怀柔地区儿童感染性腹泻结果调查与分析

目的:对怀柔地区第一医:儿童腹泻样本检验分析,调查轮状病毒腹泻的流行状况。方法用胶体金免疫层析法检测A群轮状病毒(Rotavirus)抗原。进行统计学分析。结果A群轮状病毒感染性腹泻阳性率14.89%。发患者群主要集中在0~2周岁之间,阳性率占88.07%。11~12月为发病高发期。男女发病比为1.29:1。与北京地区的报道[1]比较,有显著性差异。结论轮状病毒是本区儿童感染性腹泻的主要病原体。其引起的腹泻发病率在0~2岁中最高,提醒临床应该根据年龄段和季节性特点,采取预防和治疗措施。

Personality factors and profiles in variants of irritable bowel syndrome

AIM: To study the association between irritable bowel syndrome (IBS) variants (constipation,diarrhea,or both) and personality traits in non-psychiatric patients. METHODS: IBS was diagnosed using the Rome Ⅱ diagnostic criteria after exclusion of organic bowel pathology. The entry of each patient was confirmed following a psychiatric interview. Personality traits and the score of each factor were evaluated using the NEO Five Factor Inventory. RESULTS: One hundred and fifty patients were studied. The mean age (± SD) was 33.4 (± 11.0) year (62% female). Subjects scored higher in neuroticism (26.25 ± 7.80 vs 22.92 ± 9.54,P < 0.0005),openness (26.25 ± 5.22 vs 27.94 ± 4.87,P < 0.0005) and conscientiousness (32.90 ± 7.80 vs 31.62 ± 5.64,P < 0.01) compared to our general population derived from universities of Iran. Our studied population consisted of 71 patients with Diarrhea dominant-IBS,33 with Constipation dominant-IBS and 46 with Altering type-IBS. Scores of conscientiousness and neuroticism were significantly higher in C-IBS compared to D-IBS and A-IBS (35.79 ± 5.65 vs 31.95 ± 6.80,P = 0.035 and 31.97 ± 9.87,P = 0.043,respectively). Conscientiousness was the highest dimension of personality in each of the variants. Patients with C-IBS had almost similar personality profiles,composed of higher scores for neuroticism and conscientiousness,with low levels of agreeableness,openness and extraversion that were close to those of the general population. CONCLUSION: Differences were observed between IBS patients and the general population,as well as between IBS subtypes,in terms of personality factors. Patients with constipation-predominant IBS showed similar personality profiles. Patients with each subtype of IBS may benefit from psychological interventions,which can be focused considering the characteristics of each subtype.

Focus on acute diarrhoeal disease

Diarrhoea is an alteration of normal bowel movement characterized by an increase in the water content, volume, or frequency of stools. Diarrhoea needs to be classified according to the trends over time （acute or chronic） and to the characteristics of the stools （watery, fatty, inflammatory）. Secretory diarrhoeas, mostly acute and of viral aetiology in more than 70% of cases, are by far the most important subtype of diarrhoeas in terms of frequency, incidence and mortality （over 2.5 million deaths/year in developing countries）. Natural and synthetic opiates such as morphine, codeine, and Ioperamide which react with endogenous opiates （enkephalins, beta-endorphins, dynorphins） mainly act on intestinal motility and slow down transit. An antidiarrhoeal drug developed in recent years, racecadotril, acts as an enkephalinase inhibitor. Clinical studies have shown that it is just as effective as ioperamide in resolving acute diarrhoea but with greater reduction in pain and abdominal distension. Some studies have explored the prevalence of diarrhoea in old age. An epidemiological study carried out in Italy by 133 General Practitioners on 5515 elderly outpatients reported a prevalence of diarrhoea, defined according to the Rome criteria, of 9.1%. Infectious diseases （19%） and drug use （16%） were the most common causes of diarrhoea in old age. Regardless of the cause, the treatment of elderly patients with diarrhoea must include rehydration and nutritional support. Every year, more than 50 million tourists travel from industrialized countries to places where hygiene levels are pool. At least 75% of those travelling for short periods mention health problems, and in particular traveller＇s diarrhoea.

