Hepatitis C is distributed worldwide and possesses a hidden characteristic. The traditional methods of screening and diagnosis of hepatitis C infection commonly used in clinics are based on anti-HCV antibody and HCV RNA detection. Advances in HCV antigen detection technologies can apparently reduce the window period for anti-HCV antibodies, providing new clinical evidence for the early detection, diagnosis, and treatment of HCV infection. This article is a current review of HCV antigen detection methodologies, clinical applications, and detection strategies.

Background::Histological healing is closely associated with improved long-term clinical outcomes and lowered relapses in patients with ulcerative colitis (UC). Here, we developed a novel diagnostic criterion for assessing histological healing in UC patients.Methods::We conducted a retrospective cohort study in UC patients, whose treatment was iteratively optimized to achieve mucosal healing at Shanghai Tenth People’s Hospital of Tongji University from January 2017 to May 2022. We identified an inflammatory cell enumeration index (ICEI) for assessing histological healing based on the proportions of eosinophils, CD177 + neutrophils, and CD40L + T cells in the colonic lamina propria under high power field (HPF), and the outcomes (risks of symptomatic relapses) of achieving histological remission vs. persistent histological inflammation using Kaplan-Meier curves. Intrareader reliability and inter-reader reliability were evaluated by each reader. The relationships to the changes in the Nancy index and the Geboes score were also assessed for responsiveness. The ICEI was further validated in a new cohort of UC patients from other nine university hospitals. Results::We developed an ICEI for clinical diagnosis of histological healing, i.e., Y = 1.701X 1 + 0.758X 2 + 1.347X 3 - 7.745 (X 1, X 2, and X 3 represent the proportions of CD177 + neutrophils, eosinophils, and CD40L + T cells, respectively, in the colonic lamina propria under HPF). The receiver operating characteristics curve (ROC) analysis revealed that Y <-0.391 was the cutoff value for the diagnosis of histological healing and that an area under the curve (AUC) was 0.942 (95% confidence interval [CI]: 0.905-0.979) with a sensitivity of 92.5% and a specificity of 83.6% ( P <0.001). The intraclass correlation coefficient (ICC) for the intrareader reliability was 0.855 (95% CI: 0.781-0.909), and ICEI had good inter-reader reliability of 0.832 (95% CI: 0.748-0.894). During an 18-month follow-up, patients with histological healing had a substantially better outcome compared with those with unachieved histological healing ( P <0.001) using ICEI. During a 12-month follow-up from other nine hospitals, patients with histological healing also had a lower risk of relapse than patients with unachieved histological healing. Conclusions::ICEI can be used to predict histological healing and identify patients with a risk of relapse 12 months and 18 months after clinical therapy. Therefore, ICEI provides a promising, simplified approach to monitor histological healing and to predict the prognosis of UC.Registration::Chinese Clinical Trial Registry, No. ChiCTR2300077792.

