Volume 87  ·   Issue 44  ·  2007

In 2007, the Nobel Prize in Physiology or Medicine was announced. American scientists Mario Capecci and Oliver Smith, and British scientist Martin Evans won this honor for their breakthrough discovery in "embryonic stem cells and mammalian DNA recombination", which once again demonstrates the great influence that cell biology will have on human beings in the 21st century.

Objective to analyze the clinical characteristics of Chinese Cronkhite-Canada syndrome (CCS). Methods the clinical data of Chinese CCS from 1985 to 2006 were retrieved in PubMed and Chinese Medical Literature Database and retrospectively analyzed. The results showed that 35 Chinese cases had multiple gastrointestinal polyps with ectodermal triad as the main manifestation, chronic diarrhea, abdominal pain, weight loss, anemia, edema and other symptoms were the most common, and 2 patients had cancer. Comprehensive treatment can "relieve" the symptoms of some patients to varying degrees. The disease presents certain ethnic and regional clustering, but it is often neglected. The application of new technologies such as gastrointestinal radionuclide imaging, double balloon enteroscopy and capsule endoscopy provides new information for understanding the disease. Conclusion The clinical characteristics of Chinese cases are basically similar to those reported in English and Japanese literature. The application of new technologies, standardization of reporting items and data sharing are helpful for deeper understanding of this rare disease.

Objective to observe the clinical efficacy of autologous peripheral blood CD34+ cells transplantation in patients with non-Hodgkin's lymphoma (NHL) by in vitro CD34+ cell sorting technique. Methods 5 patients with NHL, 3 females and 2 males; Median age 29 years; There were 3 cases of T cell NHL, 1 case of diffuse large B cell NHL and 1 case of true histiocytic NHL; Clinical stage ⅡA in 2 cases and IVB in 3 cases; CD34+ and CD34-cell fractions were collected by Clini MACS clinical magnetic cell separator, and sorted CD34+ cells were infused after pretreatment. Results 3.3 log-order CD34-cells were removed by Clini MACS in vitro sorting. The median number of reinfused CD34+ cells was 2.0×106/kg; The recovery rate of CD34+ was 52%, and the purity of CD34+ cells was 86%; The median days of recovery of leukocytes to>0.5×109/L and platelets to>20×109/L after transplantation were 12 days and 19 days, respectively. The overall survival rate and disease-free survival rate were 4/5, the 1-year survival rate was 4/5, and the estimated 5-year survival rate was 75%.

Objective to investigate the feasibility, accuracy and clinical value of in vitro localization technique of sentinel lymph node (SLN) in colorectal carcinoma. Methods Intraoperative injection of isothiol blue was used to study the localization of SLN in 45 patients with colorectal carcinoma. During operation, SLN was taken for rapid freezing pathology and compared with conventional wax pathology. The correlation between frozen pathological SLN metastasis and conventional pathological mesenteric lymph metastasis was observed, and its predictive value on mesenteric lymph node metastasis was observed. Results Among 45 patients with colorectal carcinoma, 42 cases had confirmed SLN. The success rate of SLN biopsy was 93.3%. A total of 250 lymph nodes were detected, 52 SLNs were detected. The sensitivity of prediction of regional lymph node pathology was 90.4% (20/22), the accuracy was 95.2% [(20+20) /42], and the false negative rate of SLN was 15% (3/20). Conclusion SLN detection has certain value in judging regional lymph node metastasis in colorectal carcinoma, and can be used to guide clinical operation.

Objective to observe the diagnostic value of two different positron emission computed tomography (PET) imaging in the diagnosis of liver occupied space which cannot be defined by routine examination.Methods Among 489 patients with clinical diagnosis of liver occupied space, 15 patients who could not be defined by various routine examinations and underwent twice PET examination.All patients underwent 11C-acetate-PET and 18F-deoxyglucose (FDG) -PET examination before operation.Results Pathology confirmed malignant lesions in 13 cases and benign lesions in 2 cases.Among the 13 malignant lesions, 11C-acetate-PET showed malignant in 10 cases and benign in 3 cases; 18F-FDG-PET showed 9 cases of malignancy and 4 cases of benignity; Among the 2 cases of benign lesions, 11C-acetate-PET showed malignant and benign lesions in 1 case; The sensitivity of 18F-FDG-PET was higher (100%) than that of 18F-FDG-PET in highly differentiated hepatocellular carcinoma (20%). The sensitivity of 18F-FDG is high for poorly and moderately differentiated hepatocellular carcinoma. Conclusion Two kinds of PET tracers can improve the diagnosis rate when routine examination cannot determine the occupying property of liver, and the combined application of two kinds of PET tracers can also indicate the differentiation degree of tumor, which has certain guiding significance for the selection of surgical methods.

