Objective: to study the effect of developmental care on feeding intolerant preterm infants. Methods: 74 cases of feeding intolerant preterm infants received in our hospital were included, all from March 2019 to Septem...Objective: to study the effect of developmental care on feeding intolerant preterm infants. Methods: 74 cases of feeding intolerant preterm infants received in our hospital were included, all from March 2019 to September 2021. According to the random number table, they were divided into the study group (37 cases, developmental care) and the control group (37 cases, routine care) to observe their nursing effects. Results: compared with the two groups, the children in the study group had shorter start time of swallowing and sucking, time to reach normal body mass, time to reach total intestinal nutrition, longer average daily sleep time, more self milk intake on the first day, the third day, the seventh day and the fourteenth day after starting self milk intake, higher head circumference, height and weight after two months of nursing, higher scores of GMQ, FMQ and TMQ in Peabody motor development scale after one month of nursing, and lower incidence of adverse reactions. The parents satisfaction with nursing was higher, and the comparison between groups was p 0.05. Conclusion: developmental nursing care for feeding intolerant preterm infants can help improve their health status and reduce the occurrence of adverse reactions. The application of this intervention method has been praised by many parents of children, and is more valuable than the conventional nursing mode in general.展开更多
Autism spectrum disorder(ASD)is a neurodevelopmental disorder where de novo mutations play a significant role.Although coding mutations in ASD have been extensively characterized,the impact of non-coding de novo mutat...Autism spectrum disorder(ASD)is a neurodevelopmental disorder where de novo mutations play a significant role.Although coding mutations in ASD have been extensively characterized,the impact of non-coding de novo mutations(ncDNMs)remains less understood.Here,we integrate cortex cell-specific cis-regulatory element annotations,a deep learning-based variant prediction model,and massively parallel reporter assays to systematically evaluate the functional impact of 227,878 ncDNMs from Simons Simplex Collection(SSC)and Autism Speaks MSSNG resource(MSSNG)cohorts.Our analysis identifies 238 ncDNMs with confirmed functional regulatory effects,including 137 down-regulated regulatory mutations(DrMuts)and 101 up-regulated regulatory mutations(UrMuts).Subsequent association analyses reveal that only DrMuts regulating loss-of-function(LoF)intolerant genes rather than other ncDNMs are significantly associated with the risk of ASD(Odds ratio=4.34;P=0.001).A total of 42 potential ASD-risk DrMuts across 41 candidate ASD-susceptibility genes are identified,including 12 recognized and 29 unreported genes.Interestingly,these noncoding disruptive mutations tend to be observed in genes extremely intolerant to LoF mutations.Our study introduces an optimized approach for elucidating the functional roles of ncDNMs,thereby expanding the spectrum of pathogenic variants and deepening our understanding of the complex molecular mechanisms underlying ASD.展开更多
In this editorial,we comment on an article by Liu et al.We focus specifically on the novel use of laparoscopic intracorporeal anastomosis(LIA)compared with open ileostomy reversal in patients with Crohn’s disease(CD)...In this editorial,we comment on an article by Liu et al.We focus specifically on the novel use of laparoscopic intracorporeal anastomosis(LIA)compared with open ileostomy reversal in patients with Crohn’s disease(CD),which is an innovative approach for improving postoperative outcomes and accelerating recovery in ileostomy reversal procedures.This study also highlights the limitations of the conventional open surgical technique,which is associated with higher rates of feeding intolerance,prolonged hospital stays,and delayed initiation of enteral nutrition.The chronic and recurrent nature of CD and the challenges posed by traditional surgical methods are issues addressed by LIA,which offers a minimally invasive approach that reduces surgical trauma,shortens recovery time,and improves tolerance to enteral nutrition,thereby enhancing postoperative outcomes.However,while LIA shows great promise,further prospective multicenter trials are needed to validate these findings and assess their broader application in other surgical scenarios.Overall,LIA represents a significant advancement in minimally invasive surgery for CD and has the potential to become the preferred standard approach for ileostomy reversal in patients requiring bowel reanastomosis.展开更多
