Choice of laxatives and colonoscopic preparation in pregnant patients from the viewpoint of obstetricians and gastroenterologists

AIM： To elucidate the preferences of gastroenterologists at our institution and compare them to those of obstetricians when making decisions in the pregnant patient, including which type of bowel preparations to use for flexible sigmoidoscopy or colonoscopy, as well as which laxatives can be used safely.METHODS： Surveys were mailed to all attending gastroenterologists （n = 53） and obstetricians （n = 99） at our institution. Each survey consisted of the 14 most common laxative or motility agents used in pregnancy and inquired about the physician＇s prescribing habits in the past as well as their willingness to prescribe each medication in the future. The survey also listed four common bowel preparations used prior to colonoscopy and sigmoidoscopy and asked the physician to rank the order of the preferred agent in each case.RESULTS： With regard to common laxatives, both gastroenterologists and obstetricians favor the use of Metamucil, Colace, and Citrucel. Both groups appear to refrain from using Fleets Phosphosoda and Castor oil. Of note, obstetricians are less inclined to use PEG solution and Miralax, which is not the case ,with gastroenterologists. In terms of comparing bowel preparations for colonoscopy, 50% of gastroenterologists prefer to use PEG solution and 50% avoid the use of Fleets Phosphosoda. Obstetricians seem to prefer Fleets Phosphosoda （20%） and tend to avoid the use of PEG solution （26%）. With regard to bowel preparation for sigmoidoscopy, both groups prefer Fleets enema the most （51%）, while magnesium citrate is used least often （38%）.CONCLUSION： It is clear that preferences in the use of bowel cleansing preparations between the two groups exist, but there have not been many case controlled human studies in the pregnant patient that give clear cut indications for using one versus another drug. In light of the challenge of performing controlled trials in pregnant women, more extensive surveys should be undertaken to gather a larger amount of data on physicians＇ experiences and individual preferences.

Hyperphosphatemia after sodium phosphate laxatives in low risk patients:Prospective study

AIM:To establish the frequency of hyperphosphate-mia following the administration of sodium phosphate laxatives in low-risk patients. METHODS:One hundred consecutive ASAⅠ-Ⅱindividuals aged 35-74 years,who were undergoing colonic cleansing with oral sodium phosphate(OSP) before colonoscopy were recruited for this prospective study.Exclusion criteria:congestive heart failure, chronic kidney disease,diabetes,liver cirrhosis,intestinal obstruction,decreased bowel motility,increased bowel permeability,and hyperparathyroidism.The day before colonoscopy,all the participants entered a 24-h period of diet that consisted of 4 L of clear fluids with sugar or honey and 90 mL(60 g)of OSP in two 45-mL doses,5 h apart.Serum phosphate was measured before and after the administration of the laxative. RESULTS:The main demographic data(mean±SD) were:age,58.9±8.4 years;height,163.8±8.6 cm; weight,71±13 kg;body mass index,26±4;women, 66%.Serum phosphate increased from 3.74±0.56 to 5.58±1.1 mg/dL,which surpassed the normal value (2.5-4.5 mg/dL)in 87%of the patients.The highest serum phosphate was 9.6 mg/dL.Urea and creatinine remained within normal limits.Post-treatment OSP se-rum phosphate concentration correlated inversely with glomerular filtration rate(P<0.007,R 2=0.0755),total body water(P<0.001,R 2=0.156)and weight(P< 0.013,R 2=0.0635). CONCLUSION:In low-risk,well-hydrated patients, the standard dose of OSP-laxative-induced hyperphos-phatemia is related to body weight.

