Background: The incidence of inflammatory bowel disease (IBD) is rapidly increasing in China, a vast country with significant geographical differences. The socioeconomic status of Eastern China is significantly higher than that of Western China. Objectives: This study aimed to describe the geographical heterogeneity in the characteristics and management of patients with IBD in both Eastern and Western China. Design: This was a multicenter, cross-sectional study. Methods: Patients with IBD with ages ⩾18 years up to 18 January 2023 were included in the analysis from the Chinese database for IBD. Logistic regression was used to identify risk factors associated with surgeries among patients with IBD. Results: Among 8305 patients with IBD, the ratio of ulcerative colitis (UC) to Crohn’s disease (CD) was 4.13 and 0.33 in Western and Eastern China, respectively. The median age at diagnosis of UC and CD was 40.69 and 28.58 years, respectively. There was a male predominance among patients with UC (54.3%) and CD (68.0%). The two regions exhibited a similar distribution of disease locations in UC. However, Western China had a higher proportion of L2 involvement (30.0% versus 19.1%) and more advanced disease behavior (B2 and B3) (48.8% versus 39.8%) than Eastern China. Patients with IBD in Western China received more 5-aminosalicylic acid and corticosteroids and fewer immunomodulators and biologicals. In terms of surgical risk, Eastern China [ versus Western China, odds ratios (OR): 5.36, 95% confidence intervals (CI): 2.96–9.68] was associated with a higher risk of surgery in UC, while Western China ( versus Eastern China, OR: 3.39, 95% CI: 2.37–4.86) was associated with a higher risk of surgery in CD. Conclusion: Geographical heterogeneity exists in the disease characteristics and management of IBD in Eastern and Western China. These findings have the potential to guide the formulation of location-specific strategies aimed at enhancing the long-term outcomes of patients with IBD.

This study aimed to understand the disease characteristics and treatment outcomes of Crohn’s disease (CD) in a real-world setting in China. In this prospective, non-interventional, multicenter disease registry, adults (≥18 years) with existing and newly diagnosed CD were recruited from 14 medical centers across China from January 2015 to January 2017. The study consisted of the enrollment and follow-up periods, of 12 months each. Demographic, clinical characteristics, diagnostic duration and management of CD at enrollment were evaluated. Logistic regression analysis and stepwise multivariate logistic regression analysis used to assess the relationship between the risk factors and CD. Of 504 enrolled patients, 499 (99.0%) were eligible for analysis. The mean (SD) age at study enrollment was 32.3 (11.43) years and the majority (69.7%) of participants were male. In the past 15 years, a sustained decrease of the period of time in the diagnosis of CD was observed, at about 39.4 (24.11) months in 2010, which decreased to 3.1 (2.13) months in 2015. The most common presenting symptoms of CD included abdominal pain (78.0%), diarrhea (58.1%), weight loss (52.9%) and fever (30.1%). Oral ulcer (19.4%) and arthritis (9.8%) were the most common extra-intestinal manifestations. Non-stricturing non-penetrating (B1) (49.9%) behavior and ileocolonic involvement (L3) (56.2%) location were more frequent. Perianal disease was observed in 29.1% of the patients. Around 23.8% (119/499) patients had CD-related surgery other than perianal disease surgery. Older age at enrollment, longer disease course, complicated disease behavior and absence of perianal disease were all surgery risk factors (p < 0.05). The most common medications was immunomodulators (e.g., azathioprine) (41.5%), anti-TNFα agents (32.9%) and aminosalicylates (20.6%). The mean (SD) Crohn’s Disease Active Index (CDAI) score was 159.1 (91.45) and almost half of the patients (49.1%, 81/165) were in remission. This study demonstrated the CD-disease characteristics, risk factors of CD-related surgery and perianal disease, and treatment strategies in a real-world setting in China and may help in developing programs to diagnose and manage patients with CD.

