关键词： 肛瘘   直肠阴道瘘   复发原因   多次手术   回顾性研究  

摘要： 目的:总结肛肠疾病患者行多次手术的原因。方法:收集42例接受肛肠疾病二次/多次手术患者进行回顾性研究,总结分析病种、再次手术原因、手术方式及手术技巧。结果:肛肠科多次手术患者的病种以肛瘘、混合痔、肛乳头肥大、直肠阴道瘘和化脓性汗腺炎为主。二次/多次手术的原因多为手术失败,术前相关检查不完善,诊断不明确、处理不当,术式及创面大小、挂线疗法技巧、紧线时机及脱落时间等。结论:肛肠疾病患者行多次手术的病种多样,原因各异,应提高一次手术成功率,若行二次手术需充分了解其原因。

关键词： 肛肠疾病   肛管直肠压力测定   手术前后  

摘要： 目的探讨肛肠疾病手术前后肛管直肠压力测定。方法此次收集了我院2015年1月-2016年12月收治的择期手术治疗的肛肠疾病患者60例作为研究对象,未行手术治疗前对60例患者肠管直肠进行测压,所获数据为术前组;患者术后恢复1个月,便对其肠管直肠重新测压,将所获数据作为术后组;比较患者术前、术后所获肠管直肠测压数据。结果环状混合痔患者、低位肛瘘患者手术前后肠管直肠测压数据差异不大,数据比较差异无统计学意义(P>0.05);环状嵌顿痔患者手术治疗前的肛管静息压偏高、肛管舒张压偏低,手术后肛管静息压低于手术前,肛管舒张压高于手术前,差异具有统计学意义(P<0.05);慢性肛裂患者、肛周脓肿患者手术治疗前的肛管静息压与直肠静息压偏高,肛管舒张压偏低,手术后肛管静息压、直肠静息压低于手术前,肛管舒张压高于手术前,差异有统计学意义(P<0.05);高位肛瘘患者手术治疗后肛管静息压低于手术前,差异具有统计学意义(P<0.05)。结论常见肛肠疾病患者术前、术后肛管直肠压力因病症情况存在较大的不同之处;要全面分析肛肠疾病患者肛管直肠压力于手术治疗前后的变化,以此准确判断手术治疗效果与患者术后恢复情况。

关键词： INFLAMMATORY bowel diseases   GLYCOLIPIDS   LACTOBACILLUS   POLYSACCHARIDES   IMMUNOCHEMISTRY   GAS chromatography  

摘要： Structural studies of the major glycolipids produced by two Lactobacillus johnsonii (LJ) strains, LJ 151 isolated from intestinal tract of healthy mice and LJ 142 isolated from mice with experimentally induced inflammatory bowel disease (IBD), were performed. Two major glycolipids, GL1 and GL2, were present in lipid extracts from L. johnsonii 142 and 151 strains. Glycolipid GL1 has been identified as beta-D-Glcp-(1 -> 6)-alpha-D-Galp-(1 -> 2)-alpha-D-Glcp-diglyceride and GL2 as alpha-D-Galp-(1 -> 2)-alpha-D-Glcp-diglyceride. The main fatty acid residues identified by gas-liquid chromatography-mass spectrometry were palmitic, stearic and lactobacillic acids. Besides structural elucidation of the major glycolipids, the aim of this study was to determine the immunochemical properties of these glycolipids and to compare their immunoreactivity to that of polysaccharides obtained from the same strains. Sera from rabbits immunized with bacterial cells possessed much higher serological reactivity with polysaccharides than with glycolipids. Inversely, reactivity of the glycolipids with human sera from patients with IBD was much higher than that determined for the polysaccharides, while reactivity of glycolipids with human sera from healthy individuals was much lower than one measured for the polysaccharides. Results indicate that glycoconjugates from Lactobacillus cell wall act as antigens and may represent new IBD diagnostic biomarkers.