Review of efficacy and safety of laxatives use in geriatrics

AIM:To study the efficacy and safety of pharmacolo-gical treatment of constipation in geriatrics.METHODS:Pub Med,MEDLINE,google scholar,and Ovid were searched to identify human studies performed on the use of laxatives in elderly with constipation,which were conducted between January1990 and January 2013 using the specified keywords.Controlled studies that enrolled geriatric patients with a diagnosis of constipation and addressed the efficacy and/or the safety of pharmacological treatments were included.Studies were excluded from this review if they were non-controlled trials,case series,or case reports.RESULTS:Out of twenty three studies we initially retrieved in our search,only nine studies met the eligibility criteria of being controlled trials within geriatrics.The laxatives examined in the nine studies were senna,lactulose,sorbital,polyethylene glycol(PEG),lubiprostone,linaclotide,and prucalopride.In those studies,senna combinations had a higher efficacy than sorbitol or lactulose as well as,a very good adverse effect profile.PEG was also shown to be safe and effective in geriatric population.Furthermore,it has been shown that PEG is as safe in geriatrics as in general population.New agents like lubiprostone and prucalopride show promising results but the data about these agents in geriatrics are still limited which warrant further investigation.CONCLUSION:Senna combinations and PEG appear to have a more favorable profile over the other traditionally used laxatives in elderly patients with constipation.

Comparison of the chloride channel activator lubiprostone and the oral laxative Polyethylene Glycol 3350 on mucosal barrier repair in ischemic-injured porcine intestine

AIM： To investigate the effects of lubiprostone and Polyethylene Glycol 3350 （PEG） on mucosal barrier repair in ischernic-injured porcine intestine. METHODS： Ileum from 6 piglets （approximately 15 kg body weight） was subjected to ischemic conditions by occluding the local rnesenteric circulation for 45 min in vivo. Ileal tissues from each pig were then harvested and mounted in Ussing chambers and bathed in oxygenated Ringer＇s solution in vitro. Intestinal barrier function was assessed by measuring transepithelial electrical resistance （TER） and mucosal-to-serosal fluxes of ^3H-rnannitol and ^14C-inulin. Statistical analyses of data collected over a 120-min time course included 2-way ANOVA for the effects of time and treatment on indices of barrier function. RESULTS： Application of 1μmol/L lubiprostone to the rnucosal surface of ischemic-injured ileum in vitro induced significant elevations in TER compared to nontreated tissue. Lubiprostone also reduced mucosal-toserosal fluxes of ^3H-rnannitol and ^14C-inulin. Alternatively, application of a polyethylene laxative （PEG, 20 rnmol/L） to the mucosal surface of ischernic tissues significantly increased flux of ^3H-rnannitol and ^14C-inulin. CONCLUSION： This experiment demonstrates that lubiprostone stimulates recovery of barrier function in ischemic intestinal tissues whereas the PEG laxative had deleterious effects on mucosal repair. These results suggest that, unlike osmotic laxatives, lubiprostone stimulates repair of the injured intestinal barrier.

Comparative Study on Effects of Rheum officinale and Wine Prepared Rheum palmatum Dachengqi Decoction on Laxative Effect of Mice

[Objectives] To study the differences in the effects of Rheum officinale and wine prepared Rheum palmatum Dachengqi Decoction(DCQ) on laxative effect of mice.[Methods]First,72 mice were randomly divided into positive control group,blank control group,6 and10 g/kg dose R.officinale DCQ groups,6 and 10 g/kg dose wine prepared R.palmatum DCQ groups.After administration at the dose of20 m L/kg,metabolic cage method and carbon powder propulsion were used to conduct Na+-K+-ATPasc activity experiment,and the comparison was made for the differences in the normal laxative effect of R.officinale and wine prepared R.palmatum on DCQ,the carbon powder propulsion rate,and Na+-K+-ATPasc activit.[Results]There are differences in the laxative effect of R.officinale and wine prepared R.palmatum on DCQ,but their differences in changes are,to some extent,connected with R.officinale and wine prepared R.palmatum.From comparison of R.officinale DCQ group,wine prepared R.palmatum DCQ group,blank control group,and positive control group,it is found that there are differences in the normal laxative effect of normal mice,carbon powder propulsion,and inhibition of Na+-K+-ATPase activity.In addition,the comparison of drug administration groups indicates that the differences in the effects of R.officinale DCQ group are most significant,and there are significant differences in the 6 and 10 g/kg groups.[Conclusions]There are certain differences in the influence of R.officinale and wine prepared R.palmatum Dachengqi Decoction on normal laxative effect of mice,which may be connected with the fact that changes in main chemical components of king drugs R.officinale and wine prepared R.palmatum lead to changes in the dissolution amount of anthraquinones in the compound Dachengqi Decoction.

