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Spatial organization of bacterial flora in normal and inflamed intestine: A fluorescence in situ hybridization study in mice

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World Journal of Gastroenterology 2005年第8期11卷 1131-1140页

作者： Alexander Swidsinski Vera Loening-Baucke Herbert Lochs Laura P.Hale innere klinik Department of Pathology

AIM: To studythe role of intestinal flora in inflammatory bowel disease (IBD).METHODS: The spatial organization of intestinal flora was investigated in normal mice and in two models of murine colitis using fluorescence in situ ***: The murine small intestine was nearly bacteriafree. The normal colonic flora was organized in three distinct compartments (crypt, interlaced, and fecal), each with different bacterial compositions. Crypt bacteria were present in the cecum and proximal colon. The fecal compartment was composed of homogeneously mixed bacterial groups that directly contacted the colonic wall in the cecum but were separated from the proximal colonic wall by a dense interlaced layer. Beginning in the middle colon, a mucus gap of growing thickness physically separated all intestinal bacteria from contact with the epithelium. Colonic inflammation was accompanied with a depletion of bacteria within the fecal compartment, a reduced surface area in which feces had direct contact with the colonic wall, increased thickness and spread of the mucus gap, and massive increases of bacterial concentrations in the crypt and interlaced compartments. Adhesive and infiltrative bacteria were observed in inflamed colon only, with dominant Bacteroides ***: The proximal and distal colons are functionally different organs with respect to the intestinal flora, representing a bioreactor and a Segregation *** highly organized structure of the colonic flora, its specific arrangement in different colonic segments, and its specialized response to inflammatory stimuli indicate that the intestinal flora is an innate part of host immunity that is under complex control.

关键词： Intestinal flora IBD

Open label trial of granulocyte apheresis suggests therapeutic efficacy in chronically active steroid refractory ulcerative colitis

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World Journal of Gastroenterology 2005年第44期11卷 7001-7006页

作者： Wolfgang Kruis Axel Dignass Elisabeth Steinhagen-Thiessen Julia Morgenstern Joachim M(o|¨)ssner Stephan Schreiber Maurizio Vecchi Alberto Malesci Max Reinshagen Robert L(o|¨)fberg Evangelisches Krankenhaus Kalk Medizinische klinik für Hepatologie und Gastroenterologie Medizinische klinik und Poliklinik Ⅱ Medizinische klinik Dep of Int Medicine IRCCS Ospedale Policlinico Istituto Clinico Humanitas innere Medizin Karolinska Institute at the IBD unit

AIM： To study the efficacy, safety, and feasibility of a granulocyte adsorptive type apheresis system for the treatment of patients with chronically active ulcerative colitis despite standard therapy. METHODS： An open label multicenter study was carried out in 39 patients with active ulcerative colitis （CAI 6-8） despite continuous use of steroids （a minimum total dose of 400 mg prednisone within the last 4 wk）. Patients received a total of five aphereses using a granulocyte adsorptive technique （Adacolumn, Otsuka Pharmaceutical Europe, UK）. Assessments at wk 6 and during follow-up until 4 mo comprised clinical （CAI） and endoscopic （EI） activity index, histology, quality of life （IBDQ）, and laboratory tests. RESULTS： Thirty-five out of thirty-nine patients were qualified for intent-to-treat analysis. After the apheresis treatment at wk 6, 13/35 （37.1%） patients achieved clinical remission and 10/35 （28.6%） patients had endoscopic remission （CAI〈4, EI〈4）. Quality of life （IBDQ） increased significantly （24 points, P〈0.01） at wk 6. Apheresis could be performed in all but one patient. Aphereses were well tolerated, only one patient experienced anemia. CONCLUSION： In patients with steroid refractory ulcerative colitis, five aphereses with a granulocyte/ monocyte depleting filter show potential short-term efficacy. Tolerability and technical feasibility of the procedure are excellent.

