厚朴三物汤合脐针治疗气机壅滞型肠结病的临床观察

观察厚朴三物汤合以脐针疗法治疗气机壅滞型肠结病的疗效。方法:选取2018年9月至2020年12月期间医院收治的120例不完全肠梗阻患者进行研究,随机分成2组,各60例。对照组予以西医常规疗法+口服厚朴三物汤加减治疗,治疗组在以上基础加用脐针疗法,均持续治疗7天,观察比较两组临床效果。结果:治疗组的总有效率(96.67%)显著高于对照组(68.33%),治疗组停止排气排便、腹痛腹胀的发生率低于对照组,差异均具有统计学意义(P<0.05)。结论:口服厚朴三物汤合以脐针疗法治疗气机壅滞型肠结病与单纯中药治疗相比,疗效可靠,安全有效,降低中医症状评分,改善临床症状。

不完全肠梗阻(肠结病)的中医理论探源

不完全肠梗阻(肠结病)是消化科的一种常见病,中医在其治疗过程中有着独特的疗效。在查阅中医古籍的过程中,发现"阴结"和"阳结"的概念,思考后发现其与"寒结旁流"与"热结旁流"的概念是是一致的,可作为对肠结病中医发病理论的形象概括,这同时也为该疾病的治疗提供了一定的理论依据。

肠通方辨治肠结病(不完全性肠梗阻)36例

目的探讨肠通方辨治肠结病(不完全性肠梗阻)的中药作用机制及疗效。方法将肠结病(不完全性肠梗阻)患者36例,按照辨证分型,气机壅滞19例,实热内结9例,脉络瘀阻5例,气阴两虚3例,采用专方专药肠通方(经验方)与辨证论治结合,在内科基础治疗及辨证施护下,观察患者的临床总体疗效、症状疗效。临床观察时间为10天。结果结果治愈11例(33.33%),显效14例(42.42%),有效8例(24.24%);无效3例,其中2例患者住院期间病情加重,转为完全性肠梗阻,1例患者并发肠出血。结论以肠通方为基础方结合辨证论治肠结病(不完全性肠梗阻)有较好疗效。

OPN-305联合化疗药物对炎症性肠病相关结、直肠癌小鼠模型炎症及肿瘤细胞增殖的影响

目的 应用Toll样受体抑制剂OPN-305联合化疗药5-氟尿嘧啶和亚叶酸钙对炎症性肠病相关结直肠癌小鼠模型炎症及肿瘤增殖的作用。方法 将24只C57BL/6J野生型小鼠各6只随机分4组,所有小鼠进行CAC模型造模后,于第0~44天给予各组动物模型NC组空白对照(无特殊处置)、OT组(腹腔注射OPN-305)、FT组(腹腔注射5-FU+Lv)及RT组(腹腔注射OPN-35联合5-FU+Lv)。期间对小鼠临床表现进行观察,造模结束后对动物模型结直肠的大体标本测量评分、HE染色进行炎症及肿瘤学评分、免疫组化检测对肿瘤增殖的影响。结果 临床表现评分、小鼠结肠缩短程度、肿瘤数量和体积、组织学染色的炎症和肿瘤学评分以及免疫组化肿瘤增殖情况,RT组显著低于NC组、OT组及FT组,且差异具有统计学意义。结论 OPN-305联合化疗药物5-FU+Lv的用药方案对CAC小鼠模型的炎症及肿瘤细胞的增殖具有抑制作用,并且优于单独应用OPN-305及5-FU+Lv。

芷陈玉枣汤合中药灌肠治疗肠结病24例疗效观察

目的:观察温化寒积,通降阳明法对肠结病(不完全性肠梗阻)的疗效。方法:选取我院2016年1月-2017年12月收治的肠结病患者24例,随机分为对照组(常规西医,n=12)和治疗组(芷陈玉枣汤合中药保留灌肠,n=12)。结果:治疗组总有效率100%,3天有效率83.33%;对照组总有效率75%,3天有效率16.67%,两组比较有显著统计学差异(P<0.05)。结论:芷陈玉枣汤口服合中药灌肠为主治疗肠结病疗效显著,明显优于西医常规治疗,值得临床推广应用。

5-ASA在炎症性肠病相关结直肠癌中的化学预防作用

癌变是溃疡性结肠炎(ulcerative colitis,UC)最严重的并发症,其预防手段包括内镜监测、分子生物标志物、手术治疗及化学预防。5-氨基水杨酸盐(5-aminosalicylic acid,5-ASA)是轻-中度UC患者的一线用药,其对炎症性肠病(inflammatory bowel disease,IBD)相关结直肠癌的化学预防作用及机制尚不十分明确。本文较全面地阐述5-ASA的化学预防作用及机制研究进展,旨在为临床实践中预防IBD相关癌变用药方案提供更多依据。

