Phytochemical Characterization and Evaluation of the Antibacterial Activity of Leaf Extracts of Mitragyna inermis (Willd.) O. Ktze on the in Vitro Growth of Clinical Strains Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa Involved in Gastro Enteritis

Gastroenteritis constitutes a group of diarrheal diseases of infectious origin, responsible for absenteeism from work, morbidity and mortality, especially among aged people. This study aimed to evaluate the antibacterial activity of Mitragyna inermis extracts on the in vitro growth of Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa involved in gastroenteritis. Phytochemical screening was carried out using two distinct methods. The detection of phytochemical compounds by tube coloring and chromatography on a thin layer of silica gel. The sensitivity of organisms was evaluated by the agar well method. The dilution method in liquid medium coupled with spreading on Mueller Hinton agar helped determine the CMB/MIC activity ratios. The investigations show that the extract has the best extraction yield (75.86% ± 0.20%) compared to the aqueous macerated (61.8% ± 0.08%) and decocted (66.6% ± 0.12%). These extracts contain several phytochemical compounds such as flavonoids, polyphenols, tannins, alkaloids, saponosides, coumarins and sterols and terpenes. These substances are endowed with biological activities and could be at the origin of antibacterial activity observed with M. inermis extracts. The analysis of antibacterial activity showed that the germs are sensitive to the extracts with inhibition diameters ranging from 8.30 ± 0.53 to 17.87 ± 0.58 mm. The ethanolic extract was the most active with diameters varying from 15.07 ± 0.62 to 17.87 ± 0.58 mm on all the germs tested. E. coli and S. aureus were the most sensitive germs to the extracts. P. aeruginosa was the least sensitive germ. Activity reports indicate that the extracts exert bactericidal activity on E. coli and S. aureus but bacteriostatic activity on P. aeruginosa. These results justify the use of M. inermis leaves in a traditional environment to treat gastroenteritis.

Over-the-scope-clip closure of long lasting gastrocutaneous fistula after percutaneous endoscopic gastrostomy tube removal in immunocompromised patients:A single center case series

Over-the-scope-clips (OTSC®) have been shown to be an effective and safe endoscopic treatment option for the closure of gastrointestinal perforations, leakages and fistulae. Indications for endoscopic OTSC® treatment have grown in number and also include gastro cutaneous fistula (GCF) after percutaneous endoscopic gastrostomy (PEG) tube removal. Non-healing GCF is a rare complication after removal of PEG tubes and may especially develop in immunosuppressed patients with multiple comorbidities. There is growing evidence in the literature that OTSC® closure of GCF after PEG tube removal is emerging as an effective, simple and safe endoscopic treatment option. However current evidence is limited to the geriatric population and short standing GCF, while information on closure of long standing GCF after PEG tube removal in a younger population with significant comorbidities is lacking. In this retrospective single-center case-series we report on five patients undergoing OTSC® closure of chronic GCF after PEG tube removal. Four out of five patients were afflicted with long lasting, symptomatic fistulae. All five patients suffered from chronic disease associated with a catabolic metabolism (cystic fibrosis, chemotherapy for neoplasia, liver cirrhosis). The mean patient age was 43 years. The mean dwell time of PEG tubes in all five patients was 808 d. PEG tube dwell time was shortest in patient 5 (21 d). The mean duration from PEG tube removal to fistula closure in patients 1-4 was 360 d (range 144-850 d). The intervention was well tolerated by all patients and no adverse events occured. Successful immediate and long-term fistula closure was accomplished in all five patients. This single center case series is the first to show successful endoscopic OTSC® closure of long lasting GCF in five consecutive middle-aged patients with significant comorbidities. Endoscopic closure of chronic persistent GCF after PEG tube removal using an OTSC® was achieved in all patients with no immediate or long-term complications. OTSC® is a promising endoscopic treatment option for this condition with a potentially high immediate and long term success rate in patients with multiple comorbidities.

