Sympathetic system modulation by stellate ganglion blockade may modulate immune dysfunction and significantly improve symptoms of chronic ulcerative colitis.
Objective:To observe and compare whether the combination of traditional Chinese and Western medicine can achieve more satisfactory results in the treatment of patients with chronic ulcerative rectitis(UR).Methods:70 c...Objective:To observe and compare whether the combination of traditional Chinese and Western medicine can achieve more satisfactory results in the treatment of patients with chronic ulcerative rectitis(UR).Methods:70 cases of chronic ulcerative rectitis were selected in all hospitals of our hospital for comparison.Observation and control were set up.The number of people was the same,but there were differences in methods.The control group retained enema,and the observation group was treated with traditional Chinese medicine.Rectal mucosa scores after different treatments were compared to evaluate the effect of intervention.Results:It was found that the observation group scored lower(P<0.05),and the effect was better.Conclusion:For the treatment of patients with chronic ulcerative rectitis,the combination of traditional Chinese and Western medicine will help to promote the prognosis of the disease,improve the problem of ulcer,promote the improvement of gastrointestinal function and bring a more positive impact.展开更多
AIM To investigate the efficacy and safety of stellate ganglion block for the treatment of patients with chronic ulcerative colitis.METHODS A total of 120 randomly selected patients with chronic ulcerative colitis tre...AIM To investigate the efficacy and safety of stellate ganglion block for the treatment of patients with chronic ulcerative colitis.METHODS A total of 120 randomly selected patients with chronic ulcerative colitis treated in Cangzhou Central Hospital from January 2014 to January 2016 were included in this study. These patients were divided into two groups: control group(n = 30), patients received oral sulfasalazine treatment; experimental group(n = 90), patients received stellate ganglion block treatment. Clinical symptoms and disease activity in these two groups were compared before and after treatment using endoscopy. Blood was collected from patients on day 0, 10, 20 and 30 after treatment. Enzyme-linked immunosorbent assay was performed to determine interleukin-8(IL-8) level. The changes in IL-8 level post-treatment in the two groups were compared using repeated measures analysis of variance.RESULTS After treatment, clinical symptoms and disease activity were shown to be alleviated by endoscopy in both the control and experimental groups. However, patients in the control group did not have obvious abdominal pain relief. In addition, the degree of pain relief in the experimental group was statistically better than that in the control group(P < 0.05). Ten days after treatment, IL-8 level was found to be significantly lower in the experimental group than in the control group, and the difference was statistically significant(P < 0.05). In addition, adverse events were significantly higher in the control group than in the experimental group, and the difference was statistically significant(χ~2 = 33.215, P = 0.000).CONCLUSION The application of stellate ganglion block effectively improves treatment efficacy in chronic ulcerative colitis, relieves clinical symptoms in patients, and reduces the level of inflammatory factors. Furthermore, this approach also had a positive impact on the disease to a certain extent.展开更多
Background The incidence of chronic ulcerative colitis （CUC） in China is remarkably increasing, while little information on surgical treatment has been reported. This study aimed to completely describe and analyze t...Background The incidence of chronic ulcerative colitis （CUC） in China is remarkably increasing, while little information on surgical treatment has been reported. This study aimed to completely describe and analyze the clinical outcome of restorative proctocolectomy with ileal pouch-anal anastomosis （IPAA）for CUC in China. Methods Ninety-five consecutive patients, who suffered CUC and had surgical indications, were carefully selected. All patients underwent IPAA. Data on patient characteristics, surgical indications, surgical details, postoperative complications, functional outcome, and quality of life were collected. Results The mean patient age at the time of the operation was 32 years. Twenty-nine （31%） patients underwent an emergency operation, and 66 （69%） underwent elective procedures. Four patients with severe dysplasia underwent operations, but no carcinoma was histologically confirmed. A two-stage operation was performed in 87 （92%） patients, and a hand-sewn technique was applied in 88 （93%） patients. Sixteen patients （17.0%） experienced early complications, and there was a significant difference between the emergency surgery group and the elective group （31.0% vs. 10.6%, respectively; P 〈0.01）. Five （5.3%） patients developed pouchitis as a late complication. The mean stool frequency after the operation was 4.6 （2-11） during the first 24 hours and 1.5 （0-4） overnight. According to the Kirwan grading scale, 87 （91.8%） patients showed satisfactory anal continence function. The quality of life improved significantly from a preoperative mean value of 0.28-0.61 before ileostomy closure to 0.78 after ileostomy closure （P 〈0.01） according to the Cleveland Global Quality of Life index. Conclusions IPAA is an effective and safe surgical procedure for patients with CUC in China. However, some characteristics, such as the low incidence of pouchitis, require further study.展开更多
Evaluating patients with chronic venous leg ulcers(CVLUs)is essential to find the underlying etiology.The basic tenets in managing CVLUs are to remove the etiological causes,to address systemic and metabolic condition...Evaluating patients with chronic venous leg ulcers(CVLUs)is essential to find the underlying etiology.The basic tenets in managing CVLUs are to remove the etiological causes,to address systemic and metabolic conditions,to examine the ulcers and artery pulses,and to control wound infection with debridement and eliminating excessive pressure on the wound.The first-line treatments of CVLUs remain wound care,debridement,bed rest with leg elevation,and compression.Evidence to support the efficacy of silver-based dressings in healing CVLUs is unavailable.Hydrogen peroxide is harmful to the growth of granulation tissue in the wound.Surgery options include a high ligation with or without stripping or ablation of the GSVs depending on venous reflux or insufficiency.Yet,not all CVLUs are candidates for surgical treatment because of comorbidities.When standard care of wound for 4 wk failed to heal CVLUs effectively,use of advanced wound care should be considered based on the available evidence.Negative pressure wound therapy facilitates granulation tissue development,thereby helping closure of CVLUs.Autologous split-thickness skin grafting is still the gold standard approach to close huge CVLUs.Hair punch graft appears to have a better result than traditional hairless punch graft for CVLUs.Application of adipose tissue or placenta-derived mesenchymal stem cells is a promising therapy for wound healing.Autologous platelet-rich plasma provides an alternative strategy for surgery for safe and natural healing of the ulcer.The confirmative efficacy of current advanced ulcer therapies needs more robust evidence.展开更多
