Cuidados de enfermagem ao usuário diagnosticado com doença de Crohn: uma revisão integrativa / Nursing care for users diagnosed with Crohn's disease: an integrative review / Cuidados de enfermería a usuarios diagnosticados de enfermedad de Crohn: una revisión integradora

Objetivo: identificar os cuidados de enfermagem direcionados a usuários diagnosticados com a doença de Crohn. Método: trata-se de uma revisão integrativa da literatura, realizada na Literatura Latino-Americana e do Caribe em Ciências da Saúde, Base de Dados em Enfermagem, Medical Literature Analysis and Retrievel System Online, Scientific Electronic Library Online e Google Acadêmico. A amostra foi composta por sete estudos. Resultados: a análise dos estudos revela uma série de resultados significativos no contexto dos cuidados de enfermagem, podendo citar.: a necessidade de planejar a assistência de enfermagem adaptada às particularidades da doença; a crescente relevância da telessaúde; monitoramento de sintomas, orientação nutricional, administração de medicamentos e apoio emocional, enfatizando a individualização desses cuidados. Considerações finais: os principais resultados do estudo destacam a importância dos cuidados de enfermagem centrados no bem-estar do usuário, controle da doença, apoio emocional e estímulo ao autocuidado.

Objective: to identify the nursing care provided to patients diagnosed with Crohn's disease. Method: this is an integrative literature review carried out in the Latin American and Caribbean Health Sciences Literature, Nursing Database, Medical Literature Analysis and Retrieval System Online, Scientific Electronic Library Online and Google Scholar. The sample consisted of seven studies. Results: the analysis of the studies reveals a series of significant results in the context of nursing care, including: the need to plan nursing care adapted to the particularities of the disease; the growing relevance of telehealth; symptom monitoring, nutritional guidance, medication administration and emotional support, emphasizing the individualization of this care. Final considerations: the main results of the study highlight the importance of nursing care centered on the user's well-being, disease control, emotional support and encouraging self-care.

Objetivos:identificar los cuidados de enfermería prestados a pacientes con diagnóstico de enfermedad de Crohn. Método: se trata de una revisión bibliográfica integradora realizada en la Literatura Latinoamericana y del Caribe en Ciencias de la Salud, Base de Datos de Enfermería, Medical Literature Analysis and Retrieval System Online, Scientific Electronic Library Online y Google Scholar. La muestra estuvo constituida por siete estudios. Resultados: el análisis de los estudios revela una serie de resultados significativos en el contexto de los cuidados de enfermería, entre ellos: la necesidad de planificar cuidados de enfermería adaptados a las particularidades de la enfermedad; la creciente relevancia de la telesalud; la monitorización de síntomas, la orientación nutricional, la administración de medicamentos y el apoyo emocional, destacando la individualización de estos cuidados. Consideraciones finales: los principales resultados del estudio destacan la importancia de los cuidados de enfermería centrados en el bienestar del usuario, el control de la enfermedad, el apoyo emocional y el fomento del autocuidado.

Analysis of clinical features of convulsion in rotavirus enteritis and the risk factors for multiple convulsion / 中国医师进修杂志

Objective:To analyze the clinical features of convulsion in rotavirus enteritis and the risk factors of multiple convulsion.Methods:The clinical data of children with rotavirus enteritis complicated with convulsion admitted to Xi'an Children's Hospital from January 2018 to March 2021 were retrospectively analyzed. According to whether there was fever during convulsion, they were divided into febrile seizure (FS) group and afebrile seizure (AFS) group.Results:A total of 274 children with rotavirus enteritis accompanied by convulsion were enrolled. The male to female ratio was 2.26∶1 in the FS group, while the male to female ratio was 1∶1.1 in the AFS group. The median number of vomiting in the AFS group was higher than that in the FS group: 4(2, 6) times per day vs. 2(1, 5) times per day, P<0.01. One convulsion was dominant in the FS group (80.68%), and more than two convulsions in the AFS group (62.90%). In the FS group, 60.23% of convulsions occurred on the first day of the course of disease, while in the AFS group,79.57% of convulsions mainly occurred on the second and third day of the course of disease. There was no statistical difference in duration of convulsion and overall course of disease between the two groups ( P>0.05). The median of hypersensitive C-reactive protein (CRP) and procalcitonin (PCT) in FS group were higher than those in AFS group: 5.52(1.45, 15.50) mg/L vs. 0.98(0.50, 3.17) mg/L, 0.17(0.07, 0.46) μg/L vs. 0.06(0.05, 0.15) μg/L. The median of alanine aminotransferase (ALT), aspartate aminotransferase (AST), uric acid (UA) and creatine kinase isoenzyme(CK-MB) in the AFS group were higher than those in the FS group: 28.00(21.00, 34.25) U/L vs. 25.00(19.00, 31.00) U/L, 53.00(45.00, 62.00) U/L vs. 50.00(40.00, 58.00) U/L, 390.00(296.00, 474.25) μmol/L vs. 331.00(250.00, 399.75) μmol/L, 67.00(49.75, 94.25) U/L vs. 59.50(37.25, 78.75) U/L, the differences were statistically significant ( P<0.05). The median age and the median of UA levels in ≥3 convulsions group were higher than those in ≤2 convulsions group: 21(18, 26) months vs. 18(15, 21) months, 411.00(296.50, 496.50) μmol/L vs. 364.00(278.00, 440.50) μmol/L, while the median of serum Na +, the mean value of serum Cl - in the ≥3 convulsions group were lower than those in the ≤2 convulsions group: 135.50(133.75, 137.25) mmol/L vs. 136.60(134.50, 138.20) mmol/L, (103.76 ± 3.26) mmol/L vs. (105.08 ± 4.26) mmol/L, the differences were statistically significant ( P<0.05). The age ≥18 months in children with rotavirus enteritis and convulsion ( OR = 3.359, P = 0.002, 95% CI 1.544 - 7.307) and the serum Cl - < 104.8 mmol/L ( OR = 2.17, P = 0.019, 95% CI 1.138 - 4.138) had an increased risk of convulsions ≥3 times during the course of rotavirus enteritis. Conclusions:Rotavirus enteritis FS mostly occurred on the first day of the course of disease, most of them had convulsion once, hs-CRP and PCT were relatively high. In AFS, convulsions were more than 2 times, and occurred on the 2nd and 3rd day of the course of disease. ALT, AST and UA were relatively high. Children with age ≥18 months and serum Cl - < 104.8 mmol/L had an increased risk of convulsions ≥3 times during the course of the disease.

