Search

The study aimed to predict surgical risks for patients with symptomatic stricturing Crohn's disease (CD) using computed tomography enterography (CTE) and to assess the association between CTE findings and pathological changes.Crohn's disease patients with symptomatic stricture(s) were included. Exclusion criteria were concomitant penetrating disease, intra-abdominal abscess, previous bowel resection, or asymptomatic. Patients from January 2016 to December 2019 were identified as the primary cohort and those from January 2020 to June 2020 were identified as the validation cohort. Two independent experienced radiologists evaluated CTE variables including mucosal enhancement, mural stratification, wall enhancement, comb sign, lymphadenopathy, thick non-enhancing wall, bowel wall thickness, luminal diameter, and upstream lumen. Receiver operating characteristic, logistic regression, and nomogram were performed to identify the independent predictors of surgical-free survival. Histopathological scores of surgical specimens were also evaluated.198 patients (primary cohort, 123 with surgery and 75 under non-surgical intervention, and 41 patients (validation cohort) were analyzed. Bowel wall thickness 5.9 mm, luminal stenosis 3.35 mm, and upstream lumen 27.5 mm were predictors of surgical-free survival for symptomatic stricturing CD patients. Logistic analysis showed the three CTE variables were the independent predictors of surgical-free survival (p 0.001). A nomogram was developed with the concordance indexes of 0.905 and 0.892 in the primary and validation cohorts. Histopathological analysis showed bowel wall muscular hyperplasia/hypertrophy significantly correlated with luminal stenosis (r = - 0.655, p = 0.008) and combined CTE variable (r = - 0.683, p = 0.005).CTE is highly predictive of disease course and surgical-free survival for patients with symptomatic stricturing CD, suggesting the important role of CTE in decision-making of treatment.

Background: Slits and Robos were associated with the generation of axons of corticospinal tract during the corticospinal tract (CST) remodeling after the cerebral ischemic stroke (CIS). However, little is known about the mechanism of CST remodeling. In this study, we detected the expression of Slits and Robos in middle cerebral artery occlusion (MCAO) rats to investigate the roles of Slits and Robos in the CIS. Methods: MCAO model was established using modified Zea Longa method. Beam walking test (BWT) was conducted to evaluate the motor function. The images of the track of cortical spinal cord beam on day 7, 14 and 21 were observed by anterograde CST tracing. Biopinylated dextan amine (BDA) was used to mark CST anterogradely. Expression of GAP-43 mRNA and GAP-43 protein in cervical spinal cord was detected by Real-Time PCR and Western blot analysis, respectively. The expression of Slit1, Slit2 and Robo1 in cervical spinal cord was detected by immunofluorescence staining.Results: The scores in the model group were significantly reduced compared to sham-operation group on day 7 (PPPP>0.05). In contrast, significant increase was noticed in the scores in model group, presenting a time-dependent manner. More CST staining fibers could be observed at the degenerative side in the model group compared with that of the sham-operation group on day 21. GAP-43 mRNA expression in the model group showed significant increase compared to that of sham-operation group on day 14 (P=0.015) and 21 days (P=0.002). The expression of GAP-43 protein in model group showed significant increase compared to that of sham-operation group on day 14 (P=0.022) and day 21 (P=0.008), respectively. The expression of Slit1 and Slit2 showed increase on day 14 and day 21, while the expression of Robo1 showed significant decrease in MCAO rats.Conclusion: Up-regulation of Slit1 and Slit2 and the downregulation of Robo1 may be related to the axons of CST midline crossing in spinal cord of MCAO rat during the spontaneous recovery of impaired motor function.

Medermycin, produced by Streptomyces species, represents a family of antibiotics with significant activity against Gram-positive pathogens. The biosynthesis of this family of natural products has been studied, and new skeletons related to medermycin have rarely been reported until recently. Herein, we report eight chimeric medermycin-type natural products with unusual polycyclic skeletons. The formation of these compounds features some key nonenzymatic steps, which inspired us to construct complex polycyclic skeletons via three efficient one-step reactions under mild conditions. This strategy was further developed to efficiently synthesize analogues for biological activity studies. The synthetic compounds, chimedermycins L and M, and sekgranaticin B, show potent antibacterial activity against Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, and methicillin-resistant Staphylococcus epidermidis. This work paves the way for understanding the nonenzymatic formation of complex natural products and using it to synthesize natural product derivatives.

Keratin-based adsorbents showed a great potential in environmental pollution remediation. However, fabrication of keratin adsorbent with an excellent performance remains a challenging issue mainly because of its poor mechanical properties. In this research, mechanical-reinforced keratin adsorbent was designed and engineered at mesoscopic scale by the induced molecular network transition method. It was found that the β-crystallite structure of silk fibroin template could induce the transformation of free unfolded molecular chains of keratin to β-sheet conformation in the keratin adsorbent and further resulted in the controllable manipulation of the mechanical properties of the adsorbent. The prepared keratin adsorbent exhibited an excellent adsorption performance for Reactive Black 5 (RB5). The qe and removal efficiency for RB5 by the adsorbent could reach as high as 550 mg/g and 95.3%, respectively. The adsorbent exhibited an excellent regeneration and recycle performance due to its mechanical reinforcement. The facile molecular network–induced reconstruction strategy is both straightforward and effective for fabricating mechanical robust adsorbent for environmentally pollutant remediation.

