Background:The incidence of perianal fistulizing Crohn's disease is increasing and can seriously affect patients'quality of life.The efficacy of perianal surgery combined with biological agents for perianal fistulizing Crohn's disease remains to be clarified.Aims:To evaluate the clinical efficacy of perianal surgery combined with anti-tumor necrosis factor(TNF)-α agents in the treatment of perianal fistulizing Crohn's disease systematically.Methods:Cohort studies on perianal surgery combined with anti-TNF-α agents in the treatment of perianal fistulizing Crohn's disease were retrieved from PubMed,Web of Science,Embase,Cochrane Library,CNKI,Wanfang Data,and SinoMed.The retrieval time span was from the establishment of each database to October 30,2024.Literatures were enrolled according to the inclusion and exclusion criteria,and the data were extracted.Newcastle-Ottawa scale was used to evaluate the quality of literature.Meta-analysis was conducted by RevMan 5.4 software.Results:A total of 9 literatures involving 736 patients with perianal fistulizing Crohn's disease were enrolled.Meta-analysis showed that perianal surgery combined with anti-TNF-α agents shortened the healing time of anal fistula(WMD=-0.76,95%CI:-1.06--0.46;Z=4.91,P<0.000 01),decreased the recurrence rate of perianal fistula(OR=0.47,95%CI:0.26-0.84;Z=2.55,P=0.01),and reduced the perianal disease activity index(PDAI)score(WMD=-1.51,95%CI:-1.84--1.18;Z=8.91,P<0.000 01)when compared with perianal surgery alone.However,no significant differences in complete healing rate,partial healing rate,and reoperation rate were found between the two groups(all P>0.05).Conclusions:Perianal surgery combined with anti-TNF-α agents in the treatment of perianal fistulizing Crohn's disease demonstrates superior efficacy compared to perianal surgery alone in terms of shortening healing time,reducing recurrence rate and decreasing PDAI score.

Background:The incidence of perianal fistulizing Crohn's disease is increasing and can seriously affect patients'quality of life.The efficacy of perianal surgery combined with biological agents for perianal fistulizing Crohn's disease remains to be clarified.Aims:To evaluate the clinical efficacy of perianal surgery combined with anti-tumor necrosis factor(TNF)-α agents in the treatment of perianal fistulizing Crohn's disease systematically.Methods:Cohort studies on perianal surgery combined with anti-TNF-α agents in the treatment of perianal fistulizing Crohn's disease were retrieved from PubMed,Web of Science,Embase,Cochrane Library,CNKI,Wanfang Data,and SinoMed.The retrieval time span was from the establishment of each database to October 30,2024.Literatures were enrolled according to the inclusion and exclusion criteria,and the data were extracted.Newcastle-Ottawa scale was used to evaluate the quality of literature.Meta-analysis was conducted by RevMan 5.4 software.Results:A total of 9 literatures involving 736 patients with perianal fistulizing Crohn's disease were enrolled.Meta-analysis showed that perianal surgery combined with anti-TNF-α agents shortened the healing time of anal fistula(WMD=-0.76,95%CI:-1.06--0.46;Z=4.91,P<0.000 01),decreased the recurrence rate of perianal fistula(OR=0.47,95%CI:0.26-0.84;Z=2.55,P=0.01),and reduced the perianal disease activity index(PDAI)score(WMD=-1.51,95%CI:-1.84--1.18;Z=8.91,P<0.000 01)when compared with perianal surgery alone.However,no significant differences in complete healing rate,partial healing rate,and reoperation rate were found between the two groups(all P>0.05).Conclusions:Perianal surgery combined with anti-TNF-α agents in the treatment of perianal fistulizing Crohn's disease demonstrates superior efficacy compared to perianal surgery alone in terms of shortening healing time,reducing recurrence rate and decreasing PDAI score.

