Objective:To investigate the clinicopathological and molecular genetic characteristics and prognosis of patients with diffuse large B-cell lymphoma (DLBCL).Methods:The clinicopathological data of 152 DLBCL patients receiving consultation and routine physical examination in Peking University Third Hospital and Peking University School of Basic Medicine from January 2008 to December 2015 were retrospectively analyzed. Immunohistochemistry was used to detect the expressions of CD10, bcl-6, MUM1, GCET1, FOXP1. EB virus encoded small RNA (EBV-EBER) was detected by using in situ hybridization. The aberrations of bcl-2, bcl-6 and c-myc genes were detected by using fluorescence in situ hybridization (FISH) to screen double-hit lymphoma (DHL). Kaplan-Meier method was used to make survival analysis.Results:Among 152 cases of DLBCL, the ratio of male to female was 1.49:1, the median age of onset was 59 years (7-90 years), and 79 cases (52.0%) were primary lymph nodes. The median overall survival (OS) time of all cases was 16 months (1-101 months). The 1-year, 3-year and 5-year OS rates were 70.2%, 44.7%, 30.3%, respectively. The OS of R-CHOP treatment group was better than that of CHOP treatment group and untreated group ( P = 0.001). Among all 137 patients receiving double-hit histochemistry score (DHS), there were 56 cases with 0 score, 57 cases with 1 score, 24 cases with 2 scores; and the difference in the OS of different DHS score groups ( P = 0.311). FISH detection showed that among 29 cases achieving results of c-myc gene detection, there were 2 cases of splitting gene and 3 cases of gene amplification; among 26 cases achieving results of bcl-2 gene detection, 2 cases had bcl-2 gene amplification; among 26 cases achieving results of bcl-6 gene detection, 2 cases had bcl-6 gene amplification and 3 cases had splitting gene. It was found that myc and bcl-2 genes were amplified simultaneously in 1 case, accompanied with bcl-6 gene splitting, which was called triple-hit lymphoma. In DHS 0-score group, 1 case of double gene abnormality was found, and 1 case of single gene abnormality was found in group 1-score; in group 2-score, 5 cases were single gene abnormality and 1 case was three gene abnormality, so the gene abnormality was inconsistent with the protein expression. Conclusions:The incidence of DHL in DLBCL patients in China is low. The major gene abnormalities are c-myc or bcl-2, bcl-6 single gene abnormalities.

The thickened and hypertrophic mesenteric fat that surrounds the inflamed intestine over 50% in Crohn′s disease (CD) is commonly defined as creeping fat. Most previous studies have focused on the mechanism of interaction between immune cells and translocated bacteria in it. However, the massive non-immune cells, including adipose-derived stem cells, adipocytes, endothelial cells and fibroblasts etc. in the mesenteric fat tissue have often been neglected. With the increasing evidence on non-immune cells in the pathogenesis of CD, their involvement in immune homeostasis and regulation of inflammationis gaining new insights. This review highlights the latest research progress on the impact of non-immune cell components in creeping fat, improving the pathogenesis of CD and explores new strategies based on mesenteric therapy.

The thickened and hypertrophic mesenteric fat that surrounds the inflamed intestine over 50% in Crohn′s disease (CD) is commonly defined as creeping fat. Most previous studies have focused on the mechanism of interaction between immune cells and translocated bacteria in it. However, the massive non-immune cells, including adipose-derived stem cells, adipocytes, endothelial cells and fibroblasts etc. in the mesenteric fat tissue have often been neglected. With the increasing evidence on non-immune cells in the pathogenesis of CD, their involvement in immune homeostasis and regulation of inflammationis gaining new insights. This review highlights the latest research progress on the impact of non-immune cell components in creeping fat, improving the pathogenesis of CD and explores new strategies based on mesenteric therapy.

