Diarrheal Diseases: A Review on Gastroenteritis Bacteria Global Burden and Alternative Control of Multidrug-Resistant Strains

Diarrheal diseases represent a significant and pervasive health challenge for humanity. The aetiology of diarrheal diseases is typically associated with the presence of enteropathogens, including viruses, bacteria and parasites. The implementation of preventive measures, including the maintenance of good food hygiene, effective water sanitation, and the development of rotavirus vaccines, has resulted in a notable reduction in the prevalence of the disease. However, the emergence of bacterial multidrug resistance due to the past or present inappropriate use of antibiotics has rendered bacterial infections a significant challenge. The objective of this review is threefold: firstly, to provide an overview of diarrheal diseases associated with bacteria;secondly, to offer a concise analysis of bacterial multidrug resistance on a global scale;and thirdly, to present the potential of filamentous fungi as an alternative solution to the challenge posed by multidrug-resistant strains. Campylobacter spp. is the most dangerous bacteria, followed by Shigella spp. and Vibrio cholerae in all age groups combined. However, Shigella spp. was the deadliest in children under five years of age and, together with E. coli, are the most antibiotic-resistant bacteria. With their highly developed secondary metabolism, fungi are a reservoir of natural bioactive compounds.

Based on network pharmacology,molecular docking and experimental validation to reveal the potential molecular mechanism of quercetin for the treatment of diarrheal irritable bowel syndrome

Objective:To explore the potential mechanism of action of quercetin in the treatment of diarrhea irritable bowel syndrome(IBS-D).Methods:The potential targets of quercetin were obtained from the TCMSP,SwissTar-getPrediction,and BATMAN-TCM databases.The targets of IBS-D were obtained by searching the GeneCards database with"diarrhea irritable bowel syndrome"as the keyword,and the targets of quercetin and IBS-D were intersected.The PPI network was constructed by Cytoscape 3.7.1 software.The intersected targets were imported into the DAVID database for GO functional analysis and KEGG pathway enrichment analysis.The binding ability of quercetin to the core targets was observed using molecular docking.Based on this,we established an IBS-D rat model,administered quercetin for intervention,and experimentally validated the network pharmacology prediction results by HE staining and ELISA assay.Results:Network pharmacology analysis showed that TP53,TNF-α,AKT1,VEGF-A,IL-6 factors and MAPK,PI3K-Akt signaling pathway as the core targets and pathways of quercetin for the treatment of IBS-D.The results of animal experiments revealed that quercetin could inhibit the secretion of TP53,TNF-α,AKT1,VEGF-A,IL-1βand IL-6,reduce the inflammatory response and improve IBS-D.Conclusion:Quercetin could protect colon tissue by regulating the expression of TP53,TNF-α,AKT1,VEGF-A,IL-1βand IL-6,thereby treating IBS-D.

Trends in epidemiological characteristics and etiologies of diarrheal disease in children under five:an ecological study based on Global Burden of Disease study 2021

Background:Diarrhea remains a significant health threat to children under five years of age.The study aims to systematically elucidate the global burden of diarrhea in children,providing scientific insights for effective prevention and control strategies.Methods:The data from the Global Burden of Disease(GBD)2021 study was analyzed to assess the trends in incidence,prevalence,mortality,and disability-adjusted life years(DALYs)of diarrhea in children under five years across the globe,21 geographical region,and 204 countries and territories,stratified by age group,sex,and socio-demographic index(SDI)levels.The trend of the disease burden for childhood diarrhea from 1990 to 2021 was described and estimated using the average annual percent change(AAPC),and a Bayesian age-period-cohort(BAPC)model was employed to predict the future burden of diarrhea in children.Results:From 1990 to 2021,there was a significant decline in the global burden of diarrhea among children under five years of age.The AAPC for incidence(-4092.18,95%confidence interval[CI]:-4224.60 to-3959.76),prevalence(-70.98,95%CI:-72.67 to-69.28),mortality(-6.89,95%CI:-6.95 to-6.83),and DALYs rate(-621.79,95%CI:-627.20 to-616.38)of diarrhea in children all showed a marked downward trend.Diarrheal incidence(r=-0.782,P<0.001),prevalence(r=-0.777,P<0.001),mortality(r=-0.908,P<0.001),and DALYs rate(r=-0.904,P<0.001)were negatively correlated with the SDI.Between 2022 and 2035,the global incidence,prevalence,and mortality rates of diarrhea in children under five years are projected to continue declining.The leading causes of diarrheal mortality in children include wasting,underweight,and non-exclusive breastfeeding.Rotavirus remains the predominant pathogen associated with diarrhea-related mortality rate and DALY rate.Conclusion:Although the global burden of diarrhea in children under five has steadily declined,it remains a significant health threat.Rotavirus is the leading pathogen,highlighting the importance of expanding rotavirus vaccination.Additionally,improving nutritional status,increasing exclusive breastfeeding rates,and enhancing access to sanitation and clean drinking water are crucial measures that,when widely implemented,can effectively reduce the health risks posed by diarrhea in children.

