Hypermethylation of DHRS3 as a Novel Tumor Suppressor Involved in Tumor Growth and Prognosis in Gastric Cancer.

BACKGROUND/AIMS: The role of DHRS3 in human cancer remains unclear. Our study explored the role of DHRS3 in gastric cancer (GC) and its clinicopathological significance and associated mechanisms. MATERIALS: Bisulfite-assisted genomic sequencing PCR and a Mass-Array system were used to evaluate and quantify the methylation levels of the promoter. The expression levels and biological function of DHRS3 was examined by both in vitro and in vivo assays. A two-way hierarchical cluster analysis was used to classify the methylation profiles, and the correlation between the methylation status of the DHRS3 promoter and the clinicopathological characteristics of GC were then assessed. RESULTS: The DHRS3 promoter was hypermethylated in GC samples, while the mRNA and protein levels of DHRS3 were significantly downregulated. Ectopic expression of DHRS3 in GC cells inhibited cell proliferation and migration in vitro, decreased tumor growth in vivo. DHRS3 methylation was correlated with histological type and poor differentiation of tumors. GC patients with high degrees of CpG 9.10 methylation had shorter survival times than those with lower methylation. CONCLUSION: DHRS3 was hypermethylated and downregulated in GC patients. Reduced expression of DHRS3 is implicated in gastric carcinogenesis, which suggests DHRS3 is a tumor suppressor.

The inhibitory effect of p75 neurotrophin receptor on growth of human hepatocellular carcinoma cells.

p75 neurotrophin receptor (p75NTR), a member of the TNF receptor superfamily, is a focus for study at present. Up to now, its role and functions in hepatocellular carcinoma were not fully elucidated. In this study, we investigated the expression of p75NTR in hepatocellular carcinoma and the impact of its alteration on tumor growth. We found that the expression of p75NTR was decreased significantly in 158 cases of hepatocellular carcinoma tissues as compared with their adjacent noncancerous counterparts, and its expression was also significantly decreased in various human hepatocellular carcinoma cell lines. Down-regulating p75NTR by specific siRNA promoted the growth of normal liver cell lines, whereas up-regulating p75NTR inhibited the growth of hepatocellular carcinoma cell lines in vitro and caused dramatic attenuation of tumor growth in vivo by induction of cell cycle arrest. Furthermore, we found that up-regulating p75NTR could down-regulate the expression of cyclin A, cyclin D1, cyclin E, cdk2, p-Rb and PCNA, but up-regulate the expression of Rb. Conversely, the results were inverse when p75NTR was down-regulated by specific siRNA. Therefore, we provided the evidence that p75NTR was a potential tumor suppressor and might be used as a therapeutic target for hepatocellular carcinoma.

Recommendations for the management of treatment and vaccination in inflammatory bowel disease patients complicated with coronavirus disease 2019 / 中华消化杂志

Coronavirus disease 2019 (COVID-19) has become a worldwide pandemic. During the rapid spread time, it is a great challenge for patients with inflammatory bowel disease (IBD) who use immunosuppressive drugs from vaccination and drug application. This article is intended to supplement and revise the recommendations of the Inflammatory Bowel Disease Group of the Chinese Society of Gastroenterology in 2020 on the "Management of patients with inflammatory bowel disease during epidemic of novel coronavirus pneumonia", mainly including the treatment and vaccination of IBD patients complicated with COVID-19. It is expected to guide clinicians in drug use, vaccination of IBD patients at an appropriate time, also help patients getting through the epidemic period of COVID-19.

Effect of Proactive and Reactive Therapeutic Drug Monitoring of Infliximab on Prognosis of Patients With Inflammatory Bowel Disease / 胃肠病学