Objective:To establish a model to predict the maintenance efficacy of anti-tumor necrosis factor (TNF) -α monoclonal antibody in active Crohn′s disease (CD) patients with small intestinal involvement.Methods:A retrospective cohort study was carried out. Ninety-eight CD patients with small intestinal involvement admitted in the Tenth People′s Hospital of Tongji University from January 2017 to December 2020 were consecutively included. All the patients received anti-TNF-α monoclonal antibody induction therapy regularly and the induced remission treatment was effective. The maintenance therapy was followed up for at least 1 year. All patients underwent computed tomography enterography (CTE) before treatment. According to whether therapeutic optimization occurred, the patients were divided into optimization group and maintenance group. Univariate analysis was used to compare the differences of clinical and CTE features between the two groups, and multivariate Logistic regression analysis was performed to select the independent factors for medication optimization. A nomogram based on the established predictive model was drawn and further validated internally.Results:During the follow-up, 40 patients underwent treatment optimization and 58 maintained the original treatment. Univariate analysis showed that compared with the maintenance group, the ages of onset[ (35.7±14.3) years old vs. (29.6±12.3) years old, P = 0.027) ] and diagnosis[ (37.7±17.8) years old vs. (30.6±11.1) years old, P = 0.006) ] were older, the level of hemoglobin [ (112.9±23.2) g/L vs. (126.9±26.5) g/L, P = 0.008] and serum albumin [ (38.1±5.0) g/L vs. (42.5±4.9) g/L, P<0.001] was lower in the optimization group, meanwhile the degree of intestinal wall enhancement (mild: 40.0% vs. 74.1%, moderate and severe: 60.0% vs. 25.9%, P = 0.001) and intestinal stenosis (no or suspicious: 47.5% vs. 87.9%, mild: 17.5% vs. 5.2%, moderate and severe: 35.0% vs. 6.9%, P<0.001) were significantly different between two groups. Multivariate analysis revealed that age at diagnosis ( OR = 1.051, 95% CI: 1.009-1.096, P = 0.018) , degree of intestinal wall enhancement ( OR = 3.807, 95% CI: 1.268-11.428, P = 0.017) and moderate-severe intestinal stenosis ( OR = 6.550, 95% CI: 1.640-26.165, P = 0.008) were the independent risk factors for treatment optimization, and high serum albumin level ( OR = 0.841, 95% CI: 0.747-0.946, P = 0.004) was the protective factor. The area under ROC of the established predictive model was 0.856 (95% CI: 0.779-0.933, P<0.001) with sensitivity of 82.5%, specificity of 81.0%, and accuracy of 95.9%. Conclusion:A model is established based on the CTE features including the degree of intestinal wall enhancement and intestinal stenosis combined with age at diagnosis and serum albumin level, it can predict the efficacy of anti-TNF-α monoclonal antibody in maintenance therapy among CD patients with small intestinal involvement.

Objective:To establish a model to predict the maintenance efficacy of anti-tumor necrosis factor (TNF) -α monoclonal antibody in active Crohn′s disease (CD) patients with small intestinal involvement.Methods:A retrospective cohort study was carried out. Ninety-eight CD patients with small intestinal involvement admitted in the Tenth People′s Hospital of Tongji University from January 2017 to December 2020 were consecutively included. All the patients received anti-TNF-α monoclonal antibody induction therapy regularly and the induced remission treatment was effective. The maintenance therapy was followed up for at least 1 year. All patients underwent computed tomography enterography (CTE) before treatment. According to whether therapeutic optimization occurred, the patients were divided into optimization group and maintenance group. Univariate analysis was used to compare the differences of clinical and CTE features between the two groups, and multivariate Logistic regression analysis was performed to select the independent factors for medication optimization. A nomogram based on the established predictive model was drawn and further validated internally.Results:During the follow-up, 40 patients underwent treatment optimization and 58 maintained the original treatment. Univariate analysis showed that compared with the maintenance group, the ages of onset[ (35.7±14.3) years old vs. (29.6±12.3) years old, P = 0.027) ] and diagnosis[ (37.7±17.8) years old vs. (30.6±11.1) years old, P = 0.006) ] were older, the level of hemoglobin [ (112.9±23.2) g/L vs. (126.9±26.5) g/L, P = 0.008] and serum albumin [ (38.1±5.0) g/L vs. (42.5±4.9) g/L, P<0.001] was lower in the optimization group, meanwhile the degree of intestinal wall enhancement (mild: 40.0% vs. 74.1%, moderate and severe: 60.0% vs. 25.9%, P = 0.001) and intestinal stenosis (no or suspicious: 47.5% vs. 87.9%, mild: 17.5% vs. 5.2%, moderate and severe: 35.0% vs. 6.9%, P<0.001) were significantly different between two groups. Multivariate analysis revealed that age at diagnosis ( OR = 1.051, 95% CI: 1.009-1.096, P = 0.018) , degree of intestinal wall enhancement ( OR = 3.807, 95% CI: 1.268-11.428, P = 0.017) and moderate-severe intestinal stenosis ( OR = 6.550, 95% CI: 1.640-26.165, P = 0.008) were the independent risk factors for treatment optimization, and high serum albumin level ( OR = 0.841, 95% CI: 0.747-0.946, P = 0.004) was the protective factor. The area under ROC of the established predictive model was 0.856 (95% CI: 0.779-0.933, P<0.001) with sensitivity of 82.5%, specificity of 81.0%, and accuracy of 95.9%. Conclusion:A model is established based on the CTE features including the degree of intestinal wall enhancement and intestinal stenosis combined with age at diagnosis and serum albumin level, it can predict the efficacy of anti-TNF-α monoclonal antibody in maintenance therapy among CD patients with small intestinal involvement.

