早产儿肠道因素对新生儿坏死性小肠结肠炎发病机制的影响

新生儿坏死性小肠结肠炎（necrotizing Enterocolitis,NEC）是新生儿期一种肠道炎症性疾病,好发于早产儿、低出生体重儿.近年来由于肺表面活性物质的应用及医疗水平的提高,未成熟儿的存活率增加,NEC的发病率不降反升.早产、肠道缺氧缺血、细菌感染以及肠道喂养是发生NEC的基本条件.早产儿肠道细菌定植模式改变、肠道屏障功能异常以及细胞因子表达异常等对NEC发生发展有重要影响,本文就上述方面研究进展做一综述.

胃肠道因素所致口臭,中医治疗有优势

中医认为,胃肠道所致的口臭是由于邪气蕴结,熏蒸于内,从口腔而出,邪气包括湿邪、食积、热邪等,还有少部分患者与阴虚内热有关。根据患者的具体情况,通过中医的辨证论治往往能够取得较好的疗效。以笔者最近接诊的一位患者为例,分享如下。

肠道因素在胰腺感染中的作用

急性胰腺炎并发的感染通常可加重胰腺损伤导致的全身炎症反应综合征（SIRS）和多器官功能障碍综合征（MODS）,即被称为原发疾病得到控制后的“二次打击”效应。此报告分析了肠道内相关因素对急性胰腺炎感染形成的作用,指出肠道内细菌的易位（BT）和过度生长造成的肠道外继发感染是触发MODS的主要原因,并初步探讨了防治细菌易位的措施在急性胰腺炎治疗中的应用价值。

肠道菌群及其影响因素在非酒精性脂肪性肝病中的研究进展

肠道菌群紊乱促进了非酒精性脂肪性肝病(NAFLD)的发生和发展,调节肠道菌群可有效治疗NAFLD。外源性补充菌群、服用抗生素及中草药等均会影响NAFLD患者的肠道菌群,肠道菌群还可被昼夜节律及营养状态等因素影响。本文就NAFLD患者肠道菌群的影响因素,肠道菌群紊乱参与NAFLD发病的机制,以及以肠道菌群为靶点的NAFLD治疗方法的研究进展作一综述,以期为NAFLD的治疗提供参考。

Irritable bowel syndrome:Diagnosis and pathogenesis

Irritable bowel syndrome (IBS) is a common gastro-intestinal (GI) disorder that considerably reduces the quality of life. It further represents an economic burden on society due to the high consumption of healthcare resources and the non-productivity of IBS patients. The diagnosis of IBS is based on symptom assessment and the Rome Ⅲ criteria. A combination of the Rome Ⅲ criteria, a physical examination, blood tests, gastros-copy and colonoscopy with biopsies is believed to be necessary for diagnosis. Duodenal chromogranin A cell density is a promising biomarker for the diagnosis of IBS. The pathogenesis of IBS seems to be multifactorial, with the following factors playing a central role in the pathogenesis of IBS:heritability and genetics, dietary/intestinal microbiota, low-grade inflammation, and disturbances in the neuroendocrine system (NES) of the gut. One hypothesis proposes that the cause of IBS is an altered NES, which would cause abnormal GI motility, secretions and sensation. All of these abnormalities are characteristic of IBS. Alterations in the NES could be the result of one or more of the following:genetic factors, dietary intake, intestinal flora, or lowgrade inflammation. Post-infectious IBS (PI-IBS) and inflammatory bowel disease-associated IBS (IBD-IBS) represent a considerable subset of IBS cases. Patients with PI-and IBD-IBS exhibit low-grade mucosal inflammation, as well as abnormalities in the NES of the gut.

