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The clinical, endoscopic and pathologic features of Crohn's disease in the differentiation from intestinal tuberculosis

Li CHENG ; Meifang HUANG ; Pengfei MEI ; Wenhui BO ; Changsheng DENG

Chinese Journal of Internal Medicine.2013;52(11):940-944. doi:10.3760/cma.j.issn.0578-1426.2013.11.011

Objective To investigate the clinical,endoscopic and pathologic features in the differential diagnosis between Crohn' s disease (CD) and intestinal tuberculosis (ITB).Methods The complete clinical data of 107 patients with CD and 69 patients with ITB in our hospital from January 2011 to January 2012 were retrospectively analyzed.The diagnostic value of the clinical and endoscopic scoring system was evaluated.Results CD occurred mainly in male.The salient features of CD included long duration of disease high incidence of colectomy.Comparing with patients with ITB,patients with CD have more cases of diarrhea,hematochezia,abdominal mass,intestinal obstruction,intestinal hemorrhage,perianal lesions,and extraintestinal manifestations (all P ＜ 0.05).It's more frequent to have positive results of anti-Saccharomyces cerevisiae antibody (ASCA),perinuclear antineutrophil cytoplasmic antibody (pANCA) and fecal occult blood in CD patients,as well as low albumin,high C-reactive protein (CRP),elevated platelet count and hematocrit (P ＜ 0.05 or P ＜ 0.01).The salient features of ITB included low fever,night sweats,active parenteral tuberculosis,increased erythrocyte sedimentation rate (ESR),chest X-ray abnormalities,the positive PPD (purified protein derivatives tuberculin) and T-SPOT (P ＜ 0.05 or P ＜0.01).Based on the imaging,CD often involved the small intestine,such as the intestinal stricture and abdominal abscess (P ＜ 0.05),while mesenteric lymphadenopathy was more common in ITB (P ＜ 0.05).The endoscopic examination showed that some patterns of disease involvement such as fissure-shape ulcer [41.12％ (44/107) vs 5.80％ (4/69)],cobblestone sign [15.89％ (17/107) vs 4.35％ (3/69)],lesions over four segment [24.30％ (26/107) vs 7.25％ (5/69)],rectum involvement [17.76％ (19/107) vs 5.80％ (4/69)],ileocecal valve stenosis [21.50％ (23/107) vs 8.70％ (6/69)] and mucosal bridge [5.61％ (6/107) vs 0(0/69)] were more frequent in CD patients than those in ITB patients(P ＜ 0.01 or P ＜0.05).However circular ulcers[37.68％ (26/69) vs 9.35％ (10/107)],rat-bite-like ulcers[24.64％ (17/69) vs 12.15％ (13/107)],persistent open ileocecal valves [39.13％ (27/69) vs 19.63％ (21/107)],tuberous and polypoid lesions [36.23％ (25/69) vs 20.56％ (22/107),37.68％ (26/69) vs 22.43％ (24/107)] were more common in ITB (P ＜ 0.01 or P ＜ 0.05).In terms of pathological findings,certain characteristic features such as transmural inflammation [5.61％ (6/107) vs 0 (0/69)],fissure-liked ulcers [14.02％ (15/107) vs 4.35％ (3/69)],non-caseous granulomas [5.61％ (6/107) vs 0(0/69)],lymphoid hyperplasia [16.82％ (18/107) vs 5.80％ (4/69)] and crypt abscess [9.35％ (10/107) vs 1.45％ (1/69)] were more common in CD than those in ITB(P ＜ 0.05).According to the clinical and endoscopic scoring system,the positive diagnostic rate of CD was 50.47 ％ (54/107)and of ITB was 66.67 ％ (46/69) (P ＜ 0.05).Conclusions The differential diagnosis between CD and ITB should be considered carefully based on clinical,endoscopic,pathological characteristics.The clinical and endoscopic scoring system may contribute to distinguish CD and ITB.