BACKGROUND There is an increased maturation of laparoscopic intracorporeal anastomosis techniques.However,research on its application for small bowel stoma reversal in patients with Crohn's disease(CD)is limited.T...BACKGROUND There is an increased maturation of laparoscopic intracorporeal anastomosis techniques.However,research on its application for small bowel stoma reversal in patients with Crohn's disease(CD)is limited.Therefore,in this study,we compared the perioperative outcomes between laparoscopic intracorporeal ileostomy reversal(LIIR)and open ileostomy reversal(OIR).AIM To compare the safety,feasibility,bowel function recovery,and short-and longterm LIIR and OIR outcomes in patients with CD.METHODS This study included patients who underwent ileal reversal for CD between January 2021 and January 2023 at our institution.The baseline data,postoperative recovery,and complication indicators were retrospectively analyzed.Logistic regression analysis was conducted to explore factors that significantly influenced the development of enteral nutrition intolerance-related symptoms.RESULTS Notably,15 of the 45 patients in this study underwent OIR,and the remaining 30 received LIIR.Notably,no statistically significant differences were found between the two groups regarding clinical baseline characteristics,operation time,intraoperative hemorrhage,anastomotic site,enterolysis range,first postoperative flatus,postoperative complications,reoperation rate,or incidence of postoperative enteral nutrition intolerance.Compared with the OIR group,the LIIR group had a shorter postoperative hospital stay(P=0.045),lower incidence of enteral nutrition intolerance symptoms(P=0.019),and earlier postoperative total enteral nutrition initiation(P=0.033);however,it incurred higher total hospital costs(P=0.038).Furthermore,multivariate logistic regression analysis revealed that the duration of surgery and anastomotic technique were independent risk factors for postoperative symptoms of enteral nutrition intolerance(P<0.05).CONCLUSION Laparoscopic intracorporeal anastomosis for ileostomy reversal is safe and feasible.Patients who underwent this technique demonstrated improved tolerance to postoperative enteral nutrition and quicker resumption of total enteral nutrition.展开更多
Cow milk protein allergy(CMPA)is a prevalent food allergy in infancy.It often presents with symptoms that overlap with other conditions,such as gastroeso-phageal reflux disease,lactose intolerance,food protein-induced...Cow milk protein allergy(CMPA)is a prevalent food allergy in infancy.It often presents with symptoms that overlap with other conditions,such as gastroeso-phageal reflux disease,lactose intolerance,food protein-induced enterocolitis syndrome,and eosinophilic esophagitis.This diagnostic overlap makes distin-guishing CMPA from its mimics difficult,resulting in potential misdiagnoses and unnecessary dietary restrictions.This review aims to comprehensively analyze CMPA and its mimicking conditions,highlighting their clinical presentations,diagnostic approaches,and management strategies to enhance diagnostic accu-racy and optimize patient care.A systematic literature search was conducted using PubMed,Scopus,Web of Science,and Google Scholar,focusing on studies published within the last 20 years.Articles addressing CMPA and its mimicking conditions were selected,with data synthesized into comparative analyses of diagnostic methods and management strategies.Accurate differentiation between CMPA and its mimics requires a thorough clinical evaluation supported by diagnostic tests such as skin prick tests,serum-specific IgE,and oral food challenges.Misdiagnosis can lead to nutritional deficiencies,psychological stress,and increased healthcare costs.Emerging diagnostic technologies,including component-resolved diagnostics and cytokine profiling,offer promising avenues for improving accuracy.A multidisciplinary approach involving pediatricians,allergists,and dietitians is essential for precise diagnosis and effective management.Ongoing research and education are crucial to enhancing clinical outcomes and reducing the burden on families.展开更多
