The prevalence of functional constipation (FC) is increased in elderly population, and seeking for a simple, safe and effective treatment modality is of great importance.Aims: To assess the clinical efficacy and safety of abdominal acupoint massage in elderly FC patients.Methods: A total of 151 elderly patients with FC were enrolled and randomly assigned into three groups: group A was treated with bisacodyl 5 mg once a day orally, group B with massage on Guanyuan, Zhongwan and Tianshu acupoints three times a day and group C with their combination.The treatment course was 4 weeks.The stool frequency per week was recorded, and the Patient Assessment of Constipation Symptoms scale (PAC-SYM) was scored.Results: The baseline data were comparable among the three groups (P>0.05).When compared with those before treatment, there was an increase in stool frequency per week and decrease in overall and dimensional scores of PAC-SYM at 1, 2, and 4 weeks after the beginning of treatment in all the three groups (P<0.05).Bisacodyl was superior to acupoint massage for improving stool frequency, consistency and rectal symptoms (P<0.05), while acupoint massage was superior to bisacodyl for alleviating abdominal symptoms (P<0.05).Mild adverse effects were recorded in patients receiving oral bisacodyl, and no adverse effects were observed in patients receiving acupoint massage.Conclusions: Abdominal acupoint massage is safe and effective for improving stool frequency and constipation-associated symptoms especially abdominal symptoms such as abdominal pain and distention in elderly FC patients.

Objective To explore the function and significance of interleukin(IL)-25 in the pathogenesis of inflammatory bowel disease (IBD) through testing its expression in the intestinal mucosal and serum of patients with IBD. Methods Intestinal or colonic mucosal biopsies of 12 patients with ulcerative colitis (UC), 16 patients with Crohn's disease (CD) and 10 healthy controls were collected. The expression of IL-25 at mRNA level was detected by real-time PCR and the situ expression of IL-25 in intestinal mucosa was analyzed with immunohistochemistry. At same time,serum of 20 UC patients, 24 CD patients and 20 controls was collected, and IL-25 concentration in the serum was determined by enzyme-linked immunosorbent assay (ELISA). Results Compared with healthy controls, the expression of IL-25 at mRNA level in inflamed mucosa of CD and UC patients was significantly decreased (P＜0.05), no statistic difference between UC and CD groups (P＞0.05).The immunohistochemistry results indicated that more IL-25 positive cells in normal lamina propria,the expression of IL-25 in mucosal epithelia cells was low, the expression of IL-25 protein in the intestinal or colonic mucosa of UC and CD patients significantly decreased ( P ＜ 0.05), no statistic difference between UC and CD groups (P＞0. 05). ELISA results showed that the level of IL-25 in the serum of UC and CD groups was significantly lower than healthy controls (P ＜ 0.05). Conclusion The expression of IL-25 in the intestinal mucosa and serum of IBD patients was significantly decreased,which suggested that IL-25 expression defects may closely related to the pathogenesis of IBD. IL-25 may be a new target for the IBD treatment.

Background:Lipopolysaccharide( LPS)and(1,3)-β-D glucan( BG)are involved in the process of Crohn’s disease(CD)by activating immune cells in gut to produce inflammatory cytokines. Aims:To investigate the relationship between LPS,BG and disease activity of CD. Methods:Sixty-eight patients with CD from April 2013 to July 2014 at Shanghai Tenth People’s Hospital were enrolled,of them 41 cases were active-CD( A-CD group)and 27 cases were remission-CD(R-CD group). Twenty healthy subjects were served as normal controls. Crohn’s disease activity index (CDAI)and simple endoscopic score for Crohn’s disease(SES-CD)were used to assess the disease activity and severity. Serum levels of LPS,BG,ESR and CRP were determined,and their relationships were analyzed. Results:Serum levels of LPS and BG in A-CD group were significantly higher than those in R-CD and control groups(P all < 0. 05). No significant differences in serum levels of LPS and BG were found between R-CD and control groups(P all > 0. 05). Levels of LPS and BG were positively correlated with CDAI,SES-CD and ESR(P all < 0. 05),but was not correlated with CRP(P all >0. 05). Conclusions:Serum levels of LPS and BG can be used to assess the disease activity and severity of endoscopic mucosal lesions in CD.

Human intestinal microbial flora has complex interaction with intestinal mucosal immune system,which maintains intestinal homeostasis. Inflammatory bowel disease( IBD)is a chronic and nonspecific intestinal inflammatory disease,the etiology and pathogenic mechanisms have not yet been fully clarified. Dysbiosis of intestinal microbiota is an important factor in the pathogenesis of IBD,and modulation of intestinal microbiota can be one of the measures for treatment of IBD. This article reviewed the dysbiosis of intestinal microbiota in IBD.

