AIM:To assess the safety,yield and clinical utility of percutaneous transgastric computed tomography(CT)-guided biopsy of pancreatic tumor using large needles, in selected patients. METHODS:We reviewed 34 CT-guided bi...AIM:To assess the safety,yield and clinical utility of percutaneous transgastric computed tomography(CT)-guided biopsy of pancreatic tumor using large needles, in selected patients. METHODS:We reviewed 34 CT-guided biopsies in patients with pancreas mass,of whom 24(71%)had a direct path to the mass without passing through a major organ.The needle passed through the liver in one case(3%).Nine passes(26%)were made through the stomach.These nine transgastric biopsies which used a coaxial technique(i.e.a 17-gauge coaxial introducer needle and an 18-gauge biopsy needle)were the basis of this study.Immediate and late follow-up CT images to detect complications were obtained. RESULTS:Tumor tissues were obtained in nine pancreatic biopsies,and histologic specimens for diagnosis were obtained in all cases.One patient,who had a rare sarco-matoid carcinoma,received a second biopsy.One patient had a complication of transient pneumoperitoneum but no subjective complaints.An immediate imaging study and clinical follow-up detected neither hemorrhage nor peritonitis.No delayed procedure-related complication was seen during the survival period of our patients.CONCLUSION:Pancreatic biopsy can be obtained by a transgastric route using a large needle as an alternative method,without complications of peritonitis or bleeding.展开更多
The gastrointestinal tract represents the largest mucosal membrane surface in the human body. The immune system in the gut is the first line of host defense against mucosal microbial pathogens and it plays a crucial r...The gastrointestinal tract represents the largest mucosal membrane surface in the human body. The immune system in the gut is the first line of host defense against mucosal microbial pathogens and it plays a crucial role in maintaining mucosal homeostasis. Membranous or microfold cells, commonly referred to as microfold cells, are specialized epithelial cells of the gut-associated lymphoid tissues (GALT) and they play a sentinel role for the intestinal immune system by delivering luminal antigens through the follicle-associated epithelium to the underlying immune cells. M cells sample and uptake antigens at their apical membrane, encase them in vesicles to transport them to the basolateral membrane of M cells, and from there deliver antigens to the nearby lymphocytes. On the flip side, some intestinal pathogens exploit M cells as their portal of entry to invade the host and cause infections. In this article, we briefly review our current knowledge on the morphology, development, and function of M cells, with an emphasis on their dual role in the pathogenesis of gut infection and in the development of host mucosal immunity.展开更多
This review provides information on the definition of constipation, normal continence and defecation and a description of the pathophysiologic mechanisms of constipation. In addition, changes in the anatomy and physio...This review provides information on the definition of constipation, normal continence and defecation and a description of the pathophysiologic mechanisms of constipation. In addition, changes in the anatomy and physiology of the lower gastrointestinal tract associated with aging that may contribute to constipation are described. MEDLINE (1966-2007) and CINAHL (1980-2007) were searched. The following MeSH terms were used: constipation/etiology OR constipation/ physiology OR constipation/physiopathology) AND (age factors OR aged OR older OR 80 and over OR middle age). Constipation is not well defined in the literature. While self-reported constipation increases with age, findings from a limited number of clinical studies that utilized objective measures do not support this association. Dysmotility and pelvic floor dysfunction are important mechanisms associated with constipation. Changes in GI function associated with aging appear to be relatively subtle based on a limited amount of conflicting data. Additional research is warranted on the effects of aging on GI function, as well as on the timing of these changes.展开更多