Use of probiotics for prevention of radiation-induced diarrhea

AIM： To investigate the efficacy of a high-potency probiotic preparation on prevention of radiation-induced diarrhea in cancer patients.METHODS： This was a double-blind, placebo-controlled trial. Four hundred and ninety patients who underwent adjuvant postoperative radiation therapy after surgery for sigmoid, rectal, or cervical cancer were assigned to either the high-potency probiotic preparation VSL#3 （one sachet t.i.d.,） or placebo starting from the first day of radiation therapy. Efficacy endpoints were incidence and severity of radiation-induced diarrhea, daily number of bowel movements, and the time from the start of the study to the use of Ioperamide as rescue medication. RESULTS： More placebo patients had radiation-induced diarrhea than VSL#3 patients （124 of 239 patients, 51.8%, and 77 of 243 patients, 31.6%; P 〈 0.001） and more patients given placebo suffered grade 3 or 4 diarrhea compared with VSL#3 recipients （55.4% and 1.4%, P 〈 0.001）. Daily bowel movements were 14.7 ± 6 and 5.1 ± 3 among placebo and VSL#3 recipients （P 〈 0.05）, and the mean time to the use of Ioperamide was 86 ± 6 h for placebo patients and 122 ± 8 h for VSL#3 patients （P 〈 0.001）. CONCLUSION： Probiotic lactic acid-producing bacteria are an easy, safe, and feasible approach to protect cancer patients against the risk of radiation-induced diarrhea.

Modelling Distribution of Under-Five Child Diarrhoea across Malawi

Analysis of diarrhoea data in Malawi has been commonly done using classical methods. However, different approaches, such as Bayesian methods, have been introduced in literature. This study aimed at trying out semi-parametric methods in comparison with classical ones, as well as how each isolates risk factors for child diarrhoea. This was done by fitting Logit, Poisson, and Bayesian models to 2006 Malawi Multiple Indicator Cluster Survey data. The comparison between Logit and Poisson models was done via chi-square＇s goodness-of-fit test. Confidence and Credible Intervals were used to compare Logit/Poisson and Bayesian model estimates. Modelling and inference in Bayesian method was done through MCMC techniques. The results showed agreement in significance and direction of estimates from Bayesian and Poisson/Logit models, but Poisson provided better fit than Logit model. Further, all the models identified child＇s age, breastfeeding status, region of stay and toilet-sharing status as significant factors for determining the child＇s risk. The models ruled out effects of mother＇s education, area of residence, and source of drinking water on the risk. Bayesian model separately proved significant closeness to lake/river factor. The findings imply that classical and semi-parametric models are equally helpful when estimating the child＇s risk to diarrhoea.

Observations on the therapeutic effiect of acupuncture with left ascending and right descending method for 52 cases of chronic diarrhea

Objective To search for effective methods of acupuncture therapy in treating chronic diarrhea. Methods Treatments were carried out on 52 patients with chronic diarrhea by using the left ascending and right descending method. Three acupoints at the left side, namely Xiàng （陷谷 ST 43）, Zúsānl （足三 里 ST 36） and Qūchí （曲池 LI 11）, and Lièqūe （列缺 LU 7） at the right side were selected, moxibustion was also carried out according to syndrome differentiation. The operation of left ascending and right descending method were firstly left and then right, first down and then up, firstly four limbs and then abdomen; the thumb moved backward and the index finger moved forward during needle twisting for the acupoints at the left side, and it was on the contrary for the right side. The needles were retained for 1 h for deficiency, and the pinholes were pressed when the needles were withdrawn; the needles were retained for 0.5 h for excess syndrome and newly-contracted disease, and the pinholes were enlarged by shaking the needles when they were withdrawn. Except that the needling was carried out twice a day for the patients with desertion following chronic diarrhea, the needling was carried out once a day, five days as a treatment course, the patients were given an interval for two days after every two treatment courses, and the therapeutic effect was observed after five treatment courses. Results totally 36 patients were cured, among which 11 patients were cured after one treatment course, 19 patients were cured after two to three treatment courses and 6 patients were cured after four to five treatment courses; eight patients were improved; six patients were not cured; the total effective rate was 88.0%. Conclusion the acupuncture with left ascending and right descending method has satisfactory therapeutic effect in treating chronic diarrhea.

