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1.
Biomed Res Int ; 2020: 9847591, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32190694

RESUMO

Aims: The aims of this study were to characterize nonatrophic and atrophic gastric mucosa under conventional endoscopy and probe-based confocal laser endomicroscopy (pCLE) modes and to define quantitative diagnostic parameters for these lesions under pCLE. Method: In phase I, 64 patients with gastric mucosal lesions diagnosed by gastrointestinal endoscopy were enrolled in the study. Normal mucosa and suspicious lesions were evaluated under normal white light imaging (WLI) and pCLE mode. Descriptive characteristic of gastric mucosal inflammation and atrophy under pCLE were defined according to the histology. In phase II, the criteria for nonatrophic gastritis (NAG) and chronic atrophic gastritis (CAG) under pCLE were used to diagnose the mucosal lesions in 431 patients. Diagnostic accuracy of each endoscopy modes was evaluated by measuring the concordance with histology. Result: A total of 64 patients with 187 positions were enrolled in the first part of this study. According to the histological diagnosis, the vessel diameter was increased in the NAG (11.18 ± 0.1 µm) and CAG (13.21 ± 0.29 µm) and CAG (13.21 ± 0.29 µm) and CAG (13.21 ± 0.29 µm) and CAG (13.21 ± 0.29 µm) and CAG (13.21 ± 0.29 µm) and CAG (13.21 ± 0.29 µm) and CAG (13.21 ± 0.29 . Conclusion: pCLE shows high potential for the diagnosis of gastric inflammation and atrophy based on quantitative criteria and has the ability to be a substitute for histology in the diagnosis of diffuse lesions in the stomach.

2.
Theranostics ; 10(8): 3594-3611, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32206110

RESUMO

Background: Accumulating evidences indicate that nanomedicines greatly decrease the side effects and enhance the efficacy of colorectal cancer (CRC) treatment. In particular, the use of rectal delivery of nanomedicines, with advantages such as fast therapeutic effects and a diminishing hepatic first-pass effect, is currently emerging. Method: We established a CRC targeted delivery system, in which α-lactalbumin peptosomes (PSs) co-loaded with a microRNA (miR)-31 inhibitor (miR-31i) and curcumin (Cur) were encapsuslated in thiolated TEMPO oxidized Konjac glucomannan (sOKGM) microspheres, referred as sOKGM-PS-miR-31i/Cur. The CRC targeting capability, drug release profiles, mucoadhesive-to-penetrating properties and therapeutic efficacy of sOKGM-PS-miR-31i/Cur delivery system were evaluated in colorectal cancer cells and azoxymethane-dextran sodium (AOM-DSS) induced tumor models. Results: sOKGM-PS-miR-31i/Cur delivery system were stable in the harsh gastrointestinal environment after rectal or oral administration; and were also mucoadhesive due to disulfide bond interactions with the colonic mucus layer, resulting in an enhanced drug retention and local bioavailability in the colon. Concomitantly, the released PS-miR-31i/Cur PSs from the microsphere was mucus-penetrating, efficiently passing through the colonic mucus layer, and allowed Cur and miR-31i specifically target to colon tumor cells with the guide of CD133 targeting peptides. Consequently, rectal delivery of sOKGM-PS-miR-31i/Cur microspheres suppressed tumor growth in an azoxymethane-dextran sodium sulfate (AOM-DSS)-induced tumor model. Conclusion: sOKGM-PS-miR-31i/Cur microspheres are effective rectal delivery system with combined advantages of mucoadhesive and mucus-penetrating properties, representing a potent and viable therapeutic approach for CRC.

3.
Medicine (Baltimore) ; 99(8): e19020, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080076

RESUMO

OBJECTIVE: The aim of this systematic review and meta-analysis is to calculate the pooled placebo response rate in patients with chronic constipation (CC) in randomized controlled trial (RCT) and its related factors. METHOD: This systematic review and meta-analysis will be conducted under the guidance of Cochrane Handbook. The inclusive and exclusive criteria and search strategies for PubMed, Cochrane Library, and Embase will be introduced in this protocol. Data collection, extraction, and assessment of risk of bias will be conducted independently by 2 reviewers. The pooled placebo response rate and its 95% confidence interval (95%CI) will be calculated and the heterogeneity assessment, publication bias assessment, and subgroup analysis will be performed using R 3.6.0. This study has been registered on the PROSPERO platform (CRD42019121287). RESULT: The results of this systematic review and meta-analysis will be published in a peer-reviewed journal.


