关键词： Vitamin D deficiency   Vitamin D   Medical risk factors   Regression analysis   Ulcerative colitis   Seasons   Crohn's disease   Inflammatory bowel disease  

摘要： Objectives Vitamin D deficiency predicts unfavorable disease outcomes in inflammatory bowel disease. Endogenous vitamin D synthesis is affected by seasonal factors including sunlight exposure, raising the question whether seasonality determines the risk of vitamin D deficiency and may mask other clinical risk factors. Methods Univariable and multiple regression analyses were performed in a retrospective cohort of 384 patients to determine risk factors for vitamin D deficiency. Since the observed 25-hydroxyvitamin D [25(OH) D] concentrations followed a sinusoidal pattern over the year, all 25 (OH) D concentrations were normalized for the predicted variability of the respective day of analysis based on a sinusoidal regression analysis of 25(OH) D test results obtained in more than 86,000 control serum samples. Results Vitamin D deficiency was highly prevalent in patients with Crohn's disease or ulcerative colitis (63% and 55%, respectively) and associated with winter/spring seasons. After normalization of 25(OH) D concentrations for the day of analysis, vitamin D deficiency was associated with histories of complications related to inflammatory bowel disease, surgery, smoking and ongoing diarrhea while initial disease manifestation during adulthood, ongoing vitamin D supplementation and diagnosis of ulcerative colitis vs. Crohn's disease appeared to be protective. Multiple regression analyses revealed that vitamin D deficiency was associated with disease activity in Crohn's disease and anemia in ulcerative colitis patients. Only few deficient patients achieved sufficient 25(OH) D concentrations over time. However, increasing 25(OH) D concentrations correlated with improved Crohn's disease activity. Conclusions Vitamin D deficiency was highly prevalent in patients with Crohn's disease and ulcerative colitis and dependent on the season of the year. Following normalization for seasonality by sinusoidal regression analysis, vitamin D deficiency was found to be associated w

关键词： 品管圈   术后护理   肛肠科  

摘要： 品管圈是一种集体出谋划策解决实际问题的较为灵活的品管形式[1],我院为进一步降低手术后护理的不规范率,在肛肠科病房开展品管圈活动进行试验。活动主题为“降低术后护理不规范率”,针对护理不规范情况进行分析调整,开展活动后护理不规范率下降了10%。肛肠科护士在本次活动后,形成了较强的团队凝聚力,养成了理论学习的习惯,促进了科室内部沟通,具有良好的效果。

关键词： Chitosan microparticles   Mesalazine   Inflammatory bowel diseases   Anti-inflammatory effect   In vivo model  

摘要： The development of innovative strategies for the efficacious treatment of inflammatory bowel diseases (IBD) still remains a goal for pharmaceutical research. Targeting the lower section of the intestine is the main aim of therapy because it is the compartment primarily affected by IBDs. Mesalazine was microencapsulated in chitosan particles in order to modulate its unfavorable pharmacokinetic profile exploiting the bioadhesive feature of the polysaccharide and increase the anti-inflammatory effect of the drug following its rectal administration in an in vivo model of induced IBD. The chitosan microparticles (1-4 mu m mean size) allowed efficient retention of the mesalazine and a prolonged drug release lasting up to 48 h. In vitro and in vivo experiments confirmed the significant mucoadhesion feature of the formulation by means of mucin assay and CLSM experiments and demonstrated its therapeutic efficacy at a drug concentration 2-fold lower than the commercial formulation Asamax (R) (13 mg/kg vs 26 mg/kg).