Research progress on the interaction between gut microbiota and radiation enteritis / 国际肿瘤学杂志

Radiotherapy is an important treatment for abdominal and pelvic tumors, but it has a high incidence of the adverse reaction radiation enteritis. Abdominal and pelvic radiotherapy can induce apoptosis of intestinal crypt cells, destroy the intestinal barrier and change the composition of gut microbiota. Dysbiosis of gut microbiota can aggravate radiation enteritis. Fecal flora transplantation, as well as the use of probiotics, prebiotics and antibiotics can regulate gut microbiota, which is an effective method to prevent and treat radiation enteritis.

Advances in clinical diagnosis and treatment of radiation enteritis / 国际肿瘤学杂志

Small bowel capsule endoscopy and double-balloon enteroscopy have become new methods for clinical diagnosis of radiation enteritis (RE) , especially for abnormal intestinal tissue. Targeted biopsy or interventional therapy is expected to achieve precision treatment of RE. The screening of molecular markers in biological samples has also become a new direction for RE diagnosis. Fecal microbiota transplantation has become one of the promising treatments for RE. In addition, mechanism studies based on traditional Chinese medicine, targeted cell death, and omics analysis provide rich strategies for the diagnosis and treatment of RE.

Oral Long oil for prevention and treatment of radiation enteritis / 药学学报

Radiation enteritis (RE) is a common syndrome in the radiotherapy of abdominal and pelvic malignant tumors, heavy influencing living quality, but no specific clinical regimens are available. Long oil (LO) is composed of the fat components from cuttlebone, safflower, walnut oil and rapeseed oil and has been clinically used for wound healing. In this study, oral LO was applied for the prevention and treatment of RE and the mechanisms were explored. Animal experiments were approved by the Ethics Committee of the Beijing Institute of Radiation Medicine, Academy of Military Medical Sciences, and the experiments were conducted in accordance with relevant guidelines and regulations. An RE mouse model was established after single whole abdominal γ-ray radiation of 13 Gy. LO (8 mL·kg-1) was intragastrically administered to the mice 1 h pre-radiation. Compared to the models, the mice of the LO group had more regenerated intestinal crypts and longer villus on day 3.5, and remarkable increase in the abundance of gut microbiota on day 7, especially the amounts of probiotics including Eubacterium and Lactobacillus. Moreover, the mice of the LO group showed longer total movement distance, shorter immobility time, and higher speed than the model mice on day 7. On day 14, the mice of the LO group showed the high descending of proinflammatory factors including tumor necrosis factor-α and interleukin-6, close to the normal levels. Therefore, oral LO can alleviate the inflamed syndromes of RE and improve the repair of damaged intestinal tissues. Moreover, the mice of the LO group had highly low permeability of intestinal mucosa according to the fluorescence labeling experiment, which was close to the normal level. Oral LO can protect intestine mucosa and prevent RE by modification of the intestinal microenvironment, alleviation of the inflammatory response, and promotion of tissue repair.

Molecular mechanism of ginsenoside Rg_1 against radiation enteritis: based on network pharmacology and in vitro experiment / 中国中药杂志