Objective:To evaluate the short-term efficacy of ustekinumab (UST) as the first-line treatment of Crohn′s disease (CD).Methods:From October 1, 2020 to March 1, 2023, at the First Affiliated Hospital of Soochow University, 64 CD patients treated with UST as first-line biologics were enrolled. The patients were classified using the Montreal classification. Clinical and endoscopic response and remission were assessed by Crohn′s disease activity index (CDAI) and simple endoscopic score for crohn′s disease (SES-CD), respectively. Clinical response was defined as a reduction in CDAI score ≥70, and clinical remission was defined as a CDAI score <150; Endoscopic response was defined as ≥50% reduction from baseline in SES-CD score, and endoscopic remission was defined as SES-CD score ≤2. The clinical response rate and clinical remission rate at week 24 and week 48, as well as the endoscopic response rate and endoscopic remission rate at week 48 were observed in CD patients (only 21 patients with endoscopic prognostic results). Mann-Whitney rank sum test was used for statistical analysis.Results:Among 64 CD patients, there were 47 males and 17 females, with an age of (33.5±13.7) years old. According to Montreal classification, there were 3 cases (4.7%) of type A1 (≤16 years old), 44 cases (68.8%) of type A2 (17 to 40 years old), and 17 cases (26.6%) of type A3 (>40 years old); 43 cases (67.2%) of type L1 (terminal ileum type), 10 cases (15.6%) of type L2 (colonic type), 8 cases (12.5%) of type L3 (ileocolonic type), 1 case (1.6%) of type L4 (upper gastrointestinal type), 2 cases (3.1%) of type L1+ L4; 23 cases (35.9%) of type B1 (non-stricturing, non-penetrating), 34 cases (53.1%) of type B2 (stricturing), 2 cases (3.1%) of type B3 (penetrating), 5 cases (7.8%) of type B2+ B3; 44 cases (68.8%) complicated with perianal lesions. Among 56 CD patients with UST maintenance therapy once every 8 weeks, the CDAI scores at week 24 and 48 after treatment were both lower than that at week 0 (64.46(30.61, 123.30), 34.24(15.77, 64.83) vs. 353.40(290.40, 391.30)), and the CDAI score at week 48 after treatment was lower than that at week 24 after treatment, and the differences were statistically significant ( Z=-9.01, -9.13, and -3.14; P<0.001, <0.001, and =0.002). The clinical response rate was 100.0% (56/56) and the clinical remission rate was 91.1% (51/56) at week 24; the clinical response rate was 100.0% (56/56) and the clinical remission rate was 98.2% (55/56) at week 48. Among 39 CD patients complicated with perianal lesions, the closure rate of anal lesions at week 24 was 87.2% (34/39) and at week 48 was 100.0% (39/39). Among 8 CD patients who received UST maintenance therapy once every 12 weeks, the CDAI scores at week 24 and 48 were both lower than that at week 0 (100.40(71.20, 171.30), 38.49(18.25, 143.50) vs. 268.00(242.60, 364.90)), and the differences were statistically significant ( Z=-3.26 and -3.36; both P<0.001). At week 24, 7 CD patients achieved clinical response and 5 CD patients achieved clinical remission. At week 48, 8 CD patients achieved clinical response and 6 CD patients achieved clinical remission. Among 5 CD patients complicated with perianal lesions, 3 CD patients achieved perianal closure at week 24 and all 5 CD patients achieved closure of perianal lesions at week 48. Among 21 CD patients who underwent endoscopic evaluation, 16 CD patients received UST maintenance therapy once every 8 weeks, the SES-CD score at week 48 was lower than that at week 0 (4.00(3.00, 7.75) vs. 9.50(7.25, 10.75)), and the difference was statistically significant ( Z=-3.43, P<0.001), among them, 9 CD patients achieved endoscopic response and 2 CD patients achieved endoscopic remission; 5 CD patients received UST maintenance therapy once every 12 weeks, there was no statistically significant difference in the SES-CD score at week 48 compared with that at week 0 (4.00(1.50, 6.50) vs. 7.00(3.50, 10.00)) ( P>0.05), among them, 3 CD patients achieved endoscopic response and 1 CD patients achieved endoscopic remission. Conclusion:UST as the first-line treatment for CD patients can achieve clinical efficacy (response or remission), and the maintenance therapy is beneficial for endoscopic remission and closure of perianal lesions.

