Inflammatory bowel disease (IBD) is a chronic gastrointestinal disorder resulting from genetic susceptibility, abnormal immune function in the intestinal mucosa, disruptions of gut microbiota, and other factors. With the population aging, the numbers of elderly patients with IBD and those with Alzheimer diseases (AD) are on the rise. Studies have demonstrated that there is a significant association between IBD and AD, as both conditions share similar pathophysiological mechanisms: immune imbalance, chronic inflammation and gut microbiota disruptions. This article reviews the comorbidity between IBD and AD and the common pathological mechanisms of these two conditions to provide reference for clinical management of these patients.

BACKGROUND: Since the diagnostic value of aldosterone to renin ratio (ARR) calculated by plasma renin concentration (PRC) or plasma renin activity (PRA) is still inconclusive, we conducted a meta-analysis by systematically reviewing relevant literature to explore the difference in the diagnostic efficacy of ARR calculated by PRC or PRA, so as to provide guidance for clinical diagnosis. METHODS: We searched PubMed, Embase, and Cochrane Library from the establishment of the database to March 2021. We included studies that report the true positive, false positive, true negative, and false negative values for the diagnosis of primary aldosteronism, and we excluded duplicate publications, research without full text, incomplete information, or inability to conduct data extraction, animal experiments, reviews, and systematic reviews. STATA 15.1 was used to analyze the data. RESULTS: The pooled results showed that ARR (plasma aldosterone concentration [PAC]/PRC) had a sensitivity of 0.82 (95% confidence interval [CI]: 0.78-0.86), a specificity of 0.94 (95% CI: 0.92-0.95), a positive-likelihood ratio (LR) of 12.77 (95% CI: 7.04-23.73), a negative LR of 0.11 (95% CI: 0.07-0.17), and symmetric area under the curve (SAUC) of 0.982, respectively. Furthermore, the diagnostic odds ratio (DOR) of ARR (PAC/PRC) was 180.21. Additionally, the pooled results showed that ARR (PAC/PRA) had a sensitivity of 0.91 (95% CI: 0.86-0.95), a specificity of 0.91 (95% CI: 0.90-0.93), a positive LR of 7.30 (95% CI: 2.99-17.99), a negative LR of 0.10 (95% CI: 0.04-0.26), and SAUC of 0.976, respectively. The DOR of ARR (PAC/PRA) was 155.52. Additionally, we conducted a subgroup analysis for the different thresholds (<35 or ≥35) of PAC/PRC. The results showed that the DOR of the cut-off ≥35 groups was higher than the cut-off <35 groups (DOR = 340.15, 95% CI: 38.32-3019.66; DOR = 116.40, 95% CI = 23.28-581.92). CONCLUSIONS The research results suggest that the determination of ARR (PAC/PRC) and ARR (PAC/PRA) was all effective screening tools for PA. The diagnostic accuracy and diagnostic value of ARR (PAC/PRC) are higher than ARR (PAC/PRA). In addition, within a certain range, the higher the threshold, the better the diagnostic value.
Aldosterone ; Area Under Curve ; Humans ; Hyperaldosteronism/diagnosis* ; Hypertension ; Renin

Objective To screen and identify the in vivo-induced antigen Tp0462 of Treponema pallidum (Tp),and to evaluate its value for clinical serological diagnosis of syphilis.Methods Genomewide DNA was extracted from the Tp Nichols strain,and polymerase chain reaction (PCR) was performed to amplify the Tp0462 gene.A recombinant plasmid pET30a (+)-Tp0462 was constructed and transfected into the Escherichia coli (E.coli) Rosetta (DE3) strain.Recombinant protein Tp0462 was abundantly expressed,purified and identified.A total of 18 New Zealand rabbits were randomly and equally divided into 3 groups:viable Tp-incubating group incubated with viable Tp in the testes,inactived Tp-incubating group incubated with ultraviolet irradiation-killed Tp in the testes,and control group receiving no treatment.After incubation,blood samples were collected at different time points,and the sera were isolated for identification of characteristics of in vivo-induced antigen Tp0462.Enzyme-linked immunosorbent assay for Tp0462 (Tp0462-ELISA),Treponema pallidum particle agglutination assay (TPPA),preliminary syphilis screening ELISA and rapid plasma reagin (RPR) card test were applied in 336 clinical serum samples from patients with syphilis,so as to preliminarily evaluate the value of Tp0462 for the diagnosis of syphilis.Results The optimum conditions for expression of the recombinant plasmid Tp0462-pET30a(+) in E.coli Rosetta (DE3) strains were the treatment with 0.5 mmol/L isopropyl thiogalactoside (IPTG) on a shaker at 180 rpm for 4 hours.In the viable Tp-incubating group,the serum level of specific anti-Tp0462 antibody sharply increased from week 2,and went steady after week 5.However,the specific anti-Tp0462 antibody maintained a low level in the inactived Tp-incubating group and the control group.The viable Tp-incubating group showed a significantly higher level of specific anti-Tp0462 antibody compared with the inactived Tp-incubating group and the control group (both P ＜ 0.05),while no significant difference was observed between the inactived Tp-incubating group and the control group (P =0.256).The level of anti-Tp92 antibody was significantly higher in the viable Tp-incubating group and the inactived Tp-incubating group than in the control group (P ＜ 0.05),while there was no significant difference between the viable Tp-incubating group and the inactived Tp-incubating group (P =0.127).Compared with TPPA,the sensitivity,specificity,consistency rate and area under the curve (AUC) of Tp0462-ELISA for the diagnosis of syphilis were 91.7％,98.8％,95.2％ and 0.997 respectively.Tp0462-ELISA was consistent to preliminary syphilis screening ELISA and RPR with a Kappa coefficient of 0.846 and 0.293,respectively.Conclusion Tp0462-ELISA has shown evidently higher sensitivity and specificity in the serodiagnosis of syphilis,and Tp0462 can serve as promising antigens for the diagnosis of syphilis.

