Objective:To observe ulcer characteristics of Crohn's disease under double balloon enteroscopy,and to evaluate the correlation between endoscopic severity and clinical manifestations.Methods:A prospective,observational study from July 2015 to December 2016 in the Third Xiangya Hospital,Central South University,we selected 45 patients with positive double-balloon enteroscopy (DBE) and confirmed Crohn's disease.Two digestive internal physician observed the ulcer characteristics of Crohn's disease under double balloon enteroscopy,and gave a simple endoscopic score for CD (SES-CD).We analyzed the correlation between SES-CD and Crohn's disease activity index (CDAI).Results:DBE indicated 24 patient ulcers (53.33％) locating at the end of the ileum,5 (11.11％)locating at ileocolon,16 (35.56％) locating at upper gatrointestinal tract and they did not affect the end of the ileum.Among them,8 cases (17.78％) affected only jejunum.Thirty-two patients with longitudinal ulcers in Crohn's disease,accounting for 71.11％.There was no correlation between SES-CD score and CDAI score (r=0.237,P=0.136).Conclusion:The ulcerative appearance in Crohn's disease were diverse under double balloon enteroscopy.Crohn's disease could only affect the upper gastrointestinal tract or jejunum.The unwounded ileum and ileocecal valve couldn't be a sign to exclude Crohn's disease.CDAI score couldn't fully assess the prognosis of Crohn's disease.

Objective:To evaluate the therapeutic effect of CXCL1 monoclonal antibody on dextra sulfate sodium (DSS)-induced acute ulcerative colitis (UC) in mice,and to elucidate its effect on the expressions ofTNF-α,IFN-γ,,IL-17 and IL-10 as well as neutrophil infiltration.Methods:Female BALB/c mice were randomly divided into a normal group (DSS-),a disease group (DSS+saline),an anti-CXCL1 antibody group (DSS+anti-CXCL1 Ab) and a treatment control group (DSS+IgG Ab).The DSS+saline,DSS+anti-CXCL1 Ab and DSS+anti-CXCL1 Ab groups were given 3.5％ DSS solution as drinking water to induce acute intestinal inflammation,while the normal control was given distilled water freely.The DSS+anti-CXCL1 Ab mice were intraperitoneal injected with anti-CXCL1 Ab (4 mg/kg) on the 3rd and 6th day.Same amount of rat IgG Ab was given in the DSS+IgG Ab group.The normal group and the disease group were injected with 0.9％ sodium chloride solution.The value of disease activity index (DAI) and the injury of colorectal tissue were measured.The levels of TNF-α,IFN-γ,IL-10 and IL-17 in colonic tissues of mice were detected by RT-PCR.Myeloperoxidase (MPO),a specific marker of neutrophils was measured by immunohistochemistry.Results:Compared with the normal control group,DAI score and colorectal injury score in the disease group were significantly increased,but the DAI and colorectal in the mice with acute ulcerative colitis tissue damage score were significantly reduced after anti-CXCL1 Ab intervention.Compared with the normal control group,mRNA levels of TNF-α,IFN-γ and IL-17 in the colorectal tissues were significantly elevated (P＜0.05) in the disease group while the IL-10 was decreased;these effects were attenuated by anti-CXCL1 Ab intervention (P＜0.05).Immunohistochemistry showed that the infiltration of neutrophils (MPO+) in the colon tissue was significantly increased in the disease group,while the anti-CXCL1 Ab treatment could significantly reduce the neutrophil infiltration in colon tissue (P＜0.05).Conclusion:Anti-CXCL1 Ab relieves the progression of DSS-induced acute ulcerative colitis by suppressing proinflammatory expression and neutrophil infiltration.

In the era of digital information,internet plus mode provides new opportunities for the development of traditional medical education.This paper introduces the application patterns of internet plus mode in the medical education,including the following aspects,such as the construction of medical quality resources sharing class,the implementing of medical massive open online courses and other kinds of open online courses,making comprehensive construction of textbooks,using social interactive software and some new wearable devices such as Google glass,distance education and so on.And from the construction of autonomy,sharing,dynamic teaching atmosphere and building a new relationship between teachers and students,it explores the application advantage of Internet plus in medical education,emphasizes thatInternet plus mode and traditional medical education should be organically integrated and financed.At the same time,we should improve the evaluation of information quality,study the integrity test,and the application of big data processing,so as to provide some ideas for the sustainable development.