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An analysis of adverse drug reactions of thalidomide in treatment of immune-related bowel diseases

Hanqing LUO ; Bei TAN ; Hong Lü ; Jiaming QIAN

Chinese Journal of Internal Medicine.2013;52(9):726-729. doi:10.3760/cma.j.issn.0578-1426.2013.09.004

Objective To investigate the safety of thalidomide in the treatment of immune-related bowel diseases for providing clinical reference.Methods Thirty-five patients with immune-related bowel diseases (31 Crohn's disease,2 ulcerative colitis and 2 Behcet's disease) treated with thalidomide were enrolled in this study.The incidence,type,severity,duration of thalidomide related adverse drug reaction (ADR) and the dose-effect relationship of neurotoxicity were analyzed.Results All the patients were treated with a mean dose of thalidomide (109.29 ± 30.37) mg/d for (18.8 ± 12.4) months,and 33 occurred ADR.The three most frequent ADR were numbness [51.4％ (18/35)],somnolence [48.6％ (17/35)] and dermatitis [37.1％ (13/35)].The median time to development of these three ADR were 6.50,0.25,and 1.00 months,respectively.Severe ADR leading to withdrawal accounted for 20.0％ (7/35),including reasons of peripheral neuritis (3/7),dermatitis (2/7) and myelosuppression (2/7).The incidence of peripheral neuritis was not significantly related to the maximal and initial dose of thalidomide (P ＞ 0.05).Conclusions Although the incidence of ADR was relatively high during the treatment of thalidomide,most of them were mild and well tolerated.Thalidomide can be safely used in patients with immune-related bowel diseases under close monitoring.

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The efficacy and safety of recombinant human granulocyte colony stimulating factor primed donor peripheral cell harvest in treatment of poor graft function after allogeneic stem cell transplantation

Yuqian SUN ; Daihong LIU ; Lanping XU ; Xiaohui ZHANG ; Kaiyan LIU ; Xiaojun HUANG

Chinese Journal of Internal Medicine.2013;52(9):730-733. doi:10.3760/cma.j.issn.0578-1426.2013.09.005

Objective To assess the efficacy and safety of recombinant human granulocyte colony stimulating factor (rhG-CSF) primed donor peripheral blood stem cell (PBSC) on the treatment of poor graft function (PGF) after allogeneic stem cell transplantation(allo-HSCT).Methods The patients diagnosed as PGF after allo-HSCT and transfused with rhG-CSF primed PBSC from January 2003 to November 2012 were retrospectively analyzed.Hematological response was assessed at day 30 after transfusion.Graft versus host disease (GVHD) was assessed until 6 months after transfusion.Results There were 28 patients including 21 men and 7 women with a median age of 28 (12-50) years old.Of these patients,16 were diagnosed as primary PGF.The median number of transfused mononuclear cells was 2.0 (1.0-5.8) ×108/kg.Totally 42.9％ (12/28) patients achieved good response.Eight patients (28.6％) developed GVHD.Sixteen patients (57.1％) survived.Age (≤/＞ 28 years),gender,donor type (matched sibling/mismatched related),additional conditioning regimen prior to transfusion,time of neutrophil engraftment (≤/＞ 18 days) time of transfusion (≤/＞ 100 days after allo-HSCT) and number of mononuclear cells (≤/＞ 2.0 × 108/kg) did not impact hematological response.However,response rate of primary PGF (4/16) was significantly lower than that of secondary PGF (8/12) (P =0.022).Conclusion Transfusion of PBSC mobilized by rhG-CSF could be considered as an option to treat secondary PGF after allogeneic stem cell transplantation.

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The clinical characteristics of primary Sj(o)gren syndrome with neuromyelitis optica

Lin QIAO ; Yan LUO ; Lili ZHANG ; Lidan ZHAO ; Qian WANG ; Yan XU ; Yan ZHAO

Chinese Journal of Internal Medicine.2013;52(9):745-748. doi:10.3760/cma.j.issn.0578-1426.2013.09.009

Objective To investigate the clinical features of neuromyelitis optica (NMO) and NMO spectrum disorders (NMOSD) with primary Sj(o)gren' s syndrome (pSS).Methods Eleven inpatients diagnosed as NMO secondary to pSS in Peking Union Medical College Hospital were retrospectively analyzed.Results Eleven patients of pSS with NMO were enrolled in this study,including 10 females and 1 male.The mean age was(35 ± 15)years old.The course of disease ranged from one month to 16 years,with a median of 10 months.The interval between optic nerve and spinal cord involvement was 3 months to 2 years.Eight patients had NMOSD as initial presentations of pSS.Eight patients had history of optic neuropathy.The most frequently involved spinal segment was cervical cord (10 cases) shown by magnetic resonance.Serum NMO-IgG antibodies were tested in 7 patients and 6 of them were positive.Conclusion NMOSD may present as an important and initial clinical manifestation of pSS,which suggesting the involvement of central nervous system.Autoimmune antibodies,NMO-IgG and imaging were supposed to be done for further evaluation of prognosis and therapy regimens.