Via network pharmacology, molecular docking, and cellular experiment, this study explored and validated the potential molecular mechanism of ginsenoside Rg_1(Rg_1) against radiation enteritis. Targets of Rg_1 and radiation enteritis were retrieved from BATMAN-TCM, SwissTargetPrediction, and GeneCards. Cytoscape 3.7.2 and STRING were employed for the construction of protein-protein interaction(PPI) network for the common targets, and screening of core targets. DAVID was used for Gene Ontology(GO) term and Kyoto Encyclopedia of Genes and Genomes(KEGG) pathway enrichment to predict the possible mechanism, followed by molecular docking of Rg_1 with core targets and cellular experiment. For the cellular experiment, ~(60)Co-γ irradiation was performed for mo-deling of IEC-6 cells, which were then treated with Rg_1, protein kinase B(AKT) inhibitor LY294002, and other drugs to verify the effect and mechanism of Rg_1. The results showed that 29 potential targets of Rg_1, 4 941 disease targets, and 25 common targets were screened out. According to the PPI network, the core targets were AKT1, vascular endothelial growth factor A(VEGFA), heat shock protein 90 alpha family class A member 1(HSP90AA1), Bcl-2-like protein 1(BCL2L1), estrogen receptor 1(ESR1), etc. The common targets were mainly involved in the GO terms such as positive regulation of RNA polymerase Ⅱ promoter transcription, signal transduction, positive regulation of cell proliferation, and other biological processes. The top 10 KEGG pathways included phosphoinositide 3-kinase(PI3K)/AKT pathway, RAS pathway, mitogen-activated protein kinase(MAPK) pathway, Ras-proximate-1(RAP1) pathway, and calcium pathway, etc. Molecular docking showed that Rg_1 had high binding affinity to AKT1, VEGFA, HSP90AA1, and other core targets. Cellular experiment indicated that Rg_1 can effectively improve cell viability and survival, decrease apoptosis after irradiation, promote the expression of AKT1 and B-cell lymphoma-extra large(BCL-XL), and inhibit the expression of the pro-apoptotic protein Bcl-2-associated X protein(BAX). In conclusion, through network pharmacology, molecular docking, and cellular experiment, this study verified the ability of Rg_1 to reduce radiation enteritis injury. The mechanism was that it regulated PI3K/AKT pathway, thereby suppressing apoptosis.

Research progress in effects of pyroptosis on intestinal inflammatory injury / 中南大学学报(医学版)

Inflammatory injury of the intestine is often accompanied by symptoms such as damage to intestinal mucosa, increased intestinal permeability, and intestinal motility dysfunction. Inflammatory factors spread throughout the body via blood circulation, and can cause multi-organ failure. Pyroptosis is a newly discovered way of programmed cell death, which is mainly characterized by the formation of plasma membrane vesicles, cell swelling until the rupture of the cell membrane, and the release of cell contents, thereby activating a drastic inflammatory response and expanding the inflammatory response cascade. Pyroptosis is widely involved in the occurrence of diseases, and the underlying mechanisms for inflammation are still a hot spot of current research. The caspase-1 mediated canonical inflammasome pathway of pyroptosis and caspase-4/5/8/11-mediated non-canonical inflammasome pathway are closely related to the occurrence and development of intestinal inflammation. Therefore, investigation of the signaling pathways and molecular mechanisms of pyroptosis in intestinal injury in sepsis, inflammatory bowel diseases, infectious enteristic, and intestinal tumor is of great significance for the prevention and treatment of intestinal inflammatory injury.

Clinical features of amoebic enteritis patients with acquired immunodeficiency syndrome / 中华传染病杂志

Objective:To investigate the clinical features of amoebic enteritis with acquired immunodeficiency syndrome (AIDS) patients.Methods:The clinical data of patients diagnosed of amoebic enteritis in Beijing Ditan Hospital, Capital Medical University from April 2011 to October 2019 were collected. They were divided into amoebic enteritis group and amoebic enteritis with AIDS group. The laboratory indexes, pathological examination and colonoscopic appearance of the two groups were analyzed retrospectively. The clinical characteristics of amoeba enteritis with AIDS patient were summarized. Pearson chi-square test, continuous calibration chi-square test, Fisher′s exact test, independent sample t test and Mann-Whitney U test were used for statistical analysis. Results:A total of 53 patients with amoebic enteritis were included, including 31 cases in amoebic enteritis group and 22 cases in amoebic enteritis with AIDS group. The detection rate of amoebic trophozoite in cases feces in amoebic enteritis with AIDS group was lower than that in amebic enteritis group (68.2%(15/22) vs 96.8%(30/31)) with statistical significance ( χ2=6.13, P=0.013). The detection rate of amoebic trophozoite by colonoscopy in amoebic enteritis with AIDS was higher than that in amebic enteritis group (7/15 vs 1/16) with statistical significance (Fisher′s exact test, P=0.015). Amoebic enteritis with AIDS cases had lower levels of red blood cell count ((3.48±0.80)×10 12/L vs (4.11±0.81)×10 12/L), hemoglobin ((102.40±25.74) g/L vs (121.52±22.73) g/L), albumin ((29.07±5.94) g/L vs (35.48±6.92) g/L), CD4 + T-lymphocyte counts (76.00 (26.25, 228.50)/μL vs 514.50 (444.00, 752.25)/μL) than patients with amoebic enteritis, which were all statistically significant ( t=2.80, 2.86, 3.52 and Z=-5.27, respectively, all P<0.050). And amoebic enteritis with AIDS cases had higher level of alanine aminotransferase (ALT) (21.00 (12.85, 41.33) U/L vs 13.40 (9.40, 22.40) U/L, Z=-2.32, P=0.020). The results of colonoscopy showed that amoebic enteritis with AIDS cases had higher rate of intestinal mucosa ulcer than amoebic enteritis cases ((11/15 vs 5/16) Fisher′s exact test, P=0.032). Conclusions:Amoebic enteritis with AIDS cases have lower levels of red blood cells, hemoglobin, albumin and CD4 + T-lymphocyte counts and higher levels of ALT. Amoebic enteritis with AIDS cases have higher rate of intestinal mucosa ulcer detected by colonoscopy. Colonoscopy combined with biopsy play an important role in the diagnosis of amoebic enteritis with AIDS patients.

