关键词： 肛肠疾病   术后   中药熏洗  

摘要： 探究在肛肠手术后实施中药熏洗的价值。方法:采用计算机随机分组法将2016.03.06日-2017.03.05日在本院接受手术治疗的65例肛肠疾病患者分成两小组,一组有33例,采取中药熏洗技术(观察组),另一组有32例,实施红外线理疗(对照组)。对比两小组病患的肛门疼痛分数、各症状消失时间、创口痊愈时间。结果:治疗后肛门疼痛分数相比,观察组(2.06±0.31分)更低,各症状消失及创口痊愈时间相比,观察组(便血消失-6.36±1.02天,肛缘水肿消失-7.14±1.25天,疼痛消失-6.23±1.06天,创口痊愈-10.25±1.56天)更短(p<0.05)。结论:中药熏洗技术值得应用在肛肠手术术后,药用价值十分明显。

关键词： Inflammatory bowel disease (IBD)   Drug targeting   Phospholipid-drug conjugate   Oral prodrug   Prodrug-activating enzyme   Phospholipase A(2)(PLA(2))  

摘要： The enzyme phospholipase A(2)(PLA(2)) is overexpressed in the inflamed intestine in inflammatory bowel disease (IBD) patients, and in this work we aimed to exploit PLA(2) as a prodrug-activating enzyme for a novel PL-drug conjugate, thereby liberating the free drug specifically in the targeted diseased tissue(s). The proposed prodrug contains a drug moiety covalently bound through a linker to the sn-2 position of a phospholipid (PL). The NSAID diclofenac was used as model molecule, and four different linker lengths (2, 4, 6 and 8 - CH2 units) were studied. The four PL-diclofenac conjugates were synthesized and characterized by LC/MS and NMR. PLA(2)- mediated activation of the prodrugs was analyzed in-vitro, and the remaining intact complex and free drug liberation were assessed after incubation with PLA(2). The rate and degree of PLA(2)- mediated activation were highly dependent on the linker length;2- and 4-carbon linker conjugates were activated to lower extent than the 6-carbon conjugate, and longer linker again decreased the affinity towards PLA2. The 6-carbon linker conjugate was found to be the optimal and released similar to 95% of the free drug after incubation with PLA2, whereas only similar to 20% were delivered by the 2- carbon linker prodrug. The 6-carbon linker conjugate was shown to be stable in intestinal perfusate, fresh plasma, and pH 4.0 and 6.8 buffers, but not at pH 1.0. In conclusion, the results of this work confirm the feasibility of our general aim to exploit PLA(2) as a prodrug-activating enzyme of PL-drug conjugates. This may provide a novel oral drug targeting approach in IBD therapy.

关键词： Surface-deacetylated chitin nanofibers   Sulfobutyl ether beta-cyclodextrin   Elastic gel   Colitis   Drug incorporation in gels   Release properties  

摘要： Surface-deacetylated chitin nanofibers (SDACNFs) reinforced with a sulfobutyl ether beta-cyclodextrin (SBE-beta-CD) (NFs-CDs) gel were developed to obtain a controlled release carrier of prednisolone (PD) for the treatment of colitis. PD was released slowly from the gel at both pH 1.2 and 6.8. The in vitro slow releaseof PD from the NFs-CDs gel was reflected in the in vivo absorption of the drug after oral administration to rats. These results suggest that a simple gel composed of a mixture of SDACNFs and SBE-beta-CD has the potential for use in the controlled release of PD. We also evaluated the therapeutic effects of the NFs-CDs gel containing PD on dextran sulfate sodium (DSS)-induced colitis model mice. The administration of the NFs-CDs gel at intervals of 3 days from the beginning of the DSS treatment resulted in a significant improvement, not only in colitis symptoms but also histopathological changes in colon tissue. In addition, the therapeutic effects of the NFs-CDs gel on colitis can be attributed to decreased levels of neutrophil infiltration and the development of oxidative stress. These efficacy profiles of the NFs-CDs gel containing PD suggest that it has the potential for use in the treatment of, not only colitis, but also a variety of other disorders associated with inflammation and oxidative injuries. (C) 2017 Elsevier Ltd. All rights reserved.