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The prospective register study of domestic tirofiban for clinical application in acute coronary syndrome

Wei DONG ; Yundai CHEN ; Geng QIAN ; Jincheng GUO ; Guoxian QI ; Ming YANG

Chinese Journal of Internal Medicine.2013;52(10):815-818. doi:10.3760/cma.j.issn.0578-1426.2013.10.005

Objective To evaluate the current clinical application of domestic tirofiban in patients with acute coronary syndrome (ACS) and to explore its safety profile focused on the common causes and correlation factors for the hemorrhagic events.Methods The patients diagnosed as ST-elevation myocardial infarction (STEMI) and medium to high risk non-ST-elevation myocardial infarction (NSTEMI)/ unstable angina(UA) in 15 hospitals from September 2009 to December 2011 and given domestic tirofiban,were enrolled in this study.The following data were carefully collected:demographic data,comorbidities,concomitant medications,laboratory data,interventional treatment,application of tirofiban,hemorrhagic events and major adverse cardiac events(MACE) in hospital and at day 30 after discharge.Results (1) A total of 927 patients were enrolled in the study.The domestic tirofiban was given to 241 subjects (26.0％) before the intervention,567 subjects (61.2％) during the intervention and 89 subjects (9.6％) after the intervention.The standardized application was performed in 737 subjects (79.5％) with the loading dose of 10 μg/kg and the maintenance dose of 0.15 μg · kg-1 · min-1 In all the subjects,the average maintenance time was (30.4 ± 14.2) hours with the average dose of (339.3 ± 182.9)ml.(2)During hospitalization,major bleeding happened in 4 cases(0.4％) and major adverse cardiac events (MACE) in 37 cases (4.0％).(3)At day 30 after discharge,1 cases (0.1％)was reported with major bleeding and 9 cases (1.0％) with MACE.(3)The least MACE was showed in the preoperative tirofiban group (2.5％) and followed by the intraoperative group (4.1％) and the postopcrative group (9.0％).Compared with the non-standardized application group,MACE was significantly decreased in the standardized application group (2.44％ vs 10.00％,P ＜ 0.05).Conclusions The standardized application of the domestic tirofiban could decrease the incidence of MACE.Taken into account the combination therapy of clopidogrel and aspirin in the vast majority of patients,the domestic tirofiban exhibits a good safety profile with a relatively lower incidence of bleeding than the similar clinical studies.

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A standardization study of Meta-analyses on nephropathy published in Chinese journals

Jinyan LIU ; Yuliang ZHAO ; Qinghua ZHOU ; Yumei WU ; Shengguo ZHOU ; Ling ZHANG ; Ping FU

Chinese Journal of Internal Medicine.2013;52(10):833-837. doi:10.3760/cma.j.issn.0578-1426.2013.10.009

Objective To evaluate the standardization of Meta-analyses on nephropathy published in Chinese journals.Methods By searching in WANFANG,VIP,CNKI databases and Chinese Biomedical Literature Database(CBM) as well as related Chinese journals,eligible Meta-analyses were enrolled and analyzed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Statement and the MOOSE (Meta-analysis of Observational Studies in Epidemiology) Checklist.Results A total of 217 Meta-analyses were enrolled with 166 on randomized controlled trials (RCT) and 51 on observational studies.Based on the PRSIMA Statement,of the 166 Meta-analyses on RCT,51.8％(86 papers) were found with the complete research hypothesis,13.9％ (23) with the literature screening flow chart,15.7％ (26) with the subgroup analysis,53.0％ (88) with the publication bias analysis and 28.3％ (47) with the sensitivity analysis.According to the MOOSE Checklist,of the 51 Meta-analyses on observational studies,only 9.8％ (5) had done the statistical stability calculation,54.9％ (28) with the outlook of application,45.1％ (23) with the limitation of the study,2.0％ (1) with the quantitative analysis on potential bias and 17.6％ (9) with the suggestion for future studies.Conclusions Unclear hypothesis,limited methodological description,lack of in-depth analysis on heterogeneity and bias are the common defects in Meta-analyses published in Chinese journals on nephrology.

