Optimal management of acute severe ulcerative colitis

Jain, Saransh; Ahuja, Vineet; Limdi, Jimmy K.

doi:10.1136/postgradmedj-2018-136072

Cited by 21 publications

(20 citation statements)

References 89 publications

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“…Synthetic glucocorticoid immunosuppressants, especially Dex, have been widely used in treating inflammatory disorders and are well known for their effects on the immune system [7,28,[48][49][50]. It has been suggested that GCs regulate a variety of different immune cell activities [51].…”

Section: Discussionmentioning

confidence: 99%

“…If treatment is ineffective or exacerbates the condition, immunosuppressive agents such as cyclosporine A or the blocking of the secretion of the pro-inflammatory cytokine TNFα with infliximab are used for emergency intravenous infusion treatment. Partial colectomy is considered if treatment is no longer effective [2,4,7,[54][55][56]. It is important to further summarize these clinical studies, and the glucocorticoid treatment of acute ulcerative colitis, especially in the development of acute ulcerative colitis, is often ineffective or even detrimental.…”

Section: Discussionmentioning

confidence: 99%

“…It is important to further summarize these clinical studies, and the glucocorticoid treatment of acute ulcerative colitis, especially in the development of acute ulcerative colitis, is often ineffective or even detrimental. However, glucocorticoids combined with immunosuppressants and TNFα blockade are often effective in the clinic [7,[12][13][14][15][16][17][18]54]. However, the theoretical basis of this phenomenon is not clear.…”

Section: Discussionmentioning

confidence: 99%

“…To alleviate acute colitis, treatment with effective drugs and deciding upon selective colectomy in a timely fashion are necessary [1,2,[4][5][6]. Acute ulcerative colitis is poorly controlled and often develops into chronic colitis and inflammatory-related cancer, even leading to death [3,[7][8][9]. Therefore, the rapid and timely control of acute colitis is an important clinical treatment strategy.…”

Section: Introductionmentioning

confidence: 99%

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Glucocorticoids Promote the Onset of Acute Experimental Colitis and Cancer by Upregulating mTOR Signaling in Intestinal Epithelial Cells

Zhang

Lin

Jia

et al. 2020

Cancers

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The therapeutic effects of glucocorticoids on colitis and colitis-associated cancer are unclear. In this study, we investigated the therapeutic roles of glucocorticoids in acute experimental ulcerative colitis and colitis-associated cancer in mice and their immunoregulatory mechanisms. Murine acute ulcerative colitis was induced by dextran sulfate sodium (DSS) and treated with dexamethasone (Dex) at different doses. Dex significantly exacerbated the onset and severity of DSS-induced colitis and potentiated mucosal inflammatory macrophage and neutrophil infiltration, as well as cytokine production. Furthermore, under inflammatory conditions, the expression of the glucocorticoid receptor (GR) did not change significantly, while mammalian target of rapamycin (mTOR) signaling was higher in colonic epithelial cells than in colonic immune cells. The deletion of mTOR in intestinal epithelial cells, but not that in myeloid immune cells, in mice significantly ameliorated the severe course of colitis caused by Dex, including weight loss, clinical score, colon length, pathological damage, inflammatory cell infiltration and pro-inflammatory cytokine production. These data suggest that mTOR signaling in intestinal epithelial cells, mainly mTORC1, plays a critical role in the Dex-induced exacerbation of acute colitis and colitis-associated cancer. Thus, these pieces of evidence indicate that glucocorticoid-induced mTOR signaling in epithelial cells is required in the early stages of acute ulcerative colitis by modulating the dynamics of innate immune cell recruitment and activation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Glucocorticoids Promote the Onset of Acute Experimental Colitis and Cancer by Upregulating mTOR Signaling in Intestinal Epithelial Cells

Zhang

Lin

Jia

et al. 2020

Cancers

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“…As the disease progresses, the beneficial effects of BNP and NT-proBNP diminish, leading to water and sodium retention and adversely affecting the heart. Therefore, the increased levels of BNP and NT-proBNP can reflect the severity of left ventricular dysfunction, which increases as the disease progresses [38]. The decision tree algorithm is a machine learning algorithm.…”