Background:Patients with unrepaired Ebstein’s anomaly experience exercise intolerance,heart failure and premature mortality.Volumetric assessment of right ventricular function is difffcult due to the complex anatomy ...Background:Patients with unrepaired Ebstein’s anomaly experience exercise intolerance,heart failure and premature mortality.Volumetric assessment of right ventricular function is difffcult due to the complex anatomy of the right ventricle and tricuspid valve.Myocardial deformation indices are an early marker in other cardiac pathologies of ventricular dysfunction.Objectives:1.Assess myocardial deformation in unrepaired Ebstein’s compared to healthy controls.2.Investigate the relationships between myocardial deformation and exercise capacity.Methods:Myocardial deformation parameters(strain)were calculated using feature tracking from standard cardiac magnetic resonance cine images.Cardiopulmonary exercise results were included where available.Results:36 patients with unrepaired Ebstein’s and 36 matched controls were included.Right ventricular,right atrial,and left ventricular global longitudinal,as well as left ventricular circumferential strain were impaired in Ebstein’s patients compared to controls(p<0.05).In Ebstein’s patients right atrial peak strain correlated with their percentage predicted VO_(2) max(r=−0.448,p=0.022)and VE/VCO_(2) slope(r=0.435,p=0.026).There were no correlations between right ventricular ejection fraction and exercise parameters.When Ebstein’s patients were divided by severity into mild or severe according to the median total right/left index,those with severe demonstrated signiffcantly impaired right ventricular global longitudinal strain compared to those in the mild category(−17.5±5.4%vs.−21.4±4.4%,p=0.0017).Conclusions:Myocardial deformation parameters for both the right and left ventricle are impaired in patients with unrepaired Ebstein’s compared to healthy controls.Right atrial peak strain is related to impaired exercise capacity and warrants further investigation as an early prognostic marker in this patient cohort.展开更多
Selecting suitable species is the most important issue for bare land reforestation, degraded secondary forest restoration, and single-species plantation transformation. However, little information has been documented ...Selecting suitable species is the most important issue for bare land reforestation, degraded secondary forest restoration, and single-species plantation transformation. However, little information has been documented related to tree species selection for these silvicultural endeavors on tropical Hainan Island of Southern China. The present study employed Baisha County, the ecological core area of Hainan Island, as a case study area. We initially inventoried a slightly disturbed primary forest and attempted to produce diameter distribution curves for each tree species. Second, the tree species were classified into shade intolerant, opportunist, and shade tolerant species based on shape of their diameter distribution curves. Third, market value was determined for each tree species based on published literature and on-site investigations at local wood trading companies. Totally 118 tree species were encountered in the inventoried forest and 13 tree species present were finally identified as potential tree species for our silvicultural endeavor on Hainan Island, of which 3 species are shade intolerant, 5 species are opportunist and 5 species are shade tolerant. Additionally, we also selected 12 tree species that were not in the inventoried forest but were extremely economically valuable and ecologically important. This study should contribute to the formulation of a sustainable forest management strategy on Hainan Island and the methodology might be replicated in other tropical region where suitable species also need to be identified for silvicultural endeavor.展开更多
Lactose malabsorption is a very common condition characterized by intestinal lactase deficiency. Primary lactose malabsorption is an inherited deficit present in the majority of the world＇s population, while secondar...Lactose malabsorption is a very common condition characterized by intestinal lactase deficiency. Primary lactose malabsorption is an inherited deficit present in the majority of the world＇s population, while secondary hypolactasia can be the consequence of an intestinal disease. The presence of malabsorbed lactose in the colonic lumen causes gastrointestinal symptoms. The condition is known as lactose intolerance. In patients with lactase nonpersistence, treatment should be considered exclusively if intolerance symptoms are present. In the absence of guidelines, the common therapeutic approach tends to exclude milk and dairy products from the diet. However, this strategy may have serious nutritional disadvantages. Several studies have been carried out to find alternative approaches, such as exogenous β-galactosidase, yogurt and probiotics for their bacterial lactase activity, pharmacological and non pharmacological strategies that can prolong contact time between enzyme and substrate delaying gastrointestinal transit time, and chronic lactose ingestion to enhance colonic adaptation. In this review the usefulness of these approaches is discussed and a therapeutic management with a flow chart is proposed.展开更多