Genetic and Antibiotic Resistance Characteristics ofCampylobacterjejuni Isolated from Diarrheal Patients,Poultry and Cattle in Shenzhen

Objective To investigate genetic and antibiotic resistance characteristics of Campylobacter jejuni(C. jejuni) isolated from Shenzhen. Methods Multilocs sequence typing and agar dilution methods were used to define the genotype and antibiotic resistance of C. jejuni, respectively. Results In total, 126 C. jejuni strains were isolated. The prevalence of C. jejuni was 5.3% in diarrheal patients. The prevalence in poultry meat(36.5%) was higher than that in cattle meat(1.1%). However, the prevalence in poultry cloacal swabs(27.0%) was lower than that in cattle stool(57.3%). Sixty-two sequence types were obtained, among which 27 of the STs and 10 alleles were previously unreported. The most frequently observed clonal complexes were ST-21(11.9%), ST-22(10.3%), and ST-403(7.1%). ST-21, ST-45, ST-354, ST-403, and ST-443 complexes overlapped between isolates from patients and cattle, whereas ST-45 and ST-574 complexes overlapped between isolates from patients and poultry. All C. jejuni were resistant to at least one antibiotic. The highest resistance rate was toward ciprofloxacin(89.7%), followed by tetracycline(74.6%), and nalidixic acid(69.0%). Conclusion This is the first report of the genotypes and antibiotic resistance of C. jejuni in Shenzhen. Overlapping clonal complexes were found between isolates from patients and cattle, and between patients and poultry.

Analgesic,anti-inflammatory and anti-diarrheal activities of ethanolic leaf extract of Typhonium trilobatum L.Schott

Objective:To explore the efficacy of ethanolic leaf extract of Typhonium trilobatum L.Schott in treating diarrhea,pain and inflammation using experimental models.Methods:In the present study,acetic acid-induced writhing,xylene-induced ear edema and castor oil-imluced diarrlieal model were used to evaluate the analgesic,anti-inflammatory and anti-diarrheal activities,respectively.Acute toxicity test was carried out to fix the safe doses of the plant extract.Results:The plant extract demonstrated a significant inhibition of writhing(P<0.01)compared with the control group in acetic acid-induced writhing test in mice.The extract also significantly inhibited the xylene induced ear edema formation(P<0.05).In anti-diarrheal test,the extract significantly decreased the frequency of defecation and increased the mean latent period(P<0.0l)in castor oil-induced diarrheal model mice at the doses of 250 and 500 mg/kg body weight.Conclusions:These results suggest that the extract possesses significant analgesic,anti-inflammatory and anti-diarrheal activities that support to the ethnopharmacologicl uses of this plant.