Background:Therapeutic drug monitoring(TDM)has emerged as the important method for managing loss of response to infliximab.The effect of reactive and proactive TDM on clinical outcomes in inflammatory bowel disease(IBD)is uncertain.Aims:To evaluate the effect of proactive and reactive TDM of infliximab on the prognosis of patients with IBD.Methods:Clinical data of 99 IBD patients treated with IFX from January 2017 to October 2021 at the First Affiliated Hospital of Air Force Military Medical University were retrospectively analyzed,including 34 patients with proactive TDM and 65 patients with reactive TDM.The rate of treatment failure,IBD-related surgery or hospitalization were compared between the two groups.Logistic regression analysis was used to determine the independent risk factors of treatment failure.Results:The median follow-up of the patients was 21(13,32)months.The rate of treatment failure,IBD-related hospitalization rate of proactive TDM group were significantly lower than those of reactive TDM group(P<0.05),however,no significant difference in IBD-related surgery rate was found between two groups(P=0.081).Univariate analysis showed that ileocolonic resection before TDM,antibodies to infliximab(ATI)and reactive TDM might be correlated with treatment failure(P<0.05).Logistic regression analysis showed that reactive TDM(OR=5.829,95%CI:1.070-31.754,P=0.042)was the risk factor of treatment failure,and ileocolonic resection before TDM(OR=0.119,95%CI:0.019-0.736,P=0.022)was the protective factor of treatment failure.Conclusions:Compared with reactive TDM group,proactive TDM can significantly decrease the rate of treatment failure and IBD-related hospitalization rate.Reactive TDM is the risk factor of treatment failure,and ileocolonic resection before TDM is the protective factor of treatment failure.

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.

An investigation of digestive healthcare workers and new chatbots on knowledge of endoscopic screening of gastrointestinal cancers / 中华消化内镜杂志

Objective:To compare the knowledge of endoscopic screening of gastrointestinal cancers between digestive healthcare workers and new chatbots (chatGPT and new Bing).Methods:A test with twenty-three questions of endoscopic screening of gastrointestinal cancers was conducted, focusing on the appropriate age of screening, high-risk factors, the follow-up time, and the advantages and risks of digestive endoscopy. Digestive healthcare workers were invited to complete the test through electronic questionnaires. New Bing and chatGPT were used to answer each question for 10 rounds. The primary endpoint was the correct rate of all answers. The answer accuracy between digestive healthcare workers and new chatbots were compared using variance analysis, and the factors that affected the accuracy of the answers in digestive healthcare workers were explored using univariate and multivariable liner regression analysis.Results:The results of the test completed by 76 digestive healthcare workers (21 residents, 28 digestive nurses, and 27 digestive doctors) were analyzed. The accuracies were 36.4%±10.9%, 34.5%±10.2%, 52.2%± 12.6%, 46.3%±9.8% and 67.1%±9.3% in residents, digestive nurses, digestive doctors, chatGPT, and new Bing, respectively, with significant difference ( F=22.6, P<0.001). The accuracy was highest in new Bing ( P<0.001). The accuracy was comparable between chatGPT and digestive doctors (LSD- t=-1.398, P=0.166), and both higher than that of digestive nurses (LSD- t=2.956, P=0.004; LSD- t=5.955, P<0.001) and residents (LSD- t=2.402, P=0.018; LSD- t=4.951, P<0.001). Furthermore, the accuracy was comparable between digestive nurses and residents (LSD- t=-0.574, P=0.567). Compared with new Bing, digestive doctors had lower accuracy in answering questions related to adverse events of screening, follow-up recommendation of intestinal metaplasia, high risk factors and screening methods for colon cancer ( P<0.05), but higher accuracy in answering questions related to endoscopic adverse events and screening methods for esophageal cancer ( P<0.05). Multivariable liner regression analysis showed that being digestive doctors ( β=11.7, t=3.054, P=0.003) and questionnaire response time (≥7.6 min) ( β=7.8, t=2.894, P=0.005) were independent factors for the answer accuracy of digestive healthcare workers. Conclusion:Compared with digestive healthcare workers, New chatbots—new Bing has higher accuracy in answering gastrointestinal cancer screening-related questions, but performs poorly in answering questions such as adverse events of endoscopy and screening methods for esophageal cancer.

Consensus on Biological Agents in Treating Patients With Inflammatory Bowel Disease / 胃肠病学

Biological agents have been increasingly used in the treatment of inflammatory bowel disease (IBD) in China. As the types of biologics and approved indications gradually increase, the rationale, effective and safe use of various biological agents pose new challenges to clinicians. In order to standardize the use of biological agents to treat IBD, Inflammatory Bowel Disease Quality Control Center and Inflammatory Bowel Disease Group of Chinese Society of Gastroenterology organized experts to formulate this guidance on indications, contraindications, effectiveness, screening and preventing opportunistic infections, methods of application, response monitoring, issues for special population and safety for use of biological agents. This consensus is expected to facilitate the standard use of biologics in patients with IBD in China.