关键词： Steroid Refractory colitis Ulcerative colitis Granulocyte Apheresis

Mandatory criteria for the application of variability-based parameters of fluid responsiveness: a prospective study in different groups of ICU patients

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Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2018年第7期19卷 515-524页

作者： Wolfgang HUBER Uli MAYR ANDreas UMGELTER Michael FRANZEN Wolfgang REINDL RolAND M.SCHMID Florian ECKEL Ⅱ. Medizinische klinik und Poliklinik Klinikum rechts der Isar der Technischen Universitat Munchen Ismaninger Straβe 22 D-81675 Miinchen Germany Universitatsklinik fur innere Medizin I Salzburger Landeskliniken Universitatsklinikum Salzburg Mullner Hauptstraβe 48A-5020 Salzburg Austria Ⅱ. Medizinische klinik Universitatsklinikum Mannheim Theodor-Kutzer-Ufer 1-3 D-68167 Mannheim Germany klinik fur innere Medizin RoMed Klinik Bad Aibling Harthauser Straβe 16 D-83043 Bad Aibling Germany

Background and objective： Stroke volume variation（SVV） has high sensitivity and specificity in predicting fluid responsiveness. However, sinus rhythm（SR） and controlled mechanical ventilation（CV） are mandatory for their application. Several studies suggest a limited applicability of SVV in intensive care unit（ICU） patients. We hypothesized that the applicability of SVV might be different over time and within certain subgroups of ICU patients. Therefore, we analysed the prevalence of SR and CV in ICU patients during the first 24 h of Pi CCO-monitoring（primary endpoint） and during the total ICU stay. We also investigated the applicability of SVV in the subgroups of patients with sepsis, cirrhosis, and acute pancreatitis. Methods： The prevalence of SR and CV was documented immediately before 1241 thermodilution measurements in 88 patients. Results： In all measurements, SVV was applicable in about 24%. However, the applicability of SVV was time-dependent： the prevalence of both SR and CV was higher during the first 24 h compared to measurements thereafter（36.1% vs. 21.9%; P0.001）. Within different subgroups, the applicability during the first 24 h of monitoring ranged between 0% in acute pancreatitis, 25.5% in liver failure, and 48.9% in patients without pancreatitis, liver failure, pneumonia or sepsis. Conclusions： The applicability of SVV in a predominantly medical ICU is only about 25%–35%. The prevalence of both mandatory criteria decreases over time during the ICU stay. Furthermore, the applicability is particularly low in patients with acute pancreatitis and liver failure.

关键词： Hemodynamic monitoring Preload Fluid responsiveness Stroke volume variation Pulse pressure variation

Treatment of eosinophlic esophagitis with swallowed topical corticosteroids

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World Journal of Gastroenterology 2020年第36期26卷 5395-5407页

作者： Simon Nennstiel Christoph Schlag klinikum rechts der Isar der Technischen Universität München Klinik und Poliklinik für Innere Medizin IIMunich 81675Germany

Eosinophilic esophagitis(EoE)is an emerging chronic local immune-mediated disease of the *** proton pump inhibitors and food-restrictiondiets swallowed topical corticosteroids(STC)can be offered as a first line therapy according to current *** review describes the background and practical management of STCs in *** far,mainly asthma inhalers containing either budesonide or fluticasone have been administered to the esophagus by swallowing these medications“off label”.Recently esophagus-targeted formulations of topical steroids have been developed showing clinicopathological response rates up to 85%-an orodispersible tablet of budesonide has been approved as the first“in label”medication for EoE in Europe in June *** it was shown that disease remission induction of EoE by STCs is highly effective,there is still a lack of data regarding long-term and maintenance ***,current studies on STC maintenance therapy add some movement into the game.

