Current goals of ulcerative colitis treatment include rapid remission,steroid-sparing remission,endoscopic mucosal healing,reduction in hospitalization and surgery and improvement in quality of life.The treatment principle is rational medications according to the severity,activity and extent of the disease with individualized and comprehensive treatment.The medications conventionally used are 5-ASA,GCS and IS.Newly developed biological agents like Anti TNF-?(infliximab)are used in severe UC and refractory cases.Traditional Chinese Medicines have been used in more than 80% of UC cases and will play a great role in the future.The indications for surgery include acute perforation,massive hemorrhage,toxic megacolon,malignancy and refractory cases for medical therapy.

Objective: To investigate the therapeutic effects of Bawei Xilei San (BWXLS), a compound traditional Chinese herbal medicine, on mice with oxazolone-induced colitis and to explore the mechanisms. Methods: Thirty-two BALB/c mice were randomly divided into 4 groups (8 for each): normal control group, untreated group, hydrocortisone group and BWXLS group. Except for the mice in the normal control group, all mice were intrarectally administered with 3.0% oxazolone to induce colitis. Then the mice in the normal control group and untreated group were administered with 0.9% carboxymethyl cellulose sodium solution. Mice in the BWXLS group were intrarectally administered with 0.2 mg/g BWXLS and hydrocortisone group with 0.02 mg/g respectively for 5 days. The body weight and stool consistency and occult or gross blood were recorded to calculate the disease activity index (DAI). The mice were sacrificed at the 6th day. The macroscopic and histological changes of the colon were evaluated. The expressions of Toll-like receptor 4 (TLR4), nuclear factor-kappaB (NF-kappaB), and epithelial tight junction protein occludin were assessed by immunohistochemical method. The level of tumor necrosis factor-alpha (TNF-alpha) in colonic mucosa was evaluated by enzyme-linked immunosorbent assay. Results: The DAI, and macroscopic and histological changes in the BWXLS group were improved as compared with those in the untreated group (P<0.05) but were similar to those in the hydrocortisone group. The expression of occludin was significantly increased (P<0.05) while the expressions of TLR4, NF-kappaB and TNF-alpha were significantly decreased in the BWXLS group as compared with the untreated group, and were similar to those in the hydrocortisone group (P>0.05). Conclusion: Up-regulating the expression of occludin and down-regulating the expressions of TLR4 and NF-kappaB, and hence inhibiting TNF-alpha expression and improving the mucosa barrier function may be part of the mechanisms of BWXLS in treating oxazolone-induced colitis in mice.

Objective To investigate the expressions of 5-lipoxygenase (5-LOX) protein and mRNA in colon mucosa of ulcerative colitis (UC) and to analyze its correlation with endoscopic and histological grading. Methods The biopsies from 32 UC patients and 26 healthy controls were collected, and the expressions of 5-LOX mRNA and protein in colonic mucosa was determined by real-time fluorescent quantitative reverse transcription polymerase chain reaction (RT-PCR) and immunohistochemistry assay, respectively. The endoscopic and histological grading of 32 UC patients were also recorded. Results According to endoscopic grading, there were 10 cases of grade Ⅰ , 19 of grade Ⅱ and 3 of grade Ⅲ in 32 UC patients, and there were 19 cases of grade Ⅰ , 9 of grade Ⅱ and 4 of grade Ⅲ according to histological grading. The expressions of 5-LOX mRNA and protein in UC patients were significantly higher than those in healthy controls (P ＜0. 05 ). The rate of 5-LOX protein expression increased with endoscopic and histological grades, which was also positively correlated with endoscopic grades ( P ＜ 0. 05 ), but not with histological grades ( P ＞0. 05 ). Conclusion The expressions of 5-LOX mRNA and protein in colon mucosa from UC patients might be a marker for disease activity. 5-LOX may play a pivotal role in inflammation of UC and be a target site for treatment.