Assuntos
Constipação Intestinal/diagnóstico , Constipação Intestinal/terapia , Placebos/farmacologia , Adolescente , Adulto , Idoso , Doença Crônica , Humanos , Pessoa de Meia-Idade , Placebos/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Adulto Jovem
4.
Inflamm Bowel Dis ; 2020 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-32010956

RESUMO

BACKGROUND: Recurrent intestinal inflammation is frequently associated with aberrant bile acid profiles and microbial community. Fucose exerts a protective effect on commensal bacteria in the case of intestinal pathogen infection. We speculated that fucose might also have certain impact on the microbial ecosystem under the chronic colitis setting. METHODS: To validate our hypothesis, multi-omics examination was performed in combination with microbiomics and metabonomics in a chronic dextran sulfate sodium (DSS) murine model in the presence or absence of fucose. The 16S RNA sequencing was carried out to determine the ileum and colon microbiota. Primary and secondary bile acids, together with the respective taurine and glycine conjugates, were quantified through ultraperformance liquid chromatography coupled with mass spectrometry (UPLC-MS). Moreover, enzymes involved in regulating bile acid synthesis were also detected. Finally, an experiment was carried out on the antibiotic-treated mice to examine the role of gut microbiota. RESULTS: Administration of exogenous-free fucose markedly alleviated the inflammatory response in colitis mice. In addition, excessive intestinal bile acid accumulated in DSS mice was decreased in the presence of fucose, along with the restoration of the compromised regulation on hepatic bile acid synthesis. Moreover, the shifts in bile acid profiles were linked with the improved gut microbiome dysbiosis. However, the protective effects of fucose were abolished in mice treated with antibiotic cocktail, indicating that microbiota played a pivotal role. CONCLUSIONS: Findings in this study suggest that fucose ameliorates colitis through restoring the crosstalk between bile acid and gut microbiota.

5.
Cytokine ; 127: 154963, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31927461

RESUMO

There has been no report investigating the role of IL-38 in inflammatory bowel diseases (IBD). Therefore, we investigated the expression of IL-38 in IBD patients and its role in regulating intestinal inflammation. The levels of IL-38 were significantly elevated in the intestine of IBD patients and DSS-induced colitis mice. Immunofluorescence analysis revealed that B cell, not macrophage or T cell, was the source of IL-38 in the intestine. We found that rIL-38 treatment significantly attenuated DSS-induced colitis, including alleviation of weight loss, disease activity index, macroscopic changes and histological damage of colon, along with lower levels of IL-1ß and TNF-α. In vitro, rIL-38 significantly decreased the expression of proinflammatory cytokines in LPS-stimulated RAW 264.7 cells and BMDM. This is the first study suggesting that IL-38 may have a protective effect in IBD, which inhibits the production of proinflammatory cytokines from macrophages. IL-38 may represent a promising therapeutic strategy in IBD.

6.
J Hepatol ; 72(3): 391-400, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31606552

RESUMO

BACKGROUND & AIMS: Alcohol-associated liver disease is a leading indication for liver transplantation and a leading cause of mortality. Alterations to the gut microbiota contribute to the pathogenesis of alcohol-associated liver disease. Patients with alcohol-associated liver disease have increased proportions of Candida spp. in the fecal mycobiome, yet little is known about the effect of intestinal Candida on the disease. Herein, we evaluated the contributions of Candida albicans and its exotoxin candidalysin in alcohol-associated liver disease. METHODS: C. albicans and the extent of cell elongation 1 (ECE1) were analyzed in fecal samples from controls, patients with alcohol use disorder and those with alcoholic hepatitis. Mice colonized with different and genetically manipulated C. albicans strains were subjected to the chronic-plus-binge ethanol diet model. Primary hepatocytes were isolated and incubated with candidalysin. RESULTS: The percentages of individuals carrying ECE1 were 0%, 4.76% and 30.77% in non-alcoholic controls, patients with alcohol use disorder and patients with alcoholic hepatitis, respectively. Candidalysin exacerbates ethanol-induced liver disease and is associated with increased mortality in mice. Candidalysin enhances ethanol-induced liver disease independently of the ß-glucan receptor C-type lectin domain family 7 member A (CLEC7A) on bone marrow-derived cells, and candidalysin does not alter gut barrier function. Candidalysin can damage primary hepatocytes in a dose-dependent manner in vitro and is associated with liver disease severity and mortality in patients with alcoholic hepatitis. CONCLUSIONS: Candidalysin is associated with the progression of ethanol-induced liver disease in preclinical models and worse clinical outcomes in patients with alcoholic hepatitis. LAY SUMMARY: Candidalysin is a peptide toxin secreted by the commensal gut fungus Candida albicans. Candidalysin enhances alcohol-associated liver disease independently of the ß-glucan receptor CLEC7A on bone marrow-derived cells in mice without affecting intestinal permeability. Candidalysin is cytotoxic to primary hepatocytes, indicating a direct role of candidalysin on ethanol-induced liver disease. Candidalysin might be an effective target for therapy in patients with alcohol-associated liver disease.

