Objective:To investigate a classification on age of diagnosis and its clinical characteristics in hospitalized elderly patients with first diagnosed Crohn's disease.Methods:This was retrospective case-control study.A total of 181 newly diagnosed CD patients were admitted to Huadong Hospital from January 2005 to December 2019.According to Montreal CD classification criteria based on the age at the time of diagnosis(sub-grouping A3 into A3 and A4 in this paper), 181 CD patients were classified into four groups: the A1 group(≤16 years, n=4), A2 group(17-40 years, n=60)and A3 group(41-59 years, n=63)(above three as control groups), and the A4 group[≥60 years, with elder-onset Crhon's disease(EOCD), n=54]as a study group.Results:A total of 181 first diagnosed CD patients who met the diagnostic criteria were included in this study.During the investigation period, the total incidence rate of CD was 37.90/100, 000, and the total prevalence rate of CD was 142.79/100, 000.Among the 181 first diagnosed CD patients, there were 4 patients(2.2%)with age of diagnosis of ≤16 years(group A1), 60 patients(33.2%)with age of diagnosis of 16-40 years(A2), 63 patients(34.8%)with age of diagnosis of 41-59 years(A3)and 54 patients(29.8%)with age of diagnosis of ≥=60 years(A4). Of these first diagnosed CD patients, male were dominant in A2 group(51 males / 9 females), while the ratio of males and females tended to be the same(32 males /31 females)in A3 group, and the proportion of female patients was greater than that of male patients in A4 group(25 males /29 females)( P<0.0001). The main CD lesion was ileocolic type in the EOCD group, accounting for 57.4%( P=0.0077). The incidence rate of ileus type CD was 42.6%( P=0.1942). Among the 163 CD patients who underwent colonoscopy, under Simple Endoscopic Score for CD(SES-CD)evaluation, the proportion of SES-CD severity type in EOCD group was as high as 82.2%, which was higher than that in the A3 group(51.7%, P=0.0187). All CD patients underwent pathological examination.There were 173 cases(95.6%)with focal lymphocytic infiltration, 120 cases(66.3%)with inflammatory infiltration on the crypt epithelial and 82 cases(45.3%)with non-caseous granuloma tissue.In the EOCD group, non-caseous granuloma accounted for 61.1%, which was higher than that in the A3 and A2 groups( P=0.0318). In the EOCD group, the non-complication rate was 1.89%, and the incidence rates of 3, 4 and ≥5 complications were 14.8%, 22.2% and 24.1%, respectively( P<0.0001, P=0.0280, 0.0141 and 0.0013). The sulphasalazine(SASP)alone was the main treatment method, accounting for 42.6%( P=0.0038), and the surgery accounted for 24.1%( P=0.9598). Conclusions:The incidence and trend of EOCD are basically consistent with those of adult-onset CD and showed an rising volatility.Incidence rate of EOCD is higher in females than in males.EOCD lesions of visual observation under endoscope are serious.The detection rate of non-caseous granulomas and related scars is high under microscope.EOCD patients have many complications, and SASP alone is the main treatment method.

Objective : To analyze the trends in mortality and life lost due to bladder cancer in Suzhou City, Jiangsu Province from 2003 to 2022, so as to provide the reference for prevention and treatment strategy of bladder cancer. Methods: The data of bladder cancer death in Suzhou City from 2003 to 2022 were collected through Suzhou Residents' Death Registration System, including age, gender, date of death and underlying cause of death. The crude mortality, standardized mortality, years of potential life lost (PYLL), standardized years of potential life lost (SPYLL), years of potential life lost rate (PYLLR), standardized years of potential life lost rate (SPYLLR) and average years of life lost (AYLL) were calculated. The average annual percent change (AAPC) was used to analyze the trends in bladder cancer death and life lost. Results: Totally 2 978 deaths occurred due to bladder cancer in Suzhou City from 2003 to 2022. The crude mortality was 2.22/105, which appeared a tendency towards a rise (AAPC=4.271%, P<0.05). The standardized mortality was 0.91/105, which appeared no significant changing trend (P>0.05). The standardized mortality was 1.58/105 in males and 0.37/105 in females, which appeared no significant tendency in males (P>0.05) and appeared a tendency towards a decline in females (AAPC=-2.331%, P<0.05). The age-specific crude mortality was low among people who aged under 45 years, began to rise among people aged over 45 years and peaked among people aged 60 years and older. The crude mortality of bladder cancer in males aged 60 years and older showed an increasing trend (AAPC=2.864%, P<0.05), but there was no significant tendency in females aged 60 years and older (P>0.05). The PYLL, SPYLL, PYLLR, SPYLLR and AYLL of bladder cancer were 5 020.00 person-years, 2 945.14 person-years, 0.04‰, 0.03‰ and 9.07 years per person. SPYLL, SPYLLR and AYLL showed an decreasing trend (AAPC=-2.867%, -3.321%, -3.738%, P<0.05). Conclusions The mortality of bladder cancer in Suzhou City appeared a tendency towards a rise from 2003 to 2022. The PYLL appeared a downward trend. Males aged 60 years and older are the key groups for the prevention and control of bladder cancer.