关键词： Biomimetics  

摘要： Inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis, is a chronic inflammatory condition of the gastrointestinal (GI) tract. Currently, it is treated with immunosuppressant or biologics that often induce severe adverse effects. Thus, there is an urgent clinical need for more specific treatments. To provide a valid therapeutic tool for IBD therapy, in this work we developed biomimetic nanovesicles by manipulating leukocyte membranes to exploit mechanisms of T-cell recruitment during inflammation. A subset of T-lymphocytes participates in homing to inflamed tissue in the gastrointestinal tract by overexpressing the alpha 4 beta 7 integrin, which is responsible for binding to its receptor on the endothelial membrane, the mucosal addressin cell adhesion molecule 1. Based on this principle, we engineered biomimetic vesicles, referred to as specialized leukosomes (SLKs), which are leukocyte-like carriers 'doped' with the alpha 4 beta 7 integrin over-induced in purified immune cells. We tested SLKs in an in vivo murine model of IBD induced by treatment with dextran sulfate sodium. Notably, treatment of IBD mice with SLKs allowed us to observe a reduction of inflammation (favorable modulation of both pro-and antiinflammatory genes, as well as reduction of immune cells infiltration into the colon tissue), and a consequent enhanced intestinal repair (low epithelial damage). In this study, we demonstrate that biologicalderived nanoparticles can be used not only as naturally targeted drug delivery systems, but also as nano-therapeutics endowed with intrinsic anti-inflammatory properties.

关键词： 2-PMPA   Colitis   TNBS   Hypotonic   Folate polyglutamate   N-acetyl-aspartyl glutamate  

摘要： Here we evaluate the potential for local administration of a small molecule FOLH1/GCPII inhibitor 2-phosphonomethyl pentanedioic acid (2-PMPA) as a novel treatment for inflammatory bowel disease (IBD). We found that FOLH1/GCPII enzyme activity was increased in the colorectal tissues of mice with TNBS-induced colitis, and confirmed that 2-PMPA inhibited FOLH1/GCPII enzyme activity ex vivo. In order to maximize local enema delivery of 2-PMPA, we studied the effect of vehicle tonicity on the absorption of 2-PMPA in the colon. Local administration of 2-PMPA in a hypotonic enema vehicle resulted in increased colorectal tissue absorption at 30 min compared to 2-PMPA administered in an isotonic enema vehicle. Furthermore, local delivery of 2-PMPA in hypotonic enema vehicle resulted in prolonged drug concentrations for at least 24 h with minimal systemic exposure. Finally, daily treatment with the hypotonic 2-PMPA enema ameliorated macroscopic and microscopic symptoms of IBD in the TNBS-induced colitis mouse model, indicating the potential of FOLH1/GCPII inhibitors for the local treatment of IBD. (C) 2017 Elsevier B.V. All rights reserved.

关键词： 无痛胃肠镜   胃肠疾病   全程   整体护理  

摘要： 目的:分析无痛胃肠镜诊疗胃肠疾病的全程整体护理。方法:选取笔者所在医院在2016年1-12月收治的106例胃肠疾病患者为本次研究对象,并随机为研究组和对照组,各53例。两组胃肠疾病患者均给予无痛胃肠镜诊疗,对照组在治疗过程中采取常规的护理措施,研究组在此基础上采取全程整体护理措施,分析两组患者的护理效果。结果:研究组患者的治疗总有效率和护理满意度均优于对照组,差异有统计学意义(P<0.05);研究组患者的住院时间明显短于对照组,差异有统计学意义(P<0.05);研究组患者的不良反应发生率明显低于对照组,差异有统计学意义(P<0.05)。结论:胃肠疾病患者在无痛胃肠镜诊疗过程中给予全程整体护理干预的意义重大,不仅可以提高治疗效果和护理满意度,还可大大缩短住院时间,减少不良反应的发生,安全性比较高,值得临床推广。

