关键词： 痔术后   排便   穴位贴敷法  

摘要： 目的:观察中药贴敷促进肛肠疾病术后排便的疗效。方法:对混合痔外剥内扎术后患者采用大黄9 g、枳实9 g、芒硝6 g贴敷于神阙、天枢等穴位进行治疗,术后连续治疗5 d,每天更换1次。结果:术后2 d有效率60%,术后3 d有效率85%,术后4 d有效率97%,术后5 d有效率100%。结论:中药穴位贴敷促进痔术后排便具有良好的疗效,是一种使用方便、疗效突出的中医特色治疗方法。

关键词： 肛肠疾病   康复治疗   应用   防治   女性   盆底   器质性疾病   功能性  

摘要： 所有发生于肛门、结肠和直肠的疾病都属于广义肛肠疾病范畴，从狭义上讲主要指发生于肛门和直肠的一系列功能性和器质性疾病，本文所指肛肠疾病主要为后者。

关键词： Crohn's Disease   Interferon lambda   Ulcerative Colitis   Wound Healing  

摘要： BACKGROUND & AIMS: We investigated the roles of interleukin 28A (also called IL28A or interferon l2) in intestinal epithelial cell (IEC) activation studying its effects in mouse models of inflammatory bowel diseases (IBD) and intestinal mucosal healing. METHODS: Colitis was induced in C57BL/ 6JCrl mice (controls) mice with IEC-specific disruption of Stat1 (Stat1IEC-KO) mice with disruption of the interferon l receptor 1 gene (Il28ra(-/-)) and mice with disruption of the interferon regulatory factor 3 gene (Irf3(-/-)) with or without disruption of Irf7 (Irf7(-/-)). We used high-resolution mini-endoscopy and in vivo imaging methods to assess colitis progression. We used 3-dimensional small intestine and colon organoids along with RNA-Seq and gene ontology methods to characterize the effects of IL28 on primary IECs. We studied the effects of IL28 on the human intestinal cancer cell line Caco-2 in a wound-healing assay and in mice colon wounds. Colonic biopsies and resected tissue from patients with IBD (n 62) and patients without colon inflammation (controls n 23) were analyzed by quantitative polymerase chain rection to measure expression of IL28A IL28RA and other related cytokines;biopsy samples were also analyzed by immunofluorescence to identify sources of IL28 production. IECs were isolated from patient tissues and incubated with IL28;signal transducer and activator of transcription 1 (STAT1) phosphorylation was measured by immunoblots and confocal imaging. RESULTS: Lamina propria cells in colon tissues of patients with IBD and mice with colitis had increased expression of IL28 compared with controls;levels of IL28R were increased in the colonic epithelium of patients with IBD and mice with colitis. Administration of IL28 induced phosphorylation of STAT1 in primary human and mouse IECs increasing with dose. Il28ra(-/-) Irf3(-/-) Irf3(-/-) Irf7(-/-) as well as Stat1IEC-KO mice developed more severe colitis after administration of dextran sulfate sodium than control

关键词： Animals   Clinical Trials as Topic   Cytokines/metabolism   Drug Discovery   Humans   Inflammatory Bowel Diseases/drug therapy   Inflammatory Bowel Diseases/metabolism   Janus Kinases/antagonists & inhibitors   Janus Kinases/metabolism   Protein Kinase Inhibitors/pharmacology   Protein Kinase Inhibitors/therapeutic use   Signal Transduction/drug effects   STAT Transcription Factors/metabolism  

摘要： Inflammatory bowel disease (IBD) is caused by a dysregulation of the immune system, inducing the production of proinflammatory cytokines and adhesion molecules. A better understanding of the mucosal immune response in IBD has led to the development of new drugs directed at inflammatory cytokines and leukocyte-trafficking molecules. Beyond tumor necrosis factor antagonists and anti-integrin molecules, which act by blocking the interaction between gut-specific lymphocytes and their receptor on vascular endothelium, the Janus kinase/signal transducer and activator of transcription (JAK/STAT) signaling pathway represents a new target in IBD. JAK inhibitors are small molecules able to selectively target the activity of specific JAKs that play a role in signal transmission via interleukins. This review presents an overview of the role of the JAK/STAT signaling pathway and updated information for JAK molecules, which are promising drugs in IBD. Currently developed to treat ulcerative colitis and Crohn's disease, tofacitinib (in a phase III study) and filgotinib (in a phase II study), respectively, are the JAK inhibitors in the most advanced stage of development for IBD. However, the utility of, and adverse events associated with, these new drugs remain to be determined and clarified (in particular, the risk of herpes zoster infections), depending on the efficacy and tolerance determined from definitive studies. The availability of these drugs could enhance the therapeutic approach to IBD in the coming years, and reinforce the concept of personalized medicine for IBD patients.

关键词： Crohn's disease   Ulcerative colitis   Monoclonal antibody   Anti-TNF   Vedolizumab   Ustekinumab   Biologics  

摘要： Inflammatory bowel diseases, Crohn's disease, and ulcerative colitis are complex multifactorial diseases that involve the interaction between innate and adaptive immunity. Tumor necrosis factor alpha is a potent proinflammatory cytokine with pleiotropic effects on cells of the innate and adaptive immune systems. Medical therapies that block tumor necrosis factor alpha have changed the clinical management of inflammatory bowel disease. This review discusses immunogenicity and safety of these agents as well as strategies to reduce infectious complications. In addition, new biologic therapies that inhibit various elements in the leukocyte infiltration process and others that target proinflammatory cytokines are addressed.