Identification of the multiple bioactive derivatives and their endogenous molecular targets that may mediate the laxative effect of rhubarb in rats

Objective:To determine the mechanism of the laxative effect of rhubarb(Rheum tanguticum Maxim.ex Balf.)in rats using a combined bioinformatic and in vivo approach.Methods:Substances derived from rhubarb that are present in the colorectum were identified using high-performance liquid chromatography,coupled with linear ion-trap quadrupole Orbitrap highresolution mass spectrometry.The targets with a potential laxative effect were identified from databases and the literature,then used with rhubarb-derived substances in molecular docking modeling.The expression of candidate endogenous target molecules that bound specific components of rhubarb was then measured in constipated rats that had or had not been administered rhubarb by western blotting.Finally,potentially bioactive compounds were traced back to their prototype components.Results:We identified 17 anthraquinones and 21 anthrones derived from rhubarb in the colorectum of rats.G-scoring identified three potential mediators of the laxative effect:c-kit,5-hydroxytryptamine receptor 4(5-HT4),and aquaporin-3(AQP3).In addition,10 rhubarb-derived components(aloeemodin,emodin,rhein,chrysophanol,physcion,sennoside A,sennoside C,physcionanthrone,aloeemodinanthrone,and rheinanthrone),which have strong binding affinities for more than one of the three potential targets,were selected as likely active compounds.Rhubarb extract increased the expression of c-kit and 5-HT4,and reduced the expression of AQP3 in the colon of constipated rats,which might mediate its laxative effect.We also found that a single prototype component may be metabolized into several active metabolites,and a single active ingredient can also be generated from various prototype compounds.Conclusion:The present study demonstrates that various anthraquinones and anthrones present in rhubarb may be metabolized to form bioactive compounds that have additive or synergistic effects to promote defecation via c-kit,5-HT4 and/or AQP3.

Beverage intake preference and bowel preparation laxative taste preference for colonoscopy

AIM: To examine whether non-alcoholic beverage intake preferences can guide polyethylene glycol(PEG)-based bowel laxative preparation selection for patients.METHODS: We conducted eight public taste test sessions using commercially procured(A) unflavored PEG,(B) citrus flavored PEG and(C) PEG with ascorbate(Moviprep). We collected characteristics of volunteers including their beverage intake preferences. The volunteers tasted the laxatives in randomly assigned orders and ranked the laxatives as 1st, 2nd, and 3rd based on their taste preferences. Our primary outcome is the number of 1st place rankings for each preparation. RESULTS: A total of 777 volunteers completed the study. Unflavored PEG was ranked as 1st by 70(9.0%), flavored PEG by 534(68.7%) and PEG with ascorbate by173(22.3%) volunteers. Demographic, lifestyle characteristics and beverage intake patterns for coffee, tea, and carbonated drinks did not predict PEG-based laxative preference.CONCLUSION: Beverage intake pattern was not a useful guide for PEG-based laxative preference. It is important to develop more tolerable and affordable bowel preparation laxatives for colonoscopy. Also, patients should taste their PEG solution with and without flavoring before flavoring the entire gallon as this may give them more opportunity to pick a pattern that may be more tolerable.

