Objective To explore the correlation between disease duration and anxiety,depression,sleep quality and quality of life in patients with inflammatory bowel disease(IBD).Methods A cross-sectional survey study was conducted from September 2021 to May 2022 in 42hospitals in 22 provinces(autonomous regions and municipalities directly under the central government).General clinical information and disease duration of adult patients with IBD who voluntarily participated in the study were collected,and the anxiety,de-pression,sleep quality,and quality of life of IBD patients were assessed by using the Generalized Anxiety Disorder(GAD-7),the Pa-tient Health Questionnaire-9(PHQ-9),the Pittsburgh Sleep Quality Index(PSQI),and the Inflammatory Bowel Disease Questionnaire(IBDQ).Results A total of 2476 valid questionnaires were collected.Among them,458(18.50％)patients had a disease duration within 1 year,481(19.43％)patients had a disease duration of 1-2 years,764(30.86％)had a disease duration of 2-5 years,529(21.37％)had a disease duration of 5-10 years,and 244(9.85％)had a disease duration of more than 10 years.The GAD-7score(P=0.005),PHQ-9score(P=0.002),and PSQI score(P=0.005)were statistically significant in different disease duration groups.In pairwise comparisons,IBD patients with a disease duration of 5-10 years were more likely to have depression,anxiety,and sleep disorder.IBDQ scores were statistically significant in different disease duration groups(P=0.005).Among them,bowel symptom score(P=0.001),emotional competence score(P=0.013),and social competence score(P＜0.001)were statistically significant.Patients with a disease duration of 2-5 years seemed to have a better quality of life,including milder bowel symptoms,better emotional,and social competence.Patients with a disease duration of 10 years or more had better social competence.Conclusion Anxiety,depres-sion,sleep disorders,and quality of life are associated with disease duration in patients with IBD,and patients with IBD with a disease duration of 5-10 years are more likely to have depressive states,anxiety and sleep states.

Objective:To investigate the influencing factors of mucosal healing under endoscopy in patients with Crohn′s disease (CD) and to establish a predictive model.Methods:From January 1, 2023 to August 31, 2024, 124 patients with CD were hospitalized at the Department of Gastroenterology, Renmin Hospital of Wuhan University were retrospectively enrolled as the modeling group. And from January 1, 2021 to December 31, 2022, 88 patients with CD were hospitalized at the Department of Gastroenterology in the same hospital were collected as the validation group. The data including simple Crohn′s disease activity index (CDAI) scores, serological markers such as fibrinogen (FIB), and medication regimens (including ustekinumab) of the patients in the modeling group were collected. Multivariate logistic regression analysis was used to screen the independent predictors of mucosal healing in CD patients, and the nomogram predictive model was established. The receiver operating characteristic curve (ROC) was plotted to evaluate the predictive performance, and calibration curve was drawn for validation. Mann-Whitney U test and Chi-square test were used for statistical analysis. Results:According to the simple endoscopic score for CD and endoscopic findings, among the 124 patients in the modeling group, 92 cases were diagnosed as mucosal healing, while 32 cases did not. The simple CDAI and FIB of patients with mucosal healing were lower than those of patients without mucosal healing (2.00(2.00, 3.00) vs. 3.00(2.25, 4.00), 2.37(2.03, 2.88) g/L vs.2.92(2.40, 4.40) g/L); the proportion of patients who used ustekinumab in mucosal healing patients was higher than that of patients without mucosal healing (62.0%, 57/92 vs. 31.2%, 10/32), and the differences were statistically significant ( Z=-2.98 and -3.57, χ2=9.01; all P<0.01).The results of multivariate logistic regression analysis showed that low simple CDAI score ( OR=0.560, 95% confidence interval (95% CI): 0.343 to 0.913), low FIB ( OR=0.475, 95% CI: 0.302 to 0.747), and ustekinumab usage ( OR=4.218, 95% CI: 1.621 to 10.977) were independent predictive factors of mucosal healing under endoscopy in CD patients (all P<0.05). The regression equation was derived as ln( p/(1- p)) mucosal healing=4.215-0.580×simple CDAI score -0.745×FIB(g/L)+ 1.439×ustekinumab usage(1 for use, 0 for unused), and the nomogram model was established. The results of ROC demonstrated that the area under the curve of the nomogram model in the modeling and validation group were 0.791(95% CI: 0.700 to 0.883) and 0.781 (95% CI: 0.666 to 0.895), with the sensitivity of 0.859 and 0.868, and with the specificity of 0.688 and 0.650, respectively. The results of calibration curve analysis showed that the average absolute errors of the nomogram model in the internal and external validation were 0.032 and 0.039, respectively, indicating a good consistency between the predicted and actual probability. Conclusions:Low simple CDAI score, low FIB, and ustekinumab usage are the independent predictive factors of mucosal healing under endoscopy in CD patients. The predictive model has certain reference value for CD management.

