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1.
Front Immunol ; 11: 559746, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33329520

RESUMO

Background: Allergic rhinitis is a common disorder that affects 10% to 40% of the population worldwide. Allergen immunotherapy (AIT) represents the only therapy that has the potential to resolve clinical symptoms of allergic rhinitis. However, up to 30% of patients do not respond to AIT. Biomarkers predicting the clinical efficacy of AIT as early as possible would significantly improve the patient selection and reduce unnecessary societal costs. Methods: Artemisia pollen allergic patients who received at least 1-year AIT were enrolled. Clinical responses before and after 1-year AIT were evaluated to determine AIT responders. Artemisia specific IgE and IgG4 levels were measured by using ImmunoCAP and enzyme-linked immunosorbent assay (ELISA) separately. Stepwise regression analysis was performed to identify which rhinitis-relevant parameters explained the most variability in AIT results. Liquid chromatography-tandem mass spectrometry (LC-MS/MS)-based proteomics was applied to identify the potential candidate biomarkers in the sera of responders and non-responders collected before and after 1-year therapy. The diagnostic performance of the potential biomarkers was then assessed using enzyme-linked immunosorbent assay (ELISA) in 30 responders and 15 non-responders. Results: Artemisia specific IgE and IgG4 levels were elevated only in the responders. Regression analysis of allergic rhinitis-relevant parameters provided a robust model that included two most significant variables (sneeze and nasal congestion). Thirteen candidate biomarkers were identified for predicting AIT outcomes. Based on their association with allergy and protein fold change (more than 1.1 or less than 0.9), four proteins were identified to be potential biomarkers for predicting effective AIT. However, further ELISA revealed that only leukotriene A4 hydrolase (LTA4H) was consistent with the proteomics data. The LTA4H level in responders increased significantly (P < 0.001) after 1-year therapy, while that of non-responders remained unchanged. Assessment of LTA4H generated area under curve (AUC) value of 0.844 (95% confidence interval: 0.727 to 0.962; P < 0.05) in distinguishing responders from the non-responders, suggesting that serum LTA4H might be a potential biomarker for predicting the efficiency of AIT. Conclusion: Serum LTA4H may be a potential biomarker for early prediction of an effective AIT.

2.
Medicine (Baltimore) ; 99(47): e23301, 2020 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-33217863

RESUMO

The clinical epidemiological characteristics of chronic urticaria (CU) in different populations were not completely consistent, and the epidemiological characteristics of CU were very complex. At present, there were some patient-based studies on CU, but few natural population-based studied in the world.This study aimed to analysis the prevalence of self-reported CU among adults in grasslands of northern China and its closely related factors.A multistage and proportionately stratified random sampling with a field interviewer-administered survey study was performed together with skin prick tests (SPT) and measurements of the daily pollen count.A total of 3406 subjects completed the study. The prevalence of self-reported CU was 5.61% (n = 191), which was higher in women than that of men (6.91% vs 4.08%, X = 12.785, P < .001). Seasonal or seasonal aggravation CU accounted for 110 (57.59%) patients. Pollen dispersal season was basically consistent with the peak season of CU, but there was no significant difference in the positive rate of pollen SPT between CU with seasonal or seasonal aggravation symptom and CU with free of symptom (X = 0.425, P = .51), as well as between CU with seasonal or seasonal aggravation symptom and perennial CU (X = 0.439, P = .51). Eczema (odds ratio [OR] = 2.807, P < .001), chronic diarrhea (OR = 2.486, P < .01), food allergy history (OR = 1.890, P < .01), history of family allergy (OR = 1.800, P < .001), and conjunctivitis (OR = 1.749, P < .01) were closely related to CU.This investigation provided the factors closely related to CU, and provided certain ideas for further research on the etiology and prevention of CU.