Psychosocial determinants of irritable bowel syndrome

From a pure motor disorder of the bowel,in the past few years,irritable bowel syndrome (IBS) has become a multifactorial disease that implies visceral hypersensitivity,alterations at the level of nervous and humoral communications between the enteric nervous system and the central nervous system,alteration of the gut microflora,an increased intestinal permeability and minimum intestinal inflammation.Psychological and social factors can interfere with the communication between the central and enteric nervous systems,and there is proof that they are involved in the onset of IBS and influence the response to treatment and outcome.There is evidence that abuse history and stressful life events are involved in the onset of functional gastrointestinal disorders.In order to explain clustering of IBS in families,genetic factors and social learning mechanisms have been proposed.The psychological features,such as anxiety,depression as well as the comorbid psychiatric disorders,health beliefs and coping of patients with IBS are discussed in relation to the symptoms and outcome.

Familial aggregation in inflammatory bowel disease:Is it genes or environment?

Inflammatory bowel disease (IBD) develops in genetically susceptible individuals due to the influence of environmental factors, leading to an abnormal recognition of microbiota antigens by the innate immune system which triggers an exaggerated immune response and subsequent bowel tissue damage. IBD has been more frequently found in families, an observation that could be due to either genetic, environmental or both types of factors present in these families. In addition to expanding our knowledge on IBD pathogenesis, defining the specific contribution to familial IBD of each one of these factors might have also clinical usefulness. We review the available evidence on familial IBD pathogenesis.

Risk factors and gene polymorphisms of inflammatory bowel disease in population of Zhejiang,China

AIM:To identify the risk factors and three single nucleotide polymorphisms(SNPs) of NOD2/CARD15 gene in inflammatory bowel disease(IBD) of the population in Zhejiang,China.METHODS:A case-control study was conducted using recall questionnaire to collect data on demographic,socioeconomic,lifestyle characteristics and dietary behaviors from 136 determined IBD patients and 136 paired healthy controls.COX regression method was used to screen the statistically significant risk factors for IBD.The polymorphisms of NOD2/CARD15 gene Arg702Trp,Gly908Arg and Leu1007fsinsC were genotyped and further compared between 60 patients with IBD and 60 healthy controls by polymerase chain reaction and restriction fragment length polymorphism.RESULTS:IBD occurred primarily in young and middle-aged people.The mean age for IBD patients was 42.6 years.The ratio of males to females was 1.23:1.COX regression indicated a higher statistical significance in milk,fried food and stress compared with the other postulated risk factors for IBD.None of the patients with IBD and healthy controls had heterozygous or homozygous SNPs variants.CONCLUSION:Milk,fried food and stress are associated with increased risk of IBD.The common variants in NOD2/CARD15 gene are not associated with IBD in China's Zhejiang population.

Morphological,kinetic,membrane biochemical and genetic aspects of intestinal enteroplasticity

The process of intestinal adaptation("enteroplasticity") is complex and multifaceted.Although a number of trophic nutrients and non-nutritive factors have been identified in animal studies,successful,reproducible clinical trials in humans are awaited.Understanding mechanisms underlying this adaptive process may direct research toward strategies that maximize intestinal function and impart a true clinical benefit to patients with short bowel syndrome,or to persons in whom nutrient absorption needs to be maximized.In this review,we consider the morphological,kinetic and membrane biochemical aspects of enteroplasticity,focus on the importance of nutritional factors,provide an overview of the many hormones that may alter the adaptive process,and consider some of the possible molecular profiles.While most of the data is derived from rodent studies,wherever possible,the results of human studies of intestinal enteroplasticity are provided.

Diet,ageing and genetic factors in the pathogenesis of diverticular disease

Diverticular disease(DD) is an age-related disorder of the large bowel which may affect half of the population over the age of 65 in the UK.This high prevalence ranks it as one of the most common bowel disorders in western nations.The majority of patients remain asymptomatic but there are associated life-threatening co-morbidities, which, given the large numbers of people with DD, translates into a considerable number of deaths per annum.Despite this public health burden, relatively little seems to be known about either the mechanisms of development or causality.In the 1970s, a model of DD formulated the concept that diverticula occur as a consequence of pressureinduced damage to the colon wall amongst those with a low intake of dietary fiber.In this review, we have examined the evidence regarding the influence of ageing, diet, inflammation and genetics on DD development.We argue that the evidence supporting the barotrauma hypothesis is largely anecdotal.We have also identified several gaps in the knowledge base which need to be filled before we can complete a model for the etiology of diverticular disease.

