Objective To investigate the effects of different therapeutic strategies on recurrence of postoperative Crohn's disease (CD) patients.Methods From September 2009 to September 2014,85 CD patients with intestinal resection were enrolled.The clinical features and maintenance therapeutic medication were retrospectively analyzed.The patients were divided into non-treatment group (induding continuously or cumulatively taking medicine less than three months),5-aminosalicylic acid (5-ASA) group and immunosuppressant agents group (including azathioprine,methotrexate and thalidomide).Kaplan-Meier method was performed to compare the recurrence rate in postoperative CD with different therapeutic medication and the risk factors of postoperative recurrence were also analyzed.Results Among 85 CD patients,there were 32,21 and 32 patients in non-treatment group,5-ASA group and immunosuppressive agents group,respectively.After surgery,the one year accumulated clinical recurrence rate of immunosuppressant agents group was 12.5％ (4/32),which was significantly lower than that of non-treatment group (56.3％,18/32) and 5-ASA group (38.1％,8/21),and the differences were statistically significant (x2 =12.250,P＜0.01;x2 =4.102,P =0.043).After surgery,the two years accumulated clinical recurrence rate of immunosuppressant agents group was 12.9 ％ (4/31),which was significantly lower than that of non-treatment group (75.9％,22/29) and 5-ASA group (47.6％,10/21),and the differences were statisitcally significant (x2 =17.840,P＜0.01;x2 =6.597,P=0.010).After operation,the one year accumulated endoscopic recurrences rates of non-treatment group,5-ASA group and immunosuppressant agents group were 39.1％ (9/23),5/16 and 34.6％ (9/26),respectively;while the two year accumulated endoscopic recurrence rates were 59.1％ (13/22),6/16 and 44.0％ (11/25),respectively.However,there was no statistically significant difference among the groups (all P＞0.05).Penetrating lesion was an risk factor of postoperative clinical recurrence in CD patients (x2 =4.963,P=0.026,oddsratio (OR) =2.221,95 ％ confidence interval (CI) 1.121 to 5.775).Conclusions Immunosuppressive agents rather than 5-ASA have remarkable effects in preventing postoperative clinical recurrence in CD patients.Postoperative clinical recurrence is more likely to happen in patients with penetrating lesions.

The extrarenal effects of mineralocorticoid receptor (MR) activation are closely related to the regulation of blood pressure. The activation ability of MR varied with age and gender in blood pressure regulation. MR of different types of cells play an important role in the pathogenesis of hypertension by increasing the expressions of osteogenic transcription factors, epithelial sodium channels, fibrotic substances and fibrogenic factors, change of vascular L-type calcium channels, aggravation of inflammation and oxidative stress, etc., leading to arterial elasticity weakened, myocardial fibrosis, and water sodium retention. Cell-specific MR block provides a theoretical basis for the development of targeted drugs for treatment of hypertension in the future. The effect of cell-specific MR on the regulation of blood pressure has been reviewed in present paper.

Objective:To investigate the imaging manifestations and diagnosis of hepatic hereditary hemorrhagic telangiectasia (HHHT). Methods:The imaging features and clinical data of three HHHT patients were analysed and the related data were reviewed. B-type ultra-sonography, contrast enhanced CT and DSA were utilized to show the changes of the involved liver and the vessels. Results:B-type ultra-sonic graph showed abnormal blood vessels in hepatic hila. CT or DSA demonstrated intra-and extra-hepatic abnormal ectatic arteries, intrahepatic telangiectasia, cirrhosis and hepatic enlargement. Conclusion:CT might be used as one of the key measures for the diagnosis of HHHT.