OBJECTIVE: To analyze the association between serum levels of S100A8/S100A9 and clinicopathological features of colorectal cancer patients.
 METHODS: A total of 82 patients with CRC and 14 healthy controls were enrolled for this study. The levels of S100A8 and S100A9 in serum were detected by ELISA assay. The association between S100A8/S100A9 and clinicopathological features was analyzed by student-t test and one-way ANOVA. Receiver Operating Characteristic curve was used to analyze diagnostic efficiency of serum S100A8 and S100A9 for colon rectal cancer. Logistic regression model was also established to analyze the possible risk factors for elevation of S100A8/S100A9.
 RESULTS: The levels of S100A8 and S100A9 were (1 403.3±593.7) and (2 890.3±994.9) pg/mL in patients with colon cancer, and (712.8±265.3) and (1 492.7±564.6) pg/mL in controls, respectively, with significant difference between the two groups (P<0.01). The similar results were found in rectal cancer patients, with a level of S100A8 and S100A9 at (1 417.7±666.5) and (3 026.7±887.6) pg/mL, respectively. Diagnostic sensitivity and specificity of S100A8 and S100A9 are better than traditional biomarkers. The levels of S100A9 in serum of CRC patients were correlated with clinical stages and distant metastasis. Serum levels of S100A9 in patients of stage III [(3 111.9±178.5) pg/mL] and stage IV [(3 831.4±278.5) pg/mL] were significantly (P<0.01) higher than that in stage I [(2 276.1±167.4) pg/mL], whereas there was significant change in S100A8 levels. Logistic regression showed the possible risk factors for the elevation of S100A9, including depth of invasion, lymphatic metastasis and degree of differentiation (P<0.05).
 CONCLUSION Serum level of S100A8 and S100A9 in CRC patients were significantly increased and serum level of S100A9 was positively correlated with the malignant features of CRC.
Calgranulin A ; Calgranulin B ; Colorectal Neoplasms ; Enzyme-Linked Immunosorbent Assay ; Humans ; Lymphatic Metastasis ; Risk Factors

Crohn's disease (CD) is a nonspecific chronic intestinal inflammatory disease with unknown etiology. The course of CD is persistent and recurrent. In the progress, CD can come with many complications such as obstruction, fistula formation, perforation, and hemorrhage. The early diagnosis, treatment, and the time of the surgery for CD pose a big controversy and challenge. There was a female patient diagnosed as Crohn's disease with severe complication in department of Gastroenterology of the Third Xiangya Hospital, Central South University.  We reported the diagnosis and treatment on this patient. The choice for the medicine and surgury was discussed.
Crohn Disease ; complications ; diagnosis ; therapy ; Female ; Humans

OBJECTIVE: To evaluate the curative effect and safety of endoscopic full-thickness resection (EFR) in the treatment of gastric tumor originated from the muscularis propria.
 METHODS: Clinical data were collected from 34 patients, who underwent EFR of gastric tumor originated from muscularis propria, to observe the resection rate and complications from November 2012 to August 2014.
 RESULTS: Of the 34 patients, 15 were male, 19 were female, with the age of 38.3-70.6 (52.3±4.3) years old. The lesions of 25 patients located in the fundus of stomach and the rest was in the gastric body. EFR was successfully performed in the 34 patients with no need for surgery. The complete resection rate was 100%. Lesion diameter ranged from 1.0 to 5.0 (2.8±1.2) centimeters. The operation time was 50-100 (76.5±18.2) min. Patients with pneumoperitoneum were relieved after abdominal puncture exhaust, without post-operation bleeding and perforation. The hospitalization duration was 3-5 (3.6±0.8) days. Except 1 case, the remaining 33 cases were spindle cell tumors, consistent with the results of immunohistochemistry. The risk for two lesions with 4.5 cm and 5.0 cm was moderate. The risk of invasion was low or very low in the remaining 31 cases. Among them, 2 stromal tumors near the cardia showed a differentiation tendency toward smooth muscle. No lesion residual or recurrence happened during the follow-up period (range 5-23 months) in 34 cases. 
 CONCLUSION EFR is a safe and effective method for gastric tumor originated from muscularis propria.
Adult ; Aged ; Cardia ; Female ; Gastric Fundus ; Gastric Mucosa ; Gastroscopy ; Humans ; Immunohistochemistry ; Length of Stay ; Male ; Middle Aged ; Operative Time ; Stomach Neoplasms