Hypervigilance and symptoms anticipation,visceral hypersensitivity and gastroduodenal sensorimotor abnormalities account for the varied clinical presentation of functional dyspepsia(FD)patients.Many patients recognize...Hypervigilance and symptoms anticipation,visceral hypersensitivity and gastroduodenal sensorimotor abnormalities account for the varied clinical presentation of functional dyspepsia(FD)patients.Many patients recognize meals as the main triggering factor;thus,dietary manipulations often represent the first-line management strategy in this cohort of patients.Nonetheless,scarce quality evidence has been produced regarding the relationship between specific foods and/or macronutrients and the onset of FD symptoms,resulting in nonstandardized nutritional approaches.Most dietary advises are indeed empirical and often lead to exclusion diets,reinforcing in patients the perception of“being intolerant”to food and self-perpetuating some of the very mechanisms underlying dyspepsia physiopathology(i.e.,hypervigilance and symptom anticipation).Clinicians are often uncertain regarding the contribution of specific foods to dyspepsia physiopathology and dedicated professionals(i.e.,dietitians)are only available in tertiary referral settings.This in turn,can result in nutritionally unbalanced diets and could even encourage restrictive eating behaviors in severe dyspepsia.In this review,we aim at evaluating the relationship between dietary habits,macronutrients and specific foods in determining FD symptoms.We will provide an overview of the evidence-based nutritional approach that should be pursued in these patients,providing clinicians with a valuable tool in standardizing nutritional advises and discouraging patients from engaging into indiscriminate food exclusions.展开更多
Celiac disease (CD) is a common autoimmune disorder characterized by an immune response to ingested gluten and has a strong HLA association with HLA- DQ2 and HLA-DQ8 molecules, but human HLA-DQ risk factors do not exp...Celiac disease (CD) is a common autoimmune disorder characterized by an immune response to ingested gluten and has a strong HLA association with HLA- DQ2 and HLA-DQ8 molecules, but human HLA-DQ risk factors do not explain the entire genetic susceptibility to gluten intolerance. CD is caused by the lack of immune tolerance (oral tolerance) to wheat gluten. In this sense, the expression of soluble HLA-G in CD is of special interest because the molecule plays an important role in the induction of immune tolerance. The enhanced expression of soluble HLA-G found in CD may be part of a mechanism to restore the gluten intolerance. In this editorial, we review recent progress in understanding CD in relation to its prevalence, diagnosis and possible mechanisms of pathogenesis.展开更多
AIM:To report preliminary results of the efficacy and safety of sunitinib in the management of Taiwan Residents gastrointestinal stromal tumors (GIST) patients facing imatinib mesylate (IM) intolerance or failure.METH...AIM:To report preliminary results of the efficacy and safety of sunitinib in the management of Taiwan Residents gastrointestinal stromal tumors (GIST) patients facing imatinib mesylate (IM) intolerance or failure.METHODS:Between 2001 and May 2010,199 Taiwan Residents patients with metastatic GIST were treated at Chang Gung Memorial Hospital.Among them,23 (11.6%) patients receiving sunitinib were investigated.RESULTS:Sixteen male and 7 female patients with a median age of 59 years (range:24-83 years) received sunitinib.Twenty-two GIST patients changed to sunitinib because of IM failure and 1 because of intolerance.The median duration of sunitinib administration was 6.0 mo (range:2-29 mo).The clinical benefit was 65.2% [2 complete response (CR),4 partial response (PR),and 9 stationary disease (SD);15/23].In 12 patients harboring mutations of the kit gene at exon 11,the clinical benefit rate (CR,PR,and SD) was 75.0% and 6 patients with tumors containing kit exon 9 mutations had a clinical benefit of 50.0% (not significant,P=0.344).The progression free survival (PFS) and overall survival (OS) did not differ between patients whose GISTs had wild type,KIT exon 9,or KIT exon 11 mutations.Hand-foot syndrome was the most common cause of grade Ⅲ adverse effect (26.1%),followed by anemia (17.4%),and neutropenia (13.0%).During the median 7.5-mo follow-up after sunitinib use,the median PFS and OS of these 23 GIST patients after sunitinib treatment were 8.4 and 14.1 mo,respectively.CONCLUSION:Sunitinib appears to be an effective treatment for Taiwan Residents with IM-resistant/intolerant GISTs and induced a sustained clinical benefit in more than 50% of Taiwan Residents advanced GIST patients.展开更多
