Slow transit constipation: A functional disorder becomes an enteric neuropathy

Slow transit constipation has been traditionally considered and classified as a functional disorder. However, clinical and manometric evidence has been accumulating that suggests how most of the motility alterations in STC might be considered of neuropathic type.In addition, further investigations showed that subtle alterations of the enteric nervous system, not evident to conventional histological examination, may be present in these patients. In the present article we will discuss these evidences, and will try to put them in relation with the abnormal motor function of the large bowel documented in this pathological condition.

Neuropathophysiology of functional gastrointestinal disorders

The investigative evidence and emerging concepts in neurogastroenterology implicate dysfunctions at the levels of the enteric and central nervous systems as underlying causes of the prominent symptoms of many of the functional gastrointestinal disorders. Neurogastroenterological research aims for improved understanding of the physiology and pathophysiology of the digestive subsystems from which the arrays of functional symptoms emerge. The key subsystems for defecation-related symptoms and visceral hyper- sensitivity are the intestinal secretory glands, the musculature and the nervous system that controls and integrates their activity. Abdominal pain and discomfort arising from these systems adds the dimension of sensory neurophysiology. This review details current concepts for the underlying pathophysiology in terms of the physiology of intestinal secretion, motility, nervous control, sensing function, immuno-neural communication and the brain-gut axis.

CCPIT Vice Chairman Dong Songgen Attended Seminar on Economic and Trade Opportunities in Peru

On the afternoon of July 3,CCPIT Vice Chairman Dong Songgen met with Mr.Gutierrez,the visiting Peruvian Vice Foreign Minister,both of whom attended the Seminar on Economic and Trade Opportunities in Peru.The seminar was organized by CCPIT and Peruvian Embassy in China,Peru- vian Vice Foreign Minister has briefed on macro economy as well as trade policies and investment opportunities in Peru.

Telecentres in Mountain Regions-A Peruvian Case Study of the Impact of Information and Communication Technologies on Remoteness and Exclusion

Communities in developing country mountain areas,in part due to their remoteness,find themselves excluded from social,political and economic systems; and excluded from access to resources. This paper aims to study the impact of information and communication technologies (ICTs) on remoteness and exclusion. It utilises two models - the resource movement framework,and the "information chain" - to analyse a telecentre in one district of mountainous Huancavelica,Peru's poorest region,set in the high Andes. It finds ICTs enabling new and positive resource flows for the two key user groups:teenaged school students and young farmers. These help to maintain social networks. They also support information searches that have improved agricultural practice where other information chain resources have been available. But non-use and ineffective use of the telecentre are found where information chain resources are lacking. ICTs have some impacts on intangible elements of remoteness. In this particular example,they also offer access to some previously-excluded resources. But they have not really addressed the systematic exclusions faced by mountain communities. And they so far appear to be a technology of inequality; favouring those residents who begin with better resource endowments.The paper concludes by offering some recommendations for mountain ICT project practice.

Hirschsprung's disease:Is there a relationship between mast cells and nerve fibers?

AIM:To define the topography of mast cells and their numbers in cases of Hirschsprung's disease(HD)and non-HD,assess neural hypertrophy using imaging software and to study the relationship between mast cells and nerve fibers.METHODS:HE stained sections of 32 cases of chronic constipation in the age group of 0-14 years were reviewed for ganglion cells.AChE staining was performed on frozen sections of colonic and rectal biopsies.Based on their findings cases were divided into HD and non-HD and mast cells stained by toluidine blue were evaluated.Image analysis by computerized software was applied to S-100 stained sections for assessment of neural hypertrophy.RESULTS:Difference between number of mast cells in HD group(mean=36.44)and in non-HD group(mean =14.79)was statistically significant.Image analysis morphometry on S-100 stained sections served as a useful adjunct.The difference between number,size,and perimeter of the nerve fibers between HD and non-HD group was statistically significant.CONCLUSION:Mast cells are significantly increased in HD and their base line values are much higher in Indian children than that reported in Western literature.Their role in HD needs further research.Morphometry of S-100 stained nerve fibers is a useful adjunct to conventional methods for diagnosis of HD.

短讯摘编

◎1月27日，美国著名作家约翰·厄普代克辞世，享年76岁。多位作家写了纪念文章，菲利普·罗斯称其为美国的国宝级人物，厄普代克的创作影响了很多同时代的小说家。

Comparison of laparoscopic selective colectomy based on barium-strip examination and subtotal colectomy for adult slow-transit constipation

Background:Surgical management of adult slow-transit constipation(ASTC)can be effective for patients with intractable symptoms.This study aimed to evaluate whether barium-strip examination and selective colectomy improved post-operative outcomes in ASTC patients in comparison with subtotal colectomy.Methods:A retrospective cohort study of 53 cases with refractory ASTC was conducted between June 2008 and June 2014.Patients were evaluated by the barium-strip technique,colonoscopy,defecography and anorectal manometry.Patients in the standard group underwent laparoscopic subtotal colectomy and patients in the laparoscopic selective colectomy(LSC)group underwent LSC at the precise location identified by barium strip.Spontaneous bowel movements,the Wexner Constipation Scale and the Gastrointestinal Quality of Life Index(GIQLI)were assessed post-operatively at 3,6,12 and 24 months.Results:A total of 49 patients were included in the analysis.The median follow-up was 37 months(range,26–60 months).The mean post-operative hospital stay was 12 days and similar between groups(P=0.071).The length of colon resection,operative time and intra-operative blood loss were reduced in the LSC group(all P<0.05).No major complications occurred.A similar number of patients(24 in the standard group and 25 in the LSC group)exhibited hypoganglionosis or aganglionosis in the colon-wall muscle layer(P=0.986).Although there were no significant differences in post-operative spontaneous bowel movements and the Wexner Constipation Scale between the two groups,the mean GIQLI of the LSC group was significantly higher at 3,6 and 24 months post-operatively(all P<0.05).Conclusions:LSC based on barium-strip examination is an appropriate modality for treating ASTC.

Clinical observation on Tui-pushing the Large Intestine Meridian plus point sticking at Tianshu(ST 25) in prevention of post-stroke constipation

Objective： To observe the prevention effect of Tui-pushing the Large Intestine Meridian plus point sticking at Tianshu（ST 25） for post-stroke constipation. Methods： Seventy eligible patients with post-stroke constipation were randomized into a treatment group and a control group, 35 cases in each group. Both groups were intervened by conventional treatment and care in Western medicine, while the treatment group was also by Tui-pushing the Large Intestine Meridian and point sticking at Tianshu（ST 25）. The treatment lasted for 14 d. Therapeutic efficacy was evaluated by the first defecation time, constipation incidence and Chinese stroke scale（CSS） score. Results： After treatment, the first defecation time was（1.86 ± 0.74） d in the treatment group, shorter than（2.77 ± 0.83） d in the control group; constipation incidence was 14.3% in the treatment group, significantly lower than 37.1% in the control group, and the between-group differences in the two items were statistically significant（both P〈0.05）. CSS score in both groups dropped significantly after treatment（both P〈0.05）; the improvement in the treatment group was better than that in the control group, and the inter-group difference was statistically significant（P〈0.05）. Conclusion： Tui-pushing the Large Intestine Meridian plus point sticking at Tianshu（ST 25） can effectively prevent post-stroke constipation, and can also promote the rehabilitation of nerve functions.