Objective To investigate the role of TLR4/NF-kB signaling pathway in inhibited invasion ability of pancreatic cancer cells caused by triptolide (TP).Methods PANC1 cells were divided into parental cells group,TP group,lipopolysaccharide (LPS) group and TP + LPS group.50 ng/ml of TP was added in culture medium in TP group,and 1 μg/ml of LPS was added in culture medium in LPS group,while 50 ng/ml of TP was pretreated for 2 h and 1 μg/ml of LPS was added in culture medium in TP + LPS group.All the ceils were cultured for 24 h.The TLR4 and matrix metalloproteinase-9 (MMP-9) mRNA and protein expression were evaluated by real-time PCR and Western blot.The NF-kB activity was determined by dual-luciferase reporter assay system.The invasion ability of pancreatic cancer cells was evaluated by transwell invasion chamberassay.Results The TLR4 mRNA expressions in parental cells group,TP group,LPS group and TP + LPS group were 0.41 ± 0.06,0.46 ± 0.10,0.20 ± 0.04,0.25 ± 0.06 ; the TLR4 protein expressions were 0.55 ±0.06,0.55 ±0.06,0.18 ±0.04,0.13 ±0.00; the activities of NF-kB were 13.0 ±3.0,31.6 ±4.3,7.3 ±1.5 and 10.8 ± 2.1,and the numbers of invasion cell were (56.8 ± 8.6),(104.5 ± 12.8),(32.0 ± 5.7) and (46.8 ± 7.0) ; the MMP-9 mRNA expressions were 0.36 ± 0.05,0.58 ± 0.07,0.18 ± 0.03,0.30 ± 0.004 ;the MMP-9 protein expressions were 0.31 ± 0.04,0.53 ± 0.08,0.11 ± 0.02,0.15 ± 0.00.In LPS group,TLR4 mRNA and protein expressions were not statistic significant when compared with those in parental cells group,but the activities of NF-kB,the numbers of invasion cell,MMP 9 mRNA and protein expressions were statistically increased when compared with those in parental cells group (t =8.654,7.593,6.655,4.982,P ＜0.01).TLR4 mRNA and protein expressions,activities of NF-kB,the numbers of invasion cell,MMP 9 mRNA and protein expressions in TP group were significantly lower than those in parental cells group (t =-7.609,-9.948,-4.176,-5.915,-8.179,-9.948,P＜ 0.01).TLR4 mRNA and protein expressions,activities of NF-kB,the numbers of invasion cell,MMP 9 mRNA and protein expressions in TP +LPS group were significantly lower than those in LPS group (t =-4.437,-14.805,-10.506,-9.700,-9.055,-8.932,P＜ 0.01).Conclusions TP can inhibit pancreatic cancer cell invasion,and the mechanism is related to the inhibition of TLR4/NF-kB signaling pathway and down-regulation of MMP-9 expression.

Objective To investigate the efficiency of chitosan hemostatic dressing combined radial artery hemostasis device in patients after transradial coronary intervention.Method Six hundred consecutive patients after transradial coronary intervention were selected and randomly divided into the experimental group and the control group according to the hospital number,there were 300 cases in each group.Single pneumatic tourniquet was used in the control group,while the chitosan hemostatic dressing combined with pneumatic tourniquet was used in the experimental group.Hemostasis consumption time,incidence of bleeding,ecchymosis and radial arterial occlusion were compared between two groups.Results There was no significant difference in the incidence of skin ecchymosis between two groups,P ＞ 0.05.The hemostasis consumption time and the incidence of bleeding,early radial arterial occlusion and chronic radial arterial occlusion were (127.6± 33.0) min,7.0％(21/300),5.7％(17/300),4.0％(12/300) in the experimental group and (181.6± 32.2) min,20.0％(60/300),11.7％(35/300),9.0％(27/300) in the control group,t or x2 values were 20.258,21.708,6.822,6.170 respectively,and there were significant differences,P＜0.01 or ＜0.05.Conclusion In patients after transradial coronary intervention,the application of chitosan hemostatic dressing combined with pneumatic tourniquet is safer and more effective than using pneumatic tourniquet alone.