Objective To explore the effect of dexmedetomidine combined with ropivacaine for continuous lumbar plexus block on the quality of early recovery in patients undergoing total hip ar-throplasty.Methods Sixty patients (35 males and 25 females)with ASA physical status Ⅱ or Ⅲ, aged 65-84 years,undergoing total hip replacement were randomly assigned to dexmedetomidine com-bined with ropivacaine group (group D)or ropivacaine group (group C).All patients received ropiva-caine which was administered via continuous lumbar plexus block as patient-controlled analgesia (PCA)after surgery.The PCA were programmed with a background infusion 8 ml/h of ropivacaine, bolus dose was 4 m1 and the block time was 30 min;the patients in group C received 0.2% ropiva-caine,and the patients in group D received 0.1% ropivaciane combined with 1 μg/ml of dexmedeto-midine by the way of intravenous infusion.In addition,all patients received another patient-controlled intravenous analgesia (PCIA)with 1 mg/ml of morphine for relieving the explosive pain.The PCIA was programmed with a lobus dose of morphine 1 mg without background dose,the block time was 5 min.Consumption of morphine and visual analog scale (VAS)score,muscle strength and maximum flexion and abduction of hip joint were recorded at the time points of 6,12,24 and 48 h after opera-tion.The side-effect reactions such as nausea,vomiting,drowsiness and itching were recorded.The sleep quality was assessed with Pittsburgh sleep quality index (PSQI)on day 1 before operation,day 1 and day 7 after operation.Results The consumption of morphine in group D was significantly fewer than group C (P <0.05).Compared with group C,muscle strength and maximum flexion and abduc-tion of hip joint in group D were increased at 6,12,24 and 48 h after operation (P <0.05 ).PSQI scores were decreased on the day 1 and day 7 after operation.The incidence of delirium,nausea and vomiting,drowsiness and itching in group D were decreased (P <0.05).Conclusion 0.1% ropiva-ciane continuous lumbar plexus block combined with 1 μg/ml of dexmedetomidine by the way of in-travenous infusion could provide satisfied analgesia for the operation of total hip arthroplasty;the sleep quality is improved,the functional exercise of hip joint is promoted.

Objective To investigate the efficacy and safety of tocilizumab inpatients with refractory systemic'onset juvenile idiopathic arthritis (SoJIA),and to provide a new option for the treatment of this severe disease.Methods We retrospectively studied 25 cases of hospitalized patients with refractory SoJIA treated withtocilizumab,of whom 22 had data that fit for analysis,from May 2005 to February 2016.Data of 22 cases were collected retrospectively from physicians in charge of the patients.Children with SoJIA were treated with nonsteroidal antiinflammatory drugs (NSAIDs),Glucocorticoid (GC),methotrexate,cyclosporin A,etanerceptetc before,but still in high disease activity due to inadequate response were involved.Weretrospective analyzedthe laboratory test results like C'reactive protein (CRP),Erythrocyte sedimentation rate (ESR),Ferritin and other inflammatory index.Improvement of pain,fever,rash,hepatosplenomegaly and lymphadenectasis of active SoJIA (disease course ≥6 months,and inadequate response to NSAIDs and GC) after tocilizumab treatment (Body weight ≥30 kg,8 mg/kg;Body weight＜30 kg,12 mg/kg,per 4 weeks) were analyzed.Safety data of 22 cases were collected throughout the treatment period including neutropenia,infections,anaphylaxis and elevated liver enzymes etc.We also retrospectively analyzedthe dose change of GC and the long'term effect.Dichtomous paramenters were compared teween groups using thex2 test.Continuous parameters were compared using the analysis of uariance.Results In comparison to the indices before the treatment,the level of CRP [(8.7±2.2) mg/L vs (111.6±74.4) mg/L,F=5.192,P=0.002],ESR [(6.4±6.3) mm/1 h) vs (65.6±24.3) mm/1 h,F=50.393,P=0.000],white blood cell (WBC) [(8.4±2.5)×109/L vs (17.6±8.6)×109/L,F=9.321,P=0.000],Neutrophil count [(4.9±2.4)×109/L vs.(14.4±8.7)×109/L,F=10.541,P=0.000],blood platelet (PLT) [(269.5±79.2)×109/L vs (405.4± 145.3)×109/L,F=5.704,P=0.000] and globulin [(19.2±4.1) g/L vs (30.1±3.8) g/L,F=22.896,P=0.000] decreased rapidly and hemoglobin [(118.3±9.0) g/L vs (108.5±9.8) g/L,F=4.693,P=0.002] increased significantly at 24 weeks after Tocilizumab (TCZ) treatment.Clinical manifestationssuch as fever,rash,hepatosplenomegaly,joint swelling and pain were significantly improved.GC dose [(1.25±3.8) mg·kg-1·d-1 vs (16.2±12.8) mg·kg-1·d-1,F=8.21,P=0.000] were significantly reduced after TCZ treatment (P＜0.05);American College of Rheumatology (ACR) Pedi 30/50/70/90 was improved after TCZ treatment.Adverse events occurred in 3 cases of 25 children,who were not included in the statistical analysis group.Conclusion This retrospective case series has demonstrated the efficacy of tocilizumab in SoJIA,low incidence of adverse reactions.Further studies are needed to be developed because this case series haslimited sample size.