Objective to investigate the effects of different methods of gamma globulin intravenous injection (IVIG) on the efficacy and coronary complications of children with Kawasaki disease. Methods IVIG treatment of children with Kawasaki disease from 2000 to 2004 in 45 hospitals in Beijing was retrospectively analyzed. A total of 1052 children (680 males and 372 females), aged from 2 months to 13.8 years, were enrolled in the study. According to the method of IVIG administration, they were divided into 3 groups: 2 g/kg single dose (single dose group), 1 g · kg-1 · d-1 for 2 days (2 days group) and 400~600 mg · kg-1 · d-1 for 4~5 days (4~5 days group). The observation indexes were referred to the incidence of IVIG unresponsiveness and the incidence of coronary complications in acute (1~2 weeks of onset) and subacute (3~6 weeks of onset). Results There were 292, 656 and 104 children in single dose group, 2 days group and 4~5 days group, respectively. The incidence of IVIG unresponsiveness in 2 days group (61/292, 20.9%) was significantly higher than that in single dose group (65/656, 9.9%) and 4~5 days group (9/104, 8.7%, P<0.01). However, the incidence of coronary complications (5.1%) and coronary aneurysms (1.6%) in single dose group in subacute phase was lower than that in 4-5 d group (11.6% and 4.7%) and 2 d group (9.8% and 5.4%, P =0.035-0.047). Conclusion IVIG 2 g/kg single dose regimen can reduce the incidence of coronary complications and IVIG unresponsiveness, which may be the better IVIG treatment regimen for Kawasaki disease at present.

Objective to investigate the relationship between the blood glucose control status and the population characteristics of type 2 diabetes patients who were treated with premixed insulin twice a day and switched to basal insulin plus oral hypoglycemic drugs once a day, and the dosage of basal insulin. Methods A randomized, open, two-center parallel controlled study was conducted for 12 weeks. Eighty patients with type 2 diabetes who were treated with premixed insulin twice a day (with or without oral hypoglycemic drugs), fasting blood glucose (FBG) was 7.8-16.7 mmol/L, and glycosylated hemoglobin (HbA1c) was 7%-10%, and were randomly divided into the treatment group of insulin glargine plus glimepiride 3 mg once a day or premixed 30 R (Novolin) islet plus glimepiride 3 mg twice a day. The insulin dose was adjusted every 3 days to target FBG ≤6.0 mmol/L. Results After 12 weeks of treatment, the HbA1c in the insulin glargine group and the insulin premixed group decreased significantly compared with the baseline level, and there was no significant difference in the decrease of HbA1c between the two groups (8.8%→8.0% vs 8.9%→7.8%, P>0.05). During the treatment period, the frequency of hypoglycemia in the insulin premixed group was significantly higher than that in the insulin glargine group. The total hypoglycemia events were 123 and 57 times, respectively, and the number of confirmed hypoglycemia cases was (94 vs 21, χ 2=23.692, P =0), especially the hypoglycemia occurred before lunch (64 vs 17, χ 2=7.762, P =0.005). After insulin glargine treatment, 28.2% (11 cases) had HbA1c ≤7.5%, and the dose was (0.58±0.29) U·kg-1·d-1; 23.1% (9 cases) had HbA1c>8.5%, and the dose was (0.66±0.30) U·kg-1·d-1. The HbA1c level before treatment, the course of diabetes mellitus and the C-peptide level at 2 h after prandial are the main indicators that affect the efficacy of one-time basal insulin combined with oral hypoglycemic drugs.