Scavenger receptor class B, member 2 (SCARB2) is linked to Gaucher disease and Parkinson's disease. Deficiency in the SCARB2 gene causes progressive myoclonus epilepsy (PME), a rare group of inherited neurodegenerative diseases characterized by myoclonus. We found that Scarb2 deficiency in mice leads to age-dependent dietary lipid malabsorption, accompanied with vitamin E deficiency. Our investigation revealed that Scarb2 deficiency is associated with gut dysbiosis and an altered bile acid pool, leading to hyperactivation of FXR in intestine. Hyperactivation of FXR impairs epithelium renewal and lipid absorption. Patients with SCARB2 mutations have a severe reduction in their vitamin E levels and cannot absorb dietary vitamin E. Finally, inhibiting FXR or supplementing vitamin E ameliorates the neuromotor impairment and neuropathy in Scarb2 knockout mice. These data indicate that gastrointestinal dysfunction is associated with SCARB2 deficiency-related neurodegeneration, and SCARB2-associated neurodegeneration can be improved by addressing the nutrition deficits and gastrointestinal issues.
Animals ; Mice ; Dysbiosis/metabolism* ; Mice, Knockout ; Humans ; Lysosomal Membrane Proteins/genetics* ; Receptors, Scavenger/genetics* ; Gastrointestinal Microbiome ; Myoclonic Epilepsies, Progressive/genetics* ; Vitamin E Deficiency/complications* ; Neurodegenerative Diseases/genetics* ; Bile Acids and Salts/metabolism* ; Male ; Lipid Metabolism ; Intestinal Mucosa/pathology*

Objective:To establish a high-performance liquid chromatography (HPLC) for determining the content of levonorgestrel (LNG) and ethinylestradiol (EE) in compound levonorgestrel sustained-release microsphere injection.Methods:C18 column Inertsil ODS-3 (4.7 mm×250 mm, 5 μm) was used. The mobile phase was acetonitrile-water (50∶50, V/V). The flow rate was 1.0 mL/min. The column temperature was 35 ℃. The detection wavelength was 265 nm, and the injection amount was 20 μL. The content of microspheres was determined after validation of HPLC detection methodology.Results:The linear relationship was good in the range of 5.03-201.20 μg/mL LNG, 1.55-61.92 μg/mL EE ( r2=0.999 8). The specificity, precision, recovery, repeatability, stability, etc, met the requirements. The content of LNG in the compound LNG sustained-release microspheres injection was 16.26%, and the content of EE was 2.58%. Conclusion:This HPLC can determine the content of compound levonorgestrel sustained-release injection microspheres, and the method is simple, stable, and has good reproducibility, providing a reference for the determination of levonorgestrel and ethinylestradiol in compound sustained-release preparations.

Objective:To establish a high-performance liquid chromatography (HPLC) for determining the content of levonorgestrel (LNG) and ethinylestradiol (EE) in compound levonorgestrel sustained-release microsphere injection.Methods:C18 column Inertsil ODS-3 (4.7 mm×250 mm, 5 μm) was used. The mobile phase was acetonitrile-water (50∶50, V/V). The flow rate was 1.0 mL/min. The column temperature was 35 ℃. The detection wavelength was 265 nm, and the injection amount was 20 μL. The content of microspheres was determined after validation of HPLC detection methodology.Results:The linear relationship was good in the range of 5.03-201.20 μg/mL LNG, 1.55-61.92 μg/mL EE ( r2=0.999 8). The specificity, precision, recovery, repeatability, stability, etc, met the requirements. The content of LNG in the compound LNG sustained-release microspheres injection was 16.26%, and the content of EE was 2.58%. Conclusion:This HPLC can determine the content of compound levonorgestrel sustained-release injection microspheres, and the method is simple, stable, and has good reproducibility, providing a reference for the determination of levonorgestrel and ethinylestradiol in compound sustained-release preparations.