Objective To explore the effects of diagnostic delay on early disease course of Crohn's disease (CD ), and to analyze the risk factors related with the progress of early disease course. Methods From December 2014 to July 2017,a total of 56 patients in Renmin Hospital of Wuhan University initially diagnosed as CD were selected.The clinical manifestation,previous history,imaging examination, endoscopic examination and pathological results of the patients were collected after initial diagnosis of CD. CD-related surgery,CD-related rehospitalization and use of immunomodulators were followed.According to time interval between initial symptom onset and initial diagnosis,the patients were divided into diagnostic delay group (diagnostic delay time＞two years,14 cases)and non-diagnostic delay group (diagnostic delay time≤two years,42 cases).The clinical characteristics at initial diagnosis and early prognosis were compared between the two groups.The risk factors affecting early prognosis of CD patients were analyzed. Kaplan-Meier was used for prognosis analysis.Log-rank test and Cox proportional hazards model were performed to analyze factors affecting early prognosis.Results The results of imaging examination indicated that the proportion of intestinal injury of diagnostic delay group was significantly higher than that of non- diagnostic delay group (χ2＝ 4.49,P ＝ 0.03 ).During follow-up,the proportion of CD-related rehospitalization of diagnostic delay group was higher than that of non-diagnostic delay group,and the difference was statistically significant (χ2＝7.34,P＝0.01).During follow-up,the nine patients received surgery.The one-year and three-year cumulative incidence of surgery was 10.7% and 22.7%,respectively;one-year cumulative incidence of surgery in diagnostic delay group and non-diagnostic delay group was 38 .6%and 9 .6%,respectively.The results of Cox univariable and multivariable analyses both indicated that intestinal injury in imaging examination at diagnosis was the risk factor of surgery (both hazard ratio (HR)＝2.313,both P＜0.01).A total of 21 patients had CD-related rehospitalization during follow-up.And one-year and 31-month cumulative incidence of hospitalization was 27 .8% and 5 6 .3%,respectively;one-year cumulative incidence of CD-related rehospitalization in diagnostic delay group and non-diagnostic delay group was 43 .7% and 2 1 .6%,respectively;and the difference was statistically significant (χ2＝5 .88 ,P＝0.02).The results of Cox univariable analysis indicated that having systematic manifestation,intestinal inj ury in imaging examination and diagnostic delay were the risk factors of CD-related rehospitalization (HR＝2.972,2.313 and 1.403,all P＜0.05).The results of multivariable analysis indicated that having systematic manifestation and intestinal injury in imaging examination were independent risk factors of CD-related rehospitalization (HR＝3.891 and 2.541, P ＜ 0.01,respectively).Conclusions The proportion of intestinal injury of patients with diagnostic delay is high and the early prognosis is poor. Intestinal injury in imaging examination at initial diagnosis is independently risk factor of CD-related surgery and rehospitalization during follow-up.