Objective to investigate the distribution of killer cell immunoglobulin-like receptor (KIR) in Chinese Han population and its influence on the prognosis of human leukocyte antigen (HLA) compatible relative transplantation. Methods the genotypes of HLA and KIR were detected by PCR sequence specific primer (SSP) typing technique. The genotypes of KIR and HLA were detected in 150 Han population, 74 allogeneic hematopoietic stem cell transplantation donors and recipients, and the data of 45 patients with malignant hematological diseases who received HLA compatible relative transplantation and non-removed T cell allogeneic hematopoietic stem cell transplantation (allo-HSCT) were retrospectively analyzed. Results the gene distribution frequency of KIR2DL1 was 100%, KIR2DL2 was 20%, KIR2DL3 was 100% and KIR3DL1 was 95%. 96% of the donors carried three groups of KIR receptors closely related to allo-HSCT. Among 45 HLA compatible relative donors, 36 patients had KIR incompatibility, accounting for 80% of the total number, 35 patients had KIR2DL1 incompatibility, 1 case had KIR2DL2/2 The difference was statistically significant (P =0.029). The incidence of aGVHD in the KIR and KIR2DL1 incompatible group (18%) was significantly lower than that in the KIR incompatible group (75%) in acute myeloid leukemia (P =0.03), but the difference was not statistically significant in lymphatic system diseases.Conclusion The vast majority of Han nationality in northern China carried the three groups of KIR receptors closely related to allo-HSCT, and the incidence of aGVHD in the KIR incompatible group between donors and recipients after HSCT with HLA compatible relatives decreased significantly.

Objective to analyze the incidence and mutation spectrum of coagulation factor C homolog (COCH) gene mutation in autosomal dominant non-syndromic deafness (DFNA) population in China.Methods The clinical data and peripheral venous blood of 26 DFNA families, 19 small families of delayed deafness with unknown genetic pattern, 22 sporadic delayed deafness cases and 100 normal controls were collected in Chinese Han population, and DNA was extracted, and the whole sequence mutation of COCH was analyzed by PCR amplification and direct sequencing.Results A heterozygous mutation of COCH 1625G>A was found in one giant DFNA family, which mutated the original cysteine at position 542 into tyrosine (C542Y); A heterozygous mutation of COCH 1535 T>C was found in a small family of delayed deafness with unknown genetic pattern, and the methionine 512 was mutated to threonine (M512T). Evolutionary conservation analysis indicated that C542 and M512 were highly conserved in mice, cattle, chicken and zebrafish. The phenotypes and genotypes of the members of the two families were co-segregated. No COCH mutation was found in 100 normal controls. Conclusion COCH M512T and C542Y mutations are the molecular causes of deafness in these two families of delayed deafness.

Objective to investigate the expression changes of tumor necrosis factor (TNF) α signaling pathway main receptor adaptor proteins-tumor necrosis factor-associated death domain protein (TRADD), FAS-associated death domain protein (FADD), receptor interacting protein 1 (RIP-1) and tumor necrosis factor receptor-associated factor 2 (TRAF-2) in peripheral blood mononuclear cells (PBMC) of patients with systemic lupus erythematosus (SLE). Methods PBMC were isolated from peripheral venous blood of 51 inpatients with SLE and 17 healthy volunteers. The expression levels of these four receptor adaptor proteins, Caspase 3 and interleukin (IL) -1 β were detected by real-time fluorescence quantitative PCR. The expression differences of these four receptor adaptor proteins and their correlation with lupus activity index were compared between SLE patients and healthy volunteers and SLE patients with different lupus activity. Results the expression levels of TRADD, FADD, RIP-1 and The expression of four receptor adaptor proteins in the high activity group of SLE was 0.31, 0.59, 0.52 and 0.49 times that in the normal control group, respectively (P<0.05), but the difference between the low activity group and the normal control group was not statistically significant (P>0.05). The expression of Caspase 3 in PBMC of SLE patients was significantly increased (P<0.01), while the expression of IL-1 β was not statistically significant (P>0.05). The expression of TRADD, FADD, RIP-1 and TRAF-2 in PBMC of SLE patients was negatively correlated with lupus activity index (SLEDAI), with correlation coefficients of-0.285, -0.280, -0.307 and-0.298, respectively (P<0.05). Conclusion The expression of TRADD, FADD, RIP-1 and TRAF-2, the four main receptor adaptor proteins in TNF-α signaling pathway, was decreased in PBMC of SLE patients, and there was a negative correlation with lupus activity index, and their abnormal expression may be involved in the immunopathological damage of SLE mediated by TNF-α signaling network disorder.

