Anorectal stricture is a highly disabling complication of Crohn's disease (CD). However, surgical decisions still rely largely on symptoms and anal canal calibre, with no standardised quantitative threshold. Using the psychometrically validated Crohn's Disease Anorectal Stricture Quality of Life (CDAS-QoL) scale, we performed diagnostic accuracy analyses to link scores to multidisciplinary team (MDT)-defined surgical indication and derive a cut-off value for surgical risk stratification and shared decision-making. We conducted a single-centre diagnostic accuracy study in a retrospectively assembled cohort of patients with CD-associated anorectal stricture from January 2016 to November 2025. CDAS-QoL was prespecified as the index test, and MDT-defined surgical indication-based on symptoms, anal canal calibre, and imaging-served as the reference standard. A CDAS-QoL surgery-alert threshold was derived using receiver operating characteristic (ROC) analysis (Youden index) and a sensitivity-prioritised rule, and evaluated by bootstrap internal validation (1,000 resamples), stratified 5-fold cross-validation, and decision-curve analysis. Among 221 patients with CD-associated anorectal stricture, 57 (25.8%) underwent surgery after completing the CDAS-QoL. Baseline scores were higher in those who proceeded to surgery than in conservatively managed patients (85.3 ± 5.9 vs. 63.4 ± 15.2, p < 0.001). CDAS-QoL showed strong discrimination for MDT-defined surgical indication (AUC 0.89; 95% CI 0.85-0.93). A cut-off of 78.5 yielded 93% sensitivity and 81% specificity, classifying 84/221 (38.0%) as high risk. Internal validation (bootstrap and stratified 5-fold cross-validation) supported robustness, and decision-curve analysis suggested potential clinical utility. A threshold based on CDAS-QoL may identify patients with CD-associated anorectal stricture who have substantial functional impairment and should be prioritised for timely surgical evaluation, thereby facilitating shared decision-making.

Malakoplakia is a rare chronic inflammatory disease, most commonly observed in immunocompromised or immunodysregulated individuals. It frequently involves the genitourinary tract, with the gastrointestinal tract considered the second most common site. Clinical manifestations vary depending on the location of the disease but are non-specific; diagnosis relies primarily on pathological examination. No standardized treatment regimen is currently available. Antimicrobial therapy is a relatively common approach and often achieves favorable outcomes. The Affiliated Hospital of Nanjing University of Chinese Medicine admitted a patient presenting with perianal pain and hematochezia. The patient had a history of acute lymphoblastic leukemia and was post-allogeneic hematopoietic stem cell transplantation. Based on histopathological findings from biopsy, including microscopic manifestations, immunohistochemical staining and special stains, a clinical diagnosis of rectal malakoplakia was made. The patient received a ciprofloxacin-based regimen for rectal malakoplakia, with good therapeutic effect.

BACKGROUND:Anorectal stricture is a severe and debilitating complication of Crohn's disease (CD). Currently, no specific patient-reported outcome measures (PROMs) exist to assess the severity of anorectal stricture or its impact on the quality of life (QoL) among patients with CD. A new PROM scale has been developed to measure CD anorectal stricture. METHODS:A 3-phase mixed-methods approach was implemented. Items were generated through a literature review and semi-structured interviews, followed by screening and refinement via pre-surveys and the Delphi method to create an initial scale. Cognitive interviews with patients were conducted to further optimize item content. Psychometric validation included structural validity assessments (comparisons with the hospital anxiety and depression scale [HADS] and the inflammatory bowel disease questionnaire [IBDQ]), as well as reliability and sensitivity evaluations through test-retest analysis. RESULTS:The study involved 171 patients with CD-associated anorectal stricture, 13 colorectal surgeons, 3 gastroenterologists, 1 general surgeon, and 1 nurse (all specializing in CD), along with 2 researchers experienced in PROM design, leading to the development of the Crohn's disease Anorectal Stricture Quality of Life Scale (CDAS-QoL). The scale demonstrated high internal consistency and reliability (Cronbach's α = 0.92; Guttman split-half = 0.84), good stability (Intraclass correlation coefficient = 0.87), and sensitivity (lower scores in patients with symptom improvement, P = .001; higher scores in those with symptom worsening, P = .03). CDAS-QoL scores were positively correlated with HADS scores (r = 0.66, P < .001) and negatively correlated with IBDQ scores (r = -0.67, P < .001). CONCLUSIONS:The CDAS-QoL scale is a validated PROM tool applicable to clinical decision-making and trials. It provides an effective instrument to quantify the severity of anorectal stricture in CD and assess its impact on patients' QoL.