Analysis of clinical features of 43 cases of inflammatory bowel disease complicated with intra- and extra-intestinal tumors / 中华消化杂志

Objective:To analyze the clinical characteristics of patients with inflammatory bowel disease (IBD) complicated with intra- and extra-intestinal tumors, and so as to provide reference for clinical practice.Methods:From October 2008 to March 2022, the clinical data of 2 360 IBD patients diagnosed at the First Affiliated Hospital of Air Force Military Medical University were collected, and the IBD patients complicated with intra- and extra-intestinal tumors were screened out. IBD with colorectal cancer, small intestine cancer and intestinal lymphoma were enrolled into intra-intestinal tumor group, IBD complicated with other tumors except intra-intestinal tumors were enrolled into extra-intestinal tumor group. The clinical characteristics of the 2 groups were retrospectively compared, and the risk factors affecting survival of IBD complicated intra- and extra-intestinal tumor were analyzed. Kaplan-Meier method was used to draw the survival curve, Cox regression model was performed to analyze the prognostic risk factors, and independent sample t test, Fisher′s exact test and log-rank test were used for statistical analysis. Results:A total of 43 IBD patients with intra- and extra-intestinal tumor were screened out, and the overall tumor incidence rate was 1.82% (43/2 360). The rate of IBD complicated with intra-intestinal tumor accounted for 1.27% (30/2 360). Among them, the rate of ulcerative colitis (UC) complicated with intra-intestinal tumor was 1.48% (25/1 685), and the rate of Crohn′s disease (CD) complicated with intra-intestinal tumor was 0.74% (5/675). The rate of IBD with extra-intestinal tumor accounted for 0.55% (13/2 360). Among them, the rate of UC complicated with extra-intestinal tumor was 0.71% (12/1 685), and the rate of CD complicated with extra-intestinal tumor was 0.15% (1/675). There were no significant differences in the rate of intra- and extra-intestinal tumors between UC and CD patients (both P>0.05). In the intra-intestinal tumor group, the age when diagnosed with IBD and the age when tumor diagnosed were (37.0±13.8) years old and (47.7±13.5) years old, which were both lower than those of the extra-intestinal tumor group ((51.8±6.2) years old and (60.7±7.8) years old), and the differences were statistically significant ( t=-3.69 and -3.24, P=0.001 and 0.002). The lesion location when tumor diagnosed of UC patients with intra-intestinal tumor mainly was extensive colonic type(64.0%, 16/25), followed by left part colonic type and rectal type in turn (28.0%, 7/25 and 8.0%, 2/25). In UC patients with extra-intestinal tumor, mainly was rectal type (8/12), followed by left part colonic type (3/12) and extensive colonic type (1/12) in turn. There was statistically significant difference bwtween the UC patients with intra- and extra-intestinal tumor in the extent of lesions when tumor diaghosed (Fisher′s exact test, P<0.001). The activity of IBD of intra-intestinal tumor group when tumor diagnosed mainly was severe activity phase (46.7%, 14/30), followed by moderate activity phase, mild activity phase and remission phase in turn (33.3%, 10/30; 20.0%, 6/30 and 0). The activity of IBD of extra-intestinal tumor group when tumor diagnosed mainly was remission phase (7/13), followed by moderate activity phase, mild activity phase and severe activity phase in turn (3/13, 2/13 and 1/13). There were statistically significant differences between the 2 groups in the composition of IBD activity when tumor diagnosed (Fisher′s exact test, P<0.001). The survival analysis indicated the median survival time of IBD complicated with intra-intestinal tumor group was 145.9 months, and that of the extra-intestinal tumor group was 29.9 months. The results of multivariate Cox analysis showed that the occurrence of extra-intestinal tumor was an independent risk factor of patient survival rate( HR=5.119, 95% confidence interval 1.485 to 17.643, P=0.010). Conclusions:IBD patients had a high risk of developing intra- and extra-intestinal tumors. The intra-intestinal tumor group mainly is extensive colonic type and severe active period, while the extra-intestinal tumor group mainly is rectal type and remission period. Compared with that of the extra-intestinal tumor group, the age at time of IBD onset and tumor diagnosed of intestinal tumor are younger, and the survival time is longer.

