Perioperative management of postoperative sigmoid colon cancer complicated by a large abdominal wall defect:A case report

BACKGROUND Large abdominal wall defect(LAWD)measures>20 cm in width.LAWD can easily lead to intestinal necrosis,peritonitis,other complications,and even mul-tiple organ dysfunction syndrome.Multiple intestinal fistulas are high-flow fis-tulas that can cause severe water–electrolyte imbalance and malnutrition,as well as inflammation,high metabolic status,and chronic intestinal failure caused by intestinal fluid corrosion in tissues around the orifice fistulas.CASE SUMMARY This article summarizes the nursing experience of a patient with sigmoid carci-noma who has LAWD with multiple intestinal fistula due to repeated operations for postoperative complications.The key points of care:Scientific assessment of nutritional status,dynamic adjustment of nutritional support programmes,com-prehensive adoption of enteral nutrition,parenteral nutrition and combined nut-rition of enteral and parenteral;taking good care of abdominal wall defects and intestinal fistulas;continuous flushing of the abdominal drainage tube and low negative pressure drainage;prevention of venous thrombosis;strengthening of physical exercise;implementation of positive psychological interventions.CONCLUSION After more than 7 months of careful care,the patient's physical fitness has been well recovered,local inflammation is well controlled,which wins the opportunity for the operation,and the postoperative recovery is good.

Evaluating the accuracy and reproducibility of ChatGPT-4 in answering patient questions related to small intestinal bacterial overgrowth

BACKGROUND Small intestinal bacterial overgrowth(SIBO)poses diagnostic and treatment challenges due to its complex management and evolving guidelines.Patients often seek online information related to their health,prompting interest in large language models,like GPT-4,as potential sources of patient education.AIM To investigate ChatGPT-4's accuracy and reproducibility in responding to patient questions related to SIBO.METHODS A total of 27 patient questions related to SIBO were curated from professional societies,Facebook groups,and Reddit threads.Each question was entered into GPT-4 twice on separate days to examine reproducibility of accuracy on separate occasions.GPT-4 generated responses were independently evaluated for accuracy and reproducibility by two motility fellowship-trained gastroenterologists.A third senior fellowship-trained gastroenterologist resolved disagreements.Accuracy of responses were graded using the scale:(1)Comprehensive;(2)Correct but inadequate;(3)Some correct and some incorrect;or(4)Completely incorrect.Two responses were generated for every question to evaluate reproducibility in accuracy.RESULTS In evaluating GPT-4's effectiveness at answering SIBO-related questions,it provided responses with correct information to 18/27(66.7%)of questions,with 16/27(59.3%)of responses graded as comprehensive and 2/27(7.4%)responses graded as correct but inadequate.The model provided responses with incorrect information to 9/27(33.3%)of questions,with 4/27(14.8%)of responses graded as completely incorrect and 5/27(18.5%)of responses graded as mixed correct and incorrect data.Accuracy varied by question category,with questions related to“basic knowledge”achieving the highest proportion of comprehensive responses(90%)and no incorrect responses.On the other hand,the“treatment”related questions yielded the lowest proportion of comprehensive responses(33.3%)and highest percent of completely incorrect responses(33.3%).A total of 77.8%of questions yielded reproducible responses.CONCLUSION Though GPT-4 shows promise as a supplementary tool for SIBO-related patient education,the model requires further refinement and validation in subsequent iterations prior to its integration into patient care.