Evolution and significance of the psychosomatic model in gastroenterology

The biomedical model,which limits itself to finding the attributions of organic disease,is challenged by gastrointestinal(GI)symptoms.Simultaneously,physicians'attribution of GI symptoms to underlying psychological issues is not readily accepted by patients and can negatively affect the clinical rapport between doctor and patient.In reality,psychosocial aspects are involved in many functional disorders and organic diseases,not just in mental disorders.Time is overdue for gastroenterologists to recognise the inadequacy and limitations of conventional gastroenterology and consider the role of psychological,social and biological variables throughout the entire clinical course of the illness,as is shown in George Engel’s model.This review discusses the following:(1)the current challenges of using the conventional clinical model for both functional and organic GI illness,(2)the inadequacy and limitations of explaining GI symptoms simply as psychological disorders,(3)the exploration of the symptom-centred,stepped reattribution clinical model,(4)the clarification of psychosomatic medical concepts for use in gastroenterology,and(5)the significance of a systematic and interdisciplinary framework for a comprehensive psychosomatic model in gastroenterology.

gastro显影葡胺在治疗粘连性小肠梗阻中的作用

Background -This study aimed to determine whether an abdominal radiograph 8 hours after ingesting oral Telebrix Gastro is a reliable marker for non-operative management in patients with adhesive small bowel obstruction. Methods -During a 5-year period (January 1, 1995, through December 31, 2000), 97 patients were admitted for small bowel occlusion due to adhesion with no indication for immediate surgery. All received 100 mL of Telebrix Gastro via gastric tube for small bowel obstruction due to adhesion. If the contrast reached the colon within 8 hours on plain abdominal radiograph, the test was considered to be negative. Results -126 cases of small bowel occlusions were analyzed due to recurring episodes for 11 patients. The test was negative in 113 cases (89.7%), and in this group, only two patients underwent surgery, the remaining being managed non-operatively. The 13 cases (10.3%) with a positive test for occlusion underwent surgery. The sensitivity, specificity and accuracy of the finding of contrast media reaching the colon as an indicator for conservative treatment were 98%, 100%, and 98%, respectively. Conclusions -A water-soluble contrast study can be of significant help in the clinical management of patients suspected of having small bowel obstruction.

Intravenous haloperidol for the treatment of intractable vomiting,cyclical vomiting,and gastroparesis

Dear editor,The incidence of emergency department(ED)visits from gastroparesis and cannabinoid hyperemesis syndrome has increased by two folds over the past decade.[1-3]Roldan et al[4]reported that patients with these conditions often have prolonged ED stays and are likely to be hospitalized because of the danger of dehydration and challenges inherent in relieving symptoms.Opioid analgesia is a particularly troublesome treatment modality;these conditions are often chronic with frequent recurrences,and repeated opiate therapy can cause opioid dependency and narcotic bowel syndrome.[5]Haloperidol(HP)and droperidol,members of the butyrophenone class,have potent antidopaminergic activity in the chemoreceptor trigger zone.[6,7]Intramuscular administration of HP is being used increasingly in the ED to treat nausea,vomiting secondary to gastroparesis,[6]intractable vomiting,[8]and cyclical vomiting.

Research Progress of Different Acupuncture and Moxibustion Methods in the Treatment of GERD(Gastro Esophageal Reflux Disease)

Over the past decade,there have been many clinical reports on acupuncture and moxibustion in the treatment of gastro esophageal reflux disease,which has been an increasing trend year by year.The authors use"acupuncture","acupuncture and moxibustion"or"electric acupuncture"and"GERD"or"gastro esophageal reflux disease"as key words for retrieval.Through the clinical articles on acupuncture and moxibustion methods in the treatment of GERD indexed by China CNKI academic literature database,VPCS database and Wanfang database from 2006 to 2016,we find that:acupuncture and moxibustion methods in the treatment of GERD has definite curative effect and outstanding advantages.It can better improve the symptoms of patients and can effectively improve their quality of life.At present,in clinical applications,there are treatment ideas such as the method of acupuncture on governor vessel back segment,the old ten needles,and compatibility of five meridians in the aspect of acupoint selection;there are treatment ideas such as fire acupuncture,thread-embedding,and electric acupuncture in the aspect of method of needling and moxibustion;there are treatment ideas such as acupuncture and moxibustion combined with pinellia ternate Xiexin Decoction,Chinese herb bath,deanxit(flupentixol and melitracen tablets)in the aspect of acupuncture and medicinal treatment.This paper comb integration of the current variety of therapies,in order to allow readers to obtain a more comprehensive clinical diagnosis and treatment ideas of gastro esophageal reflux disease.