ObjectiveTo investigate the value of diffusion tensor imaging (DTI) at high b value for unilateral middle cerebral artery (MCA) occlusive disease in patients without obvious infarct lesions on conventional MR imaging.MethodsDTI at high b value (2200 s/mm2 ) was performed using a 3.0 Tesla MR scanner in 34 patients with unilateral middle cerebral artery occlusion,who had no obvious infarct lesions on conventional MR imaging. Fractional anisotropy (FA),apparent diffusion coefficient (ADC),axial diffusivity (eigenvalue λ1) and radial diffusivity (eigenvalues λ2,λ3) were measured at the ipsilateral and contralateral corona radiata,anterior and posterior limbs of the internal capsule,cerebral peduncle and pons in all subjects.Mean ADC,FA,λ1,λ2 and λ3 values of corona radiata,anterior and posterior limbs of the internal capsule,cerebral peduncle and pons were compared between the ipsilateral and contralateral MCAterritory by t test. Results Among the 34 patients,left MCA occlusion in M1 segment occurred in 16 patients and right MCA occlusion in Ml segment occurred in 18 patients.At the ipsilateral corona radiata,mean FA,ADC,λ1,λ2 and λ3 were 0.419 ±0.032,(5.975 ±0.272) × 10 3,(5.704 ±0.365) ×10-3,(6.412 ±0.368) × 10-3 and (6.605 ±0.343) × 10-3 mm2/s,respectively.At the contralateral corona radiata,mean FA,ADC,λ1,λ2 and λ3 were 0.443 ± 0.033,(5.804 ± 0.282) × 10 -3,(5.651 ±0.350) × 10-3,(6.099 ±0.353) × 10-3 and(6.372 ±0.355) × 10-3 mm2/s,respectively.At the ipsilateral corona radiata,mean FA was significantly decreased(t =11.614,P ＜0.01),and mean ADC (t=12.421,P＜0.01),λ1(t =7.447,P＜0.01),λ2(t=10.244,P＜0.01) and λ3(t=9.890,P＜0.01) were significantly increased.At the ipsilateral anterior and posterior limb of the internal capsule,mean FA were 0.609 ±0.026 and 0.674 ±0.033,λ1 were(5.330 ±0.462) × 10 -3 and(5.171 ±0.456) ×10-3 mm2/s,respectively.At the contralateral anterior and posterior limb of the internal capsule,FA were 0.622 ±0.026 and 0.694 ±0.034,λ1 were(5.064 ± 0.448) × 10 -3 and(4.924 ± 0.365) × 10 -3 mm2/s,respectively.Mean FA was significantly decreased (t =7.823,8.013,all P ＜ 0.01) and mean λ1 was significantly increased (t =7.811,8.800,all P ＜0.01) at the ipsilateral anterior and posterior limbs of the internal capsule.There was no significant difference in ADC,λ2 and λ3 value between the ipsilateral and contralateral sides.And all the DTI parameters,including mean ADC,FA,λ1,λ2 and λ3 values,showed no statistical difference between both sides of cerebral peduncle and pons.ConclusionDTI at high b valuc can provide useful information for visualizing ischemic white matter injury in patients without obvious infarct lesions on conventional MR imaging.

Objective To investigate the expression and the effects of tissue inhibitor of metalloproteinases-1 (TIMP-1) on lungs of rats with sepsis.Methods Forty Sprague-Dawley (SD) rats were randomly divided into two groups,namely sham group (n =8) and sepsis model group (n =32).The rats of model group were modeled by cecal ligation and puncture (CLP),and were further divided into four subgroups as per the time after modeling,namely 6 h (n =8),12 h (n =8),24 h (n =8),48 h (n =8)subgroups.Blood and lung samples were taken 6 h,12 h,24 h and 48 h after modeling.The histological changes in lungs of the rats were observed under light microscope.Expressions of TIMP-1 mRNA,Bax mRNA and Bcl-2 mRNA in lungs were measured by RT-PCR.The immunohistochemistry was used to label the CD18 in lungs during different phases of sepsis.The data were processed by t test.Results Compared with sham group,the lung tissues of rats in model group were injured to a certain extent after CLP.The expression of TIMP-1 mRNA and the number of CD18 positive cells increased at the same time (P ＜ 0.01),and peaked 24 hours later (P ＜ 0.01).While the expression of Bax mRNA in model group decreased markedly 12-48 hours after modeling (P ＜ 0.01-0.05),and reached minimum 48 hours later (P ＜ 0.01).The expression of Bcl-2 mRNA in model group changed unnoticeable.The positive correlation between variations in number of CD18 positive cells and expression of TIMP-1 mRNA was found in model group (r =0.426,P ＜ 0.01).Conclusions The increase in expression of TIMP-1 mRNA in lungs is closely associated with the lung injury of sepsis.The mechanism of lung injury is likely attributed to the preservation of inflammatory cells from apoptosis,and the persistent inflammation response causes tissue damage,leading to organ dysfunction.