The specialist instruction for diagnosis and treatment of chronic atrophic gastritis and clinical application of Lamb′s tripe extract and vitamin B12 capsule / 中华消化杂志

Chronic atrophic gastritis (CAG) and gastric intestinal metaplasia (GIM) significantly increase the risk of gastric cancer. Blocking the development of CAG and GIM would help to decrease the incidence of gastric cancer. It was revealed that eradication of Helicobacter pylori could reverse gastric mucosa atrophy. Recent studies reported that GIM could be reversed to a certain extent. Clinical studies demonstrated that Lamb′s tripe extract and vitamin B12 capsule exhibited significant reversal effects on GIM. The present study systemically reviewed the diagnosis and treatment of CAG and clinical application of Lamb′s tripe extract and vitamin B12 capsule, and established the specialist instruction that would guide the reversal treatment of CAG and GIM.

Analysis of Clinical Efficacy and Safety of Ustekinumab in Treatment of Inflammatory Bowel Disease / 胃肠病学

Background: The efficacy of ustekinumab (UST) in the treatment of patients with inflammatory bowel disease (IBD) has been affirmed abroad, but its efficacy and safety have not been reported in China due to its short term of use. Aims: To analyze the clinical efficacy and safety of UST in the treatment of IBD. Methods: The clinical data of IBD patients treated with UST from November 2020 to June 2022 in the First Affiliated Hospital of Air Force Medical University were analyzed retrospectively. Results: A total of 46 patients with IBD treated with UST were enrolled, including 41 patients with Crohn’s disease (CD) and 5 patients with ulcerative colitis (UC). At the 8

Specialist Instruction for Diagnosis and Treatment of Chronic Atrophic Gastritis and Clinical Application of Lamb’s Tripe Extract and Vitamin B12 Capsule / 胃肠病学

Chronic atrophic gastritis (CAG) and gastric intestinal metaplasia (GIM) significantly increase the risk of gastric cancer. Blocking the development of CAG and GIM would help to decrease the incidence of gastric cancer. It was revealed that eradication of Helicobacter pylori could reverse gastric mucosa atrophy. Recent studies reported that GIM could also be reversed to a certain extent. Clinical studies demonstrated that Lamb’s tripe extract and vitamin B12 capsule exhibited significant reversal effect on GIM. The present study systemically reviewed the diagnosis and treatment of CAG and clinical application of Lamb’s tripe extract and vitamin B12 capsule, and established the specialist instruction that would guide the reversal treatment of CAG and GIM.

Drug therapy and monitoring for inflammatory bowel disease: a multinational questionnaire investigation in Asia

Background/Aims@#The incidence and prevalence of inflammatory bowel disease (IBD) is rising in Asia recently. The study aimed to obtain a comprehensive understanding of the current status of drug therapy and monitoring for IBD in Asia. @*Methods@#A questionnaire investigation on drug therapy and monitoring for IBD was conducted right before the 6th Annual Meeting of Asian Organization for Crohn’s & Colitis. Questionnaires were provided to Asian physicians to fill out via emails between March and May 2018. @*Results@#In total, responses of 166 physicians from 129 medical centers were included for analysis. Among the surveyed regions, the most average number of IBD specialist gastroenterologists and nurses was 4.8 per center in Taiwan and 2.5 per center in Mainland China, respectively. 5-Aminosalicylic acid/sulfasalazine (99.4%) was the most preferred first-line choice for mild-moderate ulcerative colitis (UC), meanwhile corticosteroid (83.7%) was widely applied for severe UC. The first-line medication for Crohn’s disease (CD) markedly varied as corticosteroid (68.1%) was the most favored in Mainland China, Japan, and South Korea, followed by infliximab (52.4%) and azathioprine (47.0%). Step-up strategy was preferred in mild-moderate UC (96.4%), while 51.8% of the physicians selected top-down treatment for CD. Only 25.9% and 17.5% of the physicians could test blood concentration of infliximab and antibody to infliximab in their hospitals, respectively. @*Conclusions@#The current status of drug therapy and monitoring for IBD in Asia possesses commonalities as well as differences. Asian recommendations, IBD specialist teams and practice of therapeutic drug monitoring are required to improve IBD management in Asia.