We had treated 102 cases of obstinate peptic ulcer and chronic gastritis with ametal ring embedded in Zusanli acupoint since October 1989 to October 1992,and got satisfactorytherapeutic effects.The total effective rat...We had treated 102 cases of obstinate peptic ulcer and chronic gastritis with ametal ring embedded in Zusanli acupoint since October 1989 to October 1992,and got satisfactorytherapeutic effects.The total effective rate is 96.08%,the cure rate of peptic ulcer is 87.32%,therecurrence rate is significantly lower than that of control group(P【0.001),and it has no side-effect.展开更多
Background: Chronic ulcers are responsible for considerable morbidity and significantly contribute to the escalation in the cost of health care. Chronic leg ulcers (CLUs) are susceptible to microbial infections and se...Background: Chronic ulcers are responsible for considerable morbidity and significantly contribute to the escalation in the cost of health care. Chronic leg ulcers (CLUs) are susceptible to microbial infections and serious complications such as tissue necrosis and osteomyelitis, can result without the timely control of infections. Recent studies have also reported an increase in the association of fungal infections with chronic non-healing ulcers. Aim: To determine the prevalence of bacterial and fungal infections among patients reporting with chronic leg ulcers in participants without co-morbidities. Methods: A prospective cross-sectional study was conducted among patients with chronic leg ulcers at the National Reconstructive Plastic Surgery and Burns Centre, Korle-Bu Teaching Hospital (NRPS/BC-KBTH) and those who consented were enrolled. Characteristics of the wound as well as micro-organisms cultured from wound swabs were recorded. Results: A total of 50 participants were enrolled for the study with the mean (SD) age of 40.7 (10.7) years. Eighty percent of the participants presented with post traumatic leg ulcers with 80% being artisans and traders in the age group 31 - 50 years. There was no statistically significant association between sex and the organism cultured for post traumatic and cellulitis (p-value > 0.05). The prevalence of bacterial and fungal infection was 79.3% and 20.7% respectively. Pseudomonas species was the most isolated bacteria (61.5%) while Aspergillus niger was the most isolated fungi (41%). Conclusion: From this study, fungal infections should be included in managing chronic leg ulcers, especially among artisans, famers and gardeners even though there was a significantly higher burden of bacterial infections.展开更多
Objective:Long-term effects of chronic skin ulcers(CSU)include diminished physical and emotional well-being,an increased risk of cancer in more severe cases,and significant social costs due to inadequate treatment.Pin...Objective:Long-term effects of chronic skin ulcers(CSU)include diminished physical and emotional well-being,an increased risk of cancer in more severe cases,and significant social costs due to inadequate treatment.Pinian powder is a topical Chinese medicine created by the late renowned traditional Chinese medicine(TCM)master WEN Zhuozhi,with a long history of clinical use,and has been proven effective in treating various CSU.However,its exact mechanism of action is unknown.This study aims to investigate the effects and mechanisms of Pinian powder on chronic skin ulcers.Methods:A mouse model with skin defects and foreign body implantation was developed.Mice were divided into five groups:Control group,model control group,Pinian powder(PNP)group,inhibitor(MSAB)group,and PNP with inhibitor group.Treatments included saline washes,daily PNP application,intraperitoneal MSAB injection,and combined treatment.Wound healing was assessed on day 1,day 3,day 7,and day 14 using photography and software.Histological and Western blotting assays evaluated epidermal repair and protein expression related to wound healing.Immunofluorescence staining detected specific protein localization and expression.Statistical analysis was conducted using GraphPad Prism software,with significance set at P<0.05.Results:Clinical cases have demonstrated that Pinian powder can influence epidermal migration,reduce wound secretion,and stimulate granulation tissue formation in chronic skin ulcers.In vivo experiments,Pinian powder is applied externally to total skin defects and added to foreign body implantation in a mouse model of CSU.It activates the Wnt4/β-catenin signaling pathway,increases the expression of crucial proteins of fibroblast proliferation and keratinocyte proliferation,such asα-smooth muscle actin(α-SMA),Ki-67,K10,and K14,promotes wound healing.After the action ofβ-catenin inhibitor MSAB,the effect of Pinian powder was reversed.Conclusions:Pinian powder can promote the proliferation of keratinocytes and fibroblasts by activating the Wnt4/β-catenin signaling pathway and accelerating the wound healing of CSU.展开更多
Introduction: The benefit of intermittent pneumatic compression (IPC) for the prevention of venous thromboembolism and lymphedema has been well established in the literature. Recent evidence suggests that IPC plays a ...Introduction: The benefit of intermittent pneumatic compression (IPC) for the prevention of venous thromboembolism and lymphedema has been well established in the literature. Recent evidence suggests that IPC plays a beneficial role in circulation, hemodynamic peripheral pump, intravascular coagulation and arterial skin perfusion. Despite such evidence, the use of IPC in the treatment of resistant and chronic venous leg ulcers, has received little attention in practice. Case Presentation: We would like to report the case of successfully treated chronic and bilateral venous leg ulcer in an obese patient with IPC application and a review of the literature. Results: The use of IPC as an adjuvant therapy to the traditional multilayered compression therapy permitted significant resolution of the ulcers, reduced secondary infection incidence and prevented ulcer recurrence. Conclusion: In obese, minimally mobile patients with venous ulcers not responding to the traditional multilayered compression therapy application of IPC, an adjuvant therapy is recommended.展开更多