Two-sample Mendelian randomization analysis of causal relationship between eczema and autoimmune diseases

Objective:The causal relationship between eczema and autoimmune diseases has not been previously reported.This study aims to evaluate the causal relationship between eczema and autoimmune diseases.Methods:The two‐sample Mendelian randomization(MR)method was used to assess the causal effect of eczema on autoimmune diseases.Summary data from the Genome-Wide Association Study Catalog(GWAS)were obtained from the Integrative Epidemiology Unit(IEU)database.For eczema and autoimmune diseases,genetic instrument variants(GIVs)were identified according to the significant difference(P<5×10−8).Causal effect estimates were generated using the inverse‐variance weighted(IVW)method.MR Egger,maximum likelihood,MR-PRESSO,and MR-RAPS methods were used for alternative analyses.Sensitivity tests,including heterogeneity,horizontal pleiotropy,and leave-one-out analyses,were performed.Finally,reverse causality was assessed.Results:Genetic susceptibility to eczema was associated with an increased risk of Crohn’s disease(OR=1.444,95%CI 1.199 to 1.738,P<0.001)and ulcerative colitis(OR=1.002,95%CI 1.001 to 1.003,P=0.002).However,no causal relationship was found for the other 6 autoimmune diseases,including systemic lupus erythematosus(SLE)(OR=0.932,P=0.401),bullous pemphigoid(BP)(OR=1.191,P=0.642),vitiligo(OR=1.000,P=0.327),multiple sclerosis(MS)(OR=1.000,P=0.965),ankylosing spondylitis(AS)(OR=1.001,P=0.121),rheumatoid arthritis(RA)(OR=1.000,P=0.460).Additionally,no reverse causal relationship was found between autoimmune diseases and eczema.Conclusion:Eczema is associated with an increased risk of Crohn’s disease and ulcerative colitis.No causal relationship is found between eczema and SLE,MS,AS,RA,BP,or vitiligo.

腹腔镜手术治疗结肠癌和炎症性肠病的临床效果分析

目的:针对腹腔镜手术治疗结肠癌和炎症性肠病的临床效果进行具体分析,以此为参考依据。方法:回顾2018年2月~2020年6月在本院就医的96例结肠癌和炎症性肠病患者作为研究对象,并进行随机分组,分为对照组与观察组。对照组选择用开腹手术进行治疗,观察组则选择采用腹腔镜手术进行治疗,对试验数据进行统计分析,将两组手术相关指标、免疫功能指标、临床效果、并发症发生情况、局部复发情况进行对比。结果:与对照组比较,观察组手术时间、术后首次排气时间、住院时间明显较短,术中出血量明显较少,CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、总有效率明显较高,并发症发生率明显较低,差异存在统计学意义(P<0.05)。结论:选择运用腹腔镜手术治疗结肠癌和炎症性肠病疗效更好,患者的手术中出血量相对较少,术后肠功能恢复普遍较快,对免疫功能的不良影响也相对较小。

Study on TCM syndrome-typing of chronic ulcerative colitis

AIMS To study the relationship between the modern clinical and pathohistological classification and TCM Syndrome-Typing of chronic ulcerative colitis (CUC). METHODS Totally 452 patients with CUC were clas- sified according to the standards of TCM Syndrome- Typing set up in the Conference of the Combination of the Chinese-Western Medicine on Digestive Diseases in Linfen. The relevant changes between both classifica- tions were analyzed and compared through the colonofiberscopic and pathohistological examination. RESULTS The type of retention of damp-heat in inte- rior is more commonly seen in the patients with initial onset of disease (P<0.01). There is no significant difference among other TCM Syndrome-Typing groups in patients with chronic persistent and recurrent disease (P>0.05). The congestion,edema,reduction of goblet cells and the infiltration of neutrophils are patho- logically common to all TCM Syndrome-Typing groups. Mucosal ulcer is dominant in damp-heat syndrome while crypt ulcer is dominant in the types of spleen-stomach asthenia and spleen-kidney Yang deficiency (P< 0.01). CONCLUSIONS There appears a certain relation- ship between the TCM syndrome typing and pathohis- tological changes of the colonal mucosa of CUC.

