Objective:To study the clinical application of Denghuo moxibustion in treating post-stroke constipation.Methods:This study included 50 patients with post-stroke constipation admitted from October 2020 to December 2021...Objective:To study the clinical application of Denghuo moxibustion in treating post-stroke constipation.Methods:This study included 50 patients with post-stroke constipation admitted from October 2020 to December 2021.They were randomly divided into two groups using the envelope method:25 patients in the observation group and 25 patients in the control group.The control group received only lactulose,while the observation group received Denghuo moxibustion in addition to lactulose.The efficacy,quality of life(PAC-QOL scale),and laboratory indicators[serum substance P(SP)and vasoactive intestinal peptide(VIP)]were compared between the two groups.Results:The efficacy of the observation group was significantly better than that of the control group(P<0.05).After treatment,the PAC-QOL scores of both groups decreased significantly,and the improvement in the observation group was more significant(P<0.05).Changes in laboratory indicators showed that VIP decreased significantly and SP increased significantly in both groups,and the improvement of these two indicators in the observation group was significantly better than that in the control group(P<0.05).Conclusion:Denghuo moxibustion can enhance the efficacy of lactulose by regulating intestinal neuropeptides and is an effective treatment for post-stroke constipation.展开更多
Stroke is the second leading cause of death worldwide and a major cause of disability among adults.With the advancement of medical technology,the survival period of stroke patients has been significantly prolonged,but...Stroke is the second leading cause of death worldwide and a major cause of disability among adults.With the advancement of medical technology,the survival period of stroke patients has been significantly prolonged,but the neuropsychiatric sequelae in the chronic stage have become increasingly prominent.Post-stroke depression is one of the very important manifestations.This article conducts a further discussion on this issue.展开更多
BACKGROUND Post-stroke depression(PSD)is associated with hypothalamic-pituitary-adrenal(HPA)axis dysfunction and neurotransmitter deficits.Selective serotonin reuptake inhibitors(SSRIs)are commonly used,but their effi...BACKGROUND Post-stroke depression(PSD)is associated with hypothalamic-pituitary-adrenal(HPA)axis dysfunction and neurotransmitter deficits.Selective serotonin reuptake inhibitors(SSRIs)are commonly used,but their efficacy is limited.This study investigated whether combining SSRIs with traditional Chinese medicine(TCM)Free San could enhance their therapeutic effects.AIM To evaluate the clinical efficacy and safety of combining SSRIs with Free San in treating PSD,and to assess its impact on HPA axis function.METHODS Ninety-two patients with PSD were enrolled and randomly divided into control groups(n=46)and study groups(n=46).The control group received the SSRI paroxetine alone,whereas the study group received paroxetine combined with Free San for 4 weeks.Hamilton Depression Scale and TCM syndrome scores were assessed before and after treatment.Serum serotonin,norepinephrine,cortisol,cor-ticotropin-releasing hormone,and adrenocorticotropic hormone were measured.The treatment responses and adverse reactions were recorded.RESULTS After treatment,the Hamilton Depression Scale and TCM syndrome scores were significantly lower in the study group than in the control group(P<0.05).Serum serotonin and norepinephrine levels were significantly higher in the study group than in the control group,whereas cortisol,corticotropin-releasing hormone,and adrenocorticotropic hormone levels were significantly lower(P<0.05).The total efficacy rates were 84.78%and 65.22%in the study and control groups,respectively(P<0.05).No significant differences in adverse reactions were observed between the two groups(P>0.05).CONCLUSION Combining SSRIs with Free San can enhance therapeutic efficacy,improve depressive symptoms,and regulate HPA axis function in patients with PSD with good safety and clinical application value.展开更多
Objective： To observe the prevention effect of Tui-pushing the Large Intestine Meridian plus point sticking at Tianshu（ST 25） for post-stroke constipation. Methods： Seventy eligible patients with post-stroke const...Objective： To observe the prevention effect of Tui-pushing the Large Intestine Meridian plus point sticking at Tianshu（ST 25） for post-stroke constipation. Methods： Seventy eligible patients with post-stroke constipation were randomized into a treatment group and a control group, 35 cases in each group. Both groups were intervened by conventional treatment and care in Western medicine, while the treatment group was also by Tui-pushing the Large Intestine Meridian and point sticking at Tianshu（ST 25）. The treatment lasted for 14 d. Therapeutic efficacy was evaluated by the first defecation time, constipation incidence and Chinese stroke scale（CSS） score. Results： After treatment, the first defecation time was（1.86 ± 0.74） d in the treatment group, shorter than（2.77 ± 0.83） d in the control group; constipation incidence was 14.3% in the treatment group, significantly lower than 37.1% in the control group, and the between-group differences in the two items were statistically significant（both P〈0.05）. CSS score in both groups dropped significantly after treatment（both P〈0.05）; the improvement in the treatment group was better than that in the control group, and the inter-group difference was statistically significant（P〈0.05）. Conclusion： Tui-pushing the Large Intestine Meridian plus point sticking at Tianshu（ST 25） can effectively prevent post-stroke constipation, and can also promote the rehabilitation of nerve functions.展开更多
Objective: To observe the clinical efficacy of acupuncture plus patent Chinese medicine in treating post-stroke constipation. Methods: Sixty eligible patients with post-stroke constipation were randomized into a treat...Objective: To observe the clinical efficacy of acupuncture plus patent Chinese medicine in treating post-stroke constipation. Methods: Sixty eligible patients with post-stroke constipation were randomized into a treatment group and a control group, 30 in each group. The treatment group was intervened by acupuncture plus Ma Zi Ren pill, while the control group was by Ma Zi Ren pill alone. The symptoms of constipation were observed before and after intervention. Results: After 2-week treatment, the constipation condition was improved in both groups, and the improvement in the treatment group was statistically more significant than that in the control group(P<0.05); respectively two weeks and a month after the intervention, the treatment group was superior to the control group in comparing the constipation score(P<0.05). However, acupuncture didn't show marked effect in improving defecation speed, initial defecation time, and spontaneous discharge frequency. The treatment group had a significantly higher short-term markedly-effective rate compared with the control group(P<0.05); the long-term therapeutic efficacy of the treatment group was significantly higher than that of the control group(P<0.05). The adverse events happened in the treatment group were significantly less than those in the control group(P<0.05). Conclusion: Acupuncture at specific acupoints plus patent Chinese medicine can produce a content therapeutic efficacy.展开更多
BACKGROUND Elobixibat reportedly improves bowel movements in patients with chronic constipation.However,its effect on bowel movements in elderly patients with chronic constipation in clinical settings has not been exa...BACKGROUND Elobixibat reportedly improves bowel movements in patients with chronic constipation.However,its effect on bowel movements in elderly patients with chronic constipation in clinical settings has not been examined.AIM To examine bowel movement frequency and stool form before and after elobixibat administration in elderly patients with chronic constipation at our clinic.METHODS A total of 10 mg elobixibat was administered to 35(<65 years old)patients and 45(≥65 years old)patients with chronic constipation.The frequency of bowel movements and stool forms,assessed using the Bristol Stool Form Scale(BSFS),were compared between the two groups 1 week before and after elobixibat administration.RESULTS In patients aged<65 years with chronic constipation,the pre-elobixibat frequency of bowel movements and BSFS scores were 2.167±0.732 and 2.286±0.742,respectively.After elobixibat administration,the frequency of bowel movements and BSFS scores improved to 2.389±0.502 and 3.995±0.566,respectively,showing a significant improvement in bowel movement status.In patients aged≥65 years with chronic constipation,the pre-elobixibat frequency of bowel movements and BSFS scores were 2.003±0.733 and 2.217±0.758,respectively.After elobixibat administration,the frequency of bowel movements and BSFS scores improved to 4.402±1.346 and 3.800±0.704,respectively,indicating an improvement in bowel movement status(P<0.001).No significant differences were observed in the frequency and improvement status of bowel movements or BSFS scores between patients with chronic constipation aged≥65 years and<65 years.Adverse events due to the administration of elobixibat occurred in 16 cases(20%).No significant differences were found in the incidence of adverse events between patients with chronic constipation aged<65 years(8 cases,22.9%)and those aged≥65 years(8 cases,17.8%).CONCLUSION Elobixibat is effective in improving bowel movement status in patients with chronic constipation.No significant differences were found in the improvement of bowel movement status or the incidence of adverse events between patients with chronic constipation aged<65 years and≥65 years,suggesting that the drug may be safely used in elderly patients.展开更多