A combined pig model to determine the net absorption of volatile fatty acids in the large intestine under different levels of crude fiber

Background:This study aimed to develop a combined model to quantify the net absorption of volatile fatty acids(VFA)in the large intestine(LI)of pigs.Methods:Fifteen female growing pigs(Duroc×Large White×Landrace)were ranked by body weight(30±2.1 kg)on day 0 and assigned to one of three treatments,namely the basal diet containing different crude fiber(CF)levels(LCF:3.0%CF,MCF:4.5%CF,and HCF:6.0%CF).The pigs were implanted with the terminal ileum fistula and the cannulation of the ileal mesenteric vein(IMV),portal vein(PV),and left femoral artery(LFA)from days 6 to 7.[13 C]-Labeled VFA and P-aminohippuric acid were constantly perfused into the terminal ileum fistula and the cannulation of the IMV(day 15),respectively.Blood samples were collected from the PV and the LFA during perfusion(5 h),and LI samples were collected.Results:The net flux of[12 C]-acetic acid in the PV was greater for LCF versus MCF(p=0.045),but no difference was observed in the net flux of[12 C]-propionic acid(p=0.505)and[12 C]-butyric acid(p=0.35)in the PV among treatments.The deposition of[12 C]-acetic acid in the LI was greater for LCF versus MCF(p=0.014),whereas the deposition of[12 C]-propionic acid(p=0.007)and[12 C]-butyric acid(p=0.037)in the LI was greater for LCF versus HCF.Conclusions:In conclusion,this pig model was found conducive to study the net absorption of VFAs in the LI,and LCF had more net absorption of VFAs in the LI than MCF and HCF.

Relationship between expression of gastrin, somatostatin,Fas/FasL and caspases in large intestinal carcinoma

AIM: To explore the correlation between the mRNAs and protein expression of gastrin (GAS), somatostatin (SS) and apoptosis index (AI), apoptosis regulation gene Fas/ FasL and caspases in large intestinal carcinoma (LIC). METHODS: Expression of GAS and SS mRNAs were detected by nested RT-PCR in 79 cases of LIC. Cell apoptosis was detected by molecular biology in situ apoptosis detecting methods (TUNEL). Immunohistochemical staining for GAS, SS, Fas/FasL, caspase-3 and caspase-8 was performed according to the standard streptavidin-biotin-peroxidase (S-P) method. RESULTS: There was a significant positive correlation between mRNA and protein expression of GAS and SS (GASrs=0.99, P < 0.01; SSrs = 0.98, P < 0.01). There was significant difference in positive expression rates of GAS, SS mRNAs and protein among different histological differentiation, histological types and Dukes’ stage of LIC. The AI in GAS high and moderate expression groups was significantly lower than that in low expression groups (3.75 ± 2.38 vs 7.82 ± 2.38, P < 0.01; 5.51 ± 2.66 vs 7.82 ± 2.38, P < 0.01), and the AI in SS high and moderate expression groups was significantly higher than that in low expression groups (9.03 ± 1.76 vs 5.35 ± 3.00, P < 0.01; 7.44 ± 2.67 vs 5.35 ± 3.00, P < 0.01). There was a significant negative correlation between the integral ratio of GAS to SS and the AI (rs = -0.41, P < 0.01). The positive expression rate of FasL in GAS high and moderate expression groups was higher than thatin low expression group (90.9% and 81.0% vs 53.2%, P < 0.05). The positive expression rates of Fas, caspase-8 and caspase-3 in SS high (90.0%, 90.0% and 100%) and moderate (80.0%, 70.0%, 75.0%) expression groups were higher than that in low expression group (53.1%, 42.9%, 49.0%) (90.0% and 80.0% vs 53.1%, P < 0.05; 90.0% and 70.0% vs 42.9%, P < 0.05; 100.0% and 75.0% vs 49.0%, P < 0.05). There was a significant positive correlation between the integral ratio of GAS to SS and the semiquantitative integral of FasL (rs = 0.32, P < 0.01). CONCLUSION: GAS and SS play important roles in the regulation and control of cell apoptosis in LIC, and the mechanism may be directly related to the aberrant expression of Fas/FasL. The GAS and SS will be valuable targets of the biological behavior of LIC.

Role of ERK-MAPK signaling pathway in pentagastrin-regulated growth of large intestinal carcinoma

AIM: To explore the role and mechanisms of extracellular signal-regulated protein kinase-mitogen-activated protein kinase (ERK-MAPK) signaling in pentagastrin-regulated growth of large intestinal carcinoma.