Chinese consensus on diagnosis and treatment of intestinal Beh?et′s disease / 中华消化杂志

Beh?et′s syndrome is a kind of chronic systemic vasculitis with involvement of multiple organs. Intestinal involvement of Beh?et′s syndrome is presently named as intestinal Beh?et′s syndrome. Recently, there is considering another kind of disease type with only typical intestinal ulcers. Since it is difficult to differentiate intestinal Beh?et′s syndrome from Crohn′s disease, intestinal tuberculosis, intestinal lymphoma, and intestinal manifestations of many other autoimmune diseases, and there is limited evidence for the therapy of intestinal Beh?et′s syndrome, proposing diagnosis and treatment recommendations for intestinal Beh?et′s syndrome through evidence-based judgment will be of great significance for clinical practice.

Chinese Consensus on Diagnosis and Treatment of Intestinal Behçet’s Syndrome / 胃肠病学

Behçet’s syndrome is a kind of chronic systemic vasculitis with involvement of multiple organs. Intestinal involvement of Behçet’s syndrome is presently named as intestinal Behçet’s syndrome (disease). Recently, there is considering another kind of disease type with only typical intestinal ulcers. Since it is difficult to differentiate intestinal Behçet’s syndrome from Crohn’s disease, intestinal tuberculosis, intestinal lymphoma, as well as intestinal manifestations of many other autoimmune diseases, and there is limited evidence for the therapy of intestinal Behçet’s syndrome, proposing diagnosis and treatment recommendations for intestinal Behçet’s syndrome through evidence-based judgment will be of great significance for clinical practice.

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.

Clinical characteristics of 56 cases of ulcerative colitis-associated dysplasia and colorectal cancer / 中华消化杂志

Objective:To analyze the clinical characteristics of patients with ulcerative colitis (UC)-associated neoplasia, including UC-associated dysplasia and ulcerative colitis-associated colorectal cancer (UC-CRC).Methods:From January 2010 to July 2019, the clinical data of 56 patients with UC-associated neoplasia at Xijing Hospital of Digestive Diseases were retrospectively analyzed. The patients with UC-associated neoplasia were divided into low-grade dysplasia (LGD) group (38 cases) and advanced neoplasia group (18 cases), the advanced neoplasia group included five patients with high-grade dysplasia and 13 patients with UC-CRC. Mann-Whitney U test, chi-square test and Fisher′s exact test were used for statistical analysis. Results:The age of patients with UC-associated neoplasia was (47.4±14.7) years old. The main type of lesion was extensive colitis (71.4%, 40/56). There were five patients (8.9%) complicated with colorectal stricture. The disease course of the advanced neoplasia group was longer than that of LGD group (10.5 years, 3.5 years to 14.5 years vs. 2.0 years, 1.0 year to 5.0 years), and the difference was statistically significant ( U=155.000, P=0.001). Four of the 18 patients of the advanced neoplasia group had colorectal stricture, the ratio was higher than that of LGD group (2.6%, 1/38), and the difference was statistically significant (Fisher exact test, P=0.033). In advanced neoplasia group, there were seven patients with multifocal lesions. Among 13 patients with UC-CRC, the lesions of five patients located in rectum, and the pathological type was mainly moderately differentiated adenocarcinoma (nine cases). Conclusions:The disease course of patients with advanced neoplasia is longer than that of patients with LGD, and the proportion of patients complicated with colorectal stricture is higher than that of patients with LGD. The proportion of multifocal lesions in patients with advanced neoplasia is higher, and the surveillance of neoplasia in UC patients should be strengthened.

Therapeutic effects of lamb′s tripe extract and vitamin B12 capsule on precancerous lesions of gastric mucosa in rats / 中华消化杂志

