Establishment of a therapeutic system in surgery for ulcerative colitis

1.溃疡性结肠炎全直结肠切除术后肠道适应机制分析口腔和肛门粘膜的比较研究表明，在全直结肠切除术后，除了激素的变化外，粪便还需要充分诱导残余回肠中的钠转运系统（包括sglt1介导的转运）。结肠转化被认为是全结肠切除术（TC）后回肠的表型改变，但尚未在分子水平上得到很好的解决。我们使用cDNA微阵列证明，TC后基因表达的改变在一定程度上以“冒号样”转化为特征。此外，循环醛固酮似乎在调节和/或适应肠上皮基因表达中发挥部分作用。促进肠道适应的新途径口服醛固酮- plga微片成功诱导了回肠黏膜中几种分子的表达并激活了钠的运输，这两者都是肠道适应所必需的。术前和（或）术后用该药治疗可弥补直肠切除术后钠和水的过量损失。由于内窥镜发现是这一标准的关键组成部分，我们编辑了袋炎图谱。图集包括对眼袋内窥镜的特殊考虑的描述和许多照片，显示了各种各样的发现和不同程度的炎症。Atlas使我们能够更客观地评估内镜检查结果，并将检查结果分为正常、轻度、中度和重度。

1.Analysis of mechanisms of intestinal adaptation after total proctocolectomy for ulcerative colitisComparative studies of oral and anal mucosae demonstrated that in addition to hormonal changes, fecal stream is required for full induction of the sodium transport system (which includes SGLT1-mediated transport) in the remnant ileum following total proctocolectomy. Colonic transformation is thought to be a phenotypic alteration in the ileum following total colectomy (TC) but has not been well addressed at molecular level. We demonstrated using cDNA roicroarray that altered gene expression following TC is, in part, characterized by "colon-like" transformation. Furthermore, circulating aldosterone appears to play a part of roles in altoring and/or adapting gene expression in intestinal epithelium.2.A novel approach to promote intestinal adaptationOral administration of aldosterone-PLGA microsheres successfully induced the expression of several molecules and activated sodium transport in the ileal mucosa, both of which are essential for intestinal adaptation. Pre-and/or post-operative treatment with this drug may compensate for the excessive loss of sodium and water following proctocolectomy.3.Diagnosis and treatment of pouchitis, a novel mucosal inflammationBecause endoscopic finding is a key component of this criteria, we edited pouchitis atlas. Atlas includes description of special consideration for pouch endoscopy and many photos showing a wide variety of findings and various degree of inflammation. Atlas enabled us to evaluate endoscopic findings more objectively and classify findings into normal, mild, moderate, and severe.