Objective To investigate the application effect of postural gravity traction combined with floss and titanium clip pulley external traction in endoscopic submucosal dissection(ESD)for early intestinal lesions.Methods A total of 100 patients with early colorectal lesions admitted to the Affiliated Hospital of Jiangsu University from January 2022 to September 2024 were selected as the research subjects and divided in-to the observation group and the control group,with 50 cases in each group.The control group underwent con-ventional intestinal ESD treatment,while the observation group used positional gravity traction combined with dental floss and titanium clips to form pulley external traction in ESD treatment.Clinical data including opera-tion time,number of submucosal injections,intraoperative blood loss,lesion resection effect,complication inci-dence,and hospital stay were compared between the two groups.Results The total operation time in the ob-servation group was shorter than that in the control group,and the total number of submucosal injections was less than that in the control group,with statistically significant differences(P<0.05).There were no signifi-cant differences in intraoperative blood loss,complete resection rate,complication incidence,en bloc resection rate,and hospital stay between the two groups(P>0.05).For lesions≤1 cm or>5 cm in size,there were no significant differences in operation time,complete resection rate and en bloc resection rate between the two groups(P>0.05).For lesions>1-3 cm or>3-5 cm in size and laterally spreading lesions,significant differences were observed in operation time,number of submucosal injections,complete resection rate,and en bloc resection rate between the two groups(P<0.05).For pedunculated polyps,there were no significant differences in the number of submucosal injections,complete resection rate and en bloc resection rate between the two groups(P>0.05),but the operation time differed significantly(P<0.05).Conclusion Postural gravity traction combined with dental floss and titanium clip to form pulley external traction is simple to oper-ate in ESD for early intestinal lesions.It can maintain a clear field of view,shorten operation time,reduce the incidence of complications,and is safe and effective.

Objective:To summarize and analyze the clinical features of patients with inflammatory bowel disease (IBD) accompanied by axial spondyloarthritis (ax-SpA) .Methods:A descriptive case series study was conducted. Consecutive IBD patients with ax-SpA admitted to Peking Union Medical College Hospital from January 2012 to December 2023 were enrolled, and the clinical data were collected and analyzed descriptively.Results:A total of 21 IBD patients with ax-SpA were enrolled, including 14 males (66.7%) and 7 females (33.3%). The median age at IBD diagnosis was 29 (24, 42) years. Among them, 10 had ulcerative colitis (UC) and 11 had Crohn's disease (CD). In 11 patients (52.4%), ax-SpA was diagnosed before IBD, while in 7 patients (33.3%), IBD was diagnosed before ax-SpA; the remaining 3 patients (14.3%) were diagnosed simultaneously. Thirteen patients (61.9%) had other extraintestinal manifestations, with 12 involving mucocutaneous manifestations. Nineteen patients including 9 UC and 10 CD were followed up for a median duration of 34 (12, 57) months. Among UC patients, 5 (55.6%) were escalated from conventional therapy to biologics or small-molecule drugs, and 6 (66.7%) developed opportunistic infections. Among CD patients, 3 (30.0%) were escalated to biologic therapy, and 2 (20.0%) developed opportunistic infections. Three patients (15.8%) underwent intestinal resection surgery.Conclusions:IBD patients with ax-SpA are predominantly male, with a similar proportion of UC and CD. There is no clear sequential pattern in the diagnosis timing of IBD and ax-SpA. These patients often present with other extraintestinal manifestations of IBD, primarily mucocutaneous manifestations.

