Background:Because of its non-invasiveness,direct inspection,and high detection rate,capsule endoscopy(CE) has been accepted as the first-line examination for diagnosis of obscure gastrointestinal bleeding(OGIB). However,no matter the result of CE is positive or negative,it is unable to accurately predict the occurrence of rebleeding. Aims:To preliminarily investigate the related risk factors of rebleeding in OGIB patients with positive or negative CE for reducing the rebleeding rate. Methods:One hundred and sixteen OGIB patients undergone CE and with follow-up data from October 2009 to October 2013 at the First Affiliated Hospital of Soochow University were recruited,the rebleeding rate of patients with positive and negative CE,and the risk factors of rebleeding were analyzed. Results:CE diagnostic rate was 56. 9% , and the overall rebleeding rate was 37. 9% . The rebleeding rate in CE positive patients was significantly higher than that in CE negative patients(48. 5% vs. 24. 0% ,P < 0. 01). Male,age ≥50 years,hypertension,accumulated bleeding ≥500 mL within 3 months before CE were the independent risk factors of increase in rebleeding rate in CE positive patients. Age≥50 years,abnormal blood coagulation,without specific treatment were the independent risk factors of increase in rebleeding rate in CE negative patients. Conclusions:Followed-up should be performed in OGIB patients with risk factors of rebleeding for at least 24 months after CE. Repeated examination can be avoided in OGIB patients without risk factors.

Objective: To explore the characteristics of clinical pathology, diagnosis, and prognosis of primary renal lymphoma (PRL).Methods: The clinical features, pathological features, immune phenotypes, treatment, and prognosis of 22 patients were retrospectively analyzed. Results: The PRL patients' ages ranged from 2 to 72 years (mean, 54.3 years), of which 13 patients were older than 50 years (59.1%). All of the 22 patients were diagnosed with non-Hodgkin's lymphoma (NHL), including 20 cases of B-cell lymphoma and 2 cases of T-cell lymphoma. Seven patients were still alive and survived for 6-50 months, but the other 15 were dead and survived for only 5-35 months. Conclusion: PRL is uncommon. Clinical manifestations and imaging performance specificity are not obvious. and easily misdiagnosed. Histopathology is still the golden standard for the final diagnosis of this entity. The kidney is most easily involved followed by the bladder. B-cell NHL is the common subtype, and the most common type is the diffuse large B-cell lymphoma. Up to now,no standard regime could be performed for PRL patients. At present, comprehensive therapy, including surgery and chemotherapy, is recommended. For patients with locally advanced or highly aggressive status, therapeutic effect with chemotherapy alone is usually satisfied.

Objective To quantitate coronary tortuosity and provide favorable conditions for understanding the hemodynamic effects caused by coronary tortuosity.Methods We obtained all images from 72 patients who received coronary computed tomo-graphy scanning.After image post-processing,we extracted the medial axis of three main coronary vessel and analysed its coordi-nates on three dimensions.Then we calculated the tortuosity coefficient of coronary artery.Results Tortuosity coefficient was 6.66±7.54 in anterior descending,13.43±12.85 in left circumflex,and 1 7.61 ±7.67 in right coronary artery.We had proved its validity by the changes in morphology with simulated shapes.Conclusion We proposed a new method for quantitating coronary tor-tuosity,by computed tomography coronary imaging.The measurement results would not be affected by projection plane,vessel length or other artificial factors.