Objective:To explore the detection rate of non-caseating granuloma under endoscopy in patients with Crohn′s disease and its influencing factors, in order to improve the pathological diagnosis rate of Crohn′s disease.Methods:From July 2016 to April 2021, at the First Affiliated Hospital of Soochow University, 199 patients who met the clinical diagnostic criteria for Crohn′s disease and underwent endoscopic biopsy were collected. The detection rates of non-caseating granulomas in all patients with Crohn′s disease, in different types (primary and recurrent) and whether the biopsy site included the colon were analyzed. According to whether non-caseating granulomas were detected by endoscopic biopsy, the patients were divided into the detected group and the undetected group. The clinical data of the two groups of patients were compared, which included gender, age, course of disease, body mass index, smoking status, clinical manifestations (abdominal pain, diarrhea, gastrointestinal bleeding, perianal lesions, weight loss, fever, intestinal obstruction), therapeutic medication (5-aminosalicylic acid, immunosuppressants, glucocorticoid, biological agents, exclusive enteral nutrition), history of bowel surgery, laboratory examination results (hemoglobin, platelet count, neutrophil count, C-reactive protein, erythrocyte sedimentation rate, albumin), endoscopic manifestation (ulcer, fistula, stricture), simplified Crohn′s disease activity index (CDAI), total number of biopsy samples, and site of biopsy. Chi-square test, continuity correction chi-square test, Mann-Whitney U test and Fisher exact test were used for statistical analysis, and logistic regression analysis was used to analyzed the influencing factors of detection of non-caseating granulomas under endoscopy. Results:Among the 199 patients with Crohn′s disease, 67 cases were detected with non-caseating granuloma (detected group), and the overall detection rate was 33.7% (67/199); 132 cases were not detected with non-caseating granuloma (undetected group). The detection rate of non-caseating granulomas in patients with primary Crohn′s disease was higher than that of recurrent patients (39.9%, 59/148 vs. 15.7%, 8/51), and the detection rate of non-caseating granulomas in patients with Crohn′s disease whose biopsy site included the colon was higher than that of patients whose biopsy site did not include colon (64.1%, 25/39 vs. 26.3%, 42/160), and the differences were statistically significant ( χ2=9.93 and 20.12 , P=0.002 and <0.001). The age of patients in the detected group was younger than that of the undetected group; the course of disease of the detected group was shorter than that of the undetected group; the proportions of patients with abdominal pain and history of biological treatment in the detected group were lower than those of the undetected group; the simplified CDAI score of the detected group was higher than that of the undetected group; and the total number of biopsy samples of the detected group was more than that of the undetected group (30.0 years old (25.0 years old, 37.00 years old) vs. 32.0 years old (28.0 years old, 41.0 years old); 1.0 year (0.0 year, 3.0 years) vs. 2.0 years (0.0 year, 5.0 years), 61.2%, 41/67 vs. 75.8%, 100/132; 0, 0/67 vs. 10.6%, 14/132; 5.00 (2.00, 7.00) vs. 4.00 (2.00, 6.00); 10 (8, 12) vs. 6 (3, 9)), and the differences were statistically significant ( Z=-2.29, -1.99, χ2=4.56, corrected χ2=6.11, Z=-2.05, -5.64, all P<0.05). The case number of biopsy location in terminal ileum, colon, ileocolon, upper gastrointestinal tract, terminal ileum+ upper gastrointestinal tract, ileocolon+ upper gastrointestinal tract in the detected group was 36, 4, 18, 1, 5 and 3, respectively, compared with those of undetected group (94, 4, 8, 11, 13 and 2), the difference was statistically significant (Fisher′s exact test, P<0.001). The results of multivariate logistic regression analysis suggested that the total number of biopsy samples, whether the biopsy site included the colon and disease type were independent influencing factors for the detection of non-caseating granulomas under endoscopy in patients with Crohn′s disease (regression coefficients=0.157, 0.979 and -0.960, OR=1.171, 2.662 and 0.383; 95% confidence interval 1.067 to 1.284, 1.140 to 6.214, 0.158 to 0.929; P=0.001, 0.024 and 0.034). Conclusions:For endoscopic examination in patients with suspected Crohn′s disease, the total number of biopsy samles should be increased as much as possible, and biopsy should be performed at the colonic lesions, in order to improve the detection rate of non-caseating granulomas under endoscopy thereby providing more pathological evidence for the diagnosis of Crohn′s disease.

To evaluate the psychological symptoms of patients with Crohn disease (CD), and to explore the risk factors affecting quality of life (QOL) in CD patients, 50 adult patients with CD, and 50 healthy controls were enrolled. Psychological questionnaires including self-rating anxiety scale (SAS), self-rating depression scale (SDS), the inflammatory bowel disease questionnaire (IBDQ) and the short form-36 health survey (SF-36) were completed. The results showed both the SAS (40.3±8.5 VS 37.6±7.0) and the SDS (47.1±11.1 VS 41.8±9.6) in CD patients were significantly higher than those in the healthy controls ( t=5.4, P<0.05; t=10.6, P<0.05). The IBDQ scores revealed the physical symptoms scores were 49.50±7.62, systemic symptoms scores 23.92±5.07, emotional functions scores 57.13±15.62, and social function scores 22.15±9.08 in CD active phase. However, the above scores were 60.12±4.01, 26.24±3.97, 67.34±15.17, and 25.44±2.03 respectively in the remission phase. Four subscale items of IBDQ in CD active phase were significant lower than those in the remission phase (all P<0.05). The subscale items of SF-36 scores (PF, RP, BP, GH, VT, SF, RE, MH) in CD patients were significant lower than those in healthy controls (all P<0.05). The SF-36 items scores of PF,RP and MH in the remission phase were significant higher than those in the active phase (all P<0.05). The SF-36 items scores of GH and VT in patients with malnutrition were significant lower than those with nutrition (both P<0.05). Multivariate regression analysis showed that disease status and nutritional risk ( P<0.05) significantly affected the patients' IBDQ scores. Factors including sex, age, marital status, education background, medical insurance, use of biologicals, surgery treatment had little influence on the total score of IBDQ ( P>0.05). Psychological conseling and treatment in the active phase may improve QOL of CD patients.