Controlled observation on the efficacy of acupuncture and western medicine on diarrhea-type irritable bowel syndrome

Objective To compare the difference in the therapeutic effects on diarrhea- type irritable bowel syndrome （D-IBS） between acupuncture based on soothing the liver and strengthening the spleen and western medicine. Methods Seventy cases were randomized into an acupuncture group and a western medicine group, 35 cases in each one. In the acupuncture group, the conventional acupuncture was applied at Tianshu {天枢 ST 25）, Zusanli （足三里 ST 36）, Shangjuxu {上巨虚 ST 37）, Sanyinjiao （三阴交 SP 6）, Taichong （太冲 LR 3） and so on. Electric stimulation was supplemented at bilateral ST 25. The treatment was given once a day, 3-4 treatments in a week. In the western medicine group, pinaverium bromide （dicetel） was prescribed for oral administration, 50 mg each time, three times a day. Four weeks made one session in the two groups. Separately, before treatment and after 1 session treatment, the integral of clinical symptom and the score in the scale of the quality of life measure for irritable bowel syndrome （IBS-Q OL） were observed for the patients in the two groups. The efficacy and recurrence rate were assessed in the two groups. Results The symptom integral and IBS-QOL score in the two groups were improved significantly after treatment Call P〈0.01）, and the improvements in the acupuncture group were superior to that in the western medicine group （P〈0.01）. The effective rate was 94.3% {33/35） in the acupuncture group, which was superior to 77.1% （27/35） in the western medicine group （P〈0.01）. In 3 months, the recurrence rate was 36.4% （12/33） in the acupuncture group, which was lower apparently than 72.0% （18/25） in the western medicine group （P〈O.01）. Conclusion Acupuncture therapy based on soothing the liver and strengthening the spleen achieves the superior efficacy on D-IBS as compared with western medication, pinaverium bromide. This therapy improves apparently the quality of life of the patients and is lower in recurrence rate.

Observation of Therapeutic Effects of Needle Warming Moxibustion for Chronic Diarrhea

Objective： To observe the therapeutic effects of needle warming moxibustion for chronic diarrhea. Methods： Two-hundred cases with chronic diarrhea were divided randomly into a treatment group and a control group. 100 cases in the treatment group were treated with needle warming moxibustion on specific acupoints. 100 cases in the control group were treated by oral administration of Smecta. Results： The therapeutic results showed cure in 52 cases, remarkable effect in 34 cases, improvement in 14 cases and the total effective rate in 100.0% in the treatment group, and cure in 5 cases, remarkable effect in 23 cases, improvement in 33 cases, failure in 39 cases and the total effective rate in 61.0% in the control group. The comparison of the total effective rate between the two groups was statistically significant （P〈0.05）. Conclusion： The needle warming moxibustion on specific acupoints is better than oral administration of Smecta in the therapeutic effects.

Clinical Research of Ulcerative Colitis Treated with Herbal Cake-partitioned Moxibustion

Objective： To observe the effects of herbal cake-partitioned moxibustion and bran-partition moxibustion in improving symptoms of ulcerative colitis （UC） and the TNF-α and its receptor of colon mucosa. Method： 67 UC cases were randomly allocated into herbal cake-partition moxibustion group of 35 cases and bran-partitioned moxibustion group of 32 cases, to compare the improvement and detect the TNF-α and its receptor with immunohistochemical method in both groups. Result： Herbal cake-partitioned moxibustion is prior to bran-partitioned moxibustion in improving of diarrhea, flatus, lassitude, tenesmus and lumbar soreness; The expression of TNF-α,TNF-αR1, and TNF-αR2 are significantly decreased after treatment in herbal cake-partitioned moxibustion group, while in bran-partitioned moxibustion group only TNF-αR1 expression is significant decreased after treatment. Conclusion： Moxibustion can well improve the syndromes of UC, Herbal cake-partitioned Moxibustion is prior to bran-partitioned moxibustion in the improvement of diarrhea and flatus; Herbal cake-partitioned moxibustion could down-regnlate the expression of TNF-α,TNF-αR1, and TNF-αR2, while bran-partitioned moxibustion could only down-regulate the expression of TNF-αR1.