Background:The incidence of inflammatory bowel disease(IBD)is increasing recently. However,the pathogenesis has not been fully clarified. Aims:To investigate the expressions and significance of interleukin-22( IL-22),matrix metalloproteinase-9(MMP-9)and macrophage migration inhibitory factor(MIF)in peripheral blood of patients with IBD. Methods:A total of 80 patients with IBD admitted from May 2011 to Nov. 2014 at the First Affiliated Hospital of Soochow University were enrolled,in which 43 cases were Crohn’s disease(CD),37 cases were ulcerative colitis(UC). Forty healthy subjects were served as normal controls. Peripheral levels of IL-22,MMP-9 and MIF were detected by ELISA. Multivariate Logistic regression model was used to analyze IL-22,MMP-9 and MIF in active CD and UC and ROC curve was used to evaluate the diagnostic performance of these markers for screening of active CD and UC. Results:Compared with normal control group,peripheral levels of IL-22,MMP-9 and MIF increased significantly in CD and UC groups(P <0. 05),while no significant difference was found between CD and UC groups(P > 0. 05). Peripheral levels of IL-22, MMP-9 and MIF in active CD and UC were significantly higher than those in remission stage(P < 0. 05). For screening of active IBD,the area under ROC curve(AUC)of combined detection of IL-22 and MMP-9(0. 853 for CD,0. 867 for UC) was superior to that of IL-22,MMP-9 or MIF only(0. 747,0. 770 and 0. 699 for CD,0. 774,0. 815 and 0. 761 for UC). Conclusions:Peripheral levels of IL-22,MMP-9 and MIF increase markedly in IBD patients,which are correlated closely with the activity of IBD. Combined detection of IL-22 and MMP-9 might greatly increase the accuracy for screening of active IBD.

Objective:To observe the clinical effect of Xu's Liu Wei Xiaoqinglong Decoction on children's pneumonia with the syndrome of phlegm blocking in the lung.Method:86 cases were randomly divided into 2 groups,43 cases in each.Treatment group was treated by Liuwei Xiaoqinglong Decoction (granules),Control group was treated by San Ao Decoction (granules),both taken orally,twice per day,for 7 days.The clinical effects and syndrome integrals improvement were observed.Result:The total effective rate of the treatment group was 95.34％ and it was 81.39％ in the control group,the difference between the 2 groups was statistically significant (P＜0.05).And the syndrome improvement of the treatment group was also significantly better than that of the control group.The disappearing time of major symtoms was statistically significantly shorter than that of the control group (P＜0.05).Conclusion:Xu's Liu Wei Xiaoqinglong Decoction has certain effect on children's pneumonia with the syndrome of phlegm blocking in the lung and it should be applied in patient with simple syndrome of phlegm blocking in the lung,or in early stage of phlegm blocking in the lung,compared with cases with syndrome of phlegm blocking in the lung accompanied by spleen deficiency.

Strategies in comprehensive therapy for gastrointestinal (GI) cancer have been optimized in the last decades to improve patients' outcomes. However, treatment options remain limited for late-stage or refractory diseases. The efficacy of immune checkpoint inhibitors (ICIs) for treatment of refractory GI cancer has been confirmed by randomized clinical trials. In 2017, pembrolizumab was approved by the US Food and Drug Administration as the first agent for treatment of metastatic solid tumors with mismatch repair deficiency, especially for colorectal cancer. Given the different mechanisms, oncologists have focused on determining whether ICIs-based combination strategies could achieve higher efficacy than conventional therapy alone in late-stage or even front-line treatment of GI cancer. This review discusses the current status of combining immune checkpoint inhibitors with molecular targeted therapy, chemotherapy, or radiotherapy in GI cancer in terms of mechanisms, safety, and efficacy to provide basis for future research.
Combined Modality Therapy ; methods ; Gastrointestinal Neoplasms ; immunology ; therapy ; Humans ; Immunotherapy ; methods ; trends ; Randomized Controlled Trials as Topic

Objective:To investigate the characteristics of serum cytokine IL-4 and IFN- γ levels in patients with chronic insomnia with mild cognitive impairment (MCI), and to further explore the relationship between cognitive function and IL-4 and IFN-γ in patients with chronic insomnia.Methods:Sixty-two patients with chronic insomnia were divided into MCI group( n=30) and non-MCI group( n=32) according to the scores of Montreal cognitive assessment(MoCA), mini-mental state examination(MMSE) score and chief complaint of cognitive decline. Pittsburgh sleep quality index(PSQI), Hamilton depression scale(HAMD 24) and Hamilton anxiety scale 14 item(HAMA 14) were evaluated. Serum IL-4 and IFN-γ were detected by flow fluorescence, correlation analysis and regression analysis were carried out. Results:The levels of IL-4 and IFN-γ in MCI group were significantly lower than those in non-MCI group (IL-4: 0.875(0.143, 1.655)μg/L, 1.855(0.813, 2.723)μg/L; IFN-γ: 0.450(0.173, 1.163)μg/L, 1.160(0.483, 3.075)μg/L, all P<0.05). There was no significant difference in IFN- γ/IL-4, PSQI, HAMA 14 and HAMD 24 scores between MCI group and non-MCI group. IL-4 was positively correlated with the total score of MoCA( r=0.318, P<0.05), orientation( r=0.324, P<0.05)and delayed recall( r=0.368, P<0.01). The results of multivariate regression showed that IL-4 had significant effects on MCI in patients with chronic insomnia( B=2.161, OR=8.682, 95% CI=2.058~36.633, P=0.003). Conclusion:The cognitive function of chronic insomnia is closely related to serum IL-4 and IFN-γ, and serum IL-4 has a protective effect on cognition in chronic insomnia patients. Therefore, it can be speculated that cytokines may be an important pathophysiological link of cognitive change in chronic insomnia patients.