7.
Life Sci ; 240: 117089, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31759038

RESUMO

AIMS: Gut microbiota has been closely linked to the mucosal immune and been regarded as a reliable target for intestinal inflammation. This study aimed to explore the therapeutic roles of probiotic mixtures of Bifidobacterium infantis, Lactobacillus acidophilus, Enterococcus faecalis with (quadruple probiotics, P-qua) or without (triple probiotics, P-tri) aerobic Bacillus cereus in colitis, focusing on the multiple barrier functions. MATERIALS AND METHODS: Chronic colitis was induced by dextran sulfate sodium (DSS) in C57BL/6 mice. The probiotic mixtures P-qua or P-tri was gavage administrated respectively, while fecal microbiota transplantation (FMT) as a positive control. The intestinal inflammation and functions of multiple barriers were assessed, including the mucus barrier, epithelial barrier and endothelial barrier known as gut-vascular barrier (GVB). Altered composition and diversity in gut microbiota were observed via sequencing analysis. KEY FINDINGS: Both P-qua and P-tri relieved the intestinal inflammation and improved the functions of multiple barriers with increased integrity of mucous layer, enhanced transepithelial electrical resistance, declined epithelial and endothelial permeability to macromolecules in DSS-colitis. Aerobe-contained P-qua revealed a more active role in barrier recovering relative to P-tri, while FMT as a positive control seemed to get better results than pure probiotics. Indeed, P-qua was effective in rebuilding the structure and diversity of gut flora in DSS-colitis, especially increased abundance of Bifidobacterium, Akkermansia, Lactobacillus and Bacteroides. SIGNIFICANCE: Aerobe-contained P-qua was a powerful adjuvant therapy for chronic colitis, via restoring the intestinal microflora and recovering the multi-barriers in the inflamed gut.


Assuntos
Bactérias Aeróbias , Colite/induzido quimicamente , Colite/tratamento farmacológico , Probióticos/uso terapêutico , Animais , Permeabilidade da Membrana Celular , Doença Crônica , Colite/patologia , Sulfato de Dextrana , Transplante de Microbiota Fecal , Fezes/microbiologia , Microbioma Gastrointestinal , Mucosa Intestinal/patologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Probióticos/administração & dosagem , Junções Íntimas
8.
Artigo em Inglês | MEDLINE | ID: mdl-31674052

RESUMO

BACKGROUND AND AIM: Small intestinal bacterial overgrowth (SIBO) has been proposed as an etiologic factor in irritable bowel syndrome, particularly the diarrhea-predominant subtype (IBS-D). We aimed to identify potential intestinal microbial pattern in IBS-D patients with SIBO. METHODS: Diarrhea-predominant irritable bowel syndrome patients fulfilling Rome III criteria were recruited and randomly divided into an exploratory cohort (57 cases) and a validation cohort (20 cases). SIBO was identified according to standard glucose hydrogen breath test. For 16S rRNA gene sequencing, samples of duodenal mucosa, duodenal fluid, rectal mucosa, and fresh feces were collected and performed. The α and ß diversity, as well as differences in microbial composition and function, in SIBO+ and SIBO- IBS-D subjects were evaluated. RESULTS: The microbial diversity and composition obviously differed between SIBO+ and SIBO- IBS-D in duodenal and rectal mucosa but not in duodenal fluid and fresh feces. For rectal mucosal microbiota, it displayed markedly reduced aerobe and Gram-negative bacteria and increased facultative anaerobe and Gram-positive bacteria, moreover, altered functions of microbial metabolism in SIBO+ IBS-D. Significantly higher rectal mucosa-related microbial dysbiosis index was observed in SIBO+ IBS-D, and a cut-off value at -0.37 had a sensitivity of 56.55% and specificity of 90.91% to identify the SIBO in IBS-D subjects. CONCLUSIONS: Mucosal microbiota, rather than luminal bacteria, has a more apparent dysbiosis in SIBO+ IBS-D patients relative to those without SIBO. Rectal mucosa-associated microbiota may act as a potential predictor of SIBO in IBS-D patients.

