ISSN:0267-1379    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

This review covers progress in identifyingHelicobacter pylori–derived factors that are involved in survival and virulence of the organism and in elucidating host response pathways that can limit the infection but are also susceptible to dysregulation. Recent work has identified genes of the cytotoxin-associated gene (cag) pathogenicity island (PAI) involved in regulating signaling, interleukin-8 secretion, and phenotypic events in epithelial cells. New roles in pathogenesis have been recognized for vacuolating toxin A (VacA) and urease,H. pylorimembrane and secreted factors, and host epithelial surface molecules. Molecular pathways involved inH. pylori–induced apoptosis in epithelial cells, T cells, and macrophages are being dissected. Activation of toll-like receptors and bacterial factors involved in nitric oxide (NO) and reactive oxygen species induction were also described. The ability ofH. pylorito limit NO production by several mechanisms may be an important part of its ability to evade the host immune response.

ISSN:0267-1379    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Foodborne infections are estimated to affect one in four Americans each year. Most these (67%) are caused by the Norwalk-like viruses, butCampylobacterand nontyphoidalSalmonellaetogether account for about one fourth of cases of illness in which a pathogen can be detected. Less common bacterial infections, such as withListeria monocytogenesand the Shiga toxin–producingEscherichia coli, cause fewer infections but are important because of their severe complications or high mortality rate, or both. This review describes the recent development of a national surveillance system for foodborne illness, newer methods for molecular characterization of organisms for epidemiologic studies, and individual etiologic agents in the order of frequency of occurrence. Methods for decreasing the disease burden are discussed, including education of health care professionals and the public, modification of food-handling behaviors, the use of food irradiation, and the application of probiotics to foods.

ISSN:0267-1379    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Bacterial infections of the small intestine and colon represent a major health problem for developing and developed nations. Recent technological progress has helped research groups to obtain important information on bacterial structure, identify evolutionary relationship between bacterial species, and learn details of the mechanisms involved in the interplay between host and microbes that culminate in disease expression. It is hoped that accumulated knowledge from in vitro experiments and animal models will translate into clinical benefit by means of developing new therapeutic strategies and effective vaccines.

ISSN:0267-1379    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Intestinal parasites continue to be a significant health problem in both developed and developing countries. In developed countries, protozoans are more commonly the cause of gastrointestinal infections than are helminths. Some protozoan parasites have stages in which, in addition to being resistant to chemicals used for water treatment, they are small enough to pass through commonly used filtration processes. The relatively large size of helminth eggs increases the likelihood of their removal during water filtration. The direct impact of protozoan parasites on both human and animal health is considerable, and there is some evidence that infection may contribute to the development of various forms of intestinal dysregulation as well as disseminated infection, especially in AIDS patients. Protozoans of special interest, due to either their frequency of isolation or their role as emerging pathogens, includeGiardia duodenalis,Cryptosporidium parvum,Cyclospora cayetanensis, and the microsporidians,Enterocytozoon bieneusiandEncephalitozoon intestinalis.

ISSN:0267-1379    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Persons with HIV infection, leukemia, lymphoma, solid organ and bone marrow transplants, and inherited immune deficiencies as well as those on immunosuppressive drugs are at high risk for infections of the gastrointestinal tract. Pathogenic as well as opportunistic viruses, bacteria, fungi, and protozoa cause infections in the esophagus, stomach, small intestine, and large intestine. Symptoms may be mild but more often are severe and even life threatening. This article reviews what is new in the field of gastrointestinal infections in the immunocompromised host during the past year. I will place specific emphasis on articles that are most pertinent to clinical care.

ISSN:0267-1379    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0267-1379    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Colorectal cancer is an ideal target for population screening because it is a prevalent disease with an identifiable precursor lesion that, when treated, favorably alters the natural history of the disease. Several strategies for screening have illustrated efficacy, including fecal occult blood testing, sigmoidoscopy and colonoscopy. Cost-effectiveness analyses have been performed to determine whether the resources required to implement screening are justified by potential gains. The U.S. Preventive Services Task Force recently commissioned a study on the cost-effectiveness of colorectal cancer screening, which revealed that screening was cost-effective compared to no screening. However, it could not be confirmed which strategy would save the most life-years, nor which was most cost-effective. Since publication of this review, several additional cost-effectiveness analyses have been performed. These studies confirm that screening average risk patients at age 50 by a variety of available strategies is likely to be reasonable by current standards for resource utilization, and that either colonoscopy every 10 years (or once at age 65) or the combination of annual fecal occult blood testing with sigmoidoscopy every 5 years are viable alternatives. Additional economic analyses have examined the use of aspirin chemoprophylaxis to prevent colorectal cancer either alone or as an adjunct to screening strategies. These studies reaffirm the cost-effectiveness of colorectal cancer screening, but illustrate that aspirin chemoprophylaxis is unlikely to be associated with gains for which society would be willing to pay. At present, the decision to choose one colorectal screening strategy over another is based on availability of screening modalities, patient and provider preferences, and associated adherence to screening recommendations. Assessment of preference and development of interventions to increase adherence to screening should be a focus of research in the future.

ISSN:0267-1379    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Surveillance examinations after detection of an adenoma are one of the largest contributors to the cost of colorectal cancer screening. Screening colonoscopy, beginning at the age of 50 years, is increasing in frequency and becoming part of the zeitgeist. Given the high rate of adenomatous polyp detection on colonoscopy, the amount of time spent and costs consumed by surveillance are likely to grow to significant levels in the coming years. Guidelines for surveillance examinations vary across specialty organizations. Individuals with advanced adenomas are at increased risk for recurrent advanced adenomas. The impact of multiple nonadvanced adenomas or a single nonadvanced adenoma on subsequent risk of an advanced adenoma or cancer is less clear. Recommended surveillance after colorectal cancer has greater consensus, but concerns remain. Studies that predict the need and the needed timing of surveillance remain an important research priority.

ISSN:0267-1379    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Colorectal cancer remains a major cause of morbidity and mortality in United States. While most newly diagnosed cases are sporadic, a small percent of colorectal cancers are due to hereditary cancer syndromes, of which hereditary nonpolyposis colorectal cancer (HNPCC) is the most common. HNPCC is caused by mutations resulting in defective DNA mismatch repair gene function. Advances in molecular technology have enabled us to use genetic testing for HNPCC genes to identify high-risk families. Over the past several years, genetic testing for HNPCC has evolved from a research endeavor to a clinical test that often is an integral part of providing care for high-risk families. This article reviews the available genetic tests, genetic testing recommendations, interpretation of test results, and the clinical impact of genetic testing for HNPCC.

ISSN:0267-1379    

出版商:OVID    

年代:2003

数据来源: OVID