关键词： META-analysis   INFLAMMATORY bowel diseases   INTESTINAL diseases   MONOCLONAL antibodies   VEDOLIZUMAB  

摘要： Background: Vedolizumab specifically recognises the alpha 4 beta 7 integrin and selectively blocks gut lymphocyte trafficking: potentially, it offers gut-specific immunosuppression. Aim: To review the safety of vedolizumab and summarise post-marketing data to assess if any safety concerns that differ from registration trials have emerged. Method: A systematic bibliographic search identified six registration trials and nine cohort studies. Results: Integrated data from registration trials included 2830 vedolizumab-exposed patients (4811 person-years exposure [PYs]) and 513 placebo patients. This reported lower exposure-adjusted incidence rates of infection (63.5/100 PYs;95% CI: 59.6-67.3) and serious adverse events (20.0/100 PYs;95% CI: 18.5-21.5) compared to placebo (82.9/100 PYs;95% CI: 68.3-97.5) and (28.3/100 PYs 95% CI: 20.6-35.9) respectively. Higher, but statistically insignificant rates of enteric infections occurred in vedolizumab-exposed patients (7.4/100 PYs;95% CI: 6.6-8.3) compared to placebo (6.7 PYs;95% CI: 3.2-10.1). Six post-marketing cohort studies (1049 patients, 403 PYs) demonstrated rates of infection of 8% (82/1049);enteric infection of 2% (21/1049) and adverse events of 16% (166/1049). Multivariate analysis in one cohort study suggested increased risk of surgical site infection with perioperative VDZ. Human experience in pregnancy is limited. Conclusions: Post-marketing data confirm the excellent safety of vedolizumab observed in registration trials. The signal of post-operative complications should be interpreted with caution, but warrants further study. Although comparative studies are needed, Vedolizumab may be a safe alternative in patients who best avoid systematic immunosuppression, including those pre-disposed to infection, malignancy or the elderly.

关键词： TNF Inhibitor   IBD Treatment   Patient Management   Inflammation  

摘要： BACKGROUND & AIMS: Anti-tumor necrosis factor (anti-TNF) agents are effective treatments for Crohn's disease (CD) and ulcerative colitis (UC). We aimed to determine their patterns of use and changes in these patterns over time, as well as use of immunomodulators and corticosteroids before anti-TNF therapy for persons with inflammatory bowel diseases. METHODS: We used the University of Manitoba IBD Epidemiology Database to identify all anti-TNF users with CD and UC from 2001 through 2014. We assessed changes in the prevalence and incidence of anti-TNF use during different time periods (April 2001-March 2005, April 2005-March 2009, or April 2009-March 2013). We also characterized patterns of corticosteroid use, corticosteroid dependence, and immunomodulator use before anti-TNF administration and determined how these changed over time. The primary end point was change in time to first receipt of anti-TNF among the different time periods. RESULTS: We identified 950 persons (761 with CD and 189 with UC) who received anti-TNF agents. The cumulative prevalence of persons with current or prior anti-TNF exposure in 2014 was 20.4% for CD and 6.0% for UC. In 2014 the cumulative incidence values of anti-TNF exposurewithin 5 years of diagnosis were 23.4% for patients with CD and 7.8% for patients with UC. Most users of anti-TNF agents had evidence of corticosteroid dependence (more than 2 g prednisone within any 12-month period) before initiation of anti-TNF therapy. Cumulative corticosteroid exposure before anti-TNF use decreased over time for patients with UC, but not significantly for patients with CD. There was no increase over time in the use of concomitant immunomodulators with anti-TNF therapy. CONCLUSIONS: Use of anti-TNF agents increased from 2001 through 2014, with a concomitant significant decrease in cumulative use of corticosteroids before anti-TNF therapy for patients with UC. However, there has been no reduction in cumulative use of corticosteroids before anti-TNF

关键词： College age   Inflammatory bowel disease   Adherence   Medication  

摘要： Adherence to treatment is a key therapeutic goal in chronic disorders including diabetes, inflammatory bowel disease (IBD), and hypertension. Non-adherence has been associated with increased health care costs. Previous studies have evaluated adherence to treatment in inflammatory bowel disease, as well as predictors of non-adherence. Higher belief of necessity for medications and membership of IBD patient organizations have been associated with higher medication adherence. This study aimed to identify patient reported factors that influence understanding of IBD in college age patients with IBD. We conducted questionnaire based survey among a group of college age patients with IBD who attended a structured program. The program consisted of a clinical appointment with an IBD physician, lecture by an IBD physician, followed by interactive segment between patients. Educational material was available for patients to review. In addition, opportunity was given to patients to share their story and ask questions in a safe environment. A total of 26 patients participated in the two C-IBD sessions over a 2-year period. Twenty-three were enrolled in college, 1 was a recent graduate, and 2 were of college age but not enrolled. All patients thought the program was beneficial, 96% rated the overall experience as "awesome" or "very good." Seventy-six percent of patients reported sharing their story as the most beneficial. Only 19% found the physician lecture beneficial. A targeted approach to a vulnerable population with IBD is an additional useful tool in improving understanding of IBD. This may lead to improved compliance with management plans.