9.
Int Immunopharmacol ; 77: 105971, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31678865

RESUMO

Estrogen receptor (ER) ß activation has anti-inflammatory activity. However, its effect on the development of inflammatory bowel disease (IBD) and the underlying mechanism have not been clarified. This study aimed to assess the clinical value of ERß+CD4+ T cells in IBD patients and examine the anti-inflammatory role of ERß activation in dextran sulfate sodium (DSS)-induced chronic colitis in mice. We investigated the effects of ERB041 (an ERß-specific agonist) on inflammatory cytokines and pro-inflammatory T-cell and regulatory T-cell (Treg) responses in murine colitis. We tested the role of ERß activation on Treg differentiation and its activity to suppress T-cell proliferation in vitro. We found that reduced frequency of circulating ERß+CD4+ T cells in IBD patients was negatively correlated with inflammation and disease severity. ERß and FoxP3 expression co-localized in the intestinal tissues of IBD patients. Treatment with ERB041 significantly mitigated colitis-induced weight loss, inflammation, and disease severity. It also restored the ERß+CD4+ T cell population in the spleen and colon lamina propria of these mice. ERB041 treatment inhibited CD4+CD25- and CD8+ T cell infiltration and restored Tregs and activated T-cell immunoreceptor with Ig and ITIM domains (TIGIT)+ Tregs in the colon lamina propria. In vitro, we found that ERß activation enhanced Treg differentiation, immunosuppression, and TGF-ß1/Smad signaling in CD4+ T cells. Our data suggest that ERß+CD4+ T cells represent a potential biomarker for evaluating IBD disease severity, and ERß activation may be valuable for the treatment of IBD by enhancing the Treg response.

10.
FASEB J ; 33(12): 13644-13659, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31601124

RESUMO

Patients with irritable bowel syndrome (IBS) show pain hypersensitivity and smooth muscle hypercontractility in response to colorectal distension (CRD). Synaptic plasticity, a key process of memory formation, in the enteric nervous system may be a novel explanation. This study aimed to explore the regulatory role of ephrinB2/ephB2 in enteric synaptic plasticity and colonic hyperreactive motility in IBS. Postinfectious (PI)-IBS was induced by Trichinella spiralis infection in rats. Isometric contractions of colonic circular muscle strips, particularly neural-mediated contractions, were recorded ex vivo. Meanwhile, ephrinB2/ephB2-mediated enteric structural and functional synaptic plasticity were assessed in the colonic muscularis, indicating that ephrinB2 and ephB2 were located on enteric nerves and up-regulated in the colonic muscularis of PI-IBS rats. Colonic hypersensitivity to CRD and neural-mediated colonic hypercontractility were present in PI-IBS rats, which were correlated with increased levels of cellular homologous fos protein (c-fos) and activity-regulated cystoskeleton-associated protein (arc), the synaptic plasticity-related immediate early genes, and were ameliorated by ephB2Fc (an ephB2 receptor blocker) or MK801 (an NMDA receptor inhibitor) exposure. EphrinB2/ephB2 facilitated synaptic sprouting and NMDA receptor-mediated synaptic potentiation in the colonic muscularis of PI-IBS rats and in the longitudinal muscle-myenteric plexus cultures, involving the Erk-MAPK and PI3K-protein kinase B pathways. In conclusion, ephrinB2/ephB2 promoted the synaptic sprouting and potentiation of myenteric nerves involved in persistent muscle hypercontractility and pain in PI-IBS. Hence, ephrinB2/ephB2 may be an emerging target for the treatment of IBS.-Zhang, L., Wang, R., Bai, T., Xiang, X., Qian, W., Song, J., Hou, X. EphrinB2/ephB2-mediated myenteric synaptic plasticity: mechanisms underlying the persistent muscle hypercontractility and pain in postinfectious IBS.

