Crohn′s disease is prone to secondary abdominal infection and malnutrition, and the clinical treatment of severe cases is very difficult. The patient started with intestinal perforation, developed massive hemorrhage of gastrointestinal tract, anastomotic leakage, abdominal infection, and secondary severe malnutrition and osteoporosis after surgery, and received preoperative optimal treatment such as nutritional support, abdominal drainage and hemostasis. During the treatment, the patient developed gastrointestinal bleeding, severe arrhythmia with shock, pulmonary edema and abdominal abscess. After active treatment, the operation conditions were created, then small intestinal anastomotic resection and double lumen enterostomy were performed as soon as possible. Nutritional support was given after the surgery. Finally, the double lumen enterostomy was successfully restored to rebulid the continuity of the intestine.

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.

Crohn′s disease is prone to secondary abdominal infection and malnutrition, and the clinical treatment of severe cases is very difficult. The patient started with intestinal perforation, developed massive hemorrhage of gastrointestinal tract, anastomotic leakage, abdominal infection, and secondary severe malnutrition and osteoporosis after surgery, and received preoperative optimal treatment such as nutritional support, abdominal drainage and hemostasis. During the treatment, the patient developed gastrointestinal bleeding, severe arrhythmia with shock, pulmonary edema and abdominal abscess. After active treatment, the operation conditions were created, then small intestinal anastomotic resection and double lumen enterostomy were performed as soon as possible. Nutritional support was given after the surgery. Finally, the double lumen enterostomy was successfully restored to rebulid the continuity of the intestine.

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.

This paper reviewed the literatures of TCM treating diabetes mellitus and pulmonary tuberculosis from two aspects, Chinese patent medicine and TCM decoctions, which showed that TCM therapy can control blood sugar levels, improve clinical symptoms such as cough, expectoration and wheezing, promote pulmonary tuberculosis lesion absorption, cavity closure and sputum vaginal discharge, and improve patients' quality of life.

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.

OBJECTIVETo explore the efficacy of over-the-scope clip (OTSC) in the treatment of gastrointestinal fistula.

METHODSClinical data of 12 gastrointestinal fistula patients, including 3 internal fistula and 9 external fistula treated with OTSC in our institute from March 2015 to May 2016 were retrospectively analyzed. OTSC was performed when pus was drained thoroughly and intra-abdominal infection around gastrointestinal fistula was controlled, and each patient received one clip to close fistula.

RESULTSThere were 6 female and 6 male patients with mean age of (50.1±12.6) years. The successful rate of endoscopic closure was 100% without complications including bleeding and intestinal obstruction during and after OTSC treatment. According to comprehensive evaluation, including drainage without digestive juices, no recurrence of intra-abdominal infection, no overflow of contrast medium during digestive tract radiography, and CT examination without intra-abdominal abscess, clinical gastrointestinal fistula closure was 91.7%(11/12). There was no recurrence of gastrointestinal fistula during 3 months of follow-up in 11 patients. In the remaining 1 case, the gastric fistula after laparoscopic sleeve gastrectomy recurred one week after OTSC treatment because of intra-abdominal infection surrounding fistula, and was cured by surgery finally.

CONCLUSIONThe endoscopic closure treatment of OTSC for gastrointestinal fistula is successful and effective, and control of intra-abdominal infection around fistula with adequate drainage is the key point.

Adult ; Digestive System Fistula ; complications ; drug therapy ; surgery ; Drainage ; Endoscopy, Gastrointestinal ; instrumentation ; methods ; Female ; Humans ; Intraabdominal Infections ; etiology ; therapy ; Male ; Middle Aged ; Recurrence ; Retrospective Studies ; Suppuration ; therapy ; Surgical Fixation Devices

Objective To investigate the different expression of microRNA-155 (miR-155) and cysteine-rich 61 (CYR61) in human placentas between severe preeclamptic and normal pregnancies.Methods Placentas were obtained from severe preeclamptic and healthy control pregnant women (n=18 for each group) at 36～40 gestational weeks. The expressions of miR-155 and CYR61 mRNA were assessed by real-time quantitative reverse transcription-polymerase chain reaction, and the levels of CYR61 protein were tested by Western blot. Results Compared with the control group, the miR-155 expression was increased in placentas from severe preeclampsia groups ( 165. 7 ± 16. 4 vs 527.9±49.1,t=7.00, P＜0.01), and the CYR61 mRNA expression (31.7±2.7 vs 16.4±1.2,t=5.10,P＜0. 01), as well as the CYR61 protein expression (36.4±1.5 vs 19.7±1.2,t=36.26, P＜0.01 ) were decreased. There was a significantly negative correlation between the expression of miR-155 and CYR61 mRNA within both groups (preeclamptic group: r=-0.52, P＜0.05;control:r=-0.57, P＜0.05). Conclusions Up-regulation of placental miR-155 in severe preeclampsia may be related to the decreased expression of CYR61. Both miR-155 and CYR61 may contribute to the disorders of placental angiogenesis in severe preeclampsia in human.

Recovery after surgery can be substantially facilitated by taking fast track surgery.Preoperative patient preparation is the beginning of the fast-track surgery,and it will influence the course of patient care after the operation.Preoperative patient preparation of the fast-track surgery was reviewed.