Isolation and Identification of Two Antibacterial Agents from <i>Chromolaena odorata</i>L. Active against Four Diarrheal Strains

Chromolaena odorata L (Asteraceae) is a bad invasive plant, found in the humid tropics and sub-tropics worldwide. It is used against dysentery, diarrhea, malaria, wound healing, headache and toothache in traditional medicine. In the present study, we investigated the antibacterial activities of different leaves extracts of Chromolaena odorata L. (cyclohexane, dichloromethane, ethyl acetate and butanol) against four clinical diarrheal strains (Klebsiella oxytoca, Salmonella enterica, Shigella sonnei and Vibrio cholera). We demonstrated that C. odorata leaves extracts show an antibacterial activity between 0.156 and 1.25 mg/mL. Bioassay-guided chromatography by bioautography with iodonitrotetrazolium-based colorimetric assay allowed the isolation and identification of two active compounds. After the combination of RP-HPLC, mass spectrometry analysis, 1D and 2D-NMR spectroscopy, we isolated and characterized two active molecules corresponding to 3’,4’,5,6,7-Pentamethoxyflavone (Sinensetin) and4’,5,6,7-Tetramethoxyflavone (Scutellareintetramethyl ether).

The effect of zinc supplementation on diarrheal diseases in children in the Niger Delta Sub-Region of Nigeria

This study evaluated the trend of diarrheal diseases managed with zinc supplementation by comparing it with diarrheal diseases managed without zinc supplementation at the University of Port Harcourt Teaching hospital (UPTH), Nigeria. The study was a descriptive retrospective study done at the Diarrhea Training Unit (DTU) of UPTH to determine the effect of zinc supplementation in the management of diarrhea in children under 5 years. Out of the 134 case records studied, of children aged 0 to 59 months who presented with diarrhea at the DTU, 57 children did not receive zinc supplementation between October and December, 2007 and 77 children received zinc supplementation between October and December 2009. The results showed that (74) 96.1% of patients who received zinc supplementation, and (48) 84.2% of those who did not, had no repeat diarrheal episodes when seen at the follow up clinic. On the other hand, 1.3% of those who received zinc supplementation and 1.8% of those who did not, had increased episodes of diarrhea when seen at the follow up clinic. Of those who received, and those who did not receive zinc supplementation, 2.6% and 14% respectively, had reduced episodes of diarrhea. These findings clearly demonstrate the effectiveness of zinc supplementation in halting the course of diarrheal diseases in children aged 0 to 59 months. We therefore advocate for the use of zinc supplementation in the management of diarrhea in

Anti-diarrheal and spasmolytic activities study of 3,4-Dihydro-2-(4-Morpholinylmethy)-1(2H)-Naphthalenone(CY)

Objective To investigate the spasmolytic and anti-diarrheal activities of 3,4-dihydro-2-(4-morpholinylmethy)-1(2H)-naphthalenone(CY),which was first synthesized by Welch,Willard M et al.in 1977.Methods The spasmolytic effects of CY were tested on isolated rabbit small intestine at the concentration of 0.01 to 3 mM;the diarrheal-index was evaluated on diarrhea mice to study the anti-diarrheal activities of CY.Results CY(0.1-1 mM)inhibited spontaneous motility of rabbit small intestine and at the concentration of 0.01 to 3 mM CY inhibited the contractile response of rabbit small intestine and colon induced by acetylcholine(10-2 mg·mL-1),high K+(60 mM)and BaCl2(1 mg·mL-1).When tested against calcium channel blocked in rabbit small intestine and colon,CY caused a rightward shift in the Ca2+ dose-response curves,similar to that produced by verapamil,a well-known calcium antagonist.CY could inhibit the diarrhea induced by castor oil,MgSO4 and liquid paraffin and LD50 of CY is 277.2 mg·kg-1.Conclusions CY may produce its spasmolytic and anti-diarrheal effects as a calcium antagonist.

Accessibility to Safe Drinking Water and Diarrheal Diseases: A Quasi-Experiment on a Case of Water Well Drilling in the Village of Kassouala, Municipality of Tchaourou, Benin, January 2018-July 2019