关键词： 肠疾病   术后创面   发病机理   肛裂   愈合  

摘要： 肛裂为何难以愈合？ 许多肛裂患者可能都有这样的疑问，为什么痔疮术后创面能够愈合，而肛裂创面却难以愈合？要回答这一问题，必须从肛裂的发病机理说起。

关键词： 胶囊内镜   小肠疾病   诊断   应用价值   安全性  

摘要： 目的分析胶囊内镜在小肠疾病诊断中的应用价值和安全性。方法 400例接受胶囊内镜检查的患者,对检查结果进行观察分析。结果全部400例患者中,396例患者将胶囊顺利吞下,4例患者在胃镜辅助下将胶囊放置到十二指肠球部。胶囊内镜诊断出血性病变的阳性率为65.0%,诊断慢性腹痛的阳性率为36.8%,诊断慢性腹泻的阳性率为32.0%,诊断腹部不适的阳性率为27.0%,胶囊内镜诊断出血性病变的阳性率显著高于其他病变的阳性率,差异均具有统计学意义(P<0.05)。胶囊内镜的检查时间为(478.5±5.7)min;胶囊排出体外的平均时间为(21.2±2.5)h,全部回收胶囊均没有出现破损,胶囊内镜的拍摄图像清晰,部分图像受到肠液和小肠气泡的影响,图像质量不理想。全部400例患者在胶囊内镜检查时,仅3例患者发生胶囊潴留,其中1例患者需外科手术治疗,1例患者经小肠镜取出,1例患者针对病因治疗后1个月后自行排出,检查顺应性比较理想。结论选择胶囊内镜对小肠疾病进行诊断,具有较高的诊断率,而且胶囊内镜检查无创伤、无痛苦,并发症发生率低,具有较高的安全性,患者容易接受。

关键词： 小肠造影   磁共振成像   肠道疾病  

摘要： 目的探讨小肠MRI造影多序列应用方法及MRI造影对小肠病变的影像诊断.方法使用Philips Achieva 3.0T MR对临床疑诊小肠病变的34例患者进行MR小肠造影(MRE)多序列联合成像.扫描序列包括横断位、冠状位屏气单次激发快速自旋回波T2WI-TSE-BH序列,冠状位平衡稳态自由进动序列(BTFE)、横断位扩散加权成像(DWI)序列及横断位、冠状位3D-THRIVE序列增强扫描.以不同等级评估小肠MRI扫描图像质量.判断各序列的应用价值.结果平扫COR-SSTSE-BH序列压脂图像显示最佳,评估炎症性肠病的活动性弥散序列应用价值较高,联合3D-THRIVE序列增强图像能为临床提供定性诊断.结论 MRE多序列联合扫描图像信息量大,敏感度高,对诊断小肠疾病有重要价值.

关键词： 中医肛肠科学   从脾胃论治   气血治法   名医经验   潘友珍  

摘要： 潘友珍主任为上海市浦东新区名中医,治疗肛肠疾病经验丰富。其认为脾为后天之本,又为诸病之源,肛肠疾病与之关系最为密切,分别从脾胃论治便秘及慢性非特异性溃疡性结肠炎;又认为气血通畅、阴阳平衡乃人体健康之本,将调理气血阴阳用到肛肠术后伤口难愈的病症中,收效明显;在专病诊治中通过望、问、触精准辨识肛周脓肿是否成脓,准确把握了治疗时机;治疗痔以减轻患者痛苦、缩短病程、延缓复发为宗旨,采用外剥内套扎术治疗;同时应用中药保留灌肠治疗肛肠疾病如肛窦炎、直肠炎,疗效显著。