达格列净片致严重便秘1例分析

目的 提高医务人员对达格列净片致严重便秘的警惕性,为达格列净的安全使用提供参考。方法 分析1例由达格列净片导致严重便秘患者的诊疗经过,对相关文献进行归纳与总结,探讨钠-葡萄糖共转运体2抑制剂(SGLT-2i)导致严重便秘的发生情况、可能机制和防治措施。结果 患者在使用达格列净片后出现严重便秘,停药后患者便秘症状好转,再次使用达格列净片后患者又出现便秘,立即停药并予润肠通便治疗后,便秘症状好转。其不良反应因果关系评估为“肯定”,故判断该患者严重便秘由达格列净片所致。结论 便秘不仅严重影响患者生活质量,还可能诱发心血管事件,应加强对达格列净片及SGLT-2i类药物致便秘不良反应的重视及用药教育。

胶囊内镜在中老年健康体检者中的应用价值探讨

目的：探讨胶囊内镜在中老年健康体检人群中的临床应用和诊断价值。方法对在我院体检科进行胶囊内镜检查的148例中老年体检者的图像资料进行回顾性分析。结果检查成功率为100%。148例健康体检者检查出不同性质的胃肠道病变65例，阳性率为43.92%。结论胶囊内镜以其无痛无创的全消化道检查优势，可作为胃肠系统疾病初步筛查的重要检查手段。

Classification of anemia for gastroenterologists

Most anemia is related to the digestive system by dietary deficiency, malabsorption, or chronic bleeding. We review the World Health Organization definition of anemia, its morphological classifi cation (microcytic, macrocytic and normocytic) and pathogenic classi-fication (regenerative and hypo regenerative), and integration of these classifications. Interpretation of laboratory tests is included, from the simplest (blood count, routine biochemistry) to the more specific (iron metabolism, vitamin B12, folic acid, reticulocytes, erythropoietin, bone marrow examination and Schilling test). In the text and various algorithms, we propose a hierarchical and logical way to reach a diagnosis as quickly as possible, by properly managing the medical interview, physical examination, appropriate laboratory tests, bone marrow examination, and other comple-mentary tests. The prevalence is emphasized in all sections so that the gastroenterologist can direct the diagnosis to the most common diseases, although the tables also include rare diseases. Digestive diseases potentially causing anemia have been studied in preference, but other causes of anemia have been included in the text and tables. Primitive hematological diseases that cause anemia are only listed, but are not discussed in depth. The last section is dedicated to simplifying all items discussed above, using practical rules to guide diagnosis and medical care with the greatest economy of resources and time.

New technologies in the gastrointestinal clinic and research: Impedance and high-resolution manometry

The last five years have been an exciting time in the study of esophageal motor disorders due to the recent advances in esophageal function testing. New technologies have emerged, such as intraluminal impedance, while conventional techniques, such as manometry, have enjoyed many improvements due to advances in transducer technology, computerization and graphic data presentation. While these techniques provide more detailed information regarding esophageal function, our understanding of whether they can improve our ability to diagnose and treat patients more effectively is evolving. These techniques are also excellent research tools and they have added substantially to our understanding of esophageal motor function in dysphagia. This review describes the potential benefits that these new technologies may have over conventional techniques for the evaluation of dysphagia.

Role of videocapsule endoscopy for gastrointestinal bleeding

Obscure gastrointestinal bleeding (OGIB) is defi ned as bleeding of an unknown origin that persists or recurs after negative initial upper and lower endoscopies. Several techniques, such as endoscopy, arteriography, scintigraphy and barium radiology are helpful for recognizing the bleeding source; nevertheless, in about 5%-10% of cases the bleeding lesion cannot be determined. The development of videocapsule endoscopy (VCE) has permitted a direct visualization of the small intestine mucosa. We will analyze those techniques in more detail. The diagnostic yield of CE for OGIB varies from 38% to 93%, being in the higher range in those cases with obscure-overt bleeding.