3.
Front Pharmacol ; 11: 305, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32256368

RESUMO

Subcutaneous immunotherapy is the only treatment that improves the natural progression of allergic rhinitis and maintains long-term outcomes after discontinuation of the drug. Metabolomics is increasingly applied in the study of allergic diseases, including allergic rhinitis. However, little is known about the discovery of metabolites that can evaluate clinical efficacy and possible mechanisms of Artemisia sieversiana pollen subcutaneous immunotherapy. Thirty-three patients with Artemisia sieversiana pollen allergic rhinitis significantly improved after 1-year subcutaneous immunotherapy treatment, while ten patients were ineffective. Pre- and post-treatment serum samples from these patients were analyzed by metabolomics based on the combined detection of liquid chromatography-mass spectrometry and gas chromatography-mass spectrometry. As a result, L-Tyrosine can be a potential biomarker because of its opposite trend in effective patients and ineffective patients. And mechanism of immunotherapy may be closely related to NO and nitric oxide synthase. The discovery of potential biomarkers and metabolic pathways has contributed to the in-depth study of mechanisms of subcutaneous immunotherapy treatment of Artemisia sieversiana pollen allergic rhinitis.

4.
J Gastroenterol ; 53(9): 989-998, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29980848

RESUMO

Crohn's disease (CD) is a chronic, progressive, and destructive disease of the gastrointestinal tract. Although its incidence appears to be stable or decreasing in most countries in the North America and Europe, the incidence is rising rapidly in Asian countries. Immunomodulators and biologics are increasingly used to avoid long-term bowel damage and subsequent disability. Therapeutic drug monitoring facilitates optimizing thiopurines and anti-TNFs use. New biologic agents targeting various pathological pathways of CD are blooming in recent years, and the high cost of biologics and expiration of patents for several biologic agents have driven the utility of biosimilars for CD treatment. Here, the literature regarding the efficacy, safety, and withdrawal of the drugs, as well as the evolution of therapeutic targets will be reviewed.


Assuntos
Doença de Crohn/tratamento farmacológico , Doença de Crohn/epidemiologia , Imunomodulação , Purinas/uso terapêutico , Tionucleosídeos/uso terapêutico , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Corticosteroides/efeitos adversos , Corticosteroides/uso terapêutico , Ásia/epidemiologia , Azatioprina/efeitos adversos , Azatioprina/uso terapêutico , Monitoramento de Medicamentos , Humanos , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Incidência , Infliximab/efeitos adversos , Infliximab/uso terapêutico , Metotrexato/efeitos adversos , Metotrexato/uso terapêutico , Purinas/efeitos adversos , Indução de Remissão , Talidomida/efeitos adversos , Talidomida/uso terapêutico , Tionucleosídeos/efeitos adversos , Resultado do Tratamento
5.
Lancet ; 390(10114): 2769-2778, 2018 12 23.
Artigo em Inglês | MEDLINE | ID: mdl-29050646

RESUMO

BACKGROUND: Inflammatory bowel disease is a global disease in the 21st century. We aimed to assess the changing incidence and prevalence of inflammatory bowel disease around the world. METHODS: We searched MEDLINE and Embase up to and including Dec 31, 2016, to identify observational, population-based studies reporting the incidence or prevalence of Crohn's disease or ulcerative colitis from 1990 or later. A study was regarded as population-based if it involved all residents within a specific area and the patients were representative of that area. To be included in the systematic review, ulcerative colitis and Crohn's disease needed to be reported separately. Studies that did not report original data and studies that reported only the incidence or prevalence of paediatric-onset inflammatory bowel disease (diagnosis at age <16 years) were excluded. We created choropleth maps for the incidence (119 studies) and prevalence (69 studies) of Crohn's disease and ulcerative colitis. We used temporal trend analyses to report changes as an annual percentage change (APC) with 95% CI. FINDINGS: We identified 147 studies that were eligible for final inclusion in the systematic review, including 119 studies of incidence and 69 studies of prevalence. The highest reported prevalence values were in Europe (ulcerative colitis 505 per 100 000 in Norway; Crohn's disease 322 per 100 000 in Germany) and North America (ulcerative colitis 286 per 100 000 in the USA; Crohn's disease 319 per 100 000 in Canada). The prevalence of inflammatory bowel disease exceeded 0·3% in North America, Oceania, and many countries in Europe. Overall, 16 (72·7%) of 22 studies on Crohn's disease and 15 (83·3%) of 18 studies on ulcerative colitis reported stable or decreasing incidence of inflammatory bowel disease in North America and Europe. Since 1990, incidence has been rising in newly industrialised countries in Africa, Asia, and South America, including Brazil (APC for Crohn's disease +11·1% [95% CI 4·8-17·8] and APC for ulcerative colitis +14·9% [10·4-19·6]) and Taiwan (APC for Crohn's disease +4·0% [1·0-7·1] and APC for ulcerative colitis +4·8% [1·8-8·0]). INTERPRETATION: At the turn of the 21st century, inflammatory bowel disease has become a global disease with accelerating incidence in newly industrialised countries whose societies have become more westernised. Although incidence is stabilising in western countries, burden remains high as prevalence surpasses 0·3%. These data highlight the need for research into prevention of inflammatory bowel disease and innovations in health-care systems to manage this complex and costly disease. FUNDING: None.


