BACKGROUND Crohn’s disease(CD)can affect the entire gastrointestinal tract.Proximal small bowel(SB)lesions are associated with a significant risk of stricturing disease and multiple abdominal surgeries.The assessment...BACKGROUND Crohn’s disease(CD)can affect the entire gastrointestinal tract.Proximal small bowel(SB)lesions are associated with a significant risk of stricturing disease and multiple abdominal surgeries.The assessment of SB in patients with CD is therefore necessary because it may have a significant impact on prognosis with potential therapeutic implications.Because of the weak correlation that exists between symptoms and endoscopic disease activity,the“treat-to-target”paradigm has been developed,and the associated treatment goal is to achieve and maintain deep remission,encompassing both clinical and endoscopic remission.Small bowel capsule endoscopy(SBCE)allows to visualize the mucosal surface of the entire SB.At that time,there is no recommendation regarding the use of SBCE during follow-up.AIM To investigate the impact of SBCE in a treat-to-target strategy in patients with CD.METHODS An electronic literature search was conducted in PubMed and Cochrane library using the following search terms:“capsule endoscopy”,in combination with“Crohn’s disease”and“treat-to-target”or synonyms.Two authors independently reviewed titles and abstracts identified by the search strategy after duplicates were removed.Following the initial screening of abstracts,all articles containing information about SBCE in the context of treat-to-target strategy in patients with CD were included.Full-text articles were retrieved,reference lists were screened manually to identify additional studies.RESULTS Forty-seven articles were included in this review.Two indexes are currently used to quantify disease activity using SBCE,and there is good correlation between them.SBCE was shown to be useful for disease reclassification in patients who are suspected of having or who are diagnosed with CD,with a significant incremental diagnostic yield compared to other diagnostic modalities.Nine studies also demonstrated that the mucosal healing can be evaluated by SBCE to monitor the effect of medical treatment in patients with CD.This review also demonstrated that SBCE can detect post-operative recurrence to a similar extent as ileocolonoscopy,and proximal SB lesions that are beyond the reach of the colonoscope in over half of the patients.CONCLUSION SBCE could be incorporated in the treat-to-target algorithm for patients with CD.Randomized controlled trials are required to confirm its usefulness and reliability in this indication.展开更多
Capsule endoscopy(CE) has proved to be an important non-invasive tool for diagnosis and monitoring Crohn's disease patients.It has the advantage of excellent visualization of digestive tract mucosa,a good tolerabi...Capsule endoscopy(CE) has proved to be an important non-invasive tool for diagnosis and monitoring Crohn's disease patients.It has the advantage of excellent visualization of digestive tract mucosa,a good tolerability and safety in well-selected patients.The risk of retention can be diminished by good selection of patients using imaging techniques and by the use of patency capsule.The aim of a capsule examination is not only an early diagnosis but also a very good stratification of prognosis,thus directing the treatment strategy for either a step up or top-down approach and also permitting the optimization of the treatment depending on the findings.When symptoms and biomarkers point to a change in the disease's activity we can either adjust the treatment directly as recommended in CALM study or choose in selected patients to visualize the digestive mucosa through a CE and take a decision afterwards.The appearance of the new capsule from Medtronicthe Pillcam Crohn's might be an important step forward in diagnosis,evaluating disease extent,the severity of the disease,prognosis,management in a treat to target approach,with treatment modifications according to the data from CE examination.Serial examinations in the same patient can be compared and a more objective evaluation of the lesions modification from one exam to another can be performed.We present the latest developments and current status and evidence that in selected patients capsule can be a tool in a treat to target approach.展开更多