The objective of this study is to analyze the relevant literature on acupoint massage applied to patients with poststroke constipation,to explore the research status,research hotspots,and research frontiers of poststr...The objective of this study is to analyze the relevant literature on acupoint massage applied to patients with poststroke constipation,to explore the research status,research hotspots,and research frontiers of poststroke constipation,and to provide reference for clinical practice and scientific research.With the help of CiteSpace software,the related literatures published in the China National Knowledge Infrastructure database on the application of acupoint massage to constipation after stroke were analyzed,and scientific atlas for visual analysis was drawn.The hot keywords in the field of acupoint massage for post-stroke constipation are constipation,nursing intervention,and traditional Chinese medicine(TCM)nursing,indicating the great importance of TCM nursing for such patients.In mutation word detection,words such as constipation,nursing,stroke,and defecation reflex have earlier mutation times.Massage is the keyword with the longest mutation time,suggesting it is an effective intervention for post-stroke patients and is widely recognized.The commonly used acupoints for poststroke constipation are Tianshu(ST 25),Zhongwan(CV 12),and Qihai(CV 6).These acupoints can regulate qi and blood and enhance gastrointestinal peristalsis,providing guiding significance for formulating relevant clinical practice guidelines.The research of acupoint massage in the nursing of poststroke constipation is still in the stage of practice and exploration,and the specific definition of operation process,technique,acupoint,time,and intensity is still not clear.Multicenter,large-sample,in-depth intervention research,and cohort studies hold immense significance for the future development of this discipline.展开更多
Functional constipation(FC)in elderly individuals is a significant health issue that adversely affects their quality of life,with recent studies indicating a close relationship between this condition and gut microbiot...Functional constipation(FC)in elderly individuals is a significant health issue that adversely affects their quality of life,with recent studies indicating a close relationship between this condition and gut microbiota dysbiosis.This review aims to explore the role of the gut microbiota in FC in elderly individuals,analyze the mechanisms of the gut-brain axis,and evaluate the potential use of microecological agents,including probiotics and prebiotics,in modulating the gut microbiota and alleviating constipation symptoms.By integrating the latest research findings,this study seeks to provide new perspectives and intervention strategies for the management of FC in elderly individuals.展开更多
BACKGROUND The development of slow transit constipation(STC)is associated with intestinal barrier damage.Huangqi decoction(HQD)is effective in treating STC,but me-chanisms are unclear.AIM To investigate whether HQD al...BACKGROUND The development of slow transit constipation(STC)is associated with intestinal barrier damage.Huangqi decoction(HQD)is effective in treating STC,but me-chanisms are unclear.AIM To investigate whether HQD alleviates STC by downregulating the nuclear factorκB(NF-κB)signaling pathway and restoring intestinal barrier function.METHODS KM mice were divided into control,model,and HQD treatment groups.Fresh colonic tissues were collected for single-cell RNA sequencing and spatial tra-nscriptome sequencing.The expressions of claudin-1,mucin 2,and NF-κB P65 proteins were detected by immunohistochemistry.In vitro experiments evaluated the effects of HQD on the LS174T cell line.RESULTS HQD improved intestinal motility,restored mucosal epithelium function and morphology.Single-cell RNA sequencing and spatial transcriptome sequencing data showed a reduction in goblet cells,decreased mucin 2 secretion,and activated apoptotic pathways in STC mice.The population of intestinal stem cells was reduced,and proliferation along with Wnt/β-catenin pathways were inhibited.STC also altered the distribution of intestinal cell states,increasing immune-associated Enterocyte_C3.Aberrant NF-κB pathway activation was noted across various cell types.After HQD treatment,NF-κB pathway activity was down-regulated,while cell proliferation pathways were up-regulated,alongside an increase in Enterocyte_C1 related to material transport.Immunocytochemical,Western blot,and immunohistochemistry analyses confirmed NF-κB pathway activation in goblet cells of STC mice,with HQD inhibiting this aberrant activation.CONCLUSION STC involves intestinal mucosal barrier damage.HQD may treat STC by suppressing NF-κB signaling in epithelial cells,restoring intestinal epithelial cell function,and promoting mucosal barrier repair.展开更多
BACKGROUND Irritable bowel syndrome with predominant constipation(IBS-C)is a chronic gastrointestinal disorder that significantly impacts the quality of life of patients and currently lacks a definitive treatment.The ...BACKGROUND Irritable bowel syndrome with predominant constipation(IBS-C)is a chronic gastrointestinal disorder that significantly impacts the quality of life of patients and currently lacks a definitive treatment.The use of electroacupuncture(EA)has demonstrated clinical efficacy in treating IBS-C and the gut-brain axis modulation,though its mechanisms remain unclear.AIM To investigate gut-brain-microbiota axis alteration and EA-associated microbial changes in IBS-C patients and treatment responders.METHODS This study consisted of two phases.The first phase was a cross-sectional study recruiting sixteen IBS-C patients and 16 healthy controls.Baseline fecal samples were collected to assess gut microbiota profiles between the two groups.The second phase was an observational longitudinal study in which the 16 IBS-C patients underwent nine EA sessions over one month.Gut microbiota profiles and clinical outcomes were assessed post-treatment course and at a one-month follow-up.RESULTS IBS-C patients exhibited significant gut dysbiosis,as indicated by altered beta diversity compared to healthy controls.EA significantly improved clinical outcomes and gut dysbiosis,with sustained therapeutic effects and normalization of neurotransmitter-related metabolic pathways observed at one-month follow-up.Notably,the gut bacterium Senegalimassilia was positively associated with symptom improvement,suggesting its potential as a predictive biomarker of EA responsiveness.CONCLUSION These findings support the integration of EA into IBS-C management and highlight Senegalimassilia as a candidate microbial biomarker for treatment response.展开更多
BACKGROUND Runchangningshen paste(RCNSP)is a paste made of four medicinal and edible homologous Chinese medicine mixed with honey.It is known for its ability to nourish yin and blood as well as to loosen the bowel to ...BACKGROUND Runchangningshen paste(RCNSP)is a paste made of four medicinal and edible homologous Chinese medicine mixed with honey.It is known for its ability to nourish yin and blood as well as to loosen the bowel to relieve constipation.The pathophysiology of functional constipation(FC)is associated with a reduction in mucin-2(MUC2)secretion and microbial dysbiosis.AIM To investigate the underlying mechanism of RCNSP against FC through MUC2 and the gut mucosal microbiota.METHODS Ultra-performance liquid chromatography tandem mass spectrometry characterized RCNSP composition to elucidate the material basis of action.FC model was induced via loperamide gavage(16 mg/kg)twice daily for 7 days.Applying defecation function and gastrointestinal motility to assess constipation severity.Hematoxylin and eosin and Alcian blue-periodic acid-schiff staining analyzed colonic mucosal morphology.Transmission electron microscope was used to observe the ultrastructure of goblet cells(GCs).Immunofluorescence colocalization,quantitative PCR,and western blot assessed the impact of RCNSP on gene and protein expression within the NLRP6/autophagy pathway.16S rDNA was employed to sequence the gut mucosal microbiota.RESULTS RCNSP contained 12 components with potential laxative effects.It enhanced defecation function,accelerated gastrointestinal motility,and maintained colonic mucosal integrity.RCNSP treatment significantly increased GC abundance and MUC2 production while preserving GC ultrastructure.At the molecular level,RCNSP enhanced the colocalized expression of key regulatory proteins and modulated mRNA and protein expressions in the NLRP6/autophagy pathway.Through 16S rDNA sequencing analysis,RCNSP significantly altered the mucosal microbiota composition.Specifically,it increased beneficial bacterial strains while reducing harmful ones.Simultaneously,RCNSP reduced butyrate-producing bacteria like Proteobacteria,Enterobacteriaceae,Blautia,and Eubacterium and decreased hydrogen sulfide-producing species,such as Prevotellaceae.It also reduced bile acidinhibiting species,such as g_Eubacter_coprostanoligenes_group and Erysipelotrichaceae while increasing bile acidproducing species,such as Colidextribacter.CONCLUSION Our findings suggested that RCNSP ameliorated constipation through a dual mechanism:It stimulated colonic MUC2 secretion by activating NLRP6 inflammasome-mediated autophagy and modulated the composition of the mucosal microbiota.展开更多
