Objective To investigate the clinical features of acute mesenteric ischemia (AMI) in the elderly and provide evidence for early prevention,diagnosis and treatment of AMI for elderly patients.Methods A retrospective analysis was performed in 104 patients with AMI in our hospital,who were divided into two groups:the elderly group (aged≥60 years) and the non-elderly group (aged ＜ 60 years).Clinical manifestations,misdiagnosis rate,laboratory data,underlying diseases,treatment and prognosis were compared between the two groups.Results Acute superior mesenteric artery thromboembolus (ASMATE) was the main cause of AMI in the elderly group and acute mesenteric venous thrombosis (ASMVT) was the main cause of AMI in the non-elderly group.Elderly patients were more prone to misdiagnosis as compared with the non-elderly group (P =0.007).Abdominal pain (100.0％) was the most common clinical manifestation of AMI patients,followed by vomiting (58.7％).Nausea and vomiting were strongly associated with AMI in the elderly (P＜0.05).In laboratory data,serum creatinine,lactate dehydrogenase and uric acid were higher and the D-Dimer level was lower in elderly patients than in non-elderly patients (P＜0.05).Hypertension,atrial fibrillation,arteriosclerosis,ischemic heart disease,cerebral infarction and chronic renal insufficiency were more common in the elderly with AMI (all P＜0.05),while history of alcohol intake was higher in the non-elderly group (P=0.042).Hypertension,arteriosclerosis and cerebral infarction were independent relevant factors for elderly-onset AMI (P =0.000,OR =4.057;P =0.001,OR=4.585;P=0.007,OR=4.269).The number of patients with colon necrosis was higher in the elderly group than in the non-elderly group (P=0.038),and the prognosis was worse in the elderly group than in the non-elderly group (P=0.001).Conclusions ASMATE is the main cause of AMI in elderly patients.Nausea and vomiting are the main clinical manifestations,together with impaired renal function.Hypertension,arteriosclerosis and cerebral infarction are the independent relevant factors for elderly-onset AMI.Elderly patients are more prone to misdiagnosis,show more severity and have worse prognosis.

For investigating the effectiveness and safety of oral sodium phosphate in preparation for colonoscopy,108 cases from both outpatient and inpatient clinics from June,1995 to March,1996 were randomized and blinded to receive either oral sodium phosphate or standardized electrolyte lavage solu- tion as control.The questionaire was designed for scoring by patients and doctors regarding to its toler- ance,taste,side effects and cleaning degree etc.Results showed that the tolerance rates in oral sodium phosphate and electrolyle lavage were 87.5% and 69.2% and the rates of preference in using them were 32.2% and 15.4% respectively(P

Objective To investigate the effects of total glucosides of paeony (TGP) on mice with experimental ulcerative colitis and the underlying mechanisms. Methods Forty-eight mice were equally randomized into 6 groups ( n = 8): normal control group, model group, salicylazosulfapyridine (SASP) group, low-dose TGP group one day after enama, the mice were treated with corresponding agent by oral gavage for3 days. The disease activity index (DAI) score was evaluated every day. After all the mice were scarified, the macroscopic and histological scores were evaluated. The tumor necrosis factor-α (TNF-α) level of the colon mucosa was measured by ELISA and the colonic expression of nuclear factor-κB (NF-κB) p65 was detected by immunohistochemistry. Results Compared with the normal control group, the DAI score was significantly higher in the model group (P ＜0. 01 ),but was similar to that in low-dose TGP group ( P ＞ 0.05 ). Compared with the model group, the DAI score was significantly decreased in SASP group, medium-dose TGP group, and high-dose TGP group (all P ＜ 0. 05). The macroscopic score, histological score, TNF-α level, and expression of NF-κB p65 were significantly higher in model group than in normal control group, SASP group, medium-dose TGP group, and high-dose TGP group ( all P ＜0. 01 ), but was similar to that in low-dose TGP group (P ＞ 0. 05). The efficacy of TGP was higher in high-dose TGP group than in SASP group. Conclusions TGP has certain therapeutic effects on experimental ulcerative colitis,which may be achieved by its inhibitory effect on the activation of NF-κB and the production of TNF-α.