Complications after pediatric percutaneous endoscopic gastrostomy: comparison of the push and pull technique

Purpose Various complications are associatedwith percutaneous endoscopic gastrostomy(PEG)procedures in children.The push technique is being increasingly used,but its complications are insufficiently characterized.We aimed to assess all complications related to PEG procedures and compare the safety of the pull and push techniques.Methods Retrospective review of consecutive pediatric patients who underwent PEG between 2002 and 2020.Results In total,216 children underwent 217 PEG procedures.The push technique was used in 138(64%)cases,and the pull technique in 79(36%)cases.The median follow-up time was 6.1(0.1-18.3)years.The complication rate was high(57%)and patients experienced complications years after the procedure.Overall,51%and 67%of patients experienced complications in the push and pull groups,respectively.The rates of minor and major complications were higher in the pull group than in the push group(63%vs 48%,p=0.028;and 11%vs 6%,p=0.140,respectively).Reoperation was also more common in the pull group(17%vs 7%,p=0.020).Conclusions The overall complication rate of PEG procedures is high.Fortunately,most complications are mild and do not require reoperations.The increasing push technique appears to be safer than the traditional pull technique.Significant long-term morbidity is related to gastrostomies in children.

Effects of electroacupuncture at "Jiaji"(EX-B 2)combined with neurodynamic mobilization on gastrocnemius muscle atrophy and expression of NF-κB and MuRF1 in rabbits after sciatic nerve injury

Objective To observe the effects of electroacupuncture(EA) at"Jiaji"(EX-B 2) combined with neurodynamic mobilization (NM) on the cross-sectional area of the gastrocnemius muscle fibers after sciatic nerve injury in rabbits,and the expression of nuclear factor-κB (NF-κB) and muscle-specific ring-finger protein 1 (MuRF1).

用GastroPlus软件模拟技术评价头孢地尼胶囊制剂的有效性

目的:评价国产头孢地尼胶囊制剂的有效性。方法:通过溶出度实验考察国产仿制头孢地尼胶囊在不同介质中的溶出行为,并同日本橙皮书中的参比制剂和当前市场中的原研产品相比较,采用Gastro Plus软件模拟药物在体内具有不同释放速率时的体内吸收情况。结果:不管是仿制品还是当前市场中的原研产品,头孢地尼胶囊的制剂工艺与日本橙皮书中的参比胶囊剂的制剂工艺已经完全不同,释放速率在延长至T85%=45 min时,头孢地尼口服制剂同头孢地尼溶液仍具有生物等效性。结论:目前市场中的头孢地尼胶囊在体内45 min内的累积溶出量均可达到85%以上;虽然与日本橙皮书中的参比胶囊剂不具有生物等效性,但与日本橙皮书中的参比颗粒剂具有生物等效性,故它们均为有效制剂。

盐酸地芬尼多片溶出度测定一致性评价及体内外相关性的研究

目的:研究评价国产盐酸地芬尼多片与参比制剂的体外溶出一致性,并分析体内外相关性。方法:参照中国药典2015年版方法,分别测定3批国产制剂与参比制剂在4种不同溶出介质(pH 1.2盐酸溶液、pH 4.0醋酸盐溶液、pH 6.8磷酸盐溶液、水)中的溶出度,绘制溶出曲线,采用相似因子(f2)法分析国产制剂与参比制剂的溶出曲线相似性。借助Gastroplus^TM软件结合体外溶出试验结果,建立盐酸地芬尼多片体内外相关性模型。结果:国产仿制制剂在4种溶出介质中的溶出行为与参比制剂不一致,f2法不适用于盐酸地芬尼多片的体外溶出一致性分析。软件分析结果提示体外溶出曲线与软件模拟的体内行为不相似。结论:国产盐酸地芬尼多制剂质量有待提高,溶出一致性评价方法待进一步研究。

国产盐酸文拉法辛缓释胶囊的虚拟生物等效性

目的采用溶出度实验结合计算机模拟技术,对国产盐酸文拉法辛缓释胶囊进行虚拟生物等效研究。方法以高效液相色谱(HPLC)法测定溶出曲线来比较2家国产企业盐酸文拉法辛缓释胶囊与原研制剂在4种不同溶出介质中体外溶出行为的差异;采用Gastro plus TM软件预测国产盐酸文拉法辛缓释胶囊的体内药动学曲线,从而进行虚拟生物等效研究。结果各溶出介质条件下国产盐酸文拉法辛缓释胶囊与原研制剂的f 2因子均>50,无区分性,而Gastro plus TM软件模拟结果为企业1制剂与原研制剂不等效,企业2制剂与原研制剂等效。结论对于盐酸文拉法辛缓释胶囊,仅以f 2因子法判断其与原研制剂之间的相似性不够准确,而Gastro plus TM软件可预测其与原研制剂的虚拟生物等效性,可提示企业改进工艺以确保与原研制剂质量疗效的一致。