OBJECTIVE: To evaluate the efficacy and safety of peroral endoscopic myotomy (POEM) for achalasia cardia (AC).
 METHODS: A total of 62 patients with AC were enrolled and treated with POEM in the Third Xiangya Hospital, Central South University from April 2012 to October 2014. The symptoms and complications were retrospectively analyzed.
 RESULTS: The ages of patients, including 32 males and 30 females, were 14-68 (43.2±5.6) years old. Eckardt scores were 4-6 or ≥7 for 25 patients or 37 patients (including 20 patients were at a score of 12). Thirteen patients suffered balloon expansion for 2-3 times. Sixty-one patients had completed POEM treatment, 1 patient were given Heller surgery instead of POEM because of extensive submucosal adhesion during POEM. The operative time for POEM was (60.8±15.1) min. Fourteen patients had mild subcutaneous emphysema. Among them, 5 suffered pneumoperitoneum and felt better after abdominal puncture exhaust; 2 patients suffered bronchospasm hypoxemia and were relieved after treatment by positive pressure oxygen for 1 h. The hospital stay was (4.3±1.2) d. The postoperative follow-up period was (11.4±5.4) months. Swallowing obstruction, vomiting and chest pain in patients was relieved at different degrees. The treatment effective rate was 100%. 
 CONCLUSION POEM is a safe, effective and minimally invasive approach for AC.
Adolescent ; Adult ; Aged ; Cardia ; physiopathology ; Endoscopy ; adverse effects ; methods ; Esophageal Achalasia ; surgery ; Esophageal Sphincter, Lower ; physiopathology ; Female ; Humans ; Length of Stay ; Male ; Middle Aged ; Operative Time ; Postoperative Period ; Retrospective Studies ; Treatment Outcome ; Young Adult

Three patients of pseudomyxoma peritonei who were diagnozed by transumbilical endoscopic surgery (TUES) were reviewed retrospectively from September 2014 to November 2014. Three cases of ascites patients underwent TUES were diagnozed as pseudomyxoma peritonei. All operations were successful. No open surgery or laparoscopic surgery was required. The mean operative time was (45±16) min; the mean intraoperative blood loss was 510 mL; the mean hospital stay time was 3 days. During the follow up of 911 months, no obvious scar was observed. Cosmetic results appear to be excellent. All patients were treated with intraperitoneal hyperthermia and chemotherapy. The survival rate was 100%. As a novel scarless endoscopic invasive abdominal surgery, TUES has high clinical value with the advantages such as small trauma, no scars, small risk and low cost in the diagnosis of unexplained ascites.
Antineoplastic Agents ; therapeutic use ; Ascites ; etiology ; Blood Loss, Surgical ; Cicatrix ; prevention & control ; Costs and Cost Analysis ; Humans ; Hyperthermia, Induced ; Laparoscopy ; adverse effects ; economics ; methods ; Length of Stay ; Operative Time ; Peritoneal Neoplasms ; Pseudomyxoma Peritonei ; diagnosis ; mortality ; therapy ; Retrospective Studies ; Treatment Outcome

This paper introduces the structure, contents, function of the digital teaching re-courses database in Clinical Skills course of Central South University, analyses the essence and char-acter of the flipped classroom (FC), and emphasizes flexible environment, learning culture, inten-tional content, professional educator in its implementation process. Meanwhile, it introduces the appli-cation of flipped classroom based on digital resources database in the teaching of Clinical Skills course, mentions the importance of the four aspects:preparing teaching materials, learning before class, guidance and cooperation in class, evaluation and knowledge expansion after class. Lastly, it analyses the advantages and foreground of it.

OBJECTIVE: To evaluate the effect of the bone marrow mesenchymal stem cells (BMSCs) transplant through peripheral vein, portal vein and hepatic artery into liver under the condition of constant magnetic field and to analyze the therapeutic effect on liver function recovery. METHODS: BMSCs were isolated, purified and induced to differentiate into liver-like cells, which were double labeled by Feridex-GFP. The double-labeled BMSCs were transplanted into liver through different ways including peripheral vein, portal vein and hepatic artery with or without constant magnetic field in vitro. The rats were sacrificed at the 1st, 2nd, 3rd and 4th week after the transplant. ALB, ALT, AST were tested. The liver tissue biopsy was collected. GFP-positive cells in liver were observed by fluorescence microscopy. RESULTS: Double-labeled BMSCs could be transplanted into liver through all ways. GFP expression was found in liver in all groups at the 4th week and the liver functions were improved. Based on the long term efficacy, the liver functions recovered more rapidly in the portal vein + constant magnetic field group and the hepatic artery + constant magnetic field group. CONCLUSION BMSCs transplantation can reduce acute liver damage. The first choice for BMSCs transplantation was via portal vein or hepatic artery under the condition of constant magnetic field. The second choice was via peripheral vein alone or under the condition of constant magnetic field.
Animals ; Dextrans ; Green Fluorescent Proteins ; Liver Diseases ; therapy ; Magnetic Fields ; Magnetite Nanoparticles ; Mesenchymal Stem Cell Transplantation ; Rats