Diagnostic value of digital continuous bowel sounds in critically ill patients with acute gastrointestinal injury: A prospective observational study

BACKGROUND Acute gastrointestinal injury(AGI)is common in intensive care unit(ICU)and worsens the prognosis of critically ill patients.The four-point grading system proposed by the European Society of Intensive Care Medicine is subjective and lacks specificity.Therefore,a more objective method is required to evaluate and determine the grade of gastrointestinal dysfunction in this patient population.Digital continuous monitoring of bowel sounds and some biomarkers can change in gastrointestinal injuries.We aimed to develop a model of AGI using continuous monitoring of bowel sounds and biomarkers.AIM To develop a model to discriminate AGI by monitoring bowel sounds and biomarker indicators.METHODS We conducted a prospective observational study with 75 patients in an ICU of a tertiary-care hospital to create a diagnostic model for AGI.We recorded their bowel sounds,assessed AGI grading,collected clinical data,and measured biomarkers.We evaluated the model using misjudgment probability and leave-one-out cross-validation.RESULTS Mean bowel sound rate and citrulline level are independent risk factors for AGI.Gastrin was identified as a risk factor for the severity of AGI.Other factors that correlated with AGI include mean bowel sound rate,amplitude,interval time,Sequential Organ Failure Assessment score,Acute Physiology and Chronic Health Evaluation II score,platelet count,total protein level,blood gas potential of hydrogen(pH),and bicarbonate(HCO3-)level.Two discriminant models were constructed with a misclassification probability of<0.1.Leave-one-out cross-validation correctly classified 69.8%of the cases.CONCLUSION Our AGI diagnostic model represents a potentially effective approach for clinical AGI grading and holds promise as an objective diagnostic standard for AGI.

TRPV6、CCK-B、β-catenin在结肠息肉/癌组织中表达及相关性

目的 通过检测在结肠息肉癌变过程中瞬时性受体电位通道香草酸受体(TRPV)6、胃泌素/胃泌素受体(Gastrin/CCK-B)、β-catenin蛋白及mRNA表达,探讨TRPV6、CCK-B在结肠癌Wnt/β-catenin信号通路中的表达及相关性。方法 通过收集正常结肠黏膜组织、结肠增生性息肉组织、结肠腺瘤性息肉组织、早期结肠癌组织标本,利用实时荧光定量聚合酶链反应(Real-Time PCR)技术检测CCK-B、TRPV6及β-catenin mRNA表达水平,运用Western印迹、免疫组织化学方法检测Gastrin/CCK-B、TRPV6及β-catenin蛋白表达水平,分析上诉指标的表达情况及相关性。结果 免疫组化结果显示β-catenin、Gastrin、TRPV6在正常结肠黏膜组织、结肠增生性息肉组织、结肠腺瘤性息肉组织、早期结肠癌组织中的表达强度呈逐渐上升的趋势;Real-Time PCR及Western印迹结果显示TRPV6、CCK-B、β-catenin mRNA和蛋白在正常人的结肠黏膜组织中也可有少量表达,且在结肠增生性息肉组织、结肠腺瘤性息肉组织、早期结肠癌组织中的表达逐渐上调;在通过Western印迹检测正常结肠黏膜组织、结肠增生性息肉组织、结肠腺瘤性息肉组织、早期结肠癌组织中TRPV6、CCK-B、β-catenin蛋白表达并统计其平均光密度值后,Spearman分析显示,β-catenin表达水平与CCK-B呈正相关(r=0.988,P=0.012),与TRPV6表达呈正相关(r=0.998,P=0.002)。结论 Gastrin/CCK-B、TRPV6、β-catenin在正常结肠组织-结肠腺瘤-早期结肠癌的演变过程中可能发挥一定作用。

Reduced secretion of epidermal growth factor in duodenal ulcer patients with Helicobacter pylori infection

AIM To investigate the concentration changes of epidermal growth factor (EGF) in duodenal ulcer patients with H. pylori infection.