Aim To estimate the anti-uterine cervix cancer effects of the extracts from Lysimachia clethroides Duby in vivo and in vitro. Methods Inhibitory effect on growth was observed by MTT, 3H-TdR and colony-forming units assay. Apoptosis was detected by Hoechst fluorescent staining analysis. The effect on cell migration and morphology was observed by scratch test; Detecting effects of ZE4 on transplant tumor (U14) in mice through observing the tumor weight and organ index. Results ZE4 could inhibit the growth and migration of HeLa cell significantly and induce cell apoptosis. Its half inhibitory concentration (IC50) at 48h was 40.56 mg?L-1 by 3H-TdR assay. The inhibition rate of ZE4 against U14 was 49.9% at the dose of 400 mg?kg-1. Conclusions ZE4 could inhibit the growth of uterine cervix cancer in vitro and in vivo.

Granular corneal dystrophy is a rare autosomal dominant genetic disease in clinic.Due to the TGFBI mutation on the 5q31 chromosome,the TGFBIp abnormally aggregates in the Bowman layer and the matrix layer and metabolic disorders,patients' bilateral cornea arise opacity,making visual acuity Progressive impairment.At present,there are at least 66 TGFBI mutations,at least 10 of which are related to granular corneal dystrophy,due to variation in genotype and the difference between homozygous and heterozygous,the patients' phenotype shows a significant difference.Along with the improvement of people's cognition,and the application of laser scanning confocal microscope and the gene diagnosis,More and more patients get the correct diagnosis,Current treatment methods mainly include corneal transplantation and laser ablation,patients are not satisfied because of the postoperative recurrence and aggravated.Due to the establishment of granular corneal dystrophy animal model,lithium and gene therapy will show a good application prospects.

Objective:To investigate the relationship between genotype and phenotype in children with CRB1 mutated Leber congenital amaurosis (LCA) and early onset retinal dystrophy (EOSRD). Methods:A retrospective clinical study. From January 2013 to December 2019, 10 children with CRB1 mutated LCA/EOSRD were enrolled in the study. The patients were identified as CRB1 mutation by the second generation targeted capture sequencing, Sanger sequencing and the family segregation analysis. All children underwent electroretinogram (ERG) and fundus examination. At the same time, 6 cases were examined by optical coherence tomography (OCT); 1 case was examined by fluorescein fundus angiography (FFA), 7 cases were examined by wide-angle laser scanning ophthalmoscope (UWF SLO). Results:There were 6 cases of LCA and 4 cases of EOSRD in 10 patients with CRB1 gene mutations. The average age of first visit was 3.61 years old. The light and dark wave of ERG was flat in 6 cases, and decreased in 4 cases. A total of 19 pathogenic mutations were detected. There were 1 homozygous mutation and 9 compound heterozygous mutations. There were 4, 2 and 1 cases of "copper-coin" like, "salt and pepper" like and "osteocyte" like pigment changes in retina, 1 case of "crystalline pigment" change and 2 cases of macular pigment scar. In 7 cases of UWF SLO examination, different degrees of para-arteriolar pigment epithelium retention (PPRPE) were found in the middle and peripheral fundus. In 6 cases examined by OCT, the outer layer of retina atrophied and the band of ellipsoid disappeared. Symmetrical cystoid macular edema, splitting cystoid macular degeneration and adhesion of epi-macular membrane to optic disc and macular area were found in 1 case, respectively, the retinal structure was rough and thickened, and the fovea became thinner in 3 cases. In FFA examination, 1 case showed uveitis-like changes with late optic disc fluorescein staining, macular fluorescence accumulation, strong fluorescence diffusing along the blood vessels in each quadrant, peripheral PPRPE of "frost-branch" like strong fluorescence. Conclusion:The relationship between genotype and phenotype of CRB1 mutation is complex, and PPRPE is a common characteristic change.

Objective:To explore the effect of lipoic acid on oxidative stress,inflammation and nutritional status in peritoneal dialysis patients.Methods:94 peritoneal dialysis patients were randomly divided into the observe group(n=47) the control group(n=47).They all accepted the conventional treatment,but the patients in the observed group were given the treatment of lipoic acid capsules(0.2 g tid) for 12 weeks.Superoxide dismutase(SOD),malondialdehyde(MDA),serum advanced oxidation protein products ( AOPPs ) were used to reflect the level of oxidative stress, high sensitive CRP, IL-6 and TNF-αwere used to reflect the micro inflammatory state, modified quantitative subjective global assessment ( MQSGA ) , mid-arm circumference, mid-arm muscle circumference,triceps skinfold thickness ( TSF ) , body mass index ( BMI ) , and serum albumin were used to reflect the nutritional status.The difference of oxidative stress, micro inflammatory state and nutritional status were compared between the two groups.Results:①In the observation group,the concentrations of AOPPs and MDA after treatment were significantly lower than that before treatment,and the concentration of SOD after treatment was significantly higher than that before treatment ( P<0.05 );after treatment,the concentrations of AOPPs and MDA in the observe group were significantly lower than that in the control group(P<0.05), and the concentration of SOD in the observe group was significantly higher than that in the control group ( P<0.05 ) .②In the observation group,the concentrations of high sensitive CRP,IL-6 and TNF-αafter treatment were significantly lower than that before treatment(P<0.05);after treatment,the concentrations of high sensitive CRP,IL-6 and TNF-αin the observe group were significantly lower than that in the control group ( P<0.05 ) .③In the observation group, the TSF, mid-arm circumference, mid-arm muscle circumference,BMI and albumin after treatment were significantly higher than that before treatment(P<0.05),and the MQSGA after treatment was significantly lower than that before treatment ( P<0.05 );after treatment, the MQSGA in the observe group was significantly lower than that in the control group(P<0.05),and serum albumin in the observe group was significantly higher than that in the control group(P<0.05).Conclusion:Lipoic acid could improve oxidative stress in peritoneal dialysis patients,so as to improve the micro inflammatory state and nutritional status.