国产硝苯地平缓释片的体外溶出度和虚拟生物等效性研究

目的:通过体外溶出试验考察4种国产硝苯地平缓释片的质量一致性,并利用GastroPlus软件进行虚拟生物等效性研究。方法:采用日本橙皮书和中国药典的溶出方法,测定不同厂家硝苯地平缓释片的溶出曲线,利用溶出曲线相似性f2因子法比较溶出曲线相似性。将原研制剂的体外溶出度数据与GastroPlus软件结合计算得到模拟的药物体内吸收曲线,通过与文献实测值比较,选择体内外相关性良好的溶出介质;采用选定的溶出介质进行国产硝苯地平缓释片的溶出试验,得到模拟的体内吸收参数,与原研制剂比较,进行虚拟生物等效性评价。结果:两种溶出方法的考察结果显示,4种国产制剂与原研制剂的f_2因子均小于50;与日本橙皮书方法相比,采用中国药典方法得到的原研制剂溶出曲线的体内外相关性更好。4种国产硝苯地平缓释片的药动学参数C_(max)及AUC_(0~∞)模拟值与原研药的实测值相差在±20%以内。结论:4种国产硝苯地平缓释片与原研制剂相比,体外溶出曲线不相似,但体内模拟生物等效。

国内外阿那曲唑片溶出曲线相似性评价及采用GastroPlus^(TM)建立体内外相关性模型的研究

目的建立阿那曲唑片新溶出度检查方法,研究阿那曲唑的溶出行为,评价国内3家片剂产品与原研片溶出曲线的相似性;并建立体内外相关性模型,预测口服阿那曲唑片的药动学参数,评价其生物等效性。方法新溶出度检查方法:桨法,50 r·min^(-1),溶出介质为水900 mL,30 min取样,HPLC测定,限度为标示量的80%。通过Gastro PlusTM软件,结合体外溶出实验结果,建立体内外相关性模型。结果新建立的溶出度检查方法在0.22~1.10μg·mL^(-1)内与峰面积呈良好的线性关系,平均回收率为99.3%(RSD=0.8%,n=9)。国内3家制药公司产品与原研样品在4种溶出介质中的溶出曲线均相似。溶出曲线与软件模拟的体内行为非常相似,吻合度较高。结论采用浆法,转速为50 r·min^(-1),能有效的控制本品的质量。通过体内外相关性的分析,可见建立的体外溶出方法能较好地体现阿那曲唑片在体内的溶出行为。

十例食管癌并食管气管瘘患者经皮内镜下胃造瘘术的护理

目的:观察内镜下胃造瘘术的临床疗效及探讨PEG相关的护理要点、并发症的预防和处理。方法:观察患者行PEG前后的营养指标变化,即体重、血清白蛋白、转铁蛋白、外周血淋巴细胞总数。并在PEG前后对其进行术前心理护理、术中严密观察病情、术后对皮肤、造瘘管护理及指导营养液配制、并发症的观察及处理。结果:PEG术后,患者营养状况均明显改善,平均体重增加4.14kg,BMI平均增加1.1kg/m2,血清白蛋白升高3.8g/L、血清转铁蛋白升高0.73g/L,其它的营养指标均有不同程度升高。结论:PEG能有效地改善各种不能经口进食患者营养状况,不同程度地提高了生活质量,是一种安全、有效、简便的胃造瘘方法。熟练置管技术、术后掌握造瘘管正确的管饲方法是保证PEG成功及预防或减少并发症的关键。

Eosinophilic esophagitis

Eosinophilic esophagitis is increasingly recognized in adults. The diagnosis is based on the presence of both typical symptoms and pathologic findings on esophageal biopsy. Patients usually present with dysphagia, food impaction and/or reflux-like symptoms, and biopsy of the esophagus shows more than 15 eosinophils per high-power fi eld. In addition, it is essential to exclude the presence of known causes of tissue eosinophilia such as gastroesophageal reflux disease, infections, malignancy, collagen vascular diseases, hypersensitivity, and inflammatory bowel disease. There are no standardized protocols for the therapy of eosinophilic esophagitis. A variety of therapeutic approaches including acid suppression, dietary modifications, topical corticosteroids and endoscopic dilation can be used alone or in combination.