AIM： To quantify the intraepithelial lymphocytes （IELs） and to document the membrane expression of CD4, CD8, TCRγδ and adhesion and/or activation-associated molecules （CD103, CD28, CD44, CD69, HLA-DR, CD95/ Fas...AIM： To quantify the intraepithelial lymphocytes （IELs） and to document the membrane expression of CD4, CD8, TCRγδ and adhesion and/or activation-associated molecules （CD103, CD28, CD44, CD69, HLA-DR, CD95/ Fas） in the duodenal mucosa of patients with functional dyspepsia （FD） in order to provide arguments for an immunological process in FD. METHODS： Twenty-six FD patients according to Rome Ⅱ criteria （20 were H pylori negative） were studied and compared to 12 healthy adults. IELs were isolated from five duodenal biopsy samples, then quantified by microscopy and flow cytometry while the membrane phenotypes were determined by cytofluorometry. RESULTS： Duodenal histological examination was normal. In H pylori negative patients, the number of IELs was not different from that in healthy controls. Median percentage expression of CD4, CD8, or TCRy8 and CD103, CD44, CD28, CD69 on CD3＋ IELs, among the adhesion/activation associated molecules tested, was not different from that in healthy controls. In contrast, the median percentage expression of CD95/ Fas [22 （9-65） vs 45 （19-88）, P = 0.03] and HLADR expressing CD3＋ IELs [4 （0-30） vs 13 （4-42）, P = 0.04] was significantly lower in the H pylori negative FD group than in healthy controls, respectively. The number of IELs was significantly greater in H pylori positive FD patients than in healthy controls [median ratio for 100 enterocytes 27.5 （6.7-62.5） vs 10.8 （3-33.3）, P = 0.02] due to a higher number of CD8＋ CD3＋ IELs. CONCLUSION： In H pylori negative FD patients, the phenotypic characterization of IELs suggests that we cannot exclude a role of IELs in FD.展开更多
AIM： To investigate the hypothesis that duodenal bulb （DB） inhibition on pyloric antrum （PA） contraction is reflex. METHODS： Balloon （condom）-tipped tube was introduced into 1^st duodenum （DD） and a manometr...AIM： To investigate the hypothesis that duodenal bulb （DB） inhibition on pyloric antrum （PA） contraction is reflex. METHODS： Balloon （condom）-tipped tube was introduced into 1^st duodenum （DD） and a manometric tube into each of PA and DD. Duodenal and antral pressure response to duodenal and then PA balloon distension with saline was recorded. These tests were repeated after separate anesthetization of DD and PA. RESULTS： Two and 4 mL of 1^st DD balloon distension produced no pressure changes in DD or PA （10.7±1.2 vs 9.8±1.2, 11.2±1.2 vs 11.3±1.2 on H20 respectively, P〉0.05）. Six mL distension effected 1^st DD pressure rise （30.6±3.4 cm H20, P 〈0.01） and PA pressure decrease （6.2±1.4 cm H20, P〈0.05）; no response in 2^nd, 3^rd and 4^th DD. There was no difference between 6, 8, and 10 mL distensions. Ten mL PA distension produced no PA or 1^st DD pressure changes （P〉 0.05）. Twenty mL distension increased PA pressure （92.4 4±10.7 cm H20, P〈0.01） and decreased 1^st DD pressure （1.6±0.3 cm H20, P〈0.01）; 30, 40, and 50 mL distension produced the same effect as the 20 mL distension （P 〉 0.05）. PA or DD distension after separate anesthetization produced no significant pressure changes in PA or DD. CONCLUSION： Large volume DD distension produced DD pressure rise denoting DD contraction and PA pressure decline denoting PA relaxation. PA relaxation upon DD contraction is postulated to be mediated through a reflex which we call duodeno-antral reflex. Meanwhile, PA distension effected DD relaxation which we suggest to be reflex and termed antro-duodenal reflex. It is suggested that these 2 reflexes, could act as investigative tools in diagnosis of gastroduodenal motility disorders.展开更多
