Characteristics of Crohn's disease under double balloon enteroscopy / 中南大学学报(医学版)

Objective:To observe ulcer characteristics of Crohn's disease under double balloon enteroscopy,and to evaluate the correlation between endoscopic severity and clinical manifestations.Methods:A prospective,observational study from July 2015 to December 2016 in the Third Xiangya Hospital,Central South University,we selected 45 patients with positive double-balloon enteroscopy (DBE) and confirmed Crohn's disease.Two digestive internal physician observed the ulcer characteristics of Crohn's disease under double balloon enteroscopy,and gave a simple endoscopic score for CD (SES-CD).We analyzed the correlation between SES-CD and Crohn's disease activity index (CDAI).Results:DBE indicated 24 patient ulcers (53.33％) locating at the end of the ileum,5 (11.11％)locating at ileocolon,16 (35.56％) locating at upper gatrointestinal tract and they did not affect the end of the ileum.Among them,8 cases (17.78％) affected only jejunum.Thirty-two patients with longitudinal ulcers in Crohn's disease,accounting for 71.11％.There was no correlation between SES-CD score and CDAI score (r=0.237,P=0.136).Conclusion:The ulcerative appearance in Crohn's disease were diverse under double balloon enteroscopy.Crohn's disease could only affect the upper gastrointestinal tract or jejunum.The unwounded ileum and ileocecal valve couldn't be a sign to exclude Crohn's disease.CDAI score couldn't fully assess the prognosis of Crohn's disease.

Therapeutic effect of anti-CXCL1 neutralizing antibody on acute ulcerative colitis in mice / 中南大学学报(医学版)

Objective:To evaluate the therapeutic effect of CXCL1 monoclonal antibody on dextra sulfate sodium (DSS)-induced acute ulcerative colitis (UC) in mice,and to elucidate its effect on the expressions ofTNF-α,IFN-γ,,IL-17 and IL-10 as well as neutrophil infiltration.Methods:Female BALB/c mice were randomly divided into a normal group (DSS-),a disease group (DSS+saline),an anti-CXCL1 antibody group (DSS+anti-CXCL1 Ab) and a treatment control group (DSS+IgG Ab).The DSS+saline,DSS+anti-CXCL1 Ab and DSS+anti-CXCL1 Ab groups were given 3.5％ DSS solution as drinking water to induce acute intestinal inflammation,while the normal control was given distilled water freely.The DSS+anti-CXCL1 Ab mice were intraperitoneal injected with anti-CXCL1 Ab (4 mg/kg) on the 3rd and 6th day.Same amount of rat IgG Ab was given in the DSS+IgG Ab group.The normal group and the disease group were injected with 0.9％ sodium chloride solution.The value of disease activity index (DAI) and the injury of colorectal tissue were measured.The levels of TNF-α,IFN-γ,IL-10 and IL-17 in colonic tissues of mice were detected by RT-PCR.Myeloperoxidase (MPO),a specific marker of neutrophils was measured by immunohistochemistry.Results:Compared with the normal control group,DAI score and colorectal injury score in the disease group were significantly increased,but the DAI and colorectal in the mice with acute ulcerative colitis tissue damage score were significantly reduced after anti-CXCL1 Ab intervention.Compared with the normal control group,mRNA levels of TNF-α,IFN-γ and IL-17 in the colorectal tissues were significantly elevated (P＜0.05) in the disease group while the IL-10 was decreased;these effects were attenuated by anti-CXCL1 Ab intervention (P＜0.05).Immunohistochemistry showed that the infiltration of neutrophils (MPO+) in the colon tissue was significantly increased in the disease group,while the anti-CXCL1 Ab treatment could significantly reduce the neutrophil infiltration in colon tissue (P＜0.05).Conclusion:Anti-CXCL1 Ab relieves the progression of DSS-induced acute ulcerative colitis by suppressing proinflammatory expression and neutrophil infiltration.

