Causal relationships between dietary habits and Barrett's esophagus risk: a univariable and multivariable Mendelian randomization study.

Aims: Dietary habits are reported to be associated with Barrett's esophagus (BE) risk; however, whether there is a causal relationship remains controversial. Here, we systematically examined the causal effects of genetically predicted dietary habits on BE risk through a Mendelian randomization (MR) analysis approach. Methods: Data for exposures were obtained from the UK Biobank (UKB), while the summary-level data for outcomes were obtained from a large sample-size GWAS meta-analysis. Genetic variants associated with 17 ordinary dietary habits at the genome-wide significance level were regarded as instrumental variables (IVs). Univariable and multivariable MR analyses were conducted to explore the causal relationships between dietary habits and BE risk. Sensitivity analyses were implemented to evaluate robustness of the results and determine the potential pleiotropy bias. Results: Univariable MR (UVMR) analysis showed that genetic predisposition to alcohol intake frequency, cooked vegetable intake, beef intake, bread intake, fresh fruit intake, salad/raw vegetable intake, and dried fruit intake were associated with BE risk, with all P values <0.05. After adjusting confounders, the effects of four dietary habits on BE risk persisted; multivariable MR (MVMR) analysis revealed that alcohol intake frequency (adjusted odds ratio (OR) = 1.74 (1.34, 2.27); P = 3.42 × 10-5) was causally associated with higher BE risk, the cooked vegetable intake (adjusted OR = 2.64 (1.16, 5.97); P = 0.02) had suggestively increased BE risk, while higher consumption of bread (adjusted OR = 0.54 (0.32-0.91); P = 0.02) and fresh fruit (adjusted OR = 0.34 (0.15, 0.77); P = 0.01) were suggestively associated with lower BE risk. Conclusions: These MR analyses demonstrate evidence of causal relationships between dietary habits and BE risk. These findings provide new insights into targeted dietary intervention strategies for BE prevention.

Analysis on the risk factors and establishment of a prediction model for primary non-response to the treatment of anti-tumor necrosis factor-α monoclonal antibody in Crohn′s disease patients / 中华消化杂志

Objective:To investigate the risk factors and establish a prediction model of primary non-response (PNR) to anti-tumor necrosis factor-α(TNF-α) monoclonal antibody in Crohn′s disease (CD) patients.Methods:From December 1, 2018 to July 31, 2022, 103 patients with CD treated with the anti-TNF-α monoclonal antibody in Renmin Hospital of Wuhan University were enrolled (modeling group), and at the same time, 109 patients with CD treated with anti-TNF-α monoclonal antibody in Zhongnan Hospital of Wuhan University were selected (validation group). The baseline clinical data of all the patients before the first treatment of anti-TNF-α monoclonal antibody were collected, which included C-reactive protein (CRP), the simplified Crohn′s disease activity index (CDAI), and modified multiplier simple endoscopic score for Crohn′s disease (MM-SES-CD), etc. Multivariate logistic regression was used to screen the independent risk factors of PNR in patients with CD treated with the anti-TNF-α monoclonal antibody, and to establish the nomograms prediction model. The area under the curve (AUC) of the receiver operating characteristic curve (ROC), the net reclassification index (NRI), integrated discrimination improvement index (IDI), and decision curve analysis (DCA) were used to evaluate the predictive efficacy and clinical application value of the prediction model. DeLong test was used for statistical analysis.Results:The results of multivariate logistic regression analysis showed that high level of CRP ( OR=1.030, 95% confidence interval (95% CI) 1.002 to 1.059), simplified CDAI ( OR=1.399, 95% CI 1.023 to 1.913), and MM-SES-CD ( OR=1.100, 95% CI 1.025 to 1.181) in baseline were independent risk factors of PNR in patients with CD treated with the anti-TNF-α monoclonal antibody ( P=0.033, 0.036 and 0.008). The results of ROC analysis showed that the AUCs of CRP, simplified CDAI, MM-SES-CD, and the prediction model in the modeling group and the validation group were 0.697(95% CI 0.573 to 0.821), 0.772(95% CI 0.666 to 0.879), 0.819(95% CI 0.725 to 0.912), 0.869 (95% CI 0.786 to 0.951) and 0.856 (95% CI 0.756 to 0.955), respectively. The AUC of the prediction model in the modeling group was greater than those of CRP and simplified CDAI, and the differences were statistically significant ( Z=3.00 and 2.75, P=0.003 and 0.006), while compared with MM-SES-CD and the validation group, the differences were not statistically significant (both P>0.05). However, compared with MM-SES-CD, the NRI and IDI of the prediction model in the modeling group were 0.205(95% CI 0.002 to 0.409, P=0.048) and 0.098(95% CI 0.022 to 0.174, P=0.011), respectively, suggesting that the predictive ability of the prediction model was better than that of MM-SES-CD. The results of DCA indicated that the prediction model had significant clinical benefits in both the modeling group and the validation group. Conclusions:A prediction model was successfully constructed based on the independent risk factors for PNR in patients with CD treated with the anti-TNF-α monoclonal antibody. After verification, the prediction model has good prediction performance and significant clinical benefits.