Determining the protective effects of Ma-Mu-Ran Antidiarrheal Capsules against acute DSS-induced enteritis using 16S rRNA gene sequencing and fecal metabolomics / 中国天然药物

Ma-Mu-Ran Antidiarrheal Capsules (MMRAC) is traditional Chinese medicine that has been used to treat diarrhea caused by acute enteritis (AE) and bacillary dysentery in Xinjiang (China) for many years. However, the potential therapeutic mechanism of MMRAC for AE and its regulatory mechanism on host metabolism is unclear. This study used fecal metabolomics profiling with GC/MS and 16S rRNA gene sequencing analysis to explore the potential regulatory mechanisms of MMRAC on a dextran sulfate sodium salt (DSS)-induced mouse model of AE. Fecal metabolomics-based analyses were performed to detect the differentially expressed metabolites and metabolic pathways. The 16S rRNA gene sequencing analysis was used to assess the altered gut microbes at the genus level and for functional prediction. Moreover, Pearson correlation analysis was used to integrate differentially expressed metabolites and altered bacterial genera. The results revealed that six intestinal bacteria and seven metabolites mediated metabolic disorders (i.e., metabolism of amino acid, carbohydrate, cofactors and vitamins, and lipid) in AE mice. Besides, ten altered microbes mediated the differential expression of eight metabolites and regulated these metabolisms after MMRAC administration. Overall, these findings demonstrate that AE is associated with metabolic disorders and microbial dysbiosis. Further, we present that MMRAC exerts protective effects against AE by improving host metabolism through the intestinal flora.

Preventive and therapeutic effects of Bateri-7 on radiation-induced intestinal injury in mice / 中华放射医学与防护杂志

Objective:To study the protective effect of Mongolian medicine Bateri-7 on radiation-induced intestinal injury in mice.Methods:C57BL/6J male mice were randomly divided into control group, irradiation group and irradiation plus drug administration group, with 10 or 15 mice in each group. For irradiation group, the mice were given a single dose of 12 Gy 60Co γ-rays with total body irradiation. For drug treatment, the mice were gavaged with Bateri-7 (530 mg/kg) 7 d before irradiation until 3 d after IR. At 6 h and 24 h after irradiation, the Tunel positive cells in intestine were detected immunohistochemically. At 3.5 d after irradiation, the structure of intestinal villi was observed by HE staining, and the BrdU and Ki67 positive cells were detected immunohistochemically. The expression levels of IL-6, TNF-α and Cxcl-5 were detected by qPCR. The FITC-dextran in peripheral blood was also determined. Results:The survival of irradiated mice was significantly increased by Bateri-7 ( χ2= 5.84, P < 0.05), but there was no significant difference in weight between two groups ( P > 0.05). The villi length of small intestine in the irradiation plus drug group was significantly longer than that in the irradiation group ( t = 20.24, P < 0.05), and there was no significant difference in the depth of intestinal crypt between two groups ( P > 0.05). At 6 and 24 h after irradiation, the number of Tunel positive cells in intestinal crypts in the irradiation plus drug group was significantly reduced in comparison with the irradiation group ( t = 3.52, 2.90, P < 0.05). At 3.5 d after irradiation, the level of FITC-dextran in serum and the expressions of IL-6, TNF-α and Cxcl-5 in small intestine of mice in the irradiation plus drug group were significantly lower than those in the irradiation group, respectively( t = 6.92, 7.01, 7.18, 13.16, P < 0.05). The number of BrdU and Ki67 positive cells in the crypt of mice in the irradiation plus drug group was higher than that of the irradiation group ( t = 3.91, 2.57, P < 0.05). Conclusions:Mongolian medicine Bateri-7 can effectively alleviate irradiation-induced intestinal injury of mice, which may have a good preventive and therapeutic effect on radiation enteritis.

Pathogen and clinical characteristics of bacterial enteritis in a third class children′s hospital in Shanghai city from 2016 to 2020 / 中国小儿急救医学