Objective:To explore the effect of enhanced recovery nursing pathway in the enhanced recovery after surgery of perioperative patients with hepatic echinococcosis.Methods:From November 2017 to February 2019, simple random sampling was used to select 160 hepatic echinococcosis patients with surgery admitted to Shannan People's Hospital of Tibet Autonomous Region as the research object. Patients were randomly divided into experimental group and control group, 80 cases in each group. Patients in control group received general surgical routine nursing, and experimental group carried out enhanced recovery nursing pathway on the basis of routine nursing. The postoperative rehabilitation indicators, pain scores and postoperative complications were compared between the two groups.Results:The time of first exhaust time and defecation in experimental group was (3.77±3.05) h and (23.81±17.29) h, which was earlier than (13.27±8.58) h and (37.79±18.23) h in control group, and the differences were statistically significant ( t=4.265, 4.975; P<0.01) . The pain scores of experimental group at 2, 4, 8, and 24 hours after surgery were (1.08±1.04) , (1.61±0.85) , (1.13±0.70) and (0.26±0.41) lower than those [ (2.41±1.20) , (2.94±0.96) , (2.94±0.96) , (1.33±0.90) ]of control group, and the differences were statistically significant ( t=7.501, 9.250, 13.650, -8.720; P<0.01) . There were 2 cases (2.50%) of lung infection in experimental group and 13 cases (16.25%) in control group. The incidence in experimental group was lower than that in control group, and the difference was statistically significant (χ 2=8.901, P<0.01) . Conclusions:The standardized nursing model based on the enhanced recovery nursing pathway is conducive to the postoperative rehabilitation of patients with hepatic echinococcosis, shortens the hospital stay, and reduces postoperative lung infection complications, which is worthy of further promotion.

Objective:To investigate the clinical characteristics and possible influencing factors of the extraintestinal manifestations (EIM) in patients with Crohn′s disease (CD) .Methods:Clinical data of 623 patients diagnosed as CD at Department of Gastroenterology, Shanghai Tenth People′s Hospital, from January 2008 to January 2018 were retrospectively analyzed. These patients were divided into two groups according to whether EIM was complicated. Univariate analysis was used to evaluate the clinical features, and multivariate analysis was used to reveal the risk factors of EIM. Fisher′s exact test was used to analyze the associations among various EIMs.Results:Among 623 CD patients, 422 (67.7%) were male and 201 (32.3%) were female; the median age at diagnosis was 31.0 years old (23.0 to 43.0 years old) ; the medium follow-up time was 53.5 months (29.0 to 84.0 months) . One hundred and twelve patients (18.0%) complicated with EIM, including 86 cases with one EIM, 22 case (19.6%) with two EIM, 3 case (2.7%) with three EIM, and 1 case (0.9%) with four EIMs simultaneously. Oral involvement was found in 84 cases (75.0%) , joints and bones in 36 cases (32.1%) , skin in 17 cases (15.2%) , and eye in 7 cases (6.3%) . Compared to patients without EIM, those with EIM had higher ratios of female (41.1% vs. 30.3%) , ileocolic (L3) type (52.7% vs. 37.6%) , non-stenosis and non-penetration (B1) type (69.6% vs. 54.2%) , diarrhea or fever as the first symptom (43.8% vs. 32.5%, 14.3% vs 6.5%) and steroids administration (53.6% vs. 39.3%) , while they had lower ratios of distal ileum (L1) type (19.6% vs. 36.8%) , stenosis (B2) type (26.8% vs. 37.0%) , penetration (B3) type (3.6% vs. 8.8%) , infliximab treatment (46.4% vs. 60.7%) , and abdominal surgery (14.3% vs. 24.1%) (all P<0.05) . Multivariate analysis showed that female ( OR = 1.665, 95% CI: 1.067-2.600, P = 0.025) , colonic type ( OR = 1.996, 95% CI: 1.072-3.718, P = 0.029) , ileocolic type ( OR = 2.568, 95% CI: 1.490-4.427, P = 0.001) , B1 type (B1 vs. B3: OR = 2.977, 95% CI: 1.015-8.726, P = 0.047; B1 vs. B2: OR = 1.882, 95% CI: 1.168-3.302, P = 0.009) and fever ( OR = 2.276, 95% CI: 1.170-4.430, P = 0.015) were the independent risk factors of EIM in CD patients. The oral lesion was significantly associated with spondylarthritis and skin diseases, and the spondylarthritis was closely associated with skin and eyes lesions (all P<0.05) . Conclusions:Female, colon involvement, B1 type and fever are the high risk factors of EIM for CD patients. Various EIM possess certain associations with each other.