脉血康胶囊(肠溶片)治疗心脑血管疾病具有良好的临床疗效及安全性。在临床医生问卷调查和脉血康胶囊(肠溶片)研究文献系统回顾的基础上,采用国际临床医学专家共识研制方法,基于现有最佳证据,充分结合专家经验,遵循“循证为主,共识为辅,...脉血康胶囊(肠溶片)治疗心脑血管疾病具有良好的临床疗效及安全性。在临床医生问卷调查和脉血康胶囊(肠溶片)研究文献系统回顾的基础上,采用国际临床医学专家共识研制方法,基于现有最佳证据,充分结合专家经验,遵循“循证为主,共识为辅,经验为鉴”的原则,国内26位中西医临床、药学、方法学等多学科专家共同研制该共识,旨在进一步提高临床医生对该药的认识,更好地指导其临床合理用药。共识采用国际公认的证据分级推荐标准即评估、发展和评价建议的分级(Grading of Recommendations Assessment,Development and Evaluation,GRADE分级),如果证据充分则形成“推荐意见”,采用GRADE网格计票规则;如果证据不充分,则形成“共识建议”,采用多数计票规则。共识对脉血康胶囊(肠溶片)用于心脑血管疾病的适应证、用法用量、疗程、禁忌证、合并用药进行了推荐或建议,并完善了安全性信息,为其临床的合理使用提供参考。展开更多
OBJECTIVE: To observe the impact of Xinfeng capsule(XFC) on cardiovascular function in adjuvant arthritis(AA) model rats and investigate the mechanism though toll-like receptor 4(TLR4)/nuclear factor kappa B(NF-κB) s...OBJECTIVE: To observe the impact of Xinfeng capsule(XFC) on cardiovascular function in adjuvant arthritis(AA) model rats and investigate the mechanism though toll-like receptor 4(TLR4)/nuclear factor kappa B(NF-κB) signaling pathway.METHODS: Seventy rats were randomly divided into seven groups: normal control(NC), model control(MC), tripterygium glycosides tablet(TPT),methotrexate(MTX), high, moderate and low dose XFC group. The administration began from day 19 after modeling for 30 day. Paw swelling, arthritic in-dex(AI), cardiac function indexes and myocardial pathological pattern were detected. The expression of TLR4, myeloid differentiation factor(My D) 88, interleukin-1 receptor-associated kinase(IRAK) 1, tumor necrosis factor receptor associated factor(TRAF) 6, NF-κB, tumor necrosis factor-alpha(TNF-α) proteins in myocardial tissue were determined by western blot method.RESULTS: Paw swelling and AI in MC group increased in MC group(P < 0.01), and decreased in high and moderate dose XFC groups(P < 0.01 or P > 0.05). Left ventricular systolic pressure(LVSP),left ventricular end-diastolic pressure(LVEDP),heart rate(HR) were elevated in MC group(P <0.01), and ± dp/dtmax and CI were reduced(P <0.01); while LVSP, LVEDP and HR declined and ±dp/dtmax, CI improved in high dose XFC group(P <0.05 or P < 0.01). LVSP in high dose XFC group were reduced more than other treatment groups(P <0.05 or P < 0.01). The improvements on LVEDP, dp/dt-max were superior to MTX and low dose XFC group, and the improvement on CI was better than low dose XFC group(P < 0.05 or P < 0.01). Myocardial fibers arranged irregular in MC group with intracellular edema and mitochondria damage. The modifications on myocardial structural were shown in each treatment group, but more prominent in TPT, high and moderate dose XFC group. The proteins of TLR4, My D88, IRAK1, TRAF6, NF-κB, TNF-αwere highly expressed in MC group, and those proteins declined in high and moderate dose XFC group(P < 0.05 or P < 0.01). High dose XFC group was superior to MTX and low dose XFC group on reducing TLR4, NF-κB, TNF-α(P < 0.05).CONCLUSION: XFC can not only inhibit the excessive activation of TLR4/NF-κB signaling pathway and the increased inflammatory mediators, but also reduce the damage of myocardial tissue and cells.展开更多
Guanxinshutong capsule(GXSTC) is an effective and safe traditional Chinese medicine used in the treatment of cardiovascular diseases(CVDs) for many years. However, the targets of this herbal formula and the underlying...Guanxinshutong capsule(GXSTC) is an effective and safe traditional Chinese medicine used in the treatment of cardiovascular diseases(CVDs) for many years. However, the targets of this herbal formula and the underlying molecular mechanisms of action involved in the treatment of CVDs are still unclear. In the present study, we used a systems pharmacology approach to identify the active ingredients of GXSTC and their corresponding targets in the calcium signaling pathway with respect to the treatment of CVDs. This method integrated chromatographic techniques, prediction of absorption, distribution, metabolism, and excretion, analysis using Kyoto Encyclopedia of Genes and Genomes, network construction, and pharmacological experiments. 12 active compounds and 33 targets were found to have a role in the treatment of CVDs, and four main active ingredients, including protocatechuic acid, cryptotanshinone, eugenol, and borneol were selected to verify the effect of(GXSTC) on calcium signaling system in cardiomyocyte injury induced by hypoxia and reoxygenation. The results from the present study revealed the active components and targets of GXSTC in the treatment of CVDs, providing a new perspective to enhance the understanding of the role of the calcium signaling pathway in the therapeutic effect of GXSTC.展开更多
