关键词： Adult   care   inflammatory bowel disease   pediatric   transition  

摘要： Background/Aims: The transition of adolescents with inflammatory bowel disease (IBD) from pediatric to adult care requires a well-structured standardized protocol to ensure the delivery of optimal healthcare and decrease the risk of nonadherence, hospitalizations, and complications. The aims of this survey are to evaluate current IBD transition practices adopted by gastroenterology services across the Kingdom of Saudi Arabia (KSA) and to identify the major challenges standing in the way of implementing effective transition strategies from the perspectives of pediatric and adult gastroenterologists. Patients and Methods: An online survey was distributed to KSA pediatric and adult gastroenterologists through the Kingdom's national gastroenterology association. The questionnaire included closed-ended questions regarding existing institutional transition strategies and perspectives regarding the impact of different factors on their ability to effectively transition adolescents from pediatric to adult care. Results: A total of 80 adult and pediatric gastroenterologists responded to the survey invitation. Most of the participating gastroenterologists worked at a tertiary care center (82.5%). The majority of gastroenterologist (73.8%) reported that they do not follow a defined protocol for transitioning in their current practices. However, a structured transition program was noted to be "very important" by 78.8% of gastroenterologists. The most favored method of transitioning was joint outpatient clinic attended by patient, caregiver, pediatric gastroenterologist, and adult gastroenterologist (35.9%) and the most commonly reported barrier to transitioning was " lack of proper preparation" for transitioning (53.2%). Conclusions: Although acknowledged by the majority of participants as being "very important," no standardized IBD transition protocol is followed in the majority of practices across KSA. A well-structured national protocol for transitioning adolescents with IBD

关键词： INFLAMMATORY bowel disease treatment   AZATHIOPRINE   CLINICAL trials   INFLIXIMAB   PHARMACOKINETICS   DRUG efficacy  

摘要： Background: Infliximab (IFX) combined with azathioprine (AZA) is more effective than IFX monotherapy in inflammatory bowel disease (IBD). Aim: To identify the AZA optimal dose that is required for efficacy when receiving combination therapy. Methods: Patients with IBD in durable remission on combination therapy were enrolled in a 1-year, open-label, prospective trial after randomisation into three groups: AZA steady (2-2.5 mg/kg/day, n=28) vs AZA down (dose was halved 1-1.25 mg/kg/day, n=27) vs AZA stopped (n=26). Primary endpoint was failure defined as occurrence of a clinical relapse and/or any change in IBD therapy. Results: Eighty-one patients were included. Five (17.9%), 3 (11.1%), and 8 (30.8%) patients experienced failure at 1 year in groups AZA steady, AZA down and AZA stopped, respectively (P=.1 across the groups). The median trough levels of IFX at inclusion were close to those measured at the end of follow-up in group AZA steady (3.65 vs 3.45 mu g/mL, P=.9) and in group AZA down (3.95 vs 3.60 mu g/mL, P=.5), whereas these levels dropped from 4.25 to 2.15 mu g/mL (P=.02) in group AZA stopped. Four (14.3%), four (14.8%) and 11 (42.3%) patients experienced an unfavourable evolution of IFX pharmacokinetics in groups AZA steady, AZA down and AZA stopped, respectively. A threshold of 6-TGN <105 pmoles/8.10(8) RBC was associated with an unfavourable evolution of IFX pharmacokinetics. Conclusions: Under combination therapy, AZA dose reduction, but not withdrawal, appears to be as effective as continuation of AZA at full dose.

关键词： CROHN'S disease diagnosis   INFLAMMATORY bowel disease diagnosis   MEDICAL care   MEDICAL screening  

摘要： Inflammatory bowel disease (IBD), a chronic immune-mediated disorder encompassing Crohn's disease and ulcerative colitis, has the highest prevalence in North America and Europe. On multivariate regression analysis, lack of evaluation by a gastroenterologist was a significant predictor of an RFS >5 (OR 2.2; 95% CI 1.3-3.7; P = 0.003). [...]the inference of misdiagnosis cannot be fully ascertained, even though the score performed well in the initial development phase. Cole R, Ashok D, Razack A, Azaz A, Sebastian S. Evaluation of Outcomes in Adolescent Inflammatory Bowel Disease Patients Following Transfer From Pediatric to Adult Health Care Services: Case for Transition.

关键词： colitis   cyclic peptide   NF-κB (NF-KB)   nuclear magnetic resonance (NMR)   peptide chemical synthesis   SFTI-1   TNBS  

摘要： Inflammatory bowel diseases (IBDs) are a set of complex and debilitating diseases for which there is no satisfactory treatment. Recent studies have shown that small peptides show promise for reducing inflammation in models of IBD. However, these small peptides are likely to be unstable and rapidly cleared from the circulation, and therefore, if not modified for better stability, represent non-viable drug leads. Wehypothesized that improving the stability of these peptides by grafting them into a stable cyclic peptide scaffold may enhance their therapeutic potential. Using this approach, we have designed a novel cyclic peptide that comprises a small bioactive peptide from the annexin A1 protein grafted into a sunflower trypsin inhibitor cyclic scaffold. We used native chemical ligation to synthesize the grafted cyclic peptide. This engineered cyclic peptide maintained the overall fold of the naturally occurring cyclic peptide, was more effective at reducing inflammation in a mouse model of acute colitis than the bioactive peptide alone, and showed enhanced stability in human serum. Our findings suggest that the use of cyclic peptides as structural backbones offers a promising approach for the treatment of IBD and potentially other chronic inflammatory conditions.