The enlightenment and application of“Laxative method used in early stage of Febrile Disease”in treating COVID-19

The theory of the TCM laxative method is rich in content.Doctors of past dynasties have used it to treat febrile diseases.And the theory of“Laxative method used in early stage of Febrile Disease”has been praised by later generations.It advocates chasing away evil influence early and paying attention to the laxative method to prevent the spread of disease.the Novel Coronavirus(COVID-19)Infectious Pneumonia belongs to the category of"epidemic"in traditional Chinese medicine.The reasonable application of the cathartic is an important way to provide a way out for evil.However,don’t be blind to use laxative method,you should get it at the right time.The treatment of COVID-19 has different solution at different stages.You should adapt to the changes of the disease to use cathartic.A case in here is attached for reference.

Laxative Effect of Eugenia Jambolana Crude Leaf Bud Extract

The therapeutic value of Eugenia jambolana Lam. commonly known as ‘Jamun’ has been recognized in different system of traditional medication for the treatment of different diseases and ailments. It contains several phytoconstituents belonging to category of alkaloids, glucosides, flavonoides and volatile oils. It has been reported as digestive, astringent to the bowels, anthelmintic, sore throat, bronchitis, asthma, thirst, biliousness, dysentery, blood purifier, ulcers and diabetes. There are few reports available on clinical uses of Eugenia jambolana in diabetes that have shown promising results. In south India ayurvedic practitioners were using the leaf buds of Eugenia jambolana to induce laxative effect and to clean up the intestinal contents before starting any medication. The result showed that of E. jambolana stimulates the contractile action of frog and mice through an acetylcholine-like mechanism and effectively stimulates gastrointestinal motility in mice and frogs. In this paper we have discussed the laxative effect of Eugenia jambolana leaf bud extract which was never reported scientifically.

Effects of Prophylactic Laxatives for Opioid-Induced Constipation on Constipation Severity and Quality of Life among Patients with Cancer

Background: To reduce patients’ unnecessary suffering, Opioids Induced Constipation (OIC) should be identified and treated as early as possible with the most current treatment. Aims: to investigate the effectiveness of prophylactic laxatives in reducing the severity of OIC and its impact on cancer patients’ quality of life. Methods: A Randomized Clinical Trial design was used. 57 cancer patients from one oncology clinic at a governmental hospital participated in the study. Patients in the intervention groups were given an oral colonic stimulant laxative (i.e. Bisacodyl, Dose = 3 tab/day) or an oral colonic osmotic laxative (i.e. Lactulose, Dose = 15 ml three times per day), while patients in the control continue receiving their routine care as usual. Results: A significant decrease in the severity of constipation symptoms among the intervention group at four weeks post-intervention was noted (p Conclusions: It can be concluded that the use prophylactic of first line laxatives concurrently with opioids decreased the severity of OIC and improved the QOL for cancer patients.

Diphenyl methane laxatives do not induce electrolyte imbalance

Aim: To analyse whether there are changes in sodium and potassium serum levels during chronic treatment with the diphenyl methanes bisacodyl and sodium picosulfate. Methods: A literature search was done using PubMed, and the reference lists of pertinent papers were screened for additional studies. Only studies of at least 4 weeks duration were considered for further analysis. Results: Four relevant studies were identified. In three randomised controlled trials with 5 to 10 mg daily of bisacodyl or sodium picosulfate, respectively, over four weeks no electrolyte losses were found. Hypokalemia was also not a problem in a group of patients with paraplegia using bisacodyl suppositories for 2 to 34 years. Conclusions: Electrolyte losses, particularly hypokalemia, are not a problem when bisacodyl or sodium picosulfate are used long-term.

