关键词： inflammatory bowel disease   genetics   myelosuppression   thiopurine  

摘要： IMPORTANCE Use of thiopurines may be limited by myelosuppression. TPMT pharmacogenetic testing identifies only 25% of at-risk patients of European ancestry. Among patients of East Asian ancestry, NUDT15 variants are associated with thiopurine-induced myelosuppression (TIM). OBJECTIVE To identify genetic variants associated with TIM among patients of European ancestry with inflammatory bowel disease (IBD). DESIGN, SETTING, AND PARTICIPANTS Case-control study of 491 patients affected by TIM and 679 thiopurine-tolerant unaffected patients who were recruited from 89 international sites between March 2012 and November 2015. Genome-wide association studies (GWAS) and exome-wide association studies (EWAS) were conducted in patients of European ancestry. The replication cohort comprised 73 patients affected by TIM and 840 thiopurine-tolerant unaffected patients. EXPOSURES Genetic variants associated with TIM. MAIN OUTCOMES AND MEASURES Thiopurine-induced myelosuppression, defined as a decline in absolute white blood cell count to 2.5 x 10(9)/L or less or a decline in absolute neutrophil cell count to 1.0 x 10(9)/L or less leading to a dose reduction or drug withdrawal. RESULTS Among 1077 patients (398 affected and 679 unaffected;median age at IBD diagnosis, 31.0 years [interquartile range, 21.2 to 44.1 years];540 [50%] women;602 [56%] diagnosed as having Crohn disease), 919 (311 affected and 608 unaffected) were included in the GWAS analysis and 961 (328 affected and 633 unaffected) in the EWAS analysis. The GWAS analysis confirmed association of TPMT (chromosome 6, rs11969064) with TIM (30.5% [95/311] affected vs 16.4% [100/608] unaffected patients;odds ratio [OR], 2.3 [95% CI, 1.7 to 3.1], P = 5.2 x 10(-9)). The EWAS analysis demonstrated an association with an in-frame deletion in NUDT15 (chromosome 13, rs746071566) and TIM (5.8% [19/328] affected vs 0.2% [1/633] unaffected patients;OR, 38.2 [95% CI, 5.1 to 286.1], P = 1.3 x 10(-8)), which was replicated in a different c

关键词： Chronic fatigue syndrome (CFS)   Myalgic encephalomyelitis (ME)   Inflammatory bowel disease   Oxidative and nitrosative stress (O&NS) pathways   Microbiota-gut-brain interactions   Bacterial translocation   Immunoinflammatory pathways  

摘要： BackgroundSimilarities in the symptoms of chronic fatigue syndrome (CFS) and inflammatory bowel disease (IBD) have been observed as follows: severe disease activity in IBD correlates with severe fatigue, major psychiatric signs, the common use of medication, and bacterial translocation. One of several hypotheses for explaining the mechanisms underlying CFS suggests a similarity to the impaired intestinal mucosa of IBD. This study investigated the risk of incident CFS among patients with *** conducted a population-based retrospective cohort study by using Taiwan's National Health Insurance Research Database to evaluate the subsequent risk of CFS in patients with IBD, according to demographic characteristics and comorbidities. The exposure cohort comprised 2163 patients with new diagnoses of IBD. Each patient was randomly selected and frequency matching according to gender and age with four participants from the general population who had no history of CFS at the index date (control cohort). Cox proportional hazards regression analysis was conducted to estimate the relationship between IBD and the subsequent risk of *** exposure cohort had a significantly higher overall risk of subsequent CFS than that of the control group [adjusted hazard ratio (Christophi in Inflamm Bowel Dis 18(12):2342-2356, 2012)=2.25, 95%, confidence interval (Aaron and Buchwald in Ann Intern Med 134(9 Pt 2):868-881, 2001;Farraye et al. in Am J Gastroenterol 112:241, 2017) 1.70-2.99]. Further analysis indicated a significantly higher risk of CFS in patients who were male (HR=3.23, 95% CI 2.12-4.91), were older than 35years, and had IBD but without comorbidity status, e.g. Cancers, diabetes, obesity, depression, anxiety, sleep disorder, renal disease (HR=2.50, 95% CI 1.63-3.84) after *** findings from this population-based retrospective cohort study suggest that IBD, especially Crohn's disease, is associated with an increased risk of subsequent CFS.

关键词： Alginate   microcapsules   aerosols   targeted drug delivery   colonic drug delivery  

摘要： Nigella sativa extract (NSE) was incorporated in alginate microcapsules using aerosolisation and homogenisation methods, respectively, with the aim of delivering high concentrations of the active species, thymoquinone (TQ), directly to sites of inflammation in the colon following oral administration. Encapsulation of NSE was accomplished either by direct loading or diffusion into blank microparticles. Microcapsules in the size range 40-60 mu m exhibited significantly higher NSE loading up to 42% w/w and encapsulation efficiency (EE) up to 63% when the extract was entrapped by direct encapsulation compared with 4.1 w/w loading, 6.2% EE when NSE was incorporated by diffusion loading. Sequential exposure of samples to simulated intestinal fluids (SIFs) revealed that the microcapsules suppressed NSE release in simulated gastric fluid (SGF) for 2 h and SIF for 4 h and liberated most of the NSE content (80%) in simulated colonic fluid (SCF) over 18 h. NSE released in SCF at 12 h exhibited antioxidant activity, when measured using the 1,1-diphenyl-2-picryl-hydrazyl (DPPH) assay at levels comparable with the activity of unencapsulated extract. These findings demonstrate the potential of oral alginate microcapsules as highly efficient, targeted carriers for colonic delivery of NSE in the treatment of inflammatory bowel disease.