Objective To explore the expression and its clinical significance of immunoglobulin G4 (IgG4) in inflammatory bowel disease (IBD) by detecting the expression of IgG4 in the serum and intestinal mucosa of patients with IBD.Methods From March 2015 to August 2016,68 patients with ulcerative colitis (UC),132 patients with Crohn's disease (CD) and 52 healthy controls were collected.The serum levels of IgG4 were detected by immunonephelometry.The expression of IgG4 in intestinal mucosa was analyzed by immunohistochemistry.Five high power fields (HPF) were randomly selected in each specimen.C-reaction protein (CRP) and erythrocyte sedimentation rate (ESR) of patients with UC,patients with CD and healthy controls were detected.The extent of disease,clinical type,disease activity scores (UC scored by Mayo score system,CD scored by Crohn's disease activity index (CDAI)) and current treatment were collected.The correlation between IgG4 expression and CRP,ESR,Mayo score and CDAI were analyzed.Independent sample t test,Chi square test and Pearson's correlation were performed for statistical analysis.Results The results of immunonephelometry indicated that the serum levels of IgG4 of patients with UC,CD and healthy controls were (0.79±-0.61),(0.69±0.59) and (0.41±0.32) g/L,respectively;all were lower than standard level 1.35 g/L.The results of immunohistochemistry revealed that the number of IgG4 positive cells in the colonic mucosa of active UC and CD patients were higher than that of healthy controls ((15.42±12.47)/HPF,(18.65±12.46)/HPF and (4.71±4.14)/HPF),and the differences were statistically significant (t=5.392 and 8.450,both P＜0.05).There was no statistically significant difference in mucosal IgG4 expression between UC,CD patients at remission phase and healthy controls ((4.72±4.23)/HPF,(5.30±4.87)/HPF and (4.71±4.14)/HPF,both P＞0.05).There was no statistically significant difference in mucosal IgG4 expression between UC and CD patients at active phase and remission phase (both P＞0.05).The case number of active patients,CRP,ESR and Mayo scores of IgG4 positive UC patients were all higher than those of IgG4 negative group(x2 =5.499,t=2.811,3.471 and 4.676;all P＜0.05).The number of active patients,CRP,ESR and CDAI of IgG4 positive CD patients were all higher than those of IgG4 negative group(x2 =4.341,t=3.842,3.892 and 2.935,all P＜ 0.05).In UC patients,the number of IgG4 positive cells was positively correlated with CRP,ESR and Mayo scores (r=0.382,0.381 and 0.470;P=0.001,0.003 and P＜0.01).The number of IgG4 positive cells was positively correlated with CRP,ESR and CDAI in CD patients (r=0.199,0.209 and 0.201;P=0.022,0.016 and 0.021).Conclusions The expression level of IgG4 significantly increased in the intestinal mucosa of IBD patients correlated with the activity of disease.The expression level of [gG4 may be one of the parameters to evaluate the activity of IBD.

Objective To investigate the role of tumor necrosis factor -?(TNF-?)in the pathogenesis of experimental murine colitis.Methods From Apr.1999 to May 2002,in the First Affiliated Hospital of Zhengzhou University,an experimental colitis model was established in which chronic colitis was induced by transfer of syngeneic CD45RB,CD~+_4T cells into severe combined immunodeficient(SCID)mice.These SCID recipients were treated with anti-TNF-? mAb,and the efficacy was observed and the mechanism was studied.Results Anti-TNF-? effectively prevented intestinal mucosal inflammation.Anti-TNF-? mAb also significantly suppressed leukocyte infiltration(e.g,CD~+_4 T cells,mononuclear macrophages)in the inflamed colon,and down-regulated production of proinflammatory cytokines interferon(IFN-?)and IL-2 of CD~+_4T cells in lamina propria.Conclusion The data suggests that administration of anti-TNF-? reverses mucosal inflammation via down-regulation of proinflammatory cytokines and decreases leukocyte infiltration in the bowel,thus providing additional support for TNF-?-targeted therapy in human Crohn's disease.

Objective To study the potential role of interleukin-23(IL-23)in induction of peripheral blood natural killer(NK)cell activation and cytotoxicity in patients with inflammatory bowel disease(IBD),and to investigate its clinical relevance to the pathogenesis.Methods Peripheral blood was collected from 12 healthy subjects,16 patients with Crohn's disease(CD)and 25 patients with ulcerative colitis(UC).NK cells isolated from peripheral blood using immunomagnetie beads were cultured in vitro and stimulated with IL-23 or IgG,or combination of two.Concentrations of tumor necrosis factor α(TNF-α)and interferon-γ(IFN-γ)were determined by enzyme linked immunosorbent assay.NK eytotoxicity to K562 cell was detected by flow cytometry.Results The levels of TNF-α and IFN-γ were not increased in healthy controls under stimulation with IgG or IL-23 (P＞0.05),but they were elevated under stimulation with IgG plus IL-23(P＜0.05).IL-23,not IgG,was found tO enhance TNF-α and IFN-γ secretion in IBD patients(P＜0.05).The levels of TNF-α and IFN-γ were significantly increased in IBD patients under the stimulation of IL-23 plus lgG (P＜0.01).The cytotoxicity of NK cells in healthy controls was not observed under stimulation with IL-23 alone or IL-23 plus IgG,whereas it could be enhanced by stimulation with IL-23 in CD patients (62.4%±5.5%)and UC patients(65.3%±6.6%,P＜0.05)or with IL-23 plus IgG in CD patients (50.2%±8.7%)and UC patients(51.5%±7.1%,P＜0.01).ConclusionIL-23 plays an important role in induction of NK cell activation and cytotoxicity in IBD patients,and may be involved in development of IBD.