Objective:To investigate the clinical characteristics and possible influencing factors of the extraintestinal manifestations (EIM) in patients with Crohn′s disease (CD) .Methods:Clinical data of 623 patients diagnosed as CD at Department of Gastroenterology, Shanghai Tenth People′s Hospital, from January 2008 to January 2018 were retrospectively analyzed. These patients were divided into two groups according to whether EIM was complicated. Univariate analysis was used to evaluate the clinical features, and multivariate analysis was used to reveal the risk factors of EIM. Fisher′s exact test was used to analyze the associations among various EIMs.Results:Among 623 CD patients, 422 (67.7%) were male and 201 (32.3%) were female; the median age at diagnosis was 31.0 years old (23.0 to 43.0 years old) ; the medium follow-up time was 53.5 months (29.0 to 84.0 months) . One hundred and twelve patients (18.0%) complicated with EIM, including 86 cases with one EIM, 22 case (19.6%) with two EIM, 3 case (2.7%) with three EIM, and 1 case (0.9%) with four EIMs simultaneously. Oral involvement was found in 84 cases (75.0%) , joints and bones in 36 cases (32.1%) , skin in 17 cases (15.2%) , and eye in 7 cases (6.3%) . Compared to patients without EIM, those with EIM had higher ratios of female (41.1% vs. 30.3%) , ileocolic (L3) type (52.7% vs. 37.6%) , non-stenosis and non-penetration (B1) type (69.6% vs. 54.2%) , diarrhea or fever as the first symptom (43.8% vs. 32.5%, 14.3% vs 6.5%) and steroids administration (53.6% vs. 39.3%) , while they had lower ratios of distal ileum (L1) type (19.6% vs. 36.8%) , stenosis (B2) type (26.8% vs. 37.0%) , penetration (B3) type (3.6% vs. 8.8%) , infliximab treatment (46.4% vs. 60.7%) , and abdominal surgery (14.3% vs. 24.1%) (all P<0.05) . Multivariate analysis showed that female ( OR = 1.665, 95% CI: 1.067-2.600, P = 0.025) , colonic type ( OR = 1.996, 95% CI: 1.072-3.718, P = 0.029) , ileocolic type ( OR = 2.568, 95% CI: 1.490-4.427, P = 0.001) , B1 type (B1 vs. B3: OR = 2.977, 95% CI: 1.015-8.726, P = 0.047; B1 vs. B2: OR = 1.882, 95% CI: 1.168-3.302, P = 0.009) and fever ( OR = 2.276, 95% CI: 1.170-4.430, P = 0.015) were the independent risk factors of EIM in CD patients. The oral lesion was significantly associated with spondylarthritis and skin diseases, and the spondylarthritis was closely associated with skin and eyes lesions (all P<0.05) . Conclusions:Female, colon involvement, B1 type and fever are the high risk factors of EIM for CD patients. Various EIM possess certain associations with each other.

Objective To investigate the prevalence rate of hypertension among 30 to 70 years old Tibetan citizens in Lhasa municipality. Methods A total of 371 Tibetan men and women aged between 30 to 70 years old were included in this cross-sectional epidemiological study with simple random sampling from October to November 2006. All participants were requested to fill in a Standard questionnaire, blood pressure was measured, body mass index and waist and hip circumference ratio were calculated. Results The overall prevalence rate of hypertension was 40. 2%(36. 6% in men vs. 40. 9% in women, P=0.921). Prevalence rate of hypertension increased with age(r = 0. 995, P ＜ 0. 001). The age-standardized prevalence of hypertension was 37.6%(38. 0% in men and 37. 5% in women). Awareness rate of hypertension was 70. 9%, treatment rate of hypertension was 38. 1%, and control rate of hypertension was 2.4%. Conclusions There was a high prevalence rate and poor control rate of hypertension among 30 to 70 years old citizens of Lhasa. Intensive medical care aimed to better control of blood pressure should be applied to this population.