AIM To study the short term effect of Danshen ( Salvia miltiorrhiza ) on acetic acid induced chronic gastric ulcer in rats and its long term effect in preventing recurrence. METHODS Rats with acetic acid indu...AIM To study the short term effect of Danshen ( Salvia miltiorrhiza ) on acetic acid induced chronic gastric ulcer in rats and its long term effect in preventing recurrence. METHODS Rats with acetic acid induced gastric ulcer were treated with Danshen and cimetidine for 30 days. Traditional gastric mucosal auto radiography and 3H TdR incorporation into gastric mucosa in vitro were employed to study the effects of Danshen in rat acetic acid induced chronic gastric ulcer, including ulcer index (UI), ulcer inhibitory rate (IR) and label rate (LR). RESULTS On the day 5, 30 and 126 of ulcer making, the UI in the Danshen group was obviously lower than that in the cimetidine group and the control group (42 3±3 9, 3 6±1 2, 4 4±2 3; 49 1±3 6, 5 9±1 4, 9 2±1 3; 61 0±3 8, 8 9±2 5, 12 4±2 4, respectively, P <0 01), the IR (%) in the Danshen group was obviously higher than that in the cimetidine group (31, 59, 64 8; 19, 33, 26, respectively), and the LR in the Danshen group was obviously higher than that in the cimetidine group and the control group (10 0±0 5, 16 2±0 8, 15 0±0 6; 9 0±0 5, 13 9±0 6, 10 8±0 7; 6 5±0 7, 10 1±0 5, 8 0±0 7, respectively, P <0 01). There was no obvious difference in UI in the Danshen group on day 30 as compared with that on day 126. CONCLUSION Danshen is effective in promoting ulcer healing and preventing recurrence. The mechanism of action is to strengthen the gastric mucosal barrier and to promote the gastric mucosal cell proliferation along the edge of the ulcer.展开更多
Recently,the use of confocal laser endomicroscopy(CLE) in the diagnosis of chronic ulcerative colitis(CUC) was reported.In this brief report we aimed to assess the application of probe-based CLE to characterize coloni...Recently,the use of confocal laser endomicroscopy(CLE) in the diagnosis of chronic ulcerative colitis(CUC) was reported.In this brief report we aimed to assess the application of probe-based CLE to characterize colonic mucosa and dysplasia in CUC.The study involved a patient presenting long-standing CUC.Confocal imaging of both the inflamed mucosa,a circumscribed lesion(dysplasiaassociated lesional mass),and adjacent colonic mucosa are demonstrated and the correlation between the CLE and histological images.Inflamed mucosa and dysplasia showed specific alteration of crypt architecture,cellular infiltration,and vessel architecture with an excellent correlation between CLE and standard histological examination.展开更多
BACKGROUND Evidence has been published on the successful applications of the anti-tumor necrosis factor alpha antibody infliximab,such as induction therapy,salvage treatment for acute cellular rejection,and treatment ...BACKGROUND Evidence has been published on the successful applications of the anti-tumor necrosis factor alpha antibody infliximab,such as induction therapy,salvage treatment for acute cellular rejection,and treatment for chronic ulcerative inflammation,in intestinal transplant recipients.However,the optimal protocol for the effective use of infliximab remains largely undetermined due to scarcity of available clinical data.We report a continuative application of infliximab as maintenance therapy for recurrent chronic ulcerative ileitis in a recipient of isolated intestinal transplantation(ITx).CASE SUMMARY The patient was a 11-year-old boy with intestinal motility disorder classified as a hypogenic type of intestinal dysganglionosis.The patient underwent living-donor related intestinal transplant.His immunosuppression regimen consisted of daclizumab,tacrolimus,and steroids.Although he did not show rejection while on tacrolimus monotherapy,routine screening endoscopy showed several ulcerative lesions in the distal end of the graft 2 years after the intestinal transplant.Endoscopic work up to evaluate the progression of anemia revealed stenosis with ulcerative inflammatory changes and multiple longitudinal ulcers in the graft.Since the endoscopic findings suggested ulcerative lesions in Crohn’s disease,infliximab treatment was considered.Treatment with infliximab and a small dose of oral prednisolone afforded successful withdrawal of total parenteral nutrition and maintenance of a well-functioning graft without infectious complications for 5 years since the administration of the first dose of infliximab.CONCLUSION Infliximab is effective as maintenance therapy for recurrent chronic ulcerative ileitis in an isolated ITx patient.展开更多
BACKGROUND We recently reported on a hereditary enteropathy associated with a gene encoding a prostaglandin transporter and referred to as chronic enteropathy associated with SLCO2 A1 gene(CEAS).Crohn's disease(CD...BACKGROUND We recently reported on a hereditary enteropathy associated with a gene encoding a prostaglandin transporter and referred to as chronic enteropathy associated with SLCO2 A1 gene(CEAS).Crohn's disease(CD)is a major differential diagnosis of CEAS,because these diseases share some clinical features.Therefore,there is a need to develop a convenient screening test to distinguish CEAS from CD.AIM To examine whether prostaglandin E major urinary metabolites(PGE-MUM)can serve as a biomarker to distinguish CEAS from CD.METHODS This was a transactional study of 20 patients with CEAS and 98 patients with CD.CEAS was diagnosed by the confirmation of homozygous or compound heterozygous mutation of SLCO2 A1.We measured the concentration of PGEMUM in spot urine by radioimmunoassay,and the concentration was compared between the two groups of patients.We also determined the optimal cut-off value of PGE-MUM to distinguish CEAS from CD by receiver operating characteristic(ROC)curve analysis.RESULTS Twenty Japanese patients with CEAS and 98 patients with CD were enrolled.PGE-MUM concentration in patients with CEAS was significantly higher than that in patients with CD(median 102.7 vs 27.9μg/g×Cre,P<0.0001).One log unit increase in PGE-MUM contributed to 7.3 increase in the likelihood for the diagnosis of CEAS[95%confidence interval(CI)3.2-16.7].A logistic regression analysis revealed that the association was significant even after adjusting confounding factors(adjusted odds ratio 29.6,95%CI 4.7-185.7).ROC curve analysis revealed the optimal PGE-MUM cut-off value for the distinction of CEAS from CD to be 48.9μg/g×Cre with 95.0%sensitivity and 79.6%specificity.CONCLUSION PGE-MUM measurement is a convenient,non-invasive and useful test for the distinction of CEAS from CD.展开更多