Assuntos
Colite Ulcerativa/epidemiologia , Doença de Crohn/epidemiologia , África/epidemiologia , Ásia/epidemiologia , Australásia/epidemiologia , Europa (Continente)/epidemiologia , Humanos , Incidência , Doenças Inflamatórias Intestinais/epidemiologia , América do Norte/epidemiologia , Prevalência , América do Sul/epidemiologia
6.
Clin Gastroenterol Hepatol ; 16(2): 190-197.e11, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28603049

RESUMO

BACKGROUND & AIMS: Inflammatory bowel diseases (IBDs) (Crohn's disease [CD], ulcerative colitis) are global diseases. Similarities and differences in disease presentation and outcomes across different geographic regions and ethnic groups have not been compared previously. METHODS: We performed a systematic review and meta-analysis of population-based cohort studies examining the phenotype and outcome of IBD across ethnic groups categorized as Whites, Blacks, Hispanics, and Asians. Further stratification was performed by migration status (native or immigrant). Pooled proportions of disease location, behavior, medication, and surgery use were calculated by using a random-effects model and compared statistically. RESULTS: Our final analysis included 198 unique studies reporting outcomes on 525,425 IBD patients (Caucasian, 65%; Asian, 30%; Hispanic, 2%; and Black, 1%). CD in Asians but not other ethnicities demonstrated a strong male predominance. Family history of IBD was infrequent in Asian patients. Both Black and Asian CD patients demonstrated perianal involvement more frequently. Surgery for both CD and UC was less common in Asians than Caucasians. Compared with native residents, a family history of IBD was reported more often among immigrant IBD patients, but no significant differences were noted in phenotype. CONCLUSIONS: We demonstrate significant variation in the demographic distribution, familial predisposition, phenotype, and outcomes of IBD between Caucasians, Blacks, Hispanics, and Asians. There is need for further study to understand the biology behind this variation.


Assuntos
Fatores Imunológicos/uso terapêutico , Doenças Inflamatórias Intestinais/tratamento farmacológico , Doenças Inflamatórias Intestinais/patologia , Fatores Raciais , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Saúde Global , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Resultado do Tratamento , Adulto Jovem
7.
J Crohns Colitis ; 11(9): 1071-1077, 2017 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-28881876

RESUMO

Background and Aims: Endoscopic and histological healing are associated with improved clinical outcomes in ulcerative colitis [UC]. We aimed to investigate the predictive value of faecal immunochemical test [FIT] for endoscopic and histological healing in UC. Methods: We measured quantitative FIT and faecal calprotectin [FC] in 140 consecutive UC patients who underwent colonoscopy. We assessed the diagnostic accuracy of FIT for predicting endoscopic healing using the Mayo endoscopic subscore [MES 0/1] and for histological healing using the Geboes score [< 2.0] and Nancy index [grade ≤ 1]. The predictive abilities of FIT were compared with those of FC. Results: FIT had an area under the curve [AUC] of 0.77 (95% confidence interval [CI] 0.67-0.86, p < 0.001) for endoscopic healing, an AUC of 0.77 [95% CI 0.67-0.86, p < 0.001] using the Geboes score, and 0.77 [95% CI 0.66-0.85, p < 0.001] using the Nancy Index for histological healing. The AUC of FIT was comparable to that of FC for endoscopic healing [p = 0.773] and histological healing [p = 0.767-0.960], and was comparable to colonoscopy for histological healing [p = 0.384-0.673]. FIT < 50 ng/ml predicted endoscopic healing with a sensitivity, specificity, and positive predictive value [PPV] of 72%, 68%, and 82%, respectively, and for histological healing with a sensitivity, specificity, and PPV of 73-75%, 67%, and 78-80%, respectively. Combining FIT with FC led to a higher specificity [90%] for histological healing. Over 85% of patients with FIT < 50 ng/ml and FC < 50 µg/g achieved histological healing. Conclusions: FIT is highly sensitive and accurate to predict endoscopic and histological healing in UC. It represents a promising non-invasive tool for monitoring mucosal healing in UC.