BACKGROUND Depression and anxiety are prevalent among university students worldwide,often coexisting with functional constipation(FC).Family relationships have been identified as crucial factors affecting mental healt...BACKGROUND Depression and anxiety are prevalent among university students worldwide,often coexisting with functional constipation(FC).Family relationships have been identified as crucial factors affecting mental health,yet the gender-specific associations between these conditions remain underexplored.AIM To assess prevalence of depressive symptoms,anxiety symptoms,and FC among Chinese university students and explore their associations.METHODS Using a cross-sectional survey design,data were collected from 12721 students at two universities in Jiangsu Province and Shandong Province.Depressive symptoms were assessed using the Patient Health Questionnaire-9,anxiety symptoms using the Generalized Anxiety Disorder-7 scale,and FC using the ROME IV.Gender-stratified analyses and population attributable risk proportions were calculated to evaluate risk factor patterns and population impact.RESULTS The prevalence of self-reported depressive,anxiety,and comorbid depressive and anxiety symptoms was 16.3%,24.9%,and 13.3%,respectively,whereas that of FC was 22%.Students with depressive symptoms were 1.811 times more likely to have FC than those without.Female gender,parental relationships,and lower household income were significant risk factors for both mental health conditions.For depressive symptoms,females experienced stronger effects from both parental conflict[odds ratio(OR)=8.006 vs OR=7.661 in males]and FC(OR=1.954 vs OR=1.628 in males).For anxiety symptoms,conflicted parental relationships had stronger effects in males(OR=5.946)than females(OR=4.262).Overall,poor parental relationships contributed to 38.6%of depressive and 33.5%of anxiety symptoms.CONCLUSION Family relationships significantly impact student mental health,with gender-specific patterns.Targeted interventions addressing family dynamics could reduce mental health burden in university settings.展开更多
BACKGROUND Obstructed defecation syndrome(ODS)is a subtype of constipation that is consi-dered one of the major pelvic floor dysfunctions affecting the aging population,particularly women over 50 seeking medical care....BACKGROUND Obstructed defecation syndrome(ODS)is a subtype of constipation that is consi-dered one of the major pelvic floor dysfunctions affecting the aging population,particularly women over 50 seeking medical care.The condition is characterized by the urge to defecate but an impaired ability to expel the fecal bolus.ODS is associated with various anorectal abnormalities,which are not always apparent during a standard physical examination,requiring specialized imaging techniques for proper diagnosis.AIM To study the distribution of causes of ODS in patients with chronic constipation by magnetic resonance defecography(MRD).METHODS This observational study evaluated the causes of ODS in 57 patients with chronic constipation who presented to Bangabandhu Sheikh Mujib Medical University between July 2020 and June 2021.After obtaining institutional review board approval and informed consent,patients underwent history taking,physical exams,and relevant investigations.ODS was diagnosed using Rome III criteria,with colonoscopy ruling out organic causes.Standard MRD was performed in different phases,and images were analyzed by expert radiologists and reported in a stan-dardized format.RESULTS Pelvic floor descent and anorectal junction descent were the most frequent findings,each present in 94.7%of cases.Rectocele was observed in 78.9%of patients,while vaginal or uterine prolapse was seen in 59.4%of females.Less common abnormalities included paradoxical contraction(7%),and there were no cases of sigmoidocele.Functional measurements showed significant differences in pelvic floor dynamics between rest and defecation,particularly in the H-line,M-line,and descent of pelvic organs(P<0.05).CONCLUSION Pelvic floor descent and anorectal descent were the most common findings in patients suffering from ODS,fo-llowed by rectocele.Younger females(<30 years)were most affected.展开更多
The activation of the sirtuin1(SIRT1)/nuclear factor erythroid 2-related factor 2(Nrf2)/heme oxygenase 1(HO-1)pathway has been shown to mitigate oxidative stress-induced apoptosis and mitochondrial damage by reducing ...The activation of the sirtuin1(SIRT1)/nuclear factor erythroid 2-related factor 2(Nrf2)/heme oxygenase 1(HO-1)pathway has been shown to mitigate oxidative stress-induced apoptosis and mitochondrial damage by reducing reactive oxygen species(ROS)levels.Clinical trials have demonstrated that Zhongfeng Xingnao Liquid(ZFXN)ameliorates post-stroke cognitive impairment(PSCI).However,the underlying mechanism,particularly whether it involves protecting mitochondria and inhibiting apoptosis through the SIRT1/Nrf2/HO-1 pathway,remains unclear.This study employed an oxygen-glucose deprivation(OGD)cell model using SHSY5Y cells and induced PSCI in rats through modified bilateral carotid artery ligation(2VO).The effects of ZFXN on learning and memory,neuroprotective activity,mitochondrial function,oxidative stress,and the SIRT1/Nrf2/HO-1 pathway were evaluated both in vivo and in vitro.Results indicated that ZFXN significantly increased the B-cell lymphoma 2(Bcl2)/Bcl2-associated X(Bax)ratio,reduced terminal deoxynucleotidyl transferase-mediated d UTP nickend-labeling(TUNEL)+cells,and markedly improved cognition,synaptic plasticity,and neuronal function in the hippocampus and cortex.Furthermore,ZFXN exhibited potent antioxidant activity,evidenced by decreased ROS and malondialdehyde(MDA)content and increased superoxide dismutase(SOD),catalase(CAT),and glutathione(GSH)levels.ZFXN also demonstrated considerable enhancement of mitochondrial membrane potential(MMP),Tom 20 fluorescence intensity,adenosine triphosphate(ATP)and energy charge(EC)levels,and mitochondrial complexⅠandⅢactivity,thereby inhibiting mitochondrial damage.Additionally,ZFXN significantly increased SIRT1 activity and elevated SIRT1,nuclear Nrf2,and HO-1 levels.Notably,these effects were substantially counteracted when SIRT1 was suppressed by the inhibitor EX-527 in vitro.In conclusion,ZFXN alleviates PSCI by activating the SIRT1/Nrf2/HO-1 pathway and preventing mitochondrial damage.展开更多
Objective:To explore the application method and clinical effect of inulin in the treatment of constipation for patients in the ICU.Methods:Sixty ICU patients with constipation were randomly divided into an experimenta...Objective:To explore the application method and clinical effect of inulin in the treatment of constipation for patients in the ICU.Methods:Sixty ICU patients with constipation were randomly divided into an experimental group and a control group,with 30 patients in each group.The control group received nasal feeding with a regular diet.The experimental group received nasal feeding with a regular diet plus inulin.The defecation status of the patients was observed and compared on the 3rd,5th,and 7th days.Results:Among the 30 patients in the experimental group and 30 patients in the control group,there was a statistically significant difference in treatment effect between the two groups(P<0.05).The treatment duration was(3.91±1.09)days in the experimental group and(5.78±1.52)days in the control group.Conclusion:Inulin has a significant effect in the treatment of constipation for critically ill patients in the ICU and is worthy of clinical promotion and application.展开更多
BACKGROUND Excipients may improve the palatability of polyethylene glycol(PEG),the firstline treatment for childhood functional constipation(FC),leading to good compliance and improved treatment outcomes.AIM To compar...BACKGROUND Excipients may improve the palatability of polyethylene glycol(PEG),the firstline treatment for childhood functional constipation(FC),leading to good compliance and improved treatment outcomes.AIM To compare the developed PEG-based formula(PEG-Chula)to the commercial formula for treating childhood FC.METHODS In this randomized controlled trial,we enrolled children aged<18 years with FC diagnosed by the Rome Ⅳ criteria to receive PEG-Chula[four flavors:(1)Strawberry;(2)Lychee;(3)Apple;and(4)Lychee-rose]or Forlax(orange-grapefruit flavor)for eight weeks.The primary outcomes included changes in stool frequency and consistency measured by the Bristol Stool scale.The secondary outcomes were constipation-related symptom improvement,adverse events,and palatability measured by the facial hedonic scale.RESULTS Fifty-two children diagnosed with FC[median age:4.21(2.33,7.88)years;35(67.31%)females]were enrolled.After the 8-week treatment,the mean weekly stool frequency increased in both groups,the mean change was 4.02(95%CI:3.09-4.95)in PEG-Chula and 3.78(95%CI:2.79-4.78)in commercial PEG compared to baseline(P<0.001).The extent of stool consistency improvement did not differ significantly.The most preferred PEG-Chula flavor was rated more palatable than the commercial PEG.Treatment compliance correlated with medication palatability(r=0.34,P=0.013).No significant differences in adverse events were found.CONCLUSION Both PEG-based formulas are effective and safe for managing pediatric FC.展开更多