The widespread use of capsule endoscopy and balloonassisted endoscopy has provided easy access for detailed mucosal assessment of the small intestine. However, the diagnosis of rare small bowel diseases, such as crypt...The widespread use of capsule endoscopy and balloonassisted endoscopy has provided easy access for detailed mucosal assessment of the small intestine. However, the diagnosis of rare small bowel diseases, such as cryptogenic multifocal ulcerous stenosing enteritis(CMUSE), remains difficult because clinical and morphological features of these diseases are obscure even for gastroenterologists. In an issue of this journal in 2017, Hwang et al reviewed and summarized clinical and radiographic features of 20 patients with an established diagnosis of CMUSE. Recently, recessive mutations in the PLA2G4A and SLCO2A1 genes have been shown to cause small intestinal diseases. The small bowel ulcers in each disease mimic those in the other and furthermore those found in nonsteroidal anti-inflammatory drug-induced enteropathy. These recent and novel findings suggest that a clinical diagnosis exclusively based on the characteristics of small bowel lesions is possibly imprecise. Genetic analyses seem to be inevitable for the diagnosis of rare small bowel disorders such as CMUSE.展开更多
Objective:Aloe Vera gel(AVG) has a prominent role as a contemporary folk remedy.The Non-healed chronic ulcers of 16 non-responders to conventional treatment were treated with AVG for which the clinical efficacy was st...Objective:Aloe Vera gel(AVG) has a prominent role as a contemporary folk remedy.The Non-healed chronic ulcers of 16 non-responders to conventional treatment were treated with AVG for which the clinical efficacy was studied.Methods:This study included 16 patients having chronic ulcer(9 males and 7 females) with mean age of 41.8±14.6 who following failure treatment to conventional therapy,were dispensed AVG to apply. AVG is consisted from gel part of Aloe Vera plant plus one preservative material,in this study ECG jelly. The patients were assessed as responder whenever intensity of inflammation,the number and /or the size of ulcers have been reduced.Results:The period of time till healing(complete or reduction in size of ulcer), were from 5 to 160 days with mean of 31.2±36.4 days.The mean time of decreasing for secreting,swelling and redness was from 5-11 days.Spearman coefficient of correlation,showed no significant correlation between first size and depth of ulcer and timing till 50%reduction in size of ulcer.Conclusion:All patients had been treated with conventional treatment all to no avail.There were some full thickness ulcer which at the end of treatment we observed an improvement and normal skin for those ulcers.There was a minor complication like itching in one patient but no leading to stop treatment.These findings suggest that AVG is an excellent and safer choice than current conventional therapeutic management of chronic ulcers.展开更多
BACKGROUND There is a growing evidence regarding an increased risk of inflammatory bowel disease(IBD)among patients with airway diseases.AIM To investigate the influence of chronic obstructive pulmonary disease(COPD)o...BACKGROUND There is a growing evidence regarding an increased risk of inflammatory bowel disease(IBD)among patients with airway diseases.AIM To investigate the influence of chronic obstructive pulmonary disease(COPD)on the risk of IBD.METHODS A nationwide,population-based study was conducted using data from the National Health Insurance Service database.A total of 1303021 patients with COPD and 6515105 non-COPD controls were identified.The COPD group was divided into the severe and the mild COPD group according to diagnostic criteria.The risk of IBD in patients with COPD compared to controls was analyzed by Cox proportional hazard regression models.The cumulative incidences of IBD were compared between the groups.RESULTS The COPD group had higher incidences of IBD compared to non-COPD controls(incidence rate,9.98 vs 7.18 per 100000 person-years,P<0.001).The risk of IBD in the COPD group was increased by 1.38(adjusted hazard ratio(HR);95%CI:1.25-1.52).The incidence rate of IBD was higher in the severe COPD group than in the mild COPD group(12.39 vs 9.77 per 100000 person-year,P<0.001).The severity of COPD was associated with an increased risk of IBD(adjusted HR 1.70 in severe COPD,95%CI:1.27-2.21 and adjusted HR 1.35 in mild COPD,95%CI:1.22-1.49)CONCLUSION The incidences of IBD were significantly increased in COPD patients in South Korea and the risk of developing IBD also increased as the severity of COPD increased.展开更多
AIM:To evaluate the clinical characteristics of nonvariceal upper gastrointestinal hemorrhage(NGIH)in patients with chronic kidney disease(CKD).METHODS:From 2003 to 2010,a total of 72 CKD patients(male n=52,72.2%;fema...AIM:To evaluate the clinical characteristics of nonvariceal upper gastrointestinal hemorrhage(NGIH)in patients with chronic kidney disease(CKD).METHODS:From 2003 to 2010,a total of 72 CKD patients(male n=52,72.2%;female n=20,27.8%)who had undergone endoscopic treatments for NGIH were retrospectively identified.Clinical findings,endoscopic features,prognosis,rebleeding risk factors,and mortality-related factors were evaluated.The characteristics of the patients and rebleeding-related data were recorded for the following variables:gender,age,alcohol use and smoking history,past hemorrhage history,endoscopic findings(the cause,location,and size of the hemorrhage and the hemorrhagic state),therapeutic options for endoscopy,endoscopist experience,clinical outcomes,and mortality.RESULTS:The average size of the hemorrhagic site was 13.7±10.2 mm,and the most common hemorrhagic site in the stomach was the antrum(n=21,43.8%).The most frequent method of hemostasis was combination therapy(n=32,44.4%).The incidence of rebleeding was 37.5%(n=27),and 16.7%(n=12)of patients expired due to hemorrhage.In a multivariate analysis of the risk factors for rebleeding,alcoholism(OR=11.19,P=0.02),the experience of endoscopists(OR=0.56,P=0.03),and combination endoscopic therapy(OR=0.06,P=0.01)compared with monotherapy were significantly related to rebleeding after endoscopic therapy.In a risk analysis of mortality after endoscopic therapy,only rebleeding was related to mortality(OR=7.1,P=0.02).CONCLUSION:Intensive combined endoscopic treatments by experienced endoscopists are necessary for the treatment of NGIH in patients with CKD,especially when a patient is an alcoholic.展开更多
文摘Sympathetic system modulation by stellate ganglion blockade may modulate immune dysfunction and significantly improve symptoms of chronic ulcerative colitis.