Function and regulation of cholecystokinin-octapeptide, β-endorphin and gastrin in anorexic infantile rats treated with ErBao Granules

AIM To study the role of cholecystokinin- octapeptide (CCK-8). β-endorphin (β-EP). and gastrin in an anorexic infantile rat model and no subsequent regulation of nose peptides by the Yunpi complex prescription ErBao Granule. METHODS We fed infantile rats with special prepared forage. A liquid extract of ErBao Granule was administered to the rats daily for 3 weeks, CCK-8, β-EP, and gastrin concentrations in hypothalamus, gastric antrum, and plasma of the rats were measured by radioimmunoassay, and were compared with controls. RESULTS Treatment of rats with ErBao Granule inhibited CCK-8 secretion and increased β-EP and gastrin secretion. CCK-8 concentration in hypothalamus and plasma of model control group increased significantly and correlated negatively with food intake of models, respectively. β-EP concentration in gastric antrum and plasma of model control group decreased significantly and showed a positive correlation with food intake of models, respectively. Hypothalamus concentration of β -EP was similar in models and controls. Gastrin concentration in gastric antrum of models was lower than in the blank control group, and correlated positively to food intake of models. Finally, CCK-8 concentrations in plasma of rats showed a positive correlation with plasma β-EP (r=-0.68, P<0.05). CONCLUSION The increased plasma and hypothalamus concentration of CCK-8, decreased gastric antrum and plasma level of β -EP, and decreased gastric antrum concentration of gastric are associated significantly with the anorexia of infantile anorexic rat models produced by special forage. ErBao Granule can reverse these changes, which may be the major mechanisms of ErBao Granule simulating feeding.

Helicobacter pylori infection and gastrointestina hormones:a review

INTRODUCTIONHelicobacter pylori(Hp)infection is closely relatedto gastrointestinal hormones and involves theformation of gastritis,gastric carcinoma and pepticulcer.Its pathogenesis relevant

Gastrin,somatostatin,G and D cells of gastric ulcer in rats

AIM: To investigate the relationship among gastrin, somatostatin, G and D cells in gastric ulcer and in its healing process in rats. METHODS: Fourty-nine Wistar rats were divided into 7 groups. The gastric ulcer model was induced by acetic acid successfully. The gastrin and the somatostatin in rat plasma, gastric fluid and antral tissue were measured by radioimmunoassay(RIA). G and D cells in antral mucosa were analyzed with polyclonal antibody of gastrin and somatostatin by immunohistochemical method and Quantimet 500 image analysis system. RESULTS: In gastric ulcer, the level of gastrin in plasma, gastric fluid, and antral tissue increased, that of somatostatin declined, and the disorder gradually recovered to the normal level in the healing process. Immunohistochemical technique of G and D cells in antral mucosa demonstrated that the number of G cells increased and that of D cells decreased, both areas of G and D cells declined, the ratio of number and area of G/D increased in gastric ulcer, and the disorder gradually recovered in the healing process. CONCLUSION: In gastric ulcer, the increased gastrin secreted by G cells, the declined somatostatin secreted by D cells, and the disordered G/D cell ratio can lead to gastrointestinal dysfunction.

Gastrin,somatostatin,and experimental disturbance of the gastrointestinal tract in rats

INTRODUCTIONThe field of gastrointestinal hormones has expanded at a dizzying rate[1-4].Gastrointestinal hormones as regulatory peptides that appear to be major components of bodily integration and have important regulatory actions on physioligical function of the gastrointestinal tract .The successful isolation of some gastrointestinal hormones and the development of sensitive methods for their detection have led to the unexpected finding that they also exist in the brain .