Association of upper gastrointestinal symptoms with functional and clinical characteristics in the elderly

AIM： To evaluate the prevalence of upper gastrointestinal symptoms and their association with clinical and functional characteristics in elderly outpatients. METHODS： The study involved 3238 outpatients ≥ 60 years consecutively enrolled by 107 general practitioners. Information on social, behavioral and de- mographic characteristics, function in the activities of daily living （ADL）, co-morbidities and drug use were collected by a structured interview. Upper gastroin- testinal symptom data were collected by the 15-items upper gastro-intestinal symptom questionnaire for the elderly, a validated diagnostic tool which includes the following five symptom clusters： （1） abdominal pain syndrome; （2） reflux syndrome; （3） indigestion syn- drome; （4） bleeding, and （5） non-specific symptoms. Presence and severity of gastrointestinal symptoms were analyzed through a logistic regression model. RESULTS： 3100 subjects were included in the final analysis. The overall prevalence of upper gastrointes- tinal symptoms was 43.0%, i.e. cluster （1） 13.9%, （2） 21.9%, （3） 30.2%, （4） 1.2%, and （5） 4.5%. Upper gastrointestinal symptoms were more frequently re- ported by females （P 〈 0.0001）, with high number of co-morbidities （P 〈 0.0001）, who were taking higher number of drugs （P 〈 0.0001） and needed assistance in the ADL. Logistic regression analysis demonstrated that female sex （OR = 1.39, 95% CI： 1.17-1.64）, dis- ability in the ADL （OR = 1.47, 95% CI： 1.12-1.93）, smoking habit （OR = 1.29, 95% C]： 1.00-1.65）, and body mass index （OR = 1.06, 95% CI： 1.04-1.08）, as well as the presence of upper （OR = 3.01, 95% C]： 2.52-3.60） and lower gastroenterological diseases （OR = 2.25, 95%CI： 1.70-2.97）, psychiatric （OR = 1.60, 95% CI： 1.28-2.01） and respiratory diseases （OR = 1.25, 95% C]： 1.01-1.54） were significantly associated with the presence of upper gastrointestinal symptoms. CONCLUSION： Functional and clinical characteristics are associated with upper gastrointestinal symptoms. A multidimensional comprehensive evaluation may be useful when approaching upper gastrointestinal symp- toms in older subjects.

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.

Giant malignant gastrointestinal stromal tumors: Recurrence and effects of treatment with STI-571

AIM: Malignant gastrointestinal stromal tumors (GISTs)are rare. Tumors larger than 10 cm tend to recur earlier:the larger the volume of the tumor, the worse the prognosis.We hypothesized that treatment with imatinib mesylate (Gleevec; STI-571), a c-kittyrosine kinase inhibitor, as palliative therapy would prolong the survival of patients with recurrent giant malignant GISTs after resection.METHODS: We performed a retrospective analysis of the effects of resection on patients with giant GISTs (＞10 cm in diameter) to determine the overall survival and recurrence rates. Twenty-three patients diagnosed with giant GISTs were included from June 1996 to December 2003. STI571 was not available until January 2000. After that time,9 patients received this drug. The factors of age, sex, tumor location, histological surgical margin, and STI-571, tumor size changes and drug side effects were reviewed. We compared the survival rate to determine the prognostic factors and the effects of STI-571 on patients with recurrent malignant gastrointestinal stromal tumor.RESULTS: The positive surgical margin group had a significantly higher recurrence rate than the negative margin group (P = 0.012). A negative surgical margin and palliative treatment with STI-571 were significant prognostic variables (Log-rank test,P＜0.05). Age, sex and tumor location were not significant prognostic variables. The 5-year survival rate of the surgical margin free patients was 80%and the 2-year survival rate of the surgical margin positive patients was 28%. The 5-year survival rate was 80% for the patients given STI-571 and 30% for the patients not given STI-571. The use of STI-571 gave a significant tumor shrinkage (6/9) rate in patients with giant GIST recurrence after resection.CONCLUSION: A negative surgical margin and the use of STI-571 after surgical resection were good prognostic indicators. Achieving a tumor-free surgical margin is still the best primary treatment for patients with such tumors.If STI-571 is used immediately when the surgical margin is positive and the tumor recurs after resection, then the prognosis of patients with giant GISTs can be improved.

Establishment of a new pig model for auxiliary partial orthotopic liver transplantation