文摘Objective:To observe and compare whether the combination of traditional Chinese and Western medicine can achieve more satisfactory results in the treatment of patients with chronic ulcerative rectitis(UR).Methods:70 cases of chronic ulcerative rectitis were selected in all hospitals of our hospital for comparison.Observation and control were set up.The number of people was the same,but there were differences in methods.The control group retained enema,and the observation group was treated with traditional Chinese medicine.Rectal mucosa scores after different treatments were compared to evaluate the effect of intervention.Results:It was found that the observation group scored lower(P<0.05),and the effect was better.Conclusion:For the treatment of patients with chronic ulcerative rectitis,the combination of traditional Chinese and Western medicine will help to promote the prognosis of the disease,improve the problem of ulcer,promote the improvement of gastrointestinal function and bring a more positive impact.
文摘AIM To investigate the efficacy and safety of stellate ganglion block for the treatment of patients with chronic ulcerative colitis.METHODS A total of 120 randomly selected patients with chronic ulcerative colitis treated in Cangzhou Central Hospital from January 2014 to January 2016 were included in this study. These patients were divided into two groups: control group(n = 30), patients received oral sulfasalazine treatment; experimental group(n = 90), patients received stellate ganglion block treatment. Clinical symptoms and disease activity in these two groups were compared before and after treatment using endoscopy. Blood was collected from patients on day 0, 10, 20 and 30 after treatment. Enzyme-linked immunosorbent assay was performed to determine interleukin-8(IL-8) level. The changes in IL-8 level post-treatment in the two groups were compared using repeated measures analysis of variance.RESULTS After treatment, clinical symptoms and disease activity were shown to be alleviated by endoscopy in both the control and experimental groups. However, patients in the control group did not have obvious abdominal pain relief. In addition, the degree of pain relief in the experimental group was statistically better than that in the control group(P < 0.05). Ten days after treatment, IL-8 level was found to be significantly lower in the experimental group than in the control group, and the difference was statistically significant(P < 0.05). In addition, adverse events were significantly higher in the control group than in the experimental group, and the difference was statistically significant(χ~2 = 33.215, P = 0.000).CONCLUSION The application of stellate ganglion block effectively improves treatment efficacy in chronic ulcerative colitis, relieves clinical symptoms in patients, and reduces the level of inflammatory factors. Furthermore, this approach also had a positive impact on the disease to a certain extent.
文摘Background The incidence of chronic ulcerative colitis （CUC） in China is remarkably increasing, while little information on surgical treatment has been reported. This study aimed to completely describe and analyze the clinical outcome of restorative proctocolectomy with ileal pouch-anal anastomosis （IPAA）for CUC in China. Methods Ninety-five consecutive patients, who suffered CUC and had surgical indications, were carefully selected. All patients underwent IPAA. Data on patient characteristics, surgical indications, surgical details, postoperative complications, functional outcome, and quality of life were collected. Results The mean patient age at the time of the operation was 32 years. Twenty-nine （31%） patients underwent an emergency operation, and 66 （69%） underwent elective procedures. Four patients with severe dysplasia underwent operations, but no carcinoma was histologically confirmed. A two-stage operation was performed in 87 （92%） patients, and a hand-sewn technique was applied in 88 （93%） patients. Sixteen patients （17.0%） experienced early complications, and there was a significant difference between the emergency surgery group and the elective group （31.0% vs. 10.6%, respectively; P 〈0.01）. Five （5.3%） patients developed pouchitis as a late complication. The mean stool frequency after the operation was 4.6 （2-11） during the first 24 hours and 1.5 （0-4） overnight. According to the Kirwan grading scale, 87 （91.8%） patients showed satisfactory anal continence function. The quality of life improved significantly from a preoperative mean value of 0.28-0.61 before ileostomy closure to 0.78 after ileostomy closure （P 〈0.01） according to the Cleveland Global Quality of Life index. Conclusions IPAA is an effective and safe surgical procedure for patients with CUC in China. However, some characteristics, such as the low incidence of pouchitis, require further study.