In order to discover structurally new and bioactive compounds from marine life, we studied the secondary metabolites of the marine-derived fungi associated with a marine sponge (XS-3) from the Xisha islands. As a result, 4-O-methylcandidusin A (1), a new p-terphenyl alcohol, along with nine known analogs (2–10), were isolated and identified from the marine sponge-derived fungus Aspergillus candidus OUCMDZ-1051. The structures of these compounds were determined by analyzing spectroscopic data, especially 1D and 2D NMR. The new compound 1 selectively inhibited the growth of the MDA-MB-468, BT474 and A431 human cancer cell lines with the IC50 values of 1.84, 6.05 and 0.98 μmol/L, respectively. Compound 1 also displayed a selective antimicrobial activity against Escherichia coli with an MIC value of 27.3 μmol/L. The results indicated 4-O-methylcandidusin A (1) as a potential lead in the new drug discovery for triple negative breast cancer, invasive ductal breast cancer and epidermoid cancer. The antimicrobial metabolites also evidenced a clue for chemical defense of sponges by their associated microorganisms.

The rate of postoperative ileus following stoma closure is high in patients with Crohn’s disease and temporary enterostomy. To evaluate the effect of chyme reinfusion on postoperative outcomes including ileus in these patients. Patients were screened from January 2012 to December 2017 and divided into chyme reinfusion group (n = 33) and non-chyme reinfusion group (n = 84). The following 30-day postoperative outcomes were evaluated. Univariate and multivariate analyses and propensity score matching were performed to identify risk factors for these postoperative outcomes. The incidence of postoperative ileus was significantly lower in the chyme reinfusion than in non-chyme reinfusion group, which had been confirmed by the results after matching (3/26 vs 11/26, p = 0.012). The rate of postoperative diarrhea was significantly lower in the chyme reinfusion group compared with non-chyme reinfusion group, whereas the difference was not significant after matching (2/26 vs 6/26, p = 0.191). Additionally, the postoperative length of stay was significantly shorter in the chyme reinfusion than in non-chyme reinfusion group before and after propensity score matching. In the multivariate analysis, chyme reinfusion was an independent protective factor for postoperative ileus (odds ratio 0.218; 95% confidence interval 0.05–0.95; p = 0.042) and for postoperative length of stay (coefficient − 0.191; 95% confidence interval − 0.350 to − 0.032, p = 0.019). Chyme reinfusion was associated with lower rate of postoperative ileus and shorter length of stay following stoma closure in Crohn’s patients with temporary ileostomy. Further randomized clinical trial between patients with or without chyme reinfusion was needed to confirm these conclusions.

Background The structures of the mesentery including adipose tissue, nerves, and lymphatics play an important role in the pathogenesis and disease progression of Crohn’s disease (CD). Conventional surgical resection for CD usually does not involve resecting the mesentery en bloc with the specimen. This contrasts with complete mesocolic excision (CME) in colorectal cancer, which involves radical resection of the mesentery. Preliminary evidence from smaller studies suggests that applying the principle of mesocolic excision to CD surgery may reduce the risk of postoperative recurrence. This randomized controlled trial is designed to test whether applying the principles of mesocolic excision to CD results in reduced postoperative recurrence. It also aims to evaluate intra- and postoperative morbidity between the two approaches. Methods This international, multicenter, randomized controlled trial will randomize patients (n = 116) scheduled to undergo primary ileocolic resection to either receive extensive mesenteric excision (EME) or conventional ileocolic resection with limited mesenteric excision (LME). Five sites will recruit patients in three countries. In the EME group, the mesentery is resected following CME, while avoiding the root region, i.e., 1 cm from the root of the ileocolic artery and vein. In the LME group, the mesentery is retained, i.e., “close shave” or Discussion If mesocolic excision in CD reduces postoperative disease recurrence and does not increase morbidity, this trial has the potential to change practice and reduce recurrence of CD after surgical resection. Trial registration Clinical Trials.gov, ID: NCT03769922. Registered on February 27, 2019.

Calotropis procera fiber (CPF) is the fruit fiber of C. procera and belongs to a typical cellulosic fiber. In this study, Calotropis procera fiber (CPF) was first purified in the pretreatment process including delignification and bleaching before the isolation of cellulose nanocrystal. Chemical composition of Calotropis procera fiber was determined according to TAPPI standard method. It was composed of 64.0 wt% cellulose, 19.5 wt% hemicelluloses, and 9.7 wt% of lignin. The morphology of the Calotropis procera fiber and fiber after each pretreatment process was also investigated. Cellulose nanocrystal was extracted by classical sulfuric acid hydrolysis of the pretreated Calotropis procera fiber. TEM and SEM were used to analyze the morphologies of the obtained CNC. The crystallinity, thermal stability and suspension stability of the CNC were also investigated. The interesting results proved that this under-utilized biomass could be exploited as a new source of cellulose raw material for the production of cellulose nanocrystal.

The aims of the present study were to examine the density of lymphatic vessels in the mesentery and to assess the predictive value of the mesenteric lymphatic vessel density for postoperative clinical recurrence. Ileocolonic resection specimens were obtained from 53 patients with Crohn’s disease and 10 non-inflammatory bowel disease control subjects. Mesentery adipose tissues adjacent to the bowel wall were used for the histological quantification of lymphatic vessels using immunohistochemistry with the D2-40 antibody. The relationships between lymphatic vessel density and disease behavior, the presence of granulomas, the presence of creeping fat, and postoperative clinical recurrence were assessed. Median lymphatic vessel density in the mesentery adjacent to inflamed or non-inflamed intestine was lower in control subjects than in Crohn’s disease patients (2.13‰; interquartile range [IQR], 1.83–2.61; 8.34‰; IQR, 6.39–10.22; 4.43‰; IQR, 3.32–5.78; P ˂ 0.001). Increased mesenteric lymphatic vessel density was significantly associated with stricturing behavior, the presence of intestinal granulomas, the presence of creeping fat, and bowel thickness. Interestingly, patients with disease recurrence had an increased mesenteric lymphatic vessel density of the proximal mesenteric margin at the time of resection compared with those who did not have disease recurrence (6.23‰; IQR, 5.43–6.75 vs. 3.28‰; IQR, 2.93–4.29; P ˂ 0.001). In addition to its correlation with disease behavior, bowel thickness, and the presence of intestinal granulomas and creeping fat, increased mesenteric lymphatic vessel density in the proximal margin is predictive of early clinical recurrence after surgery in patients with Crohn’s disease.

