炎性肠病相关骨质疏松的影像学研究进展

骨质疏松症（OP）是炎性肠病（IBD）病人最常见的肠道外表现之一。双能X线吸收测量仪、CT、MRI以及定量超声等影像方法可以评估IBD病人的骨量、骨结构、骨髓脂肪以及骨强度变化,对IBD的诊断治疗及预后评估具有重要意义。就IBD相关OP的发病机制、影像学研究进展及其临床应用予以综述。     

自我管理教育对炎症性肠病患者生活质量的影响

目的探讨自我管理教育对炎症性肠病（IBD）患者生活质量的影响。方法随机选取2012年6月～2013年6月在我院消化内科治疗的IBD患者48例,按照住院先后时间段进行分组,每组24例。对照组进行常规健康教育,观察组进行自我管理教育。治疗前和治疗后6个月分别采用自我效能量表、自我管理能力量表和IBD生活质量量表（IBDQ）对患者进行测量,比较两组评分改善情况。结果治疗前,两组自我效能水平、自我管理能力及生活质量均处于较低水平,组间无统计学差异（均P〉0.05）;治疗6个月后,观察组自我效能水平、自我管理能力、IBDQ各维度指标明显优于对照组（P〈0.05）。结论通过对IBD患者实施自我管理教育,可提高患者的自我管理能力,对提高临床疗效,改善患者的生活质量有着重要意义。     

细菌与炎症性肠病

炎症性肠病（IBD）是一种病因尚不明确的慢性非特异性肠道炎症性疾病，包括溃疡性结肠炎（UC）和克罗恩病（CD）。此病可能的病因有由基因决定的宿主易患性、肠道细菌的作用、自身免疫、环境因素等。肠道细菌的感染因素作为一种主要病因，虽尚未被证实，但已有许多研究表明，细菌是IBD的促发因素。近年的研究表明，     

炎症性肠病的MRI进展

炎症性肠病（IBD）是一组病因不明的慢性炎症性肠病,包括克罗恩病（CD）和溃疡性结肠炎（UC）,常导致肠腔狭窄或穿透性肠损伤,其病程发展过程中需要经常评估疾病的活动性和并发症,以便制定正确的治疗方案。MRI软组织分辨力高,可以获得肠壁的动态信息,已应用于对IBD的检出、评估病变活动性、判断病变纤维化程度及鉴别CD与UC等。就MR小肠成像、扩散加权成像、动态增强MRI及磁化传递成像等在IBD中的应用进展予以综述。     

微生物感染与炎症性肠病相关流行病学及临床研究进展

炎症性肠病（IBD）包括溃疡性结肠炎（UC）和克罗恩病（CD）,近年来发病率呈上升趋势。虽然发病机制尚不明确,但已知肠道黏膜免疫系统异常是该病发病的重要因素,微生物感染因素在其发生和发展中亦起着一定作用。虽然尚未找到某一特异微生物病原感染与IBD有恒定关系,     

部队合理用药系列讲座（3） 炎症性肠病临床合理用药

炎症性肠病（IBD）是一种病因尚不明确的慢性非特异性肠道炎症性疾病,包括溃疡性结肠炎（UC）和克罗恩病（CD）。     

炎症性肠病研究新进展

炎症性肠病（IBD）指溃疡性结肠炎（UC）和克罗恩病（CD）,该二种病均以慢性过程、自动复发、病因未明为其特征.西方国家发病率较高,国内发病有上升趋势,为此,中华医学会消化学会于1978（杭州）、1993（太原）和2000（成都）分别召开了炎症性肠病专项研讨会,对其病因、诊断和治疗的规范进行了讨论.     

