This paper reports a case of a rare patient with inherited thrombophilia leading to mesenteric venous thrombosis and secondary small bowel obstruction. The diagnosis of the patient was confirmed through multidisciplinary team collaboration, and the intestinal obstruction was finally relieved through small bowel endoscopic treatment and surgical treatment. This paper also discusses the differential diagnosis and treatment of small bowel stricture lesions for peer reference.

Objective To investigate the protective effect and mechanism of Polygonatum sibiricum polysaccharides(PSP)on diabetic cardiomyopathy(DCM).Methods Forty SPF-grade male Sprague-Dawley rats were divided randomly into Control,Model,PSP,and metformin groups.After 4 weeks of feeding a high-fat diet,streptozotocin was injected intraperitoneally to establish a rat model of diabetes mellitus.The drug was administered by gavage for 12 weeks,and body mass and blood glucose were recorded every 2 weeks.Cardiac function was detected by non-invasive echocardiography at week 16.Myocardial histopathological changes and the degree of myocardial fibrosis were assessed by hematoxylin and eosin and Masson staining.Serum interleukin(IL)-6,IL-1β,IL-18,tumor necrosis factor-α(TNF-α),triglycerides,total cholesterol,low-density lipoprotein,and high-density lipoprotein were detected by enzyme-linked immunosorbent assay.Expression levels of the fibrosis-related proteins transforming growth factor(TGF)-β1,Smad2,Collagen-Ⅰ,Collagen-Ⅲ,and the pyroptosis-related proteins NOD-like receptor thermal protein domain associated protein 3(NLRP3),apoptosis-associated speck-like protein containing a caspase recruitment domain(ASC),and Caspase-1 were detected in rat myocardial tissues by Western blot.Cellular experiments were performed by exposing H9c2 cells to high glucose(40 mmol/L)to mimic the in vitro DCM model,cell viability was detected by Cell Counting Kit-8 assay,and the apoptotic cell ratio was detected by flow cytometry.Results Rats in the treatment group had significantly lower blood glucose,lipid,and serum inflammatory factor levels compared with the model group(P＜0.05),significantly higher ejection fraction and fractional shortening values(P＜0.05),and improved cardiac function.Myocardial fibers were better aligned and collagen fiber accumulation was reduced,and myocardial tissue levels of NLRP3,ASC,Caspase-1,Collagen-Ⅰ,Collagen-Ⅲ,TGF-β1,and Smad2 were significantly reduced(P＜0.05).In the cellular assay,PSP increased the viability and decreased the proportion of apoptotic cells in high glucose-induced H9c2 cardiomyocytes.Conclusions PSP can improve glucose-lipid metabolism,protect cardiac function,and delay the occurrence of myocardial fibrosis in diabetic rats,and can also improve the viability of cardiomyocytes.Its mechanism of action may be related to the inhibition of cellular pyroptosis and delayed occurrence of ventricular remodeling.

Objective To investigate the protective effect and mechanism of Polygonatum sibiricum polysaccharides(PSP)on diabetic cardiomyopathy(DCM).Methods Forty SPF-grade male Sprague-Dawley rats were divided randomly into Control,Model,PSP,and metformin groups.After 4 weeks of feeding a high-fat diet,streptozotocin was injected intraperitoneally to establish a rat model of diabetes mellitus.The drug was administered by gavage for 12 weeks,and body mass and blood glucose were recorded every 2 weeks.Cardiac function was detected by non-invasive echocardiography at week 16.Myocardial histopathological changes and the degree of myocardial fibrosis were assessed by hematoxylin and eosin and Masson staining.Serum interleukin(IL)-6,IL-1β,IL-18,tumor necrosis factor-α(TNF-α),triglycerides,total cholesterol,low-density lipoprotein,and high-density lipoprotein were detected by enzyme-linked immunosorbent assay.Expression levels of the fibrosis-related proteins transforming growth factor(TGF)-β1,Smad2,Collagen-Ⅰ,Collagen-Ⅲ,and the pyroptosis-related proteins NOD-like receptor thermal protein domain associated protein 3(NLRP3),apoptosis-associated speck-like protein containing a caspase recruitment domain(ASC),and Caspase-1 were detected in rat myocardial tissues by Western blot.Cellular experiments were performed by exposing H9c2 cells to high glucose(40 mmol/L)to mimic the in vitro DCM model,cell viability was detected by Cell Counting Kit-8 assay,and the apoptotic cell ratio was detected by flow cytometry.Results Rats in the treatment group had significantly lower blood glucose,lipid,and serum inflammatory factor levels compared with the model group(P＜0.05),significantly higher ejection fraction and fractional shortening values(P＜0.05),and improved cardiac function.Myocardial fibers were better aligned and collagen fiber accumulation was reduced,and myocardial tissue levels of NLRP3,ASC,Caspase-1,Collagen-Ⅰ,Collagen-Ⅲ,TGF-β1,and Smad2 were significantly reduced(P＜0.05).In the cellular assay,PSP increased the viability and decreased the proportion of apoptotic cells in high glucose-induced H9c2 cardiomyocytes.Conclusions PSP can improve glucose-lipid metabolism,protect cardiac function,and delay the occurrence of myocardial fibrosis in diabetic rats,and can also improve the viability of cardiomyocytes.Its mechanism of action may be related to the inhibition of cellular pyroptosis and delayed occurrence of ventricular remodeling.