Objective To investigate the effect of pioglitazone on oxazolone-induced colitis and to clarify the mechanism of apoptosis by Fas/Fas ligand(FasL). Methods Eighteen BALb/c mice of ulcerative colitis induced by oxazolone enema were equally allocated into 3 groups. The mice in group 1 were sacrificed 3 days after enema,lamina propria mononuclear cells(LPMC) were isolated from freshly obtained colonic specimens and treated in vitro with pioglitazone (40 ?mol/L),the annexin-V-FITC was used for detection of apoptosis,and Fas/FasL expression was assayed by flow cytometry. Meanwhile,untreated mice were served as normal controls. Mice in group 2 (control group) and 3 (experiment group) were treated with methylcellulose or pioglitazone(20 mg?kg -1 ?d -1 ) 3 days after enema and were administrated for consecutive 7 days. The colonic inflammation including disease activity index (DAI),macroscopic and histological changes,myeloperoxidase(MPO) activity and levels of interleukin (IL)-4,IL-5 were evaluated. Results Apoptosis of LPMC,expression of Fas and FasL in normal and colitis mucosa were 12.89?1.23,70.63?6.24,8.59?5.47 and 4.25?0.84,62.60?5.85,23.75?10.23,respectively. After treated with pioglitazone,both apoptosis of LPMC and expression of Fas increased,while FasL expression decreased (40.58?10.32,83.98?11.38 and 10.04?5.21 respectively). In group 2 and group 3,the macroscopic and microscopic score,MPO activity,IL-4 and IL-5 level were 2.50?0.55,8.83?0.75, 3.81?0.17,216.46?34.32,102.28?25.74 and 0.33 ?0.52,4.00?0.63,1.25?0.16,179.36?18.15,61.65?17.45,respectively. Conclusion The results indicate that pioglitazone treatment can significantly attenuate colonic inflammation,and it might be related to the apoptosis of LPMC through Fas and FasL.

Objective To investigate the expression and significance of human β-defensin-2 (HBD2),TNFα and IL-1βin ulcerative colitis(UC).Methods Thirty-five patients with active UC diagnosed by the department of gastroenterology in West China Hospital were included in this study.Ulcerative colitis disease activity index(UCAI)was assessed and the pathological grades of UC were classified.Immunohistochemistry assay and real-time quantitative PCR were used for the expression of HBD2,TNFα,IL-1β in colonic mucosa of UC.Results Among the 35 patients with UC,10 cases were mild.13 moderate and 12 severe.Of the 35 cases.there were 11 with grade Ⅰ.13 grade Ⅱ and 11 grade Ⅲ lesion according to Truelove criteria.The score of UCAI had positive correlation with pathological grading (r=0.890,P＜0.01).The expressions of HBD2,TNFα,IL-1β in colonic mucosa of UC with immunohistochemistry and real-time quantitative PCR were significantly higher than those in healthy control (P＜0.05);the expressions increased gradually with the severity of pathological grade and there was a higher expression of them in inflamed area than in non-inflamed(P＜0.05).A good positive correlation was also found between HBD2 and other inflammatory cytokines.Conclusions It is shown that there is a higher expression of HBD2 in colonic mucosa as compared with healthy control.a higher expression of it in inflamed area than in non-inflamed area and a positive correlation of expression between HBD2 and pro-inflammatory cytokines such as TNFα and IL-1 β,implying that HBD2 and pro-inflammatory cytokines are interdependent and interactive playing an important role in magnifying and aggravating inflammatory injury in UC.

p53 gene mutations and their expression in protein levels of colorectal adenomas, carcinomas and regional lymph nodes metastasis were detected by PCR-SSCP and AB-PAP immunohistochemical analysis, respectively. The results showed that p53 gene mutations were detected in 25% colorectal adenomas, 80% carcinomas and 100% regional lymph nodes metastasis. Meanwhile, p53 proteins were detected at rates of 75%, 60% and 57% in these three groups, respectively. It is suggested that p53 gene mutations occur frequently at late stage of progression to colorectal adenoma-carcinoma sequence and may relate to its metastasis, while the accumulation of p53 protein may be a specific genetic alteration initiated from adenomatous stage. Thus, the biological significances of the two genetic alterations are different. Investigations of these concomitantly would be helpful in understanding the malignant potential of adenoma and evaluation of its staging.