Objective to evaluate the effect of colonic electrical stimulation on colonic transmission in rats and to explore its possible mechanism.Methods A pair of electrodes and a catheter were placed in the colon of rats and randomly divided into 6 groups: saline electrical stimulation or non-electrical stimulation group (14 rats each); Nitric oxide synthase inhibitor N-nitro-L-arginine (L-NNA) electrically stimulated or non-electrically stimulated group (12 rats each); In the first 40 min of the transmission experiment, the colonic transmission was evaluated by calculating the amount of phenol red excretion from the anus of rats every 10 min within 90 min. Results (1) The colonic transmission rate of colonic transmission was significantly promoted by string pulse stimulation, which was 57%±6% in the saline non-electrical stimulation group and 82%±5% in the saline electrical stimulation group. (2) L-NNA slowed down the colonic transmission and blocked the promoting effect of string pulse stimulation on colonic transmission. (3) Atropine significantly slowed down the colonic transmission, and the phenol red excretion rate was 16%±3% in 90 min, which was significantly lower than that in the saline non-electrical stimulation group, but it could not block the promoting effect of string pulse stimulation on colonic transmission.

Objective to investigate the expression of receptor interaction-related protein (RIP) 140 in brain development of normal mice. Methods Immunohistochemistry was used to study the localization of RIP140 in brain tissue, and the dynamic expression pattern of RIP140 in different developmental stages of normal mice was studied by real-time quantitative PCR and Western blot. Results Immunohistochemistry results showed that RIP140 mRNA expression was always expressed during brain development of normal mice, and there was clear expression in cerebral cortex, hippocampus, thalamus and other parts. Real-time quantitative PCR results showed that the expression of RIP140 mRNA in different developmental stages of normal mice showed a dynamic change pattern, and Western blot results showed that the expression of RIP140 protein also showed a dynamic change pattern in different developmental stages of mouse brain, and there was a positive correlation with the expression of mRNA (rs =0.767, P =0.016, bilateral). Conclusion RIP140 is involved in brain development and brain function of normal mice.

Objective to investigate the inhibitory effect and mechanism of exogenous carbon monoxide on early lung injury and inflammatory response in mice after severe burn. Methods a 15% Ⅲ degree burn model was established in mice. The experimental animals were randomly divided into 3 groups: Sham group (12 rats), scald group (12 rats) and scald plus carbon monoxide releasing molecule (CORM) -2 group (12 rats). Mice in the scald plus CORM-2 group were injected with CORM-2 (8 mg/kg) into the tail vein after scald; The activity of myeloperoxidase (MPO), nuclear factor, κ B (NF-κ B), expression of intercellular adhesion molecule-1 (ICAM-1), TNF-α and IL-1 β in alveolar lavage fluid, injury indexes of lung tissue (wet-to-dry ratio, vascular permeability) and adhesion of lung endothelial cells to leukocytes after stimulation with burn serum were detected in the Sham group. Results The activity of MPO (87 ± 11) U/g tissue in the lung tissue, TNF-α (160 ± 9) pg/ml and IL-1 β (27.2 ± 2.9) pg/ml in alveolar lavage fluid, NF-κ B and ICAM-1 protein expression levels in the burn group were significantly higher than those in the Sham group. The adhesion of pulmonary endothelial cells to leukocytes was increased (46.5±8.5) % after burn serum stimulation, and the adhesion of pulmonary endothelial cells to leukocytes was significantly weakened (25.4±5.6) % after burn serum stimulation treated with CORM-2. Conclusion Exogenous carbon monoxide releasing molecules can significantly inhibit the activity of NF-κ B in lung tissue and reduce the expression of adhesion molecules in lung tissue after severe burn, thus reducing the retention of leukocytes in tissue and effectively reducing the inflammatory reaction of lung.

