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Anemia and iron deficiency in gastrointestinal and liver conditions

World Journal of Gastroenterology 2016年第35期22卷 7908-7925页

作者： Jürgen Stein Susan connor Garth Virgin David Eng Hui Ong Lisandro Pereyra Interdisciplinary Crohn Colitis Centre Rhein-Main Frankfurt am Main Department of Gastroenterology and Clinical Nutrition DGD Clinics Sachsenhausen Frankfurt am Main60594 Frankfurt Germany Department of Gastroenterology and Hepatology Liverpool Hospital South Western Clinical School University of New South Wales Vifor Pharma Flughofstrasse 61 CH-8152 Zurich Switzerland Division of Gastroenterology and Hepatology University Medicine Cluster National University Hospital Servicio de Gastroenterología y Endoscopia Hospital Alemán

Iron deficiency anemia(IDA) is associated with a number of pathological gastrointestinal conditions other than inflammatory bowel disease, and also with liver disorders. Different factors such as chronic bleeding, malabsorption and inflammation may contribute to IDA. Although patients with symptoms of anemia are frequently referred to gastroenterologists, the approach to diagnosis and selection of treatment as well as follow-up measures is not standardized and suboptimal. Iron deficiency, even without anemia, can substantially impact physical and cognitive function and reduce quality of life. Therefore, regular iron status assessment and awareness of the clinical consequences of impaired iron status are critical. While the range of options for treatment of IDA is increasing due to the availability of effective and well-tolerated parenteral iron preparations, a comprehensive overview of IDA and its therapy in patients with gastrointestinal conditions is currently lacking. Furthermore, definitions and assessment of iron status lack harmonization and there is a paucity of expert guidelines on this topic. This review summarizes current thinking concerning IDA as a common co-morbidity in specific gastrointestinal and liver disorders, and thus encourages a more unified treatment approach to anemia and iron deficiency, while offering gastroenterologists guidance on treatment options for IDA in everyday clinical practice.

关键词：熨缺乏贫血症胃肠的流血 Nonsteroidal 反煽动性的药胃炎感染 Bariatric 外科腹的疾病胃肠的瘤长期的肝炎非酒精的脂肪肝疾病

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Higher infliximab and adalimumab trough levels are associated with fistula healing in patients with fistulising perianal Crohn’s disease

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World Journal of Gastroenterology 2022年第23期28卷 2597-2608页

作者： Bonita Gu Kavya Venkatesh Astrid-Jane Williams Watson Ng Crispin Corte Ali Gholamrezaei Simon Ghaly Wei Xuan Sudarshan Paramsothy Susan connor South Western Sydney Clinical School University of New South WalesSydney 2170New South WalesAustralia Department of Gastroenterology and Hepatology Liverpool HospitalSydney 2170New South WalesAustralia AW Morrow Gastroenterology and Liver Centre Royal Prince Alfred HospitalSydney 2050New South WalesAustralia Department of Medicine University of NewcastleNewcastle 2308New South WalesAustralia Central Clinical School University of SydneySydney 2050New South WalesAustralia Ingham Institute of Applied Medical Research Sydney 2170New South WalesAustralia Department of Gastroenterology St Vincent’s Hospital SydneySydney 2010New South WalesAustralia St Vincent’s Clinical School University of New South WalesSydney 2010New South WalesAustralia Department of Gastroenterology and Hepatology Concord Repatriation General HospitalSydney 2139New South WalesAustralia Concord Clinical School University of SydneySydney 2139New South WalesAustralia

