Objective To further understand factors that influence health-related quality of life (HRQOL) in patients with ulcerative colitis (UC),especially the role of perceived stress and coping modes in Chinese patients with UC.Methods This study was a cross-sectional study.Patients with UC were recruited from July 2013 to September 2014 in Peking Union Medical College Hospital.HRQOL was measured using the inflammatory bowel disease questionnaire (IBDQ).Perceived stress was measured by Perceived Stress Scale (PSS).Coping strategy was evaluated using Medical Coping Modes Questionnaire (MCMQ).Demographic data,course of the disease,clinical disease activity,and disease phenotype according to Montreal classification were also collected.Univariate analyses were conducted to determine which variables were associated with HRQOL,and those were statistically significant were entered into a multivariate regression model.Results We recruited 214 patients (response rate 92.2％),whose median age was 37.5 (29.0,49.3) years old and median course of UC was 4 (2,9) years.Through univariate analyses,better HRQOL was significantly associated with regular medical visits,lower number of previous relapses and hospitalizations,no steroid use,Montreal E1,lower Mayo scores,clinical remission,less perceived stress and less acceptance strategy use.However,multivariate analyses revealed that perceived stress (OR =1.112,95％ CI 1.058-1.169),acceptance (OR =0.310,95％ CI 0.141-0.685),number of hospitalizations (OR =2.924,95 ％ CI 1.328-6.437) and clinical activity (OR =5.058,95 ％ CI 2.312-11.066) were most strongly related to HRQOL.Conclusions HRQOL of UC patients are not only associated with clinical activity of the disease,but also associated with coping strategy and perceivedstress.Further research needs to focus on whether or not relieving stress and guiding patients to cope with ulcerative colitis would improve HRQOL.

Objective To evaluate the efficacy and safety of thalidomide (100 to 200mg per day) in the treatment of adult refractory Crohn's disease (CD).Methods From July 2008 to February 2013,29 refractory CD patients were enrolled in thalidomide (100 to 200 mg per day)cohort study.The clinical activity was evaluated by simplified CD activity index.Patients in clinical remission underwent colon endoscope examination,and mucosal healing was assessed by simple endoscopic score for Crohn's disease (SES-CD).Adverse reactions (ADR) were also observed.Results Among the 29 CD patients,23 males and six females,the baseline of 19 patients (65.5％) were in clinical active period and 10 in clinical remission period.Among patients with baseline in clinical active period,three patients did not reach the target dose because of ADR,the left 16 patients were treated with thalidomide for one year and 14 patients achieved clinical remission.The median time of inducing clinical remission was one month.A totle of 24 patients with clinical remission induced by thalidomide and with baseline in clinical remission period were assessed in efficacy evaluation of mucosal healing.Thalidomide was withdrawn in three patients in six months because of ADR and colonoscopy evaluation did not complete,while the other 21 patients received colonoscopy evaluation among whom 33.3％ (7/21) achieved mucosal healing after two years of thalidomide treatment.Numbness of the hands,feet or mouth,somnolence and dermatitis were the top three ADR of thalidomide treatment.A total of nine patients withdrew the medication because of ADR (four (13.8％) with numbness of the hands,feet or mouth,four (13.8％) with dermatitis and one (3.4％) with leukopenia).Conclusions Thalidomide 100 to 200 mg per day can induce clinical remission and mucosal healing in refractory CD.However,it has some adverse reactions and close monitoring and follow up are required during treatment.

Objective This study aimed to explore the differences in global and local brain network topological properties between deficient pattern(DP)and excess pattern(EP)of mild vascular cognitive impairment caused by subcortical small vessel disease based on graph theory network.Methods Patients were recruited prospectively and were classified with DP and EP subtype.The global small-world topological attributes and local nodes were calculated for the comparison of DP,EP,and healthy controls(CN)using the GRETNA platform.Results The three groups all had small-world attributes,but only the patients in EP had a significantly lower small world attribute δ in the range of 0.05-0.26 than the control group(P<0.05).The node efficiency and node strength indicators of multiple brain region were able to significantly distinguish the DP group from the EP group.However,there was no positive brain region in the node efficiency of the DP patients(P>0.05),and only a few brain regions showed increased node strength efficiency(P<0.05).Conclusion The results indicate that the syndrome of DP and EP have significantly different neuroimaging phenotypes,providing a basis for further research of biological classification based on Chinese Medicine syndromes.

Objective:To explore the influencing factors of hospitalization in patients with mild active Crohn′s disease or in clinical remission during long-term follow-up.Methods:This was a prospective cohort study. From August 5, 2013 to January 5, 2015, 123 patients with mild active Crohn′s disease or in clinical remission visited the Department of Gastroenterology, Peking Union Medical College Hospital were selected. The baseline information of all the patients were collected, including the general data such as age and gender, clinical data such as extra-intestinal manifestations, complications, efficacy of glucocorticoid usage, serum hypersensitive C-reactive protein (hsCRP), serum albumin, and the total score and the subscore in systemic symptoms of inflammatory bowel disease questionnaire (IBDQ). All the patients were followed up for a long time till May 31, 2022 or the date of hospitalization due to the disease. Receiver operating characteristic curve (ROC) was used to define the optimal cut-off values of hsCRP and serum albumin for hospitalization prediction. Multivariate Cox regression model was used to analyze the influencing factors of hospitalization.Results:The median age of 123 patients was 32.0 years old (25.0 years old, 49.0 years old), 32.5% (40/123) were female, and 71 cases (57.7%) were hospitalized because of disease, and the median follow-up time was 29.2 months (9.0 months, 57.9 months). ROC analysis showed that the optimal cut-off value of hsCRP and serum albumin in predicting hospitalization because of disease in patients with Crohn′s disease was 1.5 mg/L and 40 g/L (both P<0.001), respectively.Multivariate Cox regression model showed that the extra-intestinal manifestations ( HR=1.869, 95% confidence interval (95% CI) 1.014 to 3.443), complications ( HR=2.511, 95% CI 1.368 to 4.608), glucocorticoid dependence or refractory ( HR=1.958, 95% CI 1.128 to 3.396), serum hsCRP≥1.5 mg/L ( HR=2.116, 95% CI 1.111 to 4.029) and serum albumin≤40 g/L ( HR=3.040, 95% CI 1.716 to 5.386) were independent risk factors of hospitalization because of disease in patients with Crohn′s disease ( P=0.045, 0.003, 0.017, 0.023, and <0.001). However, IBDQ subscore in systemic symptoms ( HR=0.873, 95% CI 0.805 to 0.948) was an independent protective factor of hospitalization because of disease ( P=0.001). Conclusions:Patients with Crohn′s disease at remission stage or mild activity stage who have extra-intestinal manifestations, complications, glucocorticoid dependence or refractory, serum hsCRP≥1.5 mg/L or serum albumin≤40 g/L are at high risk of hospitalization because of disease, and should be given more active treatments and more frequent follow-up. Patients with higher IBDQ subscore in systemic symptoms are more likely to gain a long-term stable condition.