Assuntos
Colite Ulcerativa , Colo , Colonoscopia , Fezes/química , Mucosa Intestinal , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Biomarcadores/metabolismo , Colite Ulcerativa/diagnóstico por imagem , Colite Ulcerativa/metabolismo , Colite Ulcerativa/patologia , Colo/diagnóstico por imagem , Colo/metabolismo , Colo/patologia , Feminino , Hemoglobinas/metabolismo , Humanos , Técnicas Imunológicas , Mucosa Intestinal/diagnóstico por imagem , Mucosa Intestinal/metabolismo , Mucosa Intestinal/patologia , Complexo Antígeno L1 Leucocitário/metabolismo , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e Especificidade , Cicatrização , Adulto Jovem
8.
Gastrointest Endosc ; 86(6): 1139-1146.e6, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28713062

RESUMO

BACKGROUND AND AIMS: Mucosal healing is the goal for ulcerative colitis (UC) therapy, but it needs to be confirmed via colonoscopy. Colon capsule endoscopy (CCE) is a noninvasive technique for colon investigation. Our study investigated the accuracy of second-generation CCE (CCE-2) in assessing mucosal lesions and disease activity in UC. METHODS: In this prospective study, CCE-2 and conventional colonoscopy were performed on the same day. CCE-2 reviewers and colonoscopists used the Mayo endoscopic subscore (MES) and the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) to assess disease activity, and they were blinded to each other's findings. Diagnostic parameters of CCE-2 for identifying mucosal lesions were evaluated by using colonoscopy as the reference. RESULTS: A total of 150 patients were enrolled. Of the 150 patients, 108 were included for per-patient analysis. CCE-2 and colonoscopy showed substantial agreement in measuring MES (intraclass correlation coefficient [ICC] 0.69; 95% confidence interval [CI], 0.46-0.81; P < .001) and UCEIS (ICC 0.64; 95% CI, 0.38-0.78; P < .001). CCE-2 had a sensitivity of 97% and 94% to detect mucosal inflammation (MES >0) and moderate to severe inflammation (MES >1), respectively. In per-segment analysis, the negative predictive values of CCE-2 to detect mucosal inflammation, including vascular pattern loss, bleeding, and erosions reached 94% to 95%. Interobserver agreement between 2 independent CCE-2 readers for both scoring systems was good (ICC > .80). The sensitivity and specificity of CCE-2 in detecting postinflammatory polyps were 100% and 91%, respectively. CCE-2 was better tolerated and preferred by patients than was colonoscopy. CONCLUSIONS: CCE-2 yields high accuracy in detecting mucosal lesions and determining disease severity in UC. It represents a well-tolerated and reliable tool for disease monitoring in UC. (Clinical trial registration number: NCT02469103.).


Assuntos
Endoscopia por Cápsula/métodos , Colite Ulcerativa/diagnóstico por imagem , Colonoscopia , Adolescente , Adulto , Idoso , Feminino , Humanos , Mucosa Intestinal/irrigação sanguínea , Mucosa Intestinal/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Mucosite/diagnóstico por imagem , Variações Dependentes do Observador , Preferência do Paciente , Valor Preditivo dos Testes , Estudos Prospectivos , Índice de Gravidade de Doença , Adulto Jovem
9.
Therap Adv Gastroenterol ; 9(4): 449-56, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27366213