The comprehensive complication index (CCI) is a novel approach to evaluate complications. However, application of the CCI in inflammatory bowel disease (IBD) population is scarce and the difference between the CCI and the Clavien-Dindo classification (CDC) remains unknown. The aim of this study was to compare the CCI to the conventional CDC by applying the CCI among the IBD patients. The data of 426 IBD patients who underwent surgery between September 1, 2015 and August 31, 2017 were collected. Univariate and multivariate analyses were conducted to identify risk factors for postoperative complications. The efficacy of CCI and CDC was compared using correlation analysis and logistic regression. Cumulative sum control (CUSUM) models were applied to monitor the CCI continuously. Totally, 297 complications occurred in 144 (33.8%) patients. The rate of severe complications (CDC grade ≥ III) was 12.9% and the mean CCI was 9.8 ± 15.5. Preoperative glucocorticoids usage and previous abdominal surgery were related to higher CCI value (p = 0.002, p = 0.006, respectively) but not related to higher incidence of severe complications (CDC grade ≥ III) (p = 0.117, p = 0.177, respectively). In patients with multiple complications, the CCI demonstrated a stronger correlation with hospital stay (ρ = 0.604, p

Acute colonic pseudo-obstruction (ACPO or Ogilvie’s syndrome) is a rare but often fatal disease; timely colonic decompression may be essential for successful treatment. This study describes a technique of placing a trans-anal tube via fluoroscopy-guiding and investigates the effect of colon decompression on ACPO. Patients undergoing colonic decompression via fluoroscopy-guided trans-anal tube placement from April 2015 to May 2017 were included. The technical and clinical successes of this procedure were evaluated. Clinical features and long-term outcomes are described. Decompression was successful in 72.73% (16/22) of the patients; the procedure was considered a clinical success in 50% (11/22) of the patients. 31.82% (7/22) of the patients underwent elective surgery, and only 18.19% (4/22) of the patients need emergency surgery. Fluoroscopy-guided trans-anal decompression tube placement was an easy and efficient method for treating ACPO. Additionally, ACPO once required emergency surgery, but now may only require elective surgery in certain instances.

Signal transducer and activator of transcription 3 (STAT3) is constitutively activated in malignant tumors and plays important roles in multiple aspects of cancer aggressiveness. Thus, targeting STAT3 promises to be an attractive strategy for the treatment of advanced metastatic tumors. Bisindolylmaleimide alkaloid (BMA) has been shown to have anti-cancer activities and was thought to suppress tumor cell growth by inhibiting protein kinase C. In this study, we show that a newly synthesized BMA analog, BMA097, is effective in suppressing tumor cell and xenograft growth and in inducing spontaneous apoptosis. We also provide evidence that BMA097 binds directly to the SH2 domain of STAT3 and inhibits STAT3 phosphorylation and activation, leading to reduced expression of STAT3 downstream target genes. Structure activity relationship analysis revealed that the hydroxymethyl group in the 2,5-dihydropyrrole-2,5-dione prohibits STAT3 inhibitory activity of BMA analogs. Altogether, we conclude that the synthetic BMA analogs may be developed as anti-cancer drugs by targeting and binding to the SH2 domain of STAT3 and inhibiting the STAT3 signaling pathway.

To obtain new bioactive natural products, the effect of acidic stress on the metabolites of an aciduric fungus was investigated. This fungus, Penicillium sp. OUCMDZ-4736, which was isolated from the sediment around roots of mangrove (Acanthus ilicifolius), produced different compounds and higher yields under pH 2.5 than under neutral conditions. Using spectroscopic analyses and calculations, three new anthraquinone derivatives (1-3) were isolated and identified from the acidic fermentation broth (pH 2.5) of OUCMDZ-4736. Compound 1 showed much stronger anti-hepatitis B virus activity than that of the positive control, lamivudine, strongly inhibiting HBsAg and HBeAg secretion from HepG2.2.15 cells. These results show that extremophiles are a valuable resource of bioactive compounds, and that pH regulation is an effective strategy to induce metabolite production in aciduric fungi.

Five new pyrazin-2(1H)-one derivatives, ochramides A-D (1-4) and ochralate A (5), as well as three known analogues (6-8) were isolated from the fermentation broth of the marine coral-derived halotolerant Aspergillus ochraceus LCJ11-102 in a nutrient-limited medium containing 10% NaI. Their chemical structures were determined by analyzing NMR and X-ray diffraction data. Compounds 2, 5 and 6 showed antimicrobial activities against Enterobacter aerogenes with the MIC values of 40.0, 18.9, and 20.1 μM, respectively.

