Soluble Fiber Improves Management of Diarrhea in Elderly Patients Receiving Enteral Nutrition

Dietary fiber is a non-digestible carbohydrate providing beneficial effects for bowel health. The aim of this study was to evaluate the clinical effects of fiber supplementation in enteral feeding on elderly patients suffering from diarrhea. This study was conducted in 15 patients (7 men and 8 women, 79.0 ± 7.5 years) who had loose stools or diarrhea during enteral nutrition. The enteral formula was supplemented with soluble dietary fiber (5.2 g/day) for 3 weeks, which was then discontinued for 1 week to confirm its effects. The effects of soluble dietary fiber on stool frequency, the Bristol Stool Form Scale (which is designed to measure stool consistency), plasma diamine oxidase (DAO) activity, and concentrations of plasma short-chain fatty acids (SCFA) were evaluated. After supplementation with soluble dietary fiber, there were no significant differences in stool frequency but there was a significant improvement in stool consistency (P < 0.05). Furthermore, ingestion of soluble dietary fiber resulted in increased plasma DAO activity and significantly increased levels of plasma SCFA (P < 0.05). Supplementation with soluble dietary fiber may be beneficial for improving stool consistency in patients suffering from diarrhea during enteral nutrition. A further controlled trial is warranted to examine the preventive effects of soluble dietary fiber in patients suffering from diarrhea.

Effects of Semi-Solid Enteral Formula on Aspiration Pneumonia and Diarrhea

Objective: The effects of semi-solid enteral formula were investigated in tube feeding patients with aspiration pneumonia and/or diarrhea caused by liquid enteral formula. Methods: In 25 cases of aspiration pneumonia and 10 cases of diarrhea (5 cases had both aspiration pneumonia and diarrhea) caused by liquid enteral formula, the rate of improvement by changing the liquid enteral formula to semi-solid enteral formula was studied. The semi-solid enteral formula (PG Soft&reg;EJ) was infused via the nasogastric tube (16Fr) or percutaneous endoscopic gastrostomy (PEG) tube (20Fr). Results: The semi-solid enteral formula was effective in 72% of aspiration pneumonia cases and in 80% of diarrhea cases. Constipation was observed in one case but was controlled with magnesium oxide. Conclusion: In cases of aspiration pneumonia and/or diarrhea, changing liquid enteral formula to semi-solid enteral formula frequently shows improvement.

Calcium/calcimimetic via calcium-sensing receptor ameliorates cholera toxin-induced secretory diarrhea in mice

BACKGROUND Enterotoxins produce diarrhea through direct epithelial action and indirectly by activating the enteric nervous system.Calcium-sensing receptor(CaSR)inhibits both actions.The latter has been well documented in vitro but not in vivo.The hypothesis to be tested was that activating CaSR inhibits diarrhea in vivo.AIM To determine whether CaSR agonists ameliorate secretory diarrhea evoked by cholera toxin(CTX)in mice.METHODS CTX was given orally to C57BL/6 mice to induce diarrhea.Calcium and calci-mimetic R568 were used to activate CaSR.To maximize their local intestinal actions,calcium was administered luminally via oral rehydration solution(ORS),whereas R568 was applied serosally using an intraperitoneal route.To verify that their actions resulted from the intestine,effects were also examined on Cre-lox intestine-specific CaSR knockouts.Diarrhea outcome was measured biochemically by monitoring changes in fecal Cl-or clinically by assessing stool consistency and weight loss.RESULTS CTX induced secretory diarrhea,as evidenced by increases in fecal Cl-,stool consistency,and weight loss following CTX exposure,but did not alter CaSR,neither in content nor in function.Accordingly,calcium and R568 were each able to ameliorate diarrhea when applied to diseased intestines.Intestinal CaSR involvement is suggested by gene knockout experiments where the anti-diarrheal actions of R568 were lost in intestinal epithelial CaSR knockouts(villinCre/Casrflox/flox)and neuronal CaSR knockouts(nestinCre/Casrflox/flox).CONCLUSION Treatment of acute secretory diarrheas remains a global challenge.Despite advances in diarrhea research,few have been made in the realm of diarrhea therapeutics.ORS therapy has remained the standard of care,although it does not halt the losses of intestinal fluid and ions caused by pathogens.There is no cost-effective therapeutic for diarrhea.This and other studies suggest that adding calcium to ORS or using calcimimetics to activate intestinal CaSR might represent a novel approach for treating secretory diarrheal diseases.