关键词： Eosinophilic esophagitis Swallowed topical corticosteroids Esophagustargeted formulations of topical steroids Fluticasone Budesonide Budesonide orodispersible tablet Budesonide oral suspension

Management of occluded self-expanding biliary metal stents in malignant biliary disease

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Hepatobiliary & Pancreatic Diseases International 2018年第1期17卷 49-54页

作者： Simon Nennstiel Isolde Tschurtschenthaler Bruno Neu Hana Algül Monther Bajbouj Roland M. Schmid Stefan von Delius Andreas Weber klinik und Poliklinik fur innere Medizin Ⅱ Klinikum rechts der Isar der Technischen Universitar Manchen Ismaninger Straβe 22 Munich 81675 Germany Medizinische klinik II Krankenhaus Landshut-Achdorf Academic Teaching Hospital Technische Universitar Munchen Achdorferweg 3 Landshut 84036Germany

Background: Occlusion of self-expanding metal stents(SEMS) in malignant biliary obstruction occurs in up to 40% of patients. This study aimed to compare the different techniques to resolve stent occlusion in our collective of ***: Patients with malignant biliary obstruction and occlusion of biliary metal stent at a tertiary referral endoscopic center were retrospectively identified between April 1, 1994 and May 31, 2014. The clinical records were further analyzed regarding the characteristics of patients, malignant strictures, SEMS,management strategies, stent patency, subsequent interventions, survival time and case ***: A total of 108 patients with biliary metal stent occlusion were identified. Seventy-nine of these patients were eligible for further analysis. Favored management was plastic stent insertion in 73.4% patients. Second SEMS were inserted in 12.7% patients. Percutaneous transhepatic biliary drainage and mechanical cleansing were conducted in a minority of patients. Further analysis showed no statistically significant difference in median overall secondary stent patency(88 vs. 143 days, P = 0.069), median survival time(95 vs. 192 days, P = 0.116), median subsequent intervention rate(53.4% vs. 40.0%, P = 0.501)and median case charge(€5145 vs. €3473, P = 0.803) for the treatment with a second metal stent insertion compared to plastic stent insertion. In patients with survival time of more than three months,significantly more patients treated with plastic stents needed re-interventions than patients treated with second SEMS(93.3% vs. 57.1%, P = 0.037).Conclusions: In malignant biliary strictures, both plastic and metal stent insertions are feasible strategies for the treatment of occluded SEMS. Our data suggest that in palliative biliary stenting, patients especially those with longer expected survival might benefit from second SEMS insertion. Careful patient selection is important to ensure a proper decision for either management

关键词： Self-expanding metal stents Biliary tract neoplasms Endoscopic retrograde cholangiopancreatography Biliary tract diseases Complications

Uber EKG-Kennzeichungen der atrioventrikul ren akzessorischen Leitungsbahnen von Rechtsmittelsepta und Linksmittelsepta

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2001年第1期21卷 26-29页

作者： WANG Lin Ouyang F *** klinikum Hamburg Deutschland Cappato R Hebe J Volkmer M Antz M Ernst S Kuck K H 王琳 Abteilung fur innere Medizin Tongji Klinik Tongji Mediszinisches Institut Huazhong Universitat fur Wissenschaft und Technik *** klinikum Hamburg Deutschland

In der Studie wurden 20 Patienten mit AV-Reentry Tachykardie unter Einbezug einer mittelseptalen gelegenen atrioventricul ren akzessorischen Leitungsbahn(MS) eingeschlossen, die seit 4 Jahren in unserem Elektrophysiologischen Untersuchungslabor mittels Katheters erfolgreich abladiert wurden. Die 20 Patienten hatten 26 akzessorische Leitungsbahnen. Daunter waren 21 MS (rechtsmittelseptal (RMS) zu linksmittelseptal(LMS)=17:4). 18 akzessorische Leitungsbahnen waren offen. Die Lokalisation der akzessorischen Leitungsbahnen wurde aufgrund der Stelle erfolgreich abladiert bestimmt. Die Ergebnisse zeigten, da die RMS und LMS den gleichen Charakter in den meisten Ableitungen des EKGs hatten, und jedoch der wenige Unterschied bei diesen beiden akzessorischen Lritungsbahnen besteht. Wenn die positive Polaritat der Delta Welle in der Ableitung V 1 bei der Patienten mit MS auftritt, mu sich berlegen, ob die M glichkeit der Lokalisation der akzessorischen Leitungsbahn im Linksmittelseptum besteht.