Functional constipation(FC)is the most common gastrointestinal disorder in children,with a global prevalence of 14.4%based on Rome IV criteria.This editorial explores the multifactorial pathogenesis and diagnostic com...Functional constipation(FC)is the most common gastrointestinal disorder in children,with a global prevalence of 14.4%based on Rome IV criteria.This editorial explores the multifactorial pathogenesis and diagnostic complexity of FC,emphasizing the importance of early and accurate diagnosis.Effective management of FC hinges on child-oriented toilet training and the use of osmotic laxatives,particularly polyethylene glycol.Emerging therapies,including probiotics,serotonin 5-HT4 receptor agonists,chloride channel activators,and herbal remedies,offer promising options but require further research.Lifestyle modifications,such as adequate fiber and fluid intake and physiotherapy,are crucial in supporting pharmacological treatments.For intractable cases,a multidisciplinary approach involving pediatric specialists,nutritionists,physiotherapists,and psychologists is essential.This comprehensive strategy aims to improve the quality of life for children with FC and their families through continuous research,education,and collaborative care.展开更多
BACKGROUND Post-stroke depression(PSD),a condition commonly developed in patients with chronic stroke,impairs both functional rehabilitation and daily living.AIM To comprehensively analyze PSD contributors in chronic ...BACKGROUND Post-stroke depression(PSD),a condition commonly developed in patients with chronic stroke,impairs both functional rehabilitation and daily living.AIM To comprehensively analyze PSD contributors in chronic phase stroke and construct a precise nomogram.METHODS Two hundred patients with chronic stroke admitted in over 7 years(January 2017 to January 2024),were enrolled and categorized into the PSD group(n=96)and the non-PSD(NPSD)group(n=104).Demographic characteristics,clinicopathological data,and biochemical indicators were collected and analyzed by univariate analysis.Significant predictors identified in the univariate analysis were subsequently incorporated into a binary logistic regression model to assess their independent effects on PSD risk.The discriminative ability/calibration of the developed PSD prediction nomogram was assessed.RESULTS Compared with the NPSD group,the PSD group included a higher proportion of patients aged≥60 years,divorced/widowed,with an education level below senior high school,presenting with≥2 comorbidities,exhibiting severe neurological impairment,and having multiple lesions.Additionally,the PSD group showed significantly higher neutrophil-to-lymphocyte ratio(NLR)and platelet-tolymphocyte ratio(PLR)than the NPSD group.After assigning values to significant predictors,multivariate analysis indicated that educational level(P=0.046),NLR(P<0.001),and PLR(P<0.001)were independently associated with PSD in patients with chronic stroke.The developed nomogram exhibited favorable discrimination performance.The nomogram's calibration remained accurate for high-risk stratification but displayed modest inconsistencies in lowand middle-risk categories.CONCLUSION Education level,NLR,and PLR independently contribute to PSD in patients with chronic stroke.The constructed nomogram effectively predicts PSD risk within the range of 0.10-0.90,presenting a valuable tool for clinical monitoring and risk assessment of PSD in patients with chronic stroke.展开更多
Objective:To evaluate the efficacy and safety of acupoint application for post-stroke depression(PSD)by regulating gastrointestinal function.A secondary objective is to explore the potential mechanism underlying this ...Objective:To evaluate the efficacy and safety of acupoint application for post-stroke depression(PSD)by regulating gastrointestinal function.A secondary objective is to explore the potential mechanism underlying this approach from the perspective of gut microbiota.Methods:This multicenter,randomized,double-blind(patients and assessors),placebo-controlled trial will enroll 80 patients with PSD,and include a 1-week run-in period,a 4-week treatment phase,and a 12-week follow-up.Eligible participants will randomly be assigned in a 1:1 ratio to either the acupoint application or placebo(non-acupoint)groups.Treatments will be administered thrice weekly for 4 weeks.The primary outcome is change in the Hamilton Rating Scale for Depression(HAMD)score.Secondary outcomes include the Beck Depression Inventory(BDI),36-Item Short-Form Health Survey(SF-36),Barthel Index of Activities of Daily Living,Social Adaptation Self-Evaluation Scale(SASS),and gut microbiota profiling.All outcomes will be assessed at baseline(prior to treatment),during treatment(weeks 2 and 4),and during follow-up(weeks 8,12,and 16).The Treatment Emergent Symptom Scale(TESS)will be used for evaluation throughout the 4-week treatment phase.Discussion:The results of this study will provide important evidence supporting a novel treatment strategy for PSD that targets gastrointestinal regulation,potentially informing future clinical practice.展开更多
OBJECTIVE:To investigate the possible mechanisms by which acupuncture improves post-stroke limb spasticity using single-cell sequencing technology.METHODS:Thirty-two rats were randomly assigned to four groups:Control,...OBJECTIVE:To investigate the possible mechanisms by which acupuncture improves post-stroke limb spasticity using single-cell sequencing technology.METHODS:Thirty-two rats were randomly assigned to four groups:Control,Sham,Model,and Acupuncture.The middle cerebral artery occlusion(MCAO)model was established,and the acupuncture groups received acupuncture treatment.After treatment,brain morphological changes and the degree of neurological impairment were assessed.The effect of acupuncture on the proportion of brain cell types in the ischemic penumbra of MCAO rats was analyzed using single-cell transcriptomics,and the expression and enrichment of differentially expressed genes were examined.Finally,selected differential genes were validated by Western blot and quantitative real-time polymerase chain reaction.RESULTS:Triphenyltetrazolium chloride staining showed that the infarct area in MCAO rats was significantly reduced after acupuncture.Garcia scoring,hematoxylin-eosin staining,Nissl staining,and terminal deoxynucleotidyl transferase d UTP nick end labeling demonstrated that acupuncture reduced brain damage.Enzyme-linked immunosorbent assay results showed that acupuncture significantly decreased serum inflammatory factors,including interleukin-1 beta(IL-1β),interleukin-6(IL-6),and tumor necrosis factor-alpha(TNF-α).Single-cell transcriptome analysis revealed marked changes in cell type proportions between the Acupuncture and Model groups.A total of 207 differential genes were identified,including 157 upregulated and 50 downregulated genes.Analysis of macrophage-specific differential genes in the ischemic penumbra showed enrichment in Gene Ontology terms such as Ras protein signal transduction and regulation of GTPase activity,and Kyoto Encyclopedia of Genes and Genomes pathways including lysosome,axon guidance,and mitogenactivated protein kinase signaling.S100a8 and leukocyte specific transcript 1(LST1)were identified as key differential genes.CONCLUSION:These findings suggest that the key differential genes S100a8 and LST1 may alleviate poststroke limb spasticity by regulating the inflammatory response in the ischemic penumbra.展开更多
基金Honghuagang District Science and Technology Plan Project of Zunyi City(Project No.:Zun Hong Ke He She Zi 202103)。
文摘Objective:To study the clinical application of Denghuo moxibustion in treating post-stroke constipation.Methods:This study included 50 patients with post-stroke constipation admitted from October 2020 to December 2021.They were randomly divided into two groups using the envelope method:25 patients in the observation group and 25 patients in the control group.The control group received only lactulose,while the observation group received Denghuo moxibustion in addition to lactulose.The efficacy,quality of life(PAC-QOL scale),and laboratory indicators[serum substance P(SP)and vasoactive intestinal peptide(VIP)]were compared between the two groups.Results:The efficacy of the observation group was significantly better than that of the control group(P<0.05).After treatment,the PAC-QOL scores of both groups decreased significantly,and the improvement in the observation group was more significant(P<0.05).Changes in laboratory indicators showed that VIP decreased significantly and SP increased significantly in both groups,and the improvement of these two indicators in the observation group was significantly better than that in the control group(P<0.05).Conclusion:Denghuo moxibustion can enhance the efficacy of lactulose by regulating intestinal neuropeptides and is an effective treatment for post-stroke constipation.