Fiber and prebiotic supplementation in enteral nutrition:A systematic review and meta-analysis

AIM:To investigate fiber and prebiotic supplementation of enteral nutrition(EN) for diarrhea,fecal microbiota and short-chain fatty acids(SCFAs).METHODS:MEDLINE,EMBASE,Cochrane Library,CINAHL,Academic Search Premier,and Web of Science databases were searched for human experimental and observational cohort studies conducted between January 1990 and June 2014.The keywords used for the literature search were fiber,prebiotics and enteral nutrition.English language studies with adult patient populations on exclusive EN were selected.Abstracts and/or full texts of selected studies were reviewed and agreed upon by two independent researchers for inclusion in the meta-analysis.Tools used for the quality assessment were Jadad Scale and the Scottish Intercollegiate Guidelines Network Critical Appraisal of the Medical Literature.RESULTS:A total of 456 possible articles were retrieved,and 430 were excluded due to lack of appropriate data.Of the 26 remaining studies,only eight investigated the effects of prebiotics.Results of the meta-analysis indicated that overall,fiber reduces diarrhea in patients receiving EN(OR = 0.47;95%CI:0.29-0.77;P = 0.02).Subgroup analysis revealed a positive effect of fiber supplementation in EN towards diarrhea in stable patients(OR = 0.31;95%CI:0.19-0.51;P < 0.01),but not in critically ill patients(OR = 0.89;95%CI:0.41-1.92;P = 0.77).Prebiotic supplementation in EN does not improve the incidence of diarrhea despite its manipulative effect on bifidobacteria concentrations and SCFA in healthy humans.In addition,the effect of fiber and/or prebiotic supplementation towards fecal microbiota and SCFA remain disputable.CONCLUSION:Fiber helps minimize diarrhea in patients receiving EN,particularly in non-critically ill patients.However,the effect of prebiotics in moderating diarrhea is inconclusive.

Effects of Saccharomycesboulardiion fecal short-chain fatty acids and microflora in patients on long-term total enteral nutrition

AIM： To assess the effects of Sb on fecal flora and shortchain fatty acids （SCFA） in patients on long-term TEN. METHODS： Ten patients （3 females, 7 males, 59±5.5 years）, on TEN for a median of 13 mo （1-125）, and 15 healthy volunteers （4 females, 11 males, 32±2.0 years） received Sb （0.5 g bid PO） for 6 d. Two stool samples were taken before, on the last 2 d and 9-10 d after treatment, for SCFA measurement and for culture and bacterial identification. Values （mean4-SE） were compared using sign tests and ANOVA. RESULTS： Fecal butyrate levels were lower in patients （10.1±2.9 mmol/kg） than in controls （19.2±3.9, P= 0.02）. Treatment with Sb increased total fecal SCFA levels in patients （150.2＋27.2 vs 107.5±18.2 mmol/kg, P= 0.02） but not in controls （129.0±28.6 vs 113.0±15.2 mmol/kg, NS）. At the end of treatment with Sb, patients had higher fecal butyrate（16.0±4.4 vs 10.1 [2.9] mmol/kg, P= 0.004）. Total SCFAs remained high 9 d after treatment was discontinued. Before the treatment, the anaerobe to aerobe ratio was lower in patients compared to controls （2.4±2.3 vs 69.8±1.8, P= 0.003）. There were no significant changes in the fecal flora of TEN patients. CONCLUSION： Sb-induced increase of fecal SCFA concentrations （especially butyrate） may explain the preventive effects of this yeast on TEN-induced diarrhea.