Background: In 2017, 900 million people in the world did not have sustainable access to safe drinking water (SDW). In addition, between 2016 and 2020, the global population with safely managed drinking water at home increased from 70 percent to 74 percent. Drinking water insecurity is the daily situation of people in developing countries. The lack of SDW supply is at the root of many diseases, including diarrheal diseases. Kassouala is a village in the municipality of Tchaourou without access to SDW, but having benefited from the drilling of a well in September 2018. The objective of this study was to study the effect of access to safe drinking water on the frequency of diarrheal diseases in Kassouala between January 2018 and July 2019. Methods: We conducted a quasi-experimental study in Kassouala using the natural experiments of the village of Bérétou as a control group for estimating the effect of a causal nature. There were double temporal (January 2018-July 2019) and geographical (Kassouala-Bérétou) comparisons based on data collected from health care registers. A population-based comparability survey of the two villages was conducted among 170 households in each village (experimental village, control village). A two-stage cluster sampling procedure was used to select the survey participants. Data were collected from heads of household by semi-structured questionnaire. We used Pearson or Mantel-Haenszel chi-square tests, as appropriate, and the “difference-in-difference” method to assess the effect. Results: In Kassouala, the proportion of households with access to safe drinking water had increased to 78.88%, whereas it was nil in 2018 before the well drilling, and the frequency of diarrheal diseases decreased significantly from January 2018 before drilling to July 2019 after drilling (57.11% to 44.64%;p Conclusion: Access to safe drinking water in Kassouala has a causal effect on the reduction of diarrheal diseases. However, for the supply of drinking water to be integrated into the community development plan of Tchaourou, it is necessary to support the scaling up of this intervention, which would be considered as a pilot, of a community participation program.

Water sanitation and hygiene in Sub-Saharan Africa:Coverage, risks of diarrheal diseases, and urbanization

Sub-Saharan Africa(SSA)has a rapidly growing urban population,with water,sanitation,and hygiene(WASH)services representing the central needs for this population.Incidentally,this region has the lowest global WASH coverage.Data from the‘WHO/UNICEF Joint Monitoring Programme for Water supply,Sanitation and Hygiene’and the‘Global Burden of Disease’study from the Institute for Health Metrics and Evaluation were used to assess WASH coverage and related health burden in SSA,its subregions,and rural and urban areas in SSA.WASH coverage in the SSA region appears to be low,but urban coverage is better than that in rural areas;however,there is unequal access to urban WASH and poor urban areas are underserved.In addition,7.75%(5.99–9.7%)of total deaths due to diarrheal diseases across SSA are attributed to unsafe WASH with a risk factor attribution(RFA)percentage of 95.93%(91.94–98.24%).Therefore,a correlation between WASH coverage and mortality due to diarrheal diseases could be established.There is a lack of data on WASH coverage in poor urban areas,although these areas have high incidence of WASH-related diseases including diarrhea.Disaggregated urban WASH data are needed to better understand the WASH service needs of poor urban areas,which would be helpful in ensuring a more inclusive implementation of WASH services.

调神健脾针刺法联合电针治疗腹泻型肠易激综合征的疗效观察及对肥大细胞活化的影响

目的观察调神健脾针刺法联合电针治疗对腹泻型肠易激综合征(irritable bowel syndromediarrheal,IBS-D)的临床疗效及其对患者肠黏膜肥大细胞活化的影响。方法将60例IBS-D患者按随机数字表法分为药物组和观察组,每组30例。药物组予口服马来酸曲美布汀分散片治疗,观察组予调神健脾针刺法联合电针治疗。观察两组治疗前后肠易激综合征症状严重程度量表(irritable bowel syndrome-symptom severity scale,IBS-SSS)评分、肠易激综合征生活质量量表(irritable bowel syndrome-quality of Life,IBS-QOL)评分和医院焦虑抑郁量表(hospital anxiety and depression scale,HADS)评分及肠黏膜肥大细胞(mast cells,MCs)活化程度的变化。比较两组临床疗效。结果观察组总有效率优于药物组(P<0.05)。治疗后,两组IBS-SSS和HADS评分均降低(P<0.05),且观察组均优于药物组(P<0.05)。治疗后,两组IBS-QOL评分均升高(P<0.05),且观察组高于药物组(P<0.05)。治疗后,两组MCs数量与脱颗粒比例均降低(P<0.05),且观察组优于药物组(P<0.05)。结论“调神健脾”针刺法联合电针治疗IBS-D的临床疗效优于单一口服药物治疗,可缓解腹痛等临床症状,提高生活质量,改善抑郁状态,降低MCs活化程度。

Epidemiological Surveillance: Genetic Diversity of Rotavirus Group A in the Pearl River Delta, Guangdong, China in 2019