Correlation between expression of gastrin, somatostatin and cell apoptosis regulation gene bcl-2/bax in large intestine carcinoma

AIM: To explore the correlation between expression of somatostatin (SS), gastrin (GAS) and cell apoptosis regulation gene bcl-2/bax in large intestine carcinoma.METHODS: Sixty-two large intestine cancer tissue samples were randomly and retrospectively selected from patients with large intestine carcinoma. Immunohistochemical staining for bcl-2, bax, GAS, SS was performed according to the standard streptavidin-biotin-peroxidase (S-P) method.According to the semi-quantitative integral evaluation, SS and GAS were divided into three groups as follows. Scores1-3 were defined as the low expression group, 4-8 as the intermediate expression group, 9-16 as the high expression group. Bax and bcl-2 protein expressions in different GAS and SS expression groups of large intestine carcinoma were assessed.RESULTS: The positive expression rate of bax had a prominent difference between SS and GAS high, intermediate and low expression groups (P＜0.05, x2ss = 9.246; P＜0.05,x2GAS = 6.981). The positive expression rate of bax in SS high (80.0%, 8/10) and intermediate (76.5%, 13/17)expression groups was higher than that in low expression group (40.0%, 14/35) (P＜0.05, x2high vs low = 5.242; P＜0.05,x2middle vs low = 6.097). The positive expression rate of bax in GAS high expression group (27.3%, 3/8) was lower than that in low expression group (69.4%, 25/36) (P＜0.05,x2 = 4.594). However, bax expression in GAS intermediate expression group (46.7%, 7/15) was lower than that in low expression group, but not statistically significant. The positive expression rate of bcl-2 had a prominent difference between SS and GAS high, intermediate and low expression groups (P＜0.05, x2ss = 7.178; P＜0.05, x2GAS = 13.831). The positive expression rate of bcl-2 in GAS high (90.9%, 10/11)and intermediate (86.7%, 13/15) expression groups was higher than that in low expression group (44.4%, 16/36)(P＜0.05,x2high vs low = 5.600; P＜0.05, x2 middle vs low = 7.695).However, the positive expression rate of bcl-2 in SS high (40.0%, 4/10) and intermediate (47.1%, 8/9) expression groups was lower than that in low expression group (77.1%, 27/35)(P＜0.05, x2 high vs low = 4.710; P＜0.05, x2 middle vs low = 4.706).There was a significant positive correlation between the integral ratio of GAS to SS and the integral of bcl-2 (P＜0.01,r=0.340). However, there was a negative correlation between the integral ratio of GAS to the SS and bax the integral of (P＜0.05, r = -0.299).CONCLUSION: The regulation and control of gastrin,somatostatin in cell apoptosis of large intestine carcinoma may be directly related to the abnormal expression of bcl-2, bax.

Heterogeneity across the murine small and large intestine

The small and large intestine of the gastrointestinal tract(GIT) have evolved to have discrete functions with distinct anatomies and immune cell composition.The importance of these differences is underlined when considering that different pathogens have uniquely adapted to live in each region of the gut.Furthermore,different regions of the GIT are also associated with differences in susceptibility to diseases such as cancer and chronic inflammation.The large and small intestine,given their anatomical and functional differences,should be seen as two separate immunological sites.However,this distinction is often ignored with findings from one area of the GIT being inappropriately extrapolated to the other.Focussing largely on the murine small and large intestine,this review addresses the literature relating to the immunology and biology of the two sites,drawing comparisons between them and clarifying similarities and differences.We also highlight the gaps in our understanding and where further research is needed.