Metrological Analysis and Evaluation of Acupuncture-Moxibustion Treatment for Diarrhea in Modern Literature

Objective： To review year 1957-2005 literature on acupuncture and moxibustion and explore point selection and methods for acupuncture-moxibustion treatment of diarrhea in order to provide objective and reliable data for research on acupuncture and moxibustion standardization. Methods： A comprehensive analysis was made by a method of metrological analysis according to the data from ＂China modem acupuncture-moxibustion information database＂. Results： Points Zusanli （ST 36）, Tianshu （ST 25） and Shenque （CV 8） were the most frequently used and the optimal combination for acupuncture-moxibustion treatment of diarrhea. Chronic adult diarrhea was often treated by moxibustion. Acute childhood diarrhea was often treated by point application and injection. Conclusion： Diarrhea is often treated by needling and moxaing methods in acupuncture-moxibustion treatment. It is proposed to use Zusanli （ST 36） and Tianshu （ST 25） as a basic prescription for acupuncture-moxibustion treatment of diarrhea and to select points according to the syndrome.

Umbilicus application with Chinese medicine for chronic diarrhea due to food intolerance in kids:a multicenter randomized trial

Objective： To observe the clinical efficacy of umbilicus application with Chinese medicine in treating children＇s chronic diarrhea due to food intolerance and the value of healthy diet education. Methods： Eighty kids with chronic diarrhea due to food intolerance were recruited from multiple centers and divided by using the random number table into a treatment group of 40 cases and a control group of 40 cases. For both groups, based on the level of serum food-specific immunoglobulin G（Ig-G）, the patients were given unified diet following the healthy diet guidance： safe, alternate, and forbidden, while the treatment group was additionally given umbilicus application with Chinese medicine. The therapeutic efficacy and symptom score of traditional Chinese medicine（TCM） were observed and compared respectively after 1-week, 2-week, 4-week, and 12-week treatment. Results： The diarrhea symptoms and coupled symptoms scores dropped significantly in the two groups after treatment（ all P〈0.05）, and the inter-group comparisons also showed statistical significances（P〈0.05）. The total effective rate was 97.5% in the treatment group versus 77.5% in the control group, and the inter-group difference was statistically significant（P〈0.05）. Conclusion： The healthy diet guidance based on the food intolerance test is effective in helping treat diarrhea, while umbilicus application with Chinese medicine works better in treating diarrhea for kids with chronic diarrhea due to food intolerance and can significantly enhance the therapeutic efficacy.

Irritable bowel syndrome with diarrhea (IBS-D) treated with moxibustion on heat-sensitive acupoints: a randomized controlled trial

Objective To compare the effects between acupuncture combined with moxibustion on heat-sensitive acupoints and acupuncture on irritable bowel syndrome with diarrhea （IBS-D）. Methods Sixty-four cases were randomly divided into an acupuncture and moxibustion group （n=32） and an acupuncture group （n=32）. Conventional acupuncture at Tiānshū （天枢 ST 14）, Zúsānlǐ （足三里 ST 36）, Gōngsūn （公孙 SP 4） and other acupoints was used in the two groups, and moxibustion on heat-sensitive acupoints was added in the acupuncture and moxibustion group. The treatment frequency was 5 times a week, and 4 weeks were a course. After 2 courses, the therapeutic effect was evaluated. Results The clinical symptom scores after treatment in two groups decreased obviously than those before treatment （both P〈0.01）. The cured and markedly effective rate in the acupuncture and moxibustion group was 87.5% （28/32）, and that in the acupuncture group was 37.5% （12/32）, so the effect in the acupuncture and moxibustion group was better than that in the acupuncture group （P〈0.01）. The improvement of all kinds of symptom scores in the acupuncture and moxibustion group was all better than that in the acupuncture group （all P〈0.05）. Conclusion The clinical effect of acupuncture combined with moxibustion on heat-sensitive acupoints on IBS-D is better than that of acupuncture.

Acupuncture treatment for depressive symptom in diarrhea-predominant irritable bowel syndrome:a randomized controlled study

Objective:To observe the clinical efficacy of acupuncture treatment for depressive symptom in diarrhea-predominant irritable bowel syndrome(IBS-D).Methods:A total of 70 patients with IBS-D accompanied by depressive symptom were randomized into a control group and an observation group,with 35 cases in each group.The control group was treated with oral intake of pinaverium bromide tablets,and the observation group was treated with regulating liver and spleen acupuncture treatment.The two groups were treated for 4 weeks.The scores of IBS symptom severity scale(IBS-SSS)and self-rating depression scale(SDS)were assessed before and after treatment.Results:After treatment,there were statistical significant differences in the scores of abdominal pain degree,abdominal pain frequency and defecation satisfaction level and the total score between the two groups(all P<0.05).The SDS score of the observation group was obviously decreased,and the improvement was significantly superior to that in the control group(P<0.05).Conclusion:Acupuncture treatment can significantly improve gastrointestinal symptom and depressive symptom in patients with IBS-D.