Objective This study aimed to understand the epidemic status and phylogenetic relationships of rotavirus group A(RVA)in the Pearl River Delta region of Guangdong Province,China.Methods This study included individuals aged 28 days–85 years.A total of 706 stool samples from patients with acute gastroenteritis collected between January 2019 and January 2020 were analyzed for 17 causative pathogens,including RVA,using a Gastrointestinal Pathogen Panel,followed by genotyping,virus isolation,and complete sequencing to assess the genetic diversity of RVA.Results The overall RVA infection rate was 14.59%(103/706),with an irregular epidemiological pattern.The proportion of co-infection with RVA and other pathogens was 39.81%(41/103).Acute gastroenteritis is highly prevalent in young children aged 0–1 year,and RVA is the key pathogen circulating in patients 6–10 months of age with diarrhea.G9P[8](58.25%,60/103)was found to be the predominant genotype in the RVA strains,and the 41 RVA-positive strains that were successfully sequenced belonged to three different RVA genotypes in the phylogenetic analysis.Recombination analysis showed that gene reassortment events,selection pressure,codon usage bias,gene polymorphism,and post-translational modifications(PTMs)occurred in the G9P[8]and G3P[8]strains.Conclusion This study provides molecular evidence of RVA prevalence in the Pearl River Delta region of China,further enriching the existing information on its genetics and evolutionary characteristics and suggesting the emergence of genetic diversity.Strengthening the surveillance of genotypic changes and gene reassortment in RVA strains is essential for further research and a better understanding of strain variations for further vaccine development.

Postnatal Total Serum Protein Concentration Influences the Health and Growth Parameters of Preweaned Female Holstein Friesian Calves

This study focuses on the effect of the total serum protein(TSP)concentrations at 3 days after birth on the health and growth parameters of preweaned female Holstein Friesian calves.A total of 165 female calves were enrolled and evaluated for morbidity which included diarrhea(D),respiratory disease(Rd)and omphalitis(O).Also,calves with more than one disorder in the same time were recorded as multi-morbid.Body weight(BW)was determined at birth,30 and 60 days of age.Blood samples were taken at 3 days after birth and TSP was determined using a digital Brix refractometer.For statistical analysis all female calves based on TSP concentration were grouped into 3 categories:1-TSP≥6.2 g/dL,2-TSP 5.8-6.1 g/dL,and 3-TSP<5.8 g/dL.Overall,the average of TSP concentration was 6.38 g/dL.The prevalence of diarrhea,respiratory disease(Rd)and omphalitis(O)was 16.96%,7.88%and 4.85%respectively,in calves with one disorder and 6.06%in calves with D+Rd,3.64%in calves with Rd+O,3.03%in calves with O+D,and 3.64%in calves with D+Rd+O.As the TSP concentration in calves decreased from≥6.2 g/dL to<5.8 g/dL the calf hood disorders increased in female calves with one disorder and with more than one disorder.The female calves with fair to poor immunity(category 3-TSP<5.8 g/dL)were significantly more likely(OR 6.28,95%CI 2.91-13.5,p value<0.001)to be affected by diseases compared with female calves with excellent immunity(category 1-TSP≥6.2 g/dL).Also BW and average daily gain(ADG)at 30 and 62 days of life decreased as TSP concentrations decreased.The female calves with TSP≥6.2 g/dL at 3 days of life had the greatest BW at 30 and 62 days of age(51.8 kg and 77.1 kg respectively)compared with female calves with TSP<5.8 g/dL at 3 days of life(46.6 and 70.6 kg respectively).Moreover,starter feed intake during the first 30 days of life,31 to 62 days of life and 1 to 62 days of life was greater in female calves with excellent immunity(TSP≥6.2 g/dL)than female calves with good immunity(TSP 5.8-6.1 g/dL)or with fair to poor immunity(<5.8 g/dL TSP).Measuring the TSP at 3 days of calf’s This study focuses on the effect of the total serum protein(TSP)concentrations at 3 days after birth on the health and growth parameters of preweaned female Holstein Friesian calves.A total of 165 female calves were enrolled and evaluated for morbidity which included diarrhea(D),respiratory disease(Rd)and omphalitis(O).Also,calves with more than one disorder in the same time were recorded as multi-morbid.Body weight(BW)was determined at birth,30 and 60 days of age.Blood samples were taken at 3 days after birth and TSP was determined using a digital Brix refractometer.For statistical analysis all female calves based on TSP concentration were grouped into 3 categories:1-TSP≥6.2 g/dL,2-TSP 5.8-6.1 g/dL,and 3-TSP<5.8 g/dL.Overall,the average of TSP concentration was 6.38 g/dL.The prevalence of diarrhea,respiratory disease(Rd)and omphalitis(O)was 16.96%,7.88%and 4.85%respectively,in calves with one disorder and 6.06%in calves with D+Rd,3.64%in calves with Rd+O,3.03%in calves with O+D,and 3.64%in calves with D+Rd+O.As the TSP concentration in calves decreased from≥6.2 g/dL to<5.8 g/dL the calf hood disorders increased in female calves with one disorder and with more than one disorder.The female calves with fair to poor immunity(category 3-TSP<5.8 g/dL)were significantly more likely(OR 6.28,95%CI 2.91-13.5,p value<0.001)to be affected by diseases compared with female calves with excellent immunity(category 1-TSP≥6.2 g/dL).Also BW and average daily gain(ADG)at 30 and 62 days of life decreased as TSP concentrations decreased.The female calves with TSP≥6.2 g/dL at 3 days of life had the greatest BW at 30 and 62 days of age(51.8 kg and 77.1 kg respectively)compared with female calves with TSP<5.8 g/dL at 3 days of life(46.6 and 70.6 kg respectively).Moreover,starter feed intake during the first 30 days of life,31 to 62 days of life and 1 to 62 days of life was greater in female calves with excellent immunity(TSP≥6.2 g/dL)than female calves with good immunity(TSP 5.8-6.1 g/dL)or with fair to poor immunity(<5.8 g/dL TSP).Measuring the TSP at 3 days of calf’s life,offers information directly correlated to an individual calf’s immunity status,their likeliness of morbidity,mortality and body development and overall the effectiveness of the colostrum management program in the dairy farm.life,offers information directly correlated to an individual calf’s immunity status,their likeliness of morbidity,mortality and body development and overall the effectiveness of the colostrum management program in the dairy farm.