AIM: To establish a new pig model for auxiliary partial orthotopic liver transplantation (APOLT).METHODS: The liver of the donor was removed from its body. The left lobe of the liver was resected in vivo and the right lobe was used as a graft. After the left lateral lobe of the recipient was resected, end-to-side anastomoses of suprahepatic inferior vena cava and portal vein were performed between the donor and recipient livers,respectively. End-to-end anastomoses were made between hepatic artery of graft and splenic artery of the host.Outside drainage was placed in donor common bile duct.RESULTS: Models of APOLT were established in 5 pigs with a success rate of 80%. Color ultrasound examination showed an increase of blood flow of graft on 5th d compared to the first day after operation. When animals were killed on the 5th d after operation, thrombosis of hepatic vein (HV) and portal vein (PV) were not found. Histopathological examination of liver samples revealed evidence of damage with mild steatosis and sporadic necrotic hepatocytes and focal hepatic lobules structure disorganized in graft. Infiltration of inflammatory cells was mild in portal or central vein area. Hematologic laboratory values and blood chemical findings revealed that compared with group A (before transplantation), mean arterial pressure (MAP), central venous pressure (CVP), buffer base (BB), standard bicarbonate (SB) and K+ in group B (after portal vein was clamped) decreased (P＜0.01). After reperfusion of the graft, MAP, CVP and K+ restored gradually.CONCLUSION: Significant decrease of congestion in portal vein and shortened blocking time were obtained because of the application of in vitro veno-venous bypass during complete vascular clamping. This new procedure,with such advantages as simple vessel processing, quality anastomosis, less postoperative hemorrhage and higher success rate, effectively prevents ischemia reperfusion injury of the host liver and deserves to be spread.

Study on Wireless Power Transmission for Gastrointestinal Microsystems Based on Inductive Coupling

Wireless power transmission based on inductive coupling for remotely implanted micro devices has been considered in this paper. The receiving coil, integrated in microsystems and the external transmitting coil compose a loosely coupled transformer. The coupling coefficient was calculated and measured on spacing misalignments. The geometric size of transmitting coil was analyzed for the target of remotely delivering power. The received power was maximized by choosing appropriate value of frequency, tuning capacitance and the load resistance. A conventional full bridge rectifier circuit was employed to convert ac to dc voltage. The received dc power was up to 160 mW with a transmitting vohage of 5 Vrms when the receiving coil was placed at the center of the transmitting coil. This may meet the requirement of some microsystems for high power over a long time.

Genes, emotions and gut microbiota:The next frontier for the gastroenterologist

Most medical specialties including the field of gastroenterology are mainly aimed at treating diseases rather than preventing them. Genomic medicine studies the health/disease process based on the interaction of the human genes with the environment. The gastrointestinal(GI) system is an ideal model to analyze the interaction between our genes, emotions and the gut microbiota. Based on the current knowledge, this mini-review aims to provide an integrated synopsis of this interaction to achieve a better understanding of the GI disorders related to bad eating habits and stress-related disease. Since human beings are the result of an evolutionary process, many biological processes such as instincts, emotions and behavior are interconnected to guarantee survival. Nourishment is a physiological need triggered by the instinct of survival to satisfy the body's energy demands. The brain-gut axis comprises a tightly connected neuralneuroendocrine circuitry between the hunger-satiety center, the dopaminergic reward system involved in the pleasure of eating and the gut microbiota that regulates which food we eat and emotions. However, genetic variations and the consumption of high-sugar and high-fat diets have overridden this energy/pleasure neurocircuitry to the point of addiction of several foodstuffs. Consequently, a gut dysbiosis generates inflammation and a negative emotional state may lead to chronic diseases. Balancing this altered processes to regain health may involve personalized-medicine and genome-based strategies. Thus, an integrated approach based on the understanding of the gene-emotions-gut microbiota interaction is the next frontier that awaits the gastroenterologist to prevent and treat GI disorders associated with obesity and negative emotions.

Role of nuclear receptor NR4A2 in gastrointestinal inflammation and cancers

NR4A2 is a transcription factor belonging to the steroid orphan nuclear receptor superfamily.It was originally considered to be essential in the generation and maintenance of dopaminergic neurons,and associated with neurological disorders such as Parkinson's disease.Recently,NR4A2 has been found to play a critical role in some inflammatory diseases and cancer.NR4A2 can be efficiently trans-activated by some proinflammatory cytokines,such as tumor necrosis factor-α,interleukin-1β,and vascular endothelial growth factor(VEGF).The nuclear factor-κB signaling pathway serves as a principal regulator of inducible NR4A expression in immune cells.NR4A2 can trans-activate Foxp3,a hallmark specifically expressed in regulatory T(Treg) cells,and plays a critical role in the differentiation,maintenance,and function of Treg cells.NR4A2 in T lymphocytes is pivotal for Treg cell induction and suppression of aberrant induction of Th1 under physiological and pathological conditions.High density of Foxp3 + Treg cells is significantly associated with gastrointestinal inflammation,tumor immune escape,and disease progression.NR4A2 is produced at high levels in CD133 + colorectal carcinoma(CRC) cells and significantly upregulated by cyclooxygenase-2-derived prostaglandin E 2 in a cyclic adenosine monophosphate(cAMP)/protein kinase A(PKA)-dependent manner in CRC cells.The cAMP/PKA signaling pathway is the common pathway of NR4A2-related inflammation and cancer.NR4A2 trans-activates osteopontin,a direct target of the Wnt/β-catenin pathway associated with CRC invasion,metastasis,and poor prognosis.Knockdown of endogenous NR4A2 expression attenuates VEGF-induced endothelial cell proliferation,migration and in vivo angiogenesis.Taken together,NR4A2 emerges as an important nuclear factor linking gastrointestinal inflammation and cancer,especially CRC,and should serve as a candidate therapeutic target for inflammation-related gastrointestinal cancer.