RESUMO

BACKGROUND: Whether low-dose azathioprine (AZA) is effective in maintaining remission in patients with steroid-dependent ulcerative colitis (UC) remains unclear. We assessed the efficacy and safety of low-dose AZA in a Chinese population with UC. METHODS: We identified steroid-dependent UC patients in clinical remission on AZA maintenance therapy from a territory-wide IBD Registry. Standard- and low-dose AZA were defined as at least 2 mg/kg/day and less than 2 mg/kg/day, respectively. Relapse rates were analyzed by Kaplan-Meier analysis and compared using log-rank test. RESULTS: Among 1226 UC patients, 128 (53% male, median duration on AZA 44 months) were included. Median maintenance AZA dose was 1.3 mg/kg/day. 97.7% of the patients were on concomitant oral 5-aminosalicylic acid. Cumulative relapse-free rates in patients on standard-dose and low-dose AZA were 71.2%, 52.8% and 45.2%, and 71.8%, 55.3% and 46.2% at 12, 24 and 36 months, respectively (p = 0.871). Relapse rate within 12 months was higher in patients who withdrew compared with those who maintained on AZA (52.6% versus 29.4%; p = 0.045). Mean corpuscular volume increased after AZA therapy in both of the low-dose [median (interquartile range, IQR): 88.2 (81.4-92.2) versus 95.1 (90.1-100.9) fl, p < 0.001] and standard-dose subgroups [median (IQR) 86.8 (76.9-89.9) versus 94.7 (85.9-99.7) fl, p < 0.001]. Leukopenia occurred in 21.1% of the patients. Patients on standard dose had a higher risk for leukopenia than those on low-dose AZA [odds ratio (OR) 3.9, 95% CI 1.9-8.2, p < 0.001]. CONCLUSIONS: In the Chinese population, low-dose AZA is effective for maintaining remission in steroid-dependent UC patients. Standard-dose AZA was associated with more than threefold increased risk of leukopenia.

10.
Inflamm Bowel Dis ; 22(8): 1954-60, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27416041

RESUMO

BACKGROUND: Incidence of inflammatory bowel disease (IBD) is increasing in Asia, but population-based prevalence data are limited. This study examined IBD incidence and prevalence based on results of a territory-wide IBD registry in Hong Kong. METHODS: We collected data on 2575 patients with IBD (1541 ulcerative colitis [UC], 983 Crohn's disease [CD], 51 IBD unclassified) from 1981 to 2014 using hospital and territory-wide administrative coding system. Prevalence and incidence, disease phenotype, surgery, and mortality were analyzed. RESULTS: Adjusted prevalence of IBD, UC, CD, and IBD unclassified per 100,000 individuals in 2014 were 44.0, 24.5, 18.6, and 0.9, respectively. Age-adjusted incidence of IBD per 100,000 individuals increased from 0.10 (95% confidence interval, 0.06-0.16) in 1985 to 3.12 (95% confidence interval, 2.88-3.38) in 2014. UC:CD incidence ratio reduced from 8.9 to 1.0 over 30 years (P < 0.001). A family history of IBD was reported in 3.0% of patients. Stricturing or penetrating disease was found in 41% and perianal disease in 25% of patients with CD. 5-aminosalicylate use was common in UC (96%) and CD (89%). Cumulative rates of surgery for CD were 20.3% at 1 year and 25.7% at 5 years, and the corresponding rates for UC were 1.8% and 2.1%, respectively. Mortality for CD and UC was not significantly different from the general population. CONCLUSIONS: In a population-based study in Hong Kong, prevalence of IBD is lower than in the west although comparable to that of other East Asian countries. Complicated CD is common. Overall mortality remains low in Asians with IBD.


Assuntos
Colite Ulcerativa/epidemiologia , Doença de Crohn/epidemiologia , Adolescente , Adulto , Idade de Início , Anti-Inflamatórios não Esteroides/uso terapêutico , Colite Ulcerativa/genética , Colite Ulcerativa/mortalidade , Colite Ulcerativa/cirurgia , Doença de Crohn/genética , Doença de Crohn/mortalidade , Doença de Crohn/cirurgia , Feminino , Hong Kong/epidemiologia , Humanos , Incidência , Masculino , Mesalamina/uso terapêutico , Pessoa de Meia-Idade , Prevalência , Sistema de Registros , Adulto Jovem
11.
J Crohns Colitis ; 10(10): 1224-36, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26928965