Section: Introductionmentioning

confidence: 99%

Application of Deep Learning Algorithm in Clinical Analysis of Patients With Serum Electrolyte Disturbance

Wang

Yao

et al. 2020

IEEE Access

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This article analyzes the serum electrolyte disturbances of patients through deep learning algorithms. Among the 104 patients with electrolyte disturbances, 6 cases of serum potassium, sodium, chloride, calcium, phosphorus, and magnesium electrolyte disturbances have occurred, the proportion of occurrence The order is sodium> chlorine> calcium> potassium> phosphorus> magnesium. This paper proposes a deep learning algorithm for serum electrolyte disorder, and analyzes and implements the functions at various levels according to the characteristics of the Hadoop framework. The system includes electronic medical records shared storage, distributed realization of definite learning algorithms, classification and recognition of myocardial ischemia by deep learning, and Web system assisting doctor diagnosis, which lays the foundation for the construction of serum electrolyte disorder scientific research data center. In order to explore this relationship, without artificially extracting features, a deep learning model of convolution and long-term and short-term memory circulation neural network cascade was proposed to determine the positive or negative myocardial ischemia by classifying serum disorders. Conduct clinical experiments, including patients with suspected coronary heart disease and coronary angiography as the research object, taking coronary angiography results as the detection standard. Experimental results show that the model has an accuracy of 89.0% for detecting myocardial ischemia, a sensitivity of 91.7%, and a specificity of 81.5%. A linear combination model of CNN and LSTM is proposed to classify and recognize serum electrolyte disorders. Determine the learning theory to dynamically model the ST-T segment in the ECG to obtain serum electrolyte disturbance, which more vividly shows the changes in electrical information under myocardial ischemia. In order to reveal the relationship between serum electrolyte disturbance and myocardial ischemia, this paper builds a neural network model to learn and train serum electrolyte disturbance data to realize the classification of positive or negative myocardial ischemia. Tests on serum electrolyte disturbance data collected in clinical experiments show that this model can better achieve early detection of myocardial ischemia. INDEX TERMS deep learning; serum; electrolyte disturbance; clinical analysis.

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Acute severe ulcerative colitis: management advice for internal medicine and emergency physicians

Rosiou

Selinger

2021

Intern Emerg Med

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Acute severe ulcerative colitis is a medical emergency that warrants in-patient management. This is best served within a multidisciplinary team setting in specialised centres or with expert consultation. Intravenous corticosteroids remain the cornerstone in the management of ASUC and should be initiated promptly, along with general management measures and close monitoring of patients. Unfortunately, one-third of patients will fail to respond to steroids. Response to intravenous corticosteroid therapy needs to be assessed on the third day and rescue therapies, including cyclosporine and infliximab, should be offered to patients not responding. Choice of rescue therapy depends on experience, drug availability and factors associated with each individual patient, such as comorbidities, previous medications or contra-indications to therapy. Patients who have not responded within 7 days to rescue therapy must be considered for surgery. Surgery is a treatment option in ASUC and should not be delayed in cases of failure of medical therapy, because such delays increase surgical morbidity and mortality. This review summarises the current management of acute severe ulcerative colitis and discusses potential future developments.

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Optimal management of acute severe ulcerative colitis

Cited by 21 publications

References 89 publications

Glucocorticoids Promote the Onset of Acute Experimental Colitis and Cancer by Upregulating mTOR Signaling in Intestinal Epithelial Cells

Glucocorticoids Promote the Onset of Acute Experimental Colitis and Cancer by Upregulating mTOR Signaling in Intestinal Epithelial Cells

Application of Deep Learning Algorithm in Clinical Analysis of Patients With Serum Electrolyte Disturbance

Acute severe ulcerative colitis: management advice for internal medicine and emergency physicians

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