Fiber and prebiotic supplementation in enteral nutrition： asystematic review and meta-analysis

AIM To investigate fiber and prebiotic supplementationof enteral nutrition （EN） for diarrhea, fecal microbiotaand short-chain fatty acids （SCFAs）.METHODS： MEDLINE, EMBASE, Cochrane Library,CINAHL, Academic Search Premier, and Web of Sciencedatabases were searched for human experimentaland observational cohort studies conducted betweenJanuary 1990 and June 2014. The keywords used forthe literature search were fiber, prebiotics and enteralnutrition. English language studies with adult patientpopulations on exclusive EN were selected. Abstractsand/or full texts of selected studies were reviewedand agreed upon by two independent researchersfor inclusion in the meta-analysis. Tools used for thequality assessment were Jadad Scale and the ScottishIntercollegiate Guidelines Network Critical Appraisal ofthe Medical Literature.RESULTS： A total of 456 possible articles wereretrieved, and 430 were excluded due to lack ofappropriate data. Of the 26 remaining studies, onlyeight investigated the effects of prebiotics. Resultsof the meta-analysis indicated that overall, fiberreduces diarrhea in patients receiving EN （OR = 0.47;95%CI： 0.29-0.77; P = 0.02）. Subgroup analysisrevealed a positive effect of fiber supplementation inEN towards diarrhea in stable patients （OR = 0.31;95%CI： 0.19-0.51; P 〈 0.01）, but not in critically illpatients （OR = 0.89; 95%CI： 0.41-1.92; P = 0.77）.Prebiotic supplementation in EN does not improve theincidence of diarrhea despite its manipulative effecton bifidobacteria concentrations and SCFA in healthyhumans. In addition, the effect of fiber and/or prebioticsupplementation towards fecal microbiota and SCFAremain disputable.CONCLUSION： Fiber helps minimize diarrhea inpatients receiving EN, particularly in non-critically illpatients. However, the effect of prebiotics in moderatingdiarrhea is inconclusive.

Optimal hang time of enteral formula at standard room temperature and high temperature

BACKGROUND Despite high risk of bacterial contamination,yet there are no studies that have evaluated the optimal hang time of blenderized and reconstituted powdered formulas at standard room temperature and high temperature.AIM To investigate the optimal hang time of both types of formulas at standard room temperature and high temperature.METHODS Ten specimens of blenderized formula and 10 specimens of reconstituted powdered formula were prepared using aseptic techniques.Five specimens of each formula were administered at 25℃and 32℃.Simulated administration was done in an incubator.The samples were collected at 0,2,4,6 h and aerobic culture was performed.Food and drug administration criteria were used to determine the unacceptable levels of bacterial contamination.RESULTS Unacceptable contamination for blenderized formula began at 4 h at 25℃and at 2 h at 32℃.As for the reconstituted powdered formula,there was no bacterial growth in all specimens up to 6 h at both temperatures.CONCLUSION The optimal hang time to avoid significant bacterial contamination of the blenderized formula should be limited to 2 h at standard room temperature and be administered by bolus method at high temperature,while a reconstituted powdered formula may hang up to 6 h at both temperatures.

2021~2023年北京经济技术开发区感染性腹泻病原谱及耐药性分析

目的了解北京经济技术开发区感染性腹泻患者常见的病原菌种类、流行趋势和耐药性,从而为该地区的流行病学研究及临床治疗提供科学依据。方法收集2021年1月1日至2023年12月31日就诊于首都医科大学附属北京同仁医院感染科肠道门诊、儿科、急诊科6902例感染性腹泻患者的粪便标本进行增菌、分离培养,用基质辅助激光解析电离飞行时间质谱仪(MALDI-TOF MS)鉴定菌种,用凝集试验确定血清型,用K-B纸片法测定抗菌药物敏感性。结果在6902例标本中,检出390株病原菌,总体检出率为5.65%。其中沙门菌属和副溶血弧菌是最常见的两种病原菌,分别占检出的390株病原菌的32.14%和28.32%。检测出的沙门菌属中,优势血清型为肠炎沙门氏菌。27株霍乱弧菌中非O1/O139血清群霍乱弧占92.59%,且近年呈现增长态势。不同年龄组和病原菌的检出差异具有统计学意义(P<0.001),其中21~30岁年龄组和31~40岁年龄组感染性腹泻患者最多,另外0~10岁年龄组、11~20岁年龄组和>60岁年龄组以沙门菌属为主,其余组以副溶血弧菌为主。不同月份和病原菌的检出差异具有统计学意义(P<0.001),肠道致病菌在7~8月检出率最高,而沙门菌属高发期则在6~7月。不同病原菌对各类抗菌药物的敏感性存在差异,其中氨基青霉素类抗菌药物显示出较高的耐药性。单环β-内酰胺类、喹诺酮类、氨基糖苷类药物敏感性较高,多重耐药情况也有发生。结论弧菌属和沙门菌属是北京经济技术开发区感染性腹泻的主要病原菌,各种病原菌耐药性不同,因此必须紧密关注感染性腹泻病原菌及其对各类抗菌药物的耐药性情况。