BACKGROUND AND AIMS:The International AIH Pathology Group (IAIH-PG) put forward the new histological criteria of autoimmune hepatitis (AIH) in 2022, which have not undergone adequate verification. In this study, we verified the applicability of the new histological criteria in the population of Chinese patients with chronic liver disease, comparing it with the simplified criteria. METHODS:The gold standard for diagnosis in all patients was based on histological findings, combined with clinical manifestations and laboratory tests and determined after a follow-up period of at least 3 years. A total of 640 patients with various chronic liver diseases from multiple centres underwent scoring using the new histological criteria and the simplified criteria, comparing their diagnostic performance. RESULTS:In this study, the new histological criteria showed a sensitivity of 73.6% and 100% for likely and possible AIH, with specificities of 100% and 69.0% respectively. The coincidence rates of possible AIH for the new histological criteria, simplified histological criteria and simplified score were 81.7%, 72.8% and 69.7% respectively. For likely AIH, the rates were 89.2%, 75.9% and 65.6% respectively. Based on the new histological criteria, all patients with AIH were correctly diagnosed. Specifically, 73.6% were diagnosed with likely AIH and 26.4% were possible AIH. Additionally, the simplified histological criteria achieved a diagnosis rate of 98.6% for AIH, while the simplified score could only diagnose 53.8% of AIH. CONCLUSIONS:Compared with the simplified score and simplified histological criteria, the sensitivity and specificity of the new histological criteria for AIH were significantly improved. The results indicate that the new histological criteria exhibit high sensitivity and specificity for diagnosing AIH in China.

BACKGROUND AND AIMS:There is no golden standard for the diagnosis of autoimmune hepatitis which still dependent on liver biopsy currently. So, we developed a noninvasive prediction model to help optimize the diagnosis of autoimmune hepatitis. METHODS:From January 2017 to December 2019, 1739 patients who had undergone liver biopsy were seen in the second hospital of Nanjing, of which 128 were here for consultation. Clinical, laboratory, and histologic data were obtained retrospectively. Multivariable logistic regression analysis was employed to create a nomogram model that predicting the risk of autoimmune hepatitis. Internal and external validation was both performed to evaluate the model. RESULTS:A total of 1288 patients with liver biopsy were enrolled (1184 from the second hospital of Nanjing, the remaining 104 from other centers). After the univariate and multivariate logistic regression analysis, nine variables including ALT, IgG, ALP/AST, ALB, ANA, AMA, HBsAg, age, and gender were selected to establish the noninvasive prediction model. The nomogram model exhibits good prediction in diagnosing autoimmune hepatitis with AUROC of 0.967 (95% CI: 0.776-0.891) in internal validation and 0.835 (95% CI: 0.752-0.919) in external validation. CONCLUSIONS:ALT, IgG, ALP/AST, ALB, ANA, AMA, HBsAg, age, and gender are predictive factors for the diagnosis of autoimmune hepatitis in patients with unexplained liver diseases. The predictive nomogram model built by the nine predictors achieved good prediction for diagnosing autoimmune hepatitis.

Crohn′s disease (CD) -related anorectal stricture is a narrowing lesion that occurs in the distal part of the gastrointestinal tract. The symptoms of anorectal stricture in CD are not obvious in the early stage, but in the later stage, manifest difficulty in defecation, fecal incontinence, and persistent anal pain, often requiring repeated medical and surgical treatment, leading to a dramatic decrease in the patient′s quality of life. The presence of anorectal stricture in patients with CD usually indicates that the intestinal tract, especially rectal inflammation, is not controlled, and the probability of diverting stoma or rectal resection is significantly increased. Clinical diagnosis requires comprehensive detailed physical examination, endoscopy and biopsy, magnetic resonance imaging, etc. Treatment is based on medical therapy, supplemented by endoscopic and instrumental anal surgical intervention when necessary, but there is a lack of standardized treatment protocols. This article reviews the existing pathogenesis, diagnosis, and treatment modalities of this disease to help with clinical diagnosis and treatment.