Radiological diagnosis of inflammatory ulcerative diseases of small bowel

AIMS To analyze the radiological features of the ul- cerative diseases of the small bowel. METHODS Thirty-five patients (20 men,15 women) with inflammatory ulcerative bowel diseases were stud- ied radiographically (barium meal and/or double con- trast study),including:11 cases of tuberculosis,13 Crohn disease,7 bowel Behcet disease,2 simple ulcer and 2 ischemic bowel disease. Diagnosis was estab- lished pathologically in 33 cases and by clinical obser- vation after therapy in 2 cases. RESULTS The lesions were located in ileum,in 9 of 11 cases of TB;in 10 of 13 cases of Crohn disease;in 5 of 7 cases of bowel Behcet disease;in 1 of 2 cases of simple ulcer and in 2 cases of ischemic bowel disease. Ulceration was always present with variable appearances. Longitudinal ulcers,and fissures were noted in Crohn disease only. There were 5 cases of large and deep ulcer and 3 occurred in bowel Behcet disease,10 of 13 cases of superficial and irregular ul- cers were tuberculous,2 cases of transverse ulcer were also tuberculous. CONCLUSIONS The morphologic appearances of the ulcer,surrounding mucosal alterations and bowel deformation were the basis for the radiologic diagnosis. Correct diagnosis was dependent on optimal X-ray ex- amination technique and proper interpretation of the morphologic changes.

Down-regulation of Wnt Antagonist,SFRP1 in Colorectal Tumorigenesis

OBJECTIVE To assess the functional change of SFRP1 （secreted frizzled-related protein1）, in colorectal tumorigenesis. METHODS Immunohistochemical investigation and the semiquantitative reverse transcription-polymerase chain reaction （RT-PCR） were used to assess the expression of SFRP1, β-catenin （β-cat） and E-caderin （E-cad） in matched samples of normal colorectal mucosa, adenomas and cancers. RESULTS SFRP1 mRNA expression was down-regulated in the neoplasms, and abnormal expressions of β-cat and E-cad were found in colorectal adenomas and colorectal cancers. CONCLUSION Down-regulation of SFRP1 observed is consistent with its acting as a tumor suppressor gene in colorectal tumorigenesis.

Ileoscopy in patients with ileocolonic tuberculosis

AIM: To study the role of retrograde terminal ileoscopy in patients suspected to have ileocolonic tuberculosis. METHODS: A retrospective analysis was performed for patients undergoing colonoscopy for suspected ileocolonic tuberculosis between January 2000 and June 2004, in whom retrograde ileoscopy had been performed. Only patients diagnosed with tuberculosis on the basis of histological findings of either a caseating granuloma or those having non-caseating granuloma or a collection of epithelioid cells at a minimum of one endoscopic lesion (either in the colon or the terminal ileum) on histology with good responses to conventional anti-tuberculous drugs were enrolled for the study. RESULTS: Fifty-three patients were included. The terminal ileum was involved in only 11 patients. Eight of these patients had involvement of the cecum too. Two patients had ileal lesions without cecal involvement; however, lesions were noted in the ascending colon. In one patient the whole colon was normal and only the terminal ileum showed nodularity and ulceration. Histological examination of the ileal biopsies obtained from the ileal lesions showed noncaseating granulomas in five, collection of epithelioid cells in four and nonspecific histology in two patients. Mucosal biopsies obtained from the lesion in the terminal ileum, in the patient in whom mucosal abnormality was observed to be confined to the ileum, showed noncaseating granulomas. In two other patients the ileal biopsies alone showed histological evidence of tuberculosis with biopsies from the colonic lesions showing non-specific inflammatory changes only. CONCLUSION: Retrograde ileoscopy should be performed in all patients undergoing colonoscopy for suspected ileocolonic tuberculosis. In some patients only the terminal ileum may be involved and histological examination may reveal evidence of tuberculosis only from the lesions in the terminal ileum. This approach would lead to additional lesions being picked up andincreasing the chances of well-timed diagnosis of tuberculosis.

Three-dimensional MR and axial CT colonography versus conventional colonoscopy for detection of colon pathologies