基于网络药理学、分子对接与实验验证揭示槲皮素治疗腹泻型肠易激综合征的潜在分子机制

目的:探索槲皮素治疗腹泻型肠易激综合征(Diarrhoeal irritable bowel syndrome,IBS-D)的潜在作用机制。方法:从TCMSP、SwissTar-getPrediction、BATMAN-TCM数据库获得槲皮素的潜在靶点,以“diarrhea irritable bowel syndrome”作为关键词检索GeneCards数据库,得到IBS-D的相关靶点,将槲皮素与IBS-D的靶点取交集。通过Cytoscape 3.7.1软件构建PPI网络。交集靶点导入DAVID数据库进行GO功能分析和KEGG途径富集分析。利用分子对接观察槲皮素与核心靶点的结合能力;在此基础上,建立IBS-D大鼠模型,给予槲皮素进行干预,通过HE染色、ELISA检测对网络药理学预测结果进行实验验证。结果:网络药理学分析显示,TP53,TNF-α,AKT1,VEGF-A,IL-6因子和MAPK、PI3K-Akt信号通路作为槲皮素治疗IBS-D的核心靶点和通路;动物实验结果发现,槲皮素能抑制TP53,TNF-α,AKT1,VEGF-A,IL-1β和IL-6的分泌,减轻炎症反应,改善IBS-D。结论:槲皮素可能下调TP53,TNF-α,AKT1,VEGF-A,IL-1β和IL-6的表达保护结肠组织,从而治疗IBS-D。

Global burden of enteric infections related foodborne diseases,1990-2021:findings from the Global Burden of Disease Study 2021