Objective to observe and compare the effects of transplantation of two kinds of endothelial progenitor cells (EPC and EOC) on the repair of intimal balloon injured vessels. Methods Rabbit peripheral blood mononuclear cells (MNC) were isolated by density gradient centrifugation. EPC and EOC of rabbit peripheral blood were obtained by different isolation and culture methods. The same number (5×105) of EPC and EOC were transplanted into intimal injured vessels of rabbits, respectively. The control group was only injected with 100 μ L of normal saline. At the same time, the two kinds of cells were labeled with lipophilic carbocian dye for cell tracing. Four weeks after operation, the animals were sacrificed. The distribution of the labeled cells was observed under fluorescence microscope, and the regenerative endothelial coverage and the degree of neointimal proliferation were measured in each group. Results Four weeks after operation, fluorescence-labeled cells were observed in the vascular media, neointimal layer and intimal surface under fluorescence microscope. The area of re-endothelialization area in the EPC transplantation group and EOC transplantation group was significantly larger than that in the control group, and the difference was statistically significant (91.6%±3.6%, 89.1%±6.3% vs 62.1%±7.5%, P<0.01), but the difference between the transplanted cell groups was not statistically significant. Conclusion EPC transplantation or EOC transplantation can significantly accelerate the re-endothelialization of intimal injured vessels and reduce the formation of neointimal.

Objective to investigate the type of death of hepatic sinusoidal endothelial cells (SEC) caused by ethanol and the effect of vascular endothelial growth factor (VEGF) on this death, as well as the mechanism of action involving Ets-1 and Caspase-8. Methods SEC were isolated and cultured from Wistar male rats according to the method of Braet et al. Then, SEC were incubated with ethanol (25-100 mmol/L) and VEGF (20-30 ng/ml) for 6 h. The apoptosis of SEC was detected by nick-end labeling (TUNEL) technique. The expression of Ets-1 protein was determined by Western blot and the change of Caspase-8 activity was determined by FLICE/Caspase-8 colorimetric protease detection kit.Results Under phase contrast microscope, the SEC incubated for 3 days showed spindle shape and basically fused, but the SEC tended to shrink and die during incubation with ethanol. Under fluorescence microscope, most of the control SECs were negative for TUNEL staining; TUNEL-positive cells increased after 2 h with ethanol (100 mmol/L), and about 75% cells showed TUNEL-positive after 6 h; Moreover, when SEC was incubated with ethanol (25-100 mmol/L) for 6 h, the increase of TUNEL-positive SEC was dose-dependent (all P<0.05). VEGF (20-30 ng/ml) significantly inhibited apoptosis of SEC induced by ethanol (100 mmol/L) in a dose-dependent (P<0.05); After adding VEGF (30 ng/ml), the number of TUNEL-positive cells was only 71% of that incubated with ethanol alone (P<0.05). After adding 100 mmol/L ethanol for 6 h, the expression of Ets-1 protein in SEC was significantly reduced, and VEGF (30 ng/ml) prevented the decrease of Ets-1 protein expression in SEC caused by ethanol (100 mmol/L). The activity of Caspase-8 increased to 44.9±14.3 when incubated with ethanol (100 mmol/L) for 2 h, and VEGF (20 and 30 ng/ml) prevented the increase of Gaspase-8 activity in SEC caused by ethanol (100 mmol/L) (30.4±2.0 and 25.2±2.2, respectively, P<0.05). Conclusion VEGF prevented the apoptosis of SEC induced by ethanol, at least partly by inhibiting the down-regulation of Ets-1 protein in SEC and the up-regulation of Caspase-8 activity in ethanol.

Objective to investigate the relationship between abnormal lymphocyte homing and colonic inflammation in experimental ulcerative colitis rats.Methods Sixty SD rats were randomly divided into control group, model group and lymphocyte homing intervention group (SLC antibody intervention), 20 rats in each group, to observe and compare the changes of colonic mucosal inflammation and tissue cytokines in different groups, and to detect and compare the expressions of secondary lymphocyte tissue chemokine (SLC) and lymphocyte homing receptor CCR7 in colon tissue by reverse transcription (RT) -PCR semi-quantitative method; The proportion of CCR7+ lymphocytes in colonic reflux blood was detected and compared by flow cytometry. Results There were statistically significant differences in colonic mucosal inflammation score and tissue cytokine content in model group, intervention group and control group. There was excessive homing of lymphocytes under the mucosa of the colon in the model group and the intervention group; The expression levels of SLC mRNA in the model group and the intervention group (0.85±0.05, 0.77±0.14) were significantly higher than those in the control group (0.31±0.11, all P<0.01), but the difference between the model group and the intervention group was not statistically significant (P>0.05); The expression levels of CCR7 mRNA in the model group and the intervention group (0.79±0.11, 0.39±0.12) were significantly higher than those in the control group (0.11±0.03, P<0.01), and the difference between the model group and the intervention group was also statistically significant (P<0.05); The proportion of CCR7+ lymphocytes in the colonic venous reflux blood in the model group and the intervention group (69%±5%, 77%±10%) was significantly higher than that in the control group (17%±8%, all P<0.01), but the difference between the model group and the intervention group was not statistically significant (P>0.05). Conclusion The abnormal homing of lymphocytes in experimental ulcerative colitis rats is related to the inflammation of colonic mucosa.

