With the increasing understanding of the pathogenesis of Crohn's disease and the advent of biological therapy,the therapeutic strategies of Crohn's disease have changed a lot in recent years.In this review,we concerned the progress in the management of active disease,maintenance of medically induced remission,and surgical options of Crohn's disease.The new concept of "top-down" approach to the treatment of Crohn's disease evolved recently was also discussed.

Altering the natural history of disease has been the goal of medical therapy for Crohn's Disease (CD) in recent years. The conventional approach has been thestep-up therapy. With the introduction of biological agents (such as infliximab) , there is growing evidence that the top-down approach is justified in a subgroup of high-risk patients. The new algorithms is not only associated with superior clinical remission rates, but also may have the potential to alter the natural history of the disease, including inducing mucosal healing, reducing the rate of complications, surgeries and mortality. Further study will have to determine which subgroup of patients will benefit most from this early aggressive biological therapy approach.

Abdominal compartment syndrome(ACS)is an important factor contributing to the multiple organ dysfunction syndrome which is commonly seen in patients with severe acute pancreatitis(SAP).As a life-saving procedure,decompressive laparotomy is widely applied to patients with SAP complicated with ACS,especially to patients with edema of the visceral tissues caused by massive fluid resuscitation at the early stage of the disease.However,decompressive laparotomy should be adopted with caution since it is associated with enteroatmospherie fistula,intraabdominal infection,postoperative ileus,third space losses,hypothermia and hemia.Therefore,decompressive laparotomy should only be considered after conservative management had failed.The indications for decompressive laparotomy are as follows:(1)intraabdominal pressure＞25 nnn Hg;(2)adequate ventilation of the patient is difficult;(3)pereutaneous drainage of ascites is not helpful.Timely temporal abdominal closure is helpful in preventing complications.Infected peripanereatie necrosis is the indication for peripancreatic exploration or necroseetomy.A thorough knowledge of decompressive laparotomy is essential for individualized management of patients with SAP complicated with ACS.

Altering the natural history of disease has been the goal of medical therapy for Crohn's Disease(CD) in recent years.The conventional approach has been the "step-up" therapy.With the introduction of biological agents (such as infliximab),there is growing evidence that the "top-down" approach is justified in a subgroup of high-risk patients.The new algorithms is not only associated with superior clinical remission rates,but also may have the potential to alter the natural history of the disease,including inducing mucosal healing,reducing the rate of complications,surgeries and mortality.Further study will have to determine which subgroup of patients will benefit most from this early aggressive biological therapy approach.

Objective To screen out the polymerase chain reaction ( PCR) primers for specifically identifying Pheretima aspergillum (E. Perrier) , so as to establish a rapid and accurate method to identify the origin of Pheretima aspergillum. Methods Four kinds of earthworms recorded in pharmacopoeia and six kinds of their adulterants commonly seen in the market were collected. The 12SrRNA sequences related to earthworm were downloaded from GenBank database. PCR amplification for ten kinds of samples was performed using the universal primers, and then the products were sequenced. According to the differences between the above sequences, three pairs of specific primers in the non-conservative district were designed for identification of Pheretima aspergillum. Results High-specificity PCR amplification for Pheretima aspergillum with 12St/12Stf primer occurred when the annealing temperature was increased to 64℃, and only Pheretima aspergillum had single amplification strip, while no strips were found in the other adulterants under the same condition. The achieved specific primers could be well verified in 15 kinds of medicinal materials of earthworm purchased in the market, which had the same morphological features showed by the traditional identifying method. Conclusion With 12St/12Stf primer as a specific marker, the identifica tion of Pheretima aspergillum is rapid and accurate in related species of Pheretima aspergillum, and avoids the effect of some factors such as integrity of experimental materials and drying process.

BACKGROUND:Thoracolumbar fracture often accompanies with the injury of adjacent intervertebral disc. Traditional posterior short-segment fixation does not deal with the injured intervertebral disc, which may be the main reason for kyphosis in patients after surgery.
OBJECTIVE:To investigate the effect of injured intervertebral disc on kyphosis angle in patients with single vertebral thoracolumbar fracture after treated with posterior short-segment fixation alone.
METHODS:From January 2009 to June 2014, 40 cases of thoracolumbar fractures were treated in Jinan Central Hospital. They were folowed-up at preoperation, 2 and 12 months after operation and 6 months after internal fixation removal. Data were obtained from X-ray and MRI scanning. According to the preoperative MRI images, cases were assigned to observation group (17 cases) and control group (23 cases) according to injury and non-injury intervertebral disc. Data of vertebral wedge angle, sagittal plane kyphosis, proximal intervertebral disc angle, sagittal index and degeneration classification of proximal intervertebral disc angle from two different groups were analyzed at each folow-up time point (18-30 months, averagely 23.6 months).
RESULTS AND CONCLUSION:(1) Imaging parameters: sagittal plane kyphosis was significantly severer at 6 months than that at 2 months in both groups (P < 0.05). Sagittal plane kyphosis, proximal intervertebral disc angle and sagittal index were greater in the observation group than in the control group at 12 months after surgery and 6 months after fixator removal (P < 0.05). (2) Degeneration classification of proximal intervertebral disc angle: Pearce degeneration grade of proximal intervertebral disc was significantly higher in the observation group than in the control group at 2 months after surgery and 6 months after internal fixation removal (P < 0.05). (3) Results suggested that kyphosis may appear in the patients with thoracolumbar fracture after a posterior short-segment fixation alone, and the injured disc may lead to more severe kyphosis.