Few articles focused on endoscopic balloon dilation (EBD) in the management of Crohn’s strictures in the upper gastrointestinal (GI) tract. The purpose of this study was to evaluate the long-term efficacy and safety of EBD for Crohn’s strictures in the upper GI tract and to determine early predictors of response and surgical intervention. All eligible patients who underwent EBD for Crohn’s strictures in the upper GI tract were retrospectively reviewed. The long-term success was defined as the recovery of normal diets without surgical intervention over the follow-up period. In order to seek early predictors, patients who achieved long-term success were compared with those who didn’t. A total of 67 dilations of upper GI strictures were performed between June 2011 and March 2015 on 24 patients (mean age 25.6 ± 6.7, 20 male) with Crohn’s disease. Technical success was achieved in 62 of 67 dilations (92.5 %) with a complication rate of 3 %. After the median follow-up period of 23.0 months (range 6.2–51.2 months), nine patients underwent surgical intervention, nine patients were still depending on tube feeding; in the meantime, only six (25 %) patients achieved long-term success. Additionally, patients who remained 1 month intervention-free (55.6 vs. 5.9 %, P = 0.015) were more likely to achieve long-term success. EBD was a safe procedure, but not a potent therapy for Crohn’s upper GI strictures. Meanwhile, 1-month response could serve as an early predictor of the long-term response.

The impact of preoperative enteral nutrition (EN) on postoperative complications and recurrence in Crohn's disease (CD) has not been investigated to date. The purpose of the present study was to determine the effect of preoperative exclusive EN on postoperative complications and recurrence after bowel resection in patients with active CD.Patient data were obtained from a prospectively maintained database. 81 patients who received bowel resection for ileal or ileocolonic CD were studied. Before operation, 42 CD patients received exclusive EN for 4 weeks, and the other patients had no nutritional therapy. All patients were followed up regularly for 2 years after surgery, and ileocolonoscopy was performed every 6 months after bowel resection.Patients receiving exclusive EN had a dramatic improvement of nutritional (BMI, albumin, pre-albumin, and Hb) and inflammatory (CRP and CDAI) status compared with baseline after the EN therapy for 4 weeks (P 0.05). Furthermore, significantly lower incidence of both infectious and non-infectious complications was observed in patients receiving exclusive EN compared with those received no nutritional therapy (P 0.05). Exclusive EN therapy for 4 weeks significantly reduced endoscopic recurrence rates after resection for CD 6 months after operation. However, during the 2-year follow-up, incidence of clinical recurrence was similar in both groups (P 0.05).Preoperative exclusive EN therapy for 4 weeks reduced postoperative complications, which may be associated with improvement of nutritional and inflammatory status in patients with active CD.

Background Since 1968, China has trained about 1.5 million barefoot doctors in a few years’ time to provide basic health services to 0.8 billion rural population. China’s Ministry of Health stopped using the term of barefoot doctor in 1985, and changed policy to develop village doctors. Since then, village doctors have kept on playing an irreplaceable role in China’s rural health, even though the number of village doctors has fluctuated over the years and they face serious challenges. United Nations declared Sustainable Development Goals in 2015 to achieve universal health coverage by 2030. Under this context, development of Community Health workers (CHWs) has become an emerging policy priority in many resource-poor developing countries. China’s experiences and lessons learnt in developing and maintaining village doctors may be useful for these developing countries. Methods This paper aims to synthesis lessons learnt from the Chinese CHW experiences. It summarizes China’s experiences in exploring and using strategic partnership between the community and the formal health system to develop CHWs in the two stages, the barefoot doctor stage (1968 –1985) and the village doctor stage (1985-now). Chinese and English literature were searched from PubMed, CNKI and Wanfang. The information extracted from the selected articles were synthesized according to the four partnership strategies for communities and health system to support CHW development, namely 1) joint ownership and design of CHW programmes; 2) collaborative supervision and constructive feedback; 3) a balanced package of incentives, both financial and non-financial; and 4) a practical monitoring system incorporating data from the health system and community. Results The study found that the townships and villages provided an institutional basis for barefoot doctor policy, while the formal health system, including urban hospitals, county health schools, township health centers, and mobile medical teams provided training to the barefoot doctors. But After 1985, the formal health system played a more dominant role in the CHW system including both selection and training of village doctors. China applied various mechanisms to compensate village doctors in different stages. During 1960s and 1970s, the main income source of barefoot doctors was from their villages’ collective economy. After 1985 when the rural collective economy collapsed and barefoot doctors were transformed to village doctors, they depended on user fees, especially from drug sale revenues. In the new century, especially after the new round of health system reform in 2009, government subsidy has become an increasing source of village doctors’ income. Conclusion The barefoot doctor policy has played a significant role in providing basic human resources for health and basic health services to rural populations when rural area had great shortages of health resources. The key experiences for this great achievement are the intersection between the community and the formal health system, and sustained and stable financial compensation to the community health workers.

The gut microbiota is involved in various physiological functions, and disturbances in the host-microbiome have been proven to contribute to the dysfunction of gut; however, whether microbiota participates in the pathogenesis of constipation remains unclear. In this study, we extracted and analyzed microbiota in feces from constipated donors who had undergone effective therapy with fecal microbiota transplantation, transplanted microbiota into pseudo-germ-free mice, and measured gut motility. These mice presented with lower pellet frequency and water percentage, smaller pellet size, delayed gastrointestinal transit time, and weaker spontaneous contractions of colonic smooth muscle. To determine the mechanism underlying delayed gut motility, microbial metabolites were measured. Short chain fatty acids and secondary bile acids were decreased in mice receiving microbiota from constipated donors. Moreover, the compositional changes of gut microbiota in constipated patients were identified, including the operational taxonomic unit, and the species richness and α diversity were much greater than those in healthy volunteers. These findings suggest that alterations of the microbiome might affect gut motility via altered microbial-derived metabolites in the development of constipation, and the restoration of disturbed microbiota might improve the clinical phenotype. This study indicates that regulating the intestinal environment may be a novel therapy strategy for constipation.