OBJECTIVE To study the anti-inflammatory effect and mechanism of the ethanol extract and the drug-containing serum of Zhuang medicine Stahlianthus involucratus on lipopolysaccharide （LPS）-induced RAW264.7 cell inflammation. METHODS The drug-containing serum or blank serum was obtained by intragastrical administration of ethanol extract of S. involucratus （75.35 g/kg） or purified water. Using RAW264.7 cells as objects， RAW264.7 cells were divided into normal control group， LPS group （1 μg/mL）， S. involucratus ethanol extract high-dose， medium-dose and low-dose groups （50， 25， 12.5 μg/mL）， 4% or 15% blank serum groups， 4% or 15% blank serum+LPS groups， 4% or 15% drug-containing serum groups， 4% or 15% drug-containing serum+LPS groups. After culturing for 24 h， cell viability， the contents of nitric oxide tumor necrosis factor α （TNF-α）， interleukinand IL-6 as well as mRNA expressions of Toll-like eceptor 4 （TLR4） and nuclear factor κB （NF- κB） and protein expressions of nitric oxide synthase （NOS） and cyclooxygenase 2 （COX-2） were all detected in each group. 0771-4953513。E-mail：zhuhuagx@163.com RESULTS After culturing for 24 h， there was no statisticalsignificance in the difference of cell viability. Compared with normal control group， the contents of NO， TNF-α， IL-1β and IL-6， mRNA expressions of TLR4 and NF-κB， and protein expressions of NOS and COX-2 were increased significantly in LPS group （P＜0.05）. Compared with 4% or 15% blank serum groups， the levels of above indexes were increased significantly in 4% or 15% blank serum+LPS groups （P＜0.05）. Compared with LPS group， the levels of above indexes were decreased significantly in S. involucratus ethanol extract groups （P＜0.05）. Compared with 4% or 15% blank serum+LPS groups， the levels of above indexes were decreased significantly in 4% or 15% drug-containing serum+LPS groups （P＜0.05）. CONCLUSIONS The ethanol extract and the drug-containing serum of S. involucratus can significantly alleviate LPS-induced inflammatory reaction， the mechanism of which may be associated with inhibiting the activity of TLR4/NF-κB signaling pathway， down-regulating the protein expressions of COX-2 and NOS， and reducing the release of inflammatory factors.

OBJECTIVE To establish the quality standard of the leaves of Litchi chinensis Sonn.. METHODS The identification of medicinal properties, microscopic characteristics, TLC and content determination method of the leaves of Litchi chinensis Sonn. was conducted. The moisture, total ash, acid insoluble ash and extract of the leaves of Litchi chinensis Sonn. were determined according to Chinese Pharmacopoeia(Volume IV), 2020. RESULTS The leaves of Litchi chinensis Sonn. under forest exhibited specific properties in characteristics, microscopic features and TLC results. The moisture content of the medicinal materials was 2.66%-6.42%, the total ash content was 2.96%-4.52%, the acid insoluble ash content was 0.17%-0.94%, the water soluble extract was 15.38%-19.87%, and the alcohol soluble extract was 24.94%-30.33%. The eight components of gallic acid, protocatechin, catechin, epicatechin, rutin, astragalin, quercetin and kaempferol had a good linear relationship in 0.003 3-0.052 0 mg·mL-1, 0.006 9-0.109 6 mg·mL-1, 0.013 0-0.208 0 mg·mL-1, 0.057 5-0.920 0 mg·mL-1, 0.013 4-0.213 6 mg·mL-1, 0.013 2-0.211 2 mg·mL-1, 0.002 9-0.045 6 mg·mL-1, 0.003 6-0.056 8 mg·mL-1(r>0.999). The average sample recovery rate was 97.43%-102.97% and the RSD was 1.70%-2.90%. CONCLUSION The established quality standard of the leaves of Litchi chinensis Sonn. medicinal material has good specificity, accuracy and reproducibility, which can be used for quality control research of the leaves of Litchi chinensis Sonn..

OBJECTI VE To optimize the extraction technology of the leaves of Dimocarpus longan according to flavonoids and phenolic acids. METHODS The contents of gallic acid ，protocatechuic acid ，ethyl gallate ，quercetin，luteolin and kaempferol in the leaves of D. longan were determined by HPLC. Based on single factor test ，with the ethanol volume fraction ，solid-liquid ratio and extraction time as factors ，using comprehensive scores of the contents of above six components as indexes ，the extraction technology of the leaves of D. longan was optimized by Box-Behnken response surface methodology. RESULTS The optimal extraction technology included ethanol volume fraction of 100％，solid-liquid ratio of l ∶ 7（g/mL），extraction time of 90 min， extraction temperature of 80 ℃. After 3 times of validation tests ，the average comprehensive score was 97.54（RSD＝0.33％，n＝ 3），relative error of which with predicted score （99.05）was 1.55％. CONCLUSIONS Box-Behnken response surface methodology combined with multi-index comprehensive score can be used for the extraction technology of the leaves of D. longan ，and the optimized extraction technology is stable and feasible.

