Factitious Disorder is a chronic and difficult-to-diagnose artificial illness characterized by the in-dividual's recurrent simulation of symptoms,deliberate self-harm to produce signs or symptoms,and a high likeli-hood of misdiagnosis and mistreatment in clinical settings.This article introduces a case of a 10-year-old girl with factitious disorder who was misdiagnosed as Henoch-Schonlein purpura in 4 medical institutions,which was the first simulated case of Henoch-Schonlein purpura in China.Based on the literature analysis of factitious disorder,the au-thor combed and analyzed the literature in order to improve clinicians'awareness of the disease and reduce misdiag-nosis and mistreatment.

Factitious Disorder is a chronic and difficult-to-diagnose artificial illness characterized by the in-dividual's recurrent simulation of symptoms,deliberate self-harm to produce signs or symptoms,and a high likeli-hood of misdiagnosis and mistreatment in clinical settings.This article introduces a case of a 10-year-old girl with factitious disorder who was misdiagnosed as Henoch-Schonlein purpura in 4 medical institutions,which was the first simulated case of Henoch-Schonlein purpura in China.Based on the literature analysis of factitious disorder,the au-thor combed and analyzed the literature in order to improve clinicians'awareness of the disease and reduce misdiag-nosis and mistreatment.

ObjectiveTo investigate the effect of Loki Zupa on airway remodeling in asthma based on ultra-performance liquid chromatography-tandem mass spectrometry（UPLC-MS）combined with network pharmacology and experimental verification. MethodThe chemical constituents in Loki Zupa were identified by UPLC-MS. The potential active constituents of Loki Zupa were screened out based on literature retrieval， oral availability （OB） and drug-likeness （DL） in the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform（TCMSP） and Lipinski's rule of five in SwissADEM. The constituent targets of Loki Zupa were obtained through the SwissTargetPrediction. The relevant targets of airway remodeling in asthma were screened out from Online Mendelian Inheritance in Man（OMIM）， GeneCards， DrugBank， and DisGeNET. The STRING was used to conduct protein-protein interaction （PPI） among the main targets. Gene Ontology （GO） and Kyoto Encyclopedia of Genes and Genomes（KEGG） pathway enrichment analyses were carried out through DAVID. Finally， an asthmatic airway remodeling model was induced by ovalbumin （OVA） in mice， followed by hematoxylin and eosin（HE）， periodic acid Schiff（PAS）， and Masson staining for the observation of the pathological conditions of lung tissues. The inflammatory cells in the bronchoalveolar lavage fluid（BALF） of mice were detected. The protein expression levels in mouse lung tissues were detected by Western blot and key signaling pathways were further determined. ResultEighty-two constituents were detected in the negative ion mode and 74 in the positive ion mode by UPLC-MS. Thirty-six candidate constituents and 578 predicted targets of Loki Zupa were screened out through network pharmacology， and 173 common targets with airway remodeling in asthma were obtained， including key compounds such as sebacic acid， pectolinarigenin， naringenin， apigenin， and potential targets such as protein kinase B1（Akt）1 and hypoxia-inducible factor 1α（HIF-1α）. As predicted by KEGG enrichment analysis， Loki Zupa mainly exerted the effect against airway remodeling in asthma through phosphatidylinositol 3-kinase （PI3K）/Akt， HIF-1α， mitogen-activated protein kinase （MAPK）， and other signaling pathways. Animal experiments showed that the compound formula of Loki Zupa could reduce the proliferation of airway goblet cells in asthmatic mice， improve the deposition of collagen under the airway epithelium， and decrease the up-regulated relative expression levels of phosphorylate（p）-Akt/Akt and HIF-1α by OVA sensitization in mice （P<0.05， P<0.01）， which was consistent with the results of network pharmacology. ConclusionUPLC-MS combined with network pharmacology was used to preliminarily clarify the chemical composition of Loki Zupa and its underlying mechanism in intervention in airway remodeling in asthma. Specifically， Loki Zupa presumably synergistically intervened in airway remodeling in asthma through key targets represented by Akt1 and HIF-1α， and multiple pathways represented by the PI3K/Akt and HIF-lα pathways， which is expected to provide ideas for further research on Loki Zupa.

Objective:To analyze the safety and efficacy of endoscopic balloon dilatation (EBD) in the treatment of duodenal Crohn′s disease (CD) -associated strictures.Methods:Clinical data of 49 patients with duodenal CD-associated strictures undergoing EBD in Jinling Hospital from January 2011 to December 2019 were collected. The clinical characters, treatment plan and prognosis were analyzed.Results:There were 39 male patients and 10 female patients. The age of onset was 23 (18, 27.5) years old and the duration was 4 (1.75, 7) years. Most strictures (83.67%, 41/49) located in duodenum bulb, and the endoscopic features included mucosal hyperaemia, edema, ulcer and cobblestone-like changes. Forty-nine patients underwent 144 EBD procedures with an average of 2.94 EBD per patient. The balloon diamater of the first EBD were 1.5 cm in 28 patients (57.14%) , 1.8 cm in 12 (24.49%) , 1.2 cm in 7 (14.29%) and 1.35 cm in 2 (4.08%) . The duodenal perforation occurred in 1 patient. The technical success rate was 99.31% (143/144) . After the median follow-up period of 211 (105, 334.5) days, the treatment success rates were 100% (49/49) , 75.51% (37/49) and 42.86% (21/49) in 1 to 3 months, 3 to 6 months and 6 to 12 months after EBD respectively. Nine patients who had recurrence of strictures received surgery to remove the strictures in duodenum.Conclusion:EBD is a safe and effective treatment for duodenal CD-associated strictures.