A 57-year-old female was admitted to the hospital on August 16, 2005 after eating for 3 years and suffered from a mass in the left upper abdomen for 1 week. There was no fever, no cough, no hematemesis, no melena, and her weight lost 10 kg in the past six months.

Since Warren and Marshall first isolated H. pylori from the gastric mucosa of patients with chronic gastritis, with the progress of research in the past 20 years, other members of the genus Helicobacter have been found in many kinds of animals. Up to now, there have been at least 24 species of Helicobacter formally named and 35 species of Helicobacter to be standardized.

The book Statistical Methods of Biomedical Research was co-written by a group of medical statistics professors organized by Professor Fang Jiqian who have been working in the front line of statistics teaching, scientific research and consulting work for a long time. It was published by Higher Education Press in June 2007. It is a new and good textbook with distinction.

I. A Historical Review of the Development of Critical Care Medicine Nightingale developed the idea of establishing an intensive care unit (ICU) as early as the Crimean War in 1854. In 1863, she wrote an article to express the basic concept of ICU and put forward the original design.

Keratoconus can be an independent disease or a component of some syndromes. It is characterized by the forward protrusion of the center of the cornea in a conical shape, which often causes highly irregular myopia, astigmatism and varying degrees of visual impairment.

In recent years, the outbreak of infectious diseases such as atypical pneumonia and avian influenza has aroused people's attention to public health problems. As far as avian influenza is concerned, it is generally believed that it is an acute infectious disease mainly caused by avian influenza virus. The symptoms after infection are mainly respiratory symptoms, and in severe cases, heart, kidney and other organ failure can lead to death, and the mortality rate is very high.

Objective to determine the normal value of serum free light chain (sFLC) in Chinese, and to evaluate the clinical significance of sFLC in the diagnosis and efficacy judgment of patients with multiple myeloma (MM). Methods sFLC levels in 63 healthy subjects were detected by automatic immunoturbidimetry, and their normal reference intervals were determined. The same method was used to detect sFLC levels in 72 patients with MM at different disease stages, and the clinical significance of sFLC was evaluated by comparing with traditional M protein detection methods. Results (1) The 95% reference intervals of sFLC-κ and sFLC-λ in healthy subjects were (9~29) mg/L and (15~34) mg/L, respectively, and the median value of sFLC-κ/λ ratio was 0.59 and the 100% reference interval was 0.27~2.49. (2) Among the newly treated MM patients, the 95% reference intervals of sFLC-κ and sFLC-λ in MM (κ-MM) patients with increased κ were (53~14 100) mg/L and (0~97) mg/L, respectively, and the median value of sFLC-κ/λ ratio was 10.27. There was no correlation between age and sFLC-κ, sFLC-λ concentration and sFLC-κ/λ ratio (P =0.861). (4) The sensitivity and specificity of nephelometry and immune fixation were 100% vs 73.7% and 100% vs 44.4%, respectively. The sensitivity and specificity of nephelometric assay and IFE assay were 100% vs 68.8% and 100% vs 58.3% respectively.The presence of monoclonal M protein can still be detected by nephelometric assay in patients with MM who reached complete remission after treatment. Conclusion A normal reference interval of sFLC-κ, sFLC-λ and sFLC κ/λ in Chinese was obtained for the first time.Automated immunoturbidimetric assay for the detection of sFLC can improve the positive rate and the accuracy of curative effect judgment in patients with MM at first diagnosis.

The patient was a 43-year-old male with recurrent abdominal distension and discomfort for more than 2 months. Two months ago, the patient had abdominal distension with nausea and vomiting without obvious trigger, no fever or abdominal pain, gradual decrease in appetite, obvious abdominal distension after eating, no diarrhea and melena, no coffee-like substances, no fatigue, weight loss of 15 kg, stool 3-4 times a day, constipation, no pus and blood in stool and tenesmus.