文摘Evaluating patients with chronic venous leg ulcers(CVLUs)is essential to find the underlying etiology.The basic tenets in managing CVLUs are to remove the etiological causes,to address systemic and metabolic conditions,to examine the ulcers and artery pulses,and to control wound infection with debridement and eliminating excessive pressure on the wound.The first-line treatments of CVLUs remain wound care,debridement,bed rest with leg elevation,and compression.Evidence to support the efficacy of silver-based dressings in healing CVLUs is unavailable.Hydrogen peroxide is harmful to the growth of granulation tissue in the wound.Surgery options include a high ligation with or without stripping or ablation of the GSVs depending on venous reflux or insufficiency.Yet,not all CVLUs are candidates for surgical treatment because of comorbidities.When standard care of wound for 4 wk failed to heal CVLUs effectively,use of advanced wound care should be considered based on the available evidence.Negative pressure wound therapy facilitates granulation tissue development,thereby helping closure of CVLUs.Autologous split-thickness skin grafting is still the gold standard approach to close huge CVLUs.Hair punch graft appears to have a better result than traditional hairless punch graft for CVLUs.Application of adipose tissue or placenta-derived mesenchymal stem cells is a promising therapy for wound healing.Autologous platelet-rich plasma provides an alternative strategy for surgery for safe and natural healing of the ulcer.The confirmative efficacy of current advanced ulcer therapies needs more robust evidence.
文摘We had treated 102 cases of obstinate peptic ulcer and chronic gastritis with ametal ring embedded in Zusanli acupoint since October 1989 to October 1992,and got satisfactorytherapeutic effects.The total effective rate is 96.08%,the cure rate of peptic ulcer is 87.32%,therecurrence rate is significantly lower than that of control group(P【0.001),and it has no side-effect.
文摘Background: Chronic ulcers are responsible for considerable morbidity and significantly contribute to the escalation in the cost of health care. Chronic leg ulcers (CLUs) are susceptible to microbial infections and serious complications such as tissue necrosis and osteomyelitis, can result without the timely control of infections. Recent studies have also reported an increase in the association of fungal infections with chronic non-healing ulcers. Aim: To determine the prevalence of bacterial and fungal infections among patients reporting with chronic leg ulcers in participants without co-morbidities. Methods: A prospective cross-sectional study was conducted among patients with chronic leg ulcers at the National Reconstructive Plastic Surgery and Burns Centre, Korle-Bu Teaching Hospital (NRPS/BC-KBTH) and those who consented were enrolled. Characteristics of the wound as well as micro-organisms cultured from wound swabs were recorded. Results: A total of 50 participants were enrolled for the study with the mean (SD) age of 40.7 (10.7) years. Eighty percent of the participants presented with post traumatic leg ulcers with 80% being artisans and traders in the age group 31 - 50 years. There was no statistically significant association between sex and the organism cultured for post traumatic and cellulitis (p-value > 0.05). The prevalence of bacterial and fungal infection was 79.3% and 20.7% respectively. Pseudomonas species was the most isolated bacteria (61.5%) while Aspergillus niger was the most isolated fungi (41%). Conclusion: From this study, fungal infections should be included in managing chronic leg ulcers, especially among artisans, famers and gardeners even though there was a significantly higher burden of bacterial infections.
基金supported by the National Natural Science Foundation of China(No.82004380).
文摘Objective:Long-term effects of chronic skin ulcers(CSU)include diminished physical and emotional well-being,an increased risk of cancer in more severe cases,and significant social costs due to inadequate treatment.Pinian powder is a topical Chinese medicine created by the late renowned traditional Chinese medicine(TCM)master WEN Zhuozhi,with a long history of clinical use,and has been proven effective in treating various CSU.However,its exact mechanism of action is unknown.This study aims to investigate the effects and mechanisms of Pinian powder on chronic skin ulcers.Methods:A mouse model with skin defects and foreign body implantation was developed.Mice were divided into five groups:Control group,model control group,Pinian powder(PNP)group,inhibitor(MSAB)group,and PNP with inhibitor group.Treatments included saline washes,daily PNP application,intraperitoneal MSAB injection,and combined treatment.Wound healing was assessed on day 1,day 3,day 7,and day 14 using photography and software.Histological and Western blotting assays evaluated epidermal repair and protein expression related to wound healing.Immunofluorescence staining detected specific protein localization and expression.Statistical analysis was conducted using GraphPad Prism software,with significance set at P<0.05.Results:Clinical cases have demonstrated that Pinian powder can influence epidermal migration,reduce wound secretion,and stimulate granulation tissue formation in chronic skin ulcers.In vivo experiments,Pinian powder is applied externally to total skin defects and added to foreign body implantation in a mouse model of CSU.It activates the Wnt4/β-catenin signaling pathway,increases the expression of crucial proteins of fibroblast proliferation and keratinocyte proliferation,such asα-smooth muscle actin(α-SMA),Ki-67,K10,and K14,promotes wound healing.After the action ofβ-catenin inhibitor MSAB,the effect of Pinian powder was reversed.Conclusions:Pinian powder can promote the proliferation of keratinocytes and fibroblasts by activating the Wnt4/β-catenin signaling pathway and accelerating the wound healing of CSU.
文摘Introduction: The benefit of intermittent pneumatic compression (IPC) for the prevention of venous thromboembolism and lymphedema has been well established in the literature. Recent evidence suggests that IPC plays a beneficial role in circulation, hemodynamic peripheral pump, intravascular coagulation and arterial skin perfusion. Despite such evidence, the use of IPC in the treatment of resistant and chronic venous leg ulcers, has received little attention in practice. Case Presentation: We would like to report the case of successfully treated chronic and bilateral venous leg ulcer in an obese patient with IPC application and a review of the literature. Results: The use of IPC as an adjuvant therapy to the traditional multilayered compression therapy permitted significant resolution of the ulcers, reduced secondary infection incidence and prevented ulcer recurrence. Conclusion: In obese, minimally mobile patients with venous ulcers not responding to the traditional multilayered compression therapy application of IPC, an adjuvant therapy is recommended.
