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Predicting short-term major postoperative complications in intestinal resection for crohn’s disease:A machine learning-based study

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World Journal of Gastrointestinal surgery 2024年第3期16卷 717-730页

作者： Fang-Tao Wang Yin Lin Xiao-Qi Yuan Ren-Yuan Gao Xiao-Cai Wu Wei-Wei Xu Tian-Qi Wu Kai Xia Yi-Ran Jiao Lu Yin Chun-Qiu Chen Diagnostic and Treatment Center for Refractory diseases of Abdomen surgery Shanghai Tenth People’s HospitalTongji University School of MedicineShanghai 200072China

BACKGROUND Due to the complexity and numerous comorbidities associated with crohn’s disease(CD),the incidence of postoperative complications is high,significantly impacting the recovery and prognosis of patients.Consequently,additional stu-dies are required to precisely predict short-term major complications following intestinal resection(IR),aiding surgical decision-making and optimizing patient care.AIM To construct novel models based on machine learning(ML)to predict short-term major postoperative complications in patients with CD following IR.METHODs A retrospective analysis was performed on clinical data derived from a patient cohort that underwent IR for CD from January 2017 to December 2022.The study participants were randomly allocated to either a training cohort or a validation cohort.The logistic regression and random forest(RF)were applied to construct models in the training cohort,with model discrimination evaluated using the area under the curves(AUC).The validation cohort assessed the performance of the constructed models.REsULTs Out of the 259 patients encompassed in the study,5.0%encountered major postoperative complications(Clavien-Dindo≥III)within 30 d following IR for CD.The AUC for the logistic model was 0.916,significantly lower than the AUC of 0.965 for the RF model.The logistic model incorporated a preoperative CD activity index(CDAI)of≥220,a diminished preoperative serum albumin level,conversion to laparotomy surgery,and an extended operation time.A nomogram for the logistic model was plotted.Except for the surgical approach,the other three variables ranked among the top four important variables in the novel ML model.CONCLUsION Both the nomogram and RF exhibited good performance in predicting short-term major postoperative complic-ations in patients with CD,with the RF model showing more superiority.A preoperative CDAI of≥220,a di-minished preoperative serum albumin level,and an extended operation time might be the most crucial variables.The findings of this study can assist clinicians in

关键词： crohn’s disease Postoperative complications Nomogram Random forest Intestinal resection

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Access to biologicals in crohn's disease in ten European countries

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World Journal of Gastroenterology 2017年第34期23卷 6294-6305页

作者： Márta Péntek Peter L Lakatos Talitha Oorsprong László Gulácsi Milena Pavlova Wim Groot Fanni Rencz Valentin Brodszky Petra Baji crohn’s disease Research Group department of health economics corvinus university of budapest mcgill university muhcmontreal general hospital 1st department of internal medicine semmelweis university department of health services research caphrimaastricht university medical centrefaculty of healthmedicine and life sciencesmaastricht university top institute evidence based education research (tier) teachers academymaastricht university 不详

AIM To analyze access(availability, affordability and acceptability) to biologicals for crohn's disease(CD) in ten European countries and to explore the associations between these dimensions, the uptake of biologicals and economic development.METHODs A questionnaire-based survey combined with desk research was carried out in May 2016. Gastroenterologists from the Czech Republic, France, Germany, Hungary, Latvia, Poland, Romania, slovakia, spain and sweden were invited to participate and provide data on the availability of biologicals/biosimilars, reimbursement criteria, clinical practice and prices, and use of biologicals. An availability score was developed to evaluate the restrictiveness of eligibility and administrative criteria applied in the countries. Affordability was defined as the annual cost of treatment as a share of gross domestic product(GDP) per capita. Correlations with the uptake of biologicals, dimensions of access and GDP per capita were calculated.REsULTs At the time of the survey, infliximab and adalimumab were reimbursed in all ten countries, and vedolizumab was reimbursed in five countries(France, Germany, Latvia, slovakia, sweden). Reimbursement criteria were the least strict in sweden and Germany, and the strictest in Hungary, Poland and slovakia. Between countries, the annual cost of different biological treatments differed 1.6-3.3-fold. Treatments were the most affordable in sweden(13%-37% of the GDP per capita) and the least affordable in the Central and Eastern European countries, especially in Hungary(87%-124%) and Romania(141%-277%). Biosimilars made treatments more affordable by driving down the annual costs. The number of patients with CD on biologicals per 100000 population was strongly correlated with GDP per capita(0.91), although substantial differences were found in the uptake among countries with similar economic development. Correlation between the number of patients with CD on biologicals per 100000 population and the availability and affordability was also strong(-0.75,-0.