Ascorbic acid secretion in the human stomach and the effect of gastrin

AIM To investigate the changes of gastricmucosal ascorbic acid secretion in patients withnonulcer dyspepsia and the effect of gastrin onit,and to relate any observed changes to H.pylori infection and mucosal histology.METHODS Ascorbic acid secretions in patientswere examined by collecting continuouslygastric juice for one hour after having aspiratedand discarded fasting gastric juice.Using theclearance rate(mL/min)of ascorbic acid fromblood to gastric juice represented ascorbic acidsecretion in the gastric mucosa.Ascorbic acidconcentrations in plasma and juice weremeasured by ferric reduced method.RESULTS Gastric ascorbic acid secretions inH.pylori-positive patients(1.46 mL/min,range0.27-3.78)did not significantly differ fromthose in H.pylori-negative patients(1.25 mL/min,0.47-3.14)(P】0.05).There were nosignificant differences in ascorbic acidsecretions between patients with mild(1.56 mL/min,0.50-3.30),moderate(1.34 mL/min,0.27-2.93)and severe(1.36 mL/min,0.47-3.78)inflammation(P】0.05).There were nosignificant differences in ascorbic acidsecretions between patients without activity(l.45mL/min,0.27-3.14)and with mild(1.32mL/min,0.61-2.93),moderate(1.49mL/min,0.50-3.78)and severe(1.43 mL/min,0.51-3.26)activity of chronic gastritis either(P】0.05).Ascorbic acid secretions in patientswith severe atrophy(0.56 mL/min,0.27-1.20)were markedly lower than those in patientswithout atrophy(1.51 mL/min,0.59-3.30)and with mild(1.43 mL/ min,0.53-3.78)andmoderate(1.31 mL/min,0.47-3.16)atrophy(P【0.005).There was a significant negativecorrelation between ascorbic acid secretion andseverity of atrophy(correlation coefficient=-0.43,P【0.005).After administration ofpentagastrin,ascorbic acid secretions weremarkedly elevated(from 1.39 mL/min,0.36-2.96 to 3.53mL/min,0.84-5.91)(P【0.001).CONCLUSION Ascorbic acid secretion ingastric mucosa is not affected by H.pyloriinfection.Gastric ascorbic acid secretion ismarkedly related to the severity of atrophy,whereas not related to the severity ofinflammation and activity.Gastrin may stimulategastric ascorbic acid secretion.A decreasedascorbic acid secretion may be an importantfactor in the link between atrophic gastritis andgastric carcinogenesis.

Possibility of non-invasive diagnosis of gastric mucosal precancerous changes

AIM: To assess the possibility of non-invasive screening of atrophic chronic gastritis for preventing further development of gastric cancer.METHODS: One hundred and seventy-eight consecutive Helicobacter pylori ( H pylori)-positive dyspeptic patients after detection of serum levels of pepsinogen-1 (PG-1) and gastrin-17 (G-17) by enzyme immunoassay were proposed for endoscopy and histology. The serologic and morphologic results were compared with estimating the sensitivity, specificity and prognostic values of the tests.RESULTS: There was statistically significant reverse dependence between the grade of stomach mucosal antral or corpus atrophy and the proper decreasing of serum G17 or PG1 levels. The serologic method was quite sensitive in the diagnosis of non-atrophic and severe antral and corpus gastritis. Also, it was characterized by the high positive and negative prognostic values.CONCLUSION: Detection of serum G-17 and PG1 levels can be offered as the screening tool for atrophic gastritis. The positive serologic results require further chromoendoscopy with mucosal biopsy, for revealing probable progressing of atrophic process with development of intestinal metaplasia, dysplasia or gastric cancer.

Influence of IFNα-2b and BCG on the release of TNF and IL-1 by Kupffer cells in rats with hepatoma

INTRODUCTIONKupffer cells are residential macrophages in the liver ,which play a critical role in the maintenance of normal liver function and in immunal surveilance of hepatocellular carcinoma (HCC) and other cancers[1].The biological immune modulants have cancers[2].In our previous studies ,the combined use of biological immune modulants showed better dffects .