Objective To retrospectively assess the clinical manifestations and treatment of secondary syphilis with ocular impairment as the initial symptom. Methods Clinical data were retrospectively analyzed on secondary syphilis with ocular impairment as the initial symptom collected from September 1998 to October 2008. Results There were 11 syphilitic patients presenting acute ocular impairment as their initial manifestation. Skin eruptions developed simultaneously with ocular impairment in 2 patients, following ocular impairment in 9 patients. All patients were positive for rapid plasma reagent test (RPR) and treponema pallidum haemagglutination assay (TPHA), but negative for HIV. Of these patients, 9 suffered from uveitis (iridocyclitis, choroiditis or panuveitis), 2 from optic neuritis; 3 had unilateral ocular involvement, 8 had bilateral ocular involvement. After treatment with injected penicillin or ceftriaxone sodium, 9 patients experienced complete visual recovery, 2 partial visual recovery. Conclusions Ocular impairment occurs in patients with secondary syphilis at a low incidence, with no characteristic clinical manifestations. For patients who have no response to conventional ocular therapy, ocular syphilis should be considered and serological examination for syphilis is recommended.

O bjective:To investigate the effectiveness of D-xylose absorption test in evaluating the ab-sorptive capacity of the remnant small bowel in short bowel patients.M ethods:5 hr urine D-xylose ex-cretion,1hr,2hr,3hr serum D-xylose levels and AUC was compared between the short bowel patients(n=22) and the healthy control(n=50).The correlationship among the D-xylose absorptive capacity,the remnant small bowel length and area,and protein absorptive capacity were analyzed.For the 6 pa-tients receiving rehabilitative therapy,theirD-xylose and protein absorption capacities before and after the therapy were also stud ied.R esu lts:5hr urine D-xylose excretion,1hr,2hr,3hr serum D-xylose levels and AUC were all significantly lower in short bowel patients compared to control group(P

Objective To investigate the effects of ciprofloxacin on anastomotic stoma,small intestinal inflammation and fibrosis in interleukin-10 knock-out mice (mice model of Crohn′s disease (CD)) after ileocaecal resection.Methods Twelve interleukin-10 knockout male C3H/HeJBir mice were evenly divided into control group and ciprofloxacin group.The mice model was established with ileocaecal resection and ileocolostomy.There was no intervention in control group.Ciprofloxacin (50 mg/kg per day)was orally administrated in ciprofloxacin group for four weeks.All the mice were executed.The intestine around anastomotic stoma was taken for hematoxylin-eosin (HE)and Sirius red staining and histological scoring.The level of interferon (IFN)-γand tumor growth factor (TGF)-βin intestine around anastomotic stoma and small intestine was detected by enzyme-linked immunosorbent assay (ELISA) method.The content of procollagen α1 was determined by real-time polymerase chain reaction.The data were analyzed by t test.Results The inflammatory reaction level of anastomotic stoma and small intestine in mice of ciprofloxacin group (2.50±0.55 and 1 .67±0.52)was significantly lower than those of control group (3.67±0.63 and 2.83±0.75 ,t=-8.273,-5 .188,both P <0.05 ).The IFN-γof anastomotic stoma and small intestine also significantly decreased ((0.72 ±0.22 )pg/mg vs (1 .76 ±0.43 )pg/mg, (0.23±0.12)pg/mg vs (0.78 ± 0.52 )pg/mg;t = - 7.354,- 5 .268,both P < 0.05).However, ciprofloxacin could not significantly decrease fibrosis in anastomotic stoma and small intestine of CD mice. There was no significant difference in the level of TGF-βcompared with control group.Conclusions The role of ciprofloxacin in improving inflammatory reation in anastomotic stoma of CD mice was limited. Maintenance therapy may be necessary to reduce the relapse of anastomotic stoma diseases.

Objective To understand the capability of parasitic disease diagnosis among professionals from the clinic labora?tory of Class A tertiary hospitals in Jiangxi Province. Methods The teams that took part in the competition were formed from 20 Class A tertiary hospitals,with 2 contestants per team. The competition contents included written examination and skill opera?tion. The written examination involved the life cycle of parasites,immunological basis,detecting techniques,etiological diagno?sis etc.,and the skill operation involved making and dying thin and thick blood smears,making Kato?Katz’s fecal thick smears, as well as microscopic examinations of smears. Results A total of 40 participants took part in the competition. Their total aver?age score was 97.3±22.4 with the pass rate of 15.0%,in which the mean score of theoretical knowledge was 56.6±12.8 with the pass rate of 52.5%,and the mean score of skill operation was 40.8±12.4 with the pass rate of 5.0%. In the written examination, the scoring rate of the life cycle of soil?transmitted helminths was the highest(90.0%),and the rate of the basic knowledge of food?borne parasites was the lowest(31.5%). Both the pass rates of blood smear making and examination were higher than those of Kato?Katz’s thick smears,and the differences were statistically significant( both P<0.05). The detection rates of Plasmodi?um vivax,Plasmodium falciparum,Plasmodium ovale and negative slides of the contestants were 38.8%,45.0%,35.0%and 25.0% respectively. As to the microscopic examination of helminth eggs,the detection rate of Trichuris trichiura egg was the highest(87.5%),and the rate of the Sparganum mansoni egg was the lowest(2.5%). The scores of Kato?Katz’s thick smear making and examination of the contestants from the provincial level hospitals were higher than those from the city level hospitals (both P<0.05),and the score of those from teaching hospitals in Kato?Katz’s thick smear making was higher than that of those from non?teaching hospitals(P < 0.05). Conclusions The technique level of professionals from the clinic laboratory of the Class A tertiary hospitals cannot meet the needs of the diagnosis of parasitic diseases in Jiangxi Province ,which should arouse the attention of the health authorities and hospitals.