Retrospective Studies on Clinical Features of Melanosis of the Colon and Its Correlation with the Polypus and Carcinoma of Large Intestine

OBJECTIVE To investigate the clinical characteristics of melanosis of the colon （MC） and its correlation with polypus and carcinoma of the large intestine. METHODS Clinical feature and colonoscopic findings of 156 MC patients were retrospectively analyzed. Final diagnosis of MC case was made after colonoscopic and pathological examination, and data of the case history was recorded. RESULTS The overall detection rate of MC was 1.12%, with 0.46% in males, 0.66% in females. An 82.69% of the patients suffered various constipations and had a history of taking cathartics. The clinical manifestation of total-colon melanosis occurred in 83.97% of the patients. There was no significant difference between the rate of concomitant polypus （27.56%） in the MC patients and the detection rate of polypus in the patients who underwent a synchronous colonoscopy （χ^2 = 1.205, P = 0.298）. Also there was no significant difference between the detection rate of carcinoma of the large intestine （8.97%） in MC patients and the detection rate of the same disease in the patients who underwent synchronous colonoscopy （χ^2 = 0.268, P = 0.604）. A logistic regression analysis has shown that the older the age of MC patients is, the more opportunities of MC and the concomitant polypus would occur. CONCLUSION MC may be related to constipations and a long-term administration of cathartics, among which total-colon melanosis ranks first in the cases. There is an earlier age of onset in the females, with a higher detection rate. The older the age of the patients is, the higher the detection rate of MC is, and the more possibility the onset of the concomitant polypus.

Network Biological Modeling:A Novel Approach to Interpret the Traditional Chinese Medicine Theory of Exterior-Interior Correlation Between the Lung and Large Intestine

Objective To study the common pathogenesis of pneumonia and colitis using modern biological network analysis tools,and to explore the theory that the lung and large intestine are exteriorly and interiorly related.Methods The relevant target genes(hereinafter,“targets”)of pneumonia and colitis were separately queried on the GeneCards database.The main targets of the two diseases were then screened out according to their correlation scores and intersected to obtain those common to the two diseases.Metascape was used to analyze the main and common targets identified,and the Database for Annotation,Visualization and Integrated Discovery(DAVID)was used to enrich and analyze the common targets.Cytoscape 3.7.2 software was used to build the network diagram.Results In total,54 targets,such as TNF,IL-10,IL-6,IL-2,IL-4,TLR4,TLR2,CXCL8,IL-17A and IFNG,etc.,are common to pneumonia and colitis,which are mainly enriched in these processes such as cytokine–cytokine receptor interaction,the Tcell receptor signaling pathway,the Toll-like receptor signaling pathway and the Jak-STAT signaling pathway.The Metascape modular analysis identified 11 modules for pneumonia,six modules for colitis,and two modules for the common targets.Conclusions Pneumonia and colitis have the same pathogenic targets and mechanisms of action and finally interact with each other through inflammatory reactions and immune responses.This provides a probable molecular mechanism that explains the theory that the lung and large intestine are exteriorly and interiorly related.

IMMUNOCYTOCHEMICAL STUDY OF ENTEROCHROMAFFIN CELLS IN CARCINOMAS OF THE LARGE INTESTINE

In a series of 130 cases of adenocarcinomas of the large intestine, enterochromaffin (EC) cells were detected in 54 cases (41.3%) by limmunocytochemistry with anti-chromogranin monoclonal antibody. Among the 54 cases, 30 were found positive for serotonin, 14 for somatostatin, 11 for glucagon, 5 for pancreatic polypeptide, and only one for gastrin. The cases with EC cell (++) or polypeptide positive cells exhibited higher grade of differentiation, earlier stage of tumor extension and higher survival rate than those without EC cells. A significant difference of the EC cell population pattern among different histological grades of the tumors and non-neoplastic mucosa was found. The proportion of hormone, especially polypeptied positive cells was the highest in the mucosa and lowest in the moderately or poorly-differentiated carcinomas. The incidence, methodology and clinicopathological significance of EC cells found in the tumors are discussed.

