关键词： 胶囊内镜   小肠镜   小肠疾病   诊断性试验   Meta分析  

摘要： 目的系统评价胶囊内镜和小肠镜对小肠疾病的诊断价值。方法计算机检索PubMed、The Cochrane Library、Web of Science、CNKI、WanFang Data、CBM和VIP数据库,搜集有关胶囊内镜和小肠镜对小肠疾病诊断价值的研究,检索时限均从建库至2020年8月31日。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件和Meta-Disc 1.4软件进行Meta分析。结果共纳入20个研究,胶囊内镜的合并敏感度(SEN)、特异度(SPE)、诊断比值比(DOR)、阳性似然比(PLR)和阴性似然比(NLR)分别为0.86[95%CI(0.83,0.87)]、0.81[95%CI(0.78,0.84)]、117.07[95%CI(37.98,360.92)]、7.20[95%CI(2.81,18.45)]和0.11[95%CI(0.06,0.21)];小肠镜的SEN、SPE、DOR、PLR和NLR分别为0.89[95%CI(0.87,0.90)]、0.91[95%CI(0.89,0.93)]、196.99[95%CI(72.63,534.26)]、13.26[95%CI(5.00,35.14)]和0.12[95%CI(0.07,0.21)]。胶囊内镜和小肠镜的工作特征曲线(SROC)下面积(AUC)分别为0.9692和0.9783。结论胶囊内镜和小肠镜在诊断小肠疾病方面均有较高的特异度与灵敏度;与胶囊内镜相比,小肠镜对部分类型小肠疾病的诊断价值可能更高。受纳入研究数量和质量的限制,上述结论尚需更多高质量研究予以验证。

关键词： 肛肠疾病   病原菌分布   术后感染   抗菌药物   预防用药  

摘要： 目的:分析医院肛肠疾病患者术后感染病原菌的分布及其耐药情况,为此类患者术后感染用药提供参考。方法:选取2016年1月—2020年1月期间医院肛肠科收治的行手术治疗患者3 026例病历资料,统计其患者不同肛肠疾病(肛裂、肛周囊肿、肛瘘、痔疮如混合痔、外痔、内痔)术后感染的病原菌培养和药敏结果,分析其术后感染主要病原菌的分布及其耐药特点。结果:3 026例患者分泌物中,分离出203株病原菌,其中革兰阳性菌占38.42%、革兰阴性菌占61.58%;革兰阳性菌中的表皮葡萄球菌、金黄色葡萄球菌、粪肠球菌,与革兰阴性菌中的大肠埃希菌、肺炎克雷伯菌、奇异变形杆菌是患者术后感染的主要病原菌,而同一菌株在不同肛肠疾病术后患者所占比差异较大;药敏结果发现金黄色葡萄球菌对青霉素、头孢唑林、庆大霉素的耐药率较高,表皮葡萄球菌对青霉素、氨苄西林、环丙沙星、头孢唑林的耐药率较高;粪肠球菌对青霉素、环丙沙星、庆大霉素的耐药率相近,而对利福平、利奈唑胺较为敏感。结论:革兰阴性菌中表皮葡萄球菌、金黄色葡萄球菌和粪肠球菌是肛肠疾病患者术后感染的主要病原菌,临床应结合药敏结果选用敏感率高的抗菌药物针对性预防用药治疗,抑制病原菌的繁殖,以减少术后感染的发生。

关键词： Artificial intelligence   Machine learning   Inflammatory bowel disease   Crohn’s disease   Ulcerative colitis   Clinical outcomes  

摘要： Inflammatory bowel disease(IBD)is a complex and multifaceted disorder of the gastrointestinal tract that is increasing in incidence worldwide and associated with significant *** rapid accumulation of large datasets from electronic health records,high-definition multi-omics(including genomics,proteomics,transcriptomics,and metagenomics),and imaging modalities(endoscopy and endomicroscopy)have provided powerful tools to unravel novel mechanistic insights and help address unmet clinical needs in *** the application of artificial intelligence(AI)methods has facilitated the analysis,integration,and interpretation of large datasets in IBD,significant heterogeneity in AI methods,datasets,and clinical outcomes and the need for unbiased prospective validations studies are current barriers to incorporation of AI into clinical *** purpose of this review is to summarize the most recent advances in the application of AI and machine learning technologies in the diagnosis and risk prediction,assessment of disease severity,and prediction of clinical outcomes in patients with IBD.

关键词： COVID-19   Inflammatory bowel diseases   Advanced glycation   Angiotensinconverting enzyme 2   Alarmins   Receptor for advanced glycation end-products   Receptor for advanced glycation end-products axis   Inflammation  

摘要： Compelling evidence supports the crucial role of the receptor for advanced glycation end-products(RAGE)axis activation in many clinical *** the beginning of the coronavirus disease 2019 pandemic,there is an increasing concern about the risk and handling of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection in inflammatory gastrointestinal disorders,such as inflammatory bowel diseases(IBD).However,clinical data raised during pandemic suggests that IBD patients do not have an increased risk of contracting SARS-CoV-2 infection or develop a more severe course of *** the present review,we intend to highlight how two potentially important contributors to the inflammatory response to SARS-CoV-2 infection in IBD patients,the RAGE axis activation as well as the cross-talk with the renin-angiotensin system,are dampened by the high expression of soluble forms of both RAGE and the angiotensin-converting enzyme(ACE)*** soluble form of RAGE functions as a decoy for its ligands,and soluble ACE2 seems to be an additionally attenuating contributor to RAGE axis activation,particularly by avoiding the transactivation of the RAGE axis that can be produced by the virus-mediated imbalance of the ACE/angiotensin II/angiotensin II receptor type 1 pathway.