Prognostic factors for recurrence of gastrointestinal bleeding due to Dieulafoy's lesion

AIM： To analyze the effectiveness of the endoscopic therapy and to identify prognostic factors for recurrent bleeding. METHODS： Retrospective study of patients with gas- trointestinal bleeding secondary to Dieulafoy＇s lesion （DL） from 2005 to 2011. We analyzed the demographic characteristics of the patients, risk factors for gastro- intestinal bleeding, endoscopic findings, characteristics of the endoscopic treatment, and the recurrence of bleeding. We included cases in which endoscopy de- scribed a lesion compatible with Dieulafoy. We exclud- ed patients who had potentially bleeding lesions such as angiodysplasia in other areas or had undergone other gastrointestinal endoscopic procedures. RESULTS： Twenty-nine patients with DL were identi- fied. Most of them were men with an average age of 71.5 years. Fifty-five percent of the patients received antiaggregatory or anticoagulant therapy. The most common location for DL was the stomach （51.7%）. The main type of bleeding was oozing in 65.5% of cases. In 27.6% of cases, there was arterial （spurting） bleeding, and 6.9% of the patients presented with an adherent clot. A single endoscopic treatment was ap- plied to nine patients （31%）, eight of them with adren- aline and one with argon, while 69% of the patients received combined treatment. Six patients （20.7%） presented with recurrent bleeding at a median of 4 d after endoscopy （interquartile range = 97.75）. Within these six patients, the new endoscopic treatment ob- tained a therapeutic success of 100%. The presence of arterial bleeding at endoscopy was associated with a higher recurrence rate for bleeding （50% vs 33.3% for other type of bleeding） rP = 0.024, odds ratio （OR） = 8.5, 95% CI = 1.13-63.87]. The use of combined en- doscopic treatment prevented the recurrence of bleed- ing （10% vs 44.4% of single treatment） （P = 0.034, OR = 0.14, 95% CI = 0.19-0.99）. CONCLUSION： Endoscopic treatment of DL is safe and effective. Adrenaline monotherapy and arterial （spurting） bleeding are associated with a high rate of bleeding recurrence.

Malignant gastrointestinal melanomas of unknown origin: Should it be considered primary?

We read with interest the article entitled： ‘Jejuno-jejunal invagination due to intestinal melanoma’ by Resta , et al. They reported a rare clinical case of a young woman with a bleeding jejunal melanoma, whose early clinical presentation was an intestinal invagination. The article is also referred to the rarity of gastrointestinal melanomas as well as their possible primary nature.

Comprehensive Treatment and Prognostic Factors in Patients with Carcinoma of the Cervical Stump

OBJECTIVE To evaluate the applicability of combined therapyand the prognostic factors in patients with carcinoma of thecervical stump (CCS).METHODS The clinical records of 60 CCS patients whounderwent combined treatment in our hospital during a periodfrom January 2000 to December 2007, were collected andretrospectively analyzed. The prognostic factors were studiedusing univariate analysis. Analytical evaluation of the independentprognostic factors was performed using COX proportionalhazardsregression model.RESULTS The 1-, 3- and 5-year survival rates of the 60 patientswere 95%, 78% and 68%, respectively, with a median survivaltime of 32 months. Univariate survival analysis showed thatthese independent prognostic factors included positive pelviclymph nodes (P = 0.001), lymphovascular tumor embolus (P =0.001), and adjuvant chemotherapy (P = 0.011). In the 60 cases,postoperative local recurrence in the pelvic cavity occurred in1 and distant metastasis in 3. Related complications, such asradiocystitis, recto-vaginal fistula and vesico-vaginal fistula werefound in 6 of the total cases (10%). The serum levels of squamousepithelium antigen detected before and after treatment weresignificantly different (P = 0.000). The incidence of CCS is low;however, the disease is difficult to cure due to the high incidenceof complications and to the frequency of distant metastasis.Therefore, individualized treatment is needed. Complications fromsubtotal hysterectomy (STH) should be treated and controlledaggressively. Careful follow-up as well as close monitoring andobservation for significant symptoms in the postoperative coursewill enhance clinical outcome.CONCLUSION Cancer of the cervical stump has a lowmorbidity and severe complications, and most recurrences aredistant metastases. Because it is difficult to cure, there is a needto design a treatment regimen for each individual patient basedon the factors deemed as high risk. The surgical indications forsubtotal uterine resection should be followed and close follow-upafter surgery should be maintained.