The purpose of this study is to assess the effects of anti-inflammatory on activation of nuclear factor-kappaB and mRNA and protein expression of intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) in intestinal mucosal biopsy specimens from patients with ulcerative colitis (UC). A total of 27 cases with UC were investigated. 15 cases received sulfasalazine (SASP) treatment or SASP and glucocorticoid treatment, 12 cases did not receive any medication related with UC. Normal mucosa from 9 colon cancer cases served as control. Ten pieces of intestinal mucosal biopsy specimens were obtained from each patient. The mRNA expression of ICAM-1 and VCAM-1 were determined by reversal transcription-polymerase chain reaction (RT-PCR). The protein levels of ICAM-1 and VCAM-1 were measured by enzyme linked immunosorbent assay (ELISA). NF-kappaB DNA binding activity was evaluated by electrophoretic mobility shift assay (EMSA). The results showed that NF-kappaB DNA binding activity, mRNA and protein expression of ICAM-1 and VCAM-1 were increased significantly in patients with UC, compared with normal control (P<0.05). Glucocorticoids and SASP markedly inhibited NF-kappaB activation and significantly decreased mRNA and protein expression of ICAM-1 and VCAM-1 (P<0.05). Adhesion molecules (ICAM-1 and VCAM-1) gene activation had significant positive correlation with the NF-kappaB DNA binding activity (r=0.8652 P<0.05, r=0.7902, P<0.05, respectively). We concluded that NF-kappaB is a major and essential factor in regulating the expression of adhesion molecules, it plays an important role in the pathogenesis of UC. SASP and glucocorticoids ameliorate UC via inhibition of NF-kappaB activation and reduction of adhesion molecules expression.
Adult ; Anti-Inflammatory Agents ; therapeutic use ; Colitis, Ulcerative ; drug therapy ; metabolism ; Female ; Humans ; Intercellular Adhesion Molecule-1 ; biosynthesis ; genetics ; Intestinal Mucosa ; metabolism ; Male ; NF-kappa B ; metabolism ; Prednisone ; therapeutic use ; RNA, Messenger ; biosynthesis ; genetics ; Sulfasalazine ; therapeutic use ; Vascular Cell Adhesion Molecule-1 ; biosynthesis ; genetics

To investigate if nuclear factor-kappa B (NF-kappa B) p65 antisense oligonucleotides might affect the expression of NF-kappa B p65 and cytokines in lamina propria mononuclear cells(LPMC) from patients with ulcerative colitis (UC). LPMC were isolated from intestinal mucosal biopsy specimens from 3 patients with UC, and cultured with or without NF-kappa B p65 antisense oligonucleotides (5'-GGAACAGTTCGTCCTATGG-3'), missense oligonucleotides (5'-GGAACAGTTCGTCTATGG-3') and dexamethasone. NF-kappa B p65 expression was determined by western blot analysis. The expression of cytokine mRNA was studied by reversal transcription-polymerase chain reaction (RT-PCR). The cytokine levels were measured by enzyme linked immunosorbent assay. The results showed that NF-kappa B p65 antisense oligonucleotides resulted in down-regulation of NF-kappa B p65 expression, blocked the expression of IL-1 beta mRNA and IL-8 mRNA, and strikingly reduced the production of IL-1 beta and IL-8, and these effects were greater than those of dexamethasone in cultured LPMC from patients with UC(P < 0.05). Therefore, the application of NF-kappa B p65 antisense oligonucleotides may serve as a novel molecular approach for the treatment of patients with UC.
Cells, Cultured ; Colitis, Ulcerative ; drug therapy ; pathology ; Cytokines ; biosynthesis ; genetics ; Humans ; Interleukin-1 ; biosynthesis ; genetics ; Interleukin-8 ; biosynthesis ; genetics ; Intestinal Mucosa ; cytology ; Monocytes ; drug effects ; metabolism ; NF-kappa B ; biosynthesis ; genetics ; Oligonucleotides, Antisense ; pharmacology ; RNA, Messenger ; biosynthesis