文摘AIM To study the short term effect of Danshen ( Salvia miltiorrhiza ) on acetic acid induced chronic gastric ulcer in rats and its long term effect in preventing recurrence. METHODS Rats with acetic acid induced gastric ulcer were treated with Danshen and cimetidine for 30 days. Traditional gastric mucosal auto radiography and 3H TdR incorporation into gastric mucosa in vitro were employed to study the effects of Danshen in rat acetic acid induced chronic gastric ulcer, including ulcer index (UI), ulcer inhibitory rate (IR) and label rate (LR). RESULTS On the day 5, 30 and 126 of ulcer making, the UI in the Danshen group was obviously lower than that in the cimetidine group and the control group (42 3±3 9, 3 6±1 2, 4 4±2 3; 49 1±3 6, 5 9±1 4, 9 2±1 3; 61 0±3 8, 8 9±2 5, 12 4±2 4, respectively, P <0 01), the IR (%) in the Danshen group was obviously higher than that in the cimetidine group (31, 59, 64 8; 19, 33, 26, respectively), and the LR in the Danshen group was obviously higher than that in the cimetidine group and the control group (10 0±0 5, 16 2±0 8, 15 0±0 6; 9 0±0 5, 13 9±0 6, 10 8±0 7; 6 5±0 7, 10 1±0 5, 8 0±0 7, respectively, P <0 01). There was no obvious difference in UI in the Danshen group on day 30 as compared with that on day 126. CONCLUSION Danshen is effective in promoting ulcer healing and preventing recurrence. The mechanism of action is to strengthen the gastric mucosal barrier and to promote the gastric mucosal cell proliferation along the edge of the ulcer.
文摘Recently,the use of confocal laser endomicroscopy(CLE) in the diagnosis of chronic ulcerative colitis(CUC) was reported.In this brief report we aimed to assess the application of probe-based CLE to characterize colonic mucosa and dysplasia in CUC.The study involved a patient presenting long-standing CUC.Confocal imaging of both the inflamed mucosa,a circumscribed lesion(dysplasiaassociated lesional mass),and adjacent colonic mucosa are demonstrated and the correlation between the CLE and histological images.Inflamed mucosa and dysplasia showed specific alteration of crypt architecture,cellular infiltration,and vessel architecture with an excellent correlation between CLE and standard histological examination.
基金Supported by JSPS KAKENHI,No. JP18K16286, and No. JP18K08600
文摘BACKGROUND Evidence has been published on the successful applications of the anti-tumor necrosis factor alpha antibody infliximab,such as induction therapy,salvage treatment for acute cellular rejection,and treatment for chronic ulcerative inflammation,in intestinal transplant recipients.However,the optimal protocol for the effective use of infliximab remains largely undetermined due to scarcity of available clinical data.We report a continuative application of infliximab as maintenance therapy for recurrent chronic ulcerative ileitis in a recipient of isolated intestinal transplantation(ITx).CASE SUMMARY The patient was a 11-year-old boy with intestinal motility disorder classified as a hypogenic type of intestinal dysganglionosis.The patient underwent living-donor related intestinal transplant.His immunosuppression regimen consisted of daclizumab,tacrolimus,and steroids.Although he did not show rejection while on tacrolimus monotherapy,routine screening endoscopy showed several ulcerative lesions in the distal end of the graft 2 years after the intestinal transplant.Endoscopic work up to evaluate the progression of anemia revealed stenosis with ulcerative inflammatory changes and multiple longitudinal ulcers in the graft.Since the endoscopic findings suggested ulcerative lesions in Crohn’s disease,infliximab treatment was considered.Treatment with infliximab and a small dose of oral prednisolone afforded successful withdrawal of total parenteral nutrition and maintenance of a well-functioning graft without infectious complications for 5 years since the administration of the first dose of infliximab.CONCLUSION Infliximab is effective as maintenance therapy for recurrent chronic ulcerative ileitis in an isolated ITx patient.
基金Supported by the Practical Research Project for Rare/Intractable Diseases from the Japan Agency for Medical Research and Development(AMED),No.15ek0109053h0002 to Matsumoto Tby grants from the Japan Society for the Promotion of Science(JSPS)KAKENHI,No.25460953,to Umeno J,Esaki M,and Matsumoto T
文摘BACKGROUND We recently reported on a hereditary enteropathy associated with a gene encoding a prostaglandin transporter and referred to as chronic enteropathy associated with SLCO2 A1 gene(CEAS).Crohn's disease(CD)is a major differential diagnosis of CEAS,because these diseases share some clinical features.Therefore,there is a need to develop a convenient screening test to distinguish CEAS from CD.AIM To examine whether prostaglandin E major urinary metabolites(PGE-MUM)can serve as a biomarker to distinguish CEAS from CD.METHODS This was a transactional study of 20 patients with CEAS and 98 patients with CD.CEAS was diagnosed by the confirmation of homozygous or compound heterozygous mutation of SLCO2 A1.We measured the concentration of PGEMUM in spot urine by radioimmunoassay,and the concentration was compared between the two groups of patients.We also determined the optimal cut-off value of PGE-MUM to distinguish CEAS from CD by receiver operating characteristic(ROC)curve analysis.RESULTS Twenty Japanese patients with CEAS and 98 patients with CD were enrolled.PGE-MUM concentration in patients with CEAS was significantly higher than that in patients with CD(median 102.7 vs 27.9μg/g×Cre,P<0.0001).One log unit increase in PGE-MUM contributed to 7.3 increase in the likelihood for the diagnosis of CEAS[95%confidence interval(CI)3.2-16.7].A logistic regression analysis revealed that the association was significant even after adjusting confounding factors(adjusted odds ratio 29.6,95%CI 4.7-185.7).ROC curve analysis revealed the optimal PGE-MUM cut-off value for the distinction of CEAS from CD to be 48.9μg/g×Cre with 95.0%sensitivity and 79.6%specificity.CONCLUSION PGE-MUM measurement is a convenient,non-invasive and useful test for the distinction of CEAS from CD.