Objective:To investigate the pathogens and drug resistance of bacterial enteritis in children, analyze the clinical characteristics of bacterial enteritis in children, and provide basis for clinical diagnosis and treatment.Methods:The fecal culture strain and drug sensitivity of patients with bacterial enteritis admitted to our hospital from January 2016 to December 2020 were analyzed and summarized, and the clinical characteristics of patients who were infected by Salmonella and Escherichia coli were compared.Results:There were a total of 173 patients, aged from 21 days to 15 years, with a median age of 2.00(1.10, 3.54)years.Bacterial enteritis was most likely to occur in summer and autumn, and the incidence rate was 40.5% and 29.5%, respectively.One hundreds and seventy-three strains of bacteria were cultured in feces, including 148 strains of Salmonella(85.5%), 18 strains of Escherichia coli(10.4%), five strains of Staphylococcus aureus and two strains of Shigella.One hundreds and one of 141 patients who were infected with Salmonella were detected for leukocytes of in feces(71.6%), and four of 16 patients with Escherichia coli were detected for leukocytes(25.0%). The difference was significant( χ2=14.1, P<0.001). Eighty-eight of 113 patients(77.9%) who were infected by Salmonella with increased CRP(CRP>8 mg/L)and the proportion in Escherichia coli infection cases was 6/13(46.2%). There was significant difference( χ2=4.63, P=0.03). The drug sensitivity of Salmonella and Escherichia coli was summarized.There was no carbapenem resistant strain cultured; The sensitivity to piperacillin/tazobactam and cefoperazone/sulbactam was higher than 85%; The sensitivity to cefepime, ceftazidimeand ceftriaxone was higher than 75%; The sensitivity to ampicillin was lower than 30%, and the sensitivity to quinolones was between 20%-40%. Conclusion:Children aged 1-3 years are prone to bacterial enteritis in summer and autumn.The most common pathogens causing bacterial enteritis are Salmonella and Escherichia coli.White blood cells are more easily detected in feces of patients with Salmonella infection, and the increase rate of C-reactive protein in peripheral blood is higher.Patients with bacterial enteritis are recommended to use the third-generation cephalosporins and aforementioned antibiotics and piperacillin/tazobactam for empirical treatment.The sensitivity to quinolones is reduced, and may not be suitable for clinical application.

Research progress of TCM in treating radiation enteritis based on intestinal microecology / 国际中医中药杂志

Patients with radioactive enteritis generally have certain intestinal microecological imbalance. Traditional Chinese Medicine (TCM) has showed good advantage in regulating intestinal microbial flora. In clinical practice, patients are treated based on syndrome differentiation of heat toxin damaging collaterals, cold-heat mixed syndrome, spleen deficiency and dampness stagnation, spleen and kidney yang deficiency, yin deficiency and body fluid deficiency. The Baitouweng Decoction, Wumei Pill, Sijunzi Decoction are the common prescriptions. TCM can promote the balance of intestinal microecology and treat digestive diseases such as radioactive enteritis, by improving the abundance of intestinal flora, inhibiting the level of inflammatory cytokines, and playing the role of probiotics and immune regulation.

Enterite mesentérica como complicação rara do lúpus eritematoso sistêmico / Mesenteric enteritis as a rare complication of systemic lupus erythematosus

A dor abdominal no paciente com lúpus eritematoso sistêmico tem amplo espectro clínico, variando desde condições inespecí- ficas, como diarreia e vômitos, até eventos de importante morbi- mortalidade, como o abdome agudo inflamatório e/ou perfura- tivo. A seguir, descreve-se um caso de paciente do sexo feminino, de 23 anos, internada por dor abdominal associada a vômitos e à diarreia crônica e progressiva. Foi diagnosticada com lúpus eritematoso sistêmico há 2 anos. Durante a internação, evoluiu com quadro de abdome agudo, e foi realizada tomografia compu- tadorizada de abdome, revelando importante edema de parede intestinal difuso. Isso, somado a alterações clínico-laboratoriais, permitiu o diagnóstico de enterite lúpica. Foi realizado tratamen- to conservador, com corticoterapia e terapia de suporte com correção de distúrbios eletrolíticos severos, sendo iniciado ciclo- fosfamida, com resolução dos sintomas gastrintestinais.

Abdominal pain in patients with systemic lupus erythematosus has a broad clinical spectrum, ranging from nonspecific symp- toms, such as diarrhea and vomiting, to events of significant morbidity and mortality, such as acute inflammatory and/or per- forating abdomen. This article describes a case of a 23-year-old female patient hospitalized for abdominal pain, associated with vomiting and progressive chronic diarrhea. She was diagnosed with systemic lupus erythematosus 2 years ago. During hospita- lization, the patient progressed with acute abdomen, and an ab- dominal computed tomography scan was performed, revealing major diffuse intestinal wall edema. This, added to clinical and laboratories alterations, allowed the diagnosis of lupus enteritis. A conservative treatment with corticotherapy and supportive therapy with correction of severe electrolyte disturbances were initiated, as well as the prescription of cyclophosphamide, with resolution of gastrointestinal symptoms.

Enfermedad de Crohn con compromiso extenso y manifestaciones extradigestivas inusuales: a propósito de un caso / Crohn's disease with extensive involvement and rare extraintestinal manifestations: A case report

Resumen La enfermedad de Crohn (EC) es considerada una entidad inmunológicamente mediada que compromete el tracto digestivo. Su compromiso suele ser transmural y puede afectar cualquier parte del tubo digestivo, desde la cavidad oral hasta el ano. Aunque se sabe que su extensión es variable, es poco habitual ver un compromiso extenso y multiorgánico. Se presenta el caso de un paciente joven, quien debutó con síntomas pulmonares asociados con la EC y años más tarde se presentaron los síntomas digestivos y de la vía biliar. El tratamiento se basó en la terapia con anticuerpos contra el factor de necrosis tumoral alfa (TNF-α), con lo cual se obtuvo una respuesta clínica satisfactoria. La relevancia clínica de este caso es la forma de presentación clínica tan florida, tanto por el compromiso gastrointestinal extenso como por las manifestaciones extradigestivas tan infrecuentes.