Effects of biologics on psychological status and quality of life in patients with inflammatory bowel disease: a multicenter study / 中华内科杂志

Objective:To investigate the effects of biologics on psychological status and quality of life in patients with inflammatory bowel disease (IBD).Methods:A cross-sectional survey was conducted in 42 hospitals in 22 provinces (autonomous regions and municipalities directly under the central government) from September 2021 to May 2022. General clinical information and the use of biologics were obtained from adult patients diagnosed with IBD who voluntarily participated in the study. Psychological status was evaluated using the Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Pittsburgh Sleep Quality Index (PSQI), and Inflammatory Bowel Disease Questionnaire (IBDQ) assessment tools. Counts were analyzed via the Chi-square test, and datasets that were not normally distributed were analyzed via nonparametric tests. P<0.05 was considered statistically significant. Results:A total of 2 478 valid questionnaires were collected. The GAD-7 score of the biologics group was significantly lower than that of the non-use group [6 (2, 9) vs. 7 (3, 10), Z=-3.49, P<0.001]. IBDQ scores [183 (158, 204) vs. 178 (152, 198), Z=-4.11, P<0.001], intestinal symptom scores [61 (52, 67) vs. 58 (49, 65), Z=-5.41, P<0.001], systemic symptom scores [28 (24, 32) vs. 27 (23, 31), Z=-2.37, P=0.018], emotional ability scores [69 (58, 77) vs. 67 (56, 75), Z=-3.58, P<0.001] and social ability scores [26 (22, 29) vs. 25 (22, 29), Z=-2.52, P=0.012] in the biologics group were significantly higher than in the non-use group. GAD-7 scores [5 (2, 9) vs. 6 (3, 10), Z=-3.50, P<0.001] and PSQI scores [6 (4, 9) vs. 6 (4, 9), Z=-2.55, P=0.011] were significantly lower in the group using infliximab than in the group not using it. IBDQ scores were significantly higher in patients using vedolizumab than in those not using it [186 (159, 205) vs. 181 (155, 201), Z=-2.32, P=0.021] and were also significantly higher in the group treated with adalimumab than in the group not treated with adalimumab [187 (159, 209) vs. 181 (155, 201), Z=-2.16, P=0.030]. However, ustekinumab had no significant effect on any of the scores. Conclusion:The use of biologics is strongly associated with improvements in anxiety status and quality of life in IBD patients.

Prevention of liver fibrosis in mice by ethanol extract of Euonymus alatus and its preliminary mechanism / 中华消化杂志