关键词： Clinical trials   Microbiome   Exercise   Body composition  

摘要： Background: Overweight and metabolic problems now add to the burden of illness in patients with Inflammatory Bowel Disease. We aimed to determine if a program of aerobic and resistance exercise could safely achieve body composition changes in patients with Inflammatory Bowel Disease. Methods: A randomized, cross-over trial of eight weeks combined aerobic and resistance training on body composition assessed by Dual Energy X-ray Absorptiometry was performed. Patients in clinical remission and physically inactive with a mean age of 25 +/- 6.5 years and Body Mass Index of 28.9 +/- 3.8 were recruited from a dedicated Inflammatory Bowel Disease clinic. Serum cytokines were quantified, and microbiota assessed using metagenomic sequencing. Results: Improved physical fitness was demonstrated in the exercise group by increases in median estimated VO2max (Baseline: 43.41 mls/kg/min;post-intervention: 46.01 mls/kg/min;p = 0.03). Improvement in body composition was achieved by the intervention group (n = 13) with a median decrease of 2.1% body fat compared with a non-exercising group (n = 7) (0.1% increase;p = 0.022). Lean tissue mass increased by a median of 1.59 kg and fat mass decreased by a median of 1.52 kg in the exercising group. No patients experienced a deterioration in disease activity scores during the exercise intervention. No clinically significant alterations in the alpha- and beta- diversity of gut microbiota and associated metabolic pathways were evident. Conclusions: Moderate-intensity combined aerobic and resistance training is safe in physically unfit patients with quiescent Inflammatory Bowel Disease and can quickly achieve favourable body compositional changes without adverse effects.

摘要： The article outlines five facts about inflammatory bowel disease in children and adolescents. Topics include the diagnostic delay common in pediatric inflammatory bowel disease, the occurrence of extraintestinal manifestations of pediatric inflammatory bowel disease before diagnosis, and the relevance of fecal calprotectin testing in the diagnosis.

关键词： 肛肠疾病   术后镇痛   硫酸吗啡   疗效观察   临床资料   手术治疗   手术方式   肛肠科  

摘要： 笔者将硫酸吗啡栓用于肛肠疾病术后镇痛,效果满意,现总结报道如下.临床资料:2017年10月至2018年5月,我院肛肠科共收治拟行手术治疗的肛肠疾病患者160例,年龄18~85岁,ASA级Ⅱ~Ⅲ级.按数字表法随机分为治疗组和对照组,各80例.2组患者性别、年龄、病种及手术方式等方面比较差异均无统计学意义(P>0.05),具有可比性.

关键词： Iron deficiency anemia   intravenous iron   Crohn's disease   ulcerative colitis   child   adolescent  

摘要： Objectives: To evaluate the therapeutic response and adverse effects of Noripurum EV (R) in children and adolescents with inflammatory bowel disease (IBD) and iron deficiency *** and methods: Cohort study involving patients with Crohn's disease (CD) and ulcerative colitis (UC) who received treatment for iron deficiency anemia with Noripurum EV (R). Anemia was defined according to WHO 2011 criteria. Iron deficiency anemia was established when ferritin <30 mu g/l and transferrin saturation <16%. Iron deficiency anemia and anemia of chronic disease were established when ferritin was between 30 and 100 mu g/l and transferrin saturation <16%. The total dose of Noripurum EV (R) was estimated by the Ganzoni formula and divided into weekly administrations. When there was an increase in hemoglobin (Hb) by a minimum of 2g/dl and or when Hb reached the target determined by WHO, treatment was considered a therapeutic ***: Noripurum EV (R) was administered to 16 patients (9.3% of total patients with IBD). Ten (65.5%) were male, the mean (SD) age was 11.3(4.6) years old, 75%(12/16) had CD and 25%(4/16) had UC. All patients presented an increase in Hb (p<.001) at a mean (SD) of 2.8(1.3)g/dl, after median and interquartile range(IQR) of 4.5(3.0-6.0) weeks that iron infusions were completed. It was found that the proportion of patients that achieved therapeutic success (68.8%) was statistically higher (p=.031) than those who did not (31.2%). No adverse events were ***: Noripurum EV (R) in pediatric patients with IBD and iron deficiency anemia was effective and safe, making it an appropriate option for the clinical management of these patients.

关键词： 疼痛护理   肛肠疾病   术后   换药   影响  

摘要： 临床上肛肠疾病多则可达100余种,该类疾病多发生在肛门、大肠等部位,具体的肛肠疾病包括痔疮、肛周脓肿、肛瘘等,这些疾病的临床症状多表现为肛门和腹部疼痛,便血、便秘等。从肛肠疾病的发病原因来看,其主要涉及到的两个方面,即患者自身的生理、遗传等原因,以及患者日常排便、饮食等不良习惯原因导致。临床上治疗肛肠疾病通常多选用手术治疗,但手术治疗后多会出现疼痛,轻度疼痛会给患者带来痛苦,严重则会直接影响到手术的效果,并且在进行术后换药当中若未加以注意则可能会加重患者疼痛。就此,本文将重点分析对肛肠疾病术后患者实施疼痛护理的方法,以及该护理对患者术后换药疼痛的影响。