Objective To test and evaluate the lung function of patients with inflammatory bowel disease (IBD),and to explore the correlation and characteristics between IBD and abnormal lung function.Methods From January 2012 to June 2013,74 hospitalized patients with IBD were collected,among them 34 cases were ulcerative colitis (UC) and 40 cases were Crohn's disease (CD).At the same period,74 healthy individuals were enrolled as controls.The database of history was established.The general state,chemical examinations,lung function,chest X-ray,the diagnosis and treatment were statistically analyzed separately.T test was performed for comparison between groups of measurement data,chi square test was for comparison between groups of count data,rank-sum test was for comparison between groups of ordinal data,and Logistic regression was for multivariate analysis.Results Among the 74 patients with IBD,56 patients (75.68％) were found with abnormal lung function.The percentage of abnormal residual volume of IBD and CD group was 51.35％(38/74) and 60.00％(24/40),which were higher than that of control group [31.08％ (23/74)] and the differences were statistically significant (t=-2.557,P=0.013; t=2.236,P=0.031).There were no significant difference between UC and CD group (P＞0.05).There was no significant correlation between abnormal pulmonary function and the severity of IBD (F=0.744,P=0.690) or extent of lesion (F-2.796,P=0.424).The course of disease ≥five years was a possible protecitive actor (OR=0.824,95％CI:0.687-0.987),and elevated erythrocyte sedimentation rate (ESR) was a possible risk factor (OR=1.093,95％CI:0.994-1.202).Conclusions Most IBD patients are complicated with impaired lung function.It might occur regardless of severity or extent of disease.Course of the disease and ESR may he the influence factors in abnormal lung function.

Objective To detect the expression of IL-23 receptor in T lymphocytes and NK cells in peripheral blood mononuclears(PBMC)from patients with inflammatory bowel disease(IBD)as well as its significance in the pathogenesis.Methods PBMC,isolated from 30 patients with UC,16 patients with CD and 30 healthy controls,were used to determine the expression of IL-23 receptor in T lymphocytes and NK cells by flow cytometry.The surface of lymphocytes was determined by three-colour flow cytometry in inflammatory bowel disease patients,and the results were compared with those of normal peripheral blood.Results The expression of IL-23R on peripheral CD4+ T,CD8+ T and CD56+ NK cells of patients was obviously higher than that in the control group.Conclusion The expression of IL-23R on T lymphocytes and NK cells of patients with IBD was increased,suggesting that IL-23 receptor plays an important role in the pathogenesis of IBD.

Objective To investigate the changes of interleukin-21 (IL 21) and interleukin-21 receptor (IL 21R) expression level in Crohn's disease (CD) patients before and after accepted infliximab (IFX) treatment.Methods From June 2009 to July 2011,twenty-two CD patients met the research criteria were recruited at Tenth People's Hospital of Tongji University.Patients were treated with infliximab at weeks 0,2,6,and 16 healthy individuals were set as healthy control group at same time.Peripheral blood of healthy control group was taken at regular physical examination and blood of CD patients was taken before treatment and 10 weeks after treatment,intestinal mucosa biopsy samples were taken under colon endoscopy examination.The changes of Crohn's disease activity index (CDAI),erythrocyte sedimentation rate (ESR),C-reactive protein (CRP) in CD patients were observed.The change of IL-21R in peripheral blood CD4+ T lymphocytes was detected by flow cytometry.The change of IL-21 expression at mRNA level in intestinal mucosa was determined by realtime quantitative polymerase chain reaction (PCR).The data were analyzed by t test.Results Before treatment,the level of IL21R in peripheral blood CD4+ T lymphocytes of CD patients (12.25％±3.25％) and the expression of IL-21 at mRNA level in inflamed intestinal mucosa (1.38±0.32) were both significantly higher than those of healthy controls (4.25 ％ ± 1.41％,0.44±0.18),the differences were statistically significant (F=15.88,6.75 ; both P＜0.05).At 10th week,the level of IL-21R in peripheral blood CD4+ T lymphocytes of CD patients (8.12％ ± 2.05％) and the expression of IL-21 at mRNA level in intestinal mucosa (0.77 ± 0.24) were both significantly lower than those before treatment,the differences were statistically significant ( t=4.880,8.019; both P＜0.01).Before treatment,ESR,CRP and CDAI of CD patients was (46.8±11.4) mm/1 h,(52.4±11.5) mg/L and 319±74,which was (23.5±9.0) mm/1 h,(11.6±4.6) mg/L and 113±42 after treatment,the differences were statistically significant (t=9.485,16.458,11.100; all P＜0.05).Conclusion The IL-21 expression of active CD patients decreases after IFX treatment,which indicates that IL-21 may involve in IFX induced clinical remission of active CD.