基金Supported by Science and Technology Program of Nantong City,No.Key003 and No.JCZ2022040Nantong Young Medical Expert,No.46+2 种基金Science and Technology Program of Nantong Health Committee,No.MA2019003,No.MA2021017,and No.MSZ2024038Kangda College of Nanjing Medical University,No.KD2021JYYJYB025,No.KD2022KYJJZD022,and No.KD2024KYJJZD289Nantong Municipal Health Commission Project,No.MSZ2023020.
文摘Stroke is the second leading cause of death worldwide and a major cause of disability among adults.With the advancement of medical technology,the survival period of stroke patients has been significantly prolonged,but the neuropsychiatric sequelae in the chronic stage have become increasingly prominent.Post-stroke depression is one of the very important manifestations.This article conducts a further discussion on this issue.
基金Supported by Open Project of Jiangsu Province Key Laboratory of Integrated Traditional Chinese and Western Medicine for the Prevention and Treatment of Geriatric Diseases,No.202232.
文摘BACKGROUND Post-stroke depression(PSD)is associated with hypothalamic-pituitary-adrenal(HPA)axis dysfunction and neurotransmitter deficits.Selective serotonin reuptake inhibitors(SSRIs)are commonly used,but their efficacy is limited.This study investigated whether combining SSRIs with traditional Chinese medicine(TCM)Free San could enhance their therapeutic effects.AIM To evaluate the clinical efficacy and safety of combining SSRIs with Free San in treating PSD,and to assess its impact on HPA axis function.METHODS Ninety-two patients with PSD were enrolled and randomly divided into control groups(n=46)and study groups(n=46).The control group received the SSRI paroxetine alone,whereas the study group received paroxetine combined with Free San for 4 weeks.Hamilton Depression Scale and TCM syndrome scores were assessed before and after treatment.Serum serotonin,norepinephrine,cortisol,cor-ticotropin-releasing hormone,and adrenocorticotropic hormone were measured.The treatment responses and adverse reactions were recorded.RESULTS After treatment,the Hamilton Depression Scale and TCM syndrome scores were significantly lower in the study group than in the control group(P<0.05).Serum serotonin and norepinephrine levels were significantly higher in the study group than in the control group,whereas cortisol,corticotropin-releasing hormone,and adrenocorticotropic hormone levels were significantly lower(P<0.05).The total efficacy rates were 84.78%and 65.22%in the study and control groups,respectively(P<0.05).No significant differences in adverse reactions were observed between the two groups(P>0.05).CONCLUSION Combining SSRIs with Free San can enhance therapeutic efficacy,improve depressive symptoms,and regulate HPA axis function in patients with PSD with good safety and clinical application value.
文摘Objective： To observe the prevention effect of Tui-pushing the Large Intestine Meridian plus point sticking at Tianshu（ST 25） for post-stroke constipation. Methods： Seventy eligible patients with post-stroke constipation were randomized into a treatment group and a control group, 35 cases in each group. Both groups were intervened by conventional treatment and care in Western medicine, while the treatment group was also by Tui-pushing the Large Intestine Meridian and point sticking at Tianshu（ST 25）. The treatment lasted for 14 d. Therapeutic efficacy was evaluated by the first defecation time, constipation incidence and Chinese stroke scale（CSS） score. Results： After treatment, the first defecation time was（1.86 ± 0.74） d in the treatment group, shorter than（2.77 ± 0.83） d in the control group; constipation incidence was 14.3% in the treatment group, significantly lower than 37.1% in the control group, and the between-group differences in the two items were statistically significant（both P〈0.05）. CSS score in both groups dropped significantly after treatment（both P〈0.05）; the improvement in the treatment group was better than that in the control group, and the inter-group difference was statistically significant（P〈0.05）. Conclusion： Tui-pushing the Large Intestine Meridian plus point sticking at Tianshu（ST 25） can effectively prevent post-stroke constipation, and can also promote the rehabilitation of nerve functions.
基金supported by the Affiliated Hospital of Hebei United University
文摘Objective: To observe the clinical efficacy of acupuncture plus patent Chinese medicine in treating post-stroke constipation. Methods: Sixty eligible patients with post-stroke constipation were randomized into a treatment group and a control group, 30 in each group. The treatment group was intervened by acupuncture plus Ma Zi Ren pill, while the control group was by Ma Zi Ren pill alone. The symptoms of constipation were observed before and after intervention. Results: After 2-week treatment, the constipation condition was improved in both groups, and the improvement in the treatment group was statistically more significant than that in the control group(P<0.05); respectively two weeks and a month after the intervention, the treatment group was superior to the control group in comparing the constipation score(P<0.05). However, acupuncture didn't show marked effect in improving defecation speed, initial defecation time, and spontaneous discharge frequency. The treatment group had a significantly higher short-term markedly-effective rate compared with the control group(P<0.05); the long-term therapeutic efficacy of the treatment group was significantly higher than that of the control group(P<0.05). The adverse events happened in the treatment group were significantly less than those in the control group(P<0.05). Conclusion: Acupuncture at specific acupoints plus patent Chinese medicine can produce a content therapeutic efficacy.
文摘BACKGROUND Elobixibat reportedly improves bowel movements in patients with chronic constipation.However,its effect on bowel movements in elderly patients with chronic constipation in clinical settings has not been examined.AIM To examine bowel movement frequency and stool form before and after elobixibat administration in elderly patients with chronic constipation at our clinic.METHODS A total of 10 mg elobixibat was administered to 35(<65 years old)patients and 45(≥65 years old)patients with chronic constipation.The frequency of bowel movements and stool forms,assessed using the Bristol Stool Form Scale(BSFS),were compared between the two groups 1 week before and after elobixibat administration.RESULTS In patients aged<65 years with chronic constipation,the pre-elobixibat frequency of bowel movements and BSFS scores were 2.167±0.732 and 2.286±0.742,respectively.After elobixibat administration,the frequency of bowel movements and BSFS scores improved to 2.389±0.502 and 3.995±0.566,respectively,showing a significant improvement in bowel movement status.In patients aged≥65 years with chronic constipation,the pre-elobixibat frequency of bowel movements and BSFS scores were 2.003±0.733 and 2.217±0.758,respectively.After elobixibat administration,the frequency of bowel movements and BSFS scores improved to 4.402±1.346 and 3.800±0.704,respectively,indicating an improvement in bowel movement status(P<0.001).No significant differences were observed in the frequency and improvement status of bowel movements or BSFS scores between patients with chronic constipation aged≥65 years and<65 years.Adverse events due to the administration of elobixibat occurred in 16 cases(20%).No significant differences were found in the incidence of adverse events between patients with chronic constipation aged<65 years(8 cases,22.9%)and those aged≥65 years(8 cases,17.8%).CONCLUSION Elobixibat is effective in improving bowel movement status in patients with chronic constipation.No significant differences were found in the improvement of bowel movement status or the incidence of adverse events between patients with chronic constipation aged<65 years and≥65 years,suggesting that the drug may be safely used in elderly patients.