Objective: To explore the optimal timing of drug application for the recovery of gastrointestinal function in patients after laparoscopic cholecystectomy. Methods: Ninety patients undergoing laparoscopic cholecystecto...Objective: To explore the optimal timing of drug application for the recovery of gastrointestinal function in patients after laparoscopic cholecystectomy. Methods: Ninety patients undergoing laparoscopic cholecystectomy were randomly divided into three groups: control group, intervention group 1 and intervention group 2. All three groups received routine perioperative nursing. Intervention group 1 and group 2 were given acupoint application of Chinese medicine at 0.5 h and 6 h after operation, and the waveform was monitored by electrogastrogram on the 1st day before operation and 3 d after operation. The first anal exhaust time, defecation time, abdominal distension and electrogastrogram changes were analyzed and compared in the three groups. Results: Compared with the first exhaust time and defecation time after operation, the intervention group 1 was earlier than the intervention group 2, and the intervention group 2 was earlier than the control group, the difference was statistically significant (P < 0.05). The average frequency, waveform response area and average amplitude of the intervention group 1 were better than those of the intervention group 2, and the intervention group 2 was better than the control group (P < 0.05). Conclusion: Administration of Chinese medicine acupoint application within 0.5 hours after operation can promote the recovery of gastrointestinal function and improve gastric motility in patients undergoing abdominal surgery, and the curative effect is significant and safe.展开更多
OBJECTIVE: To investigate the therapeutic effect of the herbal medication Xiao Pi-II on the symptoms and gastric motility of patients with functional dysepsia (FD). METHODS: A total of 180 FD patients were divided ran...OBJECTIVE: To investigate the therapeutic effect of the herbal medication Xiao Pi-II on the symptoms and gastric motility of patients with functional dysepsia (FD). METHODS: A total of 180 FD patients were divided randomly and equally into Xiao Pi-II and mosapride groups. The two groups were treated with Xiao Pi-II (100 mL, t.d.s., ante cibum) and mosapride (5 mg, t. d.s., ante cibum) for 2 weeks. Before treatment and 3 days after all medication was stopped, patients responded to a questionnaire evaluating gastrointestinal symptoms and were assessed with abdominal three dimensional ultrasonography (3D-US) for gastric motility. RESULTS: Gastrointestinal symptoms (especially bloating, post-prandial fullness and eructation) were improved significantly in FD patients treated with Xiao Pi-II (P<0.05, P<0.05, and P<0.05), but no significant difference was found in the mosapride group (P>0.05). The effective rates in the Xiao Pi-II and mosapride group were 86.7% and 60.0%, respectively (P<0.05). The gastric liquid emptyingrate (GLER) in the Xiao Pi-II group showed a significant increase (P<0.01) after 2 weeks of treatment but there was no significant change (P>0.05) of GLER in the mosapride group. CONCLUSION: Compared with mosapride, Xiao Pi-II improved symptoms and GLER significantly in FD patients with delayed gastric emptying.展开更多
文摘AIM:To assess the safety,yield and clinical utility of percutaneous transgastric computed tomography(CT)-guided biopsy of pancreatic tumor using large needles, in selected patients. METHODS:We reviewed 34 CT-guided biopsies in patients with pancreas mass,of whom 24(71%)had a direct path to the mass without passing through a major organ.The needle passed through the liver in one case(3%).Nine passes(26%)were made through the stomach.These nine transgastric biopsies which used a coaxial technique(i.e.a 17-gauge coaxial introducer needle and an 18-gauge biopsy needle)were the basis of this study.Immediate and late follow-up CT images to detect complications were obtained. RESULTS:Tumor tissues were obtained in nine pancreatic biopsies,and histologic specimens for diagnosis were obtained in all cases.One patient,who had a rare sarco-matoid carcinoma,received a second biopsy.One patient had a complication of transient pneumoperitoneum but no subjective complaints.An immediate imaging study and clinical follow-up detected neither hemorrhage nor peritonitis.No delayed procedure-related complication was seen during the survival period of our patients.CONCLUSION:Pancreatic biopsy can be obtained by a transgastric route using a large needle as an alternative method,without complications of peritonitis or bleeding.