关键词： crohn’s disease Biological therapy Access Inequality Europe

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Progress of Transmural Healing in crohn’s disease

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Journal of Biosciences and Medicines 2024年第5期12卷 276-292页

作者： Yinan Han Xiaoping Tan Department of Gastroenterology First Hospital of Yangtze University Jingzhou China

Recently transmural healing (TH) has become a subject of increasing interest as a potential therapeutic purpose for inflammatory bowel disease (IBD). crohn’s disease (CD) is characterized by chronic inflammation of the gastrointestinal tract, which can involve any part of the digestive tract, and the lesions are usually discontinuous, with progressive and destructive transmural lesions that can lead to irreversible damage such as fibrotic strictures, complications such as fistulas and abscesses. disease remission remains the primary goal of therapeutic management;however transmural healing is a very promising endpoint for monitoring treatment response. Along with small bowel imaging tests such as computed tomography scans Intestinal imaging (CTE), magnetic resonance intestinal imaging (MRE), intestinal ultrasound (IUs) and other related imaging technologies are popularized in CD diagnosis and treatment benefit. Transmural healing has been initially used in clinical practice and the correlation between its rules and long-term clinical remission has been explored.

关键词： Transmural Healing Inflammatory Bowel disease crohn’s disease

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Nursing Care of Infliximab for Injection in crohn’s disease

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Yangtze Medicine 2024年第2期8卷 41-47页

作者： Liu Yang Xiaomei Cai Zhimin Tian The First Affiliated Hospital of Yangtze University Jingzhou China

Objective: To summarize the nursing experience of infliximab injection in the treatment of crohns disease. Methods: 25 patients with crohns disease admitted to our hospital from November 2017 to February 2024 were treated with infliximab. The therapeutic effect and adverse drug reactions were observed, nursing intervention was given, and follow-up was performed at 2 weeks, 6 weeks after the first treatment and every 2 months after the treatment cycle. According to crohns disease activity index (CDAI) score, 23 cases with 4 were classified as remission stage and 2 cases with 6 were classified as mild activity stage. Infliximab-treated crohns patients had a good prognosis and minor adverse reactions. A correct grasp of the basic knowledge of the drug, standardized operation, attention to the psychological state of the patient, close observation of the change of the patients condition, and predictability of the treatment of adverse drug reactions are the guarantee of smooth treatment.

关键词： crohn’s disease Infliximab Adverse Reactions Nursing

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Duodenal crohn’s disease:Case report and systematic review

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World Journal of Methodology 2024年第1期14卷 124-142页

作者： Muniratu Amadu Jonathan soldera Department of Gastroenterology University of South WalesCardiff CF371DLUnited Kingdom

BACKGROUND Inflammatory bowel disease,including ulcerative colitis,microscopic colitis,and crohn’s disease(CD),has a global impact.This review focuses on duodenal CD(DCD),a rare subtype affecting the duodenum.DCD’s rarity and asymptomatic nature create diagnostic challenges,impacting prognosis and patient well-being.Delayed diagnosis can worsen DCD outcomes.AIM To report a rare case of DCD and to discuss the diagnostic challenges and its implications on prognosis.METHODs A systematic literature search,following the PRIsMA statement,was conducted.Relevant studies were identified and analysed using specific Medical subject Terms(MesH)from PubMed/MEDLINE,American Journal of Gastroenterology,and the University of south Wales database.Data collection included information from radiology scans,endoscopy procedures,biopsies,and histopathology results.REsULTs The review considered 8 case reports and 1 observational study,involving 44 participants diagnosed with DCD,some of whom developed complications due to delayed diagnosis.Various diagnostic methods were employed,as there is no gold standard workup for DCD.Radiology scans[magnetic resonance imaging(MRI),computed tomography(CT),and upper gastrointestinal X-ray],endoscopy procedures(colonoscopy and esophagogastroduodenoscopy),biopsies,and clinical suspicions were utilized.CONCLUsION This review discusses DCD diagnosis challenges and the roles of CT,MRI,and fluoroscopy.It notes their limitations and compares findings with endoscopy and histopathology studies.Further research is needed to improve diagnosis,emphasizing scan interpretation,endoscopy procedures,and biopsies,especially in high-risk patients during routine endoscopy.

