OBJECTIVES: At present, there are many studies on Crohn's disease of terminal ileum and colon, but few studies on Crohn's disease of small intestine alone. This study aims to analyze the clinical features and therapeutic effect of small bowel in adult patients with Crohn's disease so as to strengthen the diagnosis and treatment for this disease. METHODS: From July 1, 2015 to October 31, 2018, patients with small bowel Crohn's disease at Department of Gastroenterology, Third Xiangya Hospital of Central South University, were enrolled. At the same time, patients' demographics and clinical data were collected. RESULTS: A total of 44 patients were small bowel Crohn's disease. Among them, 40 patients were male. The age at diagnosis was (35.8±10.3) years old and disease duration was (35.2±59.5) months. The subtypes included 29(65.9%) of ileum, 7(15.9%) of jejunum, 8(18.2%) of ileum with jejunum. There were 27(61.4%) of stricture behavior, 4(9.1%) of penetrating behavior, and 13(29.5%) of non-stricture and non-penetrating behavior. Endoscopic visible stricture (29/85, 34.1%) was common, followed by longitudinal ulcers (27/85, 31.8%). Non-caseate granulomatous were found in 2 cases (4.5%). The score of Crohn's disease activity index was correlated to hemoglobin, hematocrit, and erythrocyte sedimentation rate (all CONCLUSIONS Patients with ileum account for a large proportion in patients with small bowel Crohn's disease. Stricture is more common in small bowel Crohn's disease. Stricture and longitudinal ulcer are more common under enteroscopy. Crohn's disease activity index is correlated to hemoglobin, red blood cell specific volume, and erythrocyte sedimentation rate. The most common complication is intestinal obstruction. Mesalazine is less effective on small bowel Crohn's disease.
Adult ; Crohn Disease/drug therapy* ; Endoscopy, Gastrointestinal ; Humans ; Ileum ; Intestinal Obstruction/etiology* ; Intestine, Small ; Male ; Middle Aged

Objective To estimate the value of urinary neutrophil gelatinase-associated lipocalin (NGAL) level for early diagnosis of acute kidney injury (AKI) in patients with sepsis.Methods One hundred and twenty-six sepsis patients admitted to intensive care unit (ICU) in Baoshan Branch Hospital of Shuguang Hospital Affiliated to Shanghai University ofTraditional Chinese Medicine from June 2014 to December 2015 were enrolled, and they were divided into two groups according to whether complication of AKI was present. The levels of urinary NGAL in the two groups of septic patients were evaluated immediately and at 12, 24 and 48 hours after the definite diagnosis, and the levels were compared between the two groups; the receiver operating characteristic curve (ROC curve) was performed and the value of urinary NGAL level in early diagnosis of sepsis AKI was evaluated.Results There were 60 septic cases complicated with AKI (AKI group), with the prolongation of time after definite diagnosis, the urinary NGAL (g/L) levels were gradually increased at 12, 24 and 48 hours, the levels were significantly higher than those at the corresponding time points in the group without AKI [non AKI group (66 cases), 12 hours: 178.2±32.8 vs. 53.8±10.4, 24 hours: 228.4±24.6 vs. 54.1±9.0, 48 hours: 186.1±43.6 vs. 52.5±9.4, allP < 0.05]. The area under ROC curve (AUC) of urinary NGAL level at 24 hours after definite diagnosis and 95% confidence interval (CI) were 0.863 (0.766-0.929) and 0.686 (0.466-0.696), respectively, when the cutoff value of urinary NGAL was 65.9μg/L, the sensitivity was 81.9% and specificity 76.1%; when the cutoff value of urinary NGAL was 57.9μg/L, the sensitivity was 70.2% and the specificity 57.2%.Conclusion Urinary NGAL level can be used as a reference marker for the early diagnosis of sepsis concomitant AKI.