基金Supported by the National Institutes of Health,USA,R21AI59064,National Research Council Canada (A-base) and Dow AgroScience
文摘The gastrointestinal tract represents the largest mucosal membrane surface in the human body. The immune system in the gut is the first line of host defense against mucosal microbial pathogens and it plays a crucial role in maintaining mucosal homeostasis. Membranous or microfold cells, commonly referred to as microfold cells, are specialized epithelial cells of the gut-associated lymphoid tissues (GALT) and they play a sentinel role for the intestinal immune system by delivering luminal antigens through the follicle-associated epithelium to the underlying immune cells. M cells sample and uptake antigens at their apical membrane, encase them in vesicles to transport them to the basolateral membrane of M cells, and from there deliver antigens to the nearby lymphocytes. On the flip side, some intestinal pathogens exploit M cells as their portal of entry to invade the host and cause infections. In this article, we briefly review our current knowledge on the morphology, development, and function of M cells, with an emphasis on their dual role in the pathogenesis of gut infection and in the development of host mucosal immunity.
文摘This review provides information on the definition of constipation, normal continence and defecation and a description of the pathophysiologic mechanisms of constipation. In addition, changes in the anatomy and physiology of the lower gastrointestinal tract associated with aging that may contribute to constipation are described. MEDLINE (1966-2007) and CINAHL (1980-2007) were searched. The following MeSH terms were used: constipation/etiology OR constipation/ physiology OR constipation/physiopathology) AND (age factors OR aged OR older OR 80 and over OR middle age). Constipation is not well defined in the literature. While self-reported constipation increases with age, findings from a limited number of clinical studies that utilized objective measures do not support this association. Dysmotility and pelvic floor dysfunction are important mechanisms associated with constipation. Changes in GI function associated with aging appear to be relatively subtle based on a limited amount of conflicting data. Additional research is warranted on the effects of aging on GI function, as well as on the timing of these changes.
文摘AIM： To quantify the intraepithelial lymphocytes （IELs） and to document the membrane expression of CD4, CD8, TCRγδ and adhesion and/or activation-associated molecules （CD103, CD28, CD44, CD69, HLA-DR, CD95/ Fas） in the duodenal mucosa of patients with functional dyspepsia （FD） in order to provide arguments for an immunological process in FD. METHODS： Twenty-six FD patients according to Rome Ⅱ criteria （20 were H pylori negative） were studied and compared to 12 healthy adults. IELs were isolated from five duodenal biopsy samples, then quantified by microscopy and flow cytometry while the membrane phenotypes were determined by cytofluorometry. RESULTS： Duodenal histological examination was normal. In H pylori negative patients, the number of IELs was not different from that in healthy controls. Median percentage expression of CD4, CD8, or TCRy8 and CD103, CD44, CD28, CD69 on CD3＋ IELs, among the adhesion/activation associated molecules tested, was not different from that in healthy controls. In contrast, the median percentage expression of CD95/ Fas [22 （9-65） vs 45 （19-88）, P = 0.03] and HLADR expressing CD3＋ IELs [4 （0-30） vs 13 （4-42）, P = 0.04] was significantly lower in the H pylori negative FD group than in healthy controls, respectively. The number of IELs was significantly greater in H pylori positive FD patients than in healthy controls [median ratio for 100 enterocytes 27.5 （6.7-62.5） vs 10.8 （3-33.3）, P = 0.02] due to a higher number of CD8＋ CD3＋ IELs. CONCLUSION： In H pylori negative FD patients, the phenotypic characterization of IELs suggests that we cannot exclude a role of IELs in FD.