Objective To investigate the mechanism underlying the WNK4 kinasemediated inhibitory effect on BK channel. Methods Cos-7 cells were cotransfected with BK in combination with either CD4 (control group) or wild type WNK4 (WNK4-WT).Immunostaining and confocal microscopy,chemiluminescence,Western blotting analysis were then employed to determine the BK localization in cells,BK surface expression and total protein level,respectively.To further investigate whether the reduction of BK protein expression is due to an increase in degradation through a lysosomal pathway,BK protein level was determined after treated with bafilomycin A1(Baf A1),a proton pump inhibitor affecting lysosomal degradation. Results Immunostaining and confocal microscopic study showed that BK was localized both in plasma membrane and cytosol in the control group.After cells transfected with WNK4-WT,BK expression was markedly reduced.Chemiluminescent assay found that BK surface expression level was 299.9±18.6 in the control group,whereas it was significantly reduced (148.4±13.7,P＜0.01) in the WNK4-WT group.Western blotting analysis showed that total BK protein level was markedly reduced in the presence of WNK4-WT compared to the control group.WNK4-WT was shown to significantly reduce the BK total protein level (42.3％±15.2％) compared to the control group (100％) (P＜0.01).When the cells was treated with Bafilomycin A1 (Baf A1,0.5 μmol/L),WNK4-mediated reduction in BK protein was reversed (82.2％±12.1％,P＜0.05). Conclusions WNK4 inhibits total and surface protein expression of BK in Cos-7 cells whick is likely due to an increase in BK degradation through a lysosomal pathway.

Objective To investigate the effects of enteral nutrition support with different doses of glutamine on nutritional status and gastrointestinal function in elderly critically ill patients.Methods Totally 90 critically ill patients were randomly divided into three group:the control group without glutamine (group A),enteral nutrition with low glutamine [0.3 g/(kg· d)] (group B),and high glutamine [0.6 g/(kg· d)] groups (group C).Fasting blood samples were collected on days 1,7,and 14 after the initiation of study,and then the indicators including serum diamine oxidase,glutamine,transferin (TF),prealbumin (PA),hemoglobin (HGB),albunin,and nitrogen balance were determined.In addition,the gastrointestinal complications including bloating,diarrhea,and gastric retention were recorded.Results On the 7th and 14th days,the serum glutamine levels in groups B and C were (1 886.8 ±420.5),(2 228.6 ±440.2) μg/L;(1 889.6 ± 436.1),(2 174.3 ± 440.8) μg/L,respectively,which were significantly higher than those in group A [(1 612.0 ±493.5),(1 869.7 ±559.8) μg/L] (P =0.027,P =0.008).The serum diamine oxidase levels were also significantly lower in group B [(2 310 ± 1 271),(1 602.5 ± 1 137.9) U/L] and group C [(2 076.3 ±567),(1 586.3 ±530.9) U/L] than in group A [(3 250 ±923),(2 476 ±862) U/L] (P =0.000,P =0.000).The serum TF and PA levels were significantly increased on the 7th day (P =0.023,P =0.047),and the HGB was significantly higher on 14th day (P =0.003),The number of patients who had undergone successful implementation of enteral nutrition were 4 and 3 in groups B and C,and the number of patients who had achieved the target volume of enterral nutrition was 25 and 27 in groups B and C,which were significantly larger than those in group A (12 and 13,respectively) (P =0.008,P =0.000).The gastrointestinal complication was also significantly decreased after the administration of enterral nutrition with glutamine.Conclusions Enteral nutrition with glutamine can improve intestinal mueosa barrier and nutritional status in elderly critically ill patients.Thus,it helps to reduce gastrointestinal complications and transition time of total enteral nutrition.