CLINICAL APPLICATION OF NEIGUAN (内关 PC 6) IN THE TREATMENT OF DISORDERS OF THE DIGESTIVE SYSTEM——THE RELATED RESEARCH PROGRESS

In the present paper, the authors review recent situations of clinical application of Neiguan (PC 6内关), etc. in the treatment of disorders of the digestive system and its related research progresses. In clinical practice, Neiguan (PC 6) is usually selected as one of the main acupoints to treat gastrointestinal reactions induced by ① nausea and vomiting, ② hiccup, ③ gastrointestinal dyskinesia, ④ gastritis, and ⑤ intra-gastric examination, cesarean section, etc. Concerning experimental studies, the effects of Neiguan (PC 6), etc. on ① gastric electrical activities, ② gastrointestinal motion, ③ gastrointestinal hormone secretion, and ④ gastric mucosal structure were observed. Results indicated that Neiguan (PC 6) is an important and effective acupoint for treatment of gastrointestinal disorders in clinic. Stimulation of Neiguan (PC 6) induced favorable regulation of both the peripheral nervous system and central nervous system, and changes of the gastrointestinal hormone secretion may contribute to its effects in treating various disorders.

Premature chomosome condensation technique: A very promising approach to radiotherapy for digestive system cancers

Dear Editior-in-Chief, I am grateful to the renowned World Journal of Gastroenterology for publishing our manuscript about hepatoma radiosensitivity in volume 11 issue 26, page 4098-4101m, Since this paper appeared online first, it was widely considered. Up to date, it has been cited four times in various journals covered by Science Citation IndexE241, and the click count and download count added up to 459 and 163tsl, respectively.

基于FAERS数据库的瑞美吉泮不良事件信号挖掘与分析

目的 挖掘瑞美吉泮的风险信号,为临床安全合理用药提供参考。方法 收集FAERS数据库2020年1月1日—2024年3月31日的瑞美吉泮相关不良事件报告数据。采用比例失衡法中的ROR法和BCPNN法进行数据挖掘,利用药物不良反应术语集的首选系统器官分类和首选术语对挖掘到的风险信号进行分类和描述。结果 共提取以瑞美吉泮为首要怀疑药物的不良事件报告10 550份,排除缺失数据,共有男性患者965份(占比9.15%),女性患者6 710份(占比63.60%)。经筛选共获得阳性信号38个,发生报告数较多的系统器官为胃肠系统疾病、各类神经系统疾病和全身性疾病及给药部位各种反应;信号强度较强的新的不良事件主要有治疗产品效果不稳、赋形剂反应、舌不适、晨吐、醉酒感和鼻水肿等。结论 瑞美吉泮在真实世界中发生的常见不良反应与说明书有一致性,但存在较多新的、可疑的、未载入说明书的不良反应,临床用药时应予以重点关注,以保障患者用药安全。

Nutritional stimulation of the autonomic nervous system

Disturbance of the inflammatory response in the gut is important in several clinical diseases ranging from inflmmatory bowel disease to postoperative ileus. Several feedback mechanisms exist that control the inflammatory cascade and avoid collateral damage. In the gast rointestinal tract, it is of particular importance tocontrol the immune response to maintain the balance that allows dietary up take and utilization of nutrientson one hand, while preventing invasion of bacteria and toxins on the other hand. The process of digestion and absorption of nutrients requires a relative hyporesponsiveness of the immune cells in the gut to luminacontents which is not yet fully understood. Recentlythe autonomic nervous system has been identifi ed asan important pathway to control local and systemic inflammation and gut barrier integrity. Activation of thepathway is possible via electrical or via pharm acological interventions, but is also achieved in a physiologicamanner by ingestion of dietary lipids. Administration of dietary lipids has been shown to be very effectivein reducing the inflammatory cascade and maintaining intestinal barrier integrity in several experimental studies. This beneficial effect of nutrition on the inflammatory response and intestinal barrier integrity opens new therapeutic opportunities for treatment of certain gastrointestinal disorders. Furthermore, this neural feedback mechanism provides more insight in the relative hyporesponsiveness of the immune cells in the gut. Here, we will discuss the regulatory function of the autonomic nervous system on the inflammatory response and gut barrier function and the potential benefit in a clinical setting.

