2017年 · 第56卷第08期

Biological agents are currently one of the most effective drugs for the treatment of Crohn's disease (CD), but their widespread clinical application has not significantly reduced the surgical rate of CD. 30% ~40% of patients need surgical treatment, and with the course of the disease, the proportion of needing surgical treatment gradually increases, and surgery is still an important means of treating CD. Due to the immunosuppressive effect of biologics, their impact on the risk of postoperative infection should be considered when used before and after surgery. Only by skillfully integrating biologics and surgical treatment can the two complement each other. In this issue, Professor Zhu Weiming, Department of General Surgery, Nanjing General Hospital, Nanjing Military Region, was invited to write an article "Problems to be considered in the use of biological agents before and after Crohn's disease surgery", and made an in-depth and meticulous analysis of this topic. It was concluded that: it is not recommended to use biological agents within one month before and after surgery; For CD patients with poor biological treatment effect, the possibility of surgery should be considered, and the treatment goal should be changed to perioperative management in time to create conditions for surgical treatment; Surgical removal of severe lesions can improve the body's sensitivity to biological therapy.

Biological agents are one of the most effective methods to treat Crohn's disease (CD) at present, and their clinical applications are becoming more and more common. At present, the only biological agent approved for the treatment of CD in China is human and mouse chimeric TNF α monoclonal antibody (IFX). Its main indication is to induce the remission of active CD, including moderate to severe active CD, glucocorticoid (abbreviated as hormone) dependence or hormone ineffectiveness, intestinal CD with rapid progression or poor prognosis, and perianal fistula CD. If the cases are selected properly, the effective rate of treatment can be as high as more than 80%^[1]。 At the same time, more and more patients use it to maintain CD remission, but due to its high price, it is not common to use IFX to maintain remission in China.

Colorectal cancer is a common malignant tumor of digestive tract worldwide, and its incidence ranks among the top two in Europe and North America, and among the top five in China. However, the incidence rate has risen rapidly in recent years, and has even soared to the second place in coastal cities such as Shanghai and Tianjin^[1]。 Since about 90% of colorectal cancers develop from adenomas, it takes about 10 years or more to develop from adenomas to invasive carcinomas^[2]Therefore, among many malignant tumors, colorectal cancer is the easiest to prevent through early detection and resection by endoscopy. In some developed countries, the incidence and mortality of colorectal cancer have begun to decline through standardized colonoscopy and adenoma resection. However, due to the influence of the cleanliness degree of intestinal preparation and the difference of endoscopist skill level, as well as the existence of objective reasons such as colonic folds, the structural particularity of descending colon-sigmoid junction and the defect of colonoscopic visual field, there is a high missed diagnosis rate of early colorectal lesions. Therefore, attaching importance to the quality control before and during colonoscopy is of great significance to realize the early diagnosis and treatment of colorectal cancer.

The patient is a male, Han nationality, 4 and a half years old, from Zhoukou, Henan. He was admitted to the pediatric department for "discovering speech impairment for more than 3 years". Three years ago, my family found that the child's speech development was backward, and his parents worked in other places all the year round, taking care of them by their grandparents, and they were not paid attention to and treated. At the age of 4 and a half, I can only call "Dad and Mother", and I often have pus and discharge, difficulty breathing, smell phlegm, no fever, cough, expectoration and other symptoms, difficulty breathing, more obvious at night, snoring during sleep, and locally diagnosed as "glandular hypertrophy". Children gradually develop finger joint deformities, cannot be straightened, face gradually becomes ugly, lips are thick. Out-of-hospital chest X-ray examination revealed "mucopolysaccharidosis", and cranial MRI revealed "local adhesion". For further treatment, the outpatient clinic plans to admit "mucopolysaccharidosis" to the hospital. Past History: Nothing special. Personal history: Full-term cesarean section, the second child, the second birth, no history of intrauterine asphyxia, the mother has no history of toxic substances and radiation exposure during pregnancy. Family History: Parents are in good health and 1 sister is normal. There is no similar disease in the family. Physical examination: Height 82 cm, weight 14 kg, moderate nutrition, poor development, unclear speech, retarded intelligence, poor cooperation in physical examination, short stature, ugly face, large head circumference, 56 cm, prominent forehead, many hairs and low hairline, small eye cleft, wide eye distance, low and flat nose bridge, large nostrils, purulent secretion, good light reflection in both eyes, no turbidity in the lens, no yellowing in the sclera, no congestion and edema in the conjunctiva, thick lips and no cyanosis. Short neck, no neck web, small thorax, no abnormalities in cardiopulmonary auscultation, abdominal swelling, umbilical protrusion, about 8 cm below the spleen costs, tough to touch, about 10 cm below the liver costs, and about 5 cm below the xiphoid process, tough to touch, no tenderness. The limbs are short, the hands are short and thick, cannot be straightened, the hands are flexed and deformed, the pinching objects are inflexible, and the external genitals of the anus are not abnormal. Blood, urine and stool routine are normal. Karyotype analysis revealed 46, XY.