Optimal bowel preparation increases the cecal intubation rate and detection of neoplastic lesions while decreasing the procedural time and procedural-related complications. Although high-volume polyethylene glycol(PEG...Optimal bowel preparation increases the cecal intubation rate and detection of neoplastic lesions while decreasing the procedural time and procedural-related complications. Although high-volume polyethylene glycol(PEG) solution is the most frequently used preparation for bowel cleansing, patients are often unwilling to take PEG solution due to its large volume, poor palatability, and high incidence of adverse events, such as abdominal bloating and nausea. Other purgatives include osmotic agents(e.g., sodium phosphate, magnesium citrate, and sodium sulfate), stimulant agents(e.g., senna, bisacodyl, and sodium picosulfate), and prokinetic agents(e.g., cisapride, mosapride, and itopride). A combination of PEG with an osmotic, stimulant, or prokinetic agent could effectively reduce the PEG solution volume and increase patients' adherence. Some such solutions have been found in several published studies to not be inferior to PEG alone in terms of bowel cleansing quality. Although combination methods showed similar efficacy and safety, the value of these studies is limited by shortcomings in study design. New effective and well-tolerated combination preparations are required, in addition to rigorous new validated studies.展开更多
During the last 100 years in medical literature,there are only 54 reports,including the report of Pasaoglu et al(World J Gastroenterol 2008;14:2915-2916),with clinical descriptions of agenesis of the dorsal pancreas i...During the last 100 years in medical literature,there are only 54 reports,including the report of Pasaoglu et al(World J Gastroenterol 2008;14:2915-2916),with clinical descriptions of agenesis of the dorsal pancreas in humans.Agenesis of the dorsal pancreas,a rare congenital pancreatic malformation,is associated with some other medical conditions such as hyperglycemia,abdominal pain,pancreatitis and a few other diseases.In approximately 50% of reported patients with this congenital malformation,hyperglycemia was demonstrated.Evaluation of hyperglycemia and diabetes mellitus in all patients with agenesis of the dorsal pancreas including description of fasting blood glucose,oral glucose tolerance test,glycated hemoglobin and medical treatment would be a future goal.Since autosomal dominant transmission has been suggested in single families,more family studies including imaging technologies with demonstration of the pancreatic duct system are needed for evaluation of this disease.With this letter to the editor,we aim to increase available information for the better understanding of this rare disease.展开更多
Irritable bowel syndrome(IBS) is one of the most common gastrointestinal disorders in Western countries. Despite the high prevalence of this disorders, the therapeutic management of these patients is often unsatisfact...Irritable bowel syndrome(IBS) is one of the most common gastrointestinal disorders in Western countries. Despite the high prevalence of this disorders, the therapeutic management of these patients is often unsatisfactory. A number of factors have been suggested to be involved in the pathogenesis of IBS, including impaired motility and sensitivity, increased permeability, changes in the gut microbiome and alterations in the brain-gut axis. Also food seems to play a critical role: the most of IBS patients report the onset or the exacerbation of their symptoms after the meals. Recently, an increasing attention has been paid to the role of food in IBS. In this review we summarize the most recent evidences about the role of diet on IBS symptoms. A diet restricted in fermentable, poorly absorbed carbohydrates and sugar alcohols has beneficial effects on IBS symptoms. More studies are needed to improve our knowledge about the relationship between food and IBS. However, in the foreseeable future, dietary strategies will represent one of the key tools in the therapeutic management of patients with IBS.展开更多
BACKGROUND Enteral nutrition(EN)is essential for critically ill patients.However,some patients will have enteral feeding intolerance(EFI)in the process of EN.AIM To develop a clinical prediction model to predict the r...BACKGROUND Enteral nutrition(EN)is essential for critically ill patients.However,some patients will have enteral feeding intolerance(EFI)in the process of EN.AIM To develop a clinical prediction model to predict the risk of EFI in patients receiving EN in the intensive care unit.METHODS A prospective cohort study was performed.The enrolled patients’basic information,medical status,nutritional support,and gastrointestinal(GI)symptoms were recorded.The baseline data and influencing factors were compared.Logistic regression analysis was used to establish the model,and the bootstrap resampling method was used to conduct internal validation.RESULTS The sample cohort included 203 patients,and 37.93%of the patients were diagnosed with EFI.After the final regression analysis,age,GI disease,early feeding,mechanical ventilation before EN started,and abnormal serum sodium were identified.In the internal validation,500 bootstrap resample samples were performed,and the area under the curve was 0.70(95%CI:0.63-0.77).CONCLUSION This clinical prediction model can be applied to predict the risk of EFI.展开更多
