Objective: Several COVID-19 patients have overlapping comorbidities. The independent role of each component contributing to the risk of COVID-19 is unknown, and how some non-cardiometabolic comorbidities affect the risk of COVID-19 remains unclear. Methods: A retrospective follow-up design was adopted. A total of 1,160 laboratory-confirmed patients were enrolled from nine provinces in China. Data on comorbidities were obtained from the patients' medical records. Multivariable logistic regression models were used to estimate the odds ratio ( Results: Overall, 158 (13.6%) patients were diagnosed with severe illness and 32 (2.7%) had unfavorable outcomes. Hypertension (2.87, 1.30-6.32), type 2 diabetes (T2DM) (3.57, 2.32-5.49), cardiovascular disease (CVD) (3.78, 1.81-7.89), fatty liver disease (7.53, 1.96-28.96), hyperlipidemia (2.15, 1.26-3.67), other lung diseases (6.00, 3.01-11.96), and electrolyte imbalance (10.40, 3.00-26.10) were independently linked to increased odds of being severely ill. T2DM (6.07, 2.89-12.75), CVD (8.47, 6.03-11.89), and electrolyte imbalance (19.44, 11.47-32.96) were also strong predictors of unfavorable outcomes. Women with comorbidities were more likely to have severe disease on admission (5.46, 3.25-9.19), while men with comorbidities were more likely to have unfavorable treatment outcomes (6.58, 1.46-29.64) within two weeks. Conclusion Besides hypertension, diabetes, and CVD, fatty liver disease, hyperlipidemia, other lung diseases, and electrolyte imbalance were independent risk factors for COVID-19 severity and poor treatment outcome. Women with comorbidities were more likely to have severe disease, while men with comorbidities were more likely to have unfavorable treatment outcomes.
Adult ; Aged ; COVID-19/virology* ; China/epidemiology* ; Comorbidity ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Severity of Illness Index ; Treatment Outcome

Objective To investigate the association between polymorphisms in ADCY3,C10orf55,IL18RAP,CARD9,NFIL3 and susceptibility for Crohn's disease in Chinese population. Methods A total of 192 patients with Crohn's disease and 192 healthy controls were enrolled. Polymorphisms of those genes was detected by Sequenom iPLEXTM Mass Assay platform. The relationship between gene polymorphisms and Crohn's disease susceptibility was analyzed. Results A polymorphism within ADCY3, rs6545800,was susceptibility loci for Crohn's disease. Compared with the TT genotype,CC + CT carriers were less likely to develop Crohn's disease (P = 0. 004,OR = 0. 45,95％ CI: 0. 26-0. 78) . There was a weak correlation between rs4743820 within the NFIL3 gene and the susceptibility to Crohn's disease. Compared with TT carriers,CC + CT carriers had a lower probability of experience Crohn's disease (P = 0. 056, OR = 0. 64, 95％ CI:0. 40-1. 02). In addition,we also found that CC + CT of rs4743820 carriers had a lower incidence of upper gastrointestinal lesions than TT carriers (P = 0. 017,OR = 0. 26,95％ CI: 0. 08-0. 83). Conclusion The polymorphisms in ADCY3 and NFIL3 gene are associated with susceptibility to Crohn's disease in Chinese population.

Objective To investigate the association between nudix hydrolase 1 (NUDT1) polymorphism and the purine-induced leukopenia.Methods A total of 176 patients with Crohn's disease were enrolled.NUDT1 rs3735092 and rs34996498 were detected using Sequenom (R) Massarray matrix-assisted laser desorption/ionization-time of flight platform.The association between different genotypes and the purine-induced leukopenia was been analysed.Results NUDT1 rs34996498 (A ＞ G) was significantly associated with the purine-induced leukopenia (P ＜0.05),and this mutation showed marginal effect after Bonferroni correction.The mutation of NUDT1 rs3735092 (C ＞ T) was not associated with the purine-induced leukopenia (P ＞ 0.05).We found female had significant higher risk of the purine-induced leukopenia than male (P ＜0.01).Conclusion NUDT1 rs34996498 polymorphism might influence the purine-induced leukopenia and further study with larger sample size was warranted.

No abstract available.
Asia* ; Inflammatory Bowel Diseases*

No abstract available.

The incidence of Crohn disease has gradually increased in recent years. The diagnosis and treatment of Crohn disease has gained more and more attention from clinicians. This article is to propose solutions to problems in the diagnosis and treatment of Crohn disease, based on evidence from clinical trials, including the diagnosis, differential diagnosis, management of steroid-refractory disease and anal fistula, and timing of surgery.
Crohn Disease ; diagnosis ; therapy ; Humans

OBJECTIVETo investigate the risk factors for the initial bowel resection and postoperative recurrence in a cohort of patients with Crohn disease(CD).

METHODSA total of 216 consecutive patients who were regularly followed up in the Department of Gastroenterology at the First Affiliated Hospital of Sun Yat-sen University between 2003 and 2009 were included. Probabilities for initial intestinal resection were calculated with Kaplan-Meier method. The influence of concomitant covariates on the cumulative probability rates was examined using Cox proportional hazard model. The risk of postoperative recurrence, including endoscopic recurrence, clinical recurrence and surgical recurrence, was also investigated during the follow-up. Logistic analysis was performed for the risk factors of recurrence.