BACKGROUND Tumor necrosis factor-alpha inhibitors,including infliximab and adalimumab,are effective medical treatments for perianal fistulising Crohn’s disease(CD),but not all patients achieve fistula healing.AIM To determine the correlation between perianal fistula healing and closure with infliximab and adalimumab trough levels.METHODS In this multicentre retrospective study conducted across four tertiary inflammatory bowel disease centres in Australia,we identified CD patients with perianal fistulae on maintenance infliximab or adalimumab who had a trough level within twelve weeks of clinical assessment.Data collected included demographics,serum infliximab and adalimumab trough levels(mg/L)within 12 wk before or after their most recent clinical assessment and concomitant medical or surgical therapy.The primary outcome was fistula healing,defined as cessation in fistula drainage.The secondary outcome was fistula closure,defined as healing and closure of all external fistula openings.Differences between patients who did or did not achieve fistula healing were compared using the chi-square test,t test or Mann-Whitney U test.RESULTS One hundred and fourteen patients(66 infliximab,48 adalimumab)were included.Forty-eight(72.7%)patients on maintenance infliximab achieved fistula healing and 18(27.3%)achieved fistula closure.Thirty-seven(77%)patients on maintenance adalimumab achieved fistula healing and 17(35.4%)achieved fistula closure.Patients who achieved fistula healing had significantly higher infliximab and adalimumab trough levels than patients who did not[infliximab:6.4(3.8-9.5)vs 3.0(0.3-6.2)mg/L,P=0.003;adalimumab:9.2(6.5-12.0)vs 5.4(2.5-8.3)mg/L,P=0.004].For patients on infliximab,fistula healing was associated with lower rates of detectable anti-infliximab antibodies and younger age.For patients on adalimumab,fistula healing was associated with higher rates of combination therapy with an immunomodulator.Serum trough levels for patients with and without fistula closure were not significantly different for

关键词： Crohn’s disease Perianal disorders Biologics Inflammatory bowel disease

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护理行业如何应对数字化未来

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英国医学杂志中文版 2021年第12期24卷 691-694页

作者： Richard G Booth Gillian Strudwick susan McBride Siobhán O'connor Ana Laura Solano López 李高华(译) Arthur Labatt Family School of Nursing Western UniversityLondonCanada Centre for Addiction and Mental Health TorontoCanada School of Nursing Texas Tech University Health Sciences CenterLubbockUSA School of Health in Social Science University of EdinburghEdinburghUK University of Costa Rica San JoséCosta Rica 剑桥朗思口语考官

数字技术对全球护理行业的影响不断增加:人工智能(AI)和机器人系统的影响力与日俱增;社会对手机、网络、社交媒体高度依赖,尤其是新型冠状病毒肺炎疫情暴发后,社会越来越依赖于远程医疗及其他通过虚拟手段进行的医疗服务。

关键词：护理行业疫情暴发机器人系统远程医疗社交媒体医疗服务新型冠状病毒数字化

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Prospective single-blinded single-center randomized controlled trial of Prep Kit-C and Moviprep:Does underlying inflammatory bowel disease impact tolerability and efficacy?

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World Journal of Gastroenterology 2021年第11期27卷 1090-1100页

作者： Waled Mohsen Astrid-Jane Williams Gabrielle Wark Alexandra Sechi Jenn-Hian Koo Wei Xuan Milan Bassan Watson Ng Susan connor Department of Digestive Diseases Gold Coast University HospitalGold Coast4215QueenslandAustralia Department of Gastroenterology and Hepatology Liverpool HospitalSydney 2170New South WalesAustralia South West Sydney Clinical School University of New South WalesSydney 2170New South WalesAustralia Ingham Institute Applied Medical Research Sydney 2170New South WalesAustralia

BACKGROUND Colonoscopy remains the gold standard for detection of colonic disease.An optimal evaluation depends on adequate bowel cleansing.Patients with inflammatory bowel disease(IBD),require frequent endoscopic assessment for both activity and dysplasia assessment.Two commonly used bowel preparations in Australia are Prep Kit-C(Pc)and Moviprep(Mp).Little is known about tolerability,efficacy and safety of split protocols of Mp and Pc in both IBD and non-IBD patients.AIM To primary aim was to compare the tolerability,efficacy and safety of split protocols of Mp and Pc in patients having a colonoscopy.The secondary aim was to compare the efficacy,tolerability and safety of either preparation in patients with or without IBD.METHODS Patients were randomized to Pc or Mp bowel preparation.Patients completed a questionnaire to assess tolerability.Efficacy was assessed using the Ottawa Bowel Preparation Score.Serum electrolytes and renal function were collected one week prior to colonoscopy and on the day of colonoscopy.RESULTS Of 338 patients met the inclusion criteria.Of 168 patients randomized to Mp and 170 to Pc.The efficacy of bowel preparation(mean Ottawa Bowel Preparation Score)was similar between Mp(5.4±2.4)and Pc(5.1±2.1)(P=0.3).Mean tolerability scores were similar in Mp(11.84±5.4)and Pc(10.99±5.2;P=0.17).125 patients had IBD(73 had Crohn’s Disease and 52 had Ulcerative colitis).Sixtyfour IBD patients were allocated to Mp and 61 to Pc.In non-IBD patients,104 were allocated to Mp and 109 to Pc.The mean tolerability score in the IBD group was lower than the non-IBD group(mean tolerability scores:IBD:10.3±5.1 and non-IBD:12.0±5.3;P=0.01).IBD patients described more abdominal pain with Mp when compared with Pc;(Mp:5.7±4.4 vs Pc:3.6±2.6,P=0.046).Serum magnesium level increased with Pc compared with Mp in all patients(mean increase in mmol/L:Mp:0.03±0.117 and Pc:0.11±0.106;P<0.0001).CONCLUSION In this study,the efficacy,tolerability and safety of Mp and Pc were similar in all patients.However,patients with IBD repo