Objective:To evaluate the value of peripheral blood systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), carcinoembryonic antigen (CEA), D-dimer, and albumin (ALB) alone or their combination in the diagnosis of early-onset colorectal cancer (EOCRC).Methods:From January 1, 2023 to November 30, 2024, 104 patients with EOCRC (EOCRC group) hospitalized at Renmin Hospital of Wuhan University were enrolled. During the same period, by simple random sampling method, 104 patients with benign colorectal polyps (benign polyp group) and 104 healthy individuals for health examinations (healthy control group) from outpatient department were enrolled. The peripheral blood parameters (including neutrophil count, lymphocyte count, CEA, and others) and pathological characteristics of EOCRC (including TNM stage, tumor differentiation grade, and depth of invasion) were collected. The relationship between peripheral blood parameters and EOCRC pathological features were analyzed. Receiver operating characteristic curves (ROC) were plotted, and the area under the curve (AUC) was calculated to evaluate the diagnostic value. Multivariate logistic regression analysis was performed to analyze the peripheral blood parameters which independently correlated with EOCRC and a combined diagnostic model was established. Simple random sampling method was used to divide the subjects in the negative control group (healthy control group + benign polyp group) and positive group (EOCRC group) into a training set (218 cases) and a validation set (94 cases) at a ratio of 7∶3, and the diagnostic performance of the combined diagnostic model in the training and validation sets was assessed. Hosmer-Lemeshow test and calibration curve were used to evaluate the fit and consistency of the model. Independent sample t-test, one-way ANOVA, Mann-Whitney U test and Kruskal-Wallis H test were used for statistical analysis. Results:EOCRC group had the highest levels of SII(744.03 (473.01, 1 246.28), 437.77 (342.28, 607.47), 497.31 (385.76, 721.63)×10 9/L), NLR(2.42 (1.76, 3.94), 1.96 (1.54, 2.52), 1.91 (1.55, 2.75)), CEA (3.58 (1.96, 20.85), 1.31 (0.95, 1.93), 1.21 (0.76, 2.11) μg/L) and D-dimer (0.36 (0.20, 0.90), 0.19 (0.12, 0.28), 0.18 (0.12, 0.30) mg/L), and the lowest levels of LMR(3.51±1.56, 4.38±1.37, 4.72±1.84) and ALB(42.40 (39.90, 44.70), 44.57 (42.83, 46.25), 44.95 (43.10, 46.58) g/L) than benign polyp group and healthy control group, and the differences were statistically significant ( H=31.18, 16.21, 76.72 and 47.72, F=15.40, H=34.19; all P<0.001). In EOCRC patients, there were statistically significant differences in SII and LMR between patients with different tumor invasion depth ( Z=-2.48, t=2.31; both P<0.05), in CEA between patients with different TNM stage, with or without lymph node metastasis and distant metastasis( Z=-2.68, -2.50 and -2.65; all P<0.05), in D-dimer between patients with different TNM stage, differentiation grade, invasion depth, and with or without lymph node metastasis and distant metastasis ( Z=-2.50, -2.60, -2.06, -2.14 and -3.33; all P<0.05), and in ALB between patients with or without distant metastasis ( Z=-2.52, P=0.012).The AUC of combination of SII, NLR, LMR, CEA, D-dimer, and ALB in differential diagnosis of the healthy control group and the EOCRC group was 0.914 (95% confidence interval (95% CI): 0.870 to 0.958, P<0.001), and the AUC of the combination in differential diagnosis of the benign polyp group and the EOCRC group was 0.904 (95% CI: 0.857 to 0.950, P<0.001). The results of multivariate logistic regression analysis revealed that SII, NLR, LMR, CEA, and ALB were all independently correlated with EOCRC (all P<0.05). The diagnostic model for EOCRC was established by the combination of SII, NLR, LMR, CEA, and ALB, and the AUC of the model in the training set and validation set was 0.911 and 0.883, respectively. The Hosmer-Lemeshow goodness-of-fit test indicated good model fit ( P=0.437). Calibration curve analysis showed strong consistency between predicted probabilities and actual probabilities, and the mean absolute error was 0.015. Conclusions:SII, NLR, LMR, CEA, D-dimer, and ALB all demonstrate diagnostic value in the diagnosis of EOCRC. The combined diagnostic model based on SII, NLR, LMR, CEA, and ALB demonstrates excellent diagnostic performance, which may serve as an adjunctive diagnostic approach for EOCRC.

