inferior to the laser with a phase-shifted grating reflector.

Influence of Vitamin D3 Supplementation on Infliximab Effectiveness in Chinese Patients With Crohn's Disease: A Retrospective Cohort Study.

Background: It remains uncertain whether vitamin D3 (vitD3) supplementation is beneficial for remission of Crohn's disease (CD). The influence of vitD3 supplementation on Infliximab (IFX) effectiveness was analyzed in Chinese CD patients. Methods: In this retrospective cohort study, moderate-to-severe CD patients, who were bio-naïve and prescribed with IFX treatment for at least 54 weeks, were recorded from January 2014 to December 2019. VitD3 supplementation was defined as patients additionally took oral vitD3 (125 IU/d) within 3 days after the first infusion and persisted in the whole follow-up period. Disease activity was assessed using Harvey-Bradshaw Index (HBI). Serum cytokine profiles (IL-2, IL-4, IL-6, IL-10, TNF-α, and IFN-γ) were quantitatively analyzed in a subset of all patients at baseline and 54-week after intervention. Results: Among 73 enrolled patients, 37 took vitD3 regularly (D3-patients), the others (non-D3-patients) did not. At 54-week, the mean 25-hydroxyvitaminD level increased in D3-patients (20.33 vs. 15.07 ng/mL, P < 0.001). The clinical remission rate was higher in D3-patients compared to non-D3-patients (83.8 vs. 61.6%, P = 0.030). The decrease of HBI from baseline to 54-week was more in D3-patients than non-D3-patients (7.41 ± 3.0 vs. 6.28 ± 2.75, P = 0.023). Furthermore, vitD3 supplementation was independently related to the increase of remission rate at 54-week in D3-patients (ß = -1.667, P = 0.015). The benefit of vitD3 supplementation was significant only in patients with deficient vitD3 (all P < 0.05), but not in non-deficient vitD3. A total of nine patients (four non-D3-patients and five D3-patients) were selected to determine serum cytokine profiles after 54-week IFX treatment. In non-D3-patients, the decreases of TNF-α and IL-6 at 54-week were more obvious than at baseline (P = 0.032, 0.022, respectively). In D3-patients, however, only IL-10 increased at 54-week compared with its baseline value (P = 0.037). Conclusions: VitD3 supplementation could improve IFX effectiveness in CD patients, especially for patients with vitD3 deficiency. This beneficial effect of vitD3 supplementation probably arose from the up-regulation of IL-10. Trial Registration: NCT04606017.

[Application of fascia-orientation of pelvic autonomic nerve preservation in rectal cancer surgery].

Rectal cancer has become the second most common gastrointestinal tumor in our country. With the development of comprehensive treatment, the long-term survival rate of patients with rectal cancer has greatly increased, meanwhile, higher postoperative quality of life is required. But the genitourinary dysfunction which is mainly caused by intraoperative pelvic autonomic nerve damage haunts postoperative rectal cancer patients. Traditional pelvic autonomic nerve protection technology born in the 1980s only improves urogenital function in a part of postoperative patients. In recent years, NOME(nerve-oriented mesorectal excision) was proposed, which needed to make pelvic autonomic never exposed. However, recovery of urinary function is not ideal due to difficulty identifying pelvic autonomic nerve and unavoidable damage on pelvic autonomic nerve. In clinical practice, we found that pelvic autonomic nerve can be divided into three parts: abdominal cavity, large pelvis, small pelvis. The pelvic autonomic nerve is closely related to the surrounding fascias in each part. The fascias are not only the protection of pelvic autonomic nerve, but also can be used as a good indicator of location of pelvic autonomic nerve. The relationship of pelvic autonomic nerve with Toldt fascia, presacral fascia, the lateral rectal ligaments, and the Denonvilliers fascia is discussed in this paper. Combined with the above theory, a new technology named FOPANP (fascia-orientation of pelvic autonomic nerve preservation) is proposed. In this technique, the fascia around the rectum is used as a guidance to select the appropriate plane in the operation, and the tumor can be removed without exposing the pelvic autonomic nerve. This technology has three advantages. First, it is not necessary to search and expose the pelvic autonomic nerve, so as to avoid secondary injury to it during the operation. Secondly, the pelvic fascias are natural barriers formed between the surgical plane and the pelvic autonomic nerve retained. They can avoid the stimulation of physical and chemical factors to pelvic autonomic nerve. Thirdly, because the fascias are easier to identify, and the texture is more tough, so the technology is easier to master.

[Anatomical basis and main points of pelvic autonomic nerve preserving in proctectomy].