OBJECTIVES:Differentiating Crohn's disease (CD) from intestinal tuberculosis (ITB) remains a diagnostic challenge. Misdiagnosis carries potential grave implications. We aimed to develop and validate a novel diagnostic nomogram for differentiating them.METHODS:In total, 310 eligible patients were recruited from 6 tertiary inflammatory bowel disease centers. Among them, 212 consecutive patients (143 CD and 69 ITB) were used in the derivation cohort for the establishment of diagnostic equation and nomogram; 7 investigative modalities including clinical manifestations, laboratory results, endoscopic findings, computed tomography enterography features, and histology results were used to derive the diagnostic model and nomogram. Ninety-eight consecutive patients (76 CD and 22 ITB) were included for validation of the diagnostic model.RESULTS:Eight out of total 79 parameters were identified as valuable parameters used for establishing diagnostic equations. Two regression models were built based on 7 differential variables: age, transverse ulcer, rectum involvement, skipped involvement of the small bowel, target sign, comb sign, and interferon-gamma release assays (for model 1) or purified protein derivative (for model 2), respectively. Accordingly, 2 nomograms of the above 2 models were developed for clinical practical use, respectively. Further validation test verified the efficacy of the nomogram 1 with 90.9% specificity, 86.8% sensitivity, 97.1% PPV, 66.7% negative predictive value (NPV), and 87.8% accuracy for identifying CD, and the efficacy of the nomogram 2 with 100% specificity, 84.2% sensitivity, 100% positive predictive value, 64.7% NPV, and 87.8% accuracy for diagnosing CD.CONCLUSIONS:The derivation and validation cohorts identified and validated 2 highly accurate and practical diagnostic nomograms for differentiating CD from ITB. These diagnostic nomograms can be conveniently used to identify some difficult CD or ITB cases, allowing for decision-making in a clinical setting.

Korea.We included patients who were diagnosed with COPD according to ICD-10 code (J43.x and J44.x) from 2010 to 2014 and were prescribed one or more COPD medications at least twice per year.We compared COPD patients with non-COPD controls matched by age and sex with a ratio of 1:5.Cases with newly diagnosed with IBD that met both of ICD-10 codes (K50 for Crohn's disease and K51 for ulcerative colitis) and V code for rare intractable disease (V130 for Crohn's disease and V131 for ulcerative colitis) were identified in the study population, respectively.The Kaplan-Meier method was used to estimate the cumulative incidence probability of IBD.Results: During the mean follow-up duration of 3.9 years, COPD patients experienced IBD more frequently than non-COPD controls (10.8 per 1,000 person-years vs 7.7 per 1000 person-years, p<0.001).The incidence of Crohn's disease was 2.58 per 1,000 person-years in patients with COPD, but 1.61 per 1,000 personyears in non-COPD control group (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.35-1.90;p<0.001).In addition, the incidence of ulcerative colitis was 8.0 per 1,000 personyears in patients with COPD, compared to 6.1 per 1,000 person-years in non-COPD controls (HR, 1.31; 95% CI, 1.19-1.44;p<0.001).Analyzing the risk of IBD according to severity of COPD, the incidence rate of IBD was higher with increasing severity of COPD.Conclusion: The risk of IBD increased in the patients with COPD of South Korea.These results suggest an association between COPD and IBD.The possibility of IBD can be considered carefully when elderly smokers complained severe gastrointestinal symptoms based on the results. Su1871

Gastroenteropancreatic neuroendocrine tumors (GEP‑NETs) are relatively uncommon. Unfortunately, epidemiological studies on the incidence of GEP‑NETs worldwide have reported a marked increase in the detection of these tumors. Although they often exhibit relatively indolent clinical courses, GEP‑NETs have the potential for lethal progression, especially in patients who present with advanced disease. Early detection and surgical removal is currently the only reliable curative treatment for GEP‑NET patients. The objective of this study was to analyze the clinicopathological characteristics of GEP‑NETs and explore the metastasis‑related risk factors of patients with GEP‑NETs. One hundred and forty‑six patients diagnosed pathologically with GEP‑NETs from January 2001 to January 2015 at the Second Xiangya Hospital of Central South University were retrospectively evaluated. We retrieved and analyzed information concerning clinical characteristics and metastasis‑related risk factors, and used Chi‑square test and logistic regression analysis to analyze the clinicopathological characteristics of GEP‑NETs and explore the association between tumor metastasis and possible related risk factors. The results revealed that the most common clinical manifestations were abdominal pain (n=88), alteration in the character of stool (n=58) and melaena (n=33). Rectum (91/146, 62.3%) and stomach (19/146, 13.0%) were the main sites of metastasis. Both Chi‑square test and logistic regression analysis showed that tumor size (P<0.05), tumor type (P=0.008) and peritumoral lymphatic vessel density (LVD) (P=0.004) were significantly correlated with tumor metastasis. Neither Chi‑square test nor logistic regression analysis indicated that gender (P>0.05), age (P>0.05), tumor location (P>0.05), tumor number (P>0.05), chromaffin granule protein A [chromogranin A (CgA), P>0.05], synaptophysin (Syn, P>0.05) or intratumoral LVD (P>0.05) had a significant correlation with tumor metastasis. Chi‑square test revealed that tumor grade was significantly correlated with tumor metastasis. In conclusion, GEP‑NETs may occur in multiple sites of the digestive system and lack specific clinical manifestations. Tumor size, tumor type, peritumoral LVD, total LVD and tumor grade are metastasis‑related risk factors for GEP‑NET patients.