Objective To explore the correlation between disease duration and anxiety,depression,sleep quality and quality of life in patients with inflammatory bowel disease(IBD).Methods A cross-sectional survey study was conducted from September 2021 to May 2022 in 42hospitals in 22 provinces(autonomous regions and municipalities directly under the central government).General clinical information and disease duration of adult patients with IBD who voluntarily participated in the study were collected,and the anxiety,de-pression,sleep quality,and quality of life of IBD patients were assessed by using the Generalized Anxiety Disorder(GAD-7),the Pa-tient Health Questionnaire-9(PHQ-9),the Pittsburgh Sleep Quality Index(PSQI),and the Inflammatory Bowel Disease Questionnaire(IBDQ).Results A total of 2476 valid questionnaires were collected.Among them,458(18.50％)patients had a disease duration within 1 year,481(19.43％)patients had a disease duration of 1-2 years,764(30.86％)had a disease duration of 2-5 years,529(21.37％)had a disease duration of 5-10 years,and 244(9.85％)had a disease duration of more than 10 years.The GAD-7score(P=0.005),PHQ-9score(P=0.002),and PSQI score(P=0.005)were statistically significant in different disease duration groups.In pairwise comparisons,IBD patients with a disease duration of 5-10 years were more likely to have depression,anxiety,and sleep disorder.IBDQ scores were statistically significant in different disease duration groups(P=0.005).Among them,bowel symptom score(P=0.001),emotional competence score(P=0.013),and social competence score(P＜0.001)were statistically significant.Patients with a disease duration of 2-5 years seemed to have a better quality of life,including milder bowel symptoms,better emotional,and social competence.Patients with a disease duration of 10 years or more had better social competence.Conclusion Anxiety,depres-sion,sleep disorders,and quality of life are associated with disease duration in patients with IBD,and patients with IBD with a disease duration of 5-10 years are more likely to have depressive states,anxiety and sleep states.