Objective:To study the role of ethanol extract of Euonymus alatus stems (EAT) and ethanol extract of Euonymus alatus wings (EAW) in anti-hepatic fibrosis induced by carbon tetrachloride in mice, and to explore its preliminary mechanism. Methods:Sixty C57BL/6 mice were selected and randomly divided into healthy control group, carbon tetrachloride model (CTM) group, EAW low dose (EAW-L) group, EAW high dose (EAW-H) group, EAT low dose (EAT-L) group and EAT high dose (EAT-H) group, with 10 mice in each group. Three days before modeling, the mice of EAT-L, EAT-H, EAW-L and EAW-H group were gavaged with EAT or EAW at 2.0 or 8.0 g/kg, respectively, and the mice of healthy control group and CTM group were gavaged with equal volume of pure water, once a day till the 30th day after modeling (total 33 times). Five percent carbon tetrachloride olive oil solution was intraperitoneally injected at 8 mL/kg to establish liver fibrosis model in CTM, EAT-L, EAT-H, EAW-L and EAW-H groups. The mice in the healthy control group were intraperitoneally injected with equal volume of 0.9% sodium chloride solution, twice per week for 30 days, and a total of 9 times of injection. The liver index, serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil) and interleukin-6 (IL-6) were detected. Hematoxylin-eosin and Masson staining were used to observe the pathological changes of mouse liver tissue and calculate the collagen volume fraction. The liver inflammatory response and fibrosis degree were evaluated by histological activity index (HAI) and Ishak system score. The level of α-smooth muscle actin(α-SMA)in liver tissue was both detected by immunohistochemistry and Western blotting. The expression of matrix metalloproteinase 2 (MMP2) and extracellular signal-regulated kinase (ERK) 1/2 at protein and mRNA level was detected by Western blotting and fluorescent quantitative polymerase chain reaction. Analysis of variance, Tukey test and Dunn test were used for statistical analysis.Results:The hepatic indexes of EAW-L, EAW-H and EAT-H groups were lower than that of CTM group(0.06±0.01, 0.05±0.01 and 0.05±0.01 vs. 0.07±0.01), and the differences were statistically significant ( q=5.12, 7.70, 7.11; all P<0.01). The serum ALT and AST levels of EAW-L, EAW-H, EAT-L and EAT-H groups were lower than those of CTM group((601.76±141.38), (283.35±42.32), (734.74±116.06) and (391.60±34.33) U/L vs.(982.45±96.04) U/L, (509.49±152.29), (345.41±67.39), (282.30±65.72) and(243.23±45.20) U/L vs.(766.01±114.49) U/L), and the differences were statistically significant ( qALT =9.88, 20.81, 7.65, 17.58, qAST =5.11, 12.52, 14.92, 15.56; all P<0.001). The serum TBil levels of EAW-H and EAT-H groups were lower than that of CTM group((6.81±0.49) and (7.08±1.78) μmol/L vs.(12.68±3.28) μmol/L), and the differences were statistically significant( q=6.31, 6.01; both P<0.01). The serum IL-6 levels of EAW-L, EAW-H, EAT-L and EAT-H groups were lower than that of CTM group((29.26±5.42), (24.28±4.75), (9.05±1.74) and (8.01±1.24) ng/L vs.(53.21±10.05) ng/L); the serum IL-6 level of EAT-L group was lower than that of EAW-L group; the serum IL-6 level of EAT-H group was lower than that of EAW-H group, and the differences were statistically significant( q=12.20, 14.73, 22.48, 22.11, 10.28, 7.96; all P <0.001). The collagen volume fractions of EAW-L, EAW-H, EAT-L and EAT-H groups were lower than that of CTM group (6.15±1.09, 2.91±0.76, 7.07±1.37 and 5.31±0.80 vs. 12.36±1.96); the collagen volume fraction of EAW-H group was lower than that of EAW-L, EAT-L and EAT-H groups, and the differences were statistically significant( q=11.68, 17.78, 9.94, 13.25; 6.10, 7.84, 4.53; all P <0.05). The HAI and Ishak system scores of EAW-H and EAT-H groups were lower than those of CTM group (6.0 (5.5, 7.5) and 7.0 (6.0, 7.5) vs. 13.0 (12.0, 13.0), 1.0 (1.0, 2.0) and 2.0 (1.0, 2.0) vs. 4.0 (3.0, 4.0)), and the differences were statistically significant( ZHAI=3.38, 3.23, Zlshak=3.22, 3.03; all P<0.05). The result of immunohistochemical analysis showed that the expression levels of α-SMA in the mice liver tissues of EAW-L, EAW-H, EAT-L, EAT-H and CTM groups were 4.76±0.36, 2.75±0.29, 3.72±0.34, 5.20±0.79 and 5.98±0.52, respectively. The result of Western blotting showed that the expression levels of α-SMA in the mice liver tissues of CTM, EAW-L, EAW-H, EAT-L and EAT-H groups were 0.96±0.11, 0.67±0.07, 0.22±0.01, 0.78±0.08 and 0.68±0.07, respectively. Two detection methods both showed that the expression levels of α-SMA of EAW-L, EAW-H and EAT-H groups were lower than that of CTM group; the expression level of α-SMA of EAW-H group was lower than that of EAW-L, EAT-L and EAT-H group, and the differences were statistically significant( qimmunohistochemical =6.06, 15.95, 11.18, 9.92, 12.10 and 4.79, qWestern blotting=7.29, 18.34, 6.84, 11.05, 13.97 and 11.49, all P<0.05). The expression levels of MMP2 and ERK1/2 at protein and mRNA levels in the mice liver tissues of EAW-L, EAW-H, EAT-L, EAT-H and CTM groups were 0.18±0.04, 0.16±0.04, 0.28±0.02, 0.21±0.02 and 0.84±0.02, 0.80±0.02, 0.57±0.08, 0.83±0.03, 0.69±0.02 and 0.91±0.04, 18.74±1.90, 10.73±1.24, 24.99±1.84, 7.19±0.48 and 24.68±1.18, 29.44±4.47, 11.96±0.53, 24.75±4.04, 5.30±0.36 and 35.76±0.85, respectively. The expression levels of MMP2 at protein level in EAW-L, EAW-H, EAT-L and EAT-H groups were lower than that in CTM group; the expression levels of ERK1/2 at protein level in EAW-H and EAT-H groups were lower than that in CTM group; the expression level of ERK1/2 at protein level in EAW-H group was lower than that in EAT-H group; the expression levels of MMP2 and ERK1/2 at mRNA level in EAW-H and EAT-H group were lower than those in CTM group; the expression levels of MMP2 and ERK1/2 at mRNA level in EAW-H group were lower than those in EAW-L group; the expression levels of MMP2 and ERK1/2 at mRNA level in EAT-H group were lower than those in EAT-L and EAW-H groups, and the differences were statistically significant( q=22.15, 22.96, 18.87, 21.31; 13.42, 8.53; 4.90; 18.57, 23.29, 16.49, 21.11; 10.66, 12.12; 23.70, 15.38, 13.48, 16.73; all P<0.05). Conclusions:Both EAT and EAW can alleviate carbon tetrachloride-induced liver injury and liver fibrosis in mice, which may be related with inhibiting the expression of ERK1/2 and IL-6 and then affecting the Ras/ERK-MMP2 signaling pathway.

Diagnostic and therapeutic value of emergency gastroscopy for upper gastrointestinal bleeding combined with post percutaneous coronary intervention / 中华消化内镜杂志

From June 2015 to June 2020, 52 patients who underwent emergency gastroscopy and treatment for upper gastrointestinal bleeding after percutaneous coronary intervention (PCI) at the Renmin Hospital of Wuhan University were included and retrospectively analyzed. The etiologic diagnosis of bleeding, results of hemostatic treatment and occurrence of complications during the emergency gastroscopy were observed. Among the 52 patients, 47 cases (90.4%) were found to have lesions that could explain upper gastrointestinal bleeding under emergency gastroscopy, and the remaining 5 cases (9.6%) could not clearly diagnose the cause of bleeding. Twenty-six cases (50.0%) were treated with emergency endoscopic hemostasis, of which 25 cases (96.2%) were successful. The median time for emergency endoscopy was 18 min. Seven cases (13.5%) had transient slowing of heart rate and lowering of blood pressure without serious complications. This shows that emergency gastroscopy is safe and effective in the diagnosis and treatment of upper gastrointestinal bleeding combined with post-PCI.