RESUMO

BACKGROUND: Little is known of the clinical outcome of patients with older-onset inflammatory bowel disease [IBD]. We performed a systematic review to determine phenotype and outcomes of older-onset IBD compared with younger-onset subjects. METHODS: A systematic search of Embase and Medline up to June 2015 identified studies investigating phenotype and outcomes of older-onset [diagnosed at age ≥ 50 years] Crohn's disease [CD] and ulcerative colitis [UC] subjects. Pooled analyses of disease phenotype, medication use, and disease-related surgery were calculated. RESULTS: We analysed findings from 43 studies comprising 8274 older-onset and 34641 younger-onset IBD subjects. Compared with younger-onset patients, older-onset CD patients were more likely to have colonic disease (odds ratio [OR] 2.56, 95% confidence interval [CI] 1.88 - 3.48) and inflammatory behaviour [OR 1.19, 95% CI 1.07 - 1.33], and less likely to have penetrating disease or perianal involvement. More older-onset UC patients had left-sided colitis [OR 1.49, 95% CI 1.18 - 1.88]. Although fewer older-onset IBD patients received immunomodulators [CD: OR 0.44; UC: OR 0.60] or biologicals [CD: OR 0.34; UC: OR 0.41], older-onset CD was similar in the need for surgery [OR 0.70, 95% CI 0.40 - 1.22] whereas more older-onset UC patients underwent surgery [OR 1.36, 95% CI 1.18 - 1.57]. CONCLUSIONS: Elderly IBD patients present with less complicated disease, but have similar or higher rates of surgery than non-elderly patients. Whether this reflects a non-benign disease course, physicians' reluctance to employ immunomodulators, or both, merits further study which is essential for improving the care of IBD in the elderly.


Assuntos
Doenças Inflamatórias Intestinais , Fenótipo , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Progressão da Doença , Humanos , Fatores Imunológicos/uso terapêutico , Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/tratamento farmacológico , Doenças Inflamatórias Intestinais/patologia , Doenças Inflamatórias Intestinais/terapia , Pessoa de Meia-Idade , Modelos Estatísticos , Prognóstico
12.
J Crohns Colitis ; 10(2): 176-85, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26512132

RESUMO

BACKGROUND AND AIMS: Data on the natural history of elderly-onset ulcerative colitis [UC] are limited. We aimed to investigate clinical features and outcomes of patients with elderly-onset UC. METHODS: Patients with a confirmed diagnosis of UC between 1981 and 2013, from 13 hospitals within a territory-wide Hong Kong Inflammatory Bowel Disease Registry, were included. Clinical features and outcomes of elderly-onset patients, defined as age ≥ 60 years at diagnosis, were compared with those of non-elderly-onset disease [< 60 years at diagnosis]. RESULTS: We identified 1225 patients, of whom 12.8% [157/1225; 56.1% male] had elderly-onset UC. Median duration of follow-up was 11 years [interquartile range, 6-16 years]. Age-specific incidence of elderly-onset UC increased from 0.1 per 100000 persons before 1991 to 1.3 per 100000 persons after 2010. There were more ex-smokers [32.2% vs. 12.2%, p < 0.001] and higher proportion of comorbidities [p < 0.001] in elderly-onset than non-elderly-onset patients. Disease extent, corticosteroids, immunosuppressants use, and colectomy rates were similar between the two groups. Elderly-onset disease was an independent risk factor for cytomegalovirus infection [odds ratio 2.9, 95% confidence interval 1.6-5.2, p < 0.001]. More elderly-onset patients had Clostridium difficile infection [11.0% vs. 5.4%, p = 0.007], hospitalisation for UC exacerbation [50.6% vs. 41.8%, p = 0.037], colorectal cancer [3.2% vs. 0.9%, p = 0.033], all-cause mortality [7.0% vs. 1.0%, p < 0.001], and UC-related mortality [1.9% vs. 0.2%, p = 0.017] than non-elderly-onset patients. CONCLUSIONS: Elderly-onset UC patients are increasing in number. These patients have higher risk of opportunistic infections, hospitalisation, colorectal cancer, and mortality than non-elderly-onset patients. Management and therapeutic strategies in this special group need careful attention.


Assuntos
Colite Ulcerativa/epidemiologia , Previsões , Sistema de Registros , Adulto , Distribuição por Idade , Fatores Etários , Idade de Início , Idoso , Colite Ulcerativa/etiologia , Feminino , Seguimentos , Hong Kong/epidemiologia , Humanos , Incidência , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo
13.
Inflamm Bowel Dis ; 21(4): 840-6, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25738375