Abstract Crohn's disease (CD) is considered an immunologically mediated entity that involves the digestive tract. It is characterized by transmural inflammation and can affect any part of the digestive tract, from the oral cavity to the anus. Although it is recognized that its severity varies, extensive and multiple organ failure is unusual. We present the case of a young patient, who initially presented with pulmonary symptoms associated with CD. Years later, digestive and bile duct symptoms appeared. Treatment was based on anti-tumor necrosis factor-alpha antibody therapy, resulting in a satisfactory clinical response. The clinical relevance of this case is its full-blown presentation, which includes extensive gastrointestinal involvement and rare extraintestinal manifestations.

Espectro Clínico Del Lupus Eritematoso Sistémico En Niños. Reporte De Caso / Clinical spectrum of systemic lupus erythematosus in children. Case report

El lupus eritematoso sistémico es una enfermedad autoinmune con afectación multisistémica, curso clínico alternante, y que constituye un reto diagnóstico, con una mayor actividad de la enfermedad en el grupo etario pediátrico, que además ensombrece su pronóstico. A continuación, reportamos el caso de una paciente de 10 años de edad que debuta con lupus eritematoso sistémico con afectación gastrointestinal, renal y hematológica; el curso crónico aunado al espectro clínico variado sugirió la posibilidad diagnóstica.

Systemic lupus erythematosus is an autoimmune disease with multisystem involvement, an alternating clinical course, and which constitutes a diagnostic challenge, with a greater disease activity in the pediatric age group, which also darkens its prognosis. In this article, we report the case of a ten year old female patient who debuted with systemic lupus erythematosus with gastrointestinal, renal and hematological involvement; the chronic course coupled with the varied clinical spectrum suggested the diagnostic possibility.

Epidemiological and pathological aspects of salmonellosis in cattle in southern Brazil / Aspectos epidemiológicos e patológicos de salmonelose em bovinos no Sul do Brasil

ABSTRACT: Salmonellosis is a bacterial disease that affects several domestic animal species, and is commonly diagnosed in cattle, horses, and pigs. This study aimed to describe the epidemiological and pathological findings of eleven cases of enteric salmonellosis and two cases of salmonellosis with pulmonary involvement in cattle in Rio Grande do Sul State, Brazil. Clinical signs included fever, yellow diarrhea, sometimes with blood streaks, and dyspnea, with a clinical course ranging from 1 to 30 days. Eight cases occurred as outbreaks, whereas five cases occurred individually. Risk factors included inadequate handling practices, such as overcrowded facilities and comorbidities, including anaplasmosis. The main gross finding of the enteric presentation was fibrinonecrotic enterocolitis, occasionally associated with button ulcers, mesenteric lymphadenomegaly, splenomegaly, cholecystitis and hepatomegaly. In addition, one steer with a chronic clinical progression presented severe segmental thickening of the ileum, associated with intestinal rupture and peritonitis. In the respiratory system, the main findings were reddened, non-collapsed lungs, with multifocal areas of atelectasis. The main microscopic findings were observed in the small and large intestines, and these were characterized by severe necrosis and mucosal ulceration, associated with marked inflammatory infiltrate of neutrophils and fibrin deposition intermixed by rod-shaped bacterial aggregates, and fibrosis, as well as interstitial pneumonia. Seven cases yielded positive bacterial cultures for Salmonella spp. and three serovars, namely Typhimurium, Dublin, and Panama were identified. All cases exhibited immunolabeling for Salmonella spp. using immunohistochemistry.

RESUMO: Salmonelose é uma doença bacteriana que afeta inúmeras espécies animais, especialmente os bovinos, os equinos e os suínos. O presente estudo teve como objetivo descrever os aspectos epidemiológicos e patológicos de onze casos de salmonelose entérica e dois de salmonelose pulmonar em bovinos no estado do Rio Grande do Sul, Brasil. Os sinais clínicos incluíram febre, diarreia amarelada, por vezes com estrias de sangue, anorexia, perda de peso e dispneia, com curso clínico que variou de um a 30 dias. Em oito casos, a doença ocorreu em forma de surtos e cinco foram individuais. Identificou-se fatores de risco relacionados ao manejo inadequado com os bovinos, como alta lotação, além de comorbidades associadas, como anaplasmose. Os principais achados macroscópicos da forma entérica consistiram em enterocolite fibrinonecrótica, por vezes associada a formação de úlceras botonosas, linfonodos mesentéricos e baço aumentados, colecistite e hepatomegalia. Ainda, um bovino com quadro clínico crônico apresentou acentuado espessamento segmentar da parede do íleo associado a ruptura intestinal e peritonite. Na forma respiratória, os principais achados incluíram pulmões não colabados, avermelhados, com áreas multifocais de atelectasia. Os principais achados microscópicos foram observados no intestino delgado e grosso e foram caracterizados por acentuada necrose e ulceração da mucosa, associada a acentuado infiltrado inflamatório de neutrófilos e deposição de fibrina entremeada por agregados bacterianos cocobacilares e fibrose, além de pneumonia intersticial. Sete casos foram positivos para Salmonella sp. no cultivo bacteriano, com identificação dos sorovares Typhimurium, Dublin e Panama. Ao exame imuno-histoquímico para Salmonella sp. todos os casos apresentaram marcação positiva nos órgãos avaliados.