Background Increases in health care utilization and costs, resulting from the rising prevalence of chronic conditions related to the aging population, is exacerbated by a high level of fragmentation that characterizes health care systems in China. There have been several pilot studies in China, aimed at system-level care coordination and its impact on the full integration of health care system, but little is known about their practical effects. Huangzhong County is one of the pilot study sites that introduced organizational integration (a dimension of integrated care) among health care institutions as a means to improve system-level care coordination. The purposes of this study are to examine the effect of organizational integration on system-level care coordination and to identify factors influencing care coordination and hence full integration of county health care systems in rural China. Methods We chose Huangzhong and Hualong counties in Qinghai province as study sites, with only Huangzhong having implemented organizational integration. A mixed methods approach was used based on (1) document analysis and expert consultation to develop Best Practice intervention packages; (2) doctor questionnaires, identifying care coordination from the perspective of service provision. We measured service provision with gap index, overlap index and over-provision index, by comparing observed performance with Best Practice; (3) semi-structured interviews with Chiefs of Medicine in each institution to identify barriers to system-level care coordination. Results Twenty-nine institutions (11 at county-level, 6 at township-level and 12 at village-level) were selected producing surveys with a total of 19 schizophrenia doctors, 23 diabetes doctors and 29 Chiefs of Medicine. There were more care discontinuities for both diabetes and schizophrenia in Huangzhong than in Hualong. Overall, all three index scores (measuring service gaps, overlaps and over-provision) showed similar tendencies for the two conditions. The gap indices of schizophrenia (> 5.10) were bigger for diabetes ( 3.25) were bigger than diabetes (

Two new rubrolides, rubrolides R (1) and S (2), were isolated from the fermentation broth of the marine-derived fungus Aspergillus terreus OUCMDZ-1925. Their structures were elucidated on the basis of spectroscopic analysis and X-ray single crystal diffraction. Compound 1 showed comparable or superior antioxidation against 2,2'-azino-di(3-ethylbenzthiazoline-6-sulfonic acid) (ABTS) radicals to those of trolox and ascorbic acid with an IC₅₀ value of 1.33 mM. Compound 2 showed comparable or superior anti-influenza A (H1N1) virus activity to that of ribavirin with an IC₅₀ value of 87.1 μM. Both compounds 1 and 2 showed weak cytotoxicity against the K562 cell line with IC₅₀ values of 12.8 and 10.9 μM, respectively.

To evaluate the diagnostic accuracy of ultrasound in assessing active Crohn’s disease (CD) in adults. We systematically searched PubMed, EMBASE, Web of Science and the Cochrane Library for prospective studies in which ultrasound was performed to evaluate active CD in adults from January 1993 to April 2013. Pooled sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR−) and diagnostic odds ratios (DORs) in a per-patient-based analysis were estimated. Additionally, the area under the receiver-operating characteristic (ROC) curve was calculated to measure the diagnostic accuracy of ultrasound in patients with known or suspected CD. Fifteen studies involving 1,558 patients were included in this meta-analysis. Overall, the pooled sensitivity (0.88) and LR- (0.14) were not heterogeneous, whereas the pooled specificity (0.97, I2 = 72.9 %) and LR + (15.10, I2 = 71.8 %) were. The DOR of ultrasound for assessing active CD was 121.70, with significant heterogeneity (I2 = 63.3 %). A symmetrical summary ROC curve was plotted showing that the area under the curve was 0.94, indicating good diagnostic accuracy. Meta-regression and subgroup analysis showed that the disease location may be a major cause of heterogeneity. This meta-analysis suggests that ultrasound has high diagnostic accuracy in detecting active CD in adults, especially for small bowel CD. • Ultrasound can detect active Crohn’s disease (CD). • A meta-analysis of ultrasound for detecting active CD was carried out. • This revealed that ultrasound has high diagnostic accuracy for detecting CD.

Anastomotic configurations may be a predictor of postoperative recurrence for Crohn’s disease. One previous meta-analysis showed side-to-side anastomosis was associated with fewer anastomotic leaks but did not reduce postoperative recurrence rates. After 2007, more articles that found distinct results were published. We aimed to update the meta-analysis comparing outcomes between side-to-side anastomosis and other anastomotic configurations after intestinal resection for patients with Crohn’s disease. A literature search that included PubMed, EMBASE, the Science Citation Index, and the Cochrane Library was conducted to identify studies up to May 2012. Trials comparing side-to-side anastomosis with other anastomotic configurations for Crohn’s disease were analyzed. Sensitivity analysis and heterogeneity assessment were also performed. Eleven trials compared side-to-side with other anastomotic configurations were included. Overall, results showed a significant reduction in the overall postoperative complications [n = 777; odds ratio (OR) = 0.60; P = 0.01], but side-to-side anastomosis did not reduce the anastomotic leak rate (n = 879; OR = 0.48; P = 0.07), complications other than anastomotic leak (n = 777; OR = 0.72; P = 0.13), endoscopic recurrence rates [hazard ratio (HR) = 0.73; P = 0.07], symptomatic recurrence rates (HR = 0.74; P = 0.20), and reoperation rates for recurrence (HR = 0.37; P = 0.06). Sensitivity analysis including two randomized controlled trials found no significant differences in short-term complications between the two groups. Sensitivity analysis including nine trials comparing only stapled side-to-side anastomosis with other anastomotic configurations showed stapled side-to-side anastomosis could reduce reoperation rates (HR = 0.38; P = 0.01). Side-to-side anastomosis did not reduce short-term complications and postoperative recurrence for Crohn’s disease. Stapled side-to-side anastomosis may lead to fewer reoperations needed for recurrence. Further randomized, controlled trials should be conducted for confirmation of recurrent events.

