Objective To report the diagnosis and treatment process of a case of cryptogenic multifocal ulcerous stenosing enteritis(CMUSE)to enhance the understanding of gastrointestinal hemorrhage caused by multiple ulcers in small intestine and provide reference for clinical diagnosis and treatment.Methods A case of early CMUSE admitted to Tianjin Union Medical Center in September 2021 was analyzed based on clinical characteristics,laboratory examinations,imaging examinations,endoscopy examinations,pathological tissues,treatment methods and follow-up results,and the statistical analysis of related literature was conducted.CMUSE was compared with Crohn's disease(CD),non-steroidal anti-inflammatory drug(NSAID)associated enteritis and intestinal tuberculosis,and the treatment principles and clinical experience of CMUSE were summarized.Results The patient,a 54-year-old male,was diagnosed in September 2021 due to"dark red bloody stool for 5 days".Enteroscopy revealed multiple patchy ulcers in the jejunoileum with local white fur,swelling at the edges,partially healed,and circumferential stenosis in some of the intestinal lumen.Histopathological examination showed acute and chronic inflammation of jejunum and ileum mucosa with ulcers and granulation tissue as well as abundant neutrophil infiltrations.The patient was diagnosed with CMUSE after ruling out other small intestine diseases.Treatment with methylprednisolone for 28 days led to significant improvements in imaging and laboratory indicators.A follow-up enteroscopy 2 years later showed no abnormalities,and as of September 2023,there has been no recurrence.Conclusions CMUSE is a rare disease of unknown etiology.CMUSE should be considered in the case of gastrointestinal hemorrhage due to multiple ulcers of small intestine and chronic small intestinal obstruction caused by fibrous stenosis at the ulcer site.Capsule endoscopy and enteroscopy can support the diagnosis,but capsule endoscopy may be entrapped in the stenosis segment,which can lead to intestinal obstruction.Glucocorticoid hormone therapy should be used as soon as possible after diagnosis,and satisfactory results can be achieved.

Objective:To investigate the effects of cannabidiol(CBD)on the NOD-like receptor protein 3(NLRP3)inflammasome in the brains of rats with multiple cerebral concussions(MCC).Methods:Rats were subjec-ted to the MCC model and divided into Sham,MCC,vehicle(MCC+TW),CBD-L(10 mg/kg),and CBD-H(40 mg/kg)groups.Immunofluorescence double staining was used to observe changes in NLRP3 and microglial cells in the brain,and Western Blot was performed to detect the expression changes of the NLRP3 inflammasome.Results:A sig-nificant increase in lectin-positive microglial cells of the cortex with enlarged cell bodies and elevated immunofluores-cence intensity of NLRP3 in the activated microglial cells was revealed by immunofluorescence double staining following MCC(P＜0.05).The immunofluorescence intensity of NLRP3 in the activated microglial cells was downregulated by the administration of CBD,with a more pronounced effect observed in the CBD-H group compared to the CBD-L group(P＜0.05).The expression of NLRP3,caspase-1,and apoptosis-associated speck-like protein(ASC)in the cortex,hippocampus,and basal ganglia of rats following MCC was significantly increased,as shown by Western Blot analysis(P＜0.05),and cortical areas are more elevated.The expression of these proteins in different brain regions was reduced by CBD-10 and CBD-40 intervention(P＜0.05).Conclusion:Cannabidiol can reduce the inflammatory response of multiple cerebral concussions rats through NLRP3 inflammasome and protect nerve tissue.

OBJECTIVETo evaluate the application of echocardiography in diagnosis of pediatric pulmonary artery sling.

METHODSTwenty-five children diagnosed as pulmonary artery sling in the Children's Hospital, Zhejiang University School of Medicine from July 2012 to August 2017, and 50 healthy children(control group) were enrolled in the study. Echocardiography was performed in all subjects. The origins of the left pulmonary artery(LPA) and right pulmonary artery(RPA) were observed; the internal diameters of LPA, RPA and main pulmonary artery(MPA) were measured; and the ratios of LPA/MPA and RPA/MPA were calculated. The value of RPA/MPA and LPA/MPA in diagnosing pulmonary artery sling was evaluated by ROC curve.

RESULTSEchocardiography showed that the internal diameters of RPA were increased in all patients; while the LPA and blood flow signals in common pulmonary arterial bifurcation were not found in 24 cases, in whom the MPA was directly extended to the RPA, and the LPA was from the massive RPA. The ultrasound of one special case showed that there was no distinct bifurcation of MPA; the MPA walked to the right and then to the left with no change in the internal diameter. There were significant differences in RPA/MPA(0.50±0.05 vs. 0.71±0.15, =7.06, <0.01) and LPA/MPA(0.52±0.05 vs. 0.39±0.09, =6.94, <0.01) between controls and the patients. ROC curve analysis showed that the AUC of RPA/MPA and LPA/MPA in diagnosis of pulmonary artery sling were 0.90 and 0.89, respectively. When taking 0.60 as the cutoff value, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of RPA/MPA in diagnosis of pulmonary artery sling were 79%, 100%, 100%, 91% and 93%, respectively. When taking 0.43 as the cutoff value, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of LPA/MPA in diagnosis of pulmonary artery sling were 71%, 96%, 89%, 87% and 88%, respectively.

CONCLUSIONSs Echocardiography can effectively diagnose pediatric pulmonary artery sling. The RPA/MPA ratio of 0.60 and the LPA/MPA ratio of 0.43 can be used as cutoff values for diagnosis.