Objective:To explore the therapeutic effects of lamb′s tripe extract and vitamin B12 (hereinafter referred to as lamb′s tripe) capsule on precancerous lesions of gastric mucosa in rats.Methods:Thirty-two rats of the 42 Wistar rats (model group) were selected for modelling, and in model group six rats died due to gavage, 10 rats were sacrificed for observing the results of modeling, and the left 16 rats were divided into administration group (eight rats) and non-administration group (eight rats). After modeling, five of the 10 rats without modelling treatment were selected as the normal control of the model group, the other five (negative control group) rats were included in drug intervention experiment. The drug intervention program was as follows: in administration group, rats were gavaged with lamb′s tripe 0.2 g/kg once per day for three months; in non-administration group and negative control group, rats were gavaged with 0.9% sodium chloride solution 0.2 g/kg once per day for three months. One rat died in each for the administration group and non-administration group due to gavage. Body weight gain, pH value of gastric juice and pathological changes of gastric mucosa of the three groups were evaluated. The number of nodules on gastric mucosal surface and the incidence and scores of precancerous lesions (intraepithelial neoplasia) in gastric mucosal were analyzed. The therapeutic effects of lamb′s tripe capsule on gastric mucosal precancerous lesions in rats were evaluated. Independent sample t test , Mann Whitney U test and chi-square test were used for statistical analysis. Results:The body weight gain of rats at the 6th week in the administration group was higher than that of rats in the non-administration group ((508.26±33.96) g vs. (495.50±23.01) g), and the pH value of gastric juice of rats in the administration group was lower than that of rats in the non-administration group (3.07±0.55 vs. 4.45±0.72), and the differences were statistically significant (both P<0.05). The number of proliferative nodules on the gastric mucosal surface of the rats in the administration group was less than that of rats in the non-administration group (the ratio of gastric fundus: 6.00(3.00, 7.00) vs. 11.00(7.00, 13.00); the ratio of gastric antrum: 0.00(0.00, 1.00) vs. 3.00(2.00, 4.00); the ratio of whole stomach: 7.00(3.00, 10.00) vs. 15.00(13.00, 17.00)), and the differences were statistically significant ( U=43.50, 49.00, 49.00, all P<0.05). The score of gastric mucosal precancerous lesions in the administration group was lower than that in the non-administration group(1.00±0.00 vs.1.14±0.38), and the incidence of precancerous lesions in the administration group was lower than that in the non-administration group (1/7 vs. 5/7), and the differences were statistically significant ( t=2.45, χ2=4.67, both P=0.031). Conclusions:Lamb′s tripe capsule can significantly inhibit the progression of precancerous lesions of gastric mucosa in rats, so as to play a role in preventing the occurrence of gastric cancer.

Analysis of the trend of medication use in patients with ulcerative colitis in a single center from 2010 to 2019 / 中华消化杂志