This paper reports a case of a rare patient with inherited thrombophilia leading to mesenteric venous thrombosis and secondary small bowel obstruction. The diagnosis of the patient was confirmed through multidisciplinary team collaboration, and the intestinal obstruction was finally relieved through small bowel endoscopic treatment and surgical treatment. This paper also discusses the differential diagnosis and treatment of small bowel stricture lesions for peer reference.

Femoral head fracture combined with posterior hip dislocation is a serious traumatic condition. Conservative treatment has a long time of bed rest, and may cause muscle apraxia atrophy, hypostatic pneumonia, deep vein thrombosis of the lower limbs, or pulmonary embolism, which has poor clinical efficacy. Therefore, surgical treatment is the first choice for femoral head fracture combined with posterior hip dislocation. The direct anterior approach of the hip can better expose Pipkin type I and type II femoral head fractures without the need to dislocate the hip completely. However, the disadvantage is that it destroys the structural integrity of the anterior hip joint, which increases the risk of femoral head necrosis and heterotopic ossification to a certain extent. The medial approach can also be chosen for Pipkin type I and II fractures, but it is important to avoid damaging the integrity of the fascial layer, some small vascular branches can be ligated, and injury to the medial rotary femoral artery should be avoided. The lateral approach is considered to be an effective treatment for Pipkin type III fractures, but there is limited exposure of the posterior acetabular injury and a risk of injury to the superior gluteal vessels and nerves, which may be secondary to adductor weakness postoperatively. The posterior approach is the main surgical approach for type IV Pipkin fracture. The classic posterior lateral approaches mainly include the Kocher - Langenbeck approach and the Ganz surgical dislocation approach. The Kocher - Langenbeck approach does not destroy the abductors and is particularly suitable for patients with posterior hip dislocation and difficult to reposition. Ganz surgical approach protects the blood supply of the medial femoral circumcator artery, so the incidence of femoral head necrosis is low. It can achieve all-round visualization of the femoral head and acetabulum, comprehensively evaluate the lesions of the femoral head and acetabulum, and find the occult injuries missed in imaging examinations..