Background:Understanding the global burden of enteric infections is crucial for prioritizing control strategies for foodborne and waterborne diseases.This study aimed to assess the global burden of enteric infections in 2021 and identify risk factors from One Health aspects.Methods:Leveraging the Global Burden of Disease(GBD)2021 database,the incidence,disability-adjusted life years(DALYs),and deaths of enteric infections and the subtypes were estimated,including diarrheal diseases,typhoid and paratyphoid fever,invasive non-typhoidal Salmonella(iNTS)infections,and other intestinal infectious diseases.The estimates were quantified by absolute number,age-standardized incidence rate(ASIR),agestandardized mortality rate(ASMR)and age-standardized DALY rate with 95%uncertainty intervals(UIs).Thirteen pathogens and three risk factors associated with diarrheal diseases were analyzed.Results:In 2021,the global age-standardized DALY rate of enteric infections was 1020.15 per 100,000 popultion(95%UI:822.70-1259.39 per 100,000 population)with an estimated annual percentage change(EAPC)of-4.11%(95%confidence interval:-4.31%to-3.90%)in 1990-2021.A larger burden was observed in regions with lower socio-demographic index(SDI)levels.Diarrheal disease was the most serious subtype with Western Sub-Saharan Africa exhibiting the highest age-standardized DALY rate(2769.81 per 100,000 population,95%UI:1976.80-3674.41 per 100,000 population).Children under 5 and adults over 65 years suffered more from diarrheal diseases with the former experiencing the highest global age-standardized DALY rate(9382.46 per 100,000 population,95%UI:6771.76-13,075.12 per 100,000 population).Rotavirus remained the leading cause of diarrheal diseases despite a cross-year decline in the observed age-standardized DALY rate.Unsafe water,sanitation,and handwashing contributed most to the disease burden.Conclusion:The reduced burden of enteric infections suggested the effectiveness of previous control strategies;however,more efforts should be made in vulnerable regions and populations through a One Health approach.

中医经方治疗腹泻型肠易激综合征的研究进展

腹泻型肠易激综合征(IBS-D)是最常见的功能障碍型肠病之一,发病率高,治愈难度大,目前对其研究主要围绕临床和实验两方面。中医经方在IBS-D的治疗中疗效显著,本文整理并总结其疗效及机制的最新进展,为中医药防治IBS-D的临床及基础研究提供思路与借鉴。

理肠丸治疗腹泻型肠易激综合征的疗效观察和对免疫球蛋白及肠道菌群调节的影响

目的目的探讨IBS-D的治疗方法。方法将100例IBS-D患者随机分为治疗组和对照组,各50例,对照组口服匹维溴铵片,治疗组口服理肠丸。观察治疗前后两组中医证候评分与疗效、IBS-SSS评分与疗效、免疫球蛋白及肠道菌群。结果治疗后,治疗组中医证候评分与疗效、IBS-SSS评分与疗效、IgA、IgG、肠杆菌、肠球菌、双歧杆菌、乳酸杆菌改善程度均优于对照组(P<0.01)。结论理肠丸治疗IBS-D效果显著。

参苓白术散加减对腹泻型肠易激综合征脾虚湿盛证患者血清胃肠激素水平的影响

目的探讨腹泻型肠易激综合征(IBS-D)脾虚湿盛证患者应用参苓白术散加减治疗的效果。方法选取2020年10月至2022年10月该院收治的78例IBS-D脾虚湿盛证患者为研究对象,按照随机数字表法分为观察组与对照组,各39例。对照组采用匹维溴铵治疗,观察组联合参苓白术散加减治疗,均连续治疗4周。比较两组总有效率、降钙素基因相关肽(CGRP)、血管活性肠肽(VIP)、5-羟色胺(5-HT)、胆囊收缩素(CCK)水平,以及中医证候总积分、生活质量、不良反应。结果治疗前,观察组与对照组CGRP、VIP、5-HT、CCK水平,中医证候总积分,IBS生活质量量表(IBS-QOL)评分比较,差异无统计学意义(P>0.05)。治疗后,观察组总有效率(94.87%)高于对照组(79.92%),CGRP、VIP、5-HT、CCK水平及中医证候总积分均低于对照组,IBS-QOL评分高于观察组,差异均有统计学意义(P<0.05)。两组均未见明显不良反应。结论匹维溴铵治疗基础上联合参苓白术散加减治疗IBS-D脾虚湿盛证患者效果确切,且具有良好的安全性,值得临床推广应用。