EGF与Gastrin联合应用对糖尿病大鼠胰岛β细胞再生的影响

表皮生长因子（EGF）是肽类生长因子，许多研究证明，EGF 参与体外诱导干细胞向胰岛样细胞分化。已有文献证实 Gastrin 是一种介导胰岛新生的生长因子［1］，观察转导胰岛素启动子调控 Gastrin 基因的小鼠，虽然没有观察到实验组小鼠胰岛细胞数量的变化，但表达 TGF、Gastrin 的胰岛细胞数增多。在大鼠的胰腺导管结扎模型中发现 Gastrin 可促进胰岛β细胞再生，推测可能在该模型中，外源性的 Gastrin 可能是促进胰岛β细胞再生必要因子［2］。本文通过联合应用 Gastrin、EGF，观察 Gastrin、EGF 对糖尿病大鼠胰岛β细胞增殖作用影响。

Gastric autoimmune disorders in patients with chronic hepatitis C before,during and after interferon-alpha therapy

AIM:To explore the prevalence of autoimmune gastritis in chronic hepatitis C virus (HCV) patients and the influence of α-interferon (IFN) treatment on autoimmune gastritis. METHODS:We performed a prospective study on 189 patients with positive anti-HCV and viral RNA enrolled in a 12-month IFN protocol.We evaluated:a) the baseline prevalence of autoimmune gastritis,b) the impact of IFN treatment on development of biochemical signs of autoimmune gastritis (at 3,6 and 12 months),c) the evolution after IFN withdrawal (12 months) in terms of anti-gastric-parietal-cell antibodies (APCA),gastrin,anti-thyroid,and anti-non-organ- specific antibodies. RESULTS:APCA positivity and 3-fold gastrin levels were detected in 3 (1.6%) and 9 (5%) patients,respectively,at baseline,in 25 (13%) and 31 (16%) patients at the end of treatment (both P<0.001,vs baseline),and in 7 (4%) and 14 (7%) patients 12 months after withdrawal (P=0.002 and P=0.01 respectively,vs baseline;P=not significant vs end of treatment).The development of autoimmune gastritis was strictly associated with the presence of autoimmune thyroiditis (P=0.0001),no relationship was found with other markers of autoimmunity. CONCLUSION:In HCV patients,IFN frequently precipitates latent autoimmune gastritis,particularly in females.Following our 12-month protocol,the phenomenon generally regressed.Since APCA positivity and high gastrin levels are associated with the presence of antithyroid antibodies, development of autoimmune thyroiditis during IFN treatment may provide a surrogate preliminary indicator of possible autoimmune gastritis to limit the need for invasive examinations.

隔药饼灸对功能性消化不良患者血清GAS、MTL影响的临床观察

目的:观察自拟中药方的隔药饼灸法对功能性消化不良患者的疗效。方法:选取于2019年1月~2019年7月我院就诊的61例功能性消化不良的患者,随机分为隔药饼灸组31例和无瘢痕灸组30例,隔药饼灸组采用自拟中药方制备药饼进行治疗,无瘢痕灸组常规采用清艾炷进行治疗。连续4个疗程结束后对比治疗前后两组患者临床症候积分及血清GAS、MTL情况。结果:隔药饼灸组在改善功能性消化不良患者的临床症候积分、血清GAS及MTL上均优于无瘢痕灸组(P<0.01)。结论:自拟中药方的隔药饼灸治疗功能性消化不良,疗效确切。

山莨菪碱联合艾司奥美拉唑治疗对急性胃炎患者临床疗效、Gastrin及炎性因子的影响

目的 分析山莨菪碱联合艾司奥美拉唑治疗对急性胃炎患者临床疗效、胃泌素(Gastrin)及炎性因子的影响。方法 选取2019年3月至2021年12月淮北矿工总医院收治的急性胃炎患者63例,根据药物治疗方案不同分为对照组(艾司奥美拉唑)30例和观察组(山莨菪碱+艾司奥美拉唑)33例。对比两组临床疗效、Gastrin水平变化、炎性因子[C反应蛋白(CRP)、白介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)]及安全性。结果 对照组总有效率为70.00%,观察组总有效率为90.91%,观察组总有效率高于对照组,差异有统计学意义(P<0.05)。治疗后1 d、3 d,两组Gastrin水平均显著下降,且观察组治疗后1 d、3 d Gastrin水平下降趋势大于对照组,差异有统计学意义(P<0.05)。两组治疗3 d后CRP、IL-6、TNF-α水平均显著降低,且观察组CRP、IL-6、TNF-α水平均显著低于对照组,差异有统计学意义(P<0.05)。对照组不良反应发生率为13.33%,观察组不良反应发生率为9.09,两组不良反应发生率比较差异无统计学意义(P>0.05)。结论 山莨菪碱联合艾司奥美拉唑治疗对急性胃炎患者临床疗效确切,可有效降低Gastrin水平,抑制炎性因子水平,改善患者微炎症反应,且具有一定安全性,临床使用价值较高。