Objective:To evaluate the efficacy and safety of vedolizumab (VDZ) in the treatment of active ulcerative colitis (UC).Methods:From November 1, 2020 to October 30, 2022, at the Department of Gastroenterology, the Sixth Affiliated Hospital of Sun Yat-sen University, 81 UC patients who received VDZ treatment and completed a 14-week follow-up were retrospectively selected. The clinical data of patients, including age, disease duration, disease activity of UC were collected. The VDZ efficacy evaluation included primary and secondary efficacy indicators. The primary efficacy indicator was the clinical remission rate after 14 weeks of VDZ treatment, and the secondary efficacy indicators included the clinical response rate, steroids-free remission rate, endoscopic remission rate after 14 weeks of treatment as well as the clinical response rate, clinical remission rate, steroids-free remission rate, secondary loss of response rate after 52 weeks of treatment. The adverse reactions during the treatment were recored. Taking clinical remission after 14 weeks of treatment as the dependent variable, univariate analysis was performed to identify the risk factors affecting clinical remission of VDZ. Binary logistic regression analysis was used for multivariate analysis to determine the independent risk factors of VDZ-included clinical remission. Chi-square test and Wilcoxon signed-rank test were used for statistical analysis.Results:Among the 81 UC patients, the age was 40.0 years old (29.0 years old, 53.5 years old) and the disease duration was 42.5 months (22.5 months, 94.7 months). The proportion of patients with mild active UC was 21.0% (17/81), the proportion of patients with moderate active UC was 64.2% (52/81), and the proportion of patients with severe active UC was 14.8% (12/81). After 14 weeks of treatment, the total Mayo score decreased from baseline level of 7.0 (6.0, 9.0) to 1.0 (0.0, 3.0), and the difference was statistically significant ( Z=-6.87, P<0.001). The clinical response rate was 84.0% (68/81) and the clinical remission rate was 69.1% (56/81) after 14 weeks of treatment. Of the 17 patients treated with combination of corticosteroid therapy, 10 achieved steroid-free remission, and the endoscopic remission rate was 34.8% (23/66). Of the 43 patients followed up to 52 weeks, the total Mayo score of UC patients decreased from baseline level of 7.0 (6.0, 9.0) to 0.0 (0.0, 1.0) after 52 weeks of treatment, and the difference was statistically significant ( Z=-3.25, P<0.001). The clinical response rate was 69.8% (30/43), and the clinical remission rate was 65.1% (28/43). Of the 13 patients treated with combination of corticosteroid therapy, 10 patients achieved steroid-free remission. The secondary loss of response rate was 15.2%(5/33) .The result of the univariate analysis showed that previous use of glucocorticoids was a risk factor of clinical remission after 14 weeks of VDZ treatment ( χ2=5.88, P=0.015). The result of multivariate logistic regression analysis showed that previous use of glucocorticoids was an independent risk factor of clinical remission after 14 weeks of VDZ treatment ( OR=3.429, 95% confidence interval 1.235 to 9.517, P=0.014). During the follow-up period, 12.3% (10/81) of patients developed Clostridium difficile infections, except for 1 case stopped VDZ treatment because the clinical response was not reached, remaining 9 cases continued VDZ treatment after received anti- Clostridium difficile treatment. Conclusion:VDZ has good clinical efficacy and safety in the treatment of Chinese UC patients, and patients with no history of glucocorticoid use may be more likely to achieve clinical remission after 14 weeks of treatment.

Objective:In order to determine the development potential of human embryos in vitro, amino acid and carnitine levels were measured in the culture medium of different grades of early human embryos. Methods:From the infertile couples who received in vitro fertilization-embryo transfer treatment in the Department of Reproductive Medicine of Linyi People′s Hospital from June 2022 to December 2022, the age of the women was defined as 25-35 years old [31.5(26.5, 33.25)] with 8-20 eggs, 126 cultured cells and embryos of the third day were randomly collected from infertile couples. They were divided into three groups according to the morphological level of the corresponding embryos: excellent, neutral and poor. Amino acids and L-carnitines levels in culture medium were detected by liquid chromatography-mass spectrometry (LC-MS). Using analysis of variance to compare differences among groups, correlation analysis, factor analysis was performed to analyze the association between the levels of amino acids and L-carnitines and development potential of early human embryos.Results:The value of Methionine/Phenylalanine was found statistically different among superior embryo (3.09±1.67), moderate embryo (4.00±1.19) and inferior embryo (4.99±2.04). The difference between the three groups was statistically different ( F=7.09, P<0.05): superior embryo vs moderate embryo ( t=-0.91, P<0.05), superior embryo vs inferior embryo ( t=-1.91, P<0.05), moderate embryo vs inferior embryo ( t=-0.99, P<0.05). Among different amino acids, Phe had the strongest positive correlation with Tyr ( r=0.99, P<0.01). Among different carnitines, C 8/C 10 has the strongest positive correlation with C 5DC+C 6OH/C 16( r=0.44, P<0.01). The weight value of leucine (isoleucine), arginine, valine/phenylalanine, glycine, tyrosine and carnitine(C 5DC+C 6OH)/C 8 calculated by the least square fitting model is 2.22, 1.99, 1.65, 1.54, 1.21 and 1.15 respectively. Conclusion:Leucine, arginine, valine/phenylalanine, glycine, tyrosine and carnitine (C 5DC+C 6OH)/C 8 in embryo culture medium were significantly correlated with the levels of early human embryos in vitro.

