Efficacy and safety of cold snare polypectomy for sessile serrated polyps ≥ 10 mm: A systematic review and meta-analysis

BackgroundCold snare polypectomy (CSP) is a promising technique for the removal of sessile serrated polyps (SSPs) ≥ 10 mm. However, the efficacy and safety of this technique remain undetermined.AimsWe aimed to comprehensively evaluate the efficacy and safety of CSP for SSPs ≥ 10 mm.MethodsPubMed, EMBASE, Web of Science and Cochrane Library were searched up to January 2021.ResultsA total of 10 studies consisting of 1727 SSPs (range, 10–40 mm) from 1021 patients were included. The overall rates of technical success, adverse events (AEs) and residual SSPs were 100%, 0.7% and 2.9%, respectively. Subgroup analysis showed that the rates of technical success and AEs were comparable between CSP and cold endoscopic mucosal resection (EMR) (99.9% vs. 100% and 1.3% vs. 0.5%, respectively), between the proximal and distal colon (100% vs. 99.9% and 0.3% vs. 0, respectively), and between polyps of 10–19 mm and ≥20 mm (99.8% vs. 100% and 0.9% vs. 0, respectively). However, subgroup analysis showed that the rate of residual SSPs was slightly lower in CSP compared with cold EMR (1.3% vs. 3.9%), as well as in polyps of 10–19 mm compared with those ≥20 mm (3.1% vs. 4.7%).ConclusionCSP was an effective and safe technique for removing SSPs ≥ 10 mm.     

翁舌汤灌肠治疗大肠湿热型溃疡性结肠炎临床研究

目的:观察翁舌汤灌肠治疗大肠湿热型溃疡性结肠炎的疗效及其对患者血清炎症因子水平的影响。方法:将80例大肠湿热型溃疡性结肠炎患者按随机数字表法分为观察组和对照组各40例。观察组给予翁舌汤灌肠治疗,对照组给予美沙拉嗪栓肛门塞入治疗,两组均连续治疗8周。比较两组患者的临床疗效、肠黏膜征象积分和血清炎症因子水平。结果:治疗后,观察组和对照组总有效率分别为95.00%、70.00%,两组疗效比较,差异有统计学意义(P<0.05)。治疗后,观察组患者炎症增生、黏膜溃疡、黏膜糜烂、黏膜水肿、黏膜充血积分均下降,与治疗前比较,差异有统计学意义(P<0.05);且观察组各项积分均低于对照组,差异有统计学意义(P<0.05)。治疗后,两组血清白细胞介素-8(IL-8)、肿瘤坏死因子-β(TNF-β)水平均降低,血清白细胞介素-10(IL-10)水平均升高,与治疗前比较,差异均有统计学意义(P<0.05);且观察组血清IL-8、TNF-β水平明显低于对照组,血清IL-10水平明显高于对照组,差异有统计学意义(P<0.05)。结论:翁舌汤灌肠治疗大肠湿热型溃疡性结肠炎疗效较好,可改善患者肠黏膜征象积分,调节血清炎症因子水平。     

Sinonasal tract pathology: an updated review of select entities

The sinonasal tract is host to numerous benign and malignant entities that can pose diagnostic challenges to pathologists as a result of limited exposure in daily practice. This review concentrates on certain key characteristics of select entities with focus on differential diagnosis, novel subtypes and/or molecular distinction. The aim of this review is to summarize current knowledge and shed light on diagnostically challenging and emerging entities in sinonasal tract pathology.     

Endoscopic therapy for pouch problems: Can we avoid surgery?

While restorative proctocolectomy and ileal pouch-anal anastomosis significantly improves patients’ quality of life, the reconstructive surgery is often associated with various structural, inflammatory, and functional disorders. Those disorders have been traditionally managed with surgery. However, the past two decades have witnessed a growing role of endoscopic management of strictures, prolapse, anastomotic leaks, sinuses, fistulae, and polyps. The main advantages of endoscopic therapy are its less invasiveness in nature and better tolerance over surgery. Endoscopic sinusotomy is at least as effective as surgical pouch redo for a majority of pouch presacral sinuses, while carrying a lower risk for procedure-associated complications.     

肠道微生态与化疗疗效的相关性

人体的肠道菌群之间存在共生或拮抗关系，并形成了独特的肠道微生态系统。在经过了长期的协同进化之后，肠道菌群与人体间形成了密切的共生关系，参与人体的多种重要生理活动，因此，保持肠道菌群的平衡对人体健康至关重要。人体肠道菌群结构的形成取决于多种因素，如饮食、性别、分娩方式、宿主遗传特征、宿主生活方式、疾病的发生和抗生素的暴露等。健康人的肠道菌群以大肠埃希菌、双歧杆菌、乳酸杆菌、变形杆菌为主，在正常生理状态下，这些细菌保持着种类和数量上的动态平衡，它们不仅可以保护肠道上皮细胞，还在宿主的生命活动中参与免疫、营养、生物拮抗、延缓衰老和抗肿瘤等生理过程。肠道菌群可以通过激活抗肿瘤细胞因子、调节肠道微环境和维持基因组稳定等途径抑制肿瘤的发展并调节炎症反应。不仅如此，完整的肠道菌群还有利于抗癌药物药效的发挥。肠道菌群通过菌群易位、免疫调节、代谢、酶降解、多样性减少和微生态变化来影响化疗的疗效及毒性。同时，化疗会显著影响肠道菌群的组成，破坏肠道微生态平衡，加重患者的不适感。越来越多的证据表明肠道细菌可以影响化疗的疗效或毒副反应，而且通过调节肠道微生态可能提高化疗疗效和降低毒性。本文就肠道菌群与化疗疗效和副反应的关系予以综述。     

基于调控肠道菌群探讨中药防治脑卒中

肠道菌群是一个独特的生态系统,被称为人体"被遗忘的器官",被誉为人类的"第二基因组"。肠道菌群失调与许多中枢神经系统疾病相关,例如帕金森病、阿尔茨海默症、精神分裂症及多发性硬化等。脑卒中具有高的发病率、复发率、死亡率和致残率的特点。肠道菌群在脑卒中的发生、发展中起着关键的作用,可通过影响机体的吸收、代谢、血压、血糖、血脂及动脉粥样斑块等因素,进一步影响脑卒中的发病。中医认为脾胃气血流注失度、阴阳盛衰失衡,机体生理功能失调,化生"风、火、痰、虚、瘀"等病理产物,可致中风的发生。脾胃主腐熟运化水谷,肠道菌群影响饮食的消化吸收,现代研究的肠道菌群功能与中医之脾胃功能失调相关。因此,调整肠道菌群的稳态,可作为一个潜在的干预靶点预防和治疗缺血性脑卒中。中药干预脑卒中已经取得了很好的疗效,是否与调节肠道菌群有关,值得未来做进一步的研究。同时对中药有效成分(小檗碱、黄芩苷、白藜芦醇等),中药单方(丹参、红景天等)和中药组方(补阳还五汤、脑心通胶囊、补中益气汤等)防治脑缺血的研究进展进行综述,为缺血性脑卒中的预防和开发提供新的途径和思路。