AIMTo explore Chinese physicians' perceptions towards fecal microbiota transplantation (FMT) and to provide information and an assessment of FMT development in China.METHODSA self-administered questionnaire was developed according to the FMT practice guidelines and was distributed to physicians in hospitals via Internet Research Electronic Data Capture (REDcap) software and electronic mails to assess their attitudes toward and knowledge of FMT. The questionnaire included a brief introduction of FMT that was followed by 20 questions. The participants were required to respond voluntarily, under the condition of anonymity and without compensation. Except for the fill-in-the-blank questions, all of the other questions were required in the REDcap data collection systems, and the emailed questionnaires were completed based on eligibility.RESULTSUp to December 9, 2014, 844 eligible questionnaires were received out of the 980 distributed questionnaires, with a response rate of 86.1%. Among the participants, 87.3% were from tertiary hospitals, and there were 647 (76.7%) gastroenterologists and 197 (23.3%) physicians in other departments (non-gastroenterologists). Gastroenterologists' awareness of FMT prior to the survey was much higher than non-gastroenterologists' (54.3 vs 16.5%, P < 0.001); however, acceptance of FMT was not statistically different (92.4 vs 87.1%, P = 0.1603). Major concerns of FMT included the following: acceptability to patients (79.2%), absence of guidelines (56.9%), and administration and ethics (46.5%). On the basis of understanding, the FMT indications preferred by physicians were recurrent Clostridium difficile infection (86.7%), inflammatory bowel disease combined with Clostridium difficile infection (78.6%), refractory ulcerative colitis (70.9%), ulcerative colitis (65.4%), Crohn's disease (59.4%), chronic constipation (43.7%), irritable bowel syndrome (39.1%), obesity (28.1%) and type 2 diabetes (23.9%). For donor selection, the majority of physicians preferred individuals with a similar gut flora environment to the recipients. 76.6% of physicians chose lower gastrointestinal tract as the administration approach. 69.2% of physicians considered FMT a safe treatment.CONCLUSIONChinese physicians have awareness and a high acceptance of FMT, especially gastroenterologists, which provides the grounds and conditions for the development of this novel treatment in China. Physicians' greatest concerns were patient acceptability and absence of guidelines.

Research purposes: The noise source between high- speed railway and normal railway differs significantly,which hinders the sound barrier from working effectively in high- speed railway. Based on the noise source characteristics of high- speed railway,with reference to one ground section of the Wuhan- Guangzhou high- speed railway,a dual- source mode to study the noise reduction effect of high- speed railway sound barrier was established.Under different source modes,simulation analysis on the noise reduction effect of 3- meter vertical noise barrier was carried out.Research conclusions: Compared simulation results with measured results,the calculated sound pressure level of dual-source mode is closer to the measured one,while the result of single- source mode is lower,the deviation is 8 d BA.Under the single- source mode,the insertion loss of sound barrier is about 10. 7 d BA ~ 13. 1 d BA,which is significantly higher than the measured one. The noise of railway clearance is higher than 70 d BA,to improve the ecological environment of the railway line,many reasonable optimization methods of sound barrier were proposed. The dual- source mode which considered the pantograph- catenary noise can provide reliable reference for the design and application of high- speed railway sound barriers.