关键词： Katheterablation rechtsmittelseptale gelegene akzessorische Leitungsbahn linksmittelseptale gelegene akzessorische Leitungsbahn

Chronic hepatitis B in 2014: Great therapeutic progress, large diagnostic deficit

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World Journal of Gastroenterology 2014年第33期20卷 11595-11617页

作者： Claus Niederau Katholisches klinikum Oberhausen GmbH St. Josef Hospital Klinik für Innere Medizin Akademisches Lehr-krankenhaus der Universit?t Duisburg-Essen 46045 Oberhausen Germany

This review analyzes progress and limitations of diagnosis, screening, and therapy of patients with chronic hepatitis B infection. A literature review was carried out by framing the study questions. Vaccination in early childhood has been introduced in most countries and reduces the infection rate. Treatment of chronic hepatitis B can control viral replication in most patients today. It reduces risks for progression and may reverse liver fibrosis. The treatment effect on development of hepatocellular carcinoma is less pronounced when cirrhosis is already present. Despite the success of vaccination and therapy chronic hepatitis B remains a problem since many infected patients do not know of their disease. Although all guidelines recommend screening in high risk groups such as migrants, these suggestions have not been implemented. In addition, the performance of hepatocellular cancer surveillance under real-life conditions is poor. The majority of people with chronic hepatitis B live in resource-constrained settings where effective drugs are not available. Despite the success of vaccination and therapy chronic hepatitis B infection remains a major problem since many patients do not know of their disease. The problems in diagnosis andscreening may be overcome by raising awareness, promoting partnerships, and mobilizing resources.

关键词： Chronic hepatitis B HBsAg Screening Liv-er cirrhosis Hepatocellular cancer Entecavir Tenofovi Telbivudine Adefovir Lamivudine Interferon

Parameters of a severe disease course in ulcerative colitis

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World Journal of Gastroenterology 2014年第35期20卷 12574-12580页

作者： Andreas Stallmach Luisa Nickel Thomas Lehmann Bernd Bokemeyer Martin Bürger Dietrich Hüppe Wolfgang Kruis Susanna Nikolaus Jan C Preiss Andreas Sturm Niels Teich Carsten Schmidt klinik für innere Medizin Ⅳ Universit?tsklinikum JenaJena 07747Germany Zentrum für klinische Studien Universit?tsklinikum JenaJena 07747Germany Gastroenterologische Gemeinschaftspraxis Minden 32423Germany Gastroenterologische Gemeinschaftspraxis Herne 44623Germany Evangelisches Krankenhaus Kalk K?ln 51103Germany klinik für innere Medizin Christian Albrechts-Universit?tKiel 24105Germany Medizinische klinik I Campus Benjamin FranklinCharitéBerlin 12203Germany Medizinische klinik Campus Berlin MitteCharitéBerlin 13353Germany Krankenhaus Waldfriede Berlin 14163Germany Internistische Gemeinschaftspraxis für Verdauungsund Stoffwechselkrankheiten Leipzig 04105Germany

AIM: To detect high risk patients with a progressive disease course of ulcerative colitis (UC) requiring immunosuppressive therapy (IT).

关键词： Clinical practice Parameter Prediction model Ulcerative colitis Inflammatory bowel disease

Lipid lowering in patients 75 years and older

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World Journal of Cardiology 2021年第10期13卷 526-532页

作者： Umidakhon Makhmudova P Christian Schulze Harry R Davis Oliver Weingartner klinik fur innere Medizin I Universitatsklinikum JenaJena 07747Germany Synergy Partners RD Solutions Synergy Partners RD SolutionsGaithersburgMD 20850United States

More than twenty years ago,knowledge about the importance of cholesterol absorption and the potential therapeutic effect of its inhibition led to the discovery and clinical application of the first and only cholesterol absorption inhibitor to date–*** then,ezetimibe has become a well-recognized player in lipid-lowering *** findings of IMPROVE-IT and EWTOPIA 75 imply that elderly patients over the age of 75 years in particular benefit from *** review summarizes the evidence,discusses the possible underlying pathophysiological mechanisms and calls for a change in future dyslipidemia guidelines.

关键词： Cholesterol Cholesterol absorption Cholesterol synthesis Ezetimibe Elderly