儿童肾病综合征甲基强的松龙冲击治疗的护理体会

总结甲基强的松龙冲击治疗儿童肾病综合征的护理体会。采用大剂量短程冲击治疗具有不良反应较少、疗效显著的特点。但因为甲基强的松龙的不良反应会导致继发感染、消化道出血、血压升高、电解质紊乱、潜在感染等危险,所以在冲击治疗护理中除一般护理外,还要注意对患儿的特殊护理,如:健康知识宣传、血压的监测、输液速度的监控、疗效的观察、预防感染等。

Need for a comprehensive medical approach to the neuroimmuno-gastroenterology of irritable bowel syndrome

Irritable bowel syndrome （IBS） is defined by the Rome ]I[ criteria as symptoms of recurrent abdominal pain or discomfort with the onset of a marked change in bowel habits with no evidence of an inflammatory, anatomic, metabolic, or neoplastic process. As such, many clinicians regard IBS as a central nervous system problem of altered pain perception. Here, we review the recent literature and discuss the evidence that supports an organic based model, which views IBS as a complex, heterogeneous, inter-dependent, and multi-variable inflammatory process along the neuronal-gut axis. We delineate the organic pathophysiology of IBS, demonstrate the role of inflammation in IBS, review the possible differences between adult and pediatric IBS, discuss the merits of a comprehensive treatment model as taught by the Institute of Functional Medicine, and describe the potential for future research for this syndrome.

Infectious causation of chronic disease:Examining the relationship between Giardia lamblia infection and irritable bowel syndrome

AIM: To evaluate whether a higher prevalence of Giardia lamblia infection is associated with an increase in irritable bowel syndrome (IBS) prescriptions at the county level in Michigan. METHODS: The Michigan Disease Surveillance System (MDSS) was used to ascertain both the numbers of Giardia lamblia infections as well as the total number of foodborne illnesses per population by county in Michigan during 2005. This was compared with Blue Cross Blue Shield (BCBS) of Michigan numbers of drug prescriptions for IBS per one thousand members per county in 2005. These data were also analyzed for associations with per capita income by county and the number of refugees entering each county in 2005. RESULTS: There were a total of 786 confirmed cases of Giardia lamblia reported to MDSS in 2005. During the same time period, the number of prescriptions for IBS varied from 0.5 per 1000 members up to 6.0 per 1000 members per month. There was no trend towards higher numbers of IBS prescriptions in the counties with more Giardia lamblia infections. Per capita income was not associated with either IBS prescriptions or Giardiasis. There was a significant linear association between the number of refugees entering each county, and the number of Giardia lamblia cases per 100 000 population. CONCLUSION: In this ecological study, there was no association found between BCBS prescriptions for IBS and Giardia lamblia infections in Michigan counties. Our findings may have been influenced by the disparate number of refugees admitted per county.

Irritable bowel syndrome: Physicians' awareness and patients' experience

AIM: To study if and how physicians use the irritable bowel syndrome (IBS) diagnostic criteria and to assess treatment strategies in IBS patients. METHODS: A questionnaire was sent to 191 physicians regarding IBS criteria, diagnostic methods and treatment. Furthermore, 94 patients who were diagnosed with IBS underwent telephone interview. RESULTS: A total of 80/191 (41.9%) physicians responded to the survey. Overall, 13 patients were diag-nosed monthly with IBS by specialists in gastroenterology (SGs) and 2.5 patients by general practitioners (GPs). All the SGs knew of the criteria to diagnose IBS, as did 46/70 (65.7%) GPs. Seventy-nine percent used the patient's history, 38% used a physical examination, and 38% exclusion of other diseases to diagnose IBS. Only 18/80 (22.5%) physicians used specific IBS criteria. Of the patients interviewed, 59/94 (62.8%) knew they had experienced IBS. Two out of five patients knew IBS and had seen a physician because of IBS symptoms. Half of those received a diagnosis of IBS. A total of 13% were satisfied with treatment. IBS affected daily activities in 43% of cases. CONCLUSION: Half of the patients with IBS who consulted a physician received a diagnosis. Awareness and knowledge of diagnostic criteria for IBS differ between SGs and GPs.

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.

Irritable bowel syndrome and diet

Irritable bowel syndrome(IBS)is a chronic functional disorder of the gastrointestinal tract and is one of the most commonly diagnosed gastrointestinal diseases.The impact of IBS on the general population is large due to its high prevalence,suboptimal medical treatments and significant economic burden.The pathophysiology of IBS is complex and treatments are often symptom-specific.Themost common therapeutic approaches for IBS include education and reassurance,lifestyles(especially nutrition-based interventions),peripherally acting medications(which typically target motility),centrally actingmedications(which target visceral hypersensitivity and pain)and psychological interventions(which aim to reduce the effects of stress or symptom-specific anxiety).A beneficial dietary approach might include the following measures:a diet low in fermentable oligo-,di-and monosaccharides and polyols(FODMAPs),limitation or exclusion of gas-producing foods and/or lactose and gluten and fiber supplementation in selected cases.New therapeutic agents,namely nutraceutics,are also an interesting option in the management of IBS patients.This paper will focus on available dietary interventions for IBS and will review the evidence for nutrition-based therapies.

Distributions of Sasang constitutions and six syndromes in patients with functional dyspepsia and healthy subjects

OBJECTIVE:To investigated the characteristics of patients with functional dyspepsia(FD)in terms of Sasang constitutional medicine.METHODS:A total of 116 patients with FD were recruited based on diagnosis by gastroscopy and symptomatic measurements.The distributions of Sasang constitutions and six syndromes in terms of TKM theory in the patients was compared with those from 1423 healthy subjects.RESULTS:The distribution of Sasang constitutions for the patients with FD significantly differed from that for healthy subjects,especially among women;36.7%vs 45.6%for Taeumin,28.9%vs 33.9%for Soumin,and 34.4%vs 20.4%for Soyangin.Our results assumed a high prevalence in Soyangin women(around 1.7 folds),and Soumin(45.2%),inparticular,had a high prevalence of"deficiency and coldness of spleen and stomach"compared with Taeumin(14.9%)and Soyangin types(15.7%).CONCLUSION:This study identified a trend for the frequency of FD and the Sasang constitutions.The findings may provide new ideas for the study of prevention and management of FD.