Background: Crohn's disease and intestinal tuberculosis (ITB) are chronic granulomatous disorders that are difficult to distinguish. Computed tomographic enterography (CTE) yields striking findings for Crohn's disease in the small bowel but its role in differentiating Crohn's from ITB is undefined. This prospective study aimed to investigate the value of CTE for differential diagnosis between Crohn's disease and ITB.Patients and methods: 105 consecutive patients (67 Crohn's, 38 ITB) who underwent CTE and colonoscopy were enrolled. CTE findings and colonoscopic parameters were compared between Crohn's disease and ITB by blinded reviewers. Based on univariate and multiple logistic regression analyses, a diagnostic algorithm combining colonoscopy and CTE was formulated. and its performance validated on 60 new patients (40 Crohn's, 20 ITB).Results: On univariate analysis of CTE findings, proximal small-bowel involvement, asymmetrical mural thickening, segmental small-bowel lesions, mural stratification, the comb sign, and mesentery fibrofatty proliferation were significantly more common in Crohn's disease, whereas mesenteric lymph node change (calcification or central necrosis) and focal ileocecal lesions were more common in ITB. On multivariate analysis, segmental small-bowel involvement (odds ratio [OR] 0.104, 95% confidence interval [95% CI] 0.022-0.50), and comb sign (OR 0.02, 95% CI 0.003-0.26) were independent predictors of Crohn's. Combining CTE and colonoscopic findings increased the accuracy of diagnosing either Crohn's disease or ITB from 66.7% (70/105) to 95.2% (100/105) in the development set (P< 0.001). Sensitivity, specificity, and area under the curve for receiver-operating characteristic (ROC) in the validation dataset were 92.5 %, 80%, and 0.862 (95 % CI 0.75-0.98), respectively.Conclusions: CTE adds unique information to colonoscopy in differential diagnosis between Crohn's disease and ITB, allowing correct diagnosis in most patients.

AIM:To evaluate potential risk factors in the development of ulcerative colitis(UC) in China.METHODS:A total of 1308 patients with UC and 1308 age-matched and sex-matched controls were prospectively studied in China.The UC cases were collected from 17 hospitals in China from April 2007 to April 2010.Uniform questionnaires were designed to investigate risk factors including smoking,appendectomy,stress,socio-economic conditions,nonsteroidal antiinflammatory drugs(NSAIDs),oral contraceptives,diet,breastfeeding,infections and family sanitary conditions.Group comparisons by each factor were done using simple logistic regression analysis.Conditional logistic regression was used for multivariate analysis.RESULTS:By univariate analysis,the variables predictive of UC included feeling stress,light and heavy alcoholic drinking,spicy food,sugar consumption and infectious diarrhea,while heavy tea intake and tap water consumption were protective against UC.On multivariate analysis,the protective factor for UC was tap water consumption [odds ratios(OR) = 0.424,95%CI:0.302-0.594,P < 0.001];while the potential risk factors for UC were heavy sugar consumption(OR = 1.632,95%CI:1.156-2.305,P < 0.001),spicy food(light intake:OR = 3.329,95%CI:2.282-4.857,P < 0.001;heavy intake:OR = 3.979,95%CI:2.700-5.863,P < 0.001),and often feeling stress(OR = 1.981,95%CI:1.447-2.711,P < 0.001).Other factors,such as smoking habit,appendectomy,breastfeeding,a history of measles,rural or urban residence,education,oral contraceptives,and NSAID use have not been found to have a significant association with the development of UC in the present study.CONCLUSION:Our study showed tap water consumption was a protective factor for UC,while spicy food,heavy sugar consumption and often feeling stress were risk factors for UC in this Chinese population.