Objective To explore the serum expression of DKK1 protein, a Wnt signaling pathway inhibitor in patients with non-small cell lung cancer (NSCLC) and its relationship with osseous metastasis. Methods Serum DKK1 protein levels were assayed by enzyme-linked immunosorbent assay (ELISA) in NSCLC patients, including 33 NSCLC patients with osseous metastasis and 41 NSCLC patients without respectively, and 32 healthy volunteers were served as the control group. Furthermore, the differential expression of the serum DKK1 protein level between the patients and the volunteers was compared by using the variance analysis and the independent sample t test. The correlation between DKK1 expression and bone metastasis was detected by Pearson correlation analysis. Results Serum DKK1 protein level of NSCLC patients was (79.6±8.3) ng/ml, which was significantly higher than that in healthy volunteers [(21.5±6.4) ng/ml, t=13.17, P=0.001]. The serum DKK1 level in osseous metastasis group was (110.3±11.4) ng/ml, which was significantly higher than that in non-skeletal metastasis group [(60.7±10.5) ng/ml, t=14.128, P=0.003]. The positive association was observed between the DKK1 level in the peripheral blood and osseous metastasis in NSCLC patients (r=0.855, P<0.001). Conclusion The serum expression level of DKK1 protein in NSCLC patients is closely related to the osseous metastasis, which may be a predicting biomarker for the osseous metastasis.

Objective To describe the current situation of pre-hospital delay and health belief in patients with colorectal cancer and explore the relationship between them. Methods With convenient sampling methods,totally 385 patients with colorectal cancer were recruited from January to June 2016. Patients with colorectal cancer were investigated using a general data survey questionnaire, visit situation questionnaire and the Champion Health Belief Model Scale. Results The median pre-hospital delay time was 3.00 months.The rate of pre-hospital delay was 43.1%(166/385). The score of the overall health belief was (119.52 ± 12.62) points. The two dimensions of"perceived susceptibility and perceived severity" scored lower, and the two dimensions of "health motivation and perceived therapeutic benefits" scored higher. The health belief was negatively correlated with the pre- hospital delay among colorectal cancer patients (r=- 0.737, P<0.01). Conclusions Pre-hospital delay occurred among patients with colorectal cancer is severe. Patients with a higher level of health belief have shorter pre-hospital delay.It′s important to improve the level of health belief of"perceived susceptibility and perceived severity"and reduce the time of pre-hospital delay to improve outcomes in patients with colorectal cancer.

Healthy granulation tissue played an important role in the wound healing process. However, some factors which interfered the process would result in unhealthy granulation tissue. Unhealthy granulation tissue may affect wound repairing. This article would focus on the concept, mechanisms, interventions of unhealthy granulation tissue.

Objective To study the psychosocial behavior reaction,psychosocial needs,anxiety and depression among colostomy patients prior to discharge and to explore the relationship between them.Methods Totally 67 colostomy patients from 2 hospitals in Guangzhou were recruited and investigated by demographic questionnaire,Ostomy Psychosocial Behavior Reaction Questionnaire,Ostomy Psychosocial Needs Questionnaire,Hospital Anxiety and Depression Scale 1-2 days prior to discharge.Results The psychosocial behavior reaction among coIostomy patients was in the moderate level with the mean score 2.15±0.27.The psychosocial needs were in medium to high level with the mean score 2.09±0.41.About 37.3％ of colostomy patients showed anxiety,while 20.9％ patients showed depression.Significant positive correlation was shown between psychosocial behavior reaction and psychosocial needs(r=0.565,P＜0.01),while significant positive correlation was also shown between psychosocial behavior reaction and anxiety-depression(r=-0.472,-0.319,P＜0.01).Psychosocial needs and anxiety could predict psychosocial behavior reaction positively(β=0.486,-0.375,P＜0.01).Conclusion The positive acknowledgement and reconstruction are the main psychosocial behavior reactions prior to discharge in colostomy patients.Patients with more psychosocial needs,severe anxiety show more psychosocial behavior reaction.