文摘The objective of this study is to analyze the relevant literature on acupoint massage applied to patients with poststroke constipation,to explore the research status,research hotspots,and research frontiers of poststroke constipation,and to provide reference for clinical practice and scientific research.With the help of CiteSpace software,the related literatures published in the China National Knowledge Infrastructure database on the application of acupoint massage to constipation after stroke were analyzed,and scientific atlas for visual analysis was drawn.The hot keywords in the field of acupoint massage for post-stroke constipation are constipation,nursing intervention,and traditional Chinese medicine(TCM)nursing,indicating the great importance of TCM nursing for such patients.In mutation word detection,words such as constipation,nursing,stroke,and defecation reflex have earlier mutation times.Massage is the keyword with the longest mutation time,suggesting it is an effective intervention for post-stroke patients and is widely recognized.The commonly used acupoints for poststroke constipation are Tianshu(ST 25),Zhongwan(CV 12),and Qihai(CV 6).These acupoints can regulate qi and blood and enhance gastrointestinal peristalsis,providing guiding significance for formulating relevant clinical practice guidelines.The research of acupoint massage in the nursing of poststroke constipation is still in the stage of practice and exploration,and the specific definition of operation process,technique,acupoint,time,and intensity is still not clear.Multicenter,large-sample,in-depth intervention research,and cohort studies hold immense significance for the future development of this discipline.
文摘Functional constipation(FC)in elderly individuals is a significant health issue that adversely affects their quality of life,with recent studies indicating a close relationship between this condition and gut microbiota dysbiosis.This review aims to explore the role of the gut microbiota in FC in elderly individuals,analyze the mechanisms of the gut-brain axis,and evaluate the potential use of microecological agents,including probiotics and prebiotics,in modulating the gut microbiota and alleviating constipation symptoms.By integrating the latest research findings,this study seeks to provide new perspectives and intervention strategies for the management of FC in elderly individuals.
基金Supported by the Natural Science Foundation of Guangdong Province for Distinguished Young Scholars,No.2022B1515020003the National Natural Science Foundation of China,No.82174369,No.82405397,No.82374442,and No.81973847+2 种基金Postdoctoral Fellowship Program of CPSF No.GZC20233247National Key Clinical Disciplineand the Program of Guangdong Provincial Clinical Research Center for Digestive Diseases,No.2020B1111170004.
文摘BACKGROUND The development of slow transit constipation(STC)is associated with intestinal barrier damage.Huangqi decoction(HQD)is effective in treating STC,but me-chanisms are unclear.AIM To investigate whether HQD alleviates STC by downregulating the nuclear factorκB(NF-κB)signaling pathway and restoring intestinal barrier function.METHODS KM mice were divided into control,model,and HQD treatment groups.Fresh colonic tissues were collected for single-cell RNA sequencing and spatial tra-nscriptome sequencing.The expressions of claudin-1,mucin 2,and NF-κB P65 proteins were detected by immunohistochemistry.In vitro experiments evaluated the effects of HQD on the LS174T cell line.RESULTS HQD improved intestinal motility,restored mucosal epithelium function and morphology.Single-cell RNA sequencing and spatial transcriptome sequencing data showed a reduction in goblet cells,decreased mucin 2 secretion,and activated apoptotic pathways in STC mice.The population of intestinal stem cells was reduced,and proliferation along with Wnt/β-catenin pathways were inhibited.STC also altered the distribution of intestinal cell states,increasing immune-associated Enterocyte_C3.Aberrant NF-κB pathway activation was noted across various cell types.After HQD treatment,NF-κB pathway activity was down-regulated,while cell proliferation pathways were up-regulated,alongside an increase in Enterocyte_C1 related to material transport.Immunocytochemical,Western blot,and immunohistochemistry analyses confirmed NF-κB pathway activation in goblet cells of STC mice,with HQD inhibiting this aberrant activation.CONCLUSION STC involves intestinal mucosal barrier damage.HQD may treat STC by suppressing NF-κB signaling in epithelial cells,restoring intestinal epithelial cell function,and promoting mucosal barrier repair.
文摘BACKGROUND Irritable bowel syndrome with predominant constipation(IBS-C)is a chronic gastrointestinal disorder that significantly impacts the quality of life of patients and currently lacks a definitive treatment.The use of electroacupuncture(EA)has demonstrated clinical efficacy in treating IBS-C and the gut-brain axis modulation,though its mechanisms remain unclear.AIM To investigate gut-brain-microbiota axis alteration and EA-associated microbial changes in IBS-C patients and treatment responders.METHODS This study consisted of two phases.The first phase was a cross-sectional study recruiting sixteen IBS-C patients and 16 healthy controls.Baseline fecal samples were collected to assess gut microbiota profiles between the two groups.The second phase was an observational longitudinal study in which the 16 IBS-C patients underwent nine EA sessions over one month.Gut microbiota profiles and clinical outcomes were assessed post-treatment course and at a one-month follow-up.RESULTS IBS-C patients exhibited significant gut dysbiosis,as indicated by altered beta diversity compared to healthy controls.EA significantly improved clinical outcomes and gut dysbiosis,with sustained therapeutic effects and normalization of neurotransmitter-related metabolic pathways observed at one-month follow-up.Notably,the gut bacterium Senegalimassilia was positively associated with symptom improvement,suggesting its potential as a predictive biomarker of EA responsiveness.CONCLUSION These findings support the integration of EA into IBS-C management and highlight Senegalimassilia as a candidate microbial biomarker for treatment response.
基金Supported by National Natural Science Foundation of China,No.82174309and Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine Siming Fund Special Project for Scientific Research,No.SGKJ-202304.
文摘BACKGROUND Runchangningshen paste(RCNSP)is a paste made of four medicinal and edible homologous Chinese medicine mixed with honey.It is known for its ability to nourish yin and blood as well as to loosen the bowel to relieve constipation.The pathophysiology of functional constipation(FC)is associated with a reduction in mucin-2(MUC2)secretion and microbial dysbiosis.AIM To investigate the underlying mechanism of RCNSP against FC through MUC2 and the gut mucosal microbiota.METHODS Ultra-performance liquid chromatography tandem mass spectrometry characterized RCNSP composition to elucidate the material basis of action.FC model was induced via loperamide gavage(16 mg/kg)twice daily for 7 days.Applying defecation function and gastrointestinal motility to assess constipation severity.Hematoxylin and eosin and Alcian blue-periodic acid-schiff staining analyzed colonic mucosal morphology.Transmission electron microscope was used to observe the ultrastructure of goblet cells(GCs).Immunofluorescence colocalization,quantitative PCR,and western blot assessed the impact of RCNSP on gene and protein expression within the NLRP6/autophagy pathway.16S rDNA was employed to sequence the gut mucosal microbiota.RESULTS RCNSP contained 12 components with potential laxative effects.It enhanced defecation function,accelerated gastrointestinal motility,and maintained colonic mucosal integrity.RCNSP treatment significantly increased GC abundance and MUC2 production while preserving GC ultrastructure.At the molecular level,RCNSP enhanced the colocalized expression of key regulatory proteins and modulated mRNA and protein expressions in the NLRP6/autophagy pathway.Through 16S rDNA sequencing analysis,RCNSP significantly altered the mucosal microbiota composition.Specifically,it increased beneficial bacterial strains while reducing harmful ones.Simultaneously,RCNSP reduced butyrate-producing bacteria like Proteobacteria,Enterobacteriaceae,Blautia,and Eubacterium and decreased hydrogen sulfide-producing species,such as Prevotellaceae.It also reduced bile acidinhibiting species,such as g_Eubacter_coprostanoligenes_group and Erysipelotrichaceae while increasing bile acidproducing species,such as Colidextribacter.CONCLUSION Our findings suggested that RCNSP ameliorated constipation through a dual mechanism:It stimulated colonic MUC2 secretion by activating NLRP6 inflammasome-mediated autophagy and modulated the composition of the mucosal microbiota.