Objective To analyze the clinical features and laboratory data of 10 patients with macrophage activation syndrome (MAS) complicating systemic onset juvenile idiopathic arthritis (soJIA),which were characterized by acute severe liver injury.Methods Data of 10 patients with soJIA/MAS from Nanjing Children's Hospital were collected retrospectively.The clinical features,laboratory findings,treatment,outcomes and prognosis were analyzed.Results In the total 10 patients,female (6/10) outnumbered male.Their age ranged from 1.5 to 9.5 years old (average 5.2±2.6).The most remarkable clinical manifestations were severe liver injury without systemic features,representing as hepatomegaly (10/10),splenomegaly (2/10) and strikingly increased transaminase (10/10,median:ALT 1 445 U/L,AST 885 U/L).Central nervous system dysfunction and hemorrhages were recorded in 20％ of the patients.Two patients had pulmonary infection.Laboratory data showed that platelet count was less than normal or precaution value (10/10,≤262×10g/L).Hyperferritinaemia (10/10,median:17 329 mg/ml) and soluble CD25 elevation (median:3 140 U/ml) were common in the soJIA/MAS patients.Evidence of macrophage hemophagocytosis was found in 90％ of the patients (9/10) who underwent bone marrow aspiration.Pathological findings of liver biopsy from 1 patient revealed massive infiltration of mononuclear cells in the portal tracts.Nearly all patients (9/10) received intravenous pulse methylprednisolone therapy,combined with cyclosporine A and high-dose intravenous immunoglobulin.Eight patients had good outcome.Only 2 patients were complicated with severe interstitial lung disease during 12-months follow-up.Conclusion MAS should be considered when patients with soJIA represents acute severeliver injury without systemic features combined with other laboratory data.Intravenous pulse methylprednisolone and cyclosporine A therapy may improve the prognosis of soJIA/MAS.

Neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD) is an autosomal recessive disease caused by SLC25A13 gene mutations, and is characterized by delayed jaundice clearance, liver dysfunction, and elevated aminoacidemia. The confirmed diagnosis depends on gene analysis. Citrin deficiency is one of the important causes of neonatal intrahepatic cholestasis in China. Recently more and more researches about NICCD were reported. The paper summarized the epidemiology, pathogenesis, clinical characteristics, and progresses in diagnosis and treatment of NICCD.

Objective To investigate the preoperative evaluation of pulmonary function and protocol for scoliotic patients with respiratory failure. Methods From September 2000 to June 2008, sixteen patients suffered from respiratory failure were recruited into this study. There were two males and three females who were diagnosed as idiopathic scoliosis with a mean age of 13.5 years (range, 10-16 years). The other eleven patients were diagnosed as congenital scoliosis, including five males and six females with a mean age of 12.4 years (range, 10-14 years). The mean preoperative Cobb angle was 126.6°±15.5° with a mean height of 137.6 cm (range, 120-160 cm) and a mean weight of 32.5 kg (range, 18-40 kg). Decision was made depending on the severity of pulmonary impairment and spinal deformity. Preoperative treatment included respiratory training, noninvasive positive pressure ventilation therapy and halo-gravity traction. Results All patients received corrective surgery; ten patients were extubated tracheal tubes successfully 1 hour after surgery and six patients had to stay in intensive care unit (ICU) for 24 hours. Pulmonaryedema occurred in two cases and pneumonia in one case. The Cobb angle had improved to 72.0°±13.2° after surgery with a correction rate of 43%. All patients recovered well after surgery with no major cardiac or pulmonary complications.Conclusion Patients with preexisting respiratory failure can tolerate deformity correction operation with few complications after receiving a set of preoperative respiratory training modalities.