May 2017Inflamm Bowel DisA clinical study on ulcerative colitis (UC) combined with cytomegalovirus (CMV) colitis-"Viremia, endoscopic characteristics and histopathological correlation in ulcerative colitis combined with cytomegalovirus infection" was published by Professor Qian Jiaming and Associate Professor Yang Hong of Department of Gastroenterology, Peking Union Medical College Hospital "[Yang H, Zhou W, Lv H, et al. The association between CMV viremia or endoscopic features and histopathological characteristics of CMV colitis in patients with underlying ulcerative colitis. Inflamm Bowel Dis, 2017, 23 (5): 814-821.] 。 This study explored the predictive value of CMV viremia and endoscopic characteristics in the diagnosis of UC complicated with CMV colitis. This result has guiding significance for the clinical diagnosis of UC and CMV colitis and the selection of endoscopic pathological biopsy sites.

"Expert Consensus on Differential Diagnosis of Fever with Lung Shadow" proposes that the first differentiation between infection and non-infection should be made in cases of fever with lung shadow^[1]。 In fact, most non-infectious lung shadows are not accompanied by fever, but it is not uncommon for non-infectious lung shadows with fever to resemble pneumonia in clinical manifestations and imaging changes. At first, most of them were misdiagnosed as pneumonia, and non-infectious diseases were only considered after a long period of treatment was ineffective. This paper analyzes a case of cryptogenic organizing pneumonia misdiagnosed as pneumonia, hoping to improve clinicians' understanding and diagnosis and treatment level.

cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) is a rare ulcerative disease of the small intestine. The main manifestations were repeated intestinal obstruction, gastrointestinal bleeding, anemia and hypoalbuminemia. Multiple superficial ulcers and multifocal localized stenosis of the small intestine can be seen under imaging or endoscopy. The pathology suggested that the ulcer only involved the mucosa and submucosa. Glucocorticoid (abbreviated as hormone) treatment is mostly effective, but dependence is prone to occurrence. For patients who are dependent or ineffective on hormones, immunosuppressants can be considered. Enteral nutrition has certain curative effect, and early diagnosis may avoid surgery. So far, less than 100 cases of CMUSE have been reported worldwide. In addition, the clinical manifestations of CMUSE are similar to other small intestine diseases such as Crohn's disease (CD), so clinical confusion is easy. The research progress and clinical characteristics of CMUSE are summarized in order to improve the clinical diagnosis and treatment of this rare disease.

Focal segmental glomerulosclerosis (FSGS) is a morphology-based pathological diagnosis whose key pathophysiological basis is podocyte injury. FSGS is common in glomerulonephritis, and its incidence varies significantly by age, race and region. FSGS accounts for about 3.3% ~16% of the total biopsy cases in China. FSGS account for about 20% of nephrotic syndrome in white children and 40% of nephrotic syndrome in adults^[1]。 FSGS has a poor prognosis and is one of the most common causes of hormone-resistant nephrotic syndrome (SRNS) and end-stage renal disease (ESRD) in adults and children. 50% of patients with FSGS nephrotic syndrome with persistent proteinuria without remission will progress to ESRD within 5 to 10 years^[2]。 The recurrence rate of FSGS patients is about 30% ~40% after first renal transplantation and 100% after second renal transplantation^[3]。 FSGS can be classified as primary, secondary, and hereditary according to the etiology. Successful localization of genetic researchNPHS1、NPHS2、CD2APThe detection rate of multiple mutations encoding podocyte-associated molecules can lead to FSGS, especially in FSGS patients with SRNS can be as high as 29.5%^[4]But there are significant differences in mutation rates among different races.

The components of Zhibitai capsules are based on classic Chinese traditional medicinal formula, including natural statin, statin homologue, triterpenes and flavonoids. Zhibitai capsules is effective on dyslipidemia by inhibiting cholesterol synthesis and absorption. Several randomized clinical trials in Chinese patients have shown that Zhibitai capsules could reduce low density lipoprotein cholesterol (LDL-C) by 18%-34% and triglycerin (TG) by 30%.Zhibitai capsules had less side effects compared to statins, which interpreted a synergistic effect with Zhibitai capsules. Although no evidence has been proved to use Zhibitai capsules as prophylaxis of cardiovascular diseases, Zhibitai capsules is still an alternative choice of both primary and secondary prophylaxis of cardiovascular diseases.

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