BACKGROUND:The balance between T helper 17 (Th17) cells and regulatory T cells (Tregs) is involved in immunological tolerance. Destruction of immunological tolerance by dendritic cell (DC)-mediated T cells is involved in the pathogenesis of ulcerative colitis (UC). Qingchang Huashi granule (QCHS) has been confirmed in the treatment of UC involved by inhibiting the activation of DCs. The aim of this study was to investigate the mechanism through which QCHS restores the Th17/Treg balance by modulating DCs in the treatment of UC.METHODS:The effects of QCHS on Th17 cells, Tregs and DCs were detected in a 2,4,6-trinitrobenzene sulfonic acid (TNBS)-induced experimental colitis model. Furthermore, we injected QCHS-treated DCs into colitis model to test whether QCHS modulates the Th17/Treg balance via DCs. Tregs and Th17 cells were analyzed by FACS. IL-10, IL-17, and Foxp3 were measured by ELISA, Western blot and qRT-PCR.RESULTS:Both QCHS and QCHS-treated DCs improved colonic histopathology, diminished Th17 cell differentiation and inhibited IL-17 production while promoting CD4+CD25+Foxp3+ Treg differentiation and augmenting IL-10 and Foxp3 expression in colitis mice. Additionally, QCHS reduced CD86 and MHC-II expression on DCs, decreased IL-12 production ex vivo and restored the Th17/Treg ratio in the colitis model.CONCLUSION:The findings of this study indicate that QCHS ameliorates TNBS-induced colitis by restoring the DC-mediated Th17/Treg balance.

Immunological tolerance is critical for maintaining gut homeostasis. An imbalance between interleukin-17 (IL-17)-producing T helper 17 (T(H)17) cells and regulatory T cells (T(reg)cells) is involved in ulcerative colitis (UC) pathogenesis. Dendritic cells (DCs) are able to induce T cell differentiation. Paeoniflorin (PF) is a monoterpene glucoside that is commonly used for treatment of autoimmune disease. However, the immunological mechanism of PF involvement in UC treatment is unclear. The present study aimed to explore whether PF can restore the T(H)17/T(reg)balance by modulating DCs. The effects of PF on DCs, T(H)17 cells and T(reg)cells were measured. Furthermore, PF-treated DCs were injected into mice with 2,4,6-trinitrobenzenesulfonic acid (TNBS)-induced colitis. PF inhibited MHC-II and CD86 expression on the DC surface (P < 0.05), decreased interleukin (IL)-12 secretion in vitro and in vivo (P < 0.05), and restored the T(H)17/T(reg)ratio in the mouse model of colitis (P < 0.05). PF-treated DCs diminished T(H)17 differentiation (4.26% in vitro and 1.64% in vivo) and decreased IL-17 expression (P < 0.05) while inducing CD4(+)CD25(+)Foxp3(+)T(reg)differentiation (7.82% in vitro and 6.85% in vivo) and increasing Foxp3 and IL-10 production (P < 0.05). Additionally, both PF and PF-treated DCs improved colonic histopathology in the mouse model of colitis (P < 0.05). In conclusion this study suggested that PF can ameliorate TNBS-induced colitis by modulating the DC-mediated T(H)17/T(reg)balance.

BACKGROUND:Ulcerative colitis (UC) is a chronic, nonspecific intestinal inflammatory disease with undefined pathogenesis. Non-SMC condensin I complex subunit D2 (NCAPD2) and non-SMC condensin II complex subunit D3 (NCAPD3) play pivotal roles in chromosome assembly and segregation during both mitosis and meiosis. To date, there has been no relevant report about the functional role of NCAPD2 and NCAPD3 in UC.AIM:To determine the level of NCAPD2/3 in intestinal mucosa and explore the mechanisms of NCAPD2/3 in UC.METHODS:Levels of NCAPD2/3 in intestinal tissue were detected in 30 UC patients and 30 healthy individuals with in situ hybridization (ISH). In vitro, NCM60 cells were divided into the NC group, model group, si-NCAPD2 group, si-NCAPD3 group and si-NCAPD2+si-NCAPD3 group. Inflammatory cytokines were measured by ELISA, IKK and NF-κB were evaluated by western blot, and IKK nucleation and NF-κB volume were analyzed by immunofluorescence assay.RESULTS:Compared with expression in healthy individuals, NCAPD2 and NCAPD3 expression in intestinal tissue was significantly upregulated (P < 0.001) in UC patients. Compared with levels in the model group, IL-1β, IL-6 and TNF-α in the si-NCAPD2, si-NCAPD3 and si-NCAPD2+si-NCAPD3 groups were significantly downregulated (P < 0.01). IKK and NF-κB protein expression in the si-NCAPD2, si-NCAPD3 and si-NCAPD2+si-NCAPD3 groups was significantly decreased (P < 0.01). Moreover, IKK nucleation and NF-κB volume were suppressed upon si-NCAPD2, si-NCAPD3 and si-NCAPD2+ si-NCAPD3 transfection.CONCLUSION:NCAPD2/3 is highly expressed in the intestinal mucosa of patients with active UC. Overexpression of NCAPD2/3 promotes the release of pro-inflammatory cytokines by modulating the IKK/NF-κB signaling pathway.