基金Supported by the Practical Research Project for Rare/Intractable Diseases from Japan Agency for Medical Research and Development(AMED),No.15ek0109053h0002the Japan Society for the Promotion of Science(JSPS)KAKENHI,No.25460953
文摘The widespread use of capsule endoscopy and balloonassisted endoscopy has provided easy access for detailed mucosal assessment of the small intestine. However, the diagnosis of rare small bowel diseases, such as cryptogenic multifocal ulcerous stenosing enteritis(CMUSE), remains difficult because clinical and morphological features of these diseases are obscure even for gastroenterologists. In an issue of this journal in 2017, Hwang et al reviewed and summarized clinical and radiographic features of 20 patients with an established diagnosis of CMUSE. Recently, recessive mutations in the PLA2G4A and SLCO2A1 genes have been shown to cause small intestinal diseases. The small bowel ulcers in each disease mimic those in the other and furthermore those found in nonsteroidal anti-inflammatory drug-induced enteropathy. These recent and novel findings suggest that a clinical diagnosis exclusively based on the characteristics of small bowel lesions is possibly imprecise. Genetic analyses seem to be inevitable for the diagnosis of rare small bowel disorders such as CMUSE.
文摘Objective:Aloe Vera gel(AVG) has a prominent role as a contemporary folk remedy.The Non-healed chronic ulcers of 16 non-responders to conventional treatment were treated with AVG for which the clinical efficacy was studied.Methods:This study included 16 patients having chronic ulcer(9 males and 7 females) with mean age of 41.8±14.6 who following failure treatment to conventional therapy,were dispensed AVG to apply. AVG is consisted from gel part of Aloe Vera plant plus one preservative material,in this study ECG jelly. The patients were assessed as responder whenever intensity of inflammation,the number and /or the size of ulcers have been reduced.Results:The period of time till healing(complete or reduction in size of ulcer), were from 5 to 160 days with mean of 31.2±36.4 days.The mean time of decreasing for secreting,swelling and redness was from 5-11 days.Spearman coefficient of correlation,showed no significant correlation between first size and depth of ulcer and timing till 50%reduction in size of ulcer.Conclusion:All patients had been treated with conventional treatment all to no avail.There were some full thickness ulcer which at the end of treatment we observed an improvement and normal skin for those ulcers.There was a minor complication like itching in one patient but no leading to stop treatment.These findings suggest that AVG is an excellent and safer choice than current conventional therapeutic management of chronic ulcers.
文摘BACKGROUND There is a growing evidence regarding an increased risk of inflammatory bowel disease(IBD)among patients with airway diseases.AIM To investigate the influence of chronic obstructive pulmonary disease(COPD)on the risk of IBD.METHODS A nationwide,population-based study was conducted using data from the National Health Insurance Service database.A total of 1303021 patients with COPD and 6515105 non-COPD controls were identified.The COPD group was divided into the severe and the mild COPD group according to diagnostic criteria.The risk of IBD in patients with COPD compared to controls was analyzed by Cox proportional hazard regression models.The cumulative incidences of IBD were compared between the groups.RESULTS The COPD group had higher incidences of IBD compared to non-COPD controls(incidence rate,9.98 vs 7.18 per 100000 person-years,P<0.001).The risk of IBD in the COPD group was increased by 1.38(adjusted hazard ratio(HR);95%CI:1.25-1.52).The incidence rate of IBD was higher in the severe COPD group than in the mild COPD group(12.39 vs 9.77 per 100000 person-year,P<0.001).The severity of COPD was associated with an increased risk of IBD(adjusted HR 1.70 in severe COPD,95%CI:1.27-2.21 and adjusted HR 1.35 in mild COPD,95%CI:1.22-1.49)CONCLUSION The incidences of IBD were significantly increased in COPD patients in South Korea and the risk of developing IBD also increased as the severity of COPD increased.
基金Supported by The Basic Science Research Program through the National Research Foundation of Korea(NRF)funded by the Ministry of Education,Science and Technology(NRF-2010-0021482)to Suk KT
文摘AIM:To evaluate the clinical characteristics of nonvariceal upper gastrointestinal hemorrhage(NGIH)in patients with chronic kidney disease(CKD).METHODS:From 2003 to 2010,a total of 72 CKD patients(male n=52,72.2%;female n=20,27.8%)who had undergone endoscopic treatments for NGIH were retrospectively identified.Clinical findings,endoscopic features,prognosis,rebleeding risk factors,and mortality-related factors were evaluated.The characteristics of the patients and rebleeding-related data were recorded for the following variables:gender,age,alcohol use and smoking history,past hemorrhage history,endoscopic findings(the cause,location,and size of the hemorrhage and the hemorrhagic state),therapeutic options for endoscopy,endoscopist experience,clinical outcomes,and mortality.RESULTS:The average size of the hemorrhagic site was 13.7±10.2 mm,and the most common hemorrhagic site in the stomach was the antrum(n=21,43.8%).The most frequent method of hemostasis was combination therapy(n=32,44.4%).The incidence of rebleeding was 37.5%(n=27),and 16.7%(n=12)of patients expired due to hemorrhage.In a multivariate analysis of the risk factors for rebleeding,alcoholism(OR=11.19,P=0.02),the experience of endoscopists(OR=0.56,P=0.03),and combination endoscopic therapy(OR=0.06,P=0.01)compared with monotherapy were significantly related to rebleeding after endoscopic therapy.In a risk analysis of mortality after endoscopic therapy,only rebleeding was related to mortality(OR=7.1,P=0.02).CONCLUSION:Intensive combined endoscopic treatments by experienced endoscopists are necessary for the treatment of NGIH in patients with CKD,especially when a patient is an alcoholic.