Objective To explore the significance of serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) for the death risk evaluation in elderly patients with chronic disease in five years.Methods A total of 765 elderly patients with chronic disease[136 patients with coronary heart disease (CHD),76 patients with hypertension disease (HD),86 patients with chronic obstructive pulmonary disease (COPD),75 patients with Type 2 diabetic mellitus (T2DM),76 patients with cerebral infarction (CI),73 patients with coronary heart disease combined with hypertension,71 patients with coronary heart disease combined with chronic obstructive pulmonary disease,61 patients with coronary heart disease combined with diabetic,51 patients with coronary heart disease combined with cerebral infarction,and 60 patients with three comorbidity] were classified into the survival group (312 cases) and the death group (453 cases) according to disease prognosis.The serum NT-proBNP levels of 88 healthy controls and 765 elderly patients with chronic disease were determined by bi-directional lateral flow immunoassay.The death events were followed up and observed for an average of 5 years.The results were analyzed statistically.Results The serum NT-proBNP levels in the death group with various diseases were significantly higher than the survival group (P ＜0.01),the patient's age and the proportion of male in the death group and the survival group had no significant difference (P ＞ 0.05).The serum NT-proBNP levels,the patient's age and the Proportion of male in the death group with various elderly chronic diseases had no statistical significance (P ＞ 0.05).The serum NT-proBNP levels in the death group with various elderly chronic diseases had no statistical significance (P ＞ 0.05),and were significantly higher than the survival group (P ＜ 0.01).The patient's age and the proportion of male in the death group and the survival group had no significant difference (P ＞ 0.05).The serum NT-proBNP levels in the death group in the different periods had statistical significance (P ＜ 0.01),and were significantly higher than the survival group and healthy control group (P ＜ 0.01).The more shorter of the survival time was,the higher the serum NT-proBNP 1eve was.The serum NT-proBNP levels were negatively correlated with the survival time of the patients (r =-0.378,P =0.000).The receiver operator characteristic (ROC) curve indicated that the optimal cut-off values of serum NT-proBNP levels for the death risk evaluation in elder patients with chronic disease were 1 499.50 ng/L.Kaplan-Meier survival curve showed that the survival rates of serum NT-proBNP levels had significant difference (P ＜0.01).The higher the serum NT-proBNP level was,the more shorter of the Survival rates were.Conclusions The levels of serum NT-proBNP have an important prognostic value in the death risk evaluation in elderly patients with various chronic disease.It is an independent risk factor for the death occurred in eiderly patients with chronic disease.The levels of serum NT-proBNP are closely correlated with the survival rates and survival time of elderly patients,It can be used as a monitoring indicator of the elderly patients with chronic disease in risk stratification.

BACKGROUND: With the development of nanotechnology, silk fibroin/nano-hydroxyapatite composite materials used for tissue repair have been reported; however, there are few reports on its use in spinal stability.OBJECTIVE: To explore the feasibility of silk fibroin/nano-hydroxyapatite composite materials for the initial segmental stability of the reconstructed spine.METHODS: Thirty-six New Zealand rabbits were randomly divided into three groups, and the L4/5 nucleus pulposus was removed in all the animals. Autologous bone group was implanted with autologous bone, experimental group implanted intervertebrally with silk fibroin/nano-hydroxyapatite composite material, and control group implanted with hydroxyapatite.At 12 weeks after implantation, lumbar interbody fusion was observed using X-ray, the spinal stability of the fusion segments was measured by biomechanical test, and histologically, bone graft fusion and material degradation at the surgical site were observed.RESULTS AND CONCLUSION: (1) X-ray observation: In the autologous bone group, the experimental group and the control group, there were respectively 11, 7, 2 rabbits meeting the standard of fusion. (2) Biomechanical test: The spinal activity during flexion-extension was significantly lower in the experimental group than the autogenous bone group and control group (P < 0.05). (3) Histological observation: Bony union was found at the junction between the iliac bone and surrounding tissues in the autologous bone group, and a large number of bone cells and fibroblasts were found around the new bone, while woven bone was found inside. The material was partially degraded in the experimental group,fibrous tissues were visible in the surrounding tissue, new woven bone was found inside, and pit cells and bone cells were scattered. Blood vessel growth around the material was visible in the control group, and a large number of macrophages were found inside the material. To conclude, the silk fibroin/nano-hydroxyapatite composite material has good biocompatibility and mechanical properties, which could rebuild the initial segmental stability in the rabbit spine in the short time.