Objective:To investigate whether memantine hydrochloride (MEM) could promote the bactericidal effect of neutrophils against methicillin-resistant Staphylococcus aureus (MRSA) and the possible mechanism. Methods:Neutrophils were co-incubated with different concentrations of MEM and MRSA for 4 h. Then the cell lysates were collected and cultured on plate for survival bacteria counting. After co-incubation, the neutrophils were collected to detect the production of reactive oxygen species (ROS) and the release of neutrophil extracellular traps (NETs). A mouse model of MRSA infection was established, and then the mice were treated with or without MEM. Blood, spleen and kidney samples were collected from the mice for bacterial colony counting and blood procalcitonin (PCT) detection. In the 48 h survival experiment, the mice were first infected with MRSA, and then treated with MEM or PBS. The survival rates of the mice were calculated and the survival curves were drawn.Results:The number of MRSA co-cultured with neutrophils decreased significantly in the presence of MEM, and within a certain concentration range, the survival number of MRSA decreased with the increase of MEM concentration. Moreover, MEM could significantly promote the production of ROS by neutrophils and the formation of NETs. In vivo experiment showed that the concentration of PCT in mouse blood samples was lower in the MRSA+ MEM group than in the MRSA+ PBS group. The animal experiment also revealed that MEM significantly decreased the bacteria loads in mouse blood and organs and increased the 48 h survival rate after MRSA infection.Conclusions:MEM could significantly promote the bactericidal effect of neutrophils against MRSA, which might be related to the enhanced generation of ROS by neutrophils and the formation of NETs.

Objective : To investigate whether Mitochondria-targeted antioxidant peptide SS-31 can inhibit the ozone ( O3 ) -induced mice lung airway hyperresponsiveness and mucus hypersecretion． Methods : Eight-week C57BL /6 mice were randomized into four groups，including phosphate buffer saline (PBS) + Air group，SS-31 + Air group， PBS + O3 group and SS-31 + O3 group．C57BL /6 mice were injected intraperitoneally with SS-31 ( 10 mg / kg) one hour before ozone exposure ，and then single-exposed to ozone at a concentration of 5. 01 × 10 －6 mol / m3 for 3 hours．After 24 hours，airway hyperresponsiveness(AHR) and bronchoalveolar lavage fluid (BALF) cells numbers were measured．Lung tissue schiff periodic acid shiff (PAS) staining，malondialdehyde (MDA) ，inflammatory factors ( interleukin，IL ) -1 β , IL-6 ，IL-18 and monocyte chemoattractant protein-1 ( MCP-1 ) ) and mucin factor (MUC5B) were detected，and the protein expression levels of NOD-like receptor thermal protein domain associated protein 3 (NLRP3) ，pro-Caspase 1 / Caspase 1 (p20) ，Gasdermin D ( GSDMD) and Cleaved GSDMD were determined by Western blot. Results: O3 exposure caused both mice lung airway hyperresponsiveness and mucus hypersecretion．However，SS-31 could inhibit the O3 -induced airway hyperresponsiveness and mucus secretion，reduce the levels of oxidative stress and inflammatory factor mRNA expression ，and downregulate the protein expression level of NLRP3 and the activated forms of Caspase 1 and GSDMD． Conclusion SS-31 could suppress O3 -induced mice airway hyperresponsiveness and mucus hypersecretion by inhibiting the NLRP3 / Caspase 1 / GSDMD signaling pathway.