Objective:To investigate the influencing factors of mucosal healing under endoscopy in patients with Crohn′s disease (CD) and to establish a predictive model.Methods:From January 1, 2023 to August 31, 2024, 124 patients with CD were hospitalized at the Department of Gastroenterology, Renmin Hospital of Wuhan University were retrospectively enrolled as the modeling group. And from January 1, 2021 to December 31, 2022, 88 patients with CD were hospitalized at the Department of Gastroenterology in the same hospital were collected as the validation group. The data including simple Crohn′s disease activity index (CDAI) scores, serological markers such as fibrinogen (FIB), and medication regimens (including ustekinumab) of the patients in the modeling group were collected. Multivariate logistic regression analysis was used to screen the independent predictors of mucosal healing in CD patients, and the nomogram predictive model was established. The receiver operating characteristic curve (ROC) was plotted to evaluate the predictive performance, and calibration curve was drawn for validation. Mann-Whitney U test and Chi-square test were used for statistical analysis. Results:According to the simple endoscopic score for CD and endoscopic findings, among the 124 patients in the modeling group, 92 cases were diagnosed as mucosal healing, while 32 cases did not. The simple CDAI and FIB of patients with mucosal healing were lower than those of patients without mucosal healing (2.00(2.00, 3.00) vs. 3.00(2.25, 4.00), 2.37(2.03, 2.88) g/L vs.2.92(2.40, 4.40) g/L); the proportion of patients who used ustekinumab in mucosal healing patients was higher than that of patients without mucosal healing (62.0%, 57/92 vs. 31.2%, 10/32), and the differences were statistically significant ( Z=-2.98 and -3.57, χ2=9.01; all P<0.01).The results of multivariate logistic regression analysis showed that low simple CDAI score ( OR=0.560, 95% confidence interval (95% CI): 0.343 to 0.913), low FIB ( OR=0.475, 95% CI: 0.302 to 0.747), and ustekinumab usage ( OR=4.218, 95% CI: 1.621 to 10.977) were independent predictive factors of mucosal healing under endoscopy in CD patients (all P<0.05). The regression equation was derived as ln( p/(1- p)) mucosal healing=4.215-0.580×simple CDAI score -0.745×FIB(g/L)+ 1.439×ustekinumab usage(1 for use, 0 for unused), and the nomogram model was established. The results of ROC demonstrated that the area under the curve of the nomogram model in the modeling and validation group were 0.791(95% CI: 0.700 to 0.883) and 0.781 (95% CI: 0.666 to 0.895), with the sensitivity of 0.859 and 0.868, and with the specificity of 0.688 and 0.650, respectively. The results of calibration curve analysis showed that the average absolute errors of the nomogram model in the internal and external validation were 0.032 and 0.039, respectively, indicating a good consistency between the predicted and actual probability. Conclusions:Low simple CDAI score, low FIB, and ustekinumab usage are the independent predictive factors of mucosal healing under endoscopy in CD patients. The predictive model has certain reference value for CD management.

Objective:To evaluate the value of peripheral blood systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), carcinoembryonic antigen (CEA), D-dimer, and albumin (ALB) alone or their combination in the diagnosis of early-onset colorectal cancer (EOCRC).Methods:From January 1, 2023 to November 30, 2024, 104 patients with EOCRC (EOCRC group) hospitalized at Renmin Hospital of Wuhan University were enrolled. During the same period, by simple random sampling method, 104 patients with benign colorectal polyps (benign polyp group) and 104 healthy individuals for health examinations (healthy control group) from outpatient department were enrolled. The peripheral blood parameters (including neutrophil count, lymphocyte count, CEA, and others) and pathological characteristics of EOCRC (including TNM stage, tumor differentiation grade, and depth of invasion) were collected. The relationship between peripheral blood parameters and EOCRC pathological features were analyzed. Receiver operating characteristic curves (ROC) were plotted, and the area under the curve (AUC) was calculated to evaluate the diagnostic value. Multivariate logistic regression analysis was performed to analyze the peripheral blood parameters which independently correlated with EOCRC and a combined diagnostic model was established. Simple random sampling method was used to divide the subjects in the negative control group (healthy control group + benign polyp group) and positive group (EOCRC group) into a training set (218 cases) and a validation set (94 cases) at a ratio of 7∶3, and the diagnostic performance