基于FAERS数据库的塞利尼索不良事件信号挖掘与分析

目的基于美国食品药品监督管理局(FDA)药品不良事件报告系统(FAERS)数据库,挖掘和分析塞利尼索药物不良事件(ADE)信号,为临床安全用药提供参考。方法采用报告比值比法(ROR)和比例报告比值法(PRR)挖掘2019年3季度—2023年3季度期间塞利尼索ADE报告,利用监管活动医学词典(MedDRA)的首选系统器官分类(SOC)和首选术语(PT)对挖掘的信号进行分类和统计分析。结果共检索到以塞利尼索为首要怀疑药物的ADE报告4991例,涉及19868个PT。经过计算筛选后得到塞利尼索ADE信号118个,涉及16个SOC。塞利尼索ADE信号与已知的相关安全性信息基本一致,ADE主要集中在胃肠系统疾病、全身性疾病及给药部位各种反应、各类检查、代谢及营养类疾病。另外还检出药品说明书未收录的ADE信号53个,如便秘、跌倒、嗜睡和肾功能异常等。结论基于FAERS的大数据可全面深入分析药品上市后的ADE,提示临床在治疗初期应密切关注塞利尼索胃肠道毒性、血液学毒性以及说明书未提及的风险,并采取预防措施,从而保障临床用药安全。

基于FAERS数据库的奥马环素不良反应信号挖掘与分析

目的利用美国FDA不良事件报告系统(FAERS)对奥马环素进行药物不良反应(ADR)高危信号挖掘,为临床合理安全使用奥马环素提供参考。方法下载2018年第4季度至2023年第2季度共19个季度的数据的FAERS数据,采用报告比值比法(ROR)和综合标准法(MHRA)对奥马环素的相关ADR报告数据进行信号挖掘。结果共获取以奥马环素为首要怀疑药物的ADR报告1180例,ROR法和MHRA法获得的奥马环素ADR风险信号基本一致,共获得奥马环素ADR信号35个,以植入物部位外渗和牙齿变色的ADR信号最强,且以胃肠道系统疾病(如恶心呕吐)最为多见,有12个ADR未在奥马环素药品说明书中出现。结论利用FAERS数据库可对奥马环素的ADR信号进行挖掘与分析,可为临床合理安全用药提供依据。

溃疡性结肠炎中医干预治疗研究

溃疡性结肠炎是一种由遗传因素与环境因素相互作用导致的胃肠系统疾病。西医常规使用激素治疗,副作用较大,且缺乏特异性,中医能有效缓解临床症状,改善患者肠道功能,提高生活质量,疗效较显著。本文就中医内治、外治、针灸对溃疡性结肠炎的治疗研究进行综述,旨在为该病的临床治疗参考。

Parsley: a review of ethnopharmacology, phytochemistry and biological activities

OBJECTIVE:To summarize comprehensive information concerning ethnomedicinal uses, phytochemistry, and pharmacological activities of parsley. METHODS: Databases including PubMed, Scopus, Google Scholar, and Web of Science were searched for studies focusing on the ethnomedicinal use, phytochemical compounds and biological and pharmacological activities of parsley. Data were collected from 1966 to 2013. The search terms were: "Parsley" or "Petroselinum crispum" or "Petroseli-num hortence ". RESULTS: Parsley has been used as carminative, gastro tonic, diuretic, antiseptic of urinary tract, anti-urolithiasis, anti-dote and anti-inflammatory and for the treatment of amenorrhea, dysmenorrhea, gastrointestinal disorder, hypertension, cardiac disease, urinary disease, otitis, sniffle, diabetes and also various dermal disease in traditional and folklore medicines. Phenolic compounds and flavonoids particularly apigenin, apiin and 6"-Acetylapiin; essential oil mainly myristicin and apiol; and also coumarins are the active compounds identified in Petroselinum crispum. Wide range of pharmacological activity including antioxidant, hepatoprotective, brain protective, anti-diabetic, analgesic, spasmolytic, immunosuppressant, anti-platelet, gastroprotective, cytoprotective, laxative, estrogenic, diuretic, hypotensive, antibacterial and antifungal activities have been exhibited for this plant in modern medicine. CONCLUSION: It is expectant that this study resulted in improvement the tendencies toward Petroselinum crispum as a useful and important medicinal plant with wide range of proven medicinal activity.