关键词： Inflammatory bowel diseases crohn’s disease Duodenum Diagnostic challenges Prognosis

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Acupuncture and Moxibustion Inhibited Intestinal Epithelial-Mesenchymal Transition in Patients with crohn's disease Induced by TGF-β1/smad3/snail Pathway:A Clinical Trial study

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Chinese Journal of Integrative Medicine 2022年第9期28卷 823-832页

作者： GUO sen ZHOU Jing ZHANG Liang BAO Chun-hui ZHAO Ji-meng GAO Yan-ling WU Pin WENG Zhijun sHI Yin Graduate school Shanghai University of Traditional Chinese MedicineShanghai201203China Department of Acupuncture and Moxibustion Shanghai Shanghai Traditional Chinese Medicine Integrated HospitalShanghai University of Traditional Chinese MedicineShanghai200082China Department of Acupuncture and Moxibustion Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese MedicineShanghai200437China Key Laboratory of Acupuncture and Immunological Effects Shanghai Research Institute of Acupuncture and MeridianShanghai200030China Outpatient Department Shanghai Research Institute of Acupuncture and MeridianShanghai200030China

Objective:To explore whether acupuncture combined with moxibustion could inhibit epithelialmesenchymal transition in crohn’s disease by affecting the transforming growth factorβ1(TGF-β1)/smad3/snail pathway.Methods:sixty-three patients with crohn’s disease were randomly divided into an observation group(31 cases)receiving moxibustion at 43℃ combined with acupuncture,and a control group(32 cases)receiving moxibustion at 37℃combined with sham acupuncture using a random number table.Patients were treated for12 weeks.crohn’s disease Activity Index(CDAI)was used to evaluate disease activity.Hematoxylin-eosin staining and transmission electron microscopy were utilized to observe the morphological and ultrastructural changes.Immunohistochemistry was used to detect the expression of transforming growth factorβ1(TGF-β1),TβR1,TβR2,smad3,snail,E-cadherin and fibronectin in intestinal mucosal tissues.Results:The decrease of the CDAI score,morphological and ultrastructural changes were more significant in observation group.The expression levels of TGF-β1,TβR2,smad3,and snail in the observation group were significantly lower than those before the treatment(Pssion levels of TGF-β1,TβR2,and snail in the observation group were significantly lower than those in the control group(all Pssion of fibronectin in the observation group was significantly decreased,and the expression of E-cadherin was significantly increased(all Psions:Moxibustion at 43℃combined with acupuncture may suppress TGF-β1/smad3/snail pathway-mediated epithelial-mesenchymal transition of intestinal epithelial cells in crohn’s disease patients by inhibiting the expression levels of TGF-β1,TβR2,smad3,and snail.(Registration No.ChiCTR-IIR-16007751).

关键词： crohn’s disease moxibustion acupuncture transforming growth factorβ1/smad3/snail pathway intestinal epithelial-mesenchymal transition

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stem cell therapy:light in the tunnel for penetrating crohn’s disease

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Gastroenterology Report 2023年第1期11卷 78-87页

作者： Nan Lan Xianrui Wu Bo shen Center for Inflammatory Bowel disease Columbia University Irving Medical Center/NewYork Presbyterian HospitalNew YorkNYUSA Department of Colorectal surgery The 6th Hospital of Sun Yat-Sen UniversityGuangzhouGuangdongP.R.China

Patients with crohn’s disease frequently suffer from fistula resulting from adverse sequelae of persistent complicated active disease or surgical intervention.Fistula affects a patient’s quality of life and is directly associated with the need for surgical intervention.Diagnosis of fistula can be made through CT enterography,MR enterography,gastrograffin-based imaging,and transanal ultrasound.Treatment for fistula mainly consists of medication,endoscopic procedures,and surgery.There are emerging approaches under current investigation,such as stem cell therapy.The results showed a decent response in patients with perianal and rectovaginal fistula with minimal side effects.Further investigation is still needed for other internal fistula.