Multiple metastases to the small bowel from large cell bronchial carcinomas

AIM: Metastases from lung cancer to gastrointestinal tract are not rare at postmortem studies but the development of clinically significant symptoms from the gastrointestinal metastases is very unusual. METHODS: Formalin-fixed, paraffin-embedded tissues were cut into 5 urn thick sections and routinely stained with hematoxylin and eosin. Some slides were also stained with Alcian-PAS. Antibodies used were primary antibodies to pancytokeratin, cytokeratin 7, cytokeratin 20, epithelial membrane antigen, vimentin, smooth muscle actin and CD-117. RESULTS: We observed three patients who presented with multiple metastases from large cell bronchial carcinoma to small intestine. Two of them had abdominal symptoms (sudden onset of abdominal pain, constipation and vomiting) and in one case the tumor was incidentally found during autopsy. Microscopically, all tumors showed a same histological pattern and consisted almost exclusively of strands and sheets of poorly cohesive, polymorphic giant cells with scanty, delicate stromas. Few smaller polygonal anaplastic cells dispersed between polymorphic giant cells, were also observed. Immunohistochemistry showed positive staining of the tumor cells with cytokeratin and vimentin. Microscopically and immunohistochemically all metastases had a similar pattern to primary anaplastic carcinoma of the small intestine. CONCLUSION: In patients with small intestine tumors showing anaplastic features, especially with multiple tumors, metastases from large cell bronchial carcinoma should be first excluded, because it seems that they are more common than expected.

Risk factors for small intestinal adenocarcinomas that are common in the proximal small intestine

The frequency of primary small intestinal adenocarcinoma is increasing but is still low.Its frequency is approximately 3%of that of colorectal adenocarcinoma.Considering that the small intestine occupies 90%of the surface area of the gastrointestinal tract,small intestinal adenocarcinoma is very rare.The main site of small intestinal adenocarcinoma is the proximal small intestine.Based on this characteristic,dietary animal proteins/lipids and bile concentrations are implicated and reported to be involved in carcinogenesis.Since most nutrients are absorbed in the proximal small intestine,the effect of absorbable intestinal content is a suitable explanation for why small intestinal adenocarcinoma is more common in the proximal small intestine.The proportion of aerobic bacteria is high in the proximal small intestine,but the absolute number of bacteria is low.In addition,the length and density of villi are greater in the proximal small intestine.However,the involvement of villi is considered to be low because the number of small intestinal adenocarcinomas is much smaller than that of colorectal adenocarcinomas.On the other hand,the reason for the low incidence of small intestinal adenocarcinoma in the distal small intestine may be that immune organs reside there.Genetic and disease factors increase the likelihood of small intestinal adenocarcinoma.In carcinogenesis experiments in which the positions of the small and large intestines were exchanged,tumors still occurred in the large intestinal mucosa more often.In other words,the influence of the intestinal contents is small,and there is a large difference in epithelial properties between the small intestine and the large intestine.In conclusion,small intestinal adenocarcinoma is rare compared to large intestinal adenocarcinoma due to the nature of the epithelium.It is reasonable to assume that diet is a trigger for small intestinal adenocarcinoma.

Screening of stimulatory effects of dietary risk factors on mouse intestinal cell kinetics