文摘AIM： To investigate the hypothesis that duodenal bulb （DB） inhibition on pyloric antrum （PA） contraction is reflex. METHODS： Balloon （condom）-tipped tube was introduced into 1^st duodenum （DD） and a manometric tube into each of PA and DD. Duodenal and antral pressure response to duodenal and then PA balloon distension with saline was recorded. These tests were repeated after separate anesthetization of DD and PA. RESULTS： Two and 4 mL of 1^st DD balloon distension produced no pressure changes in DD or PA （10.7±1.2 vs 9.8±1.2, 11.2±1.2 vs 11.3±1.2 on H20 respectively, P〉0.05）. Six mL distension effected 1^st DD pressure rise （30.6±3.4 cm H20, P 〈0.01） and PA pressure decrease （6.2±1.4 cm H20, P〈0.05）; no response in 2^nd, 3^rd and 4^th DD. There was no difference between 6, 8, and 10 mL distensions. Ten mL PA distension produced no PA or 1^st DD pressure changes （P〉 0.05）. Twenty mL distension increased PA pressure （92.4 4±10.7 cm H20, P〈0.01） and decreased 1^st DD pressure （1.6±0.3 cm H20, P〈0.01）; 30, 40, and 50 mL distension produced the same effect as the 20 mL distension （P 〉 0.05）. PA or DD distension after separate anesthetization produced no significant pressure changes in PA or DD. CONCLUSION： Large volume DD distension produced DD pressure rise denoting DD contraction and PA pressure decline denoting PA relaxation. PA relaxation upon DD contraction is postulated to be mediated through a reflex which we call duodeno-antral reflex. Meanwhile, PA distension effected DD relaxation which we suggest to be reflex and termed antro-duodenal reflex. It is suggested that these 2 reflexes, could act as investigative tools in diagnosis of gastroduodenal motility disorders.
文摘Objective: To explore the optimal timing of drug application for the recovery of gastrointestinal function in patients after laparoscopic cholecystectomy. Methods: Ninety patients undergoing laparoscopic cholecystectomy were randomly divided into three groups: control group, intervention group 1 and intervention group 2. All three groups received routine perioperative nursing. Intervention group 1 and group 2 were given acupoint application of Chinese medicine at 0.5 h and 6 h after operation, and the waveform was monitored by electrogastrogram on the 1st day before operation and 3 d after operation. The first anal exhaust time, defecation time, abdominal distension and electrogastrogram changes were analyzed and compared in the three groups. Results: Compared with the first exhaust time and defecation time after operation, the intervention group 1 was earlier than the intervention group 2, and the intervention group 2 was earlier than the control group, the difference was statistically significant (P < 0.05). The average frequency, waveform response area and average amplitude of the intervention group 1 were better than those of the intervention group 2, and the intervention group 2 was better than the control group (P < 0.05). Conclusion: Administration of Chinese medicine acupoint application within 0.5 hours after operation can promote the recovery of gastrointestinal function and improve gastric motility in patients undergoing abdominal surgery, and the curative effect is significant and safe.
文摘OBJECTIVE: To investigate the therapeutic effect of the herbal medication Xiao Pi-II on the symptoms and gastric motility of patients with functional dysepsia (FD). METHODS: A total of 180 FD patients were divided randomly and equally into Xiao Pi-II and mosapride groups. The two groups were treated with Xiao Pi-II (100 mL, t.d.s., ante cibum) and mosapride (5 mg, t. d.s., ante cibum) for 2 weeks. Before treatment and 3 days after all medication was stopped, patients responded to a questionnaire evaluating gastrointestinal symptoms and were assessed with abdominal three dimensional ultrasonography (3D-US) for gastric motility. RESULTS: Gastrointestinal symptoms (especially bloating, post-prandial fullness and eructation) were improved significantly in FD patients treated with Xiao Pi-II (P<0.05, P<0.05, and P<0.05), but no significant difference was found in the mosapride group (P>0.05). The effective rates in the Xiao Pi-II and mosapride group were 86.7% and 60.0%, respectively (P<0.05). The gastric liquid emptyingrate (GLER) in the Xiao Pi-II group showed a significant increase (P<0.01) after 2 weeks of treatment but there was no significant change (P>0.05) of GLER in the mosapride group. CONCLUSION: Compared with mosapride, Xiao Pi-II improved symptoms and GLER significantly in FD patients with delayed gastric emptying.