AIM： To evaluate the sensitivity and specificity of MR colonography （MRC） and CT performance in detecting colon lesions, and to compare their sensitivity and specificity with that of conventional colonoscopy. METHODS： Forty-two patients suspected of having colonic lesions, because of rectal bleeding, positive fecal occult blood test results or altered bowel habits, underwent the examinations. After insertion of a rectal tube, the colon was filled with 1000-1500 mL of a mixture of 9 g/L NaCI solution, 15-20 mL of 0.5 mmol/L gadopentetate dimeglumine and 100 mL of iodinized contrast material. Once colonic distension was achieved, three-dimensional gradient-echo （3D-GRE） sequences for MR colonography and complementary MR images were taken in all cases. Immediately after MR colonography, abdominal CT images were taken by spiral CT in the axial and supine position. Then all patients were examined by conventional colonoscopy （CC）. RESULTS： The sensitivity and specificity of MRC for colon pathologies were 96.4% and 100%, respectively. The percentage of correct diagnosis by MRC was 97.6%. The sensitivity and specificity of CT for colon pathologies were 92.8%, 100%, respectively. The percentage of correct diagnosis by CT was 95.2%. CONCLUSION： In detecting colon lesions, MRC achieved a diagnostic accuracy similar to CC. However, MRC is minimally invasive, with no need for sedation or analgesics during investigation. There is a lower percentage of perforation risk, and all colon segments can be evaluated due to multi-sectional imaging availability; intramural, extra-intestinal components of colonic lesions, metastasis and any additional lesions can be evaluated easily. MRC and CT colonography are new radiological techniques that promise to be highly sensitive in the detection of colorectal mass and inflammatory bowel lesions.

Toothpick impaction with sigmoid colon pseudodiverticulum formation successfully treated with colonoscopy

Foreign bodies in the colon are encountered with increasing frequency, but only sporadic reports concerning their management have appeared in the literature. While most ingested foreign bodies usually pass through the gastrointestinal tract uneventfully, sharp foreign bodies such as toothpicks infrequently cause intestinal perforation and may even result in death. We report our experience with a patient with a sigmoid colon pseudodiverticulum formation, a complication of accidental ingestion of a toothpick that was diagnosed and successfully managed colonoscopically.

Role of LPS/CD14/TLR4-mediated inflammation in necrotizing enterocolitis:Pathogenesis and therapeutic implications

AIM:To establish the roles of lipopolysaccharide (LPS)/CD14/toll-like receptor 4 (TLR4)-mediated inflammation in a rat model of human necrotizing enterocolitis (NEC).METHODS: Six pairs of intestinal samples from human NEC were collected before and after recovery for histological and molecular analysis of inflammatory cytokines and signaling components. In the rat NEC model, we isolated 10-cm jejunum segments and divided them into six groups (n=6) for sham operation, treatment with LPS, bowel distension, combined bowel distension and LPS stimulation, and two therapeutic groups. The potential eff icacy of a recombinant CD18 peptide and a monoclonal CD14 antibody was evaluated in the latter two groups. The serum and tissue levels of several inflammatory mediators were quantified by real-time polymerase chain reaction, ELISA and immunoblotting.RESULTS: Human acute phase NEC tissues displayed significant increases (P<0.05) in levels of TLR4, CD14, myeloid differentiation protein (MD)-2, tumor necrosis factor (TNF)-α and nuclear factor-κB when compared to those after recovery. The histological and inflammatory picture of human NEC was reproduced in rats that were treated with combined bowel distension and LPS, but not in the sham-operated and other control rats. Serum levels of interleukin-6 and TNF-α were also elevated. The NEC pathology was attenuated by treating the NEC rats with a monoclonal CD14 antibody or an LPS-neutralizing peptide.CONCLUSION:LPS and distension are required to produce the histological and inflammatory features of NEC. A potential treatment option is blocking LPS activation and leukocyte infi ltration.

Pediatric inflammatory bowel disease

Inflammatory bowel disease is an important cause of gastrointestinal pathology in children and adolescents. The incidence of pediatric inflammatory bowel disease is increasing; therefore, it is important for the clinician to be aware of the presentation of this disease in the pediatric population. Laboratory tests, radiology studies, and endoscopic procedures are helpful in diagnosing inflammatory bowel disease and differentiating between Crohn＇s disease and ulcerative colitis. Once diagnosed, the goal of medical management is to induce remission of disease while minimizing the side effects of the medication. Specific attention needs to be paid to achieving normal growth in this susceptible population. Surgical management is usually indicated for failure of medical management, complication, or malignancy. Algorithms for diagnostic evaluation and treatment of pediatric inflammatory bowel disease are presented. The specific psychosocial issues facing these patients are also discussed in this review as are the future goals of research in the complex problem of pediatric inflammatory bowel disease.

Family and twin studies in inflammatory bowel disease

Studies examining the inheritance of inflammatory bowel disease （IBD） within different family groups have been the basis for recent molecular advances in the genetics of IBD. The derived heritability in Crohn＇s disease （CD） is higher than in many other complex diseases. The risk of IBD is highest in first-degree relatives of a CD proband, but first-degree relatives of a proband suffering from ulcerative colitis （UC） and more distant relatives are also at increased risk. Disease concordance rates in IBD have been examined in multiplex families and in three large European twin studies.