Objective To study the effect of the long-term administration of hemocoagulasein vitro and in vivo,whether it may cause hypofibrinogenemia and changes of cytokine interleukin-6(IL-6) expression level which related to fibrinogen synthesis.Methods Totally 50 healthy subjects pooled plasma was chose in vitro experiments,which was divided into 7 groups.After that,added various of dilutions of injection hemocoagulase and incubated at 37 ℃,detected FIB concentration every 12 h.In vivo experiments,80 rats with six-week old were randomly divided into 4 groups:negative control group,high-dose group,middle-dose group,low-dose group,After 3 weeks administration,the serum level of Ⅴfactor,Ⅷ factor,PT,activated partial thromboplastin time (APTT),FIB,IL-6 was detected.Results Hemocoagulase in vitro had a strong role to reduce fibrin,and showed a significant dose-dependent and time-dependent;Hemocoagulase prolonged low-dose use might reduce the concentration of FIB in mice,but theⅤfactor,Ⅷ factor,PT,APTT,TT were not significantly affected.Compared with the negative control group,FIB and IL-6 concentration decreased in high-dose group,middle-dose group,low-dose group and had statistically significant differences (P<0.05);The level of FIB among the groups had statistically significant differences (P<0.05).The APTT of the middle and high dose groups was slightly prolonged,which was significantly different from that of the negative control group (P<0.05).Conclusion Hemocoagulase has a strong effect to reduce the concentration of fibrin,when there is a long-term medication,fibrin concentration of the patient should be closely monitored,hemocoagulase not only directly decomposed fibrin,but also may affect the synthesis of IL-6,the specific mechanism needs further study.

Objective: The aim of the study is to validate whether the Recognition Of Stroke In the Emergency Room (ROSIER) scale can be used by general practitioners (GPs) in an emergency medical service (EMS) protocol to transfer stroke patients from primary care center to advanced hospital with acute stroke center. Methods: GPs prospectively performed the ROSIER scale and the Cincinnati Prehospital Stroke Scale (CPSS) on suspected stroke patients as a transfer protocol. All patients were immediately transferred to the Level-II hospital for further treatment. Results: 468 of the 512 suspected stroke patients met the inclusion criteria in this study. The ROSIER scale showed a diagnostic sensitivity of 83.13% (95% confidence intervals [CI] 79.74-86.52%) and specificity of 80.88% (95% CI 77.32- 84.44%). The CPSS showed a diagnostic sensitivity of 78.01% (95% CI 74.26-81.76%) and specificity of 70.59% (95% CI 66.46-74.72%). The Kappa statistic value of the ROSIER scale and the CPSS were 0.601 and 0.454, respectively. The area under the curve (AUC) of ROSIER scale was large than the CPSS (AUC 0.855 vs. 0.791). However, the difference was not significantly different. Conclusions: This study suggest that ROSIER and CPSS could be used in an EMS protocol to transfer stroke patients from a primary care center to an advanced hospital offering thrombolysis service
Stroke

Objective To evaluate the effect of conversion from mycophenolic acid (MPA) to mizoribine (MZR) in renal transplant recipients with gastrointestinal tract (GI) symptoms.Methods A total of 355 renal transplant recipients with GI symptoms caused by MPA administration were enrolled from April 2015 to March 2017 in 25 different renal transplant centers in China.The symptomatic improvement of GI before (baseline) and after conversion to MZR (1,2,4 weeks) was assessed by each item of GI symptoms indication.In addition,the efficacy and safety of the conversion therapy during 12 months were determined.Results Patients showed improvement in GI symptoms including diarrhea,abdominal pain,abdominal distention and stomachache after conversion to MZR 1,2,4 weeks (P＜0.05).In patients with different severity of diarrhea,conversion to MZR therapy significantly improved diarrhea (P＜0.05).During 12 months,no patient experienced clinical immune rejection.We did not observe any infections,leucopenia and other serious side effects.Conclusion MZR could markedly improve GI symptoms caused by MPA administration in renal transplant recipients.

Objective To analysis curative effect of triple therapy and sequential therapy for eradication of Helicobacter pylori in patients with long-term aspirin use.Methods 52 patients with long-term aspirin use who were diagnosed with helicobacter pylori infection were collected.All patients were divided into sequential group and triple group according to different drugs classified, each 26 cases in each group were given corresponding drug treatment, after the end of treatment, the serum pepsinogen, Hp-IgG antibody levels and Helicobacter pylori clearance rate were detected in all patients. Results After treatment, compared with the triple Group, in the sequential group, the levels of serum PG I and PG II were lower, and PGⅠ/PGⅡwas higher, and the differences were statistically significant (P<0.05);the serum Hp-IgG antibody levels were lower in the sequential group (P<0.05);the Hp clearance rate of patients in the sequential group was higher (P<0.05).Conclusion Compared with triple therapy, sequential therapy can lower serum PG, PG II and Hp-IgG levels, and improve the Hp clearance rate and clinical efficacy, have guiding significance to clinical.