Objective To investigate the effect of renal dysfunction on the prognosis of hospitalized patients with decompensated heart failure (DHF).Methods 191 patients with DHF hospitalized between June 2011 and June 2013 in Baoshan Branch of Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine were enrolled. These patients were divided into three groups according to the glomerular filtration rate (eGFR): normal renal function group (eGFR ≥ 90 mL·min-1·1.73 m-2, 63 cases), mild renal function descend group (eGFR 60 - 89 mL·min-1·1.73 m-2, 80 cases) and moderate or severe renal function descend group (eGFR < 60 mL·min-1·1.73 m-2, 48 cases). The general clinical data were recorded; the serum tumor necrosis factor-α (TNF-α) and interleukins (IL-1, IL-6, IL-8, IL-10, IL-13) were determined by enzyme-linked immunosorbent assay (ELISA). After discharge, the patients were followed-up for 1 year, and their outcomes were compared among the three groups.Results In 191 hospitalized patients with DHF, there were 67.0% with renal function impairment. Compared with normal renal function group and mild renal function descend group, the patients in moderate or severe renal function descend group were older (years: 83.4±5.1 vs. 66.2±5.4, 76.8±6.3), their cardiac functions were poorer, and their incidences of complications were higher than those in the normal renal function group [hypertension: 66.7% (32/48) vs. 42.9% (27/63), diabetes: 65.6% (31/48) vs. 41.3% (26/63), anemia: 37.5% (18/48) vs. 15.9% (10/63), acute myocardial infarction (AMI): 25.0% (12/48) vs. 9.5% (6/63), old myocardial infarction: 31.3% (15/48) vs. 11.1% (7/63), pulmonary infection: 29.2% (14/48) vs. 11.1% (7/63), allP < 0.05]. The complication incidences of hypertension [66.7% (32/48) vs. 51.3% (41/80)], diabetes [65.6% (31/48) vs. 48.8% (39/80)], anemia [37.5% (18/48) vs. 25.0% (20/80)] and pulmonary infection [29.2% (14/48) vs. 16.3% (13/80)] had no statistically significant differences between the moderate or severe renal function descend group and mild renal function descend group (allP > 0.05). The complication incidence of AMI [25.0% (12/48) vs. 10.0% (8/80)] and old myocardial infarction [31.3% (15/48) vs. 11.3% (9/80)] in moderate or severe renal function descend group was obviously higher than that in mild renal function descend group (bothP < 0.05). There were no statistically significant differences in the complication incidences of chronic obstructive pulmonary disease [COPD, 12.7% (8/63), 17.5% (14/80), 20.8% (10/48)], atrial fibrillation [30.2% (19/63), 27.5% (22/80), 29.2% (14/48)], ventricular premature beat [9.5% (6/63), 11.3% (9/80), 10.4% (5/48)] and cerebrovascular disease [20.6% (13/63), 22.5% (18/80), 22.9% (11/48)] among the three groups (allP > 0.05). Compared with normal renal function group, the levels of inflammatory cytokines in serum TNF-α, IL-1, IL-6, IL-8, IL-10, IL-13, and the mortality, the re-admission rates due to heart failure, rates of malignant arrhythmia in the two renal function descend groups were increased significantly, the increment being more remarkable in moderate or severe renal function descend group [TNF-α (ng/L): 235.8±20.9 vs. 121.6±10.7, IL-1 (ng/L): 345.9±40.8 vs. 203.5±34.7, IL-6 (ng/L): 502.8±64.2 vs. 321.9±53.8, IL-8 (ng/L): 723.9±210.3 vs. 431.5±110.5, IL-10 (ng/L): 155.4±23.5 vs. 103.1±13.2, IL-13 (ng/L): 184.5±27.3 vs. 136.8±20.2, the rate of mortality in the first time of hospitalization: 14.6% (7/48) vs. 5.0% (4/80), mortality within one year after discharge: 25.0% (12/48) vs. 18.0% (9/80), readmission rate due to heart failure: 47.9% (23/48) vs. 30.0% (24/80), rate of relapse of coronary events: 72.9% (35/48) vs. 37.5% (30/80), malignant arrhythmia rate: 39.6% (19/48) vs. 20.0% (16/80), allP < 0.05]. There were no significant differences in the rates of stroke among moderate or severe, mild and normal renal function descend groups [4.2% (2/48), 3.8% (3/80), 3.2% (2/63),P > 0.05].Conclusions The incidence of renal dysfunction in patients with DHF is relatively high, and their mortality, re-admission rate and their levels of inflammatory cytokines are high obviously. Thus, the intervention of renal dysfunction may have important significance in the improvement of their prognoses.

