Inflammatory bowel disease (IBD) is a chronic, nonspecific inflammatory disease of the intestine. In recent years, the treatment goals for IBD have evolved from symptom control and endoscopic remission to histological remission, which is associated with significantly better prognoses. Current parameters for histological evaluation include the Nancy histological index (NHI), Geboes score (GS), Robarts histological index (RHI), and global histological activity score (GHAS). However, the evaluation of clinical histological remission remains limited by the lack of standardized criteria and poor reproducibility, hindering its widespread application. With the development of artificial intelligence (AI) technology, AI tools have been increasingly applied in histological evaluation of IBD and can be integrated with endoscopic and multi-omics approaches. This article reviews the current applications, research progress, and associated challenges of AI in the histological evaluation of IBD.

Inflammatory bowel disease (IBD) is a chronic, nonspecific inflammatory disease of the intestine. In recent years, the treatment goals for IBD have evolved from symptom control and endoscopic remission to histological remission, which is associated with significantly better prognoses. Current parameters for histological evaluation include the Nancy histological index (NHI), Geboes score (GS), Robarts histological index (RHI), and global histological activity score (GHAS). However, the evaluation of clinical histological remission remains limited by the lack of standardized criteria and poor reproducibility, hindering its widespread application. With the development of artificial intelligence (AI) technology, AI tools have been increasingly applied in histological evaluation of IBD and can be integrated with endoscopic and multi-omics approaches. This article reviews the current applications, research progress, and associated challenges of AI in the histological evaluation of IBD.

Inflammatory bowel disease (IBD) is a group of digestive tract diseases characterized by chronic intestinal inflammation, including ulcerative colitis and Crohn′s disease. The over-sustained immune response driven by imbalance of intestinal microbiota plays a key role in the initiation and progression of IBD. Studies have identified that intestinal microbiome possesses more than a hundred trillion types, including bacteria and fungi, which collectively participates in energy metabolism, intestinal barrier function and immune balance. There exists a stable relationship between fungi and bacteria in the intestine, involving cooperation, antagonism, and mutualism. Fungus-bacterium homeostasis plays an important role in maintaining intestinal homeostasis. Based on intestinal fungus changes in IBD patients, this article reviews the research progress in intestinal immunomodulation and therapeutic strategies derived from fungus-bacterial homeostasis.

Inflammatory bowel disease (IBD) is a group of digestive tract diseases characterized by chronic intestinal inflammation, including ulcerative colitis and Crohn′s disease. The over-sustained immune response driven by imbalance of intestinal microbiota plays a key role in the initiation and progression of IBD. Studies have identified that intestinal microbiome possesses more than a hundred trillion types, including bacteria and fungi, which collectively participates in energy metabolism, intestinal barrier function and immune balance. There exists a stable relationship between fungi and bacteria in the intestine, involving cooperation, antagonism, and mutualism. Fungus-bacterium homeostasis plays an important role in maintaining intestinal homeostasis. Based on intestinal fungus changes in IBD patients, this article reviews the research progress in intestinal immunomodulation and therapeutic strategies derived from fungus-bacterial homeostasis.

Ulcerative colitis (UC) is a non-specific, chronic and relapsing intestinal inflammatory disease with unknown etiology. Biological agents had been used to treat UC, and efficacy was superior to traditional therapeutic drugs, however, many problems followed. This article reviewed the application of biological agents in the treatment of moderate-to-severe UC, therapeutic drug monitoring, special conditions occurred during the use of biological agents and their management.

Inflammatory bowel disease (IBD) is a chronic non-specific inflammatory digestive tract disease with unknown etiology. Patients with IBD are recommended to take life-long follow-up and treatment due to the long disease course and repeated recurrence of disease. With the development of ultrasound technology, trans-abdominal bowel ultrasound has been brought into focus in recent years because of its high sensitivity, specificity, free of radiation, convenience and economy. This article reviewed the characteristics of ultrasound of IBD and the application and value of trans-abdominal bowel ultrasound in IBD.