RESULTSThe median follow-up was 55 months. A total of 44 patients(20.4%) underwent bowel resection. The cumulative frequency of surgery was 11%, 25%, and 45% at 1, 5, and 10 years after initial onset. Multivariate analyses showed that age at diagnosis and disease behavior were independent risk factors for initial intestinal resection(P<0.05). All but 4 patients had complete follow-up after the surgery with a median duration of 20.4 months. Endoscopic recurrence rate was 52.6% within 1 year, and clinical recurrence rate was 22.5%. Median time to clinical recurrence was 22.6 months. Multivariate analyses showed that perianal disease was the only independent risk factor for clinical recurrence(P<0.05). During the follow-up 2 patients(5%) underwent further operation and both had the same indications for the reoperation as that for the initial surgery.

CONCLUSIONSPatients with CD have a high frequency of surgery and the postoperative recurrent rate is also high. Age at diagnosis and disease behavior are associated with the probability of initial surgery. The presence of perianal disease is associated with a higher risk of clinical recurrence.

Adolescent ; Adult ; Crohn Disease ; surgery ; Digestive System Surgical Procedures ; methods ; Female ; Follow-Up Studies ; Humans ; Logistic Models ; Male ; Postoperative Period ; Proportional Hazards Models ; Recurrence ; Retrospective Studies ; Risk Factors ; Young Adult

BACKGROUNDCarcinoma of unknown primary (CUP) encompasses a heterogeneous group of tumors with varying clinical features. The management of patients of CUP remains a clinical challenge. The purpose of this study was to evaluate the clinical applications of integrated (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) information in patients with CUP, including detecting the occult primary tumor and effecting on disease therapy.

METHODSOne hundred and forty-nine patients with histologically-proven metastases of CUP were included. For all patients, the conventional diagnostic work-up was unsuccessful in localizing the primary site. Whole-body PET/CT images were obtained approximately 60 minutes after intravenous injection of 350 - 425 MBq of (18)F-FDG.

RESULTSIn 24.8% of patients, FDG PET/CT detected primary tumors that were not apparent after conventional workup. In this group of patients, the overall sensitivity, specificity, and accuracy rates of FDG PET/CT in detecting unknown primary tumors were 86.0%, 87.7%, and 87.2%, respectively. FDG PET/CT imaging also led to the detection of previously unrecognized metastases in 29.5% of patients. Forty-seven (31.5%, 47 of 149) patients underwent a change in therapeutic management.

CONCLUSIONSFDG PET/CT is a valuable tool in patients with CUP, because it assisted in detecting unknown primary tumors and previously unrecognized distant metastases, and optimized the management of these patients.

Adult ; Aged ; Carcinoma ; diagnostic imaging ; pathology ; Female ; Fluorodeoxyglucose F18 ; Humans ; Male ; Middle Aged ; Positron-Emission Tomography ; methods ; Radiography ; Reproducibility of Results

BACKGROUNDThe relationship between symptom elimination and normalization of esophageal acid level of gastroesophageal reflux disease (GERD) on proton-pump inhibitor (PPI) therapy has been questioned. This study aimed to evaluate the relationship between symptom response and gastro-esophageal acidity control in Chinese patients with GERD on esomeprazole therapy, and to assess the role of 24-hour esophageal pH-metry after therapy in GERD patients.

METHODSGERD patients with typical reflux symptoms were enrolled and received esomeprazole 40 mg once daily for 4 weeks. Patients with positive baseline 24-hour esophageal pH-metry were divided into two groups depending on an additional dual-channel 24-hour pH-metry after treatment. The pH- group achieved normalization of esophageal pH level whereas the pH+ group did not.

RESULTSOf the 80 patients studied, 76 had abnormal baseline esophageal pH levels. Of these, 90% (52/58) of symptom-free patients and 67% (12/18) of symptom-persistent patients achieved esophageal pH normalization after therapy (P = 0.030). The mean post-therapy gastric nocturnal percent time of pH < 4.0 was significantly higher in pH+ group than that in pH- group (P < 0.001) after therapy. The multivariate regression analysis identified hiatus hernia (P < 0.001) and persistent reflux symptom (P = 0.004) were two independent factors predicting the low post-therapy esophageal pH level.

CONCLUSIONSSymptom elimination is not always accompanied by esophageal pH normalization, and vice verse. Esophageal pH-metry is recommended for GERD patients with hiatus hernia or with persistent reflux symptoms after PPI therapy.

Adolescent ; Adult ; Aged ; Anti-Ulcer Agents ; therapeutic use ; Endoscopy, Gastrointestinal ; Esomeprazole ; therapeutic use ; Esophageal pH Monitoring ; Esophagus ; metabolism ; pathology ; Female ; Gastroesophageal Reflux ; drug therapy ; Humans ; Hydrogen-Ion Concentration ; Male ; Middle Aged ; Prospective Studies ; Young Adult