Background There are many similarities and overlaps in clinical manifestations and ileocolonoscopic features between Crohn’s disease (CD) and intestinal tuberculosis (ITB). Differentiation between CD and ITB is of great importance. Aim To investigate the values of clinical and endoscopic findings in differential diagnosis between CD and ITB. Methods Clinical and endoscopic features of a cohort of 130 cases of CD and 122 cases of ITB from June 2003 to February 2009 were retrospectively reviewed following predetermined criteria. Parameters were screened by logistic regression analysis. Furthermore, the diagnostic efficacy of screened parameters was analyzed by regression equation (mathematical model) and receiver operating characteristic curve (ROC curve). Results The clinical features helpful in differentiating CD from ITB are hematochezia, intestinal surgery, perianal diseases, pulmonary tuberculosis, ascites, and positive of PPD skin test; the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of regression mathematical model established by clinical features were 90.3, 76.8, 83.8, 80.7, and 88.0%, respectively. The endoscopic features helpful in differentiating CD from ITB were rectum involved lesions, longitudinal ulcer, cobblestone appearance, fixed-open ileocecal valve, transverse ulcer, and rodent ulcer; the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of regression mathematical model established by endoscopic features were 82.9, 82.0, 82.5, 82.9, and 82.0%, respectively. Conclusions It was proposed that a diagnostic algorithm based on available clinical and endoscopic regression equation could improve the current sensitivity, specificity, and accuracy in differentiating between CD from ITB.

Based on study and analyses of the theory of urban rail transit network program, it is indicated that urban rail transit has become more and more important and rail transit line network planning is more significant with the rapid development of transport construction. On this basis, the program decision making assessment by layer index system is established; at the same time, the method of combing AHP and fuzzy is proposed due to the problem of present evaluation methods. The AHP-fuzzy model established in this paper can be used to evaluate a certain city's rail transit line network planning. With an example, it is proved and verified that all the information can be used and theory can be combined with experiences in the AHP-fuzzy model. The results show that they are in conformity with the actual situation of urban rail transit line network planning. It can provide service for the assessment and solution of urban rail transit network program, thus avoiding human errors in policy making.

Background: The purpose of the present paper was to investigate the status of Crohn's disease hospitalization in China.methods: Medical records of hospitalized Crohn's disease came from 22 medical centers across China during 1990-2003 and were retrospectively reviewed. Every incident case was recorded in detail on a regular comprehensive datum form by investigators in person. Clinical manifestations, examinations and therapeutic status were analyzed.Results: A total of 515 cases of Crohn's disease were found. The ratio of patients with Crohn's disease to total hospitalized patients has increased steadily year by year. Endoscopy was performed in 348 patients (67.57%). Barium meal or enema was performed in 221 patients (42.91%). Histological examination (endoscopical or surgical biopsy) was performed in 340 patients (66.02%). Reasonable treatment strategies were used for 435 patients (84.47%). The evaluation of quality of life for 54/303 patients (17.82%) was poor.Conclusions: This retrospective, hospital-based study shows that the number of patients with Crohn's disease in China has steadily increased over a period of 14 years. Further population-based epidemiological studies specifically focusing on risk factors are needed. The diagnosis of Crohn's disease and therapeutic strategy require improvement. (c) 2006 Blackwell Publishing Asia Pty Ltd.

AIM:To describe the pattern of inheritance and confirm the diagnostic criteria of primary shunt hyperbilirubinaemia (PSH).METHODS:Forty members of a family pedigree across four generations were included in this study. All family members were interviewed and investigated by physical examination, hematology and liver function test and the pattern of inheritance was analyzed.RESULTS:Nine of the forty family members suffered primary shunt hyperbilirubinaemia. The mature erythrocytes of the propositus were irregular in shape and size. The pedigree showed transmission of the trait through four generations with equal distribution in male and female. No individual with a primary shunt hyperbilirubinaemia was born to unaffected parents. The penetrance was complete in adult.CONCLUSION:The pattern of inheritance is autosomal dominant. The abnormality of erythrocytes and decrease in white blood cell could be supplemented in the diagnosis of PSH. The PSH is a genetic disorder and could by renamed as hereditary shunt hyperbilirubinaemia.

The paper studies the alternative environmental impacts from economic aspect in the process of alternatives selection during feasibility study stape.By comparing and analyzing the related methods,some economic analysis methods are adopted to evaluate the cost of alternative environmental impacts.The monetized methods of environment impacts are generalized.The environmental impacts including landscape,noise and ecology in the course of railway location are analyzed apart from the computed formula that is taken to evaluate the cost of alternative environmental impacts in railway location in monetizing environmental impacts are put forward,which makes the difference among different alternatives environmental impacts more clearly.Finally,the results are practically applied in the second project in Rebuilding Xuan-hang Railway.