A multicenter survey on the psychological status and quality of life of patients with inflammatory bowel disease in China / 中华消化杂志

Objective:To investigate the psychology status and quality of life in patients with inflammatory bowel disease(IBD) in China, and to analyze the influencing factors.Methods:From September 2021 to May 2022, 42 hospitals in 22 provinces(autonomous regions and municipalities directly under the central government) in China, the clinical data of 2 478 IBD patients were collected, which included age, gender, weight, first visit or not, disease activity, disease course, main clinical manifestations(diarrhea, abdominal pain, hematochezia, extraintestinal manifestations), complications, treatment medication(5-aminosalicylic acid, glucocorticoids, immunosuppressive agents, and biological agents), and whether to have surgery. Anxiety, depression, sleep quality and quality of life of IBD patients were evaluated by generalized anxiety disorder-7 items, patient health questionnaire-9 items, Pittsburgh sleep quality index and inflammatory bowel disease questionnaire, and the related influencing factors were analyzed. Univariate analysis and multiple linear regression analysis were used for statistical analysis.Results:The average age of 2 478 IBD patients was 37.96 years old, and male counted for 62.43%(1 547/2 478). There were 61.82%(1 532/2 478) of the IBD patients in the active stage of disease, mostly mild or moderate(588 and 734 cases). There were 60.61%(1 502/2 478) of the IBD patients with different degrees of anxiety, 58.35%(1 446/2 478) of the IBD patients with different degrees of depression, and 48.87%(1 211/2 478) of the IBD patients had different degrees of sleep problems. The results of multiple linear regression analysis indicated that female, higher level of disease activity and longer disease course were independent risk factors of anxiety, depression and sleep quality in the IBD patients(unstandardized regression coefficient(95% confidence interval) 1.08(0.65 to 1.50), 0.45(0.23 to 0.68), 0.19(0.02 to 0.36), 0.83(0.33 to 1.32), 0.62(0.36 to 0.88), 0.28(0.08 to 0.47), 0.47(0.16 to 0.77), 0.39(0.23 to 0.55), 0.14(0.02 to 0.26); P<0.001, <0.001, =0.025 , =0.001, <0.001, =0.005, =0.003, <0.001, =0.027). The usage of biological agents was an independent protective factor of anxiety(unstandardized regression coefficient(95% confidence interval) -0.67(-1.17 to -0.17), P=0.008), and older age was an independent risk factor of sleep quality(unstandardized regression coefficient(95% confidence interval) 0.35(0.09 to 0.61), P=0.008). Higher level of disease activity, symptoms of diarrhea, abdominal pain, presence of extraintestinal manifestations, usage of 5-aminosalicylic acid and glucocorticoid, and with surgical treatment were independent risk factors of quality of life(unstandardized regression coefficient(95% confidence interval) -11.00(-12.24 to -9.76), -2.90(-5.26 to -0.55), -3.93(-6.25 to -1.61), -5.79(-9.87 to -1.71), -4.78(-7.79 to -1.76), -7.71(-11.07 to -4.35), -4.37(-8.00 to -0.73); P<0.001, =0.016, =0.001, =0.005 , =0.002, <0.001, =0.019), while the usage of biological agents was an independent protective factor of quality of life (unstandardized regression coefficient(95% confidence interval) 4.72(1.97 to 7.48), P=0.001). Conclusion:IBD patients generally have different degrees of anxiety, depression and sleep problems, which affect the quality of life of patients. Gender, disease activity and disease course are the influencing factors of mental disorders in IBD patients.

The mechanism of microRNA-124-3p in regulating proliferation and invasion of gastric cancer cell by aryl hydrocarbon receptor-activated β-catenin pathway / 中华消化杂志