Objective To investigate the therapeutic value of enteral nutrition in disease activity, nutritional status and complications of patients with Crohn's disease (CD).Methods From January 2015 to February 2017,64 CD patients with malnutrition in the First Affiliated Hospital of Soochow University were selected and received basic treatment with enteral nutrition.Before enteral nutrition and three months after therapy,white blood cell (WBC),red blood cell (RBC),hemoglobin,platelet,total protein,albumin,erythrocyte sedimentation rate (ESR)and C-reaction protein (CRP)were examined;Crohn's disease activity index (CDAI)was calculated;abdominal and perianorectal lesions of patients were observed by small intestinal computed tomography (CT ), abdominal ultrasound and anus magnetic resonance imaging (MRI).Paired t test and McNemar test were performed for statistical analysis.Results Compared with those before enteral nutrition treatment,who received enteral nutrition for three months, the levels of WBC,platelet,ESR,CRP and CDAI scores of CD patients were lowered ((7.83±3.61)× 109/L vs.(4.82±2.26)×109/L,(272.52±191.79)×109/L vs.(166.17±67.18)×109/L,33.5 mm/1 h vs.5.5 mm/1 h,21.70 mg/L vs.1.97 mg/L,220.75±119.71 vs.33.48 ±20.22),and the differences were statistically significant (t＝13.14 and 10.02;Z＝501.50 and 57.80;t＝25.44,all P＜0.01).The levels of RBC,hemoglobin,total protein,albumin increased ((4.17 ±0.97)×1012/L vs. (4.97±0.98)×1012/L,(115.33±40.38)g/L vs.(133.88±43.87)g/L,(57.82±19.46)g/L vs. (69.68±16.53)g/L,(34.32 ±16.85)g/L vs.(43.29 ±17.57)g/L),and the differences were statistically significant (t＝-10.45,-7.12,-11.44 and -6.87,all P＜0.01).The CDAI scores of patients with remission of abdominal pelvic diseases and intestinal stenosis were both lower than those of patients without remission (214.3±113.54 vs.296.77±60.24,219.31±104.74 vs.221.04±121.47), and the differences were statistically significant (both t＝28.91,both P＜0.05).Three months after enteral nutrition treatment,the remission patients of perianal lesions,abdominal pelvic diseases and intestinal stenosis were 28,14 and 18 cases,respectively.Conclusion CD patients can achieve clinical remission with enteral nutrition treatment,which also prevent and treat CD related malnutrition and may prove to be a safe and first-line therapeutic approach.

Background: There is no gold standard for the diagnosis and monitoring of inflammatory bowel disease (IBD).As immune system plays crucial role in the pathogenesis of IBD,some immune-specific serum antibodies are considered to be useful tools for the diagnosis and differential diagnosis of the disease.Aims: To investigate the clinical significance of serum antibodies,including anti-Saccharomyces cerevisiae antibody (ASCA) and perinuclear anti-neutrophil cytoplasmic antibody (pANCA) in IBD.Methods: Serum samples were obtained from 91 consecutive IBD patients from Feb.2015 to May 2016 at the First Affiliated Hospital of Soochow University.Of them,52 were Crohn's disease (CD) and 39 were ulcerative colitis (UC).Serum samples of 36 non-IBD patients were served as controls.ASCA-IgG and ASCA-IgA were detected by ELISA,and pANCA by indirect immunofluorescence assay.Using clinical diagnosis as gold standard,crosstabs statistics was performed to measure the diagnostic accuracy of ASCA and pANCA,and ROC curve,Pearson Chi-square test and Fisher's exact test were employed for analyzing the correlations of these two serum antibodies with IBD,CD,UC,and the location of the disease.Results: Both serum ASCA-IgG and IgA were correlated with CD (AUC=0.626 and 0.614),while UC was correlated with ASCA-IgA only (AUC=0.486).Serum pANCA had relevance to IBD (r=0.342),CD (r=-0.262) and UC (r=0.614);its sensitivity and specificity for IBD and UC were superior to those for CD (P＜0.05).In CD patients,ASCA-IgG was associated with terminal ileal disease (P＜0.05),and pANCA was associated with colonic involvement (P＜0.05).In UC patients,both ASCA-IgG and IgA were correlated with terminal ileal disease (P＜0.05).Conclusions: Serum ASCA and pANCA may be helpful for discrimination between CD and UC when the diagnosis of IBD is established.Furthermore,they are closely associated with the disease location,ASCA is related with the terminal ileal disease and pANCA is related with colonic involvement.