Objective: To investigate clinical value of ankle arthroscopy in diagnosis of type Danis-Weber B ankle fracture with the distal tibiofibular syndesmosis injury. Methods: From August 2014 to January 2018, a total of 52 cases of type Danis-Weber B ankle fractures with an average age of 35.37±11.19 years, including 31 males and 21 females were treated. Each patient underwent preoperative assessment, according to the patient's clinical manifestations and imaging examination before operation. The Cotton test and the external rotation test were conducted in the C arm X-ray to evaluate whether there is the distal tibiofibular syndesmosis injury. All fractures were treated with open reduction and internal fixation. Repair was conducted with 3.5 mm wire anchor and nail for triangular ligament injury. The Cotton test and external rotation test were performed under ankle arthroscopy. The injury of the lower tibiofibular syndesmosis was observed and evaluated by cotton test and external rotation test in patients who were found to be associated with lower tibiofibular joint injury. After internal fixation of fracture and repair of tibiofibular syndesmosis injury with TightRope, the repair effects of tibiofibular syndesmosis injury was observed under direct vision of ankle arthroscopy. The VAS score, AOFAS score and Baird-Jackson score was used as an index to observe the pain and ankle function before and after operation for 12 months follow-up. Results: Preoperative X-ray showed 19 cases of lower tibiofibular joint injury. Preoperative CT showed 28 cases of lower tibiofibular joint injury. Preoperative MRI showed 39 cases of lower tibiofibular joint injury. A total of 36 cases of joint injury of lower tibiofibular syndesmosis were confirmed under arthroscopy of ankle. After repair of tibiofibular syndesmosis injury with TightRope, complete reduction and stability of inferior tibiofibular syndesmosis were confirmed under ankle arthroscopy. At 12 months after operation, the VAS score decreased from 8.13±1.32 points preoperation to 0.75±0.73 points after operation. The AOFAS and Baird-Jackson scores increased from 26.59±3.35 points, 16.44±3.63 points preoperation to 94.36±3.03 points, 90.29±6.45 points after operation, respectively. There was significant difference before and after operation (P<0.05). The postoperative VAS score, AOFAS score and Baird-Jackson score of 16 patients without lower tibiofibular ligament injury were confirmed in the ankle arthroscopy group, namely 0.58±0.67 points, 95.27±4.67 points, 91.98±9.23 points. Conclusion Ankle arthroscopy can be used to observe the injury of tibiofibular syndesmosis under direct vision. The positive rate of diagnosis of inferior tibiofibular syndesmosis injury was 69.2% (36/52). It can provide reliable evidence for correct diagnosis and treatment of type Danis-Weber B ankle fracture with lower tibiofibular joint injury with significant meaning in selecting operative methods and in evaluating the effect of lower tibiofibular ligament repair.

BACKGROUND/AIMS: Resection of the diseased segment and suture of the victim segment is recommended for enteroenteric fistula in Crohn's disease (CD). The main difficulty in this procedure remains reliable diagnosis of the victim segment, especially for fistulas found intraoperatively and inaccessible on endoscopic examination. We aimed to explore whether intraoperative inspection alone is reliable. METHODS: Patients undergoing conservative surgery between 2011 and 2016 for enteroenteric fistulas complicating CD were identified from a prospectively maintained database. Patients were divided according to whether the victim segment was evaluated by preoperative endoscopy + intraoperative inspection (PI group) or by intraoperative inspection alone (I group). Outcomes were compared. RESULTS: Of 65 patients eligible for the study, 37 were in in the PI group and 28 were in the I group. The baseline characteristics were similar between the groups, except for the rate of emergency surgery (0/37 in PI group vs. 5/28 in I group, P=0.012). Fistulas involved more small intestines (4/37 in PI group vs. 15/28 in I group, P < 0.001) and fewer sigmoid colons (17/37 in PI group vs. 4/28 in I group, P=0.008) in I group due to accessibility with endoscopy. No difference was found in postoperative complications, stoma rates, postoperative recurrence, or disease at the repair site between the 2 groups (P>0.05). CONCLUSIONS: For fistulas found intraoperatively and inaccessible on endoscopic examination, intraoperative inspection was a reliable guide when choosing between en bloc resection and a conservative procedure.
Colon, Sigmoid ; Crohn Disease* ; Diagnosis ; Emergencies ; Endoscopy ; Fistula* ; Humans ; Intestine, Small ; Postoperative Complications ; Prospective Studies ; Recurrence ; Sutures