Objective:To explore the value of microRNA(miR)-124-3p and its target gene aryl hydrocarbon receptor (AHR) in the diagnosis and prognostic evaluation of gastric cancer, and the related molecular mechanisms in regulating proliferation and invasion of gastric cancer cell.Methods:The clinical and prognostic characteristics of patients with gastric adenocarcinoma expressing miR-124-3p were obtained from The Cancer Genome Atlas database and Genotype-Tissue Expression database. The correlation between miR-124-3p expression level and pathological stage, TNM stage, overall survival (OS), disease-specific survival (DSS) and progression-free interval (PFI) in patients with gastric adenocarcinoma were studied by bioinformatics analysis. The interaction sites between miR-124-3p and AHR mRNA were predicted by Target Scan 7.1 online tool. The target binding sites of miR-124-3p in AHR mRNA were verified by subcutaneous tumorigenesis experiment in mice, immunohistochemistry, dual luciferase assay, quantitative real time-polymerase chain reaction (RT-qPCR) and Western blotting. Nine male Balb/c nude mice, aged 4 to 6 weeks with weight of (18.43±0.29) g were injected with miR-124-3p simulant (miR-124-3p group), negative control simulant (negative control group) and 0.9% sodium chloride solution (sodium chloride control group) through the tail vein. Gastric cancer cell lines (MKN-45, AGS) were transfected with RNA simulants (including miR-124-3p simulant, negative control simulant and 0.9% sodium chloride solution). The expression of AHR and Catenin β 1 gene ( CTNNB1) at mRNA level, the expression of AHR and β-catenin at protein level in 3 mice groups and the effects of miR-124-3p transfection on the proliferation and invasion of transfected gastric cancer cells were analyzed. Pearson correlation analysis and Holm-Sidak corrected multiple t test were used for statistical analysis. Results:Low expression of miR-124-3p was positively correlated with severe pathological stages and TNM stages in patients with gastric adenocarcinoma ( R2=0.83 and 0.86, P=0.031 and 0.023). High expression of miR-124-3p was positively correlated with OS, DSS and PFI ( R2=1.00, 0.99 and 0.99, P=0.029, 0.044 and 0.049). The results of subcutaneous tumorigenesis experiment in mice demonstrated that the number of apoptotic cells in the tumor of miR-124-3p group was more than that of negative control group and sodium chloride control group ((43.33±1.86)/high power field (HPF) vs. (20.00±1.73)/HPF and (18.67±1.76)/HPF), and the differences were statistically significant ( t=8.55 and 8.33, P=0.013 and 0.014). The results of immunohistochemistry showed that the optical density of AHR protein in mice tumor tissue of miR-124-3p group was lower than that of negative control group and sodium chloride control group (0.081±0.008 vs. 0.276±0.019 and 0.273±0.018), and the differences were statistically significant ( t=9.06 and 7.51, P=0.012 and 0.017). The results of dual luciferase assay indicated that the fluorescence intensity in wild-type AHR MKN-45 cells transfected with miR-124-3p simulant was lower than that of negative control group (0.293±0.020 vs. 1.000±0.032), and the difference was statistically significant ( t=18.56, P<0.001). The results of RT-qPCR demonstrated that the mRNA levels of AHR and CTNNB1 in MKN-45 cells transfected with miR-124-3p simulant were both lower than those in untreated MKN-45 cells (0.51±0.09 vs. 1.02±0.02, 0.46±0.03 vs. 1.03±0.01), and the differences were statistically significant ( t=4.51 and 16.60, P=0.046 and 0.004). The results of Western blotting experiments showed that the relative protein expression levels of AHR and β-catenin of MKN-45 cells transfected with miR-124-3p simulant were lower than those of transfected with 0.9% sodium chloride solution and negative control simulant (3 332.94±81.25 vs. 9 041.60±439.79 and 8 276.54±562.52, 2 725.79±167.57 vs. 9 701.94±410.02 and 8 081.66±275.84), and the differences were statistically significant ( t=15.49, 7.91, 17.35 and 19.42, P=0.004, 0.016, 0.003 and 0.003). Conclusions:MiR-124-3p is correlated with diagnosis and prognosis of gastric cancer. MiR-124-3p induces apoptosis of gastric cancer cells in vitro and vivo by negatively regulating AHR expression at mRNA and protein level, thereby down-regulating the expression of CTNNB1 mRNA and β-catenin pathway-related protein. Therefore, miR-124-3p may become a potential diagnostic and prognostic marker of gastric cancer.

Clinical characteristics of 70 patients with coronavirus disease 2019 accompanied with diarrhea / 中华消化杂志

Objective:To retrospectively analyze the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) accompanied with diarrhea.Methods:From January 11 to February 6 in 2020, the clinical data of 663 patients diagnosed with COVID-19 admitted to Renmin Hospital of Wuhan University were collected and divided into diarrhea group and non-diarrhea group according to whether they had diarrhea or not. The differences in baseline characteristics, basic disease history, clinical manifestations, chest computed tomography (CT), laboratory findings, disease severity and mortality between the two groups were compared. Chi-square test and Fisher exact test were used for statistical analysis.Results:Among 663 COVID-19 patients, 70 (10.6%) patients accompanied with diarrhea. The proportion of fatigue and increased lactate dehydrogenase (LDH) levels of diarrhea group were higher than those of non-diarrhea group (58.6%, 41/70 vs. 28.2%, 167/593; and 64.2%, 43/67 vs. 50.4%, 277/550), and the differences were statistically significant ( χ2=26.891 and 4.566, both P<0.05). There was no statistically significant difference in the proportion of pneumonia in chest CT between diarrhea group and non-diarrhea group (100.0%, 62/62 vs. 99.4%, 529/532) ( P>0.05). There were no statistically significant differences in the proportions of mild and normal type, severe type and critical type between diarrhea group and non-diarrhea group (35.7%, 25/70 vs. 38.6%, 229/593; 50.0%, 35/70 vs. 47.2%, 280/593; and 14.3%, 10/70 vs. 14.2%, 84/593, respectively) (all P>0.05). There were no statistically significant differences in the mortality of mild and normal type, severe type and critical type between diarrhea group and non-diarrhea group (0 vs. 0.5%, 3/593; 0 vs. 0 and 1.4%, 1/70 vs. 3.5%, 21/593) (all P>0.05). Conclusions:Patients with COVID-19 accompanied with diarrhea are more likely to have fatigue and increased LDH level. Diarrhea is not significantly correlated with the disease severity of patients with COVID-19.