Objective:To summarize and analyze the clinical features of patients with inflammatory bowel disease (IBD) accompanied by axial spondyloarthritis (ax-SpA) .Methods:A descriptive case series study was conducted. Consecutive IBD patients with ax-SpA admitted to Peking Union Medical College Hospital from January 2012 to December 2023 were enrolled, and the clinical data were collected and analyzed descriptively.Results:A total of 21 IBD patients with ax-SpA were enrolled, including 14 males (66.7%) and 7 females (33.3%). The median age at IBD diagnosis was 29 (24, 42) years. Among them, 10 had ulcerative colitis (UC) and 11 had Crohn's disease (CD). In 11 patients (52.4%), ax-SpA was diagnosed before IBD, while in 7 patients (33.3%), IBD was diagnosed before ax-SpA; the remaining 3 patients (14.3%) were diagnosed simultaneously. Thirteen patients (61.9%) had other extraintestinal manifestations, with 12 involving mucocutaneous manifestations. Nineteen patients including 9 UC and 10 CD were followed up for a median duration of 34 (12, 57) months. Among UC patients, 5 (55.6%) were escalated from conventional therapy to biologics or small-molecule drugs, and 6 (66.7%) developed opportunistic infections. Among CD patients, 3 (30.0%) were escalated to biologic therapy, and 2 (20.0%) developed opportunistic infections. Three patients (15.8%) underwent intestinal resection surgery.Conclusions:IBD patients with ax-SpA are predominantly male, with a similar proportion of UC and CD. There is no clear sequential pattern in the diagnosis timing of IBD and ax-SpA. These patients often present with other extraintestinal manifestations of IBD, primarily mucocutaneous manifestations.

Objective:To analyze the mutation spectrum and hematological phenotype of hemoglobin subunit delta(HBD) gene among prenatal population in Xiangtan City, and to provide scientific basis for screening and diagnosis of rare and complex hemoglobinopathia.Methods:Prenatal population underwent screening and genetic testing for thalassemia at Xiangtan Maternal and Child Health Hospital from October 2022 to December 2023 were selected as the study subjects, combined with capillary electrophoresis results, further HBD gene sequencing was performed to identify specific genotypes.Results:A total of 5 371 subjects were enrolled, 22 cases of HBD gene mutations were detected, with a mutation carrier rate of 0.41% (22/5 371). Among them, 14 cases were diagnosed with δ thalassemia, 7 cases were δ abnormal hemoglobin, and 1 case was δ thalassemia combined with δ abnormal hemoglobin. There were 7 HBD mutant genotypes were included, with -77(T>C) being the most common, followed by hemoglobin (Hb) A 2-Huadu and CD34(+GGT); accounting for 68.2% (15/22), 9.1% (2/22), 9.1% (2/22). CD34(+GGT) was a newly discovered genotype, and CD7(GAG>TAG) was the first reported genotype in Chinese population. The Hb content, mean corpuscular volume, and mean corpuscular hemoglobin content were normal or nearly normal in 22 carriers of the HBD gene mutation; capillary electrophoresis demonstrated reduced Hb A 2 content in all cases. Conclusions:HBD gene mutations have been detected in the prenatal population in Xiangtan City, with -77(T>C) being the most common mutation genotype. None of the mutation carriers showed anemia.

Small bowel Crohn′s disease (CD) has a hidden onset, with a high risk of complications such as intestinal stenosis and fistulas, and a poor prognosis. Currently, there is still no ideal biomarker for clinical assessment of disease activity in small bowel CD, and there is a lack of non-invasive biomarkers that can sensitively reflect the activity of small bowel CD. Studies have found that the serum level of leucine-rich alpha-2 glycoprotein (LRG) is positively correlated with the disease activity of small bowel CD. This article reviews the relevant research of LRG in evaluating the small bowel CD and looks into its potential application prospects.

Small bowel Crohn′s disease (CD) has a hidden onset, with a high risk of complications such as intestinal stenosis and fistulas, and a poor prognosis. Currently, there is still no ideal biomarker for clinical assessment of disease activity in small bowel CD, and there is a lack of non-invasive biomarkers that can sensitively reflect the activity of small bowel CD. Studies have found that the serum level of leucine-rich alpha-2 glycoprotein (LRG) is positively correlated with the disease activity of small bowel CD. This article reviews the relevant research of LRG in evaluating the small bowel CD and looks into its potential application prospects.

