Ischemic colitis and large bowel infarction:A case report

Ischemic bowel disease results from an acute or chronic drop in the blood supply to the bowel and may have various clinical presentations, such as intestinal angina, ischemic colitis or intestinal infarction. Elderly patients with systemic atherosclerosis who are symptomatic for the disease in two or more vascular beds have multiple comorbidities and are particularly at risk. The clinical evolution and outcome of this disease are difficult to predict because of its pleomorphic aspects and the general lack of statistical data. In this paper, we present the case of a patient who was monitored in our unit for six years. For this patient, we encountered iterative changes in the clinical pattern, beginning with chronic "intestinal angina" and finishing with signs of acute mesenteric ischemia after an episode of ischemic colitis. This evolution is particularly rare in clinical practice, and the case is instructive because it raises discussions about the natural history of the condition and the thera-peutic decisions that should be made at every stage of the disease. An important lesson is that ischemic bowel disease should always be considered in patients who have multiple risk factors for atherosclerosis and have experienced recurrent "indistinct" abdominal symptoms.In these cases, aggressive investigation and therapeutic decisions must be taken whenever possible. Despite an absence of standardized protocols, angiographic evaluation and revascularization procedures have beneficial outcomes. Current advances in endovascular therapy, such as percutaneous transluminal angioplasty with stenting, should be increasingly used in patients with chronic mesenteric ischemia. Such therapy can avoid the risks that are associated with open repair. However, technical difficulties, especially in severe stenotic lesions, frequently occur.

Glucagon-like peptide (GLP)-1 regulation of lipid and lipoprotein metabolism

Metabolic health is highly dependent on intestinal and hepatic handling of dietary and endogenous lipids and lipoproteins.Disorders of lipid and lipoprotein metabolism are commonly observed in patients with insulin resistant states such as obesity,metabolic syndrome,and type 2 diabetes.Ev-idence from both animal models and human studies indicates that a major underlying factor in metabolic or diabetic dysli-pidemia is the overproduction of hepatic and intestinal apoli-poprotein(apo)B-containing lipoprotein particles.These particles are catabolized down into highly proatherogenic remnants,which can be taken up into the arterial intima and promote plaque development.Several gut-derived peptides have been identified as key regulators of energy metabolism;one such peptide is the incretin hormone glucagon-like peptide(GLP)-1.Our laboratory has previously demonstrated that GLP-1 can signal both centrally and peripherally to reduce postprandial and fasting lipoprotein secretion.Moreover,we have demonstrated that GLP-1 receptor(GLP-1R)agonists can ameliorate diet-induced dyslipidemia.Recently,we published evidence for a novel vagal neuroendocrine signalling pathway by which native GLP-1 may exert its anti-lipemic effects.Furthermore,we demonstrated a novel role for other gut-derived peptides in regulating intestinal lipoprotein produc-tion.Overall,ample evidence supports a key role for GLP-1R on the portal vein afferent neurons and nodose ganglion in modulating intestinal fat absorption and lipoprotein produc-tion and identifies other gut-derived peptides as novel regula-tors of postprandial lipemia.Insights from these data may support identification of potential drug targets and the development of new therapeutics targeting treatment of dia-betic dyslipidemia.

Literature-based analysis on relationship of symptoms,drugs and therapies in treatment of intestinal diseases

OBJECTIVE:To evaluate clinical articles published in the past 30 years using the Traditional Chinese Medicine(TCM)theory of the lung being connected with large intestine to treat intestinal diseases.We also analyzed the relationship between symptoms,drugs and therapies with data-excavating technology to aid management.METHODS:After retrieving relevant clinical articles,we set up a database,used Microsoft Structured Query Language Server 2005 Analysis Services as a data-excavating tool,and applied the association rule to study the relationship between the symptoms,drugs and therapies of intestinal diseases.RESULTS:The key symptoms of dyschesia,constipation,abdominal fullness,fatigue and pale tongue could be treated with Kuxingren(Semen Armeniacae Amarum),Huangqi(Radix Astragali Mongolici)and Gualou(Fructus et Semen Trichosanthis)to invigorate Qi and moisten the intestine.Among these agents,Kuxingren(Semen Armeniacae Amarum)was used most frequently.Clearing Fu-organs was the most prevalent therapy for abdominal fullness,dyschesia,constipation and red tongue.Clearing Fu-organs could be achieved with Kuxingren(Semen Armeniacae Amarum)and Gualou(Fructus et Semen Trichosanthis),whereas Qi could be invigorated using Huangqi(Radix Astragali Mongolici),Gancao(Radix Glycyrrhizae),Baizhu(Rhizoma Atractylodis Macrocephalae)and Kuxingren(Semen Armeniacae Amarum).Moistening the intestine was possible with Kuxingren(SemenArmeniacae Amarum),Huomaren(Fructus Cannabis)and Jiegeng(Radix Platycodi).Also,moistening the lungs was done with Kuxingren(Semen Armeniacae Amarum),ventilating the lungs with Kuxingren(Semen Armeniacae Amarum)and Gualou(Fructus et Semen Trichosanthis),and nourishing the lungs with Huangqi(Radix Astragali Mongolici),Gancao(Radix Glycyrrhizae)and Kuxingren(Semen Armeniacae Amarum).These data demonstrated that Kuxingren(SemenArmeniacaeAmarum)was a key agent.CONCLUSION:Our analyses of the literature showed clear relationships between symptoms(constipation,dyschesia,abdominal fullness),drugs[Gualou(Fructus et Semen Trichosanthis),Kuxingren(Semen Armeniacae Amarum),Huangqi(Radix Astragali Mongolici)]and therapies(moistening the intestine,clearing Fu-organs,invigorating Qi,ventilating the lungs).

Analysis on clinically drug-used law for lung-intestine related diseases

OBJECTIVE： To analyze the application laws of clini- cal drugs by descriptive statistical method with the clinical literatures guided by ＂lung being connect- ed with large intestine＂ used as the object. METHODS： Retrieve publicly published clinical litera- tures about ＂lung being connected with large intes- tine＂ in recent 30 years, establish the data base of clini- cal literature, and study on the clinically drug-used laws by descriptive statistical analytic method. RESULTS： The common high frequent drugs used for the lung-intestine related diseases were Gualou （Ructus Trichsanthis）, Dahuang （Radix et Rhizoma）, Kuxingren （Semen Armeniacae Amarum）, Gancao （Radix Glycyrrhizae）, Houpu （Cortex Magnoliae Offi- cinalis）, Zhishi （Fructus Aurantii Immaturus）. For the different clinical syndrome types, in the commonly used drugs there were different characteristics, re- flecting the principle of TCM syndrome differentia- tion treatment.CONCLUSION： The common high frequent drugs used for the lung-intestine related diseases are Gua- Iou （Fructus Trichsantffis）, Dahuang （Radix et Rhi- zoma）, Kuxingren （Semen Armeniacae Amarum）, Gancao （Radix Glycyrrhizae）, Houpu （Cortex Mag- noliae Officinalis）, Zhishi （Fructus Aurantii Immatu- rus）, which are commonly-used drugs for the lung-intestine related diseases ,with differences for different syndrome types.