AIM: Although epidemiological and experimental studies validate influence of genetic, environmental and dietary factors in the causation of various types of cancers including colon, results from all these sources are inconclusive. Hypothesizing that high fat diet and obesity are among the major predisposing factors in the incidence of colon cancer, we evaluated the role of diet constituted with food material derived from a tropical plant, Tamarindus indica Linn (TI). METHODS: A two part randomized double-blind study was conducted employing inbred Swiss albino mice from a single generation for the whole investigation. One day-old neonates (n=12) were subcutaneously administered with monosodium glutamate (MSG) to induce obesity (OB). At weaning these animals were maintained on modified AIN-76 diet supplemented with 10% TI and 10% fat bolus (w/w,TIFB) for 8 wk. Subsequently, in the second part of study, four groups of animals belonging to the same generation, age and gender (n=12 per group), were maintained on: AIN-76 control diet (CD); AIN-76 mixed with 10% TI extract (TI); and, mixed with 10% TI and 10% FB (TIFB) for 8 wk, to determine intestinal crypt cell proliferation, functionally-specific enzyme activities, fermentation profile, and energy preferences. RESULTS: We observed a significant increase in the crypt cell production rate in distal colonic segment of experimental animals when compared with the controls. This segment also contained significantly low butyrate levels compared to control and TIFB groups. All the experimental groups showed a gross decrease in the enzyme activities viz., succinate dehydrogenase, acid-galactosidase and dipeptidyl amino peptidase IV demonstrating pathological stress caused by the test regimens, and an altered metabolic flux in the cellular environment. CONCLUSION: We have demonstrated a cumulative response to the three dietary factors, one of which (TI) is reported, herein, for the first time to modulate kinetics of large intestinal mucosa, contributing to total risk posed by these test agents.

Intestinal metastasis from breast cancer:Presentation,treatment and survival from a systematic literature review

BACKGROUND Intestinal metastases from breast cancer(BC)arerare;available data depend mainly on case reports and case series.AIM To conduct a review of the literature regarding presentation,diagnosis,treatment and survival of patients with intestinal metastasis from BC.METHODS We identified all articles that described patients with intestinal metastasis(from duodenum to anum)from BC using MEDLINE(1975 to 2020)and EMBASE(1975 to 2020)electronic databases.RESULTS We found 96 cases of intestinal metastasis of BC.Metastasization involved large bowel(cecum,colon,sigmoid,rectum)(51%),small bowel(duodenum,jejunum,ileum)(49%),and anum(<1%).Median age of patients was 61-years.The most frequent histology was infiltrating lobular carcinoma followed by infiltrating ductal carcinoma.In more than half of patients,the diagnosis was made after the diagnosis of BC(median:7.2 years)and in many cases of emergency,for bowel obstruction,bleeding or perforation.Diagnosis was achieved through endoscopy,radiological examination or both.In most of the cases,patients underwent surgery with or without systemic therapies.Survival of patients included in this review was available in less than 50%of patients and showed an overall median of 12 mo since diagnosis of the intestinal metastasis.CONCLUSION Although,intestinal metastases of BC are considered a rare condition,clinicians should consider the possibility of intestinal involvement in case of abdominal symptoms even in acute setting and many years after the diagnosis of BC,especially in patients with a histology of lobular carcinoma.

Endogenous mucin conveyed to the mucosa with microbes can assure lumen fermentation and large intestinal security-swine versus fowl

Endogenous protein leaving the ileum largely consists of accrued mucins from the upper gastrointestinal tract(GIT)that had resisted digestion.The amounts released rely on their mucosal generation during enteral feeding which vary with age as well as diet.These digestion resistant proteins of endogenous origin continue to be unavailable in the large intestine,whereas those of dietary origin provide amino acids that largely support the existing microbial population while denying limited amounts for absorption.Other mucins pre-exist within the large intestine as two layers at the lumen surface.A loose layer harboring a diverse microbial population is superimposed on the unstirred water layer(USWL)which simultaneously acts as an obstacle to microbes at the loose layer while performing as a molecular sieve for nutrients.The USWL is formed through interplay between enterocyte and goblet cells;however,the basis for presence of the loose layer is elusive.Large intestinal fermentation predominates within the colon of swine,whereas fowl employ their ceca.Motility within the colon of swine segregates fine materials into haustrae out-pocketings that parallel their placement within the ceca of fowl.Viscous mucins from small intestinal endogenous losses may envelop microbes within the large intestinal lumen to present successive adherents on the USWL that assemble its loose layer.The loose layer continually functions as a microbial reservoir in support of lumen fermentation.Microbial catabolism of mucin within the loose layer is known to be slow,but its proximity to the enterocyte is of advantage to enterocyte absorption with by-product amino acids fostering the USWL.