Objective To study the expression of ALK protein in pulmonary adenocarcinoma as detected by Ventana immunohistochemistry, with correlation of clinicopathologic features. Methods Immunohistochemical study for ALK protein using Ventana ALK ( D5F3) kit was carried in 7 371 pulmonary adenocarcinoma samples.The clinicopathologic features were subsequently analyzed.Results ALK fusion protein was detected in 446 of the 7 371 lung adenocarcinoma samples studied ( 6.05%) .The ALK positivity rate in small biopsy samples was higher than that in surgical specimens [ 9.02% ( 153/1 696 ) versus 5.16%(293/5 675);P<0.01] .ALK fusion protein expression correlated with patient age, sample type and smoking history.ALK positivity rate in each age group increased with younger patient age.ALK positivity rate was 45.45%(10/22) in patients younger than 30 years old.The positivity rate of ALK fusion protein in adenocarcinoma in-situ, minimally invasive adenocarcinoma and invasive adenocarcinoma was 0, 0.48%(2/418) and 5.63% (291/5 165), respectively.The differences of ALK positivity rate amongst different subtypes had statistical significance ( P<0.01 ).Invasive mucinous adenocarcinoma had highest ALK positivity rate, followed by invasive adenocarcinoma with predominantly solid pattern.Conclusions ALK fusion protein is more often found in young patients with pulmonary adenocarcinoma, especially in those younger than 30 years old.ALK fusion protein is rarely expressed in early-stage pulmonary adenocarcinoma. Invasive mucinous adenocarcinoma and invasive adenocarcinoma with solid pattern have higher ALK positivity rate than other adenocarcinoma subtypes.

Background:The incidence of inflammatory bowel disease(IBD)is increasing recently. However,the pathogenesis has not been fully clarified. Aims:To investigate the expressions and significance of interleukin-22( IL-22),matrix metalloproteinase-9(MMP-9)and macrophage migration inhibitory factor(MIF)in peripheral blood of patients with IBD. Methods:A total of 80 patients with IBD admitted from May 2011 to Nov. 2014 at the First Affiliated Hospital of Soochow University were enrolled,in which 43 cases were Crohn’s disease(CD),37 cases were ulcerative colitis(UC). Forty healthy subjects were served as normal controls. Peripheral levels of IL-22,MMP-9 and MIF were detected by ELISA. Multivariate Logistic regression model was used to analyze IL-22,MMP-9 and MIF in active CD and UC and ROC curve was used to evaluate the diagnostic performance of these markers for screening of active CD and UC. Results:Compared with normal control group,peripheral levels of IL-22,MMP-9 and MIF increased significantly in CD and UC groups(P <0. 05),while no significant difference was found between CD and UC groups(P > 0. 05). Peripheral levels of IL-22, MMP-9 and MIF in active CD and UC were significantly higher than those in remission stage(P < 0. 05). For screening of active IBD,the area under ROC curve(AUC)of combined detection of IL-22 and MMP-9(0. 853 for CD,0. 867 for UC) was superior to that of IL-22,MMP-9 or MIF only(0. 747,0. 770 and 0. 699 for CD,0. 774,0. 815 and 0. 761 for UC). Conclusions:Peripheral levels of IL-22,MMP-9 and MIF increase markedly in IBD patients,which are correlated closely with the activity of IBD. Combined detection of IL-22 and MMP-9 might greatly increase the accuracy for screening of active IBD.

ObjectiveTo discuss the central modulating mechanisms while acupuncturing the Stomach 36[ST36(Zusanli)]by brain functional imaging with positron emission tomography (PET).MethodsPET imaging of whole brain was performed in a group of six healthy subjects during two stimulation paradigms: pseudo acupuncture and real acupuncture at acupoint ST36(Zusanli). The data on cerebral glycometabolism,obtained by using PET,was analyzed by using statistical parametric mapping (SPM).ResultsThere was certain increase of glycometabolism in ipsilateral hypothalamus,back of medulla oblongata;bilateral insular lobe; contralateral paracentral lobule,superior part of precentral and postcentral gyrus,opercular part of frontal and temporal lobe,middle part of cingulate gyrus,head of caudate nucleus,middle part of the back of midbrain and pons,and deep part of cerebellum,whereas decrease in ipsilateral superior part of precentral and postcentral gyrus and lateral part of ipsilateral anterior cerebellar lobe,while acupuncturing at acupoint ST36(Zusanli on the right leg).ConclusionsThe central modulating mechanisms of acupuncturing ST36 are realized by neural and neuroendocrine network modulation mechanisms of vegetative nerve center in cortex and subcortex.