滤泡辅助性T细胞（TFH）在炎性肠病中的表达研究

目的观察新型CD4＋T辅助细胞亚群-滤泡辅助性T细胞（T follicular helper cells,TFH）在炎性肠病（inflammatory bowel diseases,IBD）中的表达,探究其在IBD发病中的作用及机制。方法用饮用葡聚硫酸钠（dex-tran sulfate sodium,DSS）的方法建立IBD动物模型,密度梯度离心法分离小鼠脾淋巴细胞,采用不同荧光素标记的CD4I、COS、CD40L、CXCR5抗体进行流式细胞染色,分析上述TFH的表面标记在DSS诱导IBD（DSS-IBD）模型中的变化;同时提取淋巴细胞RNA,用实时定量PCR检测TFH的特异性转录因子Bcl-6和效应分子IL-21的表达变化。结果与结论与对照组相比,DSS-IBD模型动物CD4＋ICOS＋,CD4＋CD40L＋,CD4＋CXCR5＋T细胞的比例,以及Bcl-6和IL-21在mRNA表达水平均显著下降,显示TFH亚群的功能调节失常可能是该类IBD的重要发病机制之一。     

类风湿性关节炎早期治疗的研究进展

类风湿性关节炎（RA）现阶段生物制剂治疗RA已取得了突破性的进展,以细胞因子为靶点的生物治疗为广大RA患者开辟了一条充满希望的新途径,但是仍然存在诸多不足之处,如感染风险、价格昂贵等.通过查阅近年来在核心期刊上发表的相关文献,总结的治疗方法.     

飞行人员的理想保健饮品——天羽抗辐射保健液

近日，一种由空军某研究所研制生产的中草药生物制剂——天羽抗辐射保健液已经问世，这是我国第一种抗辐射保健品，现已被国家卫生部正式批准为适合于航空航天等人员使用的具有抗辐射、免疫调节和耐缺氧三种功能的保健食品。     

Inflammatory bowel diseases (IBD) -- critical discussion of etiology,pathogenesis, diagnostics,and therapy

AIMS: Crohn's disease and ulcerative colitis are the most frequent inflammatory bowel diseases (IBD) with a prevalence of approximately one out of 500.Cytokine research opened new and potent treatment options and thus stimulated clinical and basic research.However, the IBD still remain a challenge for patients and physicians,demanding close cooperation between gastroenterologists,radiologists and surgeons.The basic understanding of IBD,which is necessary for efficient diagnostic and therapeutic concepts is reviewed. METHODS: Based upon recent publications and our clinical experience we discuss aspects of etiology,pathogenesis,diagnostics,and therapy of Crohn's disease and ulcerative colitis. RESULTS: A genetically influenced, exaggerated and sustained immune response against the own gut flora seems to be one of the most important factors in the pathogenesis of IBD.Not less important are environmental influences.For instance, cigarette smoking had been judged to have some negative influence on the natural course of Crohn's disease.Now,however, recent studies show that smoking is even a significant independent risk factor in the pathogenesis of IBD. Since IBD and especially Crohn's disease can effect the whole body, detailed analysis of inflammatory organ involvement is necessary before therapy.For instance, the MRI enteroclysis technique adds a necessary diagnostic tool for the exploration of those parts of the small bowel that cannot been reached by routine endoscopy like the upper ileum and the lower jejunum. In terms of therapy, a change of paradigms can be observed: patients will no longer be treated only when symptoms arise, but will early be integrated into a therapeutic concept, which is determined by site and extent of the disease and adapted to the abilities and needs of the patient.Furthermore,immunosuppressive agents like azathioprine and 6-mercaptopurine will establish as central concept in the medical treatment of IBD. DISCUSSION: IBD-therapy should rather be adapted to the patient's individual inflammatory pattern than be oriented to schematic treatment rules.New endoscopic and radiologic techniques provide the necessary diagnostic tools.     

Development of radioimmunotherapeutic and diagnostic antibodies: an inside-out view

Only a handful of radiolabeled antibodies (Abs) have gained US Food and Drug Administration (FDA) approval for use in clinical oncology, including four immunodiagnostic agents and two targeted radioimmunotherapeutic agents. Despite the advent of nonimmunogenic Abs and the availability of a diverse library of radionuclides, progress beyond early Phase II radioimmunotherapy (RIT) studies in solid tumors has been marginal. Furthermore, [¹⁸F]fluorodeoxyglucose continues to dominate the molecular imaging domain, underscored by a decade-long absence of any newly approved Ab-based imaging agent (none since 1996). Why has the development of clinically successful Abs for RIT been limited to lymphoma? What obstacles must be overcome to allow the FDA approval of immuno-positron emission tomography (immuno-PET) imaging agents? How can we address the unique challenges that have thus far prevented the introduction of Ab-based imaging agents and therapeutics for solid tumors? Many poor decisions have been made regarding radiolabeled Abs, but useful insight can be gained from these mistakes. The following review addresses the physical, chemical, biological, clinical, regulatory and financial limitations that impede the progress of this increasingly important class of drugs.     