of the combined diagnostic model in the training and validation sets was assessed. Hosmer-Lemeshow test and calibration curve were used to evaluate the fit and consistency of the model. Independent sample t-test, one-way ANOVA, Mann-Whitney U test and Kruskal-Wallis H test were used for statistical analysis. Results:EOCRC group had the highest levels of SII(744.03 (473.01, 1 246.28), 437.77 (342.28, 607.47), 497.31 (385.76, 721.63)×10 9/L), NLR(2.42 (1.76, 3.94), 1.96 (1.54, 2.52), 1.91 (1.55, 2.75)), CEA (3.58 (1.96, 20.85), 1.31 (0.95, 1.93), 1.21 (0.76, 2.11) μg/L) and D-dimer (0.36 (0.20, 0.90), 0.19 (0.12, 0.28), 0.18 (0.12, 0.30) mg/L), and the lowest levels of LMR(3.51±1.56, 4.38±1.37, 4.72±1.84) and ALB(42.40 (39.90, 44.70), 44.57 (42.83, 46.25), 44.95 (43.10, 46.58) g/L) than benign polyp group and healthy control group, and the differences were statistically significant ( H=31.18, 16.21, 76.72 and 47.72, F=15.40, H=34.19; all P<0.001). In EOCRC patients, there were statistically significant differences in SII and LMR between patients with different tumor invasion depth ( Z=-2.48, t=2.31; both P<0.05), in CEA between patients with different TNM stage, with or without lymph node metastasis and distant metastasis( Z=-2.68, -2.50 and -2.65; all P<0.05), in D-dimer between patients with different TNM stage, differentiation grade, invasion depth, and with or without lymph node metastasis and distant metastasis ( Z=-2.50, -2.60, -2.06, -2.14 and -3.33; all P<0.05), and in ALB between patients with or without distant metastasis ( Z=-2.52, P=0.012).The AUC of combination of SII, NLR, LMR, CEA, D-dimer, and ALB in differential diagnosis of the healthy control group and the EOCRC group was 0.914 (95% confidence interval (95% CI): 0.870 to 0.958, P<0.001), and the AUC of the combination in differential diagnosis of the benign polyp group and the EOCRC group was 0.904 (95% CI: 0.857 to 0.950, P<0.001). The results of multivariate logistic regression analysis revealed that SII, NLR, LMR, CEA, and ALB were all independently correlated with EOCRC (all P<0.05). The diagnostic model for EOCRC was established by the combination of SII, NLR, LMR, CEA, and ALB, and the AUC of the model in the training set and validation set was 0.911 and 0.883, respectively. The Hosmer-Lemeshow goodness-of-fit test indicated good model fit ( P=0.437). Calibration curve analysis showed strong consistency between predicted probabilities and actual probabilities, and the mean absolute error was 0.015. Conclusions:SII, NLR, LMR, CEA, D-dimer, and ALB all demonstrate diagnostic value in the diagnosis of EOCRC. The combined diagnostic model based on SII, NLR, LMR, CEA, and ALB demonstrates excellent diagnostic performance, which may serve as an adjunctive diagnostic approach for EOCRC.

Objective:To identify the Key genes in the development of sepsis through weighted gene co-expression network analysis (WGCNA).Methods:The gene expression dataset GSE154918 was downloaded from the public database Gene Expression Omnibus (GEO) database, which containes data from 105 microarrays of 40 control cases, 12 cases of asymptomatic infection, 39 cases of sepsis, and 14 cases of follow-up sepsis. The R software was used to screen out differentially expressed genes (DEG) in sepsis, and the distributed access view integrated database (DAVID), search tool for retrieval of interacting neighbouring genes (STRING) and visualization software Cytoscape were used to perform gene function and pathway enrichment analysis, Protein-protein interaction (PPI) network analysis and key gene analysis to screen out the key genes in the development of sepsis.Results:Forty-six candidate genes were obtained by WGCNA and combined with DEG expression analysis, and these 46 genes were analyzed by gene ontology (GO) and Kyoto City Encyclopedia of Genes and Genomes (KEGG) pathway enrichment to obtain gene functions and involved signaling pathways. The PPI network was further constructed using the STRING database, and 5 key genes were selected by the PPI network visualization software Cytoscape, including the mast cell expressed membrane protein 1 gene (MCEMP1), the S100 calcium-binding protein A12 gene (S100A12), the adipokine resistance factor gene (RETN), the c-type lectin structural domain family 4 member gene (CLEC4D), and peroxisome proliferator-activated receptor gene (PPARG), and differential expression analysis of each of these 5 genes showed that the expression levels of the above 5 genes were significantly upregulated in sepsis patients compared with healthy controls.Conclusion:In this study, 5 key genes related to sepsis were screened by constructing WGCNA method, which may be potential candidate targets related to sepsis diagnosis and treatment.