ObjectiveTo investigate the features and changing trend of drug-induced liver injury (DILI) in the elderly from 2009 to 2019, and to provide a reference for clinical prevention and treatment of DILI in the elderly. MethodsA retrospective analysis was performed for the clinical data of 2107 elderly patients, aged ≥60 years, who were diagnosed with DILI in The Fifth Medical Center of Chinese PLA General Hospital from January 2009 to December 2019, and they were divided into groups according to age. Related clinical data were analyzed, including age, sex, clinical features, prognosis, and regional distribution. The Chi-square test was used for comparison of categorical data between groups. ResultsAmong the 2107 patients with DILI, there were 802 male patients and 1305 female patients, with a male/female ratio of 1∶1.63. Cholestasis type was the most common clinical type and was observed in 1439 patients (68.3%). There was the highest number of patients in the 60-64 years group (942 patients, 44.7%), among whom 618(65.6%) were female, 589(62.5%) had cholestasis type, 471(50.0%) had chronic DILI, 421(44.7%) had drug-induced liver cirrhosis, and 25(2.7%) had drug-induced liver failure. There were 187 patients in the 75-79 years group, among whom 110 (58.8%) patients were male, 137(73.3%) had cholestasis type, 114(60.9%) had liver cirrhosis, 4(2.1%) had drug-induced liver failure. The results showed that chronic DILI was more common in the 60-64 years group, and liver cirrhosis was more common in the 75-79 years group. As for prognosis, in the 60-64 years group, 27 patients (2.9%) were cured, 885 (93.9%) were improved, 30(32%) had no response or died; in the 65-69 years group, 16 (2.8%) were cured, 528 (92.0%) were improved, and 30(5.2%) had no response or died; in the 70-74 years group, 9(2.8%) were cured, 305(94.1%) were improved, and 10 (3.6%) had no response or died. The results showed that there was no significant difference in mortality rate between the different age groups (P＞0.05). The proportion of elderly DILI patients among hospitalized DILI patients increased from 15.90% in 2009 to 22.05% in 2013 and 27.51% in 2019, with a 1.73-fold increase in 11 years. As for regional distribution, the patients in North China accounted for the highest proportion of 47.08% (the patients from Hebei, Shanxi, and Inner Mongolia accounted for 24.92%, 10.96%, and 10.25%, respectively), followed by those in Northeast China who accounted for 17.85%. The patients in Beijing accounted for 11.53%. ConclusionThe proportion of elderly DILI patients among hospitalized DILI patients tends to increase in these years. Cholestasis type is the most common clinical type, and most of the patients with this clinical type progress to chronic DILI and drug-induced liver cirrhosis. Early diagnosis, early intervention, and standardized treatment of elderly DILI should be taken seriously.

ObjectiveTo investigate the clinical features of patients with Caroli disease. MethodsThe clinical data were collected from 41 patients who were diagnosed with Caroli disease in The Fifth Medical Center of Chinese PLA General Hospital from April 2015 to January 2020, and the patients were divided into type I group with 16 patients and type Ⅱ group with 25 patients. A retrospective analysis was performed for general information, laboratory markers, and clinical features. The independent samples t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data; a Spearman correlation analysis was also performed. ResultsThe type Ⅰ group had a significantly higher level of albumin (Alb) than the type Ⅱ group (t=0.976, P=0.048), and the type Ⅱ group had a significantly higher prothrombin time (PT) than the type I group (Z=3.115, P=0.001). Compared with the type I group, the type Ⅱ group had significantly higher incidence rates of esophageal and gastric varices, upper gastrointestinal bleeding and/or tarry stool, and portal hypertension (χ2=6.077, 5.468, and 2.403, P=0.002, 0.019, and 0.028). In the patients with type Ⅱ Caroli disease, the level of cholinesterase was negatively correlated with the incidence rates of esophageal and gastric varices and portal hypertension (r=-0.468 and -0.436, P=0.018 and 0.029); Alb level was negatively correlated with the incidence rate of esophageal and gastric varices (r=-0.561, P=0.004); red blood cell count was negatively correlated with the incidence rates of esophageal and gastric varices, upper gastrointestinal bleeding and/or tarry stool, and portal hypertension (r=-0.662, -0.566, and -0.436, P＜0.001, P=0.003, and P=0.029); hemoglobin count was negatively correlated with the incidence rates of esophageal and gastric varices, upper gastrointestinal bleeding and/or tarry stool, and portal hypertension (r=-0.605, -0.590, and -0.510, P=0.001, 0.002, and 0.009); PT was positively correlated with the incidence rates of esophageal varices and portal hypertension (r=0.488 and 0.520, P=0.013 and 0.008). ConclusionCompared with the patients with type I Caroli disease, the patients with type Ⅱ Caroli disease have a higher incidence rates of esophageal and gastric varices, upper gastrointestinal bleeding and/or tarry stool, and portal hypertension, with the changes in clinical indicators such as the decrease of Alb level and the increase of PT level, and they tend to have poor prognosis.