With the rapid development of highway construction in the west of China, new demands are brought out in protecting western environment. In the environmental protection, environmental monitoring is important foundation and supporting power, while ascertaining environmental monitor index is the most important part of environmental monitoring. The nature of establishing index system of environmental monitoring for highway construction in the west of China lies in extracting the variant information of kinds of environmental factors in time and space, and evaluating current situation, variation and development trend of kinds of natural resource, and seeking the relationship between highway construction and natural environment in the west of China, and it can offer theoretical basis for protecting and improving quality of natural environment in the west. In order to reduce the adverse influence in western highway construction, this paper summarized the application of high-way construction and environmental protection in the west of China, studied the principles that should be followed in establishing environmental monitoring indexes in western highway construction, and on this basis, put forward the index system of environmental monitoring and the monitoring method of indexes for highway construction in west of China.

According to the demand and aim on environment impacl assessment of urban traffic, this paper discussed the foundation of valuation index system, including five factors that nature, social, culture and so on.. Three layers about the valuation index system was set up. Then the methods on environment impact assessment of urban traffic was studied, which were survey of public opinion, AHP (The analytic hierarchy process), synthetic evaluation method.

Through extensive surveying correlation-materials, this paper discusses the current study of urban mass transit network planning and optimizing decision making theory and method in domestic and overseas research. Based on the analysis of this, the paper points out the question exist in the urban mass transit network planning and its optimizing decision making: (1) Has the insufficiency in the optimized decision making content comprehensive aspect, and it will not truly covers the urban mass transit network planning with multi-levelly, multi-facet and multi-relational connotation structure. (2) Lacks the rationality in the optimized decision making index system structure aspect, even if it has established the optimization decision making index system structure which content is relatively comprehensive, its each index will still exists overlap phenomenon in the connotation intrinsic. (3) Optimized decision making theory and method existence one-sidedness and limitation. (4) The method and technical backwardness cause the model advanced nature and the usable relative insufficiency. So we can clear realize its research vital significance, and this research result has the instruction significance to the next city urban mass transit network planning optimization decision-making theory research.

Graph overlay method is used in route alignment noise impact assessment.Each route alignment noise comprehensive impact area is calculated.The result could act as reference in the route alignment optimal selection and make for realizing harmonious development between railway construction and surrounding environment.In this process,(Geographic) Information System with its powerful function of handling attributes and spatial analysis is adopted,which improves the effciency and the reliability greatly.

AIM: To examine the protein expression alterations in liver injury/repair network regulation as a response to gut-derived lipopolysaccharide (LPS) treatment, in order to anticipate the possible signal molecules or biomarkers in signaling LPS-related liver injury.METHODS: Male BALB/c mice were treated with intraperitoneal (i.p.) LPS (4 mg/kg) and sacrificed at 0, 6, 24 and 30 h to obtain livers. The livers were stained with hematoxylin and eosin for histopathologic analyses. Total liver protein was separated by two-dimensional gel electrophoresis (2-DE). The peptide mass of liver injury or repair related proteins were drawn up and the protein database was searched to identify the proteins.RESULTS: Observations were as follows: (1) TRAIL-R2 was down regulated in livers of LPS-treated mice. TNFAIP1 was significantly up regulated at 6 h, then down- regulated at 24, 30 h with silent expression during senescent stage.(2) The amount of metaxin 2 and mitochondria import inner membrane translocase subunit TIM8a (TIMM8A) was increased upon treatment with LPS, (3) P34 cdc2 kinase was significantly up-regulated 30 h after LPS administration with silent expression during senescent, 6, 24 h treated stage. (4) The amount of proteasome activator 28 alpha subunit (PA28), magnesium dependent protein phosphatase(MDPP) and lysophospholipase 2 was decreased 6 h after LPS treatment but recovered or up-regulated 24 and 30 h after LPS treatment.CONCLUSION: LPS-treated mouse liver displaying a timedependent liver injury can result in expression change of some liver injury or repair related proteins.