Objective:To evaluate the relationship between inflammatory bowel disease (IBD) and diabetes mellitus.Methods:The database of PubMed, EMBASE and Cochrane were searched by computer, and the related studies on the relationship between IBD and diabetes were collected. The retrieval time was from the database establishment to November 2, 2019. The heterogeneity analysis was conducted by Cochran Q test and I2 value. The relative risk ( RR) and 95% confidence interval ( CI) were used as the research indexes to conduct Meta analysis. Sensitivity analysis and publication bias test were also carried out. Results:Twelve observational studies were included in the study, and 216 024 IBD patients were included. Meta analysis showed that there was a significant correlation between IBD and diabetes ( RR = 1.27, 95% CI 1.09 - 1.49), and the risk of diabetes in IBD patients was 1.27 times higher than that of the general population. The results of subgroup analysis showed that: compared with the general population, the risk of type 2 diabetes mellitus (T2DM) in patients with ulcerative colitis (UC) increased ( RR = 1.44, 95% CI 1.25 -1.66), while the risk of type 1 diabetes mellitus (T1DM) had no significant difference. Compared with the general population, the risk of T1DM and T2DM in patients with Crohn′s disease (CD) both increased (T1DM: RR = 1.34, 95% CI 1.05 - 1.71; T2DM: RR = 1.44, 95% CI 1.01 - 2.07). Conclusions:There is a relationship between IBD and diabetes mellitus, and the risk of diabetes is increased in IBD patients.

Objective: To evaluate the efficacy and safety of Oryz-Aspergillus enzyme and pancreatin tablets (Combizym^®) in the treatment of postprandial distress syndrome (PDS) in the elderly, compared with gastrointestinal motility drugs. Methods: A prospective randomized controlled trial was designed and registered in the China Clinical Trials Registry (ChiCTR-IPR-16008185). The elderly patients with PDS were randomly divided into three groups, including Mosapride group with Mosapride citrate tablets 5 mg 3 times per day for 2 weeks; Combizym^® group with Combizym tablets 244 mg 3 times per day for 2 weeks; combined treatment group with both drugs and same doses for 2 weeks. The modified Nepean dyspepsia index (NDSI) score, discomfort intensity score and PDS score were calculated on patients before treatment, at the end of first and second week of treatment, as well as 4 weeks after treatment finished, respectively. Adverse effects were evaluated. Results: A total of 323 patients from 16 tertiary hospitals in China were enrolled in this study. Among them, 105 patients were in Mosapride group, 109 in Combizym^® group and 109 in combined treatment group. There were 148 males (45.8%) and 175 females (54.2%) with median age 71.4±9.0 years (60-100 years). Baseline characteristics of three groups were comparable. After treatment, the NDSI scores in three groups all decreased significantly (P<0.001), while they were similar between groups (P>0.05). The discomfort intensity score and PDS score in three groups showed a significant reduction after treatment (P<0.001), especially in the combined treatment group. Compared with Mosapride group, the scores in Combizym^® group decreased significantly after one or two weeks [discomfort intensity score: after one week, 4.0(2.5, 8.0) vs. 6.0(3.0, 10.0); after two weeks, 3.0(0.0, 5.0) vs. 4.0(2.0, 6.0); all P<0.05. PDS score: after one week, 6.0(3.0, 9.0) vs. 7.0(3.5, 10.5); after two weeks, 3.0(0.0, 5.0) vs. 4.0(2.0, 7.0); all P<0.05]. The efficacy rate in all patients after first week of treatment was over 15.0%. The efficacy rates after two weeks were 55.2%, 68.8% and 73.4% in Mosapride group, Combizym^® group and combined treatment group, respectively. After two week treatment, the efficacy rates in Combizym^® group (P=0.041) and combined group (P=0.006) were higher than that of Mosapride group. The recurrence rate of Mosapride group was 9.5%, which was significantly higher than that of Combizym^® group (1.8%, P<0.05) and combined treatment group (1.8%, P<0.05). There were no serious adverse effects in the three groups. Conclusions The efficacy of Oryz-Aspergillus enzyme and pancreatin tablets is comparable with that of Mosapride in elderly PDS patients, with fewer adverse effects and low recurrence rate. Combination regimen indicates better efficacy than that of Oryz-Aspergillus enzyme and pancreatin tablets or Mosapride alone.