11.
Exp Ther Med ; 18(1): 278-288, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31258663

RESUMO

Inflammatory bowel diseases (IBDs), including ulcerative colitis (UC) and Crohn's disease (CD), are chronic inflammatory disorders caused by genetic influences, the immune system and environmental factors. However, the underlying pathogenesis of IBDs and the pivotal molecular interactions remain to be fully elucidated. The aim of the present study was to identify genetic signatures in patients with IBDs and elucidate the potential molecular mechanisms underlying IBD subtypes. The gene expression profiles of the GSE75214 datasets were obtained from the Gene Expression Omnibus database. Differentially expressed genes (DEGs) were identified in UC and CD patients compared with controls using the GEO2R tool. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses of DEGs were performed using DAVID. Furthermore, protein-protein interaction (PPI) networks of the DEGs were constructed using Cytoscape software. Subsequently, significant modules were selected and the hub genes were identified. In the GO and KEGG pathway analysis, the top enriched pathways in UC and CD included Staphylococcus aureus infection, rheumatoid arthritis, complement and coagulation cascades, PI3K/Akt signaling pathway and osteoclast differentiation. In addition, the GO terms in the category biological process significantly enriched by these genes were inflammatory response, immune response, leukocyte migration, cell adhesion, response to molecules of bacterial origin and extracellular matrix (ECM) organization. However, several other biological processes (GO terms) and pathways (e.g., 'chemotaxis', 'collagen catabolic process' and 'ECM-receptor interaction') exhibited significant differences between the two subtypes of IBD. The top 10 hub genes were identified from the PPI network using respective DEGs. Of note, the hub genes G protein subunit gamma 11 (GNG11), G protein subunit beta 4 (GNB4), Angiotensinogen (AGT), Phosphoinositide-3-kinase regulatory subunit 3 (PIK3R3) and C-C motif chemokine receptor 7 (CCR7) are disease-specific and may be used as biomarkers for differentiating UC from CD. Furthermore, module analysis further confirmed that common significant pathways involved in the pathogenesis of IBD subtypes were associated with chemokine-induced inflammation, innate immunity, adapted immunity and infectious microbes. In conclusion, the present study identified DEGs, key target genes, functional pathways and enrichment analysis of IBDs, enhancing the understanding of the pathogenesis of IBDs and also advancing the clarification of the underlying molecular mechanisms of UC and CD. Furthermore, these results may provide potential molecular targets and diagnostic biomarkers for UC and CD.

12.
Quant Imaging Med Surg ; 9(5): 905-920, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31281783

RESUMO

Endoscopic imaging is the main method for detecting gastrointestinal diseases, which adversely affect human health. White light endoscopy (WLE) was the first method used for endoscopic examination and is still the preliminary step in the detection of gastrointestinal diseases during clinical examination. However, it cannot accurately diagnose gastrointestinal diseases owing to its poor correlation with histopathological diagnosis. In recent years, many advanced endoscopic methods have emerged to improve the detection accuracy by endoscopy. Chromoendoscopy (CE) enhances the contrast between normal and diseased tissues using biocompatible dye agents. Narrow band imaging (NBI) can improve the contrast between capillaries and submucosal vessels by changing the light source acting on the tissue using special filters to realize the visualization of the vascular structure. Flexible spectral imaging color enhancement (FICE) technique uses the reflectance spectrum estimation technique to obtain individual spectral images and reconstructs an enhanced image of the mucosal surface using three selected spectral images. The i-Scan technology takes advantage of the different reflective properties of normal and diseased tissues to obtain images, and enhances image contrast through post-processing algorithms. These abovementioned methods can be used to detect gastrointestinal diseases by observing the macroscopic structure of the digestive tract mucosa, but the ability of early cancer detection is limited with low resolution. However, based on the principle of confocal imaging, probe-based confocal laser endomicroscopy (pCLE) can enable cellular visualization with high-performance probes, which can present cellular morphology that is highly consistent with that shown by biopsy to provide the possibility of early detection of cancer. Other endoscopic imaging techniques including endoscopic optical coherence tomography (EOCT) and photoacoustic endoscopy (PAE), are also promising for diagnosing gastrointestinal diseases. This review focuses on these technologies and aims to provide an overview of different technologies and their clinical applicability.

13.
J Neurogastroenterol Motil ; 25(3): 343-362, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31327218

RESUMO

Background/Aims: There has been major progress in our understanding of the irritable bowel syndrome (IBS), and novel treatment classes have emerged. The Rome IV guidelines were published in 2016 and together with the growing body of Asian data on IBS, we felt it is timely to update the Asian IBS Consensus. Methods: Key opinion leaders from Asian countries were organized into 4 teams to review 4 themes: symptoms and epidemiology, pathophysiology, diagnosis and investigations, and lifestyle modifications and treatments. The consensus development process was carried out by using a modified Delphi method. Results: Thirty-seven statements were developed. Asian data substantiate the current global viewpoint that IBS is a disorder of gut-brain interaction. Socio-cultural and environmental factors in Asia appear to influence the greater overlap between IBS and upper gastrointestinal symptoms. New classes of treatments comprising low fermentable oligo-, di-, monosacharides, and polyols diet, probiotics, non-absorbable antibiotics, and secretagogues have good evidence base for their efficacy. Conclusions: Our consensus is that all patients with functional gastrointestinal disorders should be evaluated comprehensively with a view to holistic management. Physicians should be encouraged to take a positive attitude to the treatment outcomes for IBS patients.