关键词： 护理干预   围术期   肛肠疼痛患者   术后疼痛  

摘要： 目的:观察并探析护理干预在肛肠疾病术后疼痛中的应用效果.方法:选择我院近2年来收治的142例肛肠科手术患者,按照随机分配原则,将患者划分成对照组和观察组,对照组接受传统的围术期护理方法,观察组在接受传统围术期护理的基础上实施围术期干预护理.分别观察对照组和观察组术后6个小时、24个小时以及36个小时的镇痛药物应用情况以及疼痛登记.使用无记名调查方法评估患者满意度.结果:在完成同一时期的治疗后,观察组术后24小时、72小时的疼痛等级一级率显著超出术后6个小时,并且比对照组相应时段的疼痛一级率高;观察组疼痛等级5级患者例数没有显著变化,但是都比对照组相应每个时段的例数低;观察组术后24个小时、72个小时镇痛药物利用率比对照组相应时段的使用率显著低,具有统计学的意义(P<0.05).结论:对肛肠手术患者实施围术期护理干预对减少患者术后的镇痛药物利用率及疼痛等级,提高患者对肛肠手术患者有关护理的满意程度具有重要意义,值得推广和应用.

关键词： Inflammatory bowel disease   ATP   P2X7 receptor  

摘要： Inflammatory bowel disease is a chronic nonspecific inflammatory disease of the intestine. Its pathogenesis is not yet fully understood. It may be related to heredity, environmental triggers, infection, immune dysfunction and other factors. Purinergic receptor (P2X7R) ligand-gated ion channel is closely related to inflammation and widely expressed in intestinal cells. Previous studies have shown that ATP/P2X7R signal is involved in the pathogenesis of intestinal inflammation, but its specific mechanism needs further study. This article reviews the research progress of P2X7 receptor in inflammatory bowel disease.

关键词： Inflammatory bowel diseases   ultrasound   fecal calprotectin   pediatric   children   diagnosis   Crohn's disease  

摘要： Objective: To assess the accuracy of noninvasive parameters, fecal calprotectin (FC), increased bowel wall thickening (BWT) at intestinal ultrasound (IUS) and blood inflammatory indexes (BII), alone or in combination, as diagnostic tools for inflammatory bowel disease (IBD) in pediatric patients. Methods: Retrospective data were collected on consecutive children (age 2-18 years) referred to our pediatric gastroenterology clinic, for recurrent abdominal pain and/or altered bowel habit from 2007 to 2013. Subjects who had diagnostic workup: laboratory tests (FC, BII, white blood cell (WBC), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)) and IUS as initial assessment were eligible. Subjects with known gastrointestinal (GI) diseases, or signs or symptoms highly suggestive for organic diseases necessitating prompt endoscopy (e.g., perianal disease or rectal bleeding), or who had recently performed endoscopy were excluded. The accuracy of noninvasive tests for detecting IBD was assessed using endoscopic and/or radiological investigations, performed in subsequent clinical follow up, as reference gold standard. Results: Seventy-seven patients (mean age 11.3, 44 males) were included, 23 (29.9%) with a final diagnosis of IBD. As single tests, FC gave the highest sensitivity (96%) but lower specificity (72%) and IUS highest specificity (96%) with lower sensitivity (70%). The combination of FC + IUS showed excellent accuracy for detecting children with IBD with positive predictive value: 100%;negative predictive value: 88.5%. The probability of IBD in children with normal FC, BII and IUS was 0.09%. Conclusions: FC and increased BWT at IUS are accurate to guide reassurance or proceeding with further invasive procedures for detecting IBD in children with mild GI symptoms.

关键词： Inflammatory bowel disease   Crohn's disease   ulcerative colitis   quality of life   Short Health Scale  