Crohn’s disease (CD) is a chronic, relapsing form of inflammatory bowel disease, seriously threatening human health. Thalidomide has been used for the treatment of CD. However, the effects and the possible mechanisms of thalidomide on CD are still unclear. Herein, our study demonstrated that thalidomide protected colon mucosa against trinitro-benzene-sulfonic acid (TNBS)-induced injury, diminished inflammatory infiltration and levels of IFN-γ, IGF-1, IL-6, IL-17, TNF-α, while increased the levels of IL-10 and TGF-γ. Moreover, it reversed the intestinal fibrosis and inhibited the accumulated infiltration, down-regulated the expression of col1a2, col3a2, MMP-3, MMP-9, MMP-1, TGF-γ, α-SMA, but up-regulated the expression of TIMP-1 and Vimentin. Although it could be observed that the effect of thalidomide administration in modeling was better than after modeling, there was no statistical difference between the two groups. The present study provided evidence that the therapeutic effect of thalidomide alleviated the inflammatory response and damage of colon tissue, mainly by restoring the imbalance of TH17/Treg cells and inhibiting intestinal fibrosis in TNBS-induced mice colitis.

Crohn's disease (CD) is a chronic relapsing form of inflammatory bowel disease, and its pathogenesis remains unknown. Total flavone of Abelmoschus manihot L. Medic (TFA), has been used as anti‑inflammatory and myocardial ischemia protective drug. The present study aimed to explore the effects of TFA on CD and its underlying mechanism. We reported that TFA comprises eight flavone glycosides, including quercetin‑3‑O‑robinobioside, gossypetin‑3‑O‑glucoside, quercetin‑3'‑O‑glucoside, isoquercetin, hyperoside, myricetin, gossypetin and quercetin. In vivo, TFA promoted the survival of 2,4,6‑trinitrobenzene sulfonic acid (TNBS)‑induced colitis in mice, decreased weight loss and increased colon length in a dose‑dependent manner. Additionally, TFA notably ameliorated the inflammatory response in mice with TNBS‑induced colitis as determined by histopathological analysis. In addition, the administration of TFA in mice with TNBS‑induced colitis led to a significant decrease in the levels of cytokines in the sera and colon tissues; a significant decrease myeloperoxidase activity in the colon tissues was also observed. These findings may be associated with the suppression of the nuclear factor‑κB (NF‑κB) and mitogen‑activated protein kinase (MAPK) signaling pathways. In vitro, TFA significantly downregulated the expression of cytokines in lipopolysaccharide (LPS)‑induced RAW264.7 cells. In addition, TFA suppressed LPS‑induced activation of the NF‑κB and MAPK signaling pathways in RAW264.7 cells. Our findings indicated that TFA could suppress the inflammatory response in mice with TNBS‑induced colitis via inhibition of the NF‑κB and MAPK signaling pathways. The results of the present study may improve understanding of the function of TFA and provide a novel theoretical basis for the treatment of CD.

目的 本研究旨在评估手术联合英夫利昔单抗(IFX)治疗肛周瘘管性克罗恩病(PFCD)后的再次手术情况及分析相关风险因素.方法 纳入2010年7月至2017年1月于南京中医药大学附属医院肛肠科接受手术联合IFX治疗的117例PFCD患者作为研究对象,分析患者治疗后到随访终点接受再次手术的影响因素.结果 117例患者中男性84例、女性33例,中位年龄24.0(20.0～29.0)岁,91％(106/117)的患者为复杂性肛瘘.88％(103/117)的患者接受挂线引流手术,56％(65/117)的患者接受了3次以上的IFX维持治疗.中位随访时间36.0(23.5～58.5)个月,随访终点共有57例(49％)患者达到临床缓解,36例(30.8％)患者需要再次手术.多因素Logistic回归分析结果提示伴有初始脓肿、IFX维持治疗3次以上是肛周瘘管性克罗恩病患者联合IFX治疗后需要再次手术的独立风险因素.结论 手术联合IFX是一种治疗复杂性PFCD的合理有效的方案,临床治疗应注重对伴有初始脓肿以及IFX维持治疗超过3次等风险因素的防控和管理.

目的 观察止瘁洗剂治疗慢性肛周湿疹的临床疗效.方法 将120例慢性肛周湿疹患者随机分为观察组和对照组各60例,治疗组采用江苏省中医院院内制剂止瘁洗剂坐浴外用,对照组采用高锰酸钾溶液坐浴外用,观察患者的临床疗效、复发率、治疗前后肛周瘙痒程度和生活质量,以及用药期间的不良反应.结果 观察组总有效率为96.67％,临床有效病例随访6个月后复发率22.4％;对照组总有效率为73.33％,临床有效病例随访6个月后复发率63.64％.各组指标结果存在统计学差异.结论 止瘁洗剂治疗慢性肛周湿疹疗效确切,复发率低,可明显改善患者的生活质量,且无明显不良反应.