Objective:To analyze the trend of medication use in patients with ulcerative colitis (UC) in recent ten years in at Xijing Hospital, Air Force Military Medical University.Methods:From 2010 to 2019, the clinical data of 1 425 patients diagnosed with UC in the Department of Gastroenterology at Xijing Hospital, Air Force Medical University, were retrospectively collected. According to the period of medication, the UC patients were divided into year 2010 to 2014 group and year 2015 to 2019 group. The general information and the medication trend of year 2010 to 2014 group and year 2015 to 2019 group were analyzed. And then according to gender and age (<40 years old and ≥40 years old), patients were divided into subgroups and analyzed. Independent sample t test and chi-square test were used for statistical analysis. Results:The number of UC patients of year 2010 to 2014 group and year 2015 to 2019 group was 369 and 1 056, respectively. The percentages of patients in remission of the two groups were 9.5% (35/369) and 12.0% (127/1 056), respectively; the percentages of mild patients were 40.4% (149/369) and 41.6% (439/1 056), respectively; the percentages of moderate patients were 37.4% (138/369) and 28.9% (305/1 056), respectively; the percentages of severe patients were 12.7% (47/369) and 17.5% (185/1 056), respectively. There was no significant difference in the proportion of UC patients with different degrees between year 2010 to 2014 group and year 2015 to 2019 group ( P>0.05). There were no significant differences in the age and proportion of female between the year 2010 to 2014 group and year 2015 to 2019 group ((46.2±15.3) years old vs. (44.6±30.6) years old; 45.8%, 169/369 vs. 44.8%, 473/1 056; both P>0.05). The utilization rates of 5-aminosalicylic acid (5-ASA), glucocorticoid, immunosuppressants, and biological agents of the year 2015 to 2019 group were all higher than those of the year 2010 to 2014 group (96.8%, 1 022/1 056 vs. 90.0%, 332/369; 29.9%, 316/1 056 vs. 14.6%, 54/369; 8.4%, 89/1 056 vs. 2.4%, 9/369; 4.8%, 51/1 056 vs. 0.5%, 2/369, respectively), and the differences were all statistically significant ( χ2=26.766, 33.256, 15.315 and 14.038, all P<0.01). Within each of the year 2010 to 2014 group and the year 2015 to 2019 group, there were no significant differences between the female and male in the age, utilization rates of 5-ASA, glucocorticoid, immunosuppressants and biological agents ((47.2±13.6) years old vs. (45.3±16.5) years old, (43.1±12.9) years old vs. (45.8±39.5) years old, 88.8%, 150/169 vs. 91.0%, 182/200; 96.8%, 458/473 vs. 96.7%, 564/583; 13.6%, 23/169 vs. 15.5%, 31/200; 28.3%, 134/473 vs. 31.2%, 182/583; 2.4%, 4/169 vs. 2.5%, 5/200; 7.0%, 33/473 vs. 9.6%, 56/583; 0 vs. 1.0%, 2/200; 5.3%, 25/473 vs. 4.5%, 26/583; all P>0.05). In the patients aged≥40 years old of the year 2010 to 2014 group, the proportion of females was higher than that of the patients aged <40 years old (50.2%, 121/241 vs. 37.5%, 48/128), and the utilization rate of 5-ASA in patients aged ≥40 years old was lower than that of patients aged <40 years old (85.9%, 207/241 vs. 97.7%, 125/128), and the differences were statistically significant ( χ2=5.438 and 12.824, P=0.020 and P<0.01). In the year 2010 to 2014 group, there were no statistically significant differences in the utilization rates of glucocorticoid, immunosuppressants and biological agents between patients aged ≥40 years old and patients aged <40 years old (13.7%, 33/241 vs. 16.4%, 21/128; 2.1%, 5/241 vs. 3.1%, 4/128; 0 vs. 1.6%, 2/128; all P>0.05). In the year 2015 to 2019 group, the utilization rate of biological agents in patients aged≥40 years old was lower than that in patients aged<40 years old (3.7%, 23/630 vs. 46.5%, 198/426), and the difference was statistically significant ( χ2=4.721, P=0.030). In the year 2015 to 2019 group, there were no statistically significant differences in female proportion, utilization rates of 5-ASA, glucocorticoid, immunosuppressants and biological agents between patients aged≥40 years old and patients aged <40 years old (43.7%, 275/630 vs. 46.5%, 198/426; 96.0%, 605/630 vs. 97.9%, 417/426; 29.7%, 187/630 vs. 30.3%, 129/426; 8.6%, 54/630 vs. 8.2%, 35/426; all P>0.05). Conclusions:Compared with year 2010 to 2014, the number of UC patients remarkably increased in the year 2015 to 2019 in the Department of Gastroenterology, Xijing Hospiatal, Air Force Medical University. The utilization rates of 5-ASA, glucocorticoid, immunosuppressants and biological agents all increased in UC patients. The medication trends of UC patients with different gender were almost the same. The medication trends of UC patients with different age were different.

Psychological Status and Influencing Factors of Patients With Inflammatory Bowel Disease / 胃肠病学

Background: The incidence of inflammatory bowel disease (IBD) is increasing in China in recent years, and the impact of psychological factors on IBD has been widely concerned. Aims: To investigate the psychological status of IBD patients and the influencing factors for anxiety and depression disorders. Methods: A total of 358 inpatients with IBD admitted from Oct. 2018 to Dec. 2019 at the Xijing Hospital were recruited; 170 patients with colonic polyps were served as controls. The presence of anxiety and depression were determined using the Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS), respectively. Demographics, disease characteristics, and medication information were also collected. Influencing factors for anxiety and depression disorders were analyzed by logistic regression model. Results: (1) The prevalence of anxiety and depression disorders, as well as the score of SAS and SDS were higher in IBD patients than in controls (P<0.05). (2) CD was associated with a higher prevalence of comorbid depression as compared with UC (P<0.05). (3) SAS and SDS score in active CD were higher than those in remission stage (P<0.05). (4) SAS and SDS score in active IBD increased in parallel with the increase of disease activity (P<0.05). (5) College education or above (OR=8.888, 95% CI: 1.714-46.095, P=0.009 for anxiety; OR=3.831, 95% CI: 1.039-14.760, P=0.008 for depression), and the severe active disease (OR=12.293, 95% CI: 1.501-100.679, P=0.041 for anxiety; OR=3.230, 95% CI: 1.051-5.506, P=0.040 for depression) were risk factors for anxiety and depression, while serving as a office clerk was a protective factor for depression (OR=0.620, 95% CI: 0.113-0.928, P=0.043). (6) SAS and SDS score decreased after 3 months of medication in IBD patients (P<0.05); SDS score of infliximab treatment group was lower than that of 5-aminosalicylic acid and steroid treatment groups (P<0.05). Conclusions: The prevalence of anxiety and depression disorders in IBD patients is considerably high. The degree of anxiety and depression is closely related to the disease activity. After standard treatment, the degree of anxiety and depression decreased. IBD patients at risk for anxiety and depression disorders should be screened for psychological comorbidities and appropriate psychotherapy should be offered.