重型颅脑损伤患者肠内营养相关性腹泻的危险因素分析

目的 探讨重症监护病房颅脑损伤患者发生肠内营养相关性腹泻的影响因素。方法 选取经鼻胃管途径行肠内营养治疗的124例重型颅脑损伤患者为研究对象,观察肠内营养后7 d内的腹泻发生情况,采用Logistic回归模型分析患者发生肠内营养相关性腹泻的危险因素。结果 124例重型颅脑损伤患者肠内营养期间发生腹泻41例,发生率为33.06%;Logistic回归分析显示:GCS评分<5分(OR=3.155)、营养剂日用量≥1 000 mL/d(OR=1.293)、低蛋白血症(OR=4.018)、使用抗生素≥2种(OR=2.161)、经消化道使用钾制剂(OR=2.902)、禁食时间>48 h(OR=2.730)是重型颅脑损伤患者发生肠内营养相关性腹泻的危险因素(P<0.05)。结论 GCS评分、营养剂用量、禁食时间,以及使用抗生素、钾制剂情况,与重型颅脑损伤患者发生肠内营养相关性腹泻有关。

2018-2021年山西地区1283例住院病儿轮状病毒肠炎的流行病学特征及临床分析

目的了解山西地区儿童轮状病毒肠炎的流行病学及临床特征,分析重型轮状病毒肠炎危险因素,以早期识别重症病例,提高轮状病毒肠炎临床诊治水平及防控,从而减轻疾病负担。方法回顾性分析2018年1月至2021年12月于山西省儿童医院消化科住院治疗的急性腹泻病病儿3359例,总结轮状病毒肠炎流行病学特点及临床特征,并分析重型轮状病毒肠炎危险因素。结果2018年1月至2021年12月,因急性腹泻病入住消化科的住院病人3359例中轮状病毒检出1283例,检出率为38.20%;时间分布,每年12月至次年2月是轮状病毒感染高峰季节,8月、9月、10月最低;年龄分布,轮状病毒肠炎年龄(1.53±0.92)岁,>1~2岁年龄组检出率最高(52.16%),6个月至1岁年龄组次之;性别分布,男童检出率多于女童,比例为1.53∶1;地区分布,居住于城镇检出率显著高于农村;喂养方式分布,≤6个月病儿中,非母乳喂养检出率高于母乳喂养;轮状病毒肠炎住院天数(4.15±1.83)d,临床表现均为急性起病,主要表现为腹泻、呕吐、发热,常见合并症为脱水、代谢性酸中毒、电解质紊乱;轻型和重型轮状病毒肠炎在居住地区、年龄分组方面差异有统计学意义。经多因素分析,居住于乡村地区病儿发生重型轮状病毒肠炎的危险性是居住于城镇病儿的1.42倍。结论山西地区轮状病毒肠炎高发季节是冬季,多见于6个月至2岁的婴幼儿,男童比女童更易感染轮状病毒,居住于城镇相比农村更易感染。但居住于农村地区病儿更易发生重型轮状病毒肠炎。