Background:The musk glands of adult male Chinese forest musk deer(Moschus berezovskii Flerov,1929)(FMD),which are considered as special skin glands,secrete a mixture of sebum,lipids,and proteins into the musk pod.Together,these components form musk,which plays an important role in attracting females during the breeding season.However,the relationship between the musk glands and skin of Chinese FMD remains undiscovered.Here,the musk gland and skin of Chinese FMD were examined using histological analysis and RNA sequencing(RNA-seq),and the expression of key regulatory genes was evaluated to determine whether the musk gland is derived from the skin.Methods:A comparative analysis of musk gland anatomy between juvenile and adult Chinese FMD was conducted.Then,based on the anatomical structure of the musk gland,skin tissues from the abdomen and back as well as musk gland tissues were obtained from three juvenile FMD.These tissues were used for RNA-seq,hematoxylin-eosin(HE)staining,immunohistochemistry(IHC),western blot(WB),and quantitative real-time polymerase chain reaction(qRT-PCR)experiments.Results:Anatomical analysis showed that only adult male FMD had a complete glandular organ and musk pod,while juvenile FMD did not have any well-developed musk pods.Transcriptomic data revealed that 88.24%of genes were co-expressed in the skin and musk gland tissues.Kyoto Encyclopedia of Genes and Genomes(KEGG)signaling pathway analysis found that the genes co-expressed in the abdomen skin,back skin,and musk gland were enriched in biological development,endocrine system,lipid metabolism,and other pathways.Gene Ontology(GO)enrichment analysis indicated that the genes expressed in these tissues were enriched in biological processes such as multicellular development and cell division.Moreover,the Metascape predictive analysis tool demonstrated that genes expressed in musk glands were skin tissue-specific.qRT-PCR and WB revealed that sex-determining region Y-box protein 9(Sox9),Caveolin-1(Cav-1),and androgen receptor(AR)were expressed in all three tissues,although the expression levels differed among the tissues.According to the IHC results,Sox9 and AR were expressed in the nuclei of sebaceous gland,hair follicle,and musk gland cells,whereas Cav-1 was expressed in the cell membrane.Conclusions:The musk gland of Chinese FMD may be a derivative of skin tissue,and Sox9,Cav-1,and AR may play significant roles in musk gland development.

The gut microbiota plays a key role in host health and disease, particularly through their interactions with the immune system. Intestinal homeostasis is dependent on the symbiotic relationships between the host and the diverse gut microbiota, which is influenced by the highly co-evolved immune-microbiota interactions. The first step of the interaction between the host and the gut microbiota is the sensing of the gut microbes by the host immune system. In this review, we describe the cells of the host immune system and the proteins that sense the components and metabolites of the gut microbes. We further highlight the essential roles of pattern recognition receptors (PRRs), the G protein-coupled receptors (GPCRs), aryl hydrocarbon receptor (AHR) and the nuclear receptors expressed in the intestinal epithelial cells (IECs) and the intestine-resident immune cells. We also discuss the mechanisms by which the disruption of microbial sensing because of genetic or environmental factors causes human diseases such as the inflammatory bowel disease (IBD).
Humans ; Inflammatory Bowel Diseases ; Gastrointestinal Microbiome ; Microbiota ; Immune System ; Intestines