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A Meta-analysis of alendronate for the prevention and treatment of glucocorticoid-induced osteoporosis

Lin YANG ; Jinhui TIAN ; Zhiyu HE ; Xulei TANG ; Kehu YANG

Chinese Journal of Internal Medicine.2013;52(10):838-843. doi:10.3760/cma.j.issn.0578-1426.2013.10.010

Objective To assess the efficiency and safety of alendronate for the prevention and treatment of glucocorticoid-induced osteoporosis (GIOP).Methods The electronic databases of PubMed,EMBASE,Cochrane Library,Web of Science,Chinese BioMedical Literature Database (CBM) and Wanfang Data were searched for all randomized controlled trials (RCT) of alendronate vs.placebo.Two reviewers independently selected trials for inclusion,assessed trial quality using Jadad's scale and extracted the data.RevMan 5.1 software was used for data synthesis and Meta-analysis.Results Seven studies with 1111 patients were included.Compared with placebo,alendronate significantly increased bone mineral density (BMD) at the lumbar spine[MD ＝3.35,95％CI (2.67-4.02),P =0.000] and the femoral neck[MD =1.90,95％ CI (0.89-2.92),P =0.000] after 12 months of therapy.After 24 months of therapy,alendronate significantly increascd BMD at the lumbar spine [MD =3.91,95％ CI (2.37-5.45),P =0.000],but not at the femoral neck [MD =1.91,95％ CI (-1.15-5.02),P =0.22].Compared with placebo,no significant reduction was found by the use of alendronate in the incidence of vertebral fractures [RR =1.00,95％ CI (0.49-2.07),P =0.99] or nonvertebral fractures[RR ＝ 1.02,95％ CI (0.49-2.14),P =0.95].No difference was shown with the adverse event between the two groups[RR =0.97,95％ CI (0.90-1.05),P =0.47].Conclusions Alendronate is effective for the prevention and treatment of glucocorticoid-induced bone loss at the lumbar spine and the femoral neck with relatively good safety profile.Yet,there is no significant difference between the two groups in reducing the incidence of vertebral fractures and non-vertebral fractures.Large-scale RCT designed to observe whether different lengths of alendronate therapy will influence the efficiency should be conducted in the future and to further explore whether it can reduce the incidence of fractures.

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A Meta-analysis of efficacy and safety of sublingual immunotherapy on allergic asthma

Yuanyuan WU ; Xinming XIE ; Dong HAN ; Shaojun LI ; Lu LIU ; Manxiang LI

Chinese Journal of Internal Medicine.2013;52(10):844-848. doi:10.3760/cma.j.issn.0578-1426.2013.10.011

Objective To evaluate the efficacy and safety of sublingual immunotherapy (SLIT) in patients with allergic asthma in order to provide reliable evidence for clinical application of SLIT.Methods To search published articles of randomized controlled trials (RCTs) in allergic asthma from CNKI,WANFANG,Pubmed and Medline databases.The methodological quality of trials was assessed by Jadadscale.The heterogeneity was examined by using Stata 11.0 software.Fixed effect model or random effect model was used to pool the data.The articles which could not be pooled were carried out by descriptive analysis.The Egger's and Begg's test were used to evaluate the publication bias.Results There were total 6 RCTs included in this text.Compared with control group,SLIT could significantly reduce asthma symptom scores (SMD =-0.89,95％ CI-1.36--0.43,P =0.000) and asthma medication scores (SMD =-4.53,95％CI-6.97--2.08,P =0.000),but not forced expiratory volume (FEV1) of lung function (SMD =0.19,95％ CI-0.02-0.41,P =0.078),neither serum sIgE levels (SMD =0.05,95％ CI -0.58-0.69,P =0.870).There were no obvious adverse events reported after treatment of SLIT.No publication bias were indicated by Egger's and Begg's tests.Conclusion SLIT significantly reduces asthma symptom scores and medication scores,suggesting that SLIT is a safe and effective approach of immunotherapy.However,it still needs more highly qualified studies of RCTs to prove.