EGF/Gastrin联用对实验性1型糖尿病大鼠胰岛β细胞再生的影响

目的观察EGF/Gastrin联用对实验性1型糖尿病大鼠胰岛β细胞再生的影响,为糖尿病的治疗开辟新途径。方法选用Wister大鼠,一次性腹腔注射STZ(55 mg.kg-1)诱导1型糖尿病模型。实验分3组:正常对照组、糖尿病组及EGF/Gastrin组。EGF(1μg.kg-1)/Gastrin(3μg.kg-1)每日一次,连续14日。实验结束检测各组大鼠的空腹血糖、血清Insulin及C肽等生化指标;进行HE染色,观察胰岛形态学变化。结果 EGF/Gastrin组大鼠空腹血糖明显低于糖尿病组(P<0.05);血清Insulin、C肽含量及胰岛β细胞数量均明显高于糖尿病组(P<0.05)。结论 EGF/Gastrin联用能够降低糖尿病大鼠的血糖,并使血清Insulin和C肽含量增加,胰岛β细胞数量增多,功能得到改善。

Changes of gastric acid secretion after cholangioduodenostomy with artificial papilla and interposed jejunum

The changes of gastric acid secretion and the levels of gastrin(Gn) and somatostatin(SS) in the serum, gastric juice and mucous membrane of pyrolic antrum were determined in 10 cases with cholangioduodenostomy with artificial papilla and interposed jejunum(Inter-JCD) and 28 cases with cholangiojenunostomy with Roux-en-Y (CJR-Y). It was found that the secondary gastric hypersecretion did not occur and the levels of Gn and SS showed no significant changes after Inter-JCD but there was secondary high secretion of gastric acid, significant reduction of the synthesis and release of SS and significant elevation of the synthesis and release of Gn after CJR-Y. These findings indicate that Inter-JCD is superior to CJR-Y since it induces no disturbance of gastric acid secretion postoperatively.

自身免疫性胃炎23例临床病理分析

目的探讨自身免疫性胃炎(autoimmune gastritis,AIG)的临床病理学特征、免疫表型、诊断及鉴别诊断。方法回顾性分析23例AIG的临床表现、病理学形态、内镜下特征及免疫表型,并复习相关文献。结果23例AIG中,女性16例,男性7例,年龄34~70岁,中位年龄54岁,发生于胃体17例,胃底7例。均表现为非特异性胃肠表现,内镜下表现为非特异性胃炎及黏膜隆起,其中5例伴有不同程度的贫血,6例合并幽门螺杆菌感染,2例伴甲状腺疾病。23例中7例伴增生性息肉,5例伴腺上皮低级别上皮内瘤变,1例伴高级别上皮内瘤变,1例伴幽门腺腺瘤,1例伴胃腺癌,1例伴多发神经内分泌肿瘤。镜下均表现为以胃体、胃底黏膜慢性炎性病变为主,伴有不同程度的壁细胞减少,程度不等的肠化、假幽门腺样化生及胰腺腺泡细胞化生。免疫表型:23例CgA示神经内分泌细胞呈线状、微结节状增生,胃底、胃体黏膜Gastrin呈阴性,胃窦Gastrin染色呈增生改变,Ki-67呈增殖区阳性。胃窦黏膜无明显炎症改变或呈轻度慢性炎。结论AIG患者的临床症状不一,起病隐匿,内镜下表现无特异性,不同临床阶段组织学表现也不尽相同,日常工作中极易漏诊。胃黏膜活检对AIG的诊断具有重要价值。