14.
Chin J Integr Med ; 25(12): 887-894, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31292845

RESUMO

OBJECTIVE: To evaluate the efficacy and safety of Tongxiening Granules (, TXNG) in the treatment of irritable bowel syndrome with predominant diarrhea (IBS-D). METHODS: A randomized, double-blind, double-dummy, and positive parallel controlled clinical trial was conducted from October 2014 to March 2016. Totally 342 patients from 13 clinical centers were enrolled and randomly assigned (at the ratio of 1:1) to a treatment group (171 cases) and a control group (171 cases) by a random coding table. The patients in the treatment group were administered orally with TXNG (5 g per time) combined with pinaverium bromide Tablet simulator (50 mg per time), 3 times per day. The patients in the control group were given TXNG simulator (5 g per time) combined with pinaverium bromide Tablets (50 mg per time), 3 times per day. The treatment course lasted for 6 weeks. The improvement of Irritable Bowel Syndrome Symptom Severity Score (IBS-SSS) was used to evaluate the primary outcome. Secondary outcomes included adequate relief (AR) rate, Irritable Bowel Syndrome-Quality of Life Questionnaire (IBS-QOL), Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), and the recurrence rate at follow-ups. Safety indices including the adverse events (AEs) and related laboratory tests were evaluated. RESULTS: Primary outcome: IBS-SSS at baseline, weeks 2, 4, 6 showed no statistical significance in both full analysis set (FAS) and per protocol set (PPS, P>0.05). After 6 weeks of treatment, the total effective rate of IBS-SSS scores in the treatment group (147/171,86.0%) was higher than the control group (143/171, 83.6%) by FAS (P>0.05). In regard to secondary outcomes, after 6-week treatment, there was no significant difference in AR rate, total score of IBS-QOL, improvement of HAMD and HAMA total scores between the two groups (P>0.05). The recurrence rate at 8-week follow-up was 12.35% (10/18) in treatment group and 15.79% (12/76) in control group, respectively (P>0.05). A total of 21 AEs occurred in 15 cases, of which 11 occurred in 8 cases in the treatment group and 10 AEs in 7 cases in the control group. The incidence of AEs had no statistical significance between the two goups (P>0.05). CONCLUSION: Tongxiening Granules could relieve the symptoms of patients with IBS-D and the treatment effect was comparable to pinaverium bromide. (No. ChiCTR-IPR-15006415).

15.
Gastroenterology ; 157(4): 1044-1054.e5, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31251929

RESUMO

BACKGROUND & AIMS: Capsule endoscopy has revolutionized investigation of the small bowel. However, this technique produces a video that is 8-10 hours long, so analysis is time consuming for gastroenterologists. Deep convolutional neural networks (CNNs) can recognize specific images among a large variety. We aimed to develop a CNN-based algorithm to assist in the evaluation of small bowel capsule endoscopy (SB-CE) images. METHODS: We collected 113,426,569 images from 6970 patients who had SB-CE at 77 medical centers from July 2016 through July 2018. A CNN-based auxiliary reading model was trained to differentiate abnormal from normal images using 158,235 SB-CE images from 1970 patients. Images were categorized as normal, inflammation, ulcer, polyps, lymphangiectasia, bleeding, vascular disease, protruding lesion, lymphatic follicular hyperplasia, diverticulum, parasite, and other. The model was further validated in 5000 patients (no patient was overlap with the 1970 patients in the training set); the same patients were evaluated by conventional analysis and CNN-based auxiliary analysis by 20 gastroenterologists. If there was agreement in image categorization between the conventional analysis and CNN model, no further evaluation was performed. If there was disagreement between the conventional analysis and CNN model, the gastroenterologists re-evaluated the image to confirm or reject the CNN categorization. RESULTS: In the SB-CE images from the validation set, 4206 abnormalities in 3280 patients were identified after final consensus evaluation. The CNN-based auxiliary model identified abnormalities with 99.88% sensitivity in the per-patient analysis (95% CI, 99.67-99.96) and 99.90% sensitivity in the per-lesion analysis (95% CI, 99.74-99.97). Conventional reading by the gastroenterologists identified abnormalities with 74.57% sensitivity (95% CI, 73.05-76.03) in the per-patient analysis and 76.89% in the per-lesion analysis (95% CI, 75.58-78.15). The mean reading time per patient was 96.6 ± 22.53 minutes by conventional reading and 5.9 ± 2.23 minutes by CNN-based auxiliary reading (P < .001). CONCLUSIONS: We validated the ability of a CNN-based algorithm to identify abnormalities in SB-CE images. The CNN-based auxiliary model identified abnormalities with higher levels of sensitivity and significantly shorter reading times than conventional analysis by gastroenterologists. This algorithm provides an important tool to help gastroenterologists analyze SB-CE images more efficiently and more accurately.