Objective:To investigate the value of programmed death-1（PD-1） expression on the T lymphocytes for the prognosis of septic patients.Methods:From September 2017 to May 2019, septic patients were included in Department of Intensive Care Unit at 6 hospitals. The PD-1 expression on T cells were measured by flow cytometry. Logistic regression was conducted to analyze independent risk factors related to death within 28 days，and receiver operating characteristic curve(ROC) was conducted to evaluate the prognostic value of PD-1 expression on T cells in septic patients.Results:A total of 64 septic patients were enrolled to this study，including 32 survivors and 32 deaths. The PD-1 expression on T cells in the death group was significantly higher than that in the surviving group ( P<0.05). Correlation analysis showed that the percentages of PD-1 +/CD3 +T cells and PD-1 +/CD8 +T cells were positively correlated with procalciton in ( r=0.313, P =0.015； r=0.375, P=0.003), logistic regression analysis showed that the percentages of PD-1 +/CD3 +，PD-1 +/CD4 +，PD-1 +/CD8 +T cells were independent risk factors for the death of sepsis patients. The percentage of PD-1 +/CD3 +T cell was 3.63%, with AUC 0.842, sensitivity to predict the mortality 96.43% and specificity 59.38%, ( P<0.000 1). The percentage of PD-1 +/CD4 +T cell was 4.65%, with AUC 0.847, sensitivity 96.43%, specificity 62.50%，( P<0.000 1). The percentage of PD-1 +/CD8 +T cell was 3.91%, with AUC 0.771, sensitivity 64.29%, specificity 81.25%，( P=0.000 3). Conclusions:The T cell PD-1 expression is an independent risk factor to predict the 28-day mortality in septic patients. Combining the proportions of PD-1 +/CD3 +, PD-1 +/CD4 +and PD-1 +/CD8 +T cells may further enhance the predictive value for death.

Sepsis is a common disease in critical patients, which may lead to myocardial damage, thereby aggravating the severity of the patients' condition, and causing adverse prognosis. How to detect sepsis with myocardial injury as early as possible, and use corresponding treatment measures on time are essential. Cardiac troponin I (cTnI), brain natriuretic peptide (BNP), myoglobin (Mb), MB isoenzyme of creatine kinase (CK-MB) and other traditional cardiac markers are easily affected by the complications of other critical diseases, thus the diagnostic value of those markers for myocardial injury of sepsis is reduced. In recent years, there have been some studies on heart-type fatty acid binding protein (H-FABP), microRNA (miRNA), soluble triggering receptor expressed on myeloid cell-1 (sTREM-1), high mobility group protein B1 (HMGB1), neutrophil gelatinase-associated lipocalin (NGAL), histone and other new biomarkers of myocardial injury in septic patients. This article reviewed the value of these unconventional cardiac markers in the diagnosis of sepsis-induced myocardial injury, with the hope to provide some help for clinic.

Sepsis is a common disease in critical patients, which may lead to myocardial damage, thereby aggravating the severity of the patients' condition, and causing adverse prognosis. How to detect sepsis with myocardial injury as early as possible, and use corresponding treatment measures on time are essential. Cardiac troponin I (cTnI), brain natriuretic peptide (BNP), myoglobin (Mb), MB isoenzyme of creatine kinase (CK-MB) and other traditional cardiac markers are easily affected by the complications of other critical diseases, thus the diagnostic value of those markers for myocardial injury of sepsis is reduced. In recent years, there have been some studies on heart-type fatty acid binding protein (H-FABP), microRNA (miRNA), soluble triggering receptor expressed on myeloid cell-1 (sTREM-1), high mobility group protein B1 (HMGB1), neutrophil gelatinase-associated lipocalin (NGAL), histone and other new biomarkers of myocardial injury in septic patients. This article reviewed the value of these unconventional cardiac markers in the diagnosis of sepsis-induced myocardial injury, with the hope to provide some help for clinic.
Biomarkers ; Creatine Kinase, MB Form ; Humans ; Myocardial Infarction ; Myoglobin ; Natriuretic Peptide, Brain ; Sepsis ; Troponin I