关键词： 针刺痔疮穴   中药熏洗   肛裂  

摘要： 目的系统评价针刺痔疮穴联合中药熏洗对肛肠术后的临床疗效。方法检索CNKI、WANFANG Data等数据库自建库至2020年10月关于针刺痔疮穴联合中药熏洗治疗肛肠疾病术后疗效的随机对照试验研究,采用RevMan5.3软件进行Meta分析。结果共纳入9个定量合成Meta分析的CRT,包含1144例患者。Meta分析显示,两组总有效率[RR=1.19,95%CI(1.14,1.24),P<0.00001],干预7及14 d疼痛程度[MD=-0.99,95%CI(-1.07,-0.91),P<0.00001]、[MD=-0.85,95%CI(-0.95,-0.74),P<0.00001],疼痛消失时间[MD=-2.93,95%CI(-3.25,-2.61),P<0.00001],渗出物消失时间[MD=-3.38,95%CI(-3.68,-3.08),P<0.00001],水肿消失时间[MD=-2.84,95%CI(-3.15,-2.53),P<0.00001]及创面愈合时间[MD=-6.21,95%CI(-6.98,-5.44),P<0.00001]比较,差异有统计学意义(P<0.05)。结论针刺痔疮穴联合中药熏洗能够减轻肛肠疾病术患者疼痛程度,缩短疼痛、渗出物及水肿消失时间以及创面愈合时间。

关键词： Inflammatory bowel disease   Endoscopy   Crohn’s disease   Ulcerative colitis   Therapeutic endoscopy   Surveillance  

摘要： Inflammatory bowel disease,encompassing Crohn’s disease(CD)and ulcerative colitis,are chronic immune-mediated inflammatory bowel diseases(IBD)that primarily affect the gastrointestinal tract with periods of activity and *** body of evidence exist to strengthen the prognostic role of endoscopic evaluation for both disease activity and severity and it remains the gold standard for the assessment of mucosal *** healing has been associated with improved clinical outcomes with prolonged remission,decreased hospitalization,IBD-related surgeries and colorectal cancer ***,endoscopic objectives in IBD have been incorporated as part of standard *** the known increased risk of colorectal cancer in IBD,although prevention strategies continue to develop,regular surveillance for early detection of neoplasia continue to be paramount in IBD patients’*** is thanks to evolving technology and visualization techniques that surveillance strategies are continuously *** endoscopic options in IBD have also been expanding,from surgery sparing therapies such as balloon dilation of fibrostenotic strictures in CD to endoscopic mucosal resection of neoplastic *** this review article,we discuss the current evidence on the use of endoscopy as part of standard of care of IBD,its role in surveillance of neoplasia,and the role of interventional endoscopic therapies.

关键词： 肛肠疾病   手术治疗   围手术期   中西医结合镇痛  

摘要： 目的探讨中西医结合无痛化治疗模式对肛肠疾病围手术期镇痛的效果。方法选取痔疮、肛裂、肛周脓肿及肛瘘患者324例,随机分为两组。观察组选用中西医结合的镇痛方法,对照组只选用西医镇痛方法,观察术后首次排气、首次排便时间,应用VAS评分评判术后4 h、12 h、1 d、2 d、3 d、5 d肛周疼痛,术前1 h及术后4 h、12 h、1d、2 d、3 d、5 d抽取肘静脉检测血清5-羟色胺(5-HT)浓度。结果两组首次排便时间有统计学差异(P<0.05);术后4 h、12 h、1 d、2 d、3 d、5 d时间节点肛周疼痛VAS评分两组比较差异具有统计学意义(P均<0.05);术前1 h及术后4h、12 h、1 d、2 d、3 d、5 d时间节点血清5-HT浓度两组比较差异具有统计学意义(P均<0.05)。结论采用中西医结合的无痛化治疗模式对肛肠疾病围手术期患者的镇痛效果良好。

关键词： inflammatory bowel disease   pathogenesis   etiology   microbiome   dysbiosis   therapy  

摘要： Inflammatory bowel disease(IBD)has become a global disease with accelerating incidence worldwide in the 21st century while its accurate etiology remains *** the past decade,gut microbiota dysbiosis has consistently been associated with *** many IBDassociated dysbiosis have not been proven to be a cause or an effect of IBD,it is often hypothesized that at least some of alteration in microbiome is protective or *** this article,we selectively reviewed the hypothesis supported by both association studies in human and pathogenesis studies in biological ***,we reviewed the potential protective bacterial pathways and species against IBD,as well as the potential causative bacterial pathways and species of *** also reviewed the potential roles of some members of mycobiome and virome in ***,we covered the current status of therapeutic approaches targeting microbiome,which is a promising strategy to alleviate and cure this inflammatory disease.

关键词： 肠疾病   基因  

摘要： 对于不明原因的腹痛、腹泻、发热,临床诊断相当困难。这些症状不一定是由于肠道疾病引起,也可能由于血管、药物、遗传代谢等疾病所致。除了感染性、免疫性、肿瘤性、血管源性、药物性原因外,更为疑难的是与遗传基因相关的肠道疾病,需要结合临床症状、体征、实验室检查、内镜检查及影像学检查,最终结合基因检测明确诊断。