Analysis of clinical characteristics of asymptomatic carriers with 2019 novel coronavirus / 中华传染病杂志

Objective:To investigate the clinical characteristics of asymptomatic carriers with 2019 novel coronavirus (2019-nCoV), and to provide clinical guidance for the management of asymptomatic infection with 2019-nCoV.Methods:The clinical data of 663 patients with confirmed coronavirus disease 2019 (COVID-19) admitted to Renmin Hospital of Wuhan University from January 11 to February 6, 2020 were collected. Patients were divided into asymptomatic group (21 cases) and symptomatic group (642 cases) according to the diagnostic criteria. General conditions, clinical classification, death, chest computed tomograph (CT) and laboratory results of patients were retrospectively collected. Mann-Whitney U test, chi-square test and Fisher exact test were used for statistical analysis. Results:All 663 patients were positive for 2019-nCoV nucleic acid tests. The age of patients in the asymptomatic group were significantly younger than those in symptomatic group (35.0 (31.5, 58.0) years old vs 58.5 (45.0, 69.0) years old, U=4 234.500, P=0.002). The proportion of patients <30 years old in the two groups was significantly different (19.0%(4/21) vs 6.1%(39/642), Fisher exact test, P=0.047). There were 15 women (71.4%) in the asymptomatic group and 327 women (50.9%) in the symptomatic group, while the difference of gender distributions was not statistically significant ( χ2=3.420, P=0.064). In addition, among patients with asymptomatic infection, the proportions of mild/ordinary, severe and critical patients were 10 cases (47.6%), 10 cases (47.6%), and one case (4.8%), respectively, which were not significantly different from those in symptomatic group (244 cases (38.0%), 305 cases (47.5%) and 93 cases (14.5%), respectively, χ2=1.847, P=0.397). As of February 9, one(4.8%) mild/ordinary patient in the asymptomatic group died who had malignant tumor. Twenty-four (3.7%) patients in the symptomatic group died including two mild/ordinary and 22 critical patients. There was no significant difference in mortality between the two groups(Fisher exact test, P=0.560). CT examination was performed on 594 patients, and 591 cases (99.5%) showed unilateral or bilateral pneumonia, and three cases (0.5%) showed normal. Conclusions:Patients with asymptomatic infection with 2019-nCoV are younger than symptomatic patients, and there are more patients under 30 years old in the asymptomatic group. The absence of clinical symptoms is not significantly associated with clinical classifications and mortality in COVID-19 patients.

Recent advances in relationship of Fusobacterium nucleatum to intestinal immunity / 中华微生物学和免疫学杂志

Gut microbial ecosystem is closely related to the immune system and influences human health. Fusobacterium nucleatum ( F. nucleatum) is one of the species of great concern. Increasing evidence shows that F. nucleatum promotes intestinal inflammation and influences the tumor-associated immune micro-environment. This review focused on the recent progress in the influence of F. nucleatum on intestinal immu-nity and the pathogenesis of intestinal diseases in order to discover the immune mechanism of F. nucleatum-associated intestinal diseases and find new therapeutic targets for immunotherapy.

Effects of diagnostic delay on early disease course of Crohn's disease / 中华消化杂志

Objective To explore the effects of diagnostic delay on early disease course of Crohn's disease (CD ), and to analyze the risk factors related with the progress of early disease course. Methods From December 2014 to July 2017,a total of 56 patients in Renmin Hospital of Wuhan University initially diagnosed as CD were selected.The clinical manifestation,previous history,imaging examination, endoscopic examination and pathological results of the patients were collected after initial diagnosis of CD. CD-related surgery,CD-related rehospitalization and use of immunomodulators were followed.According to time interval between initial symptom onset and initial diagnosis,the patients were divided into diagnostic delay group (diagnostic delay time＞two years,14 cases)and non-diagnostic delay group (diagnostic delay time≤two years,42 cases).The clinical characteristics at initial diagnosis and early prognosis were compared between the two groups.The risk factors affecting early prognosis of CD patients were analyzed. Kaplan-Meier was used for prognosis analysis.Log-rank test and Cox proportional hazards model were performed to analyze factors affecting early prognosis.Results The results of imaging examination indicated that the proportion of intestinal injury of diagnostic delay group was significantly higher than that of non- diagnostic delay group (χ2＝ 4.49,P ＝ 0.03 ).During follow-up,the proportion of CD-related rehospitalization of diagnostic delay group was higher than that of non-diagnostic delay group,and the difference was statistically significant (χ2＝7.34,P＝0.01).During follow-up,the nine patients received surgery.The one-year and three-year cumulative incidence of surgery was 10.7% and 22.7%,respectively;one-year cumulative incidence of surgery in diagnostic delay group and non-diagnostic delay group was 38 .6%and 9 .6%,respectively.The results of Cox univariable and multivariable analyses both indicated that intestinal injury in imaging examination at diagnosis was the risk factor of surgery (both hazard ratio (HR)＝2.313,both P＜0.01).A total of 21 patients had CD-related rehospitalization during follow-up.And one-year and 31-month cumulative incidence of hospitalization was 27 .8% and 5 6 .3%,respectively;one-year cumulative incidence of CD-related rehospitalization in diagnostic delay group and non-diagnostic delay group was 43 .7% and 2 1 .6%,respectively;and the difference was statistically significant (χ2＝5 .88 ,P＝0.02).The results of Cox univariable analysis indicated that having systematic manifestation,intestinal inj ury in imaging examination and diagnostic delay were the risk factors of CD-related rehospitalization (HR＝2.972,2.313 and 1.403,all P＜0.05).The results of multivariable analysis indicated that having systematic manifestation and intestinal injury in imaging examination were independent risk factors of CD-related rehospitalization (HR＝3.891 and 2.541, P ＜ 0.01,respectively).Conclusions The proportion of intestinal injury of patients with diagnostic delay is high and the early prognosis is poor. Intestinal injury in imaging examination at initial diagnosis is independently risk factor of CD-related surgery and rehospitalization during follow-up.