益肾痛泄方对腹泻型肠易激综合征大鼠IL-2、IL-10、TGF-β、IFN-γ表达的影响

[目的]研究益肾痛泄方对腹泻型肠易激综合征模型大鼠小肠组织白细胞介素2(IL-2)、白细胞介素10(IL-10)、转化生长因子β(TGF-β)、γ-干扰素(IFN-γ)表达水平的影响。[方法]将24只Wistar大鼠按随机数字表法分为正常组、模型组、奥替溴铵组、益肾痛泄方组,每组6只,除正常组大鼠外,其余各组均采用4%醋酸灌肠叠加慢性心理应激法复制腹泻型肠易激综合征模型,奥替溴铵组、益肾痛泄方组大鼠连续给药14 d。观察大鼠的一般情况,大鼠处死后,采用苏木素-伊红(HE)染色法观察各组大鼠小肠组织病理变化,采用实时荧光定量聚合酶链式反应(RT-PCR)及蛋白免疫印迹法(Western Blot)分别检测各组大鼠小肠组织IL-2、IL-10、TGF-β、IFN-γmRNA及蛋白表达水平。[结果]与正常组比较,模型组大鼠小肠出现明显的淋巴细胞灶性浸润,且模型组大鼠小肠组织中IL-2、IL-10、TGF-β、IFN-γmRNA及蛋白表达水平均显著升高,差异有统计学意义(P<0.01);与模型组比较,奥替溴铵组、益肾痛泄方组大鼠小肠组织未见明显炎症浸润,且小肠IL-2、IL-10、TGF-β、IFN-γmRNA及蛋白表达水平均显著降低(P<0.05或P<0.01);与奥替溴铵组比较,益肾痛泄方组大鼠小肠组织固有层肠腺丰富,未见明显炎症细胞浸润,IL-2、IL-10、TGF-β、IFN-γmRNA及蛋白表达水平均低于奥替溴铵组,但差异无统计学意义(P>0.05)。[结论]益肾痛泄方可能通过降低IL-2、IL-10、TGF-β、IFN-γ的表达,进而缓解小肠炎症损伤,发挥治疗腹泻型肠易激综合征的作用。

温肾健脾方对腹泻型肠易激综合征大鼠肠道菌群的影响

目的基于16S rRNA技术探讨温肾健脾方对腹泻型肠易激综合征(IBS-D)大鼠的影响及作用机制。方法将新生雄性SD大鼠随机分为正常组,模型组,温肾健脾方低、中、高剂量组及匹维溴铵组,每组8只。除正常组外,其余各组大鼠采用母婴分离+醋酸刺激+束缚应激结合的方法建立IBS-D模型。造模成功后,各给药组大鼠给予低、中、高剂量的温肾健脾方或匹维溴铵,正常组和模型组大鼠给予等体积的生理盐水,均灌胃给药,连续2周。比较各组大鼠内脏敏感性、体质量、粪便含水量;苏木素-伊红(HE)染色观察大鼠结肠的病理组织学形态;16S rRNA技术检测各组大鼠粪便微生物的变化。结果与正常组对比,模型组大鼠体质量及内脏感觉阈值显著降低(P<0.05),粪便含水量显著升高(P<0.05)。给药后,与模型组对比,温肾健脾方高、中剂量及匹维溴铵组大鼠体质量显著上升(P<0.05),各给药组大鼠内脏感觉阈值显著升高(P<0.05),粪便含水量显著降低(P<0.05)。与正常组对比,模型组大鼠肠道菌群α多样性无显著性差异(P>0.05),β多样性有显著性差异(P<0.05)。在属水平上,温肾健脾方高剂量可显著升高IBS-D大鼠杜氏杆菌属、布劳特氏菌属的丰度(P<0.05),各剂量给药组大鼠阿克曼菌属的丰度较模型组显著下降(P<0.05),温肾健脾方高、中剂量组大鼠拟普雷沃氏菌属、瘤胃球菌属的丰度显著下降(P<0.05)。结论温肾健脾方可改善IBS-D大鼠腹泻和内脏高敏感性的状态,这可能与其调节肠道菌群结构和组成有关。