"The application of ""Internet +"" model in medical education" / 中华医学教育探索杂志

In the era of digital information,internet plus mode provides new opportunities for the development of traditional medical education.This paper introduces the application patterns of internet plus mode in the medical education,including the following aspects,such as the construction of medical quality resources sharing class,the implementing of medical massive open online courses and other kinds of open online courses,making comprehensive construction of textbooks,using social interactive software and some new wearable devices such as Google glass,distance education and so on.And from the construction of autonomy,sharing,dynamic teaching atmosphere and building a new relationship between teachers and students,it explores the application advantage of Internet plus in medical education,emphasizes thatInternet plus mode and traditional medical education should be organically integrated and financed.At the same time,we should improve the evaluation of information quality,study the integrity test,and the application of big data processing,so as to provide some ideas for the sustainable development.

Experience in transumbilical endoscopic surgery diagnosis for 3 cases of pseudomyxoma peritonei / 中南大学学报(医学版)

Three patients of pseudomyxoma peritonei who were diagnozed by transumbilical endoscopic surgery (TUES) were reviewed retrospectively from September 2014 to November 2014. Three cases of ascites patients underwent TUES were diagnozed as pseudomyxoma peritonei. All operations were successful. No open surgery or laparoscopic surgery was required. The mean operative time was (45±16) min; the mean intraoperative blood loss was 510 mL; the mean hospital stay time was 3 days. During the follow up of 911 months, no obvious scar was observed. Cosmetic results appear to be excellent. All patients were treated with intraperitoneal hyperthermia and chemotherapy. The survival rate was 100%. As a novel scarless endoscopic invasive abdominal surgery, TUES has high clinical value with the advantages such as small trauma, no scars, small risk and low cost in the diagnosis of unexplained ascites.

Efficacy and safety of peroral endoscopic myotomy in the treatment of achalasia cardia / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the efficacy and safety of peroral endoscopic myotomy (POEM) for achalasia cardia (AC).
@*METHODS@#A total of 62 patients with AC were enrolled and treated with POEM in the Third Xiangya Hospital, Central South University from April 2012 to October 2014. The symptoms and complications were retrospectively analyzed.
@*RESULTS@#The ages of patients, including 32 males and 30 females, were 14-68 (43.2±5.6) years old. Eckardt scores were 4-6 or ≥7 for 25 patients or 37 patients (including 20 patients were at a score of 12). Thirteen patients suffered balloon expansion for 2-3 times. Sixty-one patients had completed POEM treatment, 1 patient were given Heller surgery instead of POEM because of extensive submucosal adhesion during POEM. The operative time for POEM was (60.8±15.1) min. Fourteen patients had mild subcutaneous emphysema. Among them, 5 suffered pneumoperitoneum and felt better after abdominal puncture exhaust; 2 patients suffered bronchospasm hypoxemia and were relieved after treatment by positive pressure oxygen for 1 h. The hospital stay was (4.3±1.2) d. The postoperative follow-up period was (11.4±5.4) months. Swallowing obstruction, vomiting and chest pain in patients was relieved at different degrees. The treatment effective rate was 100%. 
@*CONCLUSION@#POEM is a safe, effective and minimally invasive approach for AC.

Application of endoscopic full-thickness resection in the treatment of gastric tumors originated from the muscularis propria / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the curative effect and safety of endoscopic full-thickness resection (EFR) in the treatment of gastric tumor originated from the muscularis propria.
@*METHODS@#Clinical data were collected from 34 patients, who underwent EFR of gastric tumor originated from muscularis propria, to observe the resection rate and complications from November 2012 to August 2014.
@*RESULTS@#Of the 34 patients, 15 were male, 19 were female, with the age of 38.3-70.6 (52.3±4.3) years old. The lesions of 25 patients located in the fundus of stomach and the rest was in the gastric body. EFR was successfully performed in the 34 patients with no need for surgery. The complete resection rate was 100%. Lesion diameter ranged from 1.0 to 5.0 (2.8±1.2) centimeters. The operation time was 50-100 (76.5±18.2) min. Patients with pneumoperitoneum were relieved after abdominal puncture exhaust, without post-operation bleeding and perforation. The hospitalization duration was 3-5 (3.6±0.8) days. Except 1 case, the remaining 33 cases were spindle cell tumors, consistent with the results of immunohistochemistry. The risk for two lesions with 4.5 cm and 5.0 cm was moderate. The risk of invasion was low or very low in the remaining 31 cases. Among them, 2 stromal tumors near the cardia showed a differentiation tendency toward smooth muscle. No lesion residual or recurrence happened during the follow-up period (range 5-23 months) in 34 cases. 
@*CONCLUSION@#EFR is a safe and effective method for gastric tumor originated from muscularis propria.