五倍子敷脐预防ICU肠内营养相关性腹泻的效果观察

目的探究五倍子敷脐预防ICU肠内营养相关性腹泻的效果。方法选取2022年1月至2023年3月就诊于福建中医药大学附属人民医院,符合纳入与排除标准的肠内营养支持患者80例作为研究对象,随机分为对照组与试验组,各40例。对照组进行常规护理,试验组在对照组基础上给予五倍子敷脐,于每日巳时(9:00~11:00)进行,留药6h,每天1次,连续7d。根据Hart腹泻积分法,分别于肠内营养开始后的第3d、第7d以及第14d观察两组患者的腹泻积分以及腹泻发生率。结果组间比较:两组腹泻积分在肠内营养第7天、第14天差异均具有统计学意义(P<0.05);组内比较:两组肠内营养第7天、第14天与第3天比较差异均具有统计学意义(P<0.05),试验组肠内营养第14天与第7天相比差异具有统计学意义(P<0.05)。结论五倍子敷脐可有效减轻ICU肠内营养患者腹泻相关症状,降低肠内营养相关性腹泻的发生率。

胃癌患者术后肠内营养期间引起腹泻的危险因素及干预对策分析

目的 分析胃癌患者术后肠内营养(EN)期间引起腹泻的危险因素及干预对策。方法 回顾性收集2019年6月至2023年6月浙江省丽水市中心医院就诊的216例行胃癌根治术并于术后行EN患者的临床资料。根据腹泻发生情况将其分为腹泻组和未腹泻组,采用单因素和多因素logistic回归分析胃癌患者术后EN期间腹泻发生的影响因素。结果 216例胃癌患者中术后EN期间有141例患者出现腹泻,其发生率为65.28%。两组年龄、手术方式、EN开始时间、营养途径、使用营养泵、术后第1天下床活动时间比较,差异有统计学意义(P<0.05)。年龄≥60岁(OR=3.808,95%CI:2.034~7.129),开腹(OR=4.811,95%CI:1.456~15.904),EN开始时间为术后24 h(OR=5.033,95%CI:1.637~15.473)、未使用营养泵(OR=4.874,95%CI:3.099~7.666)、术后第1天下床活动时间<1 h(OR=2.612,95%CI:1.153~5.914)是胃癌患者术后EN期间腹泻发生的独立危险因素(P<0.05)。结论 胃癌患者术后EN期间腹泻的发生是多种因素影响的结果,临床针对性进行干预有助于预防腹泻的发生。

回访单院外管理联合多元化心理干预在小儿轮状病毒感染性肠炎腹泻中的应用效果

目的 分析回访单院外管理联合多元化心理干预在小儿轮状病毒感染性肠炎腹泻中的应用效果。方法 选取2020年1月至2022年12月期间泉州市安溪县虎邱卫生院收治的80例小儿轮状病毒感染性肠炎腹泻患儿,按照随机数字表法将其分为对照组(常规护理)及观察组(回访单院外管理联合多元化心理干预),比较两组间疗效、各临床症状缓解时间、家属心理状态、疾病知识掌握度以及护理满意度。结果 观察组总有效率、家属干预后疾病知识掌握度以及家属护理满意度均高于对照组(均P <0.05);观察组呕吐缓解时间、脱水缓解时间、腹泻缓解时间、发热缓解时间、大便形成时间均比对照组短(均P <0.05);观察组干预后家属SAS评分、SDS评分均低于对照组(均P <0.05)。结论 小儿轮状病毒感染性肠炎腹泻采取回访单院外管理联合多元化心理干预,可以快速改善患儿临床症状,同时,有助于帮助家属掌握更多疾病知识,减轻家属心理负面情绪,提升家属护理满意度。

辨证饮食与醒脾养儿颗粒及黄连素治疗小儿急性肠炎临床观察

目的探讨辨证饮食与醒脾养儿颗粒及黄连素合用治疗急性肠炎患儿的临床效果。方法选取100例急性肠炎患儿,采用随机数字表法将其分为2组,每组50例。所有患儿均予以常规治疗,对照组增用黄连素治疗,观察组在对照组基础上应用醒脾养儿颗粒,并采取辨证饮食治疗,比较2组主要症状消退时间与住院总时长、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、中医证候积分与总有效率。结果治疗后,观察组主要症状消退时间与住院总时长均短于对照组,TNF-α、IL-6、IL-10水平低于对照组,中医证候积分低于对照组,总有效率高于对照组,差异有统计学意义(均P<0.05)。结论在急性肠炎患儿的治疗过程中,辨证饮食与醒脾养儿颗粒及黄连素合用具有较好的治疗效果,能够促进主要症状的改善,降低炎症因子水平与中医证候积分,缩短住院时长。