Objective To construct four recombinant Lactococcus lactis strains exhibiting high β-galactosidase activity in fusion or non-fusion ways, and to study the influence factors for their protein expression and secretion....Objective To construct four recombinant Lactococcus lactis strains exhibiting high β-galactosidase activity in fusion or non-fusion ways, and to study the influence factors for their protein expression and secretion. Methods The gene fragments encoding β-galactosidase from two strains of Loctobacillus bulgaricus, wch9901 isolated from yogurt and 1.1480 purchased from the Chinese Academy of Sciences, were amplified and inserted into lactococcal expression vector pMG36e. For fusion expression, the open reading frame of the β-galactosidase gene was amplified, while for non-fusion expression, the open reading frame of the β-galactosidase gene was amplified with its native Shine-Dalgarno sequence upstream. The start codon of the β-galactosidase gene partially overlapped with the stop codon of vector origin open reading frame. Then, the recombinant plasmids were transformed into Escherichia coli DH5α and Lactococcus lactis subsp, lactis MG1363 and confirmed by determining β-galactosidase activities. Results The non-fusion expression plasmids showed a significantly higher β-galactosidase activity in transformed strains than the fusion expression plasmids. The highest enzyme activity was observed in Lactococcus lactis transformed with the non-fusion expression plasmids which were inserted into the β-galactosidase gene from Lactobacillus bulgaricus wch9901. The β-galactosidase activity was 2.75 times as high as that of the native counterpart. In addition, β-galactosidase expressed by recombinant plasmids in Lactococcus lactis could be secreted into the culture medium. The highest secretion rate （27.1%） was observed when the culture medium contained 20 g/L of lactose. Conclusion Different properties of the native bacteria may have some effects on the protein expression of recombinant plasmids. Non-fusion expression shows a higher enzyme activity in host bacteria. There may be a host-related weak secretion signal peptide gene within the structure gene of Lb. bulgaricus β-galactosidase, and its translation product may introduce the enzyme secretion out of cells in special hosts.展开更多
文摘Objective: to study the effect of developmental care on feeding intolerant preterm infants. Methods: 74 cases of feeding intolerant preterm infants received in our hospital were included, all from March 2019 to September 2021. According to the random number table, they were divided into the study group (37 cases, developmental care) and the control group (37 cases, routine care) to observe their nursing effects. Results: compared with the two groups, the children in the study group had shorter start time of swallowing and sucking, time to reach normal body mass, time to reach total intestinal nutrition, longer average daily sleep time, more self milk intake on the first day, the third day, the seventh day and the fourteenth day after starting self milk intake, higher head circumference, height and weight after two months of nursing, higher scores of GMQ, FMQ and TMQ in Peabody motor development scale after one month of nursing, and lower incidence of adverse reactions. The parents satisfaction with nursing was higher, and the comparison between groups was p 0.05. Conclusion: developmental nursing care for feeding intolerant preterm infants can help improve their health status and reduce the occurrence of adverse reactions. The application of this intervention method has been praised by many parents of children, and is more valuable than the conventional nursing mode in general.
基金supported by the National Natural Science of China(82322032 and 82221005)the Outstanding Youth Foundation of Jiangsu Province(BK20220050)+4 种基金the National Key Research&Development(R&D)Program of China(2024YFC2706800 and 2021YFC2700600)the Major Project of Changzhou Medical Center(CZKY1040101)the Major Project of Taizhou Clinical Medical College(TZKY20240003)the Major Program of Gusu School(GSKY20210102)the China Postdoctoral Science Foundation(2024M760296).