文摘BACKGROUND Crohn’s disease(CD)can affect the entire gastrointestinal tract.Proximal small bowel(SB)lesions are associated with a significant risk of stricturing disease and multiple abdominal surgeries.The assessment of SB in patients with CD is therefore necessary because it may have a significant impact on prognosis with potential therapeutic implications.Because of the weak correlation that exists between symptoms and endoscopic disease activity,the“treat-to-target”paradigm has been developed,and the associated treatment goal is to achieve and maintain deep remission,encompassing both clinical and endoscopic remission.Small bowel capsule endoscopy(SBCE)allows to visualize the mucosal surface of the entire SB.At that time,there is no recommendation regarding the use of SBCE during follow-up.AIM To investigate the impact of SBCE in a treat-to-target strategy in patients with CD.METHODS An electronic literature search was conducted in PubMed and Cochrane library using the following search terms:“capsule endoscopy”,in combination with“Crohn’s disease”and“treat-to-target”or synonyms.Two authors independently reviewed titles and abstracts identified by the search strategy after duplicates were removed.Following the initial screening of abstracts,all articles containing information about SBCE in the context of treat-to-target strategy in patients with CD were included.Full-text articles were retrieved,reference lists were screened manually to identify additional studies.RESULTS Forty-seven articles were included in this review.Two indexes are currently used to quantify disease activity using SBCE,and there is good correlation between them.SBCE was shown to be useful for disease reclassification in patients who are suspected of having or who are diagnosed with CD,with a significant incremental diagnostic yield compared to other diagnostic modalities.Nine studies also demonstrated that the mucosal healing can be evaluated by SBCE to monitor the effect of medical treatment in patients with CD.This review also demonstrated that SBCE can detect post-operative recurrence to a similar extent as ileocolonoscopy,and proximal SB lesions that are beyond the reach of the colonoscope in over half of the patients.CONCLUSION SBCE could be incorporated in the treat-to-target algorithm for patients with CD.Randomized controlled trials are required to confirm its usefulness and reliability in this indication.
文摘Capsule endoscopy(CE) has proved to be an important non-invasive tool for diagnosis and monitoring Crohn's disease patients.It has the advantage of excellent visualization of digestive tract mucosa,a good tolerability and safety in well-selected patients.The risk of retention can be diminished by good selection of patients using imaging techniques and by the use of patency capsule.The aim of a capsule examination is not only an early diagnosis but also a very good stratification of prognosis,thus directing the treatment strategy for either a step up or top-down approach and also permitting the optimization of the treatment depending on the findings.When symptoms and biomarkers point to a change in the disease's activity we can either adjust the treatment directly as recommended in CALM study or choose in selected patients to visualize the digestive mucosa through a CE and take a decision afterwards.The appearance of the new capsule from Medtronicthe Pillcam Crohn's might be an important step forward in diagnosis,evaluating disease extent,the severity of the disease,prognosis,management in a treat to target approach,with treatment modifications according to the data from CE examination.Serial examinations in the same patient can be compared and a more objective evaluation of the lesions modification from one exam to another can be performed.We present the latest developments and current status and evidence that in selected patients capsule can be a tool in a treat to target approach.