Objective:To analyze the safety and efficacy of endoscopic balloon dilatation (EBD) in the treatment of duodenal Crohn′s disease (CD) -associated strictures.Methods:Clinical data of 49 patients with duodenal CD-associated strictures undergoing EBD in Jinling Hospital from January 2011 to December 2019 were collected. The clinical characters, treatment plan and prognosis were analyzed.Results:There were 39 male patients and 10 female patients. The age of onset was 23 (18, 27.5) years old and the duration was 4 (1.75, 7) years. Most strictures (83.67%, 41/49) located in duodenum bulb, and the endoscopic features included mucosal hyperaemia, edema, ulcer and cobblestone-like changes. Forty-nine patients underwent 144 EBD procedures with an average of 2.94 EBD per patient. The balloon diamater of the first EBD were 1.5 cm in 28 patients (57.14%) , 1.8 cm in 12 (24.49%) , 1.2 cm in 7 (14.29%) and 1.35 cm in 2 (4.08%) . The duodenal perforation occurred in 1 patient. The technical success rate was 99.31% (143/144) . After the median follow-up period of 211 (105, 334.5) days, the treatment success rates were 100% (49/49) , 75.51% (37/49) and 42.86% (21/49) in 1 to 3 months, 3 to 6 months and 6 to 12 months after EBD respectively. Nine patients who had recurrence of strictures received surgery to remove the strictures in duodenum.Conclusion:EBD is a safe and effective treatment for duodenal CD-associated strictures.

Objective:To analyze the endoscopic manifestations and clinical characteristics of Crohn′s disease (CD) under the single-balloon enteroscopy (SBE) and to provide evidence for its diagnosis and treatment.Methods:Clinical data of 117 CD patients undergoing SBE examination in Jingling Hospital from January 2016 to January 2019 were analyzed retrospectively. The endoscopic manifestation of CD was observed to give simple endoscopic score for CD (SES-CD) and the simple Crohn′s disease activity index (CDAI) was recorded. Results of the peripheral blood inflammatory indexes, including white blood cell count (WBC) , neutrophil count (NEUT) , lymphocyte count (LC), neutrophil proportion (NEUT%) , lymphocyte proportion (LC%) , neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) were collected. The associations of SES-CD with simple CDAI and CRP were analyzed, meanwhile the influencing factors of endoscopic stricture were analyzed as well.Results:The main endoscopic findings presented skip ulcer, stricture lesion and proliferative lesion in segmental distribution. The SES-CD was positively correlated with the simple CDAI ( r=0.308, P=0.001) and CRP ( r=0.313, P=0.001) . Excluding 6 patients treated with azathioprine, 111 patients were divided into two groups as stricture group ( n=62) and non-stricture group ( n=49) according to the occurrence of intestinal stricture lesion. Compared with non-stricture group, the levels of WBC and LC were significantly lower in stricture group ( P=0.030, 0.043) . Conclusions:The main endoscopic manifestations of CD are skip ulcer, stricture lesion and proliferative lesion. The SES-CD is positively correlated with clinical disease activity. The decrease of WBC and LC can predict stricture lesion of CD to guide clinical therapy.

Objective:To analyze the endoscopic manifestations and clinical characteristics of Crohn′s disease (CD) under the single-balloon enteroscopy (SBE) and to provide evidence for its diagnosis and treatment.Methods:Clinical data of 117 CD patients undergoing SBE examination in Jingling Hospital from January 2016 to January 2019 were analyzed retrospectively. The endoscopic manifestation of CD was observed to give simple endoscopic score for CD (SES-CD) and the simple Crohn′s disease activity index (CDAI) was recorded. Results of the peripheral blood inflammatory indexes, including white blood cell count (WBC) , neutrophil count (NEUT) , lymphocyte count (LC), neutrophil proportion (NEUT%) , lymphocyte proportion (LC%) , neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) were collected. The associations of SES-CD with simple CDAI and CRP were analyzed, meanwhile the influencing factors of endoscopic stricture were analyzed as well.Results:The main endoscopic findings presented skip ulcer, stricture lesion and proliferative lesion in segmental distribution. The SES-CD was positively correlated with the simple CDAI ( r=0.308, P=0.001) and CRP ( r=0.313, P=0.001) . Excluding 6 patients treated with azathioprine, 111 patients were divided into two groups as stricture group ( n=62) and non-stricture group ( n=49) according to the occurrence of intestinal stricture lesion. Compared with non-stricture group, the levels of WBC and LC were significantly lower in stricture group ( P=0.030, 0.043) . Conclusions:The main endoscopic manifestations of CD are skip ulcer, stricture lesion and proliferative lesion. The SES-CD is positively correlated with clinical disease activity. The decrease of WBC and LC can predict stricture lesion of CD to guide clinical therapy.

OBJECTIVE:To establish a method for the simultaneous determination of coumarin compounds in Yifu pill. METH-ODS:HPLC was performed on the column of Inertsil ODS-3 with mobile phase of acetonitrile-water(49∶51,V/V) at a flow rate was 1.0 ml/min,the detection wavelength was 320 nm,column temperature was 30 ℃,injection volume was 20 μl. RESULTS:The linear range was 5.16-206.4μg/ml for osthole (r=0.999 9),37.40-1 495.89μg/ml for isoimperatorin(r=0.999 9) and 9.95-318.34 μg/ml for columbianadin(r=0.999 9);RSDs of precision,stability and reproducibility tests were lower than 3.0%;recov-eries were 96.05%-103.19%(RSD=2.18%,n=9) for osthole,96.90%-103.09%(RSD=2.07%,n=9) for isoimperatorin, 95.50%-103.57%(RSD=2.15%,n=9)for columbianadin. CONCLUSIONS:The method is simple with good precision,stability and reproducibility,and can be used for the simultaneous determination of coumarin compounds in Yifu pill.