Association of endothelial nitric oxide synthase gene T-786C promoter polymorphism with gastric cancer

AIM: To investigate the role of endothelial nitric oxide synthase-786 T > C promoter polymorphism in the etiology of gastric cancer(GC). METHODS: A total of 150 GC patients and 150 control subjects were included in the study. The information on demographic features was elicited with an informed consent from all the patients and control subjects using a structured questionnaire. Helicobacter pylori(H. pylori) infectivity status was tested in antral biopsies from all the subjects by rapid urease test following the method of Vaira et al. Genomic DNA was isolated from whole blood samples following the salting out method of Lahiri et al. Genotype analysis of the rs2070744 polymorphism was carried out by allele-specific polymerase chain reaction method. The genotypes were determined based on the appearance of bands on an agarose gel stained with ethidium bromide under ultraviolet gel documentation with the help of 100 bp ladder. Odds ratios and corresponding 95%CIs were determined using java stat online software. RESULTS: There was a significant difference in the distribution of C allele(C vs T; P = 0.000, OR = 5.038) in patient group compared to the control subjects exhibiting a fivefold increased risk for GC. When the T/T and C/C genotypes were compared, there was an enhanced GC risk for individuals with C/C genotype(T/T vs C/C; P = 0.000). Among the demographic factors, smoking and alcoholism were the common risk factors in patients compared to the control subjects(P < 0.05). Patients with smoking and alcoholism developed cancer even in heterozygous T/C condition(smoking: P = 0.020 and alcoholism: P = 0.005). Individuals with H. pylori infection showed seven fold increased risk for cancer. All the patients with C/C genotype revealed a significant association between H. pylori infection and GC. Among the patients 2.4% of them revealed familial incidence of GC. No significant difference was noticed between cases and controls with regard to consanguinity(P = 0.473).CONCLUSION: The Present data suggest that eN OS-786 C/C genotype and C allele may be considered as potential risk factors in patients with GC.

ANALGESIC EFFECT OF ACUPUNCTURE ON ACUTE INTESTINAL COLIC IN 190 CASES

Acute intestinal colic is a common clin-ical emergency.The author treated thissyndrome with acupuncture on bilateralZusanli(St 36)points with satisfactoryanalgesic results reported as follows.

CLINICAL APPLICATION OF MOVING CUPPING ON THE BACK

Movine cupping, also called pulling cup-ping, refers to the therapeutic method withcharacteristics of moving the sucked cup so as toenlarge the stimulated area and enhance thestimulus, Moving cupping on back is one kind ofthe moving cupping methods, in which thesucked cup is moved along the running routes ofDumai and Urinary Bladder Meridians. It hasbeen approved clinically as a effective way totreat wide range of diseases in the respiratorysystem, cardio-vascular system, gastro-intesti-nal system and nervous system. It is also impor-tant for the diagnosis and prognosis of the dis-eases.

Eosinophilic esophagitis-endoscopic distinguishing findings

Eosinophilic esophagitis （EE） is the most frequent con- dition found in a group of gastrointestinal disorders called eosinophilic gastrointestinal diseases. The hypo- thetical pathophysiological mechanism is related to a hypersensitivity reaction. Gastroesophageal reflux dis- ease-like complaints not ameliorated by acid blockade or occasional symptoms of dysphagia or food impac- tion are likely presentations of EE. Due to its unclear pathogenesis and unspecific symptoms, it is difficult to diagnose EE without a strong suspicion. Although histo- togical criteria are necessary to diagnosis EE, there are some characteristic endoscopic features. We present the case of a healthy 55-year-old woman with dyspha- gia and several episodes of esophageal food impaction over the last six months. This case report stresses the most distinguishing endoscopic findings-mucosa rings, white exudative plaques and linear furrows-that can help in the prompt recognition of this condition.

Jejunal Stromal Tumor Revealed by a Digestive Hemorrhage

Introduction: Gastro intestinal stromal tumors are rare which can arise at any age, mostly between 50 and 60 years old. They are characterized by the expression on the surface of their cells, a specific gene c-kit. They can be located in any segment of the digestive tract, with a preference for the stomach (60%). The jejunum location is found in 200% to 30% of the cases. The originality of our observation is the revelation of a stromal jejunum tumor by a digestive bleeding. Case Report: A 71-year-old man was admitted in emergencies for a low digestive plentiful bleeding with state of hypovolemia shock. Result: The operation was performed after stabilization of his dynamic state and blood transfusion and we discovered a jejunal stromal tumor in operation. The follow-up was simple with a good evolution under treatment by Imatinib. Conclusion: Stromal digestive tumors are rare which can interest all the segments of the digestive tract and their diagnosis must be often evoked in front of any digestive bleeding.