Objective To study the therapeutic effect and safety of pleurodesis with medical thoracoscopy by powdery talc on treatment of malignant pleural effusion.Methods Retrospective analysis were done in 74 cases of malignant pleural effusion accepted simple powdery talc pleurodesis under medical thoracoscopy.Results The doses of powdery talc were from 1g to 5g,average 2.18g in the course of the treatment.After operation,45 (60.8％) cases which were complete remission(CR) were full pleural adhesion and complete lung recruitment,14cases (18.9％),which were partial remission(PR),were less pleural adhesion and most lung recruitment,and 10cases(13.6％) were stable diseases(SD),while 5cases(6.7％),which were progressive diseases(PD),were without pleural reaction.The total effective rate,including CR,PR and SD,was 93.3 ％ (69/74).The complications of simple powdery talcage under medical thoracoscopy were included in:95.9％ (71/74) with chest pain,64.8％ (48/74) with fever,28.4％ (21/74) with shortness of breath,12.2 ％ (9/74) with mediastinal and subcutaneous emphysema,5.4％ (4/74) with nausea and vomiting,4.1％ (3/74) with abdominal distension,while the complications of acute pulmonary edema,massive hemorrhage,pulmonary embolism and wound infection were not observed.Conclusion Treatment of malignant pleural effusion by simple powdery talcage under medical thoracoscopy has definite clinic therapeutic effect,which is safe,cost-effective,less trauma and worthy of clinical application.

Objective To observe the effect of rhTRAIL on survivin gene expression of human lung adeno-carcinoma A549 xenografted tumor in nude mice,and investigate the possible inhibitory mechanism of rhTRAIL on the implanted-tumor growth.Methods The solid tumor model was formed in nude mice with human lung adeno-carcinoma cell line.A549.24 mice were randomly divided into the four groups,rhTRAIL single treated group (1 μg/mL),rhTRAIL combined with cisplatin (DDP) treated group,cisplatin treated (1.5mg/kg) and 0.9％ sodium chloride injection(NS) control group.The rhTRAIL and DDP were injected once every other day by intraperitoneal injection to mice in the treated groups,lasting eight times,the same volume of saline solution was injected to the control group.After these,mice were killed and dissected completely.The expression level of survivin mRNA and protein in the tumor tissues was detected by real-time polymerase chain reaction (RT-PCR) and immunohistochemistry,respectively.And the expression of survivin gene in serum of each group was tested by ELISA.Results The expression levels of survivin mRNA in implanted-tumor tissues in rhTRAIL,rhTRAIL combined with DDP,DDP and NS group were (48.7 ± 2.5) ％,(53.1 ± 4.6) ％,(99.1 ± 5.3) ％ and (95.6 ± 3.7) ％,respectively.While the protein expressions of survivin gene in those groups were (0.319 ± 0.025),(0.483 ± 0.058),(0.635 ± 0.041) and (0.619 ± 0.017),respectively.Moreover,the serum levels of survivin were (71.9 ± 7.05),(80.26 ± 10.80),(112.75 ± 15.41) and (105.03 ± 20.37),respectively.The data showed that the expression levels of rhTRAIL and rhTRAIL combined with DDP group were lower than that of DDP-treated group or the NS control group (P ＜ 0.0 5).Compared with the rhTRAIL combined with DDP group,the survivin gene expression level of rhTRAIL-single treated group decreased a little lower,but the difference was not significant (P ＞ 0.05).Conversely,the survivin gene level was increased to some degree compared with the NS control group,and uniformly there was no significant difference (P ＞ 0.05).Conclusion rhTRAIL can downregulate the expression level of survivin gene of human lung adeno-carcinoma A549 xenografted tumor in nude mice.It may be one of the possible inhibitory mechanisms of rhTRAIL on the implanted-tumor growth that rhTRAIL can downregulate survivin gene expression and promote tumor cell apoptosis.

Objective To explore the quality of life and its influencing factors among permanent colostomy patients. Methods Totally 219 permanent colostomy patients were recruited by convenient sampling method from January 2013 to December 2014 and investigated by Stoma Quality of life-Chinese Version, Stoma self-efficacy Scale, Stoma Self-care Scale-general version , and demographic questionnaire. Data were analyzed by SPSS 17.0. Results The score of Stoma-QoL-C among permanent colostomy patients was (54.86±12.17) points, which showed a dynamic V-type change as time went by. The quality of life of patients with colostomy for 1 to 3 years was especially low (50.46±13.77) points, P<0.01. The influencing factors of quality of life among permanent colostomy patients included self-efficacy, body image change, family members′acceptance of stoma except their spouses and self-care ability, while self-efficacy was the most important influencing factor. Conclusions The enterostomal nurses should pay more attention to the quality of life of the patients who have had colostomy for 1 to 3 years, enhance the patients self-efficacy and self-care ability, and help the patients to accept their body image changes and their family members′acceptance of stoma to improve their quality of life.