Acupuncture with Du's heat-reinforcing method for diarrhea-predominant irritable bowel syndrome: a ran domized con trolled trial

Objective: To compare the clinical efficacy of Du's heat-reinforcing method and Western medication in treating diarrheapredominant irritable bowel syndrome (IBS-D). Methods: Sixty-five IBS-D patients were randomized into two groups by the random number table. Thirty-three cases in the treatment group were intervened by acupuncture with Du's heat-reinforcing method, while thirty-two cases in the control group were given oral administration of pinaverium bromide tablets. The intervention lasted 4 weeks for both groups. The IBS symptom severity score (IBS-SSS), IBS-quality of life (IBS-QOL) and hospital anxiety and depression scale (HAD) were adopted to evaluate the therapeutic efficacy. Results: The two groups each had two dropout cases. The clinical recovery rate was 38.7% and the total effective rate was 90.3% in the treatment group versus 13.3% and 66.7% in the control group. The treatment group was superior to the control group in both clinical recovery rate and total effective rate (both P<0.05). After 1-week and 4-week treatment, respectively, the IBS-SSS scores were lower compared with the baseline in both groups, and the intra-group differences were statistically significant (both P<0.05);the score in the treatment group was lower than that in the control group, and the betwee n-g roup differe nee was statistically sign ifica nt (both P<0.05). After 4-week treatme ntz the comp on ent scores of IBS-QOL showed improvements in both groups, and the treatment group was superior to the control group in the improvements of dysphoria, interference with activity, health worry and food avoidanee (all P<0.05). The anxiety and depression scales of HAD (HAD-a, HAD-d) in the treatment group and the HAD-a in the control group obtained significant improvements (all P<0.05);the scores of HAD-a and HAD-d in the treatment group were significantly better than those in the control group (both P<0.05). Conclusion: Acupuncture with Du's heat-reinforcing method can effectively ease the symptoms of IBS-D, improve the quality of life and the state of anxiety and depression. It can produce a more significant efficacy than oral administration of pinaverium bromide tablets.

Clinical efficacy of umbilical therapy with herbal cakes of different dosages for damp-heat diarrhea in young children

Objective:To observe the clinical efficacy of umbilical therapy with herbal cakes made of Ge Gen Qin Lian Tang prescription of different dosages in treating damp-heat diarrhea in young children.Methods:Seventy-two kids with diarrhea of damp-heat pattern were recruited and divided into a high-dosage group and a low-dosage group using the random number table method,with 36 cases in each group.They all received conventional antidiarrheal treatment and umbilical application with herbal cakes.However,the herbal cakes for the high-dosage group were made of the mixture of Ge Gen Qin Lian Tang powder and water,and those for the low-dosage group consisted of 10%Ge Gen Qin Lian Tang powder and 90%auxiliary materials(corn starch)plus water.The treatment duration was 3 d.The clinical efficacy,antidiarrheal rate,effective rate for symptoms and signs of traditional Chinese medicine(TCM),TCM symptoms score,and safety indicators were compared between the two groups.Results:After the treatment,the TCM symptoms scores dropped significantly in both groups(P<0.01)and were lower in the high-dosage group than in the low-dosage group(P<0.05).The clinical efficacy was more significant in the high-dosage group than in the low-dosage group after the treatment,and the between-group difference was statistically significant(P<0.05);the antidiarrheal rate was markedly higher in the high-dosage group than in the low-dosage group(P<0.05).Regarding the TCM symptoms and signs,the high-dosage group showed better results in improving the greasy and yellowish tongue coating,bowel movement frequency,watery excrement,short and dark urine,red tongue body,red anus,vomiting,bowel sounds,and abdominal bloating compared with the low-dosage group,and the between-group differences were statistically significant(P<0.01).Conclusion:Umbilical therapy with herbal cakes made of Ge Gen Qin Lian Tang is safe,reliable,and effective in treating damp-heat diarrhea in young children;the high-dosage herbal cakes produce more significant efficacy than the low-dosage ones and are worth further investigation.