Objective To investigate the feasibility and effect of simple support bracket combined with one stitch suture in terminal ileostomy of two stomas during anus-preserving radical resection in low rectal cancer patients. Methods Retrospectively analysis was performed for rectal cancer patients with high risk factors for postoperative anastomotic leakage, who admitted to the Department of General Surgery our hospital from December 2019 to May 2021. The patients underwent laparoscopic-assisted low rectal cancer radical resection and terminal ileostomy. There were two groups including 35 patients in the group of simple bracket combined with one stitch suture, and 35 patients in the group of conventional suture. Preoperative and postoperative clinical data were analyzed. Results General data of two groups were similar. No difference statistical significantly in the rate of postoperative stoma‐related complications between the two groups ((P>0.05). All patients were without any severe complications. All stomas were successfully closed. The time of first-stage ileostomy (13.77±2.02) min vs. (22.66±3.64) min (P<0.001), second-stage stoma closure time (88.14±28.03) min vs. (103.29±30.96) min (P=0.04), and postoperative total time in hospital (14.54±2.32) d vs. (17.34±4.57) d (P=0.002) were shorter in simple bracket combined with one stitch suture group; both total cost in the hospital of first-stage operation (42 057.98±4 938.69) yuan vs. (44 728.46±5 223.62) yuan (P=0.03), and second-stage stoma closure blood loss (17.94±9.83) mL vs. (25.86±8.24) mL (P=0.001) lower compared with that in conventional suture group. Conclusions Simple support bracket combined with one stitch suture ileostomy did not increase postoperative stoma-related complications compared with conventional suture. However, it decreased the time for both first-stage ileostomy and second-stage stoma closure, and total cost in hospital. Therefore, it could be used for prophylactic ileostomy in low rectal cancer.

Objective A meta-analysis is to be performed to compare the entire efficacy on decompression (D) alone and decompression with fusion (F) for patients with 1-2 level lumbar stenosis (LSS) regardless of degenerative spandylolisthesis (DS) based on published RCTs.Methods The databases include Pubmed,Embase,Cochrane Library and Web of Science from January 1970 to March 2018 with a certain search strategy and inclusion criteria.Two reviewers assessed eligible trials,evaluated articles quality and extracted information independently and the information included basic characteristics of demographic information,primary and secondary measures,then data synthesis and meta-analysis was progressed as well as subgroup analysis by DS and follow-up time (36 months).Continuous variables were reported as weighted mean difference (WMD) and dichotomous variables were reported as odds ratios (ORs).Finally the strength of evidence and grade of recommendation was evaluated by the grades of recommendation,assessment,development and evaluation (GRADE) system for the overall outcome.Results A total of 9 RCTs with a low to moderate risk of bias met inclusion criteria with a total of 857 patients (367 were in D group and 490 were in F group) in 1-2 level operation and the average age,sex ratio and preoperative visual analogue scale (VAS) were of no significance.In primary measures,there were no statistical difference in VAS changes on back and leg pain between D and F group [MD=-0.03,95％ CI (--0.38,0.76),Z=0.08,P=0.94;MD=0.1 1,95％CI (-1.08,1.30),Z=0.18,P=0.86,respectively];Patients' satisfaction was of no difference between the two groups (OR=0.74,P=0.48),together with the change of Oswestry disability index (ODI,P=0.29) and European quality of life-5 dimensions (EQ-SD,P=0.41).As to the secondary measures,there were no difference in the rate of complication (OR=0.75,P=0.50) and reoperation (OR=1.93,P=0.11) while a statistical significance of longer operation duration (P=0.000),more blood loss (P=0.004),longer hospital stays (P=0.000) but amazing lower rate of ASD (OR=2.35,P=0.02) in F group.The subgroup analysis on whether combined with DS showed that basically all of the compared measures were in consistency with the whole meta-analysis;As to the follow-up,there was a higher reoperation rate in middle-to-long term (＞ 36months) in D group while the other measures were in line with the overall meta-analysis and adjacent segment degeneration/disease (ASD) was the most seasons of reoperation yet no matter the follow-up time.According to the GRADE system,the grade of this meta-analysis is of "High" quality.Conclusion F group has no better clinical results than D alone in short-segment LSS,regardless of DS,and even further,no significant change with shot-term or middle-to-long term follow-up.F approach has a longer duration of operation,more hospital stays and more blood loss,even perhaps a lager cost.According to the GRADE,the grade of this meta-analysis is of "High" quality,the grade strength of recommendation was "Strong".