关键词： Bowel preparation Inflammatory bowel disease Tolerability Efficacy Moviprep Prep Kit-C

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护理行业如何应对数字化未来

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中国医院院长 2022年第23期18卷 22-25页

作者： Richard G Booth Gillian Strudwick susan McBride Siobhán O′connor Ana Laura Solano López 李高华(译) 不详

护理行业必须投资并引领数字健康的发展,努力与各方合作研究输出患者和公众需要的数字化工具。数字技术对全球护理行业的影响不断增加:人工智能(AI)和机器人系统的影响力与日俱增;社会对手机、网络、社交媒体高度依赖,尤其是新型冠状病... 详细信息

护理行业必须投资并引领数字健康的发展,努力与各方合作研究输出患者和公众需要的数字化工具。数字技术对全球护理行业的影响不断增加:人工智能(AI)和机器人系统的影响力与日俱增;社会对手机、网络、社交媒体高度依赖,尤其是新型冠状病毒肺炎疫情暴发后,社会越来越依赖于远程医疗及其他通过虚拟手段进行的医疗服务。

关键词：护理行业疫情暴发机器人系统远程医疗社交媒体医疗服务新型冠状病毒数字化工具

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Gastroenterologist perceptions of faecal microbiota transplantation

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World Journal of Gastroenterology 2015年第38期21卷 10907-10914页

作者： Sudarshan Paramsothy Alissa J Walsh Thomas Borody Douglas Samuel Johan van den Bogaerde Rupert WL Leong Susan connor Watson Ng Hazel M Mitchell Nadeem O Kaakoush Michael A Kamm Gastroenterology and Hepatology Department St Vincent’s Hospital Centre for Digestive Diseases Gastroenterology and Hepatology Department Bankstown-Lidcombe Hospital Gastroenterology and Hepatology Department Nambour General Hospital Gastroenterology and Hepatology Department Liverpool Hospital University of New South Wales School of Biotechnology and Biomolecular Sciences Departments of Gastroenterology and Medicine St Vincent's Hospital and University of Melbourne

AIM: To explore gastroenterologist perceptions towards and experience with faecal microbiota transplantation(FMT).METHODS: A questionnaire survey consisting of 17 questions was created to assess gastroenterologists' attitude towards and experience with FMT. This was anonymously distributed in hard copy format amongst attendees at gastroenterology meetings in Australia between October 2013 and April 2014. Basic descriptive statistical analyses were performed.RESULTS: Fifty-two clinicians participated. Twenty one percent had previously referred patients for FMT,8% more than once. Ninety percent would refer patients with Clostridium difficile infection(CDI) for FMT if easily available,37% for ulcerative colitis,13% for Crohn's disease and 6% for irritable bowel syndrome. Six percent would not refer any indication,including recurrent CDI. Eighty-six percent would enroll patients in FMT clinical trials. Thirty-seven percent considered the optimal mode of FMT administration transcolonoscopic,17% nasoduodenal,13% enema and 8% oral capsule. The greatest concerns regarding FMT were: 42% lack of evidence,12% infection risk,10% non infectious adverse effects/lack of safety data,10% aesthetic,10% lack of efficacy,4% disease exacerbation,and 2% inappropriate use; 6% had no concerns. Seventy seven percent believed there is a lack of accessibility while 52% had an interest in learning how to provide FMT. Only 6% offered FMT at their institution.CONCLUSION: Despite general enthusiasm,most gastroenterologists have limited experience with,or access to,FMT. The greatest concerns were lack of supportive evidence and safety issues. However a significant proportion would refer indications other than CDI for FMT despite insufficient evidence. These data provide guidance on where education and training are required.