文摘脉血康胶囊(肠溶片)治疗心脑血管疾病具有良好的临床疗效及安全性。在临床医生问卷调查和脉血康胶囊(肠溶片)研究文献系统回顾的基础上,采用国际临床医学专家共识研制方法,基于现有最佳证据,充分结合专家经验,遵循“循证为主,共识为辅,经验为鉴”的原则,国内26位中西医临床、药学、方法学等多学科专家共同研制该共识,旨在进一步提高临床医生对该药的认识,更好地指导其临床合理用药。共识采用国际公认的证据分级推荐标准即评估、发展和评价建议的分级(Grading of Recommendations Assessment,Development and Evaluation,GRADE分级),如果证据充分则形成“推荐意见”,采用GRADE网格计票规则;如果证据不充分,则形成“共识建议”,采用多数计票规则。共识对脉血康胶囊(肠溶片)用于心脑血管疾病的适应证、用法用量、疗程、禁忌证、合并用药进行了推荐或建议,并完善了安全性信息,为其临床的合理使用提供参考。
基金the National Natural Science Foundation of China:Research the Immune Mechanism of Xinfeng Capsule Treat the Heart Disease of AA Rats based on the mi R146a-TLR4/NF-κB Signal Pathway(No.81302967)The Key Subject Constructing Units by the State Administrative Bureau(No.[2009]30)+1 种基金Anhui Provincial Laboratory Construction Projects on Chinese Medicine Research and Development(No.[2008]150)Anhui Provincial Innovation Team in the Eleventh Five-Year Plan Period:Research and Development on Xin'an Medicine(2010TD005)
文摘OBJECTIVE: To observe the impact of Xinfeng capsule(XFC) on cardiovascular function in adjuvant arthritis(AA) model rats and investigate the mechanism though toll-like receptor 4(TLR4)/nuclear factor kappa B(NF-κB) signaling pathway.METHODS: Seventy rats were randomly divided into seven groups: normal control(NC), model control(MC), tripterygium glycosides tablet(TPT),methotrexate(MTX), high, moderate and low dose XFC group. The administration began from day 19 after modeling for 30 day. Paw swelling, arthritic in-dex(AI), cardiac function indexes and myocardial pathological pattern were detected. The expression of TLR4, myeloid differentiation factor(My D) 88, interleukin-1 receptor-associated kinase(IRAK) 1, tumor necrosis factor receptor associated factor(TRAF) 6, NF-κB, tumor necrosis factor-alpha(TNF-α) proteins in myocardial tissue were determined by western blot method.RESULTS: Paw swelling and AI in MC group increased in MC group(P < 0.01), and decreased in high and moderate dose XFC groups(P < 0.01 or P > 0.05). Left ventricular systolic pressure(LVSP),left ventricular end-diastolic pressure(LVEDP),heart rate(HR) were elevated in MC group(P <0.01), and ± dp/dtmax and CI were reduced(P <0.01); while LVSP, LVEDP and HR declined and ±dp/dtmax, CI improved in high dose XFC group(P <0.05 or P < 0.01). LVSP in high dose XFC group were reduced more than other treatment groups(P <0.05 or P < 0.01). The improvements on LVEDP, dp/dt-max were superior to MTX and low dose XFC group, and the improvement on CI was better than low dose XFC group(P < 0.05 or P < 0.01). Myocardial fibers arranged irregular in MC group with intracellular edema and mitochondria damage. The modifications on myocardial structural were shown in each treatment group, but more prominent in TPT, high and moderate dose XFC group. The proteins of TLR4, My D88, IRAK1, TRAF6, NF-κB, TNF-αwere highly expressed in MC group, and those proteins declined in high and moderate dose XFC group(P < 0.05 or P < 0.01). High dose XFC group was superior to MTX and low dose XFC group on reducing TLR4, NF-κB, TNF-α(P < 0.05).CONCLUSION: XFC can not only inhibit the excessive activation of TLR4/NF-κB signaling pathway and the increased inflammatory mediators, but also reduce the damage of myocardial tissue and cells.
基金supported by Ministry of National Science and Technology(No.2011ZX09401-308-6)National Natural Science Foundation of China(Nos.81773772 and 81704088)Shaanxi Department of Science and Technology(No.2016KTTSSF01-04-01)
文摘Guanxinshutong capsule(GXSTC) is an effective and safe traditional Chinese medicine used in the treatment of cardiovascular diseases(CVDs) for many years. However, the targets of this herbal formula and the underlying molecular mechanisms of action involved in the treatment of CVDs are still unclear. In the present study, we used a systems pharmacology approach to identify the active ingredients of GXSTC and their corresponding targets in the calcium signaling pathway with respect to the treatment of CVDs. This method integrated chromatographic techniques, prediction of absorption, distribution, metabolism, and excretion, analysis using Kyoto Encyclopedia of Genes and Genomes, network construction, and pharmacological experiments. 12 active compounds and 33 targets were found to have a role in the treatment of CVDs, and four main active ingredients, including protocatechuic acid, cryptotanshinone, eugenol, and borneol were selected to verify the effect of(GXSTC) on calcium signaling system in cardiomyocyte injury induced by hypoxia and reoxygenation. The results from the present study revealed the active components and targets of GXSTC in the treatment of CVDs, providing a new perspective to enhance the understanding of the role of the calcium signaling pathway in the therapeutic effect of GXSTC.