杨燕教授从肺论治儿童功能性便秘的临床经验

儿童功能性便秘约占小儿便秘的95%以上,是小儿消化系统的常见病,病程迁延易对儿童的身心健康产生严重影响。文章总结杨燕教授治疗儿童功能性便秘的临床经验。杨燕教授认为便秘的病机主要是大肠的传导功能失常,但与肺脏密切相关。肺与大肠相表里,肺气亏虚或肺气郁闭,宣肃失职,气机不畅,津液疏布失常,肺热移于大肠,肠失濡润,均可导致便秘发生。从肺论治,临证采用塞因塞用之法补气启闭治虚秘,提壶揭盖之法理肺通腑治实秘,同时重视良好的饮食结构及日常护理,临床疗效显著。附验案1则以佐证。

基于"肝与大肠相通"理论探讨高血压肝阳上亢证"肝肠同治"策略

从肝阳上亢到肝阳化风是高血压发生发展的主要病机演变特征,气机升降异常是其核心病机;联系《医学入门》"肝与大肠相通"理论并溯源其依据,分析肝、肠两个器官在解剖学和功能上的关联基础;提出肝升肠降方可调畅气机,阐释肝肠同治是治疗高血压肝阳上亢证的重要策略.

基于“肺与大肠相表里”探析血管内皮细胞与肠道菌群的关联

肠道菌群及其代谢物失调对内皮细胞损伤和功能障碍具有重要影响。中医“肺”与血管内皮细胞在结构、生理及病理方面具有相关性。中医学“肺与大肠相表里”理论是肺与肠在结构、生理及病理方面相关性的高度概括,可作为血管内皮细胞与肠道菌群相关联的理论基础。本文可为以肠道菌群为切入点、修复血管内皮细胞损伤干预心血管疾病的实验研究提供理论依据,并为中医药临床治疗相关疾病提供参考。

清溃愈疡方在大肠湿热型溃疡性结肠炎患者中的应用价值

目的探究清溃愈疡方在大肠湿热型溃疡性结肠炎患者中的应用价值。方法选取2020年5月—2024年2月南京中医药大学附属连云港市中医院收治的108例溃疡性结肠炎患者为研究对象,按照治疗方法的不同将患者分为对照组和观察组,各54例。对照组使用美沙拉嗪治疗,观察组在对照组治疗的基础上联合使用清溃愈疡方。比较两组中医证候积分、肠道菌群、免疫功能。结果治疗前,两组中医证候积分、肠道菌群数量、免疫功能指标对比,差异无统计学意义(P均>0.05)。治疗后,观察组中医证候积分中主症为(6.27±1.21)分,次症为(2.21±0.19)分,低于对照组的(8.41±1.25)分、(3.33±0.22)分,差异有统计学意义(t=9.039、28.313,P均<0.05)。观察组大肠杆菌数量、CD8^(+)水平低于对照组,双歧杆菌、乳酸杆菌数量及CD4^(+)、CD4^(+)/CD8^(+)水平高于对照组,差异有统计学意义(P均<0.05)。结论清溃愈疡方能有效降低大肠湿热型溃疡性结肠炎患者中医证候积分,改善肠道菌群结构,并提升患者免疫功能。

健脾祛湿和络方治疗特发性膜性肾病内涵探讨

从多维论治角度结合部分健脾祛湿和络方的研究进展,阐释健脾祛湿和络方有效治疗特发性膜性肾病(IMN)的中医学内涵。IMN以脾虚证、肾虚证为核心证候,健脾祛湿和络方立方以调理脾胃为基础,脾肾同治。从肺肾相关、肠肾相关、肺与大肠相表里等理论看,健脾祛湿和络方亦体现出了脾肺同治、肠肾同治、肠肺同治的中医学内涵,脾、肺、肠、肾相结合的多维论治是健脾祛湿和络方取效之根本。