Recent progress of vitamin C in management of sepsis / 中华全科医师杂志

Sepsis is frequently associated with multi-system organ dysfunction and refractory hypotension,leading to a high mortality and poor prognosis.As an antioxidant,ascorbic acid (vitamin C) is an important auxiliary factor for many enzymes in the organism.Numerous studies have revealed that vitamin C can attenuate the inflammatory response,improve microcirculatory and hypotension in sepsis,and also can enhance the role of catecholamine in central nervous system,to prevent sepsis-induced organ failure and improve prognosis of patients.

Research advances on bifidobacterium and inflammatory bowel disease / 中华全科医师杂志

Inflammatory bowel disease (IBD) is achronic and relapsing inflammation of the intestinal tract.The pathogenesis of IBD is still unknown.In recent years,the research on the relationship between intestinal flora and IBD has become a hot topic.The change of intestinal flora may be one of the important pathogenic factors of IBD.Bifidobacterium is known as one of the probiotics in the intestine,the change of the bifidobacterium flora is closely related to the pathogenesis of IBD.It can effectively reduce the intestinal inflammatory response of IBD patients by enhancing the mucosal barrier function,regulating intestinal immunity and intestinal flora.The regulation of bifidobacterium in the intestine may have a positive effect on the treatment of IBD.

Comparison of the gastric residual volume between conventional single-dose and split-dose bowel preparation before colonoscopy under general anesthesia / 中华消化杂志

Objective To explore the difference in gastric residual volume (GRV) between singledose and split-dose bowel preparation before colonoscopy under general anesthesia.Methods From October 8th to December 30th in 2016,the out-patients undergoing gastroscopy and colonoscopy with anesthesia services on the same day were selected and divided into the traditional single-dose bowel preparation group and split-dose bowel preparation group.The GRV and intestinal preparation quality were compared between the two groups.T test was used for statistical analysis and multiple linear regression analysis was performed for the influence factors of GRV analysis.Results A total of 121 patients were enrolled,60 patients in the spilt-dose bowel preparation group and 61 in the traditional single-dose bowel preparation group.The mean GRV of the split-dose bowel preparation group was (17.3 ± 12.2) mL,which was lower than that of the single-dose bowel preparation group ((23.7 ± 14.6) mL),and the difference was statistically significant (t =2.642,P=0.009).The score of intestinal preparation quality of the split-dose bowel preparation group was 8.05 ± 0.85,which was higher than that of the single-dose bowel preparation group (7.67±1.19),and the difference was statistically significant (t =-2.002,P=0.048).Fasting time was related with GRV (odd ratios (OR)=1.732,95％ contidence interval (CI) O.299 to 3.168,P=0.018).Conclusion The GRV of patients with split-dose bowel preparation before colonoscopy is lower than that of traditional single-dose bowel preparation,thus reducing the risk of aspiration during anesthesia.

The use of TCGA and GEO datasets to analyze clinical significance of glutathione reductase in gastric cancer / 中国医师杂志

Objective To explore the expressions of glutathione reductase in gastric cancer,to investigate the relationship between glutathione reductase (GSR) and clinical pathological characteristics of gastric cancers,to identify the role of GSR in evaluation of the prognosis of gastric cancer patients,and to investigate the role of GSR in the development of gastric cancer.Methods The gastric cancer datasets were searched and downloaded from The Cancer Genome Atlas (TCGA),and chip data were analyzed with clinical information.Gene set enrichment analysis (GSEA) was conducted to explore the gene sets enriched in samples with high GSR expression.Results The expression of GSR was down-regulated in high grade tumors (P ＜ 0.01).No significant difference was found between different age,Shortest tumor diameter,American Joint Committee on Cancer (AJCC) M stage,Barrett's esophagus,family history of gastric cancer,and Helicobacter pylori (H.pylori) infection.Higher expression of GSR indicated poor prognosis in gastric cancer.GSEA indicated that GSR regulates gene sets associated with oxidative phosphorylation,metabolism of nucleotides,mitochondrial protein import,and mitotic G1 S phases.Conclusions GSR can be used as an indicator to predict the prognosis of gastric cancer patients and a target for the treatment of gastric cancer.

Application of Proteomics in Research of Biomarkers for Gastric Cancer / 胃肠病学

Gastric cancer is one of the most commonly seen malignant tumors in digestive tract.Early diagnosis and treatment is crucial for the improvement of patients'survival.By analyzing the proteins aberrantly expressed in gastric cancer using proteomics technologies,a series of proteins that are strongly related to the occurrence and development of gastric cancer have been identified,which are promising to be applied for the early diagnosis and prediction of patients' prognosis.This article reviewed the recent advances in research on proteomic biomarkers for gastric cancer.