Current Status of Clinical Application and Basic Research on Draba nemerosa Hebecarpa Jujube Lung-Diarrhoea Soup

The clinical application and basic research of Draba nemerosa Hebecarpa jujube diarrhoea lung soup focus on respiratory diseases and circulatory diseases, and its clinical application is more compared with the basic research, and Draba nemerosa Hebecarpa jujube diarrhoea lung soup is mostly used in the form of “Draba nemerosa Hebecarpa Hebecarpa jujube diarrhoea lung soup with additional subtractions or other formulas combining Draba nemerosa Hebecarpa Hebecarpa Hebecarpa jujube diarrhoea lung soup” in the clinical application. This article will focus on the main mechanisms of Draba nemerosa Hebecarpa jujube diarrhoea lung soup and its main components in the treatment of respiratory and circulatory diseases, and will give a review of the basic research on Draba nemerosa Hebecarpa Hebecarpa jujube diarrhoea lung soup as follows.

α-螺旋蛋白中三分量高阶非线性薛定谔方程的怪波解

以三分量高阶非线性薛定谔方程为α-螺旋蛋白中生物能量沿蛋白质分子链传输的控制方程,研究三个相互耦合的波函数在极限状态下激发的怪波.基于控制模型的Lax对表示,利用规范变换得到了达布变换的行列式形式.通过Lax对的变量分离和平移参数的引入,给出了怪波激发的代数条件.进一步利用幂级数的多项分裂构造怪波解的基础特征函数,并由此导出退化的达布变换.最后通过退化的达布变换获得怪波解,并在不同参数下,用三维图形示例怪波的波形演化及其极值轨迹.

Jimbo-Miwa-Like方程的Lax可积性研究

基于双Bell多项式方法,将Jimbo-Miwa-Like方程化为双线性形式,运用Bell多项式的相关性质,构造出方程的双Bell多项式B?cklund变换、双线性B?cklund变换、Lax对、无穷守恒律和孤子解。运用试探函数法和符号计算软件Mathematica获得方程的复合型解,并选取适当的参数,绘制一部分精确解的图像来说明性质。

Evaluation of diuretic and laxative activity of hydro-alcoholic extract of Desmostachya bipinnata(L.) Stapf in rats

OBJECTIVE： In continuation to the growing evidence for therapeutical potential of Desmostachya bipinnata （Linn） Stapf, the current pharmacological study was carried out to evaluate the diuretic and laxative activity of its hydro-alcoholic extract in rats. METHODS： The hydro-alcoholic extract of D. bipinnata whole plant was prepared by using Sox- hlet extractor and subjected to analysis by standard preliminary phytochemical tests. Evaluation of both diuretic and laxative activity was carried out using standard methods as reported earlier. Frusemide （20 mg/kg） was served as positive control for diuretic activity and sennosides （10 mg/kg） served as negative control for laxative activity. RESULTS： The hydro-alcoholic extract showed significant diuretic activity and was found to be the most potent in increasing the urinary output at 500 mg/kg when the effect was compared with that of the standard frusemide （P〈0.01）. Moreover, this extract was found to be most effective in increasing urinary electrolyte concentration （Na＋, K＋, and Cl-） at both doses tested. Whereas the results for laxative activity showed minimal increase of feces output at the dose of 500 mg/kg and the increase was negligible when compared with that of the standard drug sennosides. CONCLUSION： Altogether, the above significant findings validate and support its folkloric diuretic use and lend pharmacological credence to the ethno-medical use of this plant in traditional system of medicine, which demands further studies to investigate its active constituents, as well as its use and safety.

In vivo laxative, anti-diarrheal, hepatoprotective and diuretic investigations of Sterculia diversifolia and its isolated compounds