摘要： Inflammatory bowel disease (IBD) is an established risk factor for cardiovascular disease (CVD). However, whether cardiac consequences present early in IBD is unknown. This is the first study in children aiming to unmask altered myocardial mechanics in IBD. We enrolled 50 consecutive normotensive children with Crohn's disease (CD) (n = 28) or ulcerative colitis (UC) (n = 22). The study groups consisted of 18 patients with active inflammatory disease (mean age 14.6 +/- 2.5 years) and 32 children with IBD in remission (14.3 +/- 2.3 years). 60 age-and gender-matched children served as healthy controls. Speckle tracking stress echocardiography (STE) was used to assess left ventricular (LV) myocardial strain and strain rate. Circumferential strain rate was significantly decreased in children with active IBD (-1.55 +/- 0.26 s(-1)) and IBD in remission (-1.49 +/- 0.26 s(-1)) versus healthy controls (1.8 +/- 0.4 s(-1)) both at rest (p < 0.001) and during exercise (p = 0.021). Moreover, longitudinal strain rate, circumferential strain and E/E' ratio were significantly impaired in IBD. Pediatric patients with IBD feature subclinical signs of LV systolic and diastolic myocardial impairment early in the course of CD and UC. This may not be reversible even when IBD is clinically controlled. Patients with IBD should be regularly screened for signs of CVD.

关键词： 肛肠疾病   尿潴留   原因   对策  

摘要： 肛肠疾病在临床上非常常见,具有非常高的发病率,在术后,也会受各种因素影响,从而诱发尿潴留,对患者造成一定的影响,这就需要相关人员做好预防工作。据此,本文主要对肛肠疾病术后尿潴留的原因进行了详细分析,并提出了一些有效对策。

关键词： 针灸   肛肠疾病   硬膜外麻醉术后   尿潴留   疗效  

摘要： 对于在临床中肛肠疾病在实施硬膜外麻醉术后发生尿潴留时应用针灸治疗的效果进行观察研究分析.方法 将我院的肛肠外科于2012年1月至2016年12月期间收治的肛肠疾病中行手术治疗时应用硬膜外麻醉后患者中发生尿潴留的患者中选出100例做为研究对象,根据治疗尿潴留的方法的不同分为每组有研究对象50名的对照组和观察组,对照组的研究对象采用常规保守的治疗方法,观察组的患者采取针灸的治疗方法,对两组的研究对象的尿潴留的情况和治疗效果进行评比.结果 观察组的研究对象在应用针灸的方法进行治疗尿潴留的效果明显要比对照组的研究对象的保守治疗尿潴留的效果要好,因为观察组的治疗总有效率是98%,而对照组的治疗的总有效率只有80%.结论 对于在临床中肛肠疾病在实施硬膜外麻醉术后发生尿潴留时应用针灸治疗的效果明确,使患者术后尿潴留的情况得到了明显的改善,比常规的西药治疗尿潴留的效果也更好,应当在临床进行普及推广.

关键词： Carrier Proteins/genetics   Inflammatory Bowel Diseases/genetics   Receptors   Pattern Recognition/metabolism   Active Transport   Cell Nucleus   Case-Control Studies   Cytokines/metabolism   Cytokines/secretion   Enterococcus faecalis/physiology   Gene Expression   Genetic Association Studies   Genetic Predisposition to Disease   HEK293 Cells   Heterozygote   Humans   MAP Kinase Signaling System   Macrophages/metabolism   Macrophages/microbiology   Myeloid Cells/secretion   Polymorphism   Single Nucleotide   Primary Cell Culture   Risk Factors   Staphylococcus aureus/physiology  

摘要： Inflammatory bowel disease (IBD) is characterized by dysregulation in both cytokines and responses to intestinal microbes, and proper regulation of pattern recognition receptor (PRR) signaling is critical for intestinal immune homeostasis. Altered functions for the IBD risk locus containing rs7554511, which encompasses the C1orf106 gene (recently named INAVA), and roles for the protein encoded by the INAVA gene are unknown. Here, we investigated the role of INAVA and INAVA genotype in regulating PRR-initiated outcomes in primary human cells. Both peripheral and intestinal myeloid cells expressed INAVA. Upon PRR stimulation, INAVA was required for optimal MAPK and NF-kappa B activation, cytokine secretion, and intracellular bacterial clearance. INAVA recruited 14-3-3t, thereby contributing to recruitment of a signaling complex that amplified downstream signals and cytokines. Further, INAVA enhanced bacterial clearance by regulating reactive oxygen, reactive nitrogen, and autophagy pathways. Macrophages from rs7554511 C risk carriers expressed lower levels of INAVA RNA and protein. Lower expression was attributed in part to decreased transcription mediated directly by the intronic region containing the rs7554511 C variant. In rs7554511 C risk carrier macrophages, lower INAVA expression led to decreased PRR-induced activation of MAPK and NF-kappa B pathways, cytokines, and bacterial clearance pathways. Thus, IBD-associated polymorphisms in INAVA modulate PRR-initiated signaling, cytokines, and intracellular bacterial clearance, likely contributing to intestinal immune homeostasis.