关键词： crohn’s disease fistula perianal disease stem cells therapy

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Moxibustion improves experimental colitis in rats with crohn's disease by regulating bile acid enterohepatic circulation and intestinal farnesoid X receptor

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Journal of Integrative Medicine 2023年第2期21卷 194-204页

作者： Jia-cheng shen Qin Qi Dong Han Yuan Lu Rong Huang Yi Zhu Lin-shan Zhang Xiu-di Qin Fang Zhang Huan-gan Wu Hui-rong Liu Key Laboratory of Acupuncture and Immunological Effects Shanghai University of Traditional Chinese MedicineShanghai 200030China shanghai Research Institute of Acupuncture and Meridian Shanghai 200030China

Objective:This study was conducted to explore the mechanism of intestinal inflammation and barrier repair in crohn’s disease(CD)regulated by moxibustion through bile acid(BA)enterohepatic circulation and intestinal farnesoid X receptor(FXR).Methods:sprague-Dawley rats were randomly divided into control group,CD model group,mild moxibustion group and herb-partitioned moxibustion group.CD model rats induced by 2,4,6-trinitrobenzene sulfonic acid were treated with mild moxibustion or herb-partitioned moxibustion at Tianshu(sT25)and Qihai(CV6).The changes in CD symptoms were rated according to the disease activity index score,the serum and colon tissues of rats were collected,and the pathological changes in colon tissues were observed via histopathology.Western blot,immunohistochemistry(IHC)and immunofluorescence were used to evaluate the improvement of moxibustion on intestinal inflammation and mucosal barrier in CD by the BA-FXR pathway.Results:Mild moxibustion and herb-partitioned moxibustion improved the symptoms of CD,inhibited inflammation and repaired mucosal damage to the colon in CD rats.Meanwhile,moxibustion could improve the abnormal expression of BA in the colon,liver and serum,downregulate the expression of interferon-γand upregulate the expression of FXR mRNA,and inhibit Toll-like receptor 4(TLR4)and myeloid differentiation factor 88(MyD88)mRNA.The IHC results showed that moxibustion could upregulate the expression of FXR and mucin2 and inhibit TLR4 expression.Western blot showed that moxibustion inhibited the protein expression of TLR4 and MyD88 and upregulated the expression of FXR.Immunofluorescence image analysis showed that moxibustion increased the colocalization sites and intensity of FXR with TLR4 or nuclear factor-κB p65.In particular,herb-partitioned moxibustion has more advantages in improving BA and upregulating FXR and TLR4 in the colon.Conclusion:Mild moxibustion and herb-partitioned moxibustion can improve CD by regulating the enterohepatic circulation stability of BA,activating colonic F

关键词： crohn’s disease Moxibustion Bile acid Farnesoid X receptor Colitis Intestinal mucosal barrier

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Glucagon-like peptide-2 analogues for crohn’s disease patients with short bowel syndrome and intestinal failure

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World Journal of Gastroenterology 2022年第44期28卷 6258-6270页

作者： Marco Pizzoferrato Pierluigi Puca sara Ennas Giovanni Cammarota Luisa Guidi UOC Gastroenterologia Dipartimento di Scienze Mediche e ChirurgicheFondazione Policlinico Universitario Agostino Gemelli IRCCSRome 00168Italy Dipartimento di Medicina e Chirurgia Traslazionale UniversitàCattolica del Sacro CuoreRome 00168Italy

short bowel syndrome(sBs)with intestinal failure(IF)is a rare but severe complication of crohn’s disease(CD),which is the most frequent benign condition that leads to sBs after repeated surgical resections,even in the era of biologics and small molecules.Glucagon-like peptide-2 analogues have been deeply studied recently for the treatment of sBs-IF.These drugs have a significant intestinotrophic effect and the potential to reduce the chronic dependence of sBsIF patients on parenteral support or nutrition.Teduglutide has been approved for the treatment of sBs-IF,and apraglutide is currently in clinical development.The use of these drugs was examined with a focus on their use in CD patients.

关键词： short bowel syndrome Intestinal failure crohn’s disease Glucagon-like peptide-2 analogues Teduglutide Apraglutide Glepaglutide

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Postoperative diarrhea in crohn's disease:Pathogenesis,diagnosis,and therapy

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World Journal of Clinical Cases 2023年第1期11卷 7-16页

作者： En-Hao Wu Zhen Guo Wei-Ming Zhu Department of General surgery Affiliated Jinling HospitalMedical School of Nanjing UniversityNanjing 210002Jiangsu ProvinceChina

Diarrhea is a frequent symptom in postoperative patients with crohn’s diseases(CD),and several different mechanisms likely account for postoperative diarrhea in CD.A targeted strategy based on a comprehensive underst... 详细信息

关键词： Postoperative diarrhea crohn’s disease Intestinal resection Bile acid malabsorption Treatment

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