Preliminary study on gut microbiota prediction of radiation enteritis in patients with cervical and endometrial cancers / 中华放射医学与防护杂志

Objective:To explore the relationships between the gut microbiota in patients with cervical and endometrial cancers and the severity of radiation enteritis they suffered during radiotherapy.Methods:Feces samples were collected from 37 patients with cervical or endometrial cancer who received radical radiotherapy (RR) and postoperative radiotherapy (PR). Symptoms were recorded according to the grades of diarrhea and proctitis stated in CTCAE 5.0. The grade of symptoms was considered a high grade (HG) in the case of ≥ 2 and a low grade (LG). The 16S rRNA sequencing technology was used for DNA analysis of the samples.Results:The α diversity of gut microbiota was significantly higher in patients with LG symptoms (LG group) than that in patients with HG symptoms (HG group, P<0.05) and the β diversity also differed between the two groups (stress<0.2) before radiotherapy. Meanwhile, the Ruminococcus gnavus was significantly higher in the HG group than that in the LG group before radiotherapy ( P<0.05), and thus it may serve as a biomarker for the prediction of the severity of radiation enteritis in the patients before radiotherapy. The gut microbiota in the LG and HG groups showed different changes after three weeks of radiotherapy. In addition, RR patients showed higher gut microbiota diversity and less severe radiation enteritis than PR patients. Meanwhile, Faecalibacterium prausnitzii was significantly higher in RR patients than that in PR patients before radiotherapy ( P<0.05), which may correlate negatively with radiation toxicity. Conclusions:The characteristics of gut microbiota in patients with cervical and endometrial cancers were closely related to the severity of radiation enteritis they suffered during radiotherapy. Furthermore, prior treatment such as surgery might reduce radiation tolerance of the patients.

Value of procalcitonin, C-reactive protein and white blood cell count in combination in the differential diagnosis of different types of infantile enteritis / 中国基层医药

Objective:To investigate the significance of procalcitonin (PCT), C-reactive protein (CRP) and white blood cell count (WBC) in the differential diagnosis of bacterial enteritis and viral enteritis in children.Methods:The clinical data of 84 children with enteritis who received treatment in General Hospital of Taiyuan Iron and Steel (Group) Co. Ltd., China were retrospectively analyzed. Among these children, 47 suffered from bacterial enteritis (bacterial enteritis group) and 37 suffered from viral enteritis (viral enteritis group). PCT, CRP and WBC were determined and compared between the bacterial enteritis and viral enteritis groups. The outcomes and efficacy of PCT, CRP and WBC alone and in combination in the diagnosis of bacterial enteritis in children were determined.Results:PCT and CRP levels and WBC in the bacterial enteritis group were significantly higher than those in the viral enteritis group ( t = 12.427, 15.219, 10.912, all P < 0.05). The proportion of abnormal PCT and CRP levels and WBC in the bacterial enteritis group was 53.19%, 46.81% and 42.55%, which were significantly higher than those in the viral enteritis group (13.51%, 8.11%, 8.11%, χ2 = 14.195, 14.832, 12.353, all P < 0.05). The sensitivity, specificity, accuracy, missed diagnosis rate and misdiagnosis rate of PCT were 53.19%, 86.49%, 67.86%, 46.81% and 13.51% respectively, while they were 46.81%, 91.89%, 66.67%, 53.19% and 8.11% respectively for CRP and 42.55%, 91.89%, 64.29%, 57.45% and 8.11% respectively for WBC. The sensitivity, specificity, accuracy, missed diagnosis rate and misdiagnosis rate for PCT, CRP and WBC in combination were 87.23%, 94.59%, 90.48%, 12.77% and 5.41% respectively. The accuracy ( χ2 = 13.028, 14.141, 16.459) and sensitivity ( χ2 = 13.021, 17.375, 10.593) of PCT, CRP and WBC in combination were significantly higher than those of PCT, CRP and WBC alone in the diagnosis of bacterial enteritis in children (all P < 0.05). The missed diagnosis rate of PCT, CRP and WBC in combination was significantly lower than that of PCT, CRP and WBC alone in the diagnosis of bacterial enteritis in children ( χ2 = 13.021, 17.375, 10.593, all P < 0.05). There were no significant differences in specificity and misdiagnosis rate between PCT, CRP and WBC in combination and alone ( χ2 = 1.420, 0.000, 0.000, all P > 0.05). Conclusion:PCT, CRP and WBC in combination can effectively distinguish bacterial enteritis from viral enteritis in children, with highly reliable diagnosis results. Therefore, this detection method is of important clinical application value.

