ObjectiveTo summarize the recent progress in studies of intestinal immunity in inflammatory bowel disease (IBD). MethodsThe literatures on studying the intestinal immunity in IBD, including ulcerative colitis and Crohn disease were reviewed and analyzed. ResultsIBD comprised two main diseases that cause inflammation of the intestines: ulcerative colitis and Crohn disease. Although the diseases had some features in common, there were some important differences in clinical symptoms and pathological features. Accumulating evidence suggested that IBD results from an inappropriate inflammatory response to intestinal microbes in a genetically susceptible host. Immunity studies highlighted the importance of host-microbe interactions in the pathogenesis of these diseases. Prominent among these findings were genomic regions containing nucleotide oligomerization domain 2 (NOD2), autophagy genes, miRNAs, and components of the interleukin-23/type 17 helper T-cell (Th17) pathway. The disfunction of the intestinal microbiome, intestinal epithelium, intestinal immune cells, and the intestinal vasculature played a key role in the process of IBD. The treatment with monoclonal antibody had been introduced to treat IBD and had been certificated effective. ConclusionThe study of basic intestinal immunity and regulation network of molecules in pathogenic process of IBD provides theory basis on prevention of IBD, while related genes of IBD can offer more gene therapy targets.
Objective To explore the value of fecal calprotectin （FCP） in the activity evaluation for ulcerative colitis （UC）. Methods Sixty three patients with UC （UC group） and 30 patients with gastrointestinal symptoms but without abnormal results of colonoscopy （control group）， who were treated in The Forth Affiliated Hospital of China Medical University between Sep. 2007 to Dec. 2009 were enrolled to examine the FCP， C-creative protein （CRP）， and erythrocyte sedimentation rate （ESR）. Then comparison between UC group and control group was performed. Results Levels of FCP and CRP in active gradeⅠ，Ⅱ， and Ⅲ group were all significantly higher than those of control group and inactive UC group （P＜0.05）， with the increase of active grade of UC， the level of FCP gradually increased （P＜0.05）. The levels of CRP in active grade Ⅱ and Ⅲ group were all significantly higher than those of gradeⅠgroup （P＜0.05）， but didn’t differed between active grade Ⅱ and Ⅲ group （P＞0.05）. There were no significant difference among 5 groups on ESR （P＞0.05）. Levels of FCP （rs=0.807， P＜0.01）， CRP（rs=0.651， P＜0.01）， and ESR （rs=0.371， P＜0.05） in active grade group were significantly related to histological grade under colonoscopy. Conclusion FCP examination is simple， inexpensive， repeatable， and noninvasive， and FCP can be used as an marker of activity evaluation in UC.
OBJECTIVE: To provide a new reconstructive method to treat refractory ulcers on the sole of the forefoot. METHODS: The reversed medial plantar flap with the medial plantar pedal artery and vein as pedicle was used to treat the refractory ulcers on the sole of the forefoot in 5 cases. The size of the flap was 3.5-5.0 cm x 4.0-5.5 cm. The deformities were corrected at the same time and the flaps were protected after operation. RESULTS: All flaps survived without complications. There was no recurrence after 6-month following-up. The patients could walk. CONCLUSION: The distal ends of medial plantar pedal artery and vein have plenty anastomoses with dorsal pedal artery and deep plantar arch. The reversed medial plantar flap has reliable blood supply by these anastomoses. The reversed medial plantar flap should be a choice in treating refractory ulcers on the sole of the forefoot.
Objective To evaluate the effect of ultrasound guided percutaneous drainage on acute perforation of gastroduodenal ulcer in elderly patients. Methods The clinical features, treatments, and the curative effects of 86 elderly cases (≥65 years) of acute perforation of gastroduodenal ulcer in our hospital between January 2004 and October 2009 were retrospectively analyzed. Twenty-one cases were treated by ultrasound guided percutaneous drainage (drainage group), and 65 cases were treated by exploring operation (operation group). Results Drainage group was cured and had no complications. In 15 patients which accepted recheck one month after drainage, gastroscope showed the ulcer healed in 12 cases， and improved in 3 cases. In operation group, 63 cases were cured and 2 cases died. Compared with the drainage group, there was no significant difference in cure rate (Pgt;0.05). However, 11 patients had operative complications in operation group, which was significantly more than that in the drainage group （Plt;0.05）. In 45 patients which accepted recheck one month after operation, gastroscope showed the ulcer healed in 38 cases， and improved in 7 cases. Conclusion For elderly patients with acute perforation of gastroduodenal ulcer， if the patients do not fit for exploring operation， ultrasound guided percutaneous drainage is proved to be a simple, safe, and effective means.
ObjectiveTo investigate the effects of Aucklandia and Coptis pills on cellular apoptosis and the expression of Bcl-2 and Bax mRNA in model rats with ulcerative colitis (UC). MethodsFifty male Wistar rats at the age of seven weeks were randomly divided into five groups: control group, model group, Chinese medicine group (Aucklandia and Coptis pills), inhibitor group, and Chinese medicine plus inhibitor group. The experiment was performed with rats of UC induced by trinitro-benzene-sulfonic acid enema. AG-490 and Aucklandia and Coptis pills were administrated to them by intraperitoneal injection and gavage. Colonic mucosal tissues in rats of all the five groups were observed and evaluated by light microscope. Cellular apoptosis in colonic mucosal tissues was detected by TUNEL. The expressions of Bcl-2 and Bax mRNA were detected by reverse transcription polymerase chain reaction. ResultsThere were many ulcers in the colon of UC rats, and pathological changes in colonic mucosa such as inflammation, congestion and edema were observed in the colon of UC model rats by naked eye and microscope. Compared with UC rats without treatment, Aucklandia and Coptis pills alleviated colonic mucosal injuries and decreased apoptosis rate of colonic epithelial cells, while the expression of Bax mRNA was decreased in the colonic mucosa in UC rats treated with Aucklandia and Coptis pills, and Bcl-2 mRNA expression was increased. ConclusionAucklandia and Coptis pills can effectively inhibit mRNA expression of apoptosisrelated molecules to down-regulate colonic epithelial cells apoptosis in colonic mucosa in rats with UC.