蜂产品对放射性损伤的防治研究进展

在军事、医疗和公共卫生方面,辐射暴露是一个持续而严重的威胁。针对辐射引起的损伤需要有效的预防或缓解治疗,但是目前这些问题尚未得到解决。临床上少数食品药品监督管理局（FDA）批准的辐射防护剂副作用大,限制其广泛使用。据报道,一些天然的无毒化合物（如蜂产品）可通过减轻辐射引起的氧化应激、细胞凋亡和DNA损伤来预防和治疗辐射引起的口腔黏膜炎、食管炎、皮肤损伤、肝损伤、肠道损伤和造血系统的损伤等。这表明这些蜂产品有作为辐射防护剂的潜力。本文就蜂产品对防治放射性损伤的实验及临床研究进行综述。     

Significance of proteinuria in patients with acute ischemic brain disease]

Brain vascular diseases are ranked the third as the cause of morbidity and mortality in majority of the countries of the world. In about 80% of the cases of vascular brain diseases, it is ischemic brain disease (IBD). Atherosclerosis of main cerebral arteries is most frequently responsible for the occurrence and development of IBD. In recent years it was reported for the first time of the association of atherosclerosis and/or its complications and proteinuria. Assuming that there exists the significant association between the degree of proteinuria and clinical parameters of IBD, the aim of this study was to investigate the frequency and patterns of the association of proteinuria and clinical IBD parameters. The study was performed in 180 patients with IBD of atherothrombotic origin and 60 patients with the diseases of non-vascular origin, as the control group. In all patients quantitative determination of proteinuria was performed, and in the patients with IBD was determined the degree of IBD and afterwards the degree of functional and neurologic impairment prior to and at the end of treatment in acute phase using the standardized scales. The results of the study revealed the existence of significant frequency of proteinuria in the patients with IBD, as well as the significant association between the degree of proteinuria and severity of IBD. It was concluded that proteinuria in patients with IBD was probably associated with the atherogenic processes and physiopathologic processes of IBD, respectively, which could have predictive value for the outcome of the disease in the early stage.     

Hepatic yttrium-90 radioembolotherapy in metastatic colorectal cancer treated with cetuximab or bevacizumab

Yttrium-90 microspheres have been recently approved by the Food and Drug Administration and have become available to physicians in the United States for the treatment of hepatic neoplasia. Published results regarding the benefits of 90Y radioembolotherapy within the rapidly evolving landscape of systemic therapies for advanced unresectable colorectal cancer are limited. In that context, outcomes in patients who have received the recently approved biologic agents bevacizumab and cetuximab in addition to chemotherapy are unknown. This report briefly describes the authors' treatment experience with this cohort of patients.     

Acute treatment for ischemic stroke in 2004

The last decade witnessed significant and unprecedented advances in the treatment of acute ischemic stroke. Intravenous tissue plasminogen activator and defibrinogenating agent are both now approved by the Food and Drug Administration for treatment of acute ischemic stroke within 3 h of symptom onset. Trials involving intra-arterial thrombolysis have demonstrated clinical benefit in patients treated within 6 h of symptom onset. The future for the development of new and better treatment for ischemic stroke looks very promising. Currently, induced hypothermia, laser evaporation, mechanical thrombectomy, angioplasty with stent placement, the combination of neuroprotective agents with thrombolysis, and the combination of intravenous with intra-arterial thrombolysis are being investigated.     

Clinical applications of radiolabeled blood elements in inflammatory bowel disease.

This work discusses the main clinical features of inflammatory bowel disease (IBD) and the methods to obtain an accurate diagnostic. Nuclear medicine procedures are deeply analyzed, with special emphasis in those where clinical experience is larger and that are available for clinical practice in most countries. In the opinion of the authors 99mTc-HMPAO is the first choice agent, while 111In-oxine could be considered as the gold standard for evaluation of new agents. In the context of IBD, the WBC scintigraphy is useful for its diagnosis (early and accurate) and the evaluation of disease extension (whole bowel examination, without patient preparation and negligible risk). The evaluation of disease severity deserves further experiences.     