摘要： MicroRNAs are critical post-transcriptional regulators of gene expression and key mediators of pathophysiology of inflammatory bowel disease (IBD). This study is aimed to study the role of miR-665 in the progression of IBD. Real-time PCR analysis was used to determine miR-665 expression in 89 freshly isolated IBD samples and dextran sulfate sodium (DSS)-induced colonic mucosal tissues. The role of miR-665 in inducing apoptosis and colitis were examined by Annexin V, TUNEL (terminal deoxynucleotidyl transferase dUTP nick-end labeling) staining, colony formation in vitro and DSS-induced colitis mice model in vivo. Moreover, luciferase reporter assay, western blot analysis and microribonucleoprotein immunoprecipitation were performed to determine that miR-665 directly repressed XBP1 (X-box-binding protein-1) and ORMDL3 expression. Herein, our results revealed that miR-665 was markedly upregulated in active colitis. Gain-of-function and loss-of-function studies showed that ectopic expression of miR-665 promoted apoptosis under different inflammatory stimuli. Importantly, delivery of miR-665 mimic promoted, while injection of antagomiR-665 markedly impaired DSS-induced colitis in vivo. Mechanistically, we demonstrated that miR-665 induced apoptosis by inhibiting XBP1 and ORMDL3. Taken together, our findings reveal a new regulatory mechanism for ER stress signaling and suggest that miR-665 might be a potential target in IBD therapy.

关键词： Crohn's Disease   Ulcerative Colitis   AUROC Analysis   Management  

摘要： BACKGROUND & AIMS: A subset of patients with inflammatory bowel diseases (IBD) have continuously active inflammation, leading to a high number of complications and high direct health care costs (diagnostic tests, medications, and surgeries) and indirect costs (reduced employment and productivity and fewer opportunities for activities). Identifying these high-risk patients and providing effective interventions could produce better outcomes and reduce costs. We used prior year data to create IBD risk models to predict IBD-related hospitalizations, emergency department visits, and high treatment charges (>$30,000/year) in the subsequent year. METHODS: We performed a retrospective study of medical records from all patients with IBD treated at the University of Michigan Hospital from fiscal years 2013-2015. We selected clinical variables from the prior year and tested their abilities to predict 3 adverse outcomes (IBD-related hospitalizations, emergency department visits, and treatment charges >$30,000/year) in the subsequent year. Individual patients were only included once in the data set. We created a multivariate model that was based on a 70% randomly selected cohort (1005 patients) and validated the model on the other 30% (425 patients). Logistic regression was used for bivariate and multivariate analyses. RESULTS: Factors that predicted high-cost outcomes included the presence of psychiatric illness, use of corticosteroids, use of narcotics, low levels of hemoglobin, and high numbers of IBD-related hospitalizations. In the validation cohort, the model predicted IBD-related hospitalizations, emergency department visits, and high charges in the following year with receiver operating characteristic curve values of 0.751, 0.738, and 0.744, respectively. CONCLUSIONS: We identified 5 factors that can effectively identify patients with IBD at high risk for hospitalization, emergency department visits, and high treatment charges in the next year. These patients should be c

关键词： biologic therapy   Crohn's disease   inflammatory bowel disease   interleukin-17 antagonists   ixekizumab   psoriasis   ulcerative colitis  

摘要： Background: Inflammatory bowel disease (IBD) occurs more frequently in patients with psoriasis. The 2 diseases have significant genetic overlap, but the pathogenesis underlying their co-occurrence is unknown. Objective: We sought to report adjudicated IBD cases (Crohn's disease [CD] and ulcerative colitis [UC]) in patients exposed to ixekizumab, a high-affinity monoclonal antibody that selectively targets interleukin-17A. Methods: Adverse events (AEs) integrated from 7 randomized controlled and uncontrolled trials were analyzed for the controlled induction period, controlled maintenance period, and all ixekizumab-treated patients. Suspected IBD cases were reviewed by blinded external experts using internationally recognized criteria (Registre Epidemiologique des Maladies de l'Appareil Digestif registry). Results: In all, 4209 patients (6480 patient-exposure years) were exposed to ixekizumab. Suspected CD (N = 12) or UC (N = 17) AEs were reported;19 were adjudicated as definite/probable IBD (CD, N = 7, incidence rate = 1.1/1000 patient-exposure years;UC, N = 12, incidence rate = 1.9/1000 patient-exposure years). Among these, 3 occurred during induction (CD, N = 1;UC, N = 2) and 7 during maintenance (CD, N = 4;UC, N = 3). Twelve of 16 patients with reported IBD history have not had an IBD treatment- emergent AE/serious AE to date. Limitations: Clinical review (adjudication) was not prespecified. AE data collected post-hoc may have been limited by length of time from occurrence. Conclusion: From an integrated database of 7 ixekizumab psoriasis trials, CD and UC cases were uncommon