Outcomes and prognostic factors of fecal microbiota transplantation in patients with slow transit constipation:results from a prospective study with long-term follow-up

Background and aim:Gutmicrobiotamay contribute to regulate colonicmotility,which is involved in the etiology of constipation.Fecalmicrobiota transplantation(FMT)has been demonstrated to restore intestinal homeostasis.The aimof this study was to evaluate the clinical outcomes and prognostic factors of FMT for the treatment of slow transit constipation(STC).Methods:Fifty-two patients with STC received standardized FMT and were followed up for 6 months.Bowel habit,colonic transit time,constipation-related symptoms(PAC-SYM score),quality of life(PAC-QOL score),treatment satisfaction scores and adverse events were monitored.The primary efficacy endpoint was the proportion of patients having on average three or more complete spontaneous bowel movements(CSBMs)per week.Results:The primary efficacy endpoint was achieved in 50.0%,38.5%and 32.7%of patients over week intervals 3–4,9–12 and 21–24,respectively(P<0.01 for all comparisons).Significant improvements were also observed in other bowel movement assessments,colonic transit time,constipation-related symptoms and quality of life;but all improvements diminished at weeks 12 and 24.Incompleteness of evacuation served as the only factor associated with efficacy.No serious treatmentrelated adverse events were observed.Conclusion:This study suggested FMT was effective and safe for STC,while a late loss of efficacy was also observed.A lower degree of sensation of incompleteness predicted a better outcome.

Risk factors connected to gastrointestinal parasites in mantled Alouatta palliata mexicana and black howler monkeys Alouatta pigra living in continuous and in fragmented rainforests in Mexico

In this study we document the prevalence of gastrointestinal parasites （helminths and protozoans） found in fecal samples of populations of Alouatta palliata mexicana and ofA. pigra in Los Tuxtlas and in Palenque, southeast Mexico, and its re- lation to habitat condition, sex/age and season. Nineteen parasite morphotypes were detected in the fecal samples from populations of the two howler monkeys, of which 58% were shared by both species. When considering all parasite species, populations of the two howler species were more likely to be parasitized in fragmented habitat compared to continuous habitat. Individuals of both howler monkey species that lived in fragmented habitat had a higher prevalence of Controrchis biliophilus. A. p. mexicana individuals had a higher prevalence of Trypanoxyuris minutus than A. pigra, probably the result of the larger group sizes found in the former species, and T. minutus was more likely to be found in A. palliata individuals that lived in fragmented habitat. Adult A. p. mexicana males had a higher risk of being parasitized compared to adult females, but these differences were not detected in A. pigra, Parasite species such as Entamoeba sp., Nematoda sp. 28, Nematoda sp. B and Parabronema sp. where only found during the wet season in both howler monkey species. Populations of both howler monkey species had a higher prevalence of Nematoda sp. A in the wet season and Ascaridae eggs were only detected during the wet season in A. pigra. Other parasites detected displayed no clear seasonal pattern [Current Zoology 58 （3）： 375-383, 2012].