文摘Autism spectrum disorder(ASD)is a neurodevelopmental disorder where de novo mutations play a significant role.Although coding mutations in ASD have been extensively characterized,the impact of non-coding de novo mutations(ncDNMs)remains less understood.Here,we integrate cortex cell-specific cis-regulatory element annotations,a deep learning-based variant prediction model,and massively parallel reporter assays to systematically evaluate the functional impact of 227,878 ncDNMs from Simons Simplex Collection(SSC)and Autism Speaks MSSNG resource(MSSNG)cohorts.Our analysis identifies 238 ncDNMs with confirmed functional regulatory effects,including 137 down-regulated regulatory mutations(DrMuts)and 101 up-regulated regulatory mutations(UrMuts).Subsequent association analyses reveal that only DrMuts regulating loss-of-function(LoF)intolerant genes rather than other ncDNMs are significantly associated with the risk of ASD(Odds ratio=4.34;P=0.001).A total of 42 potential ASD-risk DrMuts across 41 candidate ASD-susceptibility genes are identified,including 12 recognized and 29 unreported genes.Interestingly,these noncoding disruptive mutations tend to be observed in genes extremely intolerant to LoF mutations.Our study introduces an optimized approach for elucidating the functional roles of ncDNMs,thereby expanding the spectrum of pathogenic variants and deepening our understanding of the complex molecular mechanisms underlying ASD.
文摘In this editorial,we comment on an article by Liu et al.We focus specifically on the novel use of laparoscopic intracorporeal anastomosis(LIA)compared with open ileostomy reversal in patients with Crohn’s disease(CD),which is an innovative approach for improving postoperative outcomes and accelerating recovery in ileostomy reversal procedures.This study also highlights the limitations of the conventional open surgical technique,which is associated with higher rates of feeding intolerance,prolonged hospital stays,and delayed initiation of enteral nutrition.The chronic and recurrent nature of CD and the challenges posed by traditional surgical methods are issues addressed by LIA,which offers a minimally invasive approach that reduces surgical trauma,shortens recovery time,and improves tolerance to enteral nutrition,thereby enhancing postoperative outcomes.However,while LIA shows great promise,further prospective multicenter trials are needed to validate these findings and assess their broader application in other surgical scenarios.Overall,LIA represents a significant advancement in minimally invasive surgery for CD and has the potential to become the preferred standard approach for ileostomy reversal in patients requiring bowel reanastomosis.
基金Supported by Chongqing Municipal Health Commission Medical Research Project,No.2023WSJK104.
文摘BACKGROUND There is an increased maturation of laparoscopic intracorporeal anastomosis techniques.However,research on its application for small bowel stoma reversal in patients with Crohn's disease(CD)is limited.Therefore,in this study,we compared the perioperative outcomes between laparoscopic intracorporeal ileostomy reversal(LIIR)and open ileostomy reversal(OIR).AIM To compare the safety,feasibility,bowel function recovery,and short-and longterm LIIR and OIR outcomes in patients with CD.METHODS This study included patients who underwent ileal reversal for CD between January 2021 and January 2023 at our institution.The baseline data,postoperative recovery,and complication indicators were retrospectively analyzed.Logistic regression analysis was conducted to explore factors that significantly influenced the development of enteral nutrition intolerance-related symptoms.RESULTS Notably,15 of the 45 patients in this study underwent OIR,and the remaining 30 received LIIR.Notably,no statistically significant differences were found between the two groups regarding clinical baseline characteristics,operation time,intraoperative hemorrhage,anastomotic site,enterolysis range,first postoperative flatus,postoperative complications,reoperation rate,or incidence of postoperative enteral nutrition intolerance.Compared with the OIR group,the LIIR group had a shorter postoperative hospital stay(P=0.045),lower incidence of enteral nutrition intolerance symptoms(P=0.019),and earlier postoperative total enteral nutrition initiation(P=0.033);however,it incurred higher total hospital costs(P=0.038).Furthermore,multivariate logistic regression analysis revealed that the duration of surgery and anastomotic technique were independent risk factors for postoperative symptoms of enteral nutrition intolerance(P<0.05).CONCLUSION Laparoscopic intracorporeal anastomosis for ileostomy reversal is safe and feasible.Patients who underwent this technique demonstrated improved tolerance to postoperative enteral nutrition and quicker resumption of total enteral nutrition.