A case of complex Crohn's disease with severe complication / 中南大学学报(医学版)

Crohn's disease (CD) is a nonspecific chronic intestinal inflammatory disease with unknown etiology. The course of CD is persistent and recurrent. In the progress, CD can come with many complications such as obstruction, fistula formation, perforation, and hemorrhage. The early diagnosis, treatment, and the time of the surgery for CD pose a big controversy and challenge. There was a female patient diagnosed as Crohn's disease with severe complication in department of Gastroenterology of the Third Xiangya Hospital, Central South University.  We reported the diagnosis and treatment on this patient. The choice for the medicine and surgury was discussed.

Association between serum levels of S100A8/S100A9 and clinical features of colorectal cancer patients / 中南大学学报(医学版)

OBJECTIVE@#To analyze the association between serum levels of S100A8/S100A9 and clinicopathological features of colorectal cancer patients.
@*METHODS@#A total of 82 patients with CRC and 14 healthy controls were enrolled for this study. The levels of S100A8 and S100A9 in serum were detected by ELISA assay. The association between S100A8/S100A9 and clinicopathological features was analyzed by student-t test and one-way ANOVA. Receiver Operating Characteristic curve was used to analyze diagnostic efficiency of serum S100A8 and S100A9 for colon rectal cancer. Logistic regression model was also established to analyze the possible risk factors for elevation of S100A8/S100A9.
@*RESULTS@#The levels of S100A8 and S100A9 were (1 403.3±593.7) and (2 890.3±994.9) pg/mL in patients with colon cancer, and (712.8±265.3) and (1 492.7±564.6) pg/mL in controls, respectively, with significant difference between the two groups (P<0.01). The similar results were found in rectal cancer patients, with a level of S100A8 and S100A9 at (1 417.7±666.5) and (3 026.7±887.6) pg/mL, respectively. Diagnostic sensitivity and specificity of S100A8 and S100A9 are better than traditional biomarkers. The levels of S100A9 in serum of CRC patients were correlated with clinical stages and distant metastasis. Serum levels of S100A9 in patients of stage III [(3 111.9±178.5) pg/mL] and stage IV [(3 831.4±278.5) pg/mL] were significantly (P<0.01) higher than that in stage I [(2 276.1±167.4) pg/mL], whereas there was significant change in S100A8 levels. Logistic regression showed the possible risk factors for the elevation of S100A9, including depth of invasion, lymphatic metastasis and degree of differentiation (P<0.05).
@*CONCLUSION@#Serum level of S100A8 and S100A9 in CRC patients were significantly increased and serum level of S100A9 was positively correlated with the malignant features of CRC.

"Application of""flipped classroom"" based on digital resource database in the teaching of Clini-cal Skills course" / 中华医学教育探索杂志

This paper introduces the structure, contents, function of the digital teaching re-courses database in Clinical Skills course of Central South University, analyses the essence and char-acter of the flipped classroom (FC), and emphasizes flexible environment, learning culture, inten-tional content, professional educator in its implementation process. Meanwhile, it introduces the appli-cation of flipped classroom based on digital resources database in the teaching of Clinical Skills course, mentions the importance of the four aspects:preparing teaching materials, learning before class, guidance and cooperation in class, evaluation and knowledge expansion after class. Lastly, it analyses the advantages and foreground of it.

Effect of Feridex-GFP double-labeled BMSC transplant on the damaged liver under the condition of constant magnetic field / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the effect of the bone marrow mesenchymal stem cells (BMSCs) transplant through peripheral vein, portal vein and hepatic artery into liver under the condition of constant magnetic field and to analyze the therapeutic effect on liver function recovery.@*METHODS@#BMSCs were isolated, purified and induced to differentiate into liver-like cells, which were double labeled by Feridex-GFP. The double-labeled BMSCs were transplanted into liver through different ways including peripheral vein, portal vein and hepatic artery with or without constant magnetic field in vitro. The rats were sacrificed at the 1st, 2nd, 3rd and 4th week after the transplant. ALB, ALT, AST were tested. The liver tissue biopsy was collected. GFP-positive cells in liver were observed by fluorescence microscopy.@*RESULTS@#Double-labeled BMSCs could be transplanted into liver through all ways. GFP expression was found in liver in all groups at the 4th week and the liver functions were improved. Based on the long term efficacy, the liver functions recovered more rapidly in the portal vein + constant magnetic field group and the hepatic artery + constant magnetic field group.@*CONCLUSION@#BMSCs transplantation can reduce acute liver damage. The first choice for BMSCs transplantation was via portal vein or hepatic artery under the condition of constant magnetic field. The second choice was via peripheral vein alone or under the condition of constant magnetic field.