基金Suzhou Clinical Medical Center for Mood Disorders,No.Szlcyxzx202109Suzhou Key Laboratory,No.SZS2024016+1 种基金Multicenter Clinical Research on Major Diseases in Suzhou,No.DZXYJ202413General Program of Lianyungang Health Committee,No.202336.
文摘BACKGROUND Depression and anxiety are prevalent among university students worldwide,often coexisting with functional constipation(FC).Family relationships have been identified as crucial factors affecting mental health,yet the gender-specific associations between these conditions remain underexplored.AIM To assess prevalence of depressive symptoms,anxiety symptoms,and FC among Chinese university students and explore their associations.METHODS Using a cross-sectional survey design,data were collected from 12721 students at two universities in Jiangsu Province and Shandong Province.Depressive symptoms were assessed using the Patient Health Questionnaire-9,anxiety symptoms using the Generalized Anxiety Disorder-7 scale,and FC using the ROME IV.Gender-stratified analyses and population attributable risk proportions were calculated to evaluate risk factor patterns and population impact.RESULTS The prevalence of self-reported depressive,anxiety,and comorbid depressive and anxiety symptoms was 16.3%,24.9%,and 13.3%,respectively,whereas that of FC was 22%.Students with depressive symptoms were 1.811 times more likely to have FC than those without.Female gender,parental relationships,and lower household income were significant risk factors for both mental health conditions.For depressive symptoms,females experienced stronger effects from both parental conflict[odds ratio(OR)=8.006 vs OR=7.661 in males]and FC(OR=1.954 vs OR=1.628 in males).For anxiety symptoms,conflicted parental relationships had stronger effects in males(OR=5.946)than females(OR=4.262).Overall,poor parental relationships contributed to 38.6%of depressive and 33.5%of anxiety symptoms.CONCLUSION Family relationships significantly impact student mental health,with gender-specific patterns.Targeted interventions addressing family dynamics could reduce mental health burden in university settings.
文摘BACKGROUND Obstructed defecation syndrome(ODS)is a subtype of constipation that is consi-dered one of the major pelvic floor dysfunctions affecting the aging population,particularly women over 50 seeking medical care.The condition is characterized by the urge to defecate but an impaired ability to expel the fecal bolus.ODS is associated with various anorectal abnormalities,which are not always apparent during a standard physical examination,requiring specialized imaging techniques for proper diagnosis.AIM To study the distribution of causes of ODS in patients with chronic constipation by magnetic resonance defecography(MRD).METHODS This observational study evaluated the causes of ODS in 57 patients with chronic constipation who presented to Bangabandhu Sheikh Mujib Medical University between July 2020 and June 2021.After obtaining institutional review board approval and informed consent,patients underwent history taking,physical exams,and relevant investigations.ODS was diagnosed using Rome III criteria,with colonoscopy ruling out organic causes.Standard MRD was performed in different phases,and images were analyzed by expert radiologists and reported in a stan-dardized format.RESULTS Pelvic floor descent and anorectal junction descent were the most frequent findings,each present in 94.7%of cases.Rectocele was observed in 78.9%of patients,while vaginal or uterine prolapse was seen in 59.4%of females.Less common abnormalities included paradoxical contraction(7%),and there were no cases of sigmoidocele.Functional measurements showed significant differences in pelvic floor dynamics between rest and defecation,particularly in the H-line,M-line,and descent of pelvic organs(P<0.05).CONCLUSION Pelvic floor descent and anorectal descent were the most common findings in patients suffering from ODS,fo-llowed by rectocele.Younger females(<30 years)were most affected.
基金supported by the Science&Technology Department of Sichuan Province(No.2019YFS0040)the Improvement Plan of“Xinglin Scholar”Scientific Research Talent,Chengdu University of Traditional Chinese Medicine(No.XKTD2022002)。
文摘The activation of the sirtuin1(SIRT1)/nuclear factor erythroid 2-related factor 2(Nrf2)/heme oxygenase 1(HO-1)pathway has been shown to mitigate oxidative stress-induced apoptosis and mitochondrial damage by reducing reactive oxygen species(ROS)levels.Clinical trials have demonstrated that Zhongfeng Xingnao Liquid(ZFXN)ameliorates post-stroke cognitive impairment(PSCI).However,the underlying mechanism,particularly whether it involves protecting mitochondria and inhibiting apoptosis through the SIRT1/Nrf2/HO-1 pathway,remains unclear.This study employed an oxygen-glucose deprivation(OGD)cell model using SHSY5Y cells and induced PSCI in rats through modified bilateral carotid artery ligation(2VO).The effects of ZFXN on learning and memory,neuroprotective activity,mitochondrial function,oxidative stress,and the SIRT1/Nrf2/HO-1 pathway were evaluated both in vivo and in vitro.Results indicated that ZFXN significantly increased the B-cell lymphoma 2(Bcl2)/Bcl2-associated X(Bax)ratio,reduced terminal deoxynucleotidyl transferase-mediated d UTP nickend-labeling(TUNEL)+cells,and markedly improved cognition,synaptic plasticity,and neuronal function in the hippocampus and cortex.Furthermore,ZFXN exhibited potent antioxidant activity,evidenced by decreased ROS and malondialdehyde(MDA)content and increased superoxide dismutase(SOD),catalase(CAT),and glutathione(GSH)levels.ZFXN also demonstrated considerable enhancement of mitochondrial membrane potential(MMP),Tom 20 fluorescence intensity,adenosine triphosphate(ATP)and energy charge(EC)levels,and mitochondrial complexⅠandⅢactivity,thereby inhibiting mitochondrial damage.Additionally,ZFXN significantly increased SIRT1 activity and elevated SIRT1,nuclear Nrf2,and HO-1 levels.Notably,these effects were substantially counteracted when SIRT1 was suppressed by the inhibitor EX-527 in vitro.In conclusion,ZFXN alleviates PSCI by activating the SIRT1/Nrf2/HO-1 pathway and preventing mitochondrial damage.
文摘Objective:To explore the application method and clinical effect of inulin in the treatment of constipation for patients in the ICU.Methods:Sixty ICU patients with constipation were randomly divided into an experimental group and a control group,with 30 patients in each group.The control group received nasal feeding with a regular diet.The experimental group received nasal feeding with a regular diet plus inulin.The defecation status of the patients was observed and compared on the 3rd,5th,and 7th days.Results:Among the 30 patients in the experimental group and 30 patients in the control group,there was a statistically significant difference in treatment effect between the two groups(P<0.05).The treatment duration was(3.91±1.09)days in the experimental group and(5.78±1.52)days in the control group.Conclusion:Inulin has a significant effect in the treatment of constipation for critically ill patients in the ICU and is worthy of clinical promotion and application.
基金Supported by the 90th Anniversary of Chulalongkorn University Fund(Ratchadapiseksomphot Endowment Fund)Ratchadapiseksompotch Funds,Graduate Affairs,Faculty of Medicine,Chulalongkorn University,Bangkok,Thailand,No.GA68/028.