Role of Autophagy in Rotavirus Enteritis and Intervention with Traditional Chinese Medicine： A Review / 中国实验方剂学杂志

Rotavirus enteritis （RVE）， a common infectious disease of the digestive system， is commonly found in infants and young children. Its incidence is high， posing great threats to human health. At present， no specific drugs are available in western medicine and the symptomatic treatments like fluid infusion， anti-diarrhea， correction of electrolyte disorder， protection of gastrointestinal mucosa， and regulation of intestinal microecology have been employed. In addition to the poor therapeutic efficacy， they do not perform well in preventing the onset of RVE and shortening the course of disease. Traditional Chinese medicine （TCM） exerts the therapeutic effect against RVE via multiple targets， without inducing obvious adverse reactions and the cost is low. The specific mechanism of action has yet to be fully explained. Although there are some studies exploring the role of Chinese medicinal monomers in the pathogenesis of RVE， the types involved are still not enough. The effects of Chinese medicinal monomers on autophagy-related pathways fail to be uncovered， which is attributed to the lack of large-scale experimental data and clinical evidence. There are also many problems that cannot be ignored in the related research of Chinese medicinal compounds， taking the superficial exploration and limited scope for instance. Autophagy is a highly conserved biological phenomenon that involves a variety of signaling pathways. Its dysfunction is related to multiple pathological processes. Studies have shown that autophagy plays an important role in the pathogenesis of RVE， especially in the early stage of viral infection. Autophagy induces intestinal mucosal barrier damage， intestinal nerve dysfunction， and immune abnormality， resulting in the occurrence and development of RVE. In recent years， a large number of experimental studies have confirmed that TCM fights against circulatory， respiratory， digestive， and immune system diseases as well as tumors by intervening in autophagy. At the same time， a handful of studies have suggested that Chinese medicinal monomers and compounds regulate autophagy and interfere with viral replication by affecting related signaling pathways， thus playing a positive role in reversing the progression of RVE. However， at present， there are few studies on the regulation of autophagy by TCM in the treatment of RVE， and no systematic elaboration is available. This review aimed to summarize the role of autophagy in the pathogenesis of RVE and its intervention with TCM， in order to provide more theoretical and clinical evidence for the treatment of RVE with TCM.

Effects of radical radiotherapy combined with different regimens of chemotherapy on radiation intestinal injury in patients with non-metastatic anal squamous cell carcinoma / 中华胃肠外科杂志

Objective: To investigate the effects of radical radiotherapy combined with different chemotherapy regimens (fluorouracil-based versus docetaxel plus cisplatin) on the incidence of radiation intestinal injury and the prognosis in patients with non-metastatic anal squamous cell carcinoma. Methods: A retrospective cohort study was conducted to recruit non-metastatic anal squamous cell carcinoma patients who underwent chemoradiotherapy in the Sixth Affiliated Hospital of Sun Yat-sen University and Nanfang Hospital from July 2013 to January 2021. Inclusion criteria: (1) newly diagnosed anal and perianal squamous cell carcinoma; (2) completed radical radiotherapy combined with concurrent chemotherapy; (3) tumor could be evaluated before radiotherapy. Exclusion criteria: (1) no imaging evaluation before treatment, or the tumor stage could not be determined; (2) patients undergoing local or radical resection before radiotherapy; (3) distant metastasis occurred before or during treatment; (4) recurrent anal squamous cell carcinoma. A total of 55 patients (48 from the Sixth Affiliated Hospital of Sun Yat-sen University and 7 from Nanfang Hospital) were given fluorouracil (the 5-FU group, n=34) or docetaxel combined with the cisplatin (the TP group, n=21). The evaluation of radiation intestinal injury, hematological toxicity and 3-year disease-free survival (DFS) rate were compared between the two groups. The effects of chemotherapy regimen and other clinicopathological factors on the incidence and severity of acute and chronic radiation intestinal injury were analyzed. The assessment of radiation intestinal injury was based on the American Cancer Radiotherapy Cooperation Group (RTOG) criteria. Results: During radiotherapy and within 3 months after radiotherapy, a total of 45 patients developed acute radiation intestinal injury, including 18 cases of grade 1 (32.7%), 22 cases of grade 2 (40.0%) and 5 cases of grade 3 (9.1%). No patient developed chronic radiation intestinal injury. Among the 34 patients in the 5-FU group, 21 had grade 2-3 radiation intestinal injury (21/34, 61.8%), which was significantly higher than that in the TP group (6/21, 28.6%) (χ(2)=5.723, P=0.017). Multivariate analysis showed that 5-FU chemotherapy regimen was an independent risk factor for radiation intestinal injury (HR=4.038, 95% CI: 1.250-13.045, P=0.020). With a median follow-up period of 26 (5-94) months, the 3-year DFS rate of patients in TP group and 5-FU group was 66.8% and 77.9%, respectively, whose difference was not significant (P=0.478). Univariate analysis showed that the DFS rate was associated with sex, age, tumor location, T stage, N stage, and induction chemotherapy (all P<0.05), while the DFS rate was not associated with chemotherapy regimen or radiation intestinal injury (both P>0.05). Multivariate analysis revealed that age ≥ 50 years old was an independent risk factor affecting the prognosis of patients (HR=8.301, 95% CI: 1.130-60.996, P=0.038). Conclusions: For patients with non-metastatic anal squamous cell carcinoma, radical radiotherapy combined with TP chemotherapy regimen can significantly reduce the incidence of radiation intestinal injury as compared to 5-FU regimen. However, due to the short follow-up time, the effect of different chemotherapy regimens on the prognosis is not yet clear.