OBJECTIVE: To elucidate the course of pelvic autonomic nerves and its relationship with pelvic fascia in order to identify the safe plane to reduce the damage of pelvic autonomic nerves in total mesorectum I excision(TME). METHODS: The course and distribution of pelvic autonomic nerves were observed and their relationship with pelvic interfascial space was examined through the anatomy of 12 adult pelvic specimens. RESULTS: The entire course of hypogastric nerves ran within the anterior sacral fascia and the inferior hypogastric plexus ran within parietal fascia. Inferior hypogastric plexus crossed the fusion line of Denonvilliers fascia and parietal fascia in the 10 o'clock and 2 o'clock directions of the rectum, and joined urogenital vessel bundle finally. Laterigrade traffic nerves could be found in Denonvilliers fascia. CONCLUSION: The safe plane should be chosen between rectal proper fascia and anterior sacral fascia near rectal proper fascia in posterior dissection and lateral dissection of rectum. More attention should be paid to protect the neurovascular bundle in the 10 o'clock and 2 o'clock directions of rectum and traffic nerve within Denonvilliers fascia in anterior dissection.

[Epidemiology survey of gastrointestinal stromal tumor in Shanxi Province in 2011].

OBJECTIVE: To explore the incidence and distribution of gastrointestinal stromal tumor (GIST) in Shanxi Province. METHODS: Newly diagnosed and suspected GIST cases of Shanxi Province on January 1, 2011 to December 31, 2011 were collected from medical insurance records and hospital surveys. All specimens were sent to the Department of Pathology at Shanxi Provincial Tumor Hospital for examinations. And the data were analyzed by SPSS statistical analysis software. RESULTS: There were 153 newly discovered cases of GIST in Shanxi Province in 2011. And its distribution was scattered in different regions. The incidence was 4.3 per million (153/35 932 786) . The high-risk areas were Taiyuan (n = 25) and Changzhi (n = 25). There were 83 (54.2%) males and 70 (45.8%) females. And the incidence of males was not different from that of females ( (4.5 vs 4.0 )per million, P > 0.05). The median onset age was 59 (24-79) years. A high incidence of GIST occurred at an age range of 50-59 years (n = 33). Among the 139 patients, the tumor locations were stomach (n = 88, 63.3%), small intestine (n = 21, 15.1%), colon (n = 7, 5.0%), duodenum (n = 6, 4.3%), esophagus (n = 3, 2.2%) and extra-gastrointestinal (n = 14, 10.1%). And 113 cases had a record of tumor size. The median diameter was 5.78 (0.3-25.0) cm. The largest diameter was ≤ 2 cm (n = 30, 26.5%), > 2-5 cm (n = 33, 29.2%), > 5-10 cm (n = 36, 31.9%) and >10 cm (n = 14, 12.4%). The cell types of 141 cases were spindle cell (n = 112, 79.4%), epithelial (n = 11, 7.8%) and mixed (n = 18, 12.8%). CONCLUSIONS: Shanxi Province has a low incidence of GIST. And no statistically significant difference exists in the incidence between males and females. Taiyuan and Changzhi are relatively more prevalent.

[Molecular phylogeny of the gayal inferred from the analysis of cytochrome b gene entire sequences].

The gayal (Bos frontalis) is a very rare, semi-wild and semi-domestic bovine species. There still exist remarkable divergences on the gayal's origin and phylogenetic status. The cytochrome b (Cyt b) gene entire sequences (1,140 bp) of 11 gayals were sequenced and analyzed. Combined with other bovine Cyt b entire sequences cited in GenBank, the phylogenetic trees of genus Bos were reconstructed by neighbor-joining (NJ) and maximum parsimony (MP) methods with Bubalus bubalis as outgroup. Sequence analysis showed that, among 1,140 sites of Cyt b gene entire sequences of 11 gayals, 95 variable sites (8.33% of all sites) and 6 haplotypes were found, showing abundant genetic diversity in mitochondrial Cyt b gene of the gayals. Both NJ and MP trees demonstrated that the gayals in this study were markedly divided into three embranchments: one embranchment clustering with Bos taurus, another clustering with Bos indicus, and the third clustering with Bos gaurus. The result of phylogenetic analysis suggested that the gayal might be the domesticated form of the gaur (Bos gaurus), and a great proportion of the gayal bloodline was invaded by other bovine species.

Phylogenetic relationships and status quo of colonies for gayal based on analysis of cytochrome B gene partial sequences.

Thirty-three mutations and four different haplotypes were found when cytochrome b(Cytb) gene partial sequences of 12 gayals were analyzed. Together with sequences of Bos indicus, Bos taurus, Bos grunniens and Bos gaurus with Bubalus bubalis as the out group, the partial sequences of Cytb gene of gayals were aligned and base composition and nucleotide variation of Cytb gene were analyzed. The phylogenetic trees were constructed by the NJ method and the MP method respectively, both supporting almost the same topology. Gayal is an independent species of Bos from Bos indicus, Bos taurus and Bos gaurus. The results also indicate that a great proportion of gayal bloodline was invaded by other species, and the protection of gayal is facing a formidable situation.