We surveyed 276 club drug users in Shanghai, China. Overall, 43.8 % reported ≥2 sex partners in the past 30 days, and 48.9 % reported having sex with non-regular partners, 67.4 % of whom had unprotected sex. Having ≥2 recent sex partners was associated with being 35 years or older, male, living with friends or others, introduced to club drug use by non-regular sex partners, using methamphetamine recently, self-identified as gay/lesbian or bisexual, had sexual debut before 20 years old, and recently had sex under the influence of drugs. Having unprotected sex with non-regular partners in the past 30 days was associated with lower education levels, having sex to obtain drugs, and lower levels of HIV/AIDS knowledge. Club drug users should be targeted for intervention programs. Future research needs to identify other protective and risk factors for sexual risk behaviors and design interventions to reduce club drug use and associated sexual risk behaviors.

(+)-Terrein has a potential application for drug discovery. To improve the yield of (+)-terrein, two-level Plackett-Burman design and response surface methodology methods were used to optimize the condition of a salt-tolerant fungus, Aspergillus terreus PT06-2. As a result, the yield of (+)-terrein reached 8.20 ± 0.072 g/L in a 500-mL flask containing 150 mL optimal medium consisted of 13.1 % NaCl, 3.6 % starch, 2 % sodium glutamate, 0.05 % KCl, 3 % inoculum size, adjusting initial pH value to 5 with 10 % HCl and shaking for 18 days at 28 °C and 180 rpm. The production of (+)-terrein was 47.0 % higher than the highest production reported in shake flasks. The advantages of this optimization are uses of single carbon source and nitrogen source and easy separation and purification by recrystallization. The result exhibited the potential and advantages of A. terreus PT06-2 in industrial production of (+)-terrein by fermentation.

Percutaneous drainage (PD) of Crohn’s related abscesses is becoming popular with the development of techniques. We retrospectively analyzed the outcome of initial PD versus initial surgical drainage for intra-abdominal abscesses in Crohn’s disease. Twenty-three patients of Crohn’s disease complicated with intra-abdominal or pelvic abscesses treated in our institution between July 2001 and April 2010 were retrospectively identified from 188 patients with proven Crohn’s disease. Outcome measures included abscess recurrence after different treatments, post-drainage complications, ultimate stoma creation, and subsequent surgery for Crohn’s disease. Patients were divided into initial PD group (n = 10) and initial surgery group (n = 13): post-drainage complications were more common in initial surgery group (2/10 vs 9/13, P = 0.036), abscess recurred in three patients (2/10 vs 1/13, NS), and subsequent surgery was needed in 10 patients (6/10 vs 4/13, NS). Ultimate stoma creation were significantly more in initial surgery group (1/10 vs 9/13, P = 0.01). Initial PD group had lower rate of post-drainage complications and ultimate stoma creation compared to the initial surgery group. Although subsequent surgery may not be avoided after PD, it can provide safe anastomosis for resections. Long-term follow-up should be done to assess the outcome of PD.

This study was designed to evaluate whether interleukin-23 receptor (IL-23R) polymorphisms were associated with Crohn’s disease (CD) susceptibility. PubMed, MEDLINE, and Embase were searched for studies that investigated the IL-23R variants and CD risk. Meta-analysis from all eligible case-control studies was performed to assess the purported associations. Our analysis found that variant minor alleles for single nucleotide polymorphisms (SNPs) rs11209026 (Arg381Gln) (P

A new hopane type pentacyclic triterpenoid, 2-hydroxydiplopterol (1) has been isolated from the metabolites produced by the halotolerant fungal strain Aspergillus variecolor B-17. The structure of 1 was determined by spectroscopic methods and single crystal X-Ray diffraction analysis. 2-Hydroxydiplopterol (1) exhibited cytotoxicity against K562 cells with an IC50 value of 22 microM.

A new natural product, iso-α-cyclopiazonic acid (1), together with its isomer α-cyclopiazonic acid (2); three mycotoxins: aflatoxin B1 (AFB1) (3), aflatoxin Q1 (AFQ1) (4), and O-methylsterigmatocystin (OMST) (5); two diketopiperazine alkaloids: ditryptophenaline (6) and 3-[(1H-indol-3-yl)methyl]-6-benzylpiperazine-2,5-dione (7), were isolated from the marine-derived fungus Aspergillus flavus. Their structures were determined by analysis of spectroscopic data. The cytotoxicities of compounds 1 and 2 were studied using HL-60, MOLT-4, A-549, and BEL-7402 cell lines.

A new cytotoxic macrocyclic diterpenoid, euphornin L (1), together with seven known analogues were isolated from the plant Euphorbia helioscopia L. The structure of 1 was elucidated by spectral data and X-ray crystallographic analysis. Euphornin L (1) and euphoscopin F (2) exhibited significant cytotoxicity against HL-60 cell lines with IC(50) values of 2.7 and 9.0 microM, respectively. The 13C-NMR data of euphoscopin F (2), epieuphoscopin B (3), euphoscopin B (5), and euphoscopin C (6) were also reported for the first time.

We investigated the potency of exogenous bone marrow mesenchymal stem cells (MSCs) to engraft into irradiated intestine, as well as these cells' effects on radiation-induced enteric injury. MSCs from beta-Gal-transgenic mice were transplanted into C57BL/6J recipient mice that received abdominal irradiation (13 Gy). At different time points, recipient intestines were examined for the engraftment of donor-derived cells by immunofluorescence analysis. Additionally, the expression status of chemokines induced by radiation injury was analyzed in the irradiated intestine. Next, MSCs were transduced with an adenoviral vector encoding a certain chemokine receptor gene in order to promote the engraftment rate via chemotaxis. The intestinal permeability and histomorphological alterations were measured to evaluate the therapeutic effect of MSC transplantation. The results demonstrated that infused MSCs possessed the potency to engraft into irradiated enteric mucosa, but the engraftment rate was too low to produce a therapeutic effect. The expression of stromal cell-derived factor-1 (SDF-1) was up-regulated in irradiated intestine. MSCs genetically modified by CXCR4 (the receptor for SDF-1) engrafted into irradiated intestine at a significantly elevated level and ameliorated the intestinal permeability and histopathological damage.