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A clinical analysis of 509 cases of sacroiliitis

Yanyan WANG ; Zheng ZHAO ; Jianglin ZHANG ; Jian ZHU ; Lixia FENG ; Feng HUANG

Chinese Journal of Internal Medicine.2013;52(11):924-927. doi:10.3760/cma.j.issn.0578-1426.2013.11.007

Objective To study the clinical features of sacroiliitis and differential diagnosis.Methods Totally 509 patients with chief complaints of back pain and diagnosed as sacroiliitis from January 2007 to January in Chinese PLA General Hospital were enrolled.The clinical manifestations,laboratory examinations,imaging and pathological data of the 509 patients were retrospectively analyzed.Results There were totally 406 male patients and 103 female patients.Among all 509 patients,436 were diagnosed as ankylosing spondylitis (AS)/ spondyloarthropathy (SpA),including 385 men.Thirty-six cases were diagnosed as sclerosing osteitis.Ten cases were diagnosed as sacroiliac joint degeneration.Ten cases were diagnosed as pyogenic sacroiliitis or sacroiliac joint tuberculosis.Four cases were diagnosed as diffuse idiopathic bone hypertrophy.Four cases were diagnosed as palmoplantar pustulosis arthritis.Four cases were diagnosed as metabolic bone disease.One case was diagnosed as sacroiliac joint gout.Four cases were diagnosed as neoplastic disease.HLA-B27 positive rate was 86.9％ in AS/SpA.Erythrocyte sedimentation rate and C-reactive protein were increased mildly-to-moderately in AS/SpA patients.Erythrocyte sedimentation rate and C-reactive protein increased obviously in sacroiliac joint infection and tumor diseases.Imaging characteristics were sacroiliac joint bone destruction.Magnetic resonance imaging showed sacroiliac joint bone marrow edema,but range was not beyond anatomical structure in AS/SpA.Conclusions Based on disease distribution of sacroiliitis,AS/SpA is predominant while non-ankylosing spondylitis is not uncommon.Differential diagnoses of sacroiliitis should be considered to avoid malpractice,especially in patients with negative HLA-B27.

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Peptidyl arginine deiminase 4 participates in the pathogenesis of rheumatoid arthritis by influencing histone methylation

Jing GUO ; Long QIAN ; Xiangpei LI ; Xiaomei LI ; Guosheng WANG ; Xuan FANG

Chinese Journal of Internal Medicine.2013;52(11):928-931. doi:10.3760/cma.j.issn.0578-1426.2013.11.008

Objective To explore the probable function of peptidyl arginine deiminase 4 (PAD4) in rheumatoid arthritis(RA).Methods Real-time quantitative polymerase chain reaction (PCR) was used to determine the expression of PAD4 mRNA in peripheral blood mononucleated cells (PBMCs) from 60 RA patients and 40 healthy individuals.Asymmetric di-methylation of histone H3R17,symmetric di-methylation and mono-methylation of H4R3 were semi-quantified by Western blotting in 12 patients with osteoarthritis (OA),26 patients with RA and 10 healthy controls.Results PAD4 mRNA in RA was significantly higher than that in healthy controls [34.6 (16.7,70.8) vs 20.6 (11.1,51.8),P ＜ 0.05].The level of histone H3R17 asymmetric di-methylation in RA was significantly higher than that of OA or control groups(71.34 ±25.65 vs 37.18 ± 18.62 vs 50.67 ± 13.99,P ＜0.01),which was positively related to Tender joint count and Swollen joint count in 28 joints (r =0.418,P =0.034 ; r =0.402,P =0.042).The level of histone H4R3 symmetric di-methylation was similar in RA,OA and control groups (75.02 ± 20.35 vs 57.92 ± 22.77 vs 68.37 ± 17.57,P ＞ 0.05).The level of histone H4R3 mono-methylation in RA patients was significantly lower than that of OA patients and healthy individuals (11.24 ±7.81 vs 32.77 ±30.77 vs 51.20 ±47.14,P ＜ 0.05).The level of histone H4R3 mono-methylation in RA patients was negatively correlated to PAD4 (r =-0.643,P ＜ 0.01).The level of histone H3R17 asymmetric di-methylation and H4R3 symmetric di-methylation was not associated with PAD4 level in RA group (r =-0.185,P =0.377; r =0.198,P =0.344).Conclusions The level of histone H3R17 asymmetric di-methylation is significantly higher and the level of histone H4R3 mono-methylation is significantly lower in RA patients comparing with OA and control groups.Abnormality of histone methylation may be one of the mechanisms for the development of RA.PAD4 probably plays an important role in rheumatoid arthritis by influencing histone methylation.

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