双歧杆菌三联活菌肠溶胶囊联合蒙脱石散治疗小儿腹泻的疗效研究

分析双歧杆菌三联活菌肠溶胶囊联合蒙脱石散治疗小儿腹泻的临床效果。选择2023年1月—2023年8月田东县人民医院儿科收治的60例小儿腹泻患儿为研究对象,按照治疗方法的不同将其分为对照组(n=30,单用蒙脱石散治疗)和观察组(n=30,双歧杆菌三联活菌肠溶胶囊联合蒙脱石散治疗),比较两组患儿的疗效差异。结果显示,观察组患儿的症状缓解时间较对照组更短,治疗有效率和家属满意度更高、患儿的免疫功能指标更优,差异具有统计学意义(P<0.05);两组腹泻患儿治疗期间均未出现如嗜睡、乏力、口干、皮疹等严重不良反应,差异无统计学意义(P>0.05)。研究发现,双歧杆菌三联活菌肠溶胶囊联合蒙脱石散治疗小儿腹泻的临床效果确切,可缩短患儿病程,促进患儿康复,值得推广。

复方谷氨酰胺肠溶胶囊联合双歧杆菌三联活菌胶囊治疗腹泻型肠易激综合征的疗效分析

目的探讨双歧杆菌三联活菌胶囊联合复方谷氨酰胺肠溶胶囊治疗腹泻型肠易激综合征的效果。方法选取兰州石化总医院2021年7月—2023年7月收治的60例腹泻型肠易激综合征患者为研究对象,采用随机数字表法将其分为对照组和观察组,每组30例。对照组采用复方谷氨酰胺肠溶胶囊治疗,观察组在对照组基础上联合双歧杆菌三联活菌胶囊治疗,持续用药4周。比较两组临床疗效、症状改善情况、症状严重程度、肠黏膜屏障功能及不良反应发生情况。结果观察组治疗总有效率高于对照组,差异有统计学意义(P<0.05)。观察组止泻时间短于对照组,每日腹泻次数及急性应激次数均少于对照组,组间差异有统计学意义(P<0.05)。治疗后,观察组肠易激综合征症状严重程度量表评分低于对照组,差异有统计学意义(P<0.05)。治疗后,观察组血清内毒素、二胺氧化酶、D-乳酸水平均低于对照组,组间差异有统计学意义(P<0.05)。治疗期间两组均未发生不良反应。结论复方谷氨酰胺肠溶胶囊联合双歧杆菌三联活菌胶囊治疗腹泻型肠易激综合征,能有效缓解患者疾病症状,修复肠黏膜屏障,且安全性良好。

Post-infectious irritable bowel syndrome:Mechanistic insights into chronic disturbances following enteric infection

Irritable bowel syndrome(IBS)is a commonly encountered chronic functional gastrointestinal(GI)disorder.Approximately 10%of IBS patients can trace the onset of their symptoms to a previous a bout of infectious dysentery.The appearance of new IBS symptoms following an infectious event is defined as post-infectiousIBS.Indeed,with the World Health Organization estimating between 2 and 4 billion cases annually,infectious diarrheal disease represents an incredible international healthcare burden.Additionally,compounding evidence suggests many commonly encountered enteropathogens as unique triggers behind IBS symptom generation and underlying pathophysiological features.A growing body of work provides evidence supporting a role for pathogen-mediated modifications in the resident intestinal microbiota,epithelial barrier integrity,effector cell functions,and innate and adaptive immune features,all proposed physiological manifestations that can underlie GI abnormalities in IBS.Enteric pathogens must employ a vast array of machinery to evade host protective immune mechanisms,and illicit successful infections.Consequently,the impact of infectious events on host physiology can be multidimensional in terms of anatomical location,functional scope,and duration.This review offers a unique discussion of the mechanisms employed by many commonly encountered enteric pathogens that cause acute disease,but may also lead to the establishment of chronic GI dysfunction compatible with IBS.