The main reason why enterocyte proliferative effects of peptide YY (PYY) have not been detected in rats undergoing massive small intestinal resection after feeding may have been the background activity of markedly increased endogenous PYY released from L cells in the distal gut in response to the intraluminal nutrients. The purpose of the present study was to evaluate the effects of PYY on enterocyte proliferation in a rat model of distal bowel resection (DBR) with total enteral nutrition (TEN). Male, adult Sprague-Dawley rats were assigned into three experimental groups: sham rats underwent bowel transection and reanastomosis, DBR rats underwent the resection of 40 cm distal small intestine and colon, and DBR-PYY rats underwent distal bowel resection as above, and were treated with PYY(1-36) from day 2 to day 14 postoperatively. During days 2-14 postoperatively, all animals received isocaloric TEN. At the endpoints, plasma PYY levels and parameters of enterocyte proliferation were determined. Compared with the sham group, DBR rats demonstrated a significant decrease in plasma PYY levels, and a significant increase in intestinal bowel and mucosal weight, mucosal DNA and protein content, villus height and crypt depth, and crypt cell proliferation index. Administration of PYY (DBR-PYY group) led to a significant increase in plasma PYY levels, intestinal bowel and mucosal weight, mucosal DNA and protein content, villus height and crypt depth, and crypt cell proliferation index in comparison with the DBR untreated group. We conclude that administration of PYY increases the plasma PYY levels, and PYY induces enterocyte proliferation with TEN after distal bowel resection.

Chrysogenamide A (1), a new member of the macfortine group of alkaloids, along with four known compounds (2 approximately 5) were identified from Penicillium chrysogenum No. 005, an endophytic fungus associated with Cistanche deserticola Y. C. Ma. The new structure was elucidated on the basis of comprehensive spectral analysis. 1 exhibited a neurocyte protection effect against oxidative stress-induced cell death in SH-SY5Y cells.

Two isocoumarin derivatives, stoloniferol A (1) and B (2), a known 5alpha, 8alpha-epidioxy-23-methyl-(22E, 24R)-ergosta-6, 22-dien-3beta-ol (3), and a known dihydrocitrinone (4) were isolated from the ethyl acetate extract of the sea squirt-derived fungus, Penicillium stoloniferum QY2-10, and a halophilic fungus, Penicillium notatum B-52, respectively. Their structures were elucidated by spectroscopic methods and optical rotation. The stereochemistry of 2 was determined on the basis of different NOE experiments and chemical transformation. Compound 3 showed cytotoxicity against P388 cells, with an IC50 value of 4.07 microM.

A novel phenazine derivative (1) together with six known compounds (2-7) were isolated by bioassay-guided fractionation from the culture broth of a bacterium, Bacillus sp., collected from a Pacific deep sea sediment sample (depth 5059 m). The structures of these compounds were determined using spectroscopic methods. Their cytotoxic effects on P388 and K562 cell lines were preliminarily examined using the sulforhodamine-B (SRB) assay.

Bioassay-guided fractionation of CHCl3 extract from the fermentation broth of a sponge Mycale plumose-derived actinomycete Saccharopolyspora sp. nov., led to the isolation of two known prodigiosin analogs--metacycloprodigiosin (1) and undecylprodigiosin (2). These compounds exhibited significant cytotoxic activities against five cancer cell lines: P388, HL60, A-549, BEL-7402, and SPCA4. This is the first report on the significant cytotoxicity of metacycloprodigiosin (1) against human cancer cell lines.

Recent researches have shown that some compounds isolated from marine organisms have striking structural similarities with the metabolites from known microorganisms. It is inferred from the researches that the symbiotic or associated marine microorganisms may be the true sources of those compounds or at least involved in the biosynthesizing process. This view has been further evidenced by the researches for many sponges and sponge-associated microorganisms. Importantly, growing evidence has highlighted that the symbiotic or associated marine microorganisms live in the microenvironment within the hosts, and they also produce secondary metabolites which are new and original in structure and unique in activity. All these suggest that the microorganisms associated with marine organisms are the sources with very high potential to be new natural bioactive agents. This article reviews briefly the research advances in the study of new bioactive metabolites from marine organisms-associated microorganisms since 2000.

A new cytotoxic indole-3-ethenamide (1) and two known compounds, 7-(3-methylbut-2-enyl)-1H-indole-3-carbaldehyde (2) and emodin (3) were isolated and identified from the ethyl acetate extract of Aspergillus sclerotiorum PT06-1 in a hypersaline nutrient-rich medium. On the basis of spectroscopic analysis and amino-acid analysis, the new structure of 1 was determined to be (S,E)-3-methyl-2-(N- methylacetamido)-N-(2-(7-(3-methylbut-2-enyl)-1H-indol-3-yl)vinyl)butanamide within 3:1 ratio of rotamers along the acetamido single bond in DMSO-d6 at room temperature. Compound 1 showed moderate cytotoxicity against A-549 cells and weak cytotoxicity against HL-60 cells with the IC50 values of 3.0 and 27mM, respectively. Compound 2 has been separated as natural product for the first time, and its NMR data were also reported for the first time in this study. The Journal of Antibiotics advance online publication, 27 July 2011; doi:10.1038/ja.2011.63