RESUMO

BACKGROUND: Mucosal healing (MH) has been associated with improved outcomes in ulcerative colitis but factors associated with MH are not well defined. METHODS: Consecutive patients with ulcerative colitis in clinical remission (Mayo symptomatic subscore = 0) who had at least 1 colonoscopy since diagnosis from 6 centers were included. For patients who had at least 2 colonoscopies during follow-up, each colonoscopy was reviewed to define whether they had early MH (Mayo endoscopic subscore reduced to 0 within 3 yr of clinical remission). Factors associated with MH and early MH were determined using logistic regression. RESULTS: Two hundred thirty-seven patients with ulcerative colitis (mean age 50.39 ± 14.10 yr; 56.5% male) were included. Independent factors for MH were clinical remission >3 years (odds ratio [OR] 4.0; 95% confidence interval [CI], 1.2-13.1), mild/moderate mucosal inflammation (OR 3.3; 95% CI, 1.3-8.5), and immunosuppressant use (OR 4.6; 95% CI, 1.5-14.6). Among patients who had ≥2 of above factors, 74% achieved MH, whereas only 39% with <2 factors achieved MH (P < 0.001). Of patients in clinical remission <1 year, 1 to 3 years and >3 years, 30%, 45.9%, and 62.9% achieved MH, respectively. Immunosuppressant therapy was associated with early MH (P = 0.025). In multivariate analysis, patients with previous mild inflammation were more likely to achieve early MH than those with moderate/severe inflammation (OR 2.8; 95% CI, 1.2-6.2). CONCLUSIONS: A longer disease remission, previous less severe mucosal inflammation, and immunosuppressant use are associated with MH. Severity of mucosal inflammation and use of immunosuppressant are also associated with early MH.


Assuntos
Colite Ulcerativa/patologia , Mucosa Intestinal/patologia , Remissão Espontânea , Adolescente , Adulto , Idoso , Colite Ulcerativa/tratamento farmacológico , Colonoscopia , Feminino , Humanos , Imunossupressores/uso terapêutico , Inflamação/patologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade
14.
Expert Rev Gastroenterol Hepatol ; 9(1): 47-54, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24966092

RESUMO

Assessment of mucosal inflammation is important in the management of patients with ulcerative colitis (UC). Colon capsule endoscopy (CCE) has recently been shown to be effective in colorectal polyp detection. However, its role in the evaluation of mucosal inflammation in UC is unclear. This systematic review aims to clarify the state of the art with an evidence-based summary of current studies on the utility of CCE in UC. The overall results show that the accuracy of CCE for assessment of mucosal inflammation in UC appeared to be comparable with that of colonoscopy. Long-term follow-up studies with larger sample size are needed to further validate the utility of CCE in the management of UC subjects in clinical practice.


Assuntos
Endoscopia por Cápsula , Colite Ulcerativa/diagnóstico , Colo/patologia , Mucosa Intestinal/patologia , Endoscopia por Cápsula/efeitos adversos , Colite Ulcerativa/patologia , Colonoscopia , Humanos , Satisfação do Paciente , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Índice de Gravidade de Doença
15.
Zhongguo Zhong Yao Za Zhi ; 39(12): 2364-6, 2014 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-25244776

RESUMO

To evaluate the efficacy of Yupingfeng droppill and western medicine in treatment of allergic rhinitis, 76 patients from Beijing Shijitan hospital during April 2011 to May 2012 were selected and randomly divided into the treatment group (n = 44) and control group (n = 32). The treatment group was treated with Yupingfeng droppill and cetirizine tablets, the control group was treated with cetirizine tablets, the effect of the two groups was observed after 28 days, after treatment, the symptoms and inferior turbinate volume contrast of the two groups were better than before. The obvious effective rate and total effective rate were 84.09%, 95.45% and 46.87%, 56.25% in the treatment group and and control group. The differences in the obvious effective rate and total effective rate were statistically significant between two groups (P < 0.05), Yupingfeng droppill has the curative effect on allergic rhinitis, which is better than simple oral cetirizine tablets.