Influence of endoscopic variceal ligation on liver function and risk factors of rebleeding / 中南大学学报(医学版)

OBJECTIVE@#To investigate the influence of endoscopic variceal ligation (EVL) on liver function and analyze the risk factors of rebleeding after EVL.@*METHODS@#A total of 137 cirrhotic patients with esophageal varices who received EVL were retrospectively analyzed, and divided into group A, B, and C according to the Child-Pugh scores of liver function. We compared the liver function 1 week preoperatively and postoperatively. The patients were further divided into a rebleeding group and a non-rebleeding group after the EVL, and risk factors about rebleeding were analyzed.@*RESULTS@#There was no significant difference on ALT, AST, T-Bil, and D-Bil either preoperatively or postoperatively in group A, B, and C (P>0.05). Thirteen patients (9.49%) rebled after the EVL. The course of disease, liver function, prothrombin time, and mass ascites were the risk factors of rebleeding.@*CONCLUSION@#EVL has no obvious effect on liver function, and the course of disease, liver function, prothrombin time and mass ascites are risk factors of rebleeding after EVL.

T-SPOT.TB in the diagnosis of tuberculous peritonitis / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the value of T-SPOT.TB in the diagnosis of tuberculous peritonitis (TBP).@*METHODS@#A total of 50 patients with clinically suspected TBP admitted from August 2011 to July 2012 from the Third Xiangya Hospital were enrolled in this prospective cohort study. Peripheral blood T-SPOT.TB, purified protein derivatives of tuberculin (PPD) skin test, serum tuberculosis antibody (TB-Ab) and ascitic adenosine deaminase (ADA) were measured in the 50 patients and we compared the diagnostic value of the 4 methods.@*RESULTS@#According to the standard of diagnosis of TBP and grouping, 24 patients were diagnosed with TBP, 17 non-TBP and 9 undiagnosed in the end. The sensitivity of T-SPOT.TB for the diagnosis of TBP was 91.7% (22/24), with statistical significance when compared with PPD skin test 37.5% (9/24), serum TB-Ab 16.7% (4/24), and ascitic ADA 36.4% (8/22) (P0.05). The positive prediction value of T-SPOT.TB for the diagnosis of TBP was 84.6% (22/26), without statistical significance when compared with PPD skin test 75.0% (9/12), serum TB-Ab 57.1% (4/7), and ascitic ADA 100%(8/8) (P>0.05). The negative prediction value of T-SPOT.TB for the identification of non-TBP was 86.7% (13/15), with statistical significance when compared with PPD skin test 31.8% (7/22), serum TB-Ab 35.5% (11/31), and ascitic ADA 50.0% (14/28) (P<0.05).@*CONCLUSION@#Peripheral blood T-SPOT.TB for the diagnosis of TBP is highly sensitive, which is better than PPD skin test, serum TB-Ab, and ascitic ADA. T-SPOT.TB has an important reference for diagnosing suspected TBP quickly and accurately.

miR-126 inhibits colon cancer proliferation and invasion through targeting IRS1, SLC7A5 and TOM1 gene / 中南大学学报(医学版)

Objective:To explore the expression pattern and function of miR-126 in human colon cancer and the underlying mechanisms. Methods:hTe expression pattern of miR-126 in high-density human colon cancer tissue microarray was analyzed by in situ hybridization. Further more, the biological function of miR-126 in colon cancer in vitro was investigated by establishing a stable miR-126 over-expression cell lines. Result:hTe expression of miR-126 was lower in the tumor tissue, especially in metastasis tissue. hTe down-regulation of miR-126 was more obvious in the patients who displayed bad prognosis (P=0.025). Over-expression of miR-126 in colon cancer cell was able to inhibit cell proliferation, promote cell apoptosis and reduce the invasive ability. MiR-126 significantly enhanced the sensitivity of the colon cancer cell to chemotherapeutic drug. It has been shown that IRS1, SLC75A and TOM1 were the potential target genes of miR-126 in colon cancer. Conclusion:MiR-126 was able to inhibit the development of colon cancer and its level was closely related with the prognosis of patients with colon cancer. The potential target genes for miR-126 might include IRS1, SLC7A5 and TOM1. Therefore, miR-126 might be a therapeutic target for colon cancer diagnosis and treatment.