Assuntos
Endoscopia por Cápsula/métodos , Aprendizado Profundo , Gastroenterologistas , Interpretação de Imagem Assistida por Computador/métodos , Enteropatias/patologia , Intestino Delgado/patologia , China , Competência Clínica , Diagnóstico Diferencial , Humanos , Variações Dependentes do Observador , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos
16.
Neurogastroenterol Motil ; 31(9): e13653, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31157483

RESUMO

BACKGROUND AND AIMS: Low-grade esophagitis (grade A and B) are no longer believed as confirmatory evidence of gastroesophageal reflux disease, but there were no data about the association of low-grade esophagitis with pathological acid reflux (PAR) in China. This study aimed to summarize the proportion of PAR in the patients with low-grade esophagitis and to explore the differential factors between low-grade esophagitis patients with and without PAR. METHODS: Database of the patients accepted 24-hour pH monitoring in the motility laboratory of a tertiary center was retrospectively searched, and the patients were diagnosed as low-grade esophagitis before the procedure was recruited. The demographics, symptoms and high-resolution manometry and pH monitoring parameters were compared between the patients with pathological and physiological acid reflux and between patients with grade A and B esophagitis. RESULTS: About 24% of grade A and 55% of grade B esophagitis patients had pathological acid reflux. The demographics, symptoms, and almost all high-resolution manometry findings were similar in patients with pathological and physiological acid reflux. About two-thirds of the participants with physiological acid reflux reported symptom improvement after PPI administration. All participants with PPI-resistant symptoms were with physiological acid reflux. CONCLUSION: The proportion of PAR in low-grade esophagitis is not high. For patients with low-grade esophagitis in China, especially the patients with grade A esophagitis, regardless of symptom change, reflux monitoring is possibly needed for the patients whose esophageal mucosa break is not improved after 8 weeks of PPI treatment.

17.
J Affect Disord ; 253: 308-311, 2019 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-31078829

RESUMO

BACKGROUND: The role of physical symptoms on suicidal ideation in adolescents is incompletely understood. The purpose of this study was to discover the potential physical symptoms predictors for suicidal ideation in college freshmen. METHODS: This cross-sectional survey was conducted in a randomly selected freshmen population in Wuhan China (N = 2449). Questionnaire evaluated suicidal ideation as well as related psychosocial risks and gastrointestinal (GI) physical symptoms. The association between the suicidal ideation and potential predictors was analyzed by Mann-Whitney test and multiple logistic regression analysis. RESULTS: A total of 2053 (83.8%) completed this survey and 64 (3.1%) was reported to have suicidal ideation. Anxiety (OR 5.44(2.40-12.35)), depression (OR 8.36(3.90-17.94)) and chronic abdominal discomfort (OR 2.06(1.07-3.94)) were independent predictors for suicidal ideation. In freshmen with chronic abdominal discomfort, interestingly, defecation disorder(P = 0.01) and low satisfaction of defecation (P = 0.04) was associated with high risk for suicidal ideation. CONCLUSION: Defecation disorders were associated with high risk of suicidal intention in young adult with chronic abdominal discomfort. Our result implied that clinicians should be vigilant for suicidal ideation in chronic abdominal discomfort patients, especially those with defecation disorders.