摘要： Objectives: Patient reported outcomes are widely used in today's clinical practice. The Short Health Scale has been proven to be an easy-to-use and reliable measure to evaluate quality of life in patients with inflammatory bowel disease. We aimed to validate this Short Health Scale in Dutch speaking ***: A total of 157 Crohn's disease and ulcerative colitis patients (46% male, median age 39years) completed the Short Health Scale on a tablet during the outpatient clinic. Validity was assessed by correlating both individual and total Short Health Scale scores with short Inflammatory Bowel Disease Questionnaire dimensions and clinical disease activity. Test-retest reliability was assessed in eight patients in stable remission who completed the Short Health Scale a second time after ***: All Short Health Scale items correlated with corresponding short Inflammatory Bowel Disease Questionnaire dimensions (correlation coefficients ranging from -0.403 to -0.833, all p<.01). Short Health Scale scores increased stepwise with increasing clinical disease activity (all p<.001). The results of the Short Health Scale questionnaire remained stable on repeated measurements in patients in remission (r(s) between 0.699 and 0.994, all p<.01 except for well-being).Conclusions: The Short health Scale is a rapid and valid instrument for measuring quality of life in Dutch speaking patients with Inflammatory Bowel Disease. Its simplicity and usability make it a good candidate for routine care and suitable for home-monitoring of patients.

关键词： anti-TNF   biological   inflammatory bowel disease   Crohn's disease   ulcerative colitis   paediatrics   children   adolescents  

摘要： Inflammatory bowel disease (IBD) presents with disabling symptoms and may lead to insufficient growth and late pubertal development in cases of disease onset during childhood or adolescence. During the last decade, the role of anti-tumor necrosis factor (TNF) in the treatment of paediatric-onset IBD has gained more ground. The number of biologicals presently available for children and adolescents with IBD has increased, biosimilars have become available, and practices in adult gastroenterology with regards to anti-TNF have changed. The aim of this study is to review the current evidence on the indications, judicious use, effectiveness and safety of anti-TNF agents in paediatric IBD. A PubMed literature search was performed and included articles published after 2000 using the following terms: child or paediatric, Crohn, ulcerative colitis, inflammatory bowel disease, anti-TNF, TNF alpha inhibitor, infliximab, adalimumab, golimumab and biological. Anti-TNF agents, specifically infliximab and adalimumab, have proven to be effective in moderate and severe paediatric IBD. Therapeutic drug monitoring increases therapy effectiveness and safety. Clinical predictors for anti-TNF response are currently of limited value because of the variation in outcome definitions and follow-ups. Future research should comprise large cohorts and clinical trials comparing groups according to their risk profile in order to provide personalized therapeutic strategies.

关键词： Inflammatory bowel disease (IBD)   Biodosimetry   Gene expression   Inflammation   Mouse model  

摘要： BackgroundIonizing Radiation (IR) is a known pro-inflammatory agent and in the process of development of biomarkers for radiation biodosimetry, a chronic inflammatory disease condition could act as a confounding factor. Hence, it is important to develop radiation signatures that can distinguish between IR-induced inflammatory responses and pre-existing disease. In this study, we compared the gene expression response of a genetically modified mouse model of inflammatory bowel disease (Il10(-/-)) with that of a normal wild-type mouse to potentially develop transcriptomics-based biodosimetry markers that can predict radiation exposure in individuals regardless of pre-existing inflammatory ***-type (WT) and Il10(-/-) mice were exposed to whole body irradiation of 7Gy X-rays. Gene expression responses were studied using high throughput whole genome microarrays in peripheral blood 24h post-irradiation. Analysis resulted in identification of 1962 and 1844 genes differentially expressed (p<0.001, FDR<10%) after radiation exposure in Il10(-/-) and WT mice respectively. A set of 155 genes was also identified as differentially expressed between WT and Il10(-/-) mice at the baseline pre-irradiation level. Gene ontology analysis revealed that the 155 baseline differentially expressed genes were mainly involved in inflammatory response, glutathione metabolism and collagen deposition. Analysis of radiation responsive genes revealed that innate immune response and p53 signaling processes were strongly associated with up-regulated genes, whereas B-cell development process was found to be significant amongst downregulated genes in the two genotypes. However, specific immune response pathways like MHC based antigen presentation, interferon signaling and hepatic fibrosis were associated with radiation responsive genes in Il10(-/-) mice but not WT mice. Further analysis using the IPA prediction tool revealed significant differences in the predicted activation status of