Cancer in inflammatory bowel disease

Patients with long-standing inflammatory bowel disease (IBD) have an increased risk of developing colorectal cancer (CRC). Many of the molecular alterations responsible for sporadic colorectal cancer, namely chromosomal instability, microsatellite instability, and hypermethylation, also play a role in colitis-associated colon carcinogenesis. Colon cancer risk in inflammatory bowel disease increases with longer duration of colitis, greater anatomic extent of colitis, the presence of primary sclerosing cholangitis, family history of CRC and degree of inflammation of the bowel. Chemoprevention includes aminosalicylates, ursodeoxycholic acid, and possibly folic acid and statins. To reduce CRC mortality in IBD, colonoscopic surveillance with random biopsies remains the major way to detect early mucosal dysplasia. When dysplasia is confirmed, proctocolectomy is considered for these patients. Patients with small intestinal Crohn’s disease are at increased risk of small bowel adenocarcinoma. Ulcerative colitis patients with total proctocolectomy and ileal pouch anal- anastomosis have a rather low risk of dysplasia in the ileal pouch, but the anal transition zone should be monitored periodically. Other extra intestinal cancers, such as hepatobiliary and hematopoietic cancer, have shown variable incidence rates. New endoscopic and molecular screening approaches may further refine our current surveillance guidelines and our understanding of the natural history of dysplasia.

Qualitative and quantitative analyses of the bifidobacterial microbiota in the colonic mucosa of patients with colorectal cancer, diverticulitis and inflammatory bowel disease

AIM： To characterize the bifidobacterial microbiota of the colonic mucosa in patients with colon cancer, inflammatory bowel disease or diverticulitis. METHODS： A sample of the distal colonic mucosa was taken during surgery from a total of 34 patients, twenty-one with diagnosed colorectal cancer, nine with diverticulitis and four with inflammatory bowel disease, requiring surgery for their condition. Bacterial DNA was extracted from the resected mucosal samples and bifidobacterial mucosa-associated microbiota was qualitatively and quantitatively determined by means of qualitative and quantitative PCR. RESULTS： Bifidobacteria were found in 100% of the samples from patients with diverticulitis or IBD and a 76% of those suffering colon cancer. The species B. Iongum and B. bifidum were the most widely found, followed by B. animalis, B. catenulatum and B. adolescentis. B. breve, B. dentium and B. angulatum were not detected in any sample. A significantly higher occurrence of B. Iongum was observed in patients with diverticulitis than in those with colon cancer or IBD （100%, 62% and 75%, respectively, P 〈 0.05）. Similar results were obtained for B, animalis （56%, 0% and 25%, P 〈 0.05）, while B. adolescentis was only found in the mucosa from patients with colon cancer （5 out of 21, 24%）. At the quantitative level, patients with colon cancer or IBD showed lower counts of total Bifidobacterium （4.94 and 5.91 vs 6.96 log Cells/sample, respectively, P 〈 0.05） and of the species B. longum （4.05 and 4.79 vs 6.76, P 〈 0.05） than those with diverticulitis.CONCLUSION： Aberrancies in mucosa associated microbiota are present in different intestinal diseases. This may indicate a role of the microbiota in the pathogenesis of these diseases.

Multidrug resistance 1 gene in inflammatory bowel disease: A meta-analysis

The MDR1 gene is an attractive candidate gene for the pathogenesis of inflammatory bowel disease （IBD） and perhaps response to therapy, with evidences at both functional and genetic levels. Its product, the P-glycoprotein （P-gp） functions as a transmembrane efflux pump thus influencing disposition and response of many drugs, some of whom （i.e. glucocorticoids） central to IBD therapy. In addition P-gp is highly expressed in many epithelial surfaces, included gastrointestinal tract （G-I） with a putative role in decreasing the absorption of endogenous or exogenous toxins, and perhaps host-bacteria interaction. Many genetic variations of MDR1 gene has been described and in some instances evidences for different P-gp expression as well drugs metabolism have been provided. However data are often conflicting due to genetic heterogeneity and different methodologies employed. Perhaps the greatest piece of evidence of the physiological importance of P-gp in the G-I tract has come from the description of the mdrl knock-out mice model, which develops a spontaneous colitis in a specific pathogen-free environment. Studies investigating MDR1 gene polymorphism and predisposition to IBD have also shown conflicting results, owing to the known difficulties in complex diseases, especially when the supposed genetic contribution is weak. In this study we have undertaken a metaanalysis of the available findings obtained with two SNPs polymorphism （C3435T and G2677T/A） in IBD; a significant association of 3435T allele and 3435TT genotype has been found with UC （OR = 1.17, P = 0.003 and OR = 1.36, P = 0.017, respectively）. In contrast no association with CD and the G2677T/A polymorphism could be demonstrated.