关键词： Perceptions Gastroenterologist Clostridium diffici

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Vedolizumab for ulcerative colitis: Real world outcomes from a multicenter observational cohort of Australia and Oxford

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World Journal of Gastroenterology 2020年第30期26卷 4428-4441页

作者： Samba Siva Reddy Pulusu Ashish Srinivasan Krupa Krishnaprasad Daniel Cheng Jakob Begun CharlotteKeung Daniel Van Langenberg Lena Thin Tamara Mogilevski Peter De Cruz Graham Radford-Smith Emma Flanagan Sally Bell Soleiman Kashkooli Miles Sparrow Simon Ghaly Peter Bampton Elise Sawyer Susan connor Quart-ul-ain Rizvi Jane M Andrews Gillian Mahy Paola Chivers Simon Travis Ian Craig Lawrance Centre for Inflammatory Bowel Diseases St John of God HospitalSubiaco 6008Western AustraliaAustralia Translational Gastroenterology Unit NIHR Oxford Biomedical Research CentreOxford University Hospitals NHS Foundation TrustJohn Radcliffe HospitalOxford OX39DUUnited Kingdom Inflammatory Bowel Disease Research Group Queensland institute of Medical ResearchHerston 4006QueenslandAustralia Department of Gastroenterology Mater HospitalBrisbane 4101QueenslandAustralia Department of Gastroenterology Mater HospitalSouth Brisbane 4101QueenslandAustralia of Gastroenterology Eastern HealthBox Hill 3128VictoriaAustralia Department of Gastroenterology Fiona Stanley HospitalMurdoch 6150Western AustraliaAustralia Department of Gastroenterology Austin HealthHeidelberg 3084VictoriaAustralia Department of Gastroenterology St Vincent’s HospitalFitzroy 3065VictoriaAustralia Department of Gastroenterology Northern HealthEpping 3076VictoriaAustralia Department of Gastroenterology The Alfred HospitalMelbourne 3004VictoriaAustralia Department of Gastroenterology St Vincent’s HospitalDarlinghurst 2010New South WalesAustralia Department of Gastroenterology Flinders Medical CentreBedford Park 5042South AustraliaAustralia Department of Gastroenterology Liverpool HospitalSydney 2170New South WalesAustralia Department of Gastroenterology Royal Adelaide Hospital&University of AdelaideAdelaide 5000South AustraliaAustralia Department of Gastroenterology Townsville HospitalDouglas 4814QueenslandAustralia Institute for Health Research University of Notre DameFremantle 6160Western AustraliaAustralia School of Medicine and Pharmacology University of Western AustraliaCrawley 6009Western AustraliaAustralia

BACKGROUND Vedolizumab(VDZ),a humanised monoclonal antibody that selectively inhibits alpha4-beta7 integrins is approved for use in adult moderate to severe ulcerative colitis(UC)patients.AIM To assess the efficacy and safety of VDZ in the real-world management of UC in a large multicenter cohort involving two countries and to identify predictors of achieving remission.METHODS A retrospective review of Australian and Oxford,United Kingdom data for UC patients.Clinical response at 3 mo,endoscopic remission at 6 mo and clinical remission at 3,6 and 12 mo were assessed.Cox regression models and Kaplan Meier curves were performed to assess the time to remission,time to failure and the covariates influencing them.Safety outcomes were recorded.RESULTS Three hundred and three UC patients from 14 centres in Australia and United Kingdom,[60%n=182,anti-TNF naïve]were included.The clinical response was 79%at 3 mo with more Australian patients achieving clinical response compared to Oxford(83%vs 70%P=0.01).Clinical remission for all patients was 56%,62%and 60%at 3,6 and 12 mo respectively.Anti-TNF naive patients were more likely to achieve remission than exposed patients at all the time points(3 mo 66%vs 40%P<0.001,6 mo 73%vs 46%P<0.001,12 mo 66%vs 51%P=0.03).More Australian patients achieved endoscopic remission at 6 mo compared to Oxford(69%vs 43%P=0.01).On multi-variate analysis,anti-TNF naïve patients were 1.8(95%CI:1.3-2.3)times more likely to achieve remission than anti-TNF exposed(P<0.001).32 patients(11%)had colectomy by 12 mo.CONCLUSION VDZ was safe and effective with 60%of UC patients achieving clinical remission at 12 mo and prior anti-TNF exposure influenced this outcome.