Research progress in relationship between vitamin D and inflammatory bowel disease / 中华临床营养杂志

Inflammatory bowel disease (IBD) is a group of chronic inflammatory diseases of the intestine mediated by abnormal immunological mechanism caused by multiple etiological factors.The main treatment at present is anti-inflammation and immunosuppression,but with severe side effects and poor efficacy.Vitamin D3 has immunoregulatory,anti-inflammatory,and antineoplastic functions.Vitamin D,as a novel immunoregulator,may provide a new treatment option for patients with IBD.This article will review the research progress on the following four aspects:the relationship of vitamin D with innate immunity,adaptive immunity,and pathogenesis of IBD,and vitamin D supplement in IBD patients.

Cyclooxygenase-2 -765G>C polymorphism and susceptibility to colorectal cancer: a meta-analysis / 中华预防医学杂志

<p><b>OBJECTIVE</b>To explore the correlation between polymorphism of cyclooxygenase-2 (COX-2) -765G>C and susceptibility to colorectal cancer.</p><p><b>METHODS</b>All eligible case-control studies published up to March 2013 were searched out from PubMed, EMABSE, CJFD, CBM, CNKI, VIP and WanFang databases, while 99 articles were concluded. Two reviewers independently identified the literature according to inclusion and exclusion criteria. Meta-analysis was performed using RevMan 5.1 and Stata 12.0 software.</p><p><b>RESULTS</b>A total of eleven studies comprising 3432 cases and 5286 controls were finally included. The included studies showed good homogeneity in the three genetic models, except the model of GC/GG genotype (I(2) = 52%, P = 0.03). Overall, there were no significant association between polymorphism of COX-2-765G>C and the susceptibility to colorectal cancer (dominant model: (GC+CC)/GG: OR = 1.08, 95%CI:0.96-1.21; recessive model:CC/(GC+GG): OR = 1.09, 95%CI:0.76-1.56; GC/GG: OR = 1.05, 95%CI:0.87-1.28; CC/GG: OR = 1.11, 95%CI:0.77-1.60). In stratification analysis by ethnicity, we observed that the polymorphism of COX-2 -765G>C could increase the susceptibility to colorectal cancer among yellow populations ((GC+CC)/GG: OR = 1.41, 95%CI:1.15-1.75; GC/ GG: OR = 1.48, 95%CI:1.15-1.90), but there was no significant association found among Caucasian populations.</p><p><b>CONCLUSION</b>This meta-analysis suggested that the polymorphism of COX-2 -765G>C may increase the susceptibility to colorectal cancer in the yellow population.</p>

Comparative study on morphology and histology about the chronic atrophic gastritis narrow-band imaging / 中国医师进修杂志

Objective To compare the morphology and histology about the chronic atrophic gastritis (CAG) narrow-band imaging (NBI),in order to improve the rate of final diagnosis.Methods The clinical data of 100 CAG patients who diagnosed by NBI from September 2011 to December 2012 were analyzed retrospectively.The morphological diagnosis by NBI and histodiagnosis by endoscopy were compared.Results In 100 patients,94 patients were diagnosed by histodiagnosis among whom 28 patients were with mild dysplasia,8 patients were with moderate dysplasia,7 patients were with severe dysplasia.In the NBI mode,gastric pits were divided into 6 kinds of types,dysplasia mainly expressed for Ⅳ and Ⅴ 1 type.In 7 severe dysplasia patients,2 patients of microvascular morphology were regular,the others were anomalism,and found neovascularization.Conclusions Endoscopic NBI technology has the advantage of simple operation,and can clearly observe the gastric pit and microvascular morphology after amplification.It can help to improve the accuracy rate of CAG and dysplasia targeted biopsy.

Cyclooxygenase-2 Polymorphisms and Susceptibility to Colorectal Cancer: A Meta-Analysis

PURPOSE: Four polymorphisms, -765G>C, -1195G>A, 8473T>C, and Val511Ala, in the cyclooxygenase-2 (COX-2) gene were identified to be associated with colorectal cancer (CRC) risk. However, the results are inconsistent. The objective of this meta-analysis was to evaluate the association between these four polymorphisms and the risk of CRC. MATERIALS AND METHODS: All eligible case-control studies published up to December 2012 on the association between the four polymorphisms of COX-2 and CRC risk were identified by searching PubMed and Web of Science. The CRC risk associated with the four polymorphisms of the COX-2 gene was estimated for each study by odds ratio (OR) together with its 95 % confidence interval (CI), respectively. RESULTS: A total of 15 case-control studies were included. Overall, no evidence has indicated that the -1195A allele, -765C allele, 8473C allele, and 511Ala allele are associated with susceptibility to CRC (-1195G>A: OR=1.11, 95 % CI: 0.82-1.51, p=0.78; -765G>C: OR=1.08, 95 % CI: 0.96-1.21, p=0.07; 8473T>C: OR=1.03, 95 % CI: 0.89-1.18, p=0.91; Val511Ala: OR=0.71, 95 % CI: 0.46-1.09, p=0.94). However, stratified analysis with ethnicity indicated that individuals with -765GC or GC/CC genotypes had an increased risk of CRC among Asian populations (GC vs. GG: OR=1.05, 95 % CI: 0.87-1.28, p=0.03; GC+CC vs. GG: OR=1.08, 95 % CI: 0.96-1.21, p=0.07). CONCLUSION: This meta-analysis indicated that -765G>C polymorphism was significantly associated with susceptibility to CRC in Asian populations.