Application of optimized Asia-Pacific colorectal screening scoring system in the screening of colorectal neoplasms / 中华消化杂志

Objective:To explore the optimization strategy of the Asia-Pacific colorectal screening (APCS) scoring system in the screening of colorectal neoplasms.Methods:From February to Decomber in 2016 and March to December in 2018, at Xijing Hospital of Air Force Military Medical University and the First Affiliated Hospital of Xi′an Medical University, patients who received opportunistic screening colonoscopy were enrolled. Before colonoscopy, the APCS score (low-risk zero to one points, medium-risk two to three points and high-risk four to seven points), body mass index (BMI), fecal occult blood test (FOBT) and plasma methylated Septin9 gene ( mSEPT9) of all patients were detected and recorded. The results of colonoscopy and biopsy pathology were taken as the gold standard, the efficacies of the above methods in screening colorectal neoplasms were compared to determine and optimize the screening efficiency of APCS scoring system. Chi-square test was used for statistical analysis. Results:A total of 494 patients were screened, of whom 133 cases were diagnosed with colorectal polyps, including 86 cases of colorectal adenomatous polyps (82 cases of non-progressive adenoma, and four cases of advanced-adenoma), and 47 cases of non-adenomatous polyps. According to the APCS score, the detection rate of colorectal adenomatous polyps of the high-risk group (33.3%, 33/99) was 2.02 and 3.76 times higher than those of the medium-risk group (16.5%, 39/237) and low-risk group (8.9%, 14/158), respectively (both Bonferroni correction test, both P<0.016). The detection rate of colorectal adenomatous polyps of patients with BMI>23.9 kg/m 2 was significantly higher than that of patients with BMI≤23.9 kg/m 2 (22.2%, 59/266 vs. 11.8%, 27/228), and the difference was statistically significant ( χ2=9.126, P=0.003). There was no statistically significant difference in the detection rate of colorectal adenomatous polyps between patients with positive- mSEPT9 expression and patients with negative- mSEPT9 expression (22.4%, 15/67 vs. 17.3%, 47/271) ( χ2=0.913, P=0.378). Among 158 low and medium risk patients (APCS score≤three points) who underwent simultaneous BMI measurement, FOBT and plasma mSEPT9 test, the detection rate of colorectal adenomatous polyps in patients with BMI>23.9 kg/m 2 was higher than that in patients with BMI≤23.9 kg/m 2 (17.8%, 16/90 vs. 5.9%, 4/68), and the difference was statistically significant ( χ2=4.957, P=0.030). The redetection efficacy of colorectal adenomatous polyps in patients with BMI>23.9 kg/m 2 and FOBT-positive was higher than that in patients with BMI≤23.9 kg/m 2 and FOBT-negative (28.1%, 9/32 vs. 8.0%, 4/50) and the difference was statistically significant ( χ2=5.942, P=0.027). In addition, the redetection rate of colorectal adenomatous polyps of patients with positive expression of FOBT and plasma mSEPT9 was also higher than that of patients with negative expression (5/14 vs. 12.9%, 12/93), and the difference was statistically significant ( χ2=4.738, P=0.045). Conclusions:When the APCS scoring system is used for sequential screening of colorectal tumors, the optinal choice of BMI replacement or combined with FOBT can improve the patients′ compliance and screening efficiency, which has significant clinical significance and promotion value in the early diagnosis and treatment of colorectal neoplasms.