Early ileocolonoscopy with biopsy for the evaluation of persistent post-transplantation diarrhea

AIM: To investigate the signifi cance of ileocolonoscopy with histology in the evaluation of post-transplantation persistent diarrhea (PD). METHODS: We retrospectively reviewed all records of renal transplant patients with PD, over a 3-year period. All patients were referred for ileocolonoscopy with biopsy, following a negative initial diagnostic work up. Clinical and epidemiological data were compared between cases with infectious or drug-induced diarrhea. RESULTS: We identif ied 30 episodes of PD in 23 renaltransplant patients (1-3 cases per patient). There were 16 male patients and the mean age at the time of PD was 51.4 years. The average time from transplantation to a PD episode was 62.3 ± 53.2 mo (range 1-199 mo). Ileocolonoscopy detected mucosal abnormalities in 19 cases, whereas the intestinal mucosa appeared normal in 11 cases. Histological examination achieved a specific diagnosis in 19/30 cases (63.3%). In nine out of 11 cases (82%) with normal endoscopic appearance of the mucosa, histological examination of blinded biopsies provided a specif ic diagnosis. The etiology of PD was infectious in 11 cases (36.6%), drug-related in 10 (33.3%), of other causes in three (10%), and of unknown origin in six cases (20%). Infectious diarrhea occurred in significantly longer intervals from transplantation compared to drug-related PD (85.5 ± 47.6 mo vs 40.5 ± 44.8 mo, P < 0.05). Accordingly, PD due to drug-toxicity was rarely seen after the f irst year post-transplantation. Clinical improvement followed therapeutic intervention in 90% of cases. Modif ication of immunosuppressive regimen was avoided in 57% of patients. CONCLUSION: Early ileocolonoscopy with biopsies from both affected and normal mucosa is an important adjunctive tool for the etiological diagnosis of PD in renal transplant patients.

Calcium-sensing receptor: A new target for therapy of diarrhea

Management of acute diarrhea remains a global challenge, particularly in resource-limiting countries. Oral rehydration solution (ORS), a passive rehydrating therapy developed approximately 40 years ago, remains the mainstay treatment. Although ORS is effective for hydration, since it does not inhibit enterotoxin-mediated excessive secretion, reduced absorption and compromised barrier function - the primary mechanisms of diarrhea, ORS does not offer a rapid relief of diarrhea symptom. There are a few alternative therapies available, yet the use of these drugs is limited by their expense, lack of availability and/or safety concerns. Novel anti-diarrheal therapeutic approaches, particularly those simple affordable therapies, are needed. This article explores intestinal calcium-sensing receptor (CaSR), a newly uncovered target for therapy of diarrhea. Unlike others, targeting this host antidiarrheal receptor system appears &#x0201c;all-inclusive&#x0201d;: it is anti-secretory, pro-absorptive, anti-motility, and anti-inflammatory. Thus, activating CaSR reverses changes of both secretory and inflammatory diarrheas. Considering its unique property of using simple nutrients such as calcium, polyamines, and certain amino acids/oligopeptides as activators, it is possible that through targeting of CaSR with a combination of specific nutrients, novel oral rehydrating solutions that are inexpensive and practical to use in all countries may be developed.

Development of Mutiplex Polymerase Chain Reaction for the Detection and Differentiation of Enteric Adenoviruses in Stool Samples

To find a technique of detecting and differentiating enteric adenoviruses (EAds) in clinical samples, a novel PCR approach was developed. EAds were able to be detected by use of a pair of subgroup F general primers (P1 and P2), and they were also be able to be differentiated from each other in the presence of another adenovirus type 40 (Ad40) specific primer (P3) in the same tube. Our results showed that there was one band for Ad41 and two bands for Ad40, respectively, on running-gel after PCR performance. PCR was performed on 40 specimens in parallel directly with dot-hybridization assay on the same diluted stool samples. 20 of 40 specimens were positive by hybridization (of them 12 were Ad41 and 8 were Ad40), whereas 26 were positive by PCR performance on the same samples with Ad41 18 and Ad40 8 positive as well. Our study indicated that this novel method could be used in clinical laboratory or in epidemic investigation for Eads