文摘BACKGROUND Excipients may improve the palatability of polyethylene glycol(PEG),the firstline treatment for childhood functional constipation(FC),leading to good compliance and improved treatment outcomes.AIM To compare the developed PEG-based formula(PEG-Chula)to the commercial formula for treating childhood FC.METHODS In this randomized controlled trial,we enrolled children aged<18 years with FC diagnosed by the Rome Ⅳ criteria to receive PEG-Chula[four flavors:(1)Strawberry;(2)Lychee;(3)Apple;and(4)Lychee-rose]or Forlax(orange-grapefruit flavor)for eight weeks.The primary outcomes included changes in stool frequency and consistency measured by the Bristol Stool scale.The secondary outcomes were constipation-related symptom improvement,adverse events,and palatability measured by the facial hedonic scale.RESULTS Fifty-two children diagnosed with FC[median age:4.21(2.33,7.88)years;35(67.31%)females]were enrolled.After the 8-week treatment,the mean weekly stool frequency increased in both groups,the mean change was 4.02(95%CI:3.09-4.95)in PEG-Chula and 3.78(95%CI:2.79-4.78)in commercial PEG compared to baseline(P<0.001).The extent of stool consistency improvement did not differ significantly.The most preferred PEG-Chula flavor was rated more palatable than the commercial PEG.Treatment compliance correlated with medication palatability(r=0.34,P=0.013).No significant differences in adverse events were found.CONCLUSION Both PEG-based formulas are effective and safe for managing pediatric FC.
基金Supported by The Hubei Pediatric Alliance Medical Research Project,No.HPAMRP202117.
文摘Functional constipation(FC)is the most common gastrointestinal disorder in children,with a global prevalence of 14.4%based on Rome IV criteria.This editorial explores the multifactorial pathogenesis and diagnostic complexity of FC,emphasizing the importance of early and accurate diagnosis.Effective management of FC hinges on child-oriented toilet training and the use of osmotic laxatives,particularly polyethylene glycol.Emerging therapies,including probiotics,serotonin 5-HT4 receptor agonists,chloride channel activators,and herbal remedies,offer promising options but require further research.Lifestyle modifications,such as adequate fiber and fluid intake and physiotherapy,are crucial in supporting pharmacological treatments.For intractable cases,a multidisciplinary approach involving pediatric specialists,nutritionists,physiotherapists,and psychologists is essential.This comprehensive strategy aims to improve the quality of life for children with FC and their families through continuous research,education,and collaborative care.
文摘BACKGROUND Post-stroke depression(PSD),a condition commonly developed in patients with chronic stroke,impairs both functional rehabilitation and daily living.AIM To comprehensively analyze PSD contributors in chronic phase stroke and construct a precise nomogram.METHODS Two hundred patients with chronic stroke admitted in over 7 years(January 2017 to January 2024),were enrolled and categorized into the PSD group(n=96)and the non-PSD(NPSD)group(n=104).Demographic characteristics,clinicopathological data,and biochemical indicators were collected and analyzed by univariate analysis.Significant predictors identified in the univariate analysis were subsequently incorporated into a binary logistic regression model to assess their independent effects on PSD risk.The discriminative ability/calibration of the developed PSD prediction nomogram was assessed.RESULTS Compared with the NPSD group,the PSD group included a higher proportion of patients aged≥60 years,divorced/widowed,with an education level below senior high school,presenting with≥2 comorbidities,exhibiting severe neurological impairment,and having multiple lesions.Additionally,the PSD group showed significantly higher neutrophil-to-lymphocyte ratio(NLR)and platelet-tolymphocyte ratio(PLR)than the NPSD group.After assigning values to significant predictors,multivariate analysis indicated that educational level(P=0.046),NLR(P<0.001),and PLR(P<0.001)were independently associated with PSD in patients with chronic stroke.The developed nomogram exhibited favorable discrimination performance.The nomogram's calibration remained accurate for high-risk stratification but displayed modest inconsistencies in lowand middle-risk categories.CONCLUSION Education level,NLR,and PLR independently contribute to PSD in patients with chronic stroke.The constructed nomogram effectively predicts PSD risk within the range of 0.10-0.90,presenting a valuable tool for clinical monitoring and risk assessment of PSD in patients with chronic stroke.
基金supported by the Chinese Medicine Development Fund,Hong Kong SAR,China(23B2/027A_R1)the National Natural Science Foundation of China(81704198).
文摘Objective:To evaluate the efficacy and safety of acupoint application for post-stroke depression(PSD)by regulating gastrointestinal function.A secondary objective is to explore the potential mechanism underlying this approach from the perspective of gut microbiota.Methods:This multicenter,randomized,double-blind(patients and assessors),placebo-controlled trial will enroll 80 patients with PSD,and include a 1-week run-in period,a 4-week treatment phase,and a 12-week follow-up.Eligible participants will randomly be assigned in a 1:1 ratio to either the acupoint application or placebo(non-acupoint)groups.Treatments will be administered thrice weekly for 4 weeks.The primary outcome is change in the Hamilton Rating Scale for Depression(HAMD)score.Secondary outcomes include the Beck Depression Inventory(BDI),36-Item Short-Form Health Survey(SF-36),Barthel Index of Activities of Daily Living,Social Adaptation Self-Evaluation Scale(SASS),and gut microbiota profiling.All outcomes will be assessed at baseline(prior to treatment),during treatment(weeks 2 and 4),and during follow-up(weeks 8,12,and 16).The Treatment Emergent Symptom Scale(TESS)will be used for evaluation throughout the 4-week treatment phase.Discussion:The results of this study will provide important evidence supporting a novel treatment strategy for PSD that targets gastrointestinal regulation,potentially informing future clinical practice.
基金the Medical Technologies R&D Program of Henan Province:Clinical Efficacy and Mechanism of Action of Intermittent Oro-esophageal Tube Feeding in the Treatment of Post-Stroke Dysphagia(No.LHGJ20220348)Natural Science Foundation of Henan Province:Mechanism of Acupuncture in Preventing and Treating Limb Spasticity after Stroke Based on Mechanistic Target of Rapamycin Lactylation and Mitophagy(No.232300420256)。
文摘OBJECTIVE:To investigate the possible mechanisms by which acupuncture improves post-stroke limb spasticity using single-cell sequencing technology.METHODS:Thirty-two rats were randomly assigned to four groups:Control,Sham,Model,and Acupuncture.The middle cerebral artery occlusion(MCAO)model was established,and the acupuncture groups received acupuncture treatment.After treatment,brain morphological changes and the degree of neurological impairment were assessed.The effect of acupuncture on the proportion of brain cell types in the ischemic penumbra of MCAO rats was analyzed using single-cell transcriptomics,and the expression and enrichment of differentially expressed genes were examined.Finally,selected differential genes were validated by Western blot and quantitative real-time polymerase chain reaction.RESULTS:Triphenyltetrazolium chloride staining showed that the infarct area in MCAO rats was significantly reduced after acupuncture.Garcia scoring,hematoxylin-eosin staining,Nissl staining,and terminal deoxynucleotidyl transferase d UTP nick end labeling demonstrated that acupuncture reduced brain damage.Enzyme-linked immunosorbent assay results showed that acupuncture significantly decreased serum inflammatory factors,including interleukin-1 beta(IL-1β),interleukin-6(IL-6),and tumor necrosis factor-alpha(TNF-α).Single-cell transcriptome analysis revealed marked changes in cell type proportions between the Acupuncture and Model groups.A total of 207 differential genes were identified,including 157 upregulated and 50 downregulated genes.Analysis of macrophage-specific differential genes in the ischemic penumbra showed enrichment in Gene Ontology terms such as Ras protein signal transduction and regulation of GTPase activity,and Kyoto Encyclopedia of Genes and Genomes pathways including lysosome,axon guidance,and mitogenactivated protein kinase signaling.S100a8 and leukocyte specific transcript 1(LST1)were identified as key differential genes.CONCLUSION:These findings suggest that the key differential genes S100a8 and LST1 may alleviate poststroke limb spasticity by regulating the inflammatory response in the ischemic penumbra.