Objective In order to improve the diagnostic level of Crohn's disease( CD),the relevant literatures with CD in China were reviewed and the causes of misdiagnosis about CD were analyzed. Methods Papers on CD published in medical journals from 1989 to 2003 in CMCC and VIP are collected and reviewed one by one, and then the characteristics of the misdiagnosed and missed CD were recorded and the causes of these cases were analyzed. Results From 1989 to 2003, there are 428 papers about CD, of which 261 papers are about clinical studies(60.9%); In these papers, total of 3397 CD cases were reported. In these cases there are 2357 cases missed, clinical symptoms are various and complex including abdomen pain (62.5%),diarrhea(51.5%), abdomenal lumps(16.6%) and so on. The most commonly involved sites of CD are terminal ileum (62.5%), colon (26.9%) and ileum combining with colon (38.9%). Cranulomas were identified in 61.2% of operative specimens and in 27.6% of biopsy specimens. The most common missed diagnosed diseases are intestinal tuberculosis(32. 2% ), simplex intestinal block (23.2%) and intestinal block caused by tumor(6.4%) and acute appenditis(27. 9% ). There are 389 cases misdiagnosed as CD, the most common diseases are tuberculosis(53.5%), small intestinal lymphoma(14.4%) and colonal cancer (17.0%). Conclusion Papers on CD are increased gradually during the periods from 1989 to 2003 with rather high missed or misdiagnosis. As a result, it is necessary for us to improve the cognitzability on CD and to improve the accuracy of diagnosis.

Objective To Investigate the disorder of colonic epithelium apoptosis and proliferation as well as its role of the epithelial barrier break down in ulcerative colitis(UC). Methods Fifty biopsy specimens were obtained endoscopically from 35 patients of UC and 15 controls respectively.The specimens were used for diagnosis of UC and investigation of epithelium proliferation an d apoptosis by IHC with markers of ki－ 67 and M30 respectively. Results Apopto sis index(marked by M30) and ratio of apoptosis to proliferation increased obvio usly in UC compared with the controls(P0.05);Disorder of epithelium apoptosis an d proliferation take place in UC.Apoptosis cells were found not only at luminal surface but also at the base of crypt;however,proliferation cells may extend to superior part of the crypt. Conclusion Unlimited and premature apoptosis as wel l as disorder of apoptosis to proliferation is maybe one of the causes which lea ding to breakdown of the epithelial barrier function i n UC.

Objective Clinical values of endoscopy and histopathology in differential diagnosis of Crohn's disease(CD) and intestinal tuberculosis were evaluated by characterising the distinctive diagnostic features of CD and intestinal tuberculosis in surgically resected specimens.Methods To review retrospectively the surgical enterocolonic specimens and to compare the clinical,endoscopic and morphologic features of CD or intestinal tuberculosis.Selected histological parameters were evaluated retrospectively in both 30 cases of CD and intestinal tuberculosis.Results The sensitivity,specificity and accuracy of endoscopy in diagnosis of CD and intestinal tuberculosis were 80.0%,25.6% 49.3% and 86.7%,46.2% 63.8% respectively.The histological characteristic parameters of intestinal tuberculosis were confluent granulomas often with caseous necrosis and thinning submucosa;the features of CD were granulomas without caseous necrosis ,submucosal hyperplasia fissure like ulceration and prominent lymphoid aggregates.Some histopathology similarities of CD and intestinal tuberculosis were found,such as chronic non-specific inflammation of intestinal wall,ulceration,collections of epithelioid histocytes,microgranulomas and transmural inflammation.Conclusions Although distinctive diagnostic features of CD and intestinal tuberculosis were found in their clinical,endoscopical and pathological study.The final differential diagnosis depends largely upon pathology.

Adult ; Humans ; Male ; Recurrent Laryngeal Nerve ; abnormalities