18.
Int Immunopharmacol ; 73: 379-388, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31132733

RESUMO

Previous studies reported that L-fucose had anti-inflammatory effects in respiratory and cutaneous system. However, the effect of L-fucose on colitis and the underlying mechanism is poorly understood. We studied the anti-inflammatory effects of L-fucose on Dextran sulfate sodium (DSS)-induced acute colitis in vivo and on LPS/ATP-induced bone marrow derived macrophages (BMDMs) damage in vitro. Our results show that L-fucose significantly alleviated weight loss and disease activity index (DAI) scores in colitis and reduced the infiltration of macrophages and neutrophils. In addition, L-fucose can inhibit macrophage M1 polarization, inactivate the NLRP3 inflammasome and reduce the release of TNFα, IL1ß, IL6 pro-inflammatory cytokines. In vitro studies showed that L-fucose ameliorated cell damage resulting from the administration of LPS with ATP in BMDMs, inhibited NLRP3 inflammasome activation and reduced the release of corresponding pro-inflammatory cytokines. Finally, L-fucose can inhibit the expression of p-NF-kB in vivo and in vitro. Overall, our results show that L-fucose can attenuate colitis by inhibiting macrophage M1 polarization, inhibiting NLRP3 inflammasome and NF-kB activation, and down-regulation of pro-inflammatory cytokines.


Assuntos
Anti-Inflamatórios/uso terapêutico , Colite/tratamento farmacológico , Fucose/uso terapêutico , Doença Aguda , Animais , Anti-Inflamatórios/farmacologia , Colite/induzido quimicamente , Colite/imunologia , Colite/patologia , Colo/efeitos dos fármacos , Colo/imunologia , Colo/patologia , Citocinas/genética , Citocinas/imunologia , Sulfato de Dextrana , Fucose/farmacologia , Inflamassomos/imunologia , Macrófagos/efeitos dos fármacos , Macrófagos/imunologia , Masculino , Camundongos Endogâmicos C57BL , NF-kappa B/imunologia , Proteína 3 que Contém Domínio de Pirina da Família NLR/imunologia
19.
Neurogastroenterol Motil ; 31(6): e13574, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30821105

RESUMO

BACKGROUND: The results of the esophageal body motility differences between liquid and solid swallows from high-resolution manometry (HRM) studies are not consistent. The information of the frequency of ineffective liquid and solid bolus swallows in healthy individuals during HRM procedure is limited. The normative values of the HRM parameters of both liquid and solid swallows for Chinese population are lacking. METHODS: The esophageal HRM data of 101 healthy volunteers from multicenters in China were analyzed. The values of the HRM parameters were summarized and compared between liquid and solid swallows. The frequencies of ineffective liquid and solid swallows were summarized. RESULTS: Esophagus contracted stronger and slower in solid bolus swallows than water swallows with HREM. Ineffective water swallow (DCI < 450 mm Hg.s.cm) and ineffective bread swallow (DCI < 800 mm Hg.s.cm) were frequently seen in asymptomatic individuals. The adding of bread swallows to the HREM procedure might cause diagnostic change in about 15.8% (16/101) of the asymptomatic individuals. CONCLUSIONS: The vigor and velocity of the esophageal peristalsis between liquid and solid bolus swallows are different. Ineffective water and solid bolus swallows are not rare. Adding solid bolus swallows brings diagnostic change, and it may be needed routinely for the HRM procedure.

20.
J Neurogastroenterol Motil ; 25(2): 233-240, 2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-30870878

RESUMO

Background/Aims: The role of psychosocial factors on irritable bowel syndrome (IBS) in adolescents is incompletely understood. The aim of this study is to investigate the association between the psychosocial factors and the risk of developing IBS in college freshmen. Methods: A cross-sectional survey was conducted in a randomly selected freshmen population in Wuhan China (n = 2449). Questionnaire evaluated demographics and psychosocial risks. The population was divided into 3 groups: non-discomfort, chronic abdominal discomfort and IBS. The association between the development of IBS and psychosocial factors was analyzed by ordinal and multiple logistic regression analysis. Results: A total of 2053 (83.8%) completed this survey (mean age, 18.2 ± 0.9 years; female, 35.6%). Among them, 82 (4.0%) fulfilled the Rome III criteria for IBS. Female (odds ratio [OR], 3.31; 95% confidence interval [CI], 2.47-4.45), experience of abuse (OR, 2.44; 95% CI, 1.10-5.56), and suicidal intention (OR, 2.17; 95% CI, 1.15-4.17) were more likely to have IBS. Compared with chronic abdominal discomfort, however, depression (OR, 5.55; 95% CI, 1.36-22.71) was the only dependent risk factor for IBS. Conclusion: The prevalence of IBS in college freshmen is 4.0%, and to the freshmen, psychosocial factors such as experience of abuse, depression, and suicidal intention were associated with high risk of developing IBS.

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