Construction of RNAi targeting TRAF1 gene and effect of TRAF1 on gastric cancer cells / 中南大学学报(医学版)

OBJECTIVE@#To construct the RNAi targeting tumor necrosis factor receptor associated factor (TRAF1) gene, and to explore the effect of interference targeting TRAF1 on the biological behavior of gastric cancer cells.@*METHODS@#We detected the expression of TRAF1 in BGC823, SGC7901, and MGC803 gastric cancer cell lines through the real-time PCR and Western blot; then we constructed three pLVXshRNA- TRAF1-shRNAs expression vector targeting TRAF1. When TRAF1 was interfered successfully, we selected the strongest interference efficiency ShRNA by real-time PCR and Western blot. Based on interference targeting TRAF1 on gastric cancer, we tested the cell proliferation activity and apoptosis through MTT assay and flow cytometry, and the cell migration by transwell migration assay.@*RESULTS@#The expression of TRAF1 was increased in BGC823, SGC7901, and MGC803 gastric cancer cell lines compared with gastric epithelial cells (P<0.05), and the highest expression was in BGC823 gastric cell line. In the three TRAF1 shRNAs, the strongest interference efficiency shRNA was pLVX-shRNA-TRAF1-shRNA2. When the gene TRAF1 of BGC823 was interfered, the cell growing power was weakened and the apoptosis rate increased, and the cell migration had no difference.@*CONCLUSION@#The expression of TRAF1 is up-regulated in gastric cancer cell lines BGC823, SGC7901, and MGC803, and the most obvious one is BGC823. The interference targeting TRAF1 can successfully inhibit the expression of TRAF1 in gastric cancer cell line BGC823. TRAF1 can inhibit the apoptosis of BGC823 cells.

Effect of macrophages on ulcerative colitis-associated carcinogenesis / 中南大学学报(医学版)

Ulcerative colitis is a non-specific colorectal inflammation of unknown causes. It is now known to complicate the dangers of colorectal cancer more than was previously thought. Macrophages are an important part of immune system and play a positive role in immune reaction. But it has been shown that the phenotype and the function of macrophages change in the tumor microenvironment. Through their interaction with colorectal cancer cells and by releasing large quantities of cytokines, macrophages promote colorectal cancer cells by inhibiting angiogenesis and inhibit apoptosis. But the macrophages are also affected by cancer, interact with other inflammatory cells, and become immune suppressed. Thus the changes of macrophages are inseparable with colitis-associated colorectal carcinogenesis.

Interest teaching of diagnostics and comprehensive quality training of medical students / 中华医学教育探索杂志

There were some limitations existed in current teaching mode of diagnostics,including simple evaluation methods,mechanical internship for body sign,tedious internship for laboratory diagnosis and unsustainable interest-stimulating.Interest teaching was proposed in the teaching reform and some concert measures were implemented including interesting inquiry,interesting skill examination,interesting teaching of laboratory diagnostics,simulated case discussion,interesting training of centesis as well as interesting clinical involvement and interesting medical community activities.The interesting teaching contributed to the improvement of students'comprehensive analysis ability,practical ability,adaptability,humanistic quality,English communication ability and doctor-patient communication,which is of grate importance.