To investigate the surgical strategy of diabetic foot (DF) and analyze the therapeutic efficacy. Methods From July 2004 to July 2007, 36 patients (22 males and 14 females) with DF were treated, with an average age of 57 years(43-82 years). The disease course of diabetes was 3 months to 27 years(12 years on average) and the disease course of DF was 1 month to 2 years (7 months on average). According to Wagner classification of DF, there were 3 cases of grade 1, 12 cases of grade 2, 10 cases of grade 3, 7 cases of grade 4 and 4 cases of grade 5. The locations of ulcer were ankle and heel in 9 cases, medial part of foot in 14 cases, in lateral part of foot in 8 cases and sinus formation in 5 cases. The ulcer sizes ranged from 4 cm × 2 cm-18 cm × 9 cm. Initial management of these patients included control of blood sugar level, proper hydration, administration of antibiotics, treatment of coexisting diseases, and repeated debridements of wounds when necessary. Ulcers were treated with debridement and spl it skin transplantation in 3 cases of grade 1, with debridement and drainage of abcesses and spl it skin transplantation in 12 of grade 2, with debridement and transplantation of flap in 17 of grade 3 and grade 4, and with transplantation of fascial flap in 5 cases of sinus; ulcers were treated firstly with artery bypass of lower extremity, and then treated with local amputation of foot to avoid high-level amputation and to save more function of foot in 4 of grade 5. Results In 36 cases, wound in 31 cases (86.1%) cured primaryly, wound did not heal in 1 patient (2.1%) and received re-amputation, there were 2 deaths because of infection with multiple organ failure postoperatively. Twenty-nine cases were followed up 8 months (range, 6 -15 months). Eight patients developed new ulcers, with 3 lesions in situ and 5 lesions in new site. Conclusion Surgicalregimen could play an important role in treatment of diabetic foot. According to different grades of DF, there were differentstrategies in deal ing with the accompanied inflammation and ulcer. An active and comprehensive surgical treatment of DF could save the foot, avoid the high-level amputation and result in more functional extremity.
Objective To explore the expression characteristics of chaperone interacting protein (CHIP) in normal, scar and chronic ulcer tissues and its relationship with wound healing. Methods Twenty biopsies including scar tissues(n=8), chronic ulcer tissues(n=4) and normal tissues(n=8)were used in this study. The immunohistochemical staining (power visionTMtwo-step histostaining reagent) was used to explore the amount and expression characteristics of such protein.Results The positive expression of CHIP was observed in fibroblasts, endothelial cells and epidermal cells in dermis and epidermis. It was not seen ininflammatory cells. The expression amount of CHIP in scar tissues, chronic ulcer tissues and normal tissues was 89%, 83% and 17% respectively. Conclusion Although the function of CHIP is not fully understood at present, the fact that this protein is expressed only at the mitogenic cells indicates that it may be involved in mitogenic regulation during wound healing.
Objective To analyze the methods of treating diabetic feet and to evaluate the optimal method. Methods The clinical data of 115 patients (137 legs) with diabetic feet were retrospectively analyzed. Results Seventy-one affected legs were treated with balloon dilation or stenting (11 with additional debridement of local ulcer), 12 legs were treated by femoral-popliteal arterial bypass (5 with additional debridement of local ulcer), and 31 legs were treated by debridement of local ulcer or amputation merely, and another 23 legs were treated by medical therapy. All diabetic feet treated by surgical treatment were improved obviously without death and severe complications, while 2 cases with medicine therapy died. Conclusion Because of the complexion of the diabetic foot, it should be treated individually, and the key point is to deal with the vascular lesions.
OBJECTIVE: Retrospective clinical analysis of primary surgical operation in the treatment of lower limb accompanied by chronic leg ulcer were adopted in this study. METHODS: From September 1990 to June 1998, there were 31 males and 20 females, aged 68 years in average, the area of ulcer varied from 5 cm x 3 cm to 22 cm x 11 cm. The ligation and strip of saphenous vein, debridement and free skin flap grafting were finished in primary operation. RESULTS: The skin flaps were survived completely in 50 cases, only 1 case was necrosis partially and healed after changing dressing. Forty-two cases were followed up for 16 months to 9 years (66 months in average), the varicosis and ulcer were healed in 39 cases and only 3 relapsed in ulceration. CONCLUSION: Primary surgical operation in the treatment of varicosis of lower limb accompanied by chronic ulcer is practicable in clinic. The curative efficacy is satisfactory and the operative manipulation is simple.
The skin and soft tissue defects or ulceration of the wight-bearing part of the sole was difficult to repair with medial plantar island flap, but would be treated with retrograde island flap carrying plantar metatarsal arteries as pedicle. Ten flaps were applied in 9 patients. They had either indolent ulcer or skin defect secondary to excision of painful corn or callosities of the front part of the sole. The flaps were 3 cm to 5 cm long and 3 cm to 4 cm wide, and they all survived following retrograde transfer. The patients were followed up for 1 to 10 years. It was found that the patients could bear weight on the operated foot and could walk without pain or lameness. The flaps were resistant to abrasion from long-time walking. It was concluded that this kind of flap was best suitable to repair the ulcers and defects over the front part of the sole despite there were some minor shortcomings such as the size of the flaps available was small and the donor site required split skin graft for coverage.