关键词： Vedolizumab Ulcerative colitis Outcomes

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The Role of Synthetic Biology in Atmospheric Greenhouse Gas Reduction: Prospects and Challenges

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BioDesign Research 2020年第1期2020卷 1-8页

作者： Charles DeLisi Aristides Patrinos Michael MacCracken Dan Drell George Annas Adam Arkin George Church Robert Cook-Deegan Henry Jacoby Mary Lidstrom Jerry Melillo Ron Milo Keith Paustian John Reilly Richard J.Roberts Daniel Segrè susan Solomon Dominic Woolf Stan D.Wullschleger Xiaohan Yang Department of Biomedical Engineering and Program in Bioinformatics College of EngineeringBoston UniversityBoston MA 02215USA The NOVIM Group Kohn HallUC Santa BarbaraCA 93106USA Climate Institute WashingtonDCUSA Department of Energy WashingtonDCUSA Center for Health Law Ethics&Human Rights at the Boston University School of Public HealthSchool of MedicineBoston UniversityUSA Department of Bioengineering University of CaliforniaBerkeley CAUSA Department of Genetics Harvard Medical SchoolCambridge MAUSA School for the Future of Innovation in Society Arizona State UniversityBarrett&O’Connor Washington Center1800 I StreetNWWashingtonDC 20006USA Sloan School of Management MITCambridge MAUSA Department of Chemical Engineering University of WashingtonSeattle WashingtonUSA The Ecosystems Center of the Marine Biological Laboratory in Woods Hole MAUSA Department of Plant and Environmental Sciences Weizmann Institute of ScienceRehovotIsrael Department of Soil and Crop Sciences Colorado State UniversityFort Collins CO 80523USA MIT Joint Program on the Science and Policy of Global Change MITCambridge MAUSA New England Biolabs Beverly MAUSA Department of Biology and Program in Bioinformatics Boston UniversityBoston MA 02215USA Department of Earth Atmospheric and Planetary SciencesMITCambridge MAUSA Soil and Crop Sciences Section School of Integrated Plant SciencesCornell UniversityIthaca NYUSA Environmental Sciences Division Oak Ridge National LaboratoryOak Ridge TNUSA Biosciences Division Oak Ridge National LaboratoryOak RidgeTNUSA

The long atmospheric residence time of CO2 creates an urgent need to add atmospheric carbon drawdown to CO2 regulatory strategies.Synthetic and systems biology(SSB),which enables manipulation of cellular phenotypes,offers a powerful approach to amplifying and adding new possibilities to current land management practices aimed at reducing atmospheric carbon.The participants(in attendance:Christina Agapakis,George Annas,Adam Arkin,George Church,Robert Cook-Deegan,Charles DeLisi,Dan Drell,Sheldon Glashow,Steve Hamburg,Henry Jacoby,Henry Kelly,Mark Kon,Todd Kuiken,Mary Lidstrom,Mike MacCracken,June Medford,Jerry Melillo,Ron Milo,Pilar Ossorio,Ari Patrinos,Keith Paustian,Kristala Jones Prather,Kent Redford,David Resnik,John Reilly,Richard J.Roberts,Daniel Segre,susan Solomon,Elizabeth Strychalski,Chris Voigt,Dominic Woolf,Stan Wullschleger,and Xiaohan Yang)identified a range of possibilities by which SSB might help reduce greenhouse gas concentrations and which might also contribute to environmental sustainability and adaptation.These include,among other possibilities,engineering plants to convert CO2 produced by respiration into a stable carbonate,designing plants with an increased root-to-shoot ratio,and creating plants with the ability to self-fertilize.A number of serious ecological and societal challenges must,however,be confronted and resolved before any such application can be fully assessed,realized,and deployed.

关键词： Synthetic Roberts enable

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