The purpose of this study was to evaluate the efficacy and long-term outcome of the ligation of the intersphincteric fistula tract (LIFT) procedure for transsphincteric fistula-in-ano.

Wnt/β-catenin信号通路（Wnt经典信号通路）是目前Wnt信号通路中研究较为深入的一条分支.他在从果蝇到人类的胚胎发育、组织器官形成以及肿瘤发生等重大事件中扮演重要角色.结直肠癌具有发病率和死亡率高的特征,故对其机制进行深入地研究十分重要.结直肠癌的分子生物学研究经常可以发现Wnt/β-catenin信号通路的异常激活.因此,研究Wnt/β-catenin信号通路可能为临床结直肠癌的治疗提供新的潜在靶点.通过回顾近年来相关文献,就Wnt/β-catenin信号通路和其与结直肠癌的关系及以Wnt/β-catenin信号通路为靶点的抗结直肠肿瘤研究做一综述.

目的:研究大肠癌HCT116细胞对10味有毒中药的敏感性.方法:采用MTT法测定药物对细胞增殖的抑制率.结果:中华蟾酥注射液、斑蟊酸钠注射液、亚砷酸氯化钠注射液及藤黄对大肠癌HCT116细胞的增殖有抑制作用,且随着药物浓度的增加抑制效果明显增强,有明显的量效关系;黄药子、龙葵、重楼、白花蛇舌草、天南星、雷公藤在相同浓度下未表现出抑制作用.斑蝥酸钠及藤黄IC50优于亚砷酸氯化钠(P＜0.05),华蟾素注射液由于采用的原药未提供原液浓度,未能得出具体的IC50值.结论:通过实验筛选证明华蟾酥注射液、斑蟊酸钠注射液、亚砷酸氯化钠注射液及藤黄可抑制HCT116细胞增殖,为进一步的体内动物研究提供实验数据,其机制还待进一步研究.

OBJECTIVE:To evaluate the efficacy of infliximab combined with surgery in the treatment of perianal fistulizing Crohn disease (CD).METHODS:Clinical data of 15 patients with perianal fistulizing CD receiving infliximab combined with surgery in the Affiliated Hospital of Nanjing University of Chinese Medicine from March 2010 to June 2011 were analyzed retrospectively. One week after operation, all the patients received infliximab infusion thrice at weeks 0, 2, and 6. Crohn disease activity index (CDAI), perianal Crohn disease activity index (PDAI), body mass index (BMI), routine blood test and endoscopy were evaluated at week 0, 14. Adverse reactions and healing time were recorded.RESULTS:At week 14, the response rate was 100% with 86.7% (13/15) complete responders. One patient had local improvement and one developed recurrent fistula. The mean healing time was 32.5 (20-45) d. Anorectal stenosis in 4 patients was significantly improved. At week 14, CDAI decreased to 114.0±90.3 from 230.5±97.5 after IFX treatment. PCDAI decreased to 2.8±3.2 from 9.9±3.4, and BMI increased to (21.5±3.0)kg/m(2) from (19.1±3.1)kg/m(2). C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), platelet and neutrophil were significantly decreased from baseline (all P<0.01). Intestinal mucosa healed completely in one patient. There were no serious adverse events except hypokalemia in one patient and severe infusion reaction in another.CONCLUSION:Infliximab combined with surgery is effective and safe for perianal fistulizing CD.

Aim The study evaluated the effect of a loose-seton technique for perianal necrotizing fasciitis. Method The medical records of seven patients with perianal necrotizing fasciitis treated by the loose-seton technique between December 2005 and June 2010 were reviewed. Age, gender, status of diabetes mellitus, duration of symptoms, the length of hospital stay and number of debridements were investigated. Results Five of the patients were men. The mean age was 53 years and the range was 4379 years. All seven patients had a past history of acute perianal abscess. Six (85.7%) patients had diabetes mellitus. The mean time for removal of the seton was 24 (1432) days and the mean hospitalization time was 31 (2345) days. All patients had primary wound healing. There was no mortality. At a median follow-up 18 (660) months one patient required inpatient treatment with cutting-seton for complex anal fistula after 11 months. All patients had normal faecal continence and none of them required a reconstructive procedure during the follow-up. Conclusion The loose-seton technique is an effective treatment for perianal necrotizing fasciitis. The advantages include inhibiting the spread of inflammation, reducing the frequency of debridements, decreasing the area of the wound and limiting extensive scar formation.