Influence of age on sedation for colonoscopy in adults / 中南大学学报(医学版)

OBJECTIVE@#To investigate the efficacy and risk of midazolam and propofol for sedation during colonoscopy procedures in adults of different age groups.@*METHODS@#A total of 180 patients undergoing colonoscopy were allocated to 3 groups: a young adult group (n=45, 18-44 years), a mid-aged group (n=78,45-64 years) and an elderly group (n=57, 65-80 years). All patients were premedicated with midazolam 0.02-0.03 mg/kg and propofol 0.5-2.5 mg/kg. The pulse rate, arterial pressure, and oxygen saturation for each patient were monitored continuously before, during and after the procedure.@*RESULTS@#The doses of midazolam and propofol for the young adults were significantly higher than that for the mid-aged and the elderly (P0.05).@*CONCLUSION@#Higher dose of midazolam and propofol is needed to obtain the sedation quality in young adults. Whereas for the elderly, properly reducing the dose of midazolam and propofol may still keep the sedation quality during colonoscopy procedures.

Transcriptomic regulation and molecular mechanism of polygenic tumor at different stages / 中南大学学报(医学版)

The research team on the National Key Scientific Program of China: "Transcriptomic regulation and molecular mechanism research of polygenic tumor at different stages" has focused on the field of transcriptomics of 4 common polygenic tumors, including nasopharyngeal carcinoma(NPC), breast cancer, colorectal cancer, and glioma. Extensive laboratory work has been carried out on the expression and regulation of tumor transcriptomics; identification of tumor suppressor/susceptible genes; mechanism of tumor epigenetics including miRNAs, and comparative study of specific gene/protein cluster of tumor transcriptomics and proteomics. Genes including SPLUNC1, LTF, BRD7, NOR1, BRCA1/2, PALB2, AF1Q, SOX17, NGX6, SOX7, and LRRC4 have been identified as the key transcriptional regulation genes during the stage of tumor initiation and invasion. Accordingly,the NPC gene signal regulation network of "SPLUNC1-miR-141-target genes", the breast cancer interaction signal pathway of "miR-193b-uPA",the glioma signal network of "miR-381- LRRC4-MEK/ERK/AKT", and the miRNA-target gene network of colorectal cancer metastasis related gene NGX6 have been thoroughly elucidated. These fruitful Results imply that the changes of key molecules in crucial signal pathway will cause severe dysfunction in signal transduction and gene regulation network in polygenic tumors, indicating that in the category of pathogenesis,these tumors may further classify as the "Disease of gene signal transduction and gene regulation network disorder". The researches have laid solid foundation for revealing the molecular mechanism and transcriptomic regulation of polygenic tumors at different stages.

Inflammatory factors promote the development of colorectal cancer / 中南大学学报(医学版)

OBJECTIVE@#To study the change of inflammatory factors at different stages of colorectal cancer (CRC).@*METHODS@#Thirty normal subjects, 30 patients with colorectal adenomatous polyps and 120 CRC patients at different stages were enrolled. IgG, IgM, and IgA levels, the inflammatory cytokines IL-2, 4, 6, 10, and 12 and the expression of TGF-β 1 and VEGF in the serum were analyzed by ELISA or immunoturbidimetry.@*RESULTS@#The serum concentrations of IL-12, TGF-β 1, and IL-6 in the CRC patients were statistically different compared with the normal and adenomatous polyps, and increased as the disease progressed (P0.05). The serum level of IgG, IgM, and IgA in the 3 groups showed no significant difference (P>0.05).@*CONCLUSION@#The serum level of inflammatory cytokines TGF-β 1, IL-6, and IL-12 increases gradually with the development of CRC, which may change the microcirculation of patients with CRC, and promote the development of CRC.

Efficacy of sequential therapy with pantoprazole in gastro esophageal reflux disease / 中南大学学报(医学版)

OBJECTIVE@#To observe the clinical efficacy of sequential therapy with pantoprazole in patients with gastro esophageal reflux disease (GERD).@*METHODS@#A total of 80 patients with GERD were double-blindedly randomized into 2 groups: 40 patients received sequential therapy with pantoprazole 40 mg injection, twice daily for 2 weeks, and then pantoprazole 40 mg oral administration,twice daily for 2 weeks; the other 40 patients received pantoprazole 40 mg oral administration alone,twice daily for 4 weeks. Doctors and patients recorded the severity and frequency of heartburn before and during the treatment. The curative effects of the 2 groups were compared.@*RESULTS@#The total effective rate in the sequential therapy group was higher than that of the oral administration group(95.0% vs 77.5%, P<0.05).@*CONCLUSION@#Pantoprazole sequential therapy is effective for GERD.