Assuntos
Medicamentos de Ervas Chinesas/administração & dosagem , Rinite Alérgica Perene/tratamento farmacológico , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Rinite Alérgica , Resultado do Tratamento , Adulto Jovem
16.
Cancer Lett ; 309(1): 19-26, 2011 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-21652147

RESUMO

COX-2 and 5-LOX are up-regulated in ESCC. This study aims to determine the efficacy of COX-2 inhibitor, 5-LOX inhibitor and their combination on ESCC. Nimesulide can suppress cell growth and promote apoptosis, accompanied with a decrease of PGE(2) production. AA861 has the similar effect with a down-regulation of LTB(4). In animal experiment, the tumor volumes in drug-treated groups were significantly smaller with the lowest rates of Ki-67 positive cells. In conclusion, either COX-2 inhibitor or 5-LOX inhibitor can suppress ESCC. Dual inhibition of COX-2 and 5-LOX pathway may present a superior anticancer efficacy to either inhibition of COX-2 or 5-LOX alone.


Assuntos
Araquidonato 5-Lipoxigenase/metabolismo , Carcinoma de Células Escamosas , Inibidores de Ciclo-Oxigenase 2/farmacologia , Ciclo-Oxigenase 2/metabolismo , Neoplasias Esofágicas , Inibidores de Lipoxigenase/farmacologia , Animais , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/enzimologia , Carcinoma de Células Escamosas/patologia , Linhagem Celular Tumoral , Proliferação de Células/efeitos dos fármacos , Regulação para Baixo/efeitos dos fármacos , Sinergismo Farmacológico , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/enzimologia , Neoplasias Esofágicas/patologia , Humanos , Masculino , Camundongos , Camundongos Nus , Transplante de Neoplasias
17.
Zhonghua Yu Fang Yi Xue Za Zhi ; 44(12): 1121-7, 2010 Dec.
Artigo em Chinês | MEDLINE | ID: mdl-21215116

RESUMO

OBJECTIVE: To assess the effects of ambient air pollutants on hospital outpatient visits for allergic disease and pollinosis. METHODS: The monitoring data of daily air pollution (SO(2), NO(2) and PM(10)) in 8 national monitoring and controlling sites of Beijing air quality, airborne pollen in 4 monitoring sites of Beijing, and daily meteorological data, along with the daily numbers of outpatients visits for allergic disease and pollinosis at the Allergy Department of Beijing Shijitan Hospital from April to September in 2004 were collected. Associations between the levels of air pollutants and outpatient visits for allergic disease and pollinosis were estimated by time serial analysis using a generalized addictive model (GAM), considering lag effect and the influence of multipollutants. RESULTS: During the study period, the average daily ambient concentrations of SO(2), NO(2) and PM(10) were (20.9 ± 12.9), (58.6 ± 13.6) and (126.8 ± 64.1) µg/m(3), respectively. The mean daily pollen count was (163.8 ± 209.0) grains/1000 mm(2), while the average daily numbers of doctor visits for allergic disease and pollinosis were (16.3 ± 5.3) and (3.5 ± 5.0), respectively. Time serial analysis showed that significant positive associations were found between levels of airborne pollen and doctor visits, with an excess risk (ER) of 2.44% (95%CI: 0.75% - 4.13%)for allergic disease and 6.58% (95%CI: 3.82% - 9.34%) for pollinosis per 100 grains/1000 mm(2) increase in pollen, in single-pollutant models. There were associations between ambient air pollutants (SO(2), NO(2), PM(10)) and doctor visits with lag effects. A 10 µg/m(3) increase in NO(2) was associated with a 3.14% (95%CI: 0.42% - 5.85%) increase in doctor visits for allergic disease at lag 6 d. For pollinosis, the highest ER was observed for 10 µg/m(3) increases in SO(2) at lag 1 d, NO(2) at lag 6 d, PM(10) at lag 3 d. However, this association was not statistically significant (RR (95%CI) were 1.0460 (0.9640 - 1.1280), 1.0325 (0.9633 - 1.1017), 1.0079 (0.9942 - 1.0217), respectively). The associations enhanced slightly in multi-pollutant models with an ER of 2.56% (95%CI: 0.80% - 4.31%) for allergic disease and 6.81% (95%CI: 3.91% - 9.71%) for pollinosis per 100 grains/1000 mm(2) of pollen. CONCLUSIONS: Our results suggest that level of airborne pollen may have a stronger effect than ambient air pollutants on allergic disease and pollinosis.


Assuntos
Poluentes Atmosféricos/análise , Poluição do Ar/análise , Monitoramento Ambiental , Ambulatório Hospitalar/estatística & dados numéricos , Doença Ambiental/prevenção & controle , Humanos , Rinite Alérgica Sazonal/prevenção & controle
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