关键词： Macrophages   Monocytes   Transcription factors   Gene regulation   Genetic loci   Inflammatory bowel disease   Gene expression   DNA transcription  

摘要： The FANTOM5 consortium utilised cap analysis of gene expression ( CAGE) to provide an unprecedented insight into transcriptional regulation in human cells and tissues. In the current study, we have used CAGE-based transcriptional profiling on an extended dense time course of the response of human monocyte- derived macrophages grown in macrophage colonystimulating factor (CSF1) to bacterial lipopolysaccharide (LPS). We propose that this system provides a model for the differentiation and adaptation of monocytes entering the intestinal lamina propria. The response to LPS is shown to be a cascade of successive waves of transient gene expression extending over at least 48 hours, with hundreds of positive and negative regulatory loops. Promoter analysis using motif activity response analysis (MARA) identified some of the transcription factors likely to be responsible for the temporal profile of transcriptional activation. Each LPS-inducible locus was associated with multiple inducible enhancers, and in each case, transient eRNA transcription at multiple sites detected by CAGE preceded the appearance of promoter-associated transcripts. LPS- inducible long noncoding RNAs were commonly associated with clusters of inducible enhancers. We used these data to re-examine the hundreds of loci associated with susceptibility to inflammatory bowel disease (IBD) in genome-wide association studies. Loci associated with IBD were strongly and specifically (relative to rheumatoid arthritis and unrelated traits) enriched for promoters that were regulated in monocyte differentiation or activation. Amongst previously-identified IBD susceptibility loci, the vast majority contained at least one promoter that was regulated in CSF1-dependent monocyte- macrophage transitions and/or in response to LPS.

关键词： INFLAMMATORY bowel diseases   STATINS (Cardiovascular agents)   LIPOPROTEIN lipase   IMMUNE system   DRUG efficacy  

关键词： Inflammatory bowel disease   Crohn's disease   Ulcerative colitis   Bactericidal/permeability increasing protein   Polymorphism  

摘要： Bactericidal/permeability increasing protein (BPI) gene polymorphisms have been extensively investigated in terms of their associations with inflammatory bowel disease (IBD), with contradictory results. The aim of this meta-analysis was to evaluate associations between BPI gene polymorphisms and the risk of IBD, Crohn's disease (CD), and ulcerative colitis (UC). Eligible studies from PubMed, Embase, and Cochrane library databases were identified. Ten studies (five CD and five UC) published in five papers were included in this meta-analysis. G645A polymorphism was associated with a decreased risk of UC in allele model, dominant model, and homozygous model. Our data suggested that BPI G645A polymorphism was associated with a decreased risk of UC;the BPI G645A polymorphism was not associated with the risk of CD.

关键词： Crohn’s disease   Inflammatory bowel disease   Treat to target   Ulcerative colitis  

摘要： Therapeutic management of patients with inflammatory bowel diseases (IBDs) has, for years, been tailored towards monitoring patient clinical presentation as a way to gauge therapeutic management. With the advent of newer biological agents, treatment and management have begun to focus on more objective rather than subjective parameters. These objective parameters include endoscopic targets and focus on the impact of mucosal healing, radiologic and histologic targets, patient reported outcomes, and use of non-invasive biomarkers. However, a recent consensus statement has identified clinical/patient-reported outcome (PRO) remission and endoscopic remission (defined as a Mayo endoscopic subscore of 0-1) as the target for UC with histological remission being an adjunctive goal. For CD, clinical/PRO remission defined as resolution of abdominal pain and diarrhea/altered bowel habit and endoscopic remission, defined as resolution of ulceration at ileocolonoscopy, and resolution of findings of inflammation on cross-sectional imaging in patients who cannot be adequately assessed with ileocolonoscopy were the primary targets. Biomarker remission (normal C-reactive protein (CRP) and calprotectin) was considered as an adjunctive target. This approach requires continuous monitoring and therapeutic adjustments with an aim to achieve the target. This article attempts to review the most updated literature regarding the treat to target approach and thus provides current recommendations and supported evidence.