Simultaneous administration of111In-human immunoglobulin and99mTc-HMPAO labelled leucocytes in inflammatory bowel disease

Technetium-99m hexamethylpropylene amine oxime (HMPAO) labelled leucocytes and indium-111 polyclonal immunoglobulin (IgG) were simultaneously injected into a group of 27 patients routinely referred for the investigation of inflammatory bowel disease (IBD). Ten-minute anterior abdomen and tail on detector views were obtained at 30 min, 4 h and 24 h p.i. of both tracers. The diagnosis of IBD was obtained in all cases by endoscopy with biopsy and/or surgery. Images were blindly evaluated by two experienced observers who only knew of the clinical suspicion of IBD. IBD was confirmed in 20 patients (12 with Crohn's disease and eight with ulcerative colitis). Sensitivity, specificity and accuracy were 100%, 85% and 96% respectively for labelled leucocytes and 70%, 85% and 74% for IgG. Both IgG and leucocyte scans were normal in six out of seven patients in whom a diagnosis of IBD was excluded; the remaining patient, with ischaemic colitis, was falsely positive with both agents. As far as disease extension is concerned, the IgG study localized 27 diseased segments, whereas 49 were seen with the leucocyte study. Eighty-four segments were normal and 25 showed tracer uptake with both agents. Twenty-four were positive only with the leucocyte study and two were positive only with the IgG study. Agreement between the agents was 80.7%. These results confirm that¹¹¹In-human polyclonal scintigraphy is less sensitive than^99mTc-HMPAO scintigraphy both for the diagnosis of IBD and in the evaluation of disease extension. Nevertheless, if leucocyte labelling is not available, labelled IgG can be used only for diagnostic purposes.     

53例初诊儿童炎症性肠病临床分析

目的探讨儿童炎症性肠病(IBD)初诊临床特点,提高对儿童IBD的认识。方法回顾性分析2005年1月至2015年10月于中国医科大学附属盛京医院儿科初诊,并确诊为IBD的53例患儿的临床资料,包括临床表现、实验室检查、影像学、内窥镜和病理组织学结果,以及治疗方案。结果 IBD患儿的临床表现主要以腹痛、腹泻、便血、发热为主。其中,溃疡性结肠炎(UC)患儿较克罗恩病(CD)患儿更易出现腹泻及便血症状(P<0.05),而CD患儿腹痛症状更为明显(P<0.05),同时更易出现肠外表现,34.0%患儿出现生长发育和营养障碍,84.9%患儿存在不同程度的精神状态改变。实验室检查结果以炎症性指标(如白细胞、C-反应蛋白、血沉)升高为主,UC和CD患儿的血清白蛋白比较,差异有统计学意义(P<0.05)。UC和CD患儿,内镜及病理表现明显不同,MRE同时观察到肠壁强化和瘘管及肿块的形成。51例单纯药物治疗,2例联合手术治疗。其中,13例患儿应用了英夫利昔单抗(IFX)治疗,诱导缓解迅速,身高、体质量有所增长。结论对临床出现腹痛、腹泻、便血、发热以及营养状态不佳的患儿,要警惕IBD的发生;需结合生化、影像学、内镜、病理进行综合诊断;MRE无创、无辐射,值得推广;中重度患者,IFX可以迅速缓解病情,促进生长发育。     

Off-label use of contrast agents

When contrast agents are approved, the label describes the approved indications and particular circumstances of use such as age, organ function or pregnancy. The use of contrast agents outside their labelled indications is increasing, namely with contrast agents used for MRI. The aim of this paper is to improve the knowledge about this topic. The basis for off-label use is the physician’s prerogative, which finds its basis in the “Declaration of Helsinki”. Off-label use is allowed under special conditions and might be even the medical state of the art. The necessity for off-label use will continue to increase for MR-contrast agents, as the regulatory requirements for approval of new indications continuously increase, and clinical trials for registration purposes are quite costly and time consuming. As a consequence, manufacturers will concentrate on clinical studies for the essential indications.