OBJECTIVE:To investigated the laxative,anti-diarrheal,hepatoprotective and diuretic activity of Sterculia diversifolia and its isolated compounds.METHODS:The laxative activity was studied by counting wet stools while anti-diarrheal activity was performed by measuring gastrointestinal tract motility.Hepatoprotective activity was studied by biochemical and histo-pathological analysis while diuretic activity was performed by urine collection protocol.RESULTS:Doses of 30 and 100 mg/kg of crude methanolic extract of Sterculia diversifolia(MESD)stem bark and leaves,significantly(P<0.05,P<0.01)produced wet feces in subjects pretreated with atropine while 8-hydroxyquercetin and dihydroquercetin showed highly significant(P<0.001)results by increasing fecal weight and water contents without producing diarrhea.MESD stem bark and leaves also dose-dependently lowered diar-rhea while 8-hydroxyquercetin and dihydroquercetin showed highly significant(P<0.001)results by producing shaped stools in mice.MESD,8-hydroxyquercetin and dihydroquercetin offered significant protection against histopathological changes in the liver.Diuretic activity of Crude MESD stem bark and leaves extracts shows highly significant diuretic effect while dihydroquercetin showed better results than 8-hydroxyquercetin.CONCLUSION:It is concluded that Sterculia diversifolia and its isolated compounds bears laxative,anti-diarrheal,hepatoprotective and diuretic effects.

Higher-dimensional Chen-Lee-Liu equation and asymmetric peakon soliton

Integrable systems play a crucial role in physics and mathematics.In particular,the traditional(1+1)-dimensional and(2+1)-dimensional integrable systems have received significant attention due to the rarity of integrable systems in higher dimensions.Recent studies have shown that abundant higher-dimensional integrable systems can be constructed from(1+1)-dimensional integrable systems by using a deformation algorithm.Here we establish a new(2+1)-dimensional Chen-Lee-Liu(C-L-L)equation using the deformation algorithm from the(1+1)-dimensional C-L-L equation.The new system is integrable with its Lax pair obtained by applying the deformation algorithm to that of the(1+1)-dimension.It is challenging to obtain the exact solutions for the new integrable system because the new system combines both the original C-L-L equation and its reciprocal transformation.The traveling wave solutions are derived in implicit function expression,and some asymmetry peakon solutions are found.

椭圆链式KP系统的可积性分析

我们以前已经深入研究了求解椭圆链式KP方程的直接线性化方法,而求解该方程的柯西矩阵方法只是近年来的一个热门主题。本文将讨论基于柯西矩阵方法的椭圆链式KP方程的可积性,为下一步的求解做准备。本文首先从辅助向量u(2i)=(IXC)−1Pic出发得到椭圆链式KP系统的lax组,然后从Lax组中推导出椭圆链式KP系统来完成闭环。

An Eight Component Integrable Hamiltonian Hierarchy from a Reduced Seventh-Order Matrix Spectral Problem

We present an eight component integrable Hamiltonian hierarchy, based on a reduced seventh order matrix spectral problem, with the aim of aiding the study and classification of multicomponent integrable models and their underlying mathematical structures. The zero-curvature formulation is the tool to construct a recursion operator from the spatial matrix problem. The second and third set of integrable equations present integrable nonlinear Schrödinger and modified Korteweg-de Vries type equations, respectively. The trace identity is used to construct Hamiltonian structures, and the first three Hamiltonian functionals so generated are computed.

Functional constipation in children:What physicians should know

Functional constipation(FC)is considered the most common functional gastrointestinal disorder in children with a pooled global prevalence of 14.4%(95%confidence interval:11.2-17.6)when diagnosed based on the Rome IV criteria.Its pathophysiological mechanisms are thought be multifactorial and complicated,resulting in difficult management.Currently,the most effective medication,when used in parallel with toilet training,is osmotic laxatives.Children’s adherence to medication and parental concern regarding long-term laxative use are the main contributors to treatment failure.Recently,novel therapies with a high safety profile have been developed,such as probiotics,synbiotics,serotonin 5-hydroxytryptamine 4 receptor agonists,chloride channel activators,and herbal and transitional medicines;nonetheless,well-designed research to support the use of these therapies is needed.This review aims to focus on multiple aspects of FC in children,including global prevalence,pathogenesis,diagnostic criteria,tools,as well as conventional and novel treatment options,such as non-pharmacological management,including adequate fiber and fluid intake,physiotherapy,or neuromodulators.We also report that in very difficult cases,surgical intervention may be required.