文摘Cow milk protein allergy(CMPA)is a prevalent food allergy in infancy.It often presents with symptoms that overlap with other conditions,such as gastroeso-phageal reflux disease,lactose intolerance,food protein-induced enterocolitis syndrome,and eosinophilic esophagitis.This diagnostic overlap makes distin-guishing CMPA from its mimics difficult,resulting in potential misdiagnoses and unnecessary dietary restrictions.This review aims to comprehensively analyze CMPA and its mimicking conditions,highlighting their clinical presentations,diagnostic approaches,and management strategies to enhance diagnostic accu-racy and optimize patient care.A systematic literature search was conducted using PubMed,Scopus,Web of Science,and Google Scholar,focusing on studies published within the last 20 years.Articles addressing CMPA and its mimicking conditions were selected,with data synthesized into comparative analyses of diagnostic methods and management strategies.Accurate differentiation between CMPA and its mimics requires a thorough clinical evaluation supported by diagnostic tests such as skin prick tests,serum-specific IgE,and oral food challenges.Misdiagnosis can lead to nutritional deficiencies,psychological stress,and increased healthcare costs.Emerging diagnostic technologies,including component-resolved diagnostics and cytokine profiling,offer promising avenues for improving accuracy.A multidisciplinary approach involving pediatricians,allergists,and dietitians is essential for precise diagnosis and effective management.Ongoing research and education are crucial to enhancing clinical outcomes and reducing the burden on families.
基金This observational retrospective study was approved by the local Clinical Governance Committee(RRK6237)conformed to the principles of Good Clinical Practice guidelines.Additionally,healthy controls were identiffed from a national ethics board approved observational CMR study(NCT01028703).
文摘Background:Patients with unrepaired Ebstein’s anomaly experience exercise intolerance,heart failure and premature mortality.Volumetric assessment of right ventricular function is difffcult due to the complex anatomy of the right ventricle and tricuspid valve.Myocardial deformation indices are an early marker in other cardiac pathologies of ventricular dysfunction.Objectives:1.Assess myocardial deformation in unrepaired Ebstein’s compared to healthy controls.2.Investigate the relationships between myocardial deformation and exercise capacity.Methods:Myocardial deformation parameters(strain)were calculated using feature tracking from standard cardiac magnetic resonance cine images.Cardiopulmonary exercise results were included where available.Results:36 patients with unrepaired Ebstein’s and 36 matched controls were included.Right ventricular,right atrial,and left ventricular global longitudinal,as well as left ventricular circumferential strain were impaired in Ebstein’s patients compared to controls(p<0.05).In Ebstein’s patients right atrial peak strain correlated with their percentage predicted VO_(2) max(r=−0.448,p=0.022)and VE/VCO_(2) slope(r=0.435,p=0.026).There were no correlations between right ventricular ejection fraction and exercise parameters.When Ebstein’s patients were divided by severity into mild or severe according to the median total right/left index,those with severe demonstrated signiffcantly impaired right ventricular global longitudinal strain compared to those in the mild category(−17.5±5.4%vs.−21.4±4.4%,p=0.0017).Conclusions:Myocardial deformation parameters for both the right and left ventricle are impaired in patients with unrepaired Ebstein’s compared to healthy controls.Right atrial peak strain is related to impaired exercise capacity and warrants further investigation as an early prognostic marker in this patient cohort.
基金supported by National Key R&D Program of China (2017YFC0505604)
文摘Selecting suitable species is the most important issue for bare land reforestation, degraded secondary forest restoration, and single-species plantation transformation. However, little information has been documented related to tree species selection for these silvicultural endeavors on tropical Hainan Island of Southern China. The present study employed Baisha County, the ecological core area of Hainan Island, as a case study area. We initially inventoried a slightly disturbed primary forest and attempted to produce diameter distribution curves for each tree species. Second, the tree species were classified into shade intolerant, opportunist, and shade tolerant species based on shape of their diameter distribution curves. Third, market value was determined for each tree species based on published literature and on-site investigations at local wood trading companies. Totally 118 tree species were encountered in the inventoried forest and 13 tree species present were finally identified as potential tree species for our silvicultural endeavor on Hainan Island, of which 3 species are shade intolerant, 5 species are opportunist and 5 species are shade tolerant. Additionally, we also selected 12 tree species that were not in the inventoried forest but were extremely economically valuable and ecologically important. This study should contribute to the formulation of a sustainable forest management strategy on Hainan Island and the methodology might be replicated in other tropical region where suitable species also need to be identified for silvicultural endeavor.
文摘Lactose malabsorption is a very common condition