Sargassum pallidum (Turn.) C. Ag., a kind of brown algae distributed mainly in the Shandong and Liaoning Provinces of China, has been used in folk medicine for a long time in China [1]. Only several polysaccharides from S. pallidum with antitumor and antioxidant activities have been reported [2]. However, there are no reports on phytochemical analysis of the secondary metabolites. In this paper, two new natural keto-acid derivatives, 2,6,6-trimethyl-4-oxo-2-cyclohexene-1-acetic acid (1) and 2,6,6-trimethyl-4-oxo-2-cyclohexene-1-acetic acid methyl ester (2), were reported from the whole plant of S. pallidum (Turn.) C. Ag.. Their structures were established by comprehensive analysis of the spectral data, especially 2D NMR spectral results. Compound 3 was isolated for the first time from the marine enviroment. Compound 1 was obtained as a yellow oil, [ ] D –7.96 (c 9.15, MeOH). The molecular formula of 1 was established as C11H16O3 from the results of ESI-MS ([M + H] + at m/z 197) and its NMR data. The molecular formula indicated four degrees of unsaturation within the molecule. The IR spectrum showed the presence of carbonyl groups (1653, 1651 cm–1). The 13C NMR and DEPT spectra showed that 1 has 11 carbon signals, attributable to 3 methyl, 2 methylene, 2 methine, and 4 quaternary carbons, including 1 ketone carbonyl at C 202.1 and 1 carboxyl at C 180.0. The 1H NMR spectrum together with HMQC data displayed one olefinic proton signal at H 5.79 (s), one triple signal due to one methine proton at H 2.70, two methylene group signals at H 2.02, 2.40 and H 2.17, 2.49, and three methyl group signals at H 1.03 (s, CH3), 1.04 (s, CH3), 2.03 (s, CH3). The whole structure of 1 was mainly determined by the HMBC spectra (Table 1). The correlations from H-9 proton to C-1, C-2, C-6, C-11 and the correlations from H-1 to C-2, C-3, C-6, C-9, C-11 suggested that C-1 was directly connected with C-2, C-6, and C-9. The correlations from H-5 to C-1, C-3, C-4, C-6, C-7, C-8, and the correlations from H-7, H-8 to C-1, C-5, C-6 indicated that C-5 was linked with C-4 and C-6. The correlations from H-3 to C-1, C-2, C-10 and the correlations from H-5 to C-3 confirmed that there were linkages between the C-3 and C-2, C-4 positions. Thus protons of 10-CH3 showed the HMBC correlations to the C-1, C-2 and C-3, placing the methyl group at the C-2 position. Thus, the structure of compound 1 was identified as 2,6,6-trimethyl-4-oxo-2-cyclohexene-1-acetic acid. As is known, compound 1 has not been reported previously as a natural product and was only obtained as a synthetic compound [3, 4].

Pennicitrinone D, a new citrinin dimer from the halotolerant fungus Penicillium notatum B-52

Background Contact tracing is especially useful for identifying an infection with few cases in the population, such as HIV in China. Little such research is available in China. Methods Every newly diagnosed HIV case from 2008–2010 in Taizhou Prefecture, Zhejiang Province in China, was invited to participate as an “index case” in a contact tracing survey by providing contact information for up to eight sexual contacts who themselves were approached for voluntary HIV counseling and testing (VCT). Those who tested HIV-positive were then subjected to another contact tracing survey. This process was repeated until no more sexual contacts were reported or tested positive. Results A total of 463 HIV-infected individuals were newly identified during the study period, including 338 cases who were identified from routine surveillance programs and 125 cases who were identified from the present contact tracing survey. Among these 463 cases, 398 (86.0%) served as ‘index cases’ in the survey, including 290 (85.8%) out of the 338 cases identified from routine surveillance programs and 108 (86.4%) out of the 125 cases identified from the present survey. These 398 ‘index cases’ reported a total of 1,403 contactable sexual contacts, of whom 320 (22.8%) received HIV testing and 125 (39.1%) tested positive for HIV. Willingness to receive HIV testing was high among spouses and long term heterosexual or homosexual partners but extremely low among casual and commercial sex partners of ‘index cases’. Consistent condom use was rare for all participants. A total of 290 independent sexual network components were constructed, with high complexity. Conclusion Contact tracing is useful for identifying new HIV infections from spouses or long term sexual partners of HIV-infected individuals. The complicated sexual networks existing between and beyond HIV-infected persons provide opportunities for rapid spread of HIV in such areas.

Dihydrogen, copper, platinum, and lead octakis(2-ethylhexyloxy)phthalocyanines (Pc's) were studied in polystyrene films at 532 nm and in chloroform solutions at 1064 nm by picosecond degenerate four wave mixing. Resonant χ(3) values of Pc's at 532 nm (a local minimum in the absorption spectrum) at a time coincident with the 20 psec pump pulses were as high as 104 times that of CS2 by extrapolation of the response from 1 wt % PtPc in polystyrene film to a value for pure PtPc. Delay of the probe pulse as long as 3 nsec revealed acoustic responses stronger than the fast electronic responses. The films showed the expected quadratic dependence of the instantaneous reflectivity on incident intensity only for a decade of magnitude of intensity, 100–1000 MW/cm2, with the output saturating at higher intensities. Excited state absorption at 532 nm was detected in the film samples by pulse-probe spectroscopy and was shown to be a factor in the saturation observed in the NLO signals. Nonresonant χ(3) values at 1064 nm were as high as 120 times that of CS2 from measured responses of 1 wt % chloroform solutions of Pc's. Time delay of the probe revealed both fast electronic and slower acoustic responses at 1064 nm too.