Objective To detect the expression of Nrf2 in mice with viral myocarditis and to investigate the changes and effects of Nrf2 after puerarin (Pue) treatment.Methods A total of 130 BALB/C male mice aged 4 weeks were randomly divided into control group,VMC group,Nrf2 activator group and Pue group (20 mice in each group) with different concentrations.The models were made with Coxsackie B3 virus (CVB3).The mice were sacrificed on day 0,4,7,14 and 28 respectively,and blood and myocardial samples were harvested.Cardiomyocyte apoptosis was detected by flow cytometry.The expression changes of Nrf2,HO-1,Fas,TGF-beta 1 mRNA were detected by real-time PCR and Western blot respectively.Statistical software SPSS19.0 was used to analyze the results.The measurement data was expressed mean ± standard deviation.The paired samples were tested with mean t test.The group data were analyzed with two-way ANOVA.A P value of less than 0.05 was considered to indicate statistical significance.Correlation analysis was performed with Spearman's correlation test.Results Nrf2 mRNA and Nrf2 protein were expressed in all groups.The correlations between Nrf2 and HO-1,Fas and TGF-beta-1 were analyzed according to CPDT or Pue,and the results were consistent with each other.It showed that the relationship between Nrf2 and HO-1,Fas and TGF-beta-1 did not change with intervention measures.The transcription and protein expression of HO1 in CPDT and Pue groups were significantly increased,and were positively correlated with Nrf2 (r =0.969,P ＜0.01).At a certain dose gradient (＜ 45 mg/kg),the transcription and protein expression of HO-1 were dose-dependent;the decreased cardiomyocyte apoptosis was observed in both CPDT and Pue group,while Nrf2 and Fas were negatively correlated (r =-0.968,P ＜ 0.01);at a certain dose gradient,the expression of TGF-beta 1 in CPDT and Pue group decreased with the increase of dose,and Nrf2 and TGF-beta 1 were negatively correlated (r =-0.753,P ＜ 0.01).Conclusion The increased expression of Nrf2 in VMC is involved in the occurrence and development of VMC.Nrf2 has antioxidant effect in VMC by up-regulating the antioxidant enzyme HO-1,has the anti-myocardial APO effect by inhibiting the Fas/FasL signaling pathway,and inhibits myocardial fibrosis by suppressing the expression of TGF-beta 1 protein and transcription.The therapeutic effect of Pue on VMC is to activate Nrf2 to produce antioxidant,anti-apoptotic and anti-fibrotic effects.

Inflammatory bowel disease(IBD)is a non-specific,chronic intestinal inflammatory disease,which mainly includes ulcerative colitis(UC)and Crohn's disease(CD). The pathogenesis of IBD is not completely clear,and is mainly related to gene,environment,dysfunction of immune system and intestinal mucosal barrier. As the first defense line of intestinal mucosal barrier,the mucus barrier plays an important role in the occurrence and development of IBD. This article reviewed the advances in study on mucus barrier in IBD.