Objectives:To evaluate the efficacy and safety of adalimumab (ADA) biosimilar in the treatment of Crohn′s disease (CD) .Methods:A retrospective cohort study was conducted. The patients with CD treated with ADA biosimilar in the Sixth Affiliated Hospital of Sun Yat-sen University from January 2019 to March 2022 with complete data were enrolled. The disease activity of patients at baseline was evaluated by Harvey-Bradshaw index (HBI) . The patients were divided into active group and remission group according to the activity. The primary endpoints were clinical response rate and remission rate at the 12th week in patients with active CD. The secondary endpoints included the clinical response rate and the remission rate in patients with active CD at the 26th week, maintenance remission rate at the 12th and the 26th weeks in patients with remission CD, and safety report.Results:Forty-eight patients were included. There were 20 patients whose HBI was 7 (6, 8) points in active group and 28 whose HBI was 3 (2, 4) points in remission group. In patients with active CD, the clinical response rate was 70.0% (14/20) and clinical remission rate was 60.0% (12/20) at the 12th week. The clinical response rate and clinical remission rate were both 61.5% (8/13) at the 26th week. The maintain remission rate of patients with remission CD was 96.4% (27/28) and 92.3% (12/13) at the 12th and the 26th weeks respectively. During the follow-up period, adverse reactions occurred in 2 patients (4.2%) and no serious adverse reaction was found.Conclusion:ADA biosimilar has good efficacy and safety in short-term induction and maintenance of clinical remission in Chinese patients with mild to moderate active CD.

Objective:To evaluate the efficacy, predictive factors, and safety of thalidomide monotherapy in the maintenance treatment of intestinal Behcet's disease.Methods:From January 2013 to March 2022, patients with intestinal Behcet's disease received thalidomide in the Sixth Affiliated Hospital of Sun Yat-sen University were retrospectively enrolled for analysis. The primary end points were the maintained steroid-free remission at 6 and 12 months. The secondary end points were the mucosal healing at 6 and 12 months, the long-term maintained steroid-free remission, predictive factors and adverse events.Results:A total of 28 patients with active intestinal Behcet's disease were enrolled. The maintained steroid-free remission at month 6, 12, 24 and 36 were 85.7%, 74.0%, 63.5% and 50.4% respectively. The median duration of maintained steroid-free remission was 49.5 (35.4, 63.6) months. Mucosal healing was 40.0% and 35.0% at month 6 and 12 respectively. Multivariate Cox regression analysis indicated that high disease activity index for intestinal Behcet's disease at baseline ( P = 0.014, HR = 1.057, 95% CI 1.011-1.104) was independently associated with lower likelihoods of maintaining steroid-free remission. During follow-up, 14 patients (50.0%) got adverse reactions and the incidence of limb numbness was 28.6%, with a median duration of 9.5 (5.5, 22.5) months. The drug dosage reduction rate was 14.3%, and the drug discontinuation rate was 17.9% due to side effects respectively. The median duration of drug discontinuation was 10.5 (23.5, 40.3) months. Conclusion:Thalidomide shows good effectiveness in maintaining long term steroid-free remission in intestinal Behcet′s disease, but the high incidence of limb numbness deserves attention.

Objectives:To evaluate the efficacy and safety of adalimumab (ADA) biosimilar in the treatment of Crohn′s disease (CD) .Methods:A retrospective cohort study was conducted. The patients with CD treated with ADA biosimilar in the Sixth Affiliated Hospital of Sun Yat-sen University from January 2019 to March 2022 with complete data were enrolled. The disease activity of patients at baseline was evaluated by Harvey-Bradshaw index (HBI) . The patients were divided into active group and remission group according to the activity. The primary endpoints were clinical response rate and remission rate at the 12th week in patients with active CD. The secondary endpoints included the clinical response rate and the remission rate in patients with active CD at the 26th week, maintenance remission rate at the 12th and the 26th weeks in patients with remission CD, and safety report.Results:Forty-eight patients were included. There were 20 patients whose HBI was 7 (6, 8) points in active group and 28 whose HBI was 3 (2, 4) points in remission group. In patients with active CD, the clinical response rate was 70.0% (14/20) and clinical remission rate was 60.0% (12/20) at the 12th week. The clinical response rate and clinical remission rate were both 61.5% (8/13) at the 26th week. The maintain remission rate of patients with remission CD was 96.4% (27/28) and 92.3% (12/13) at the 12th and the 26th weeks respectively. During the follow-up period, adverse reactions occurred in 2 patients (4.2%) and no serious adverse reaction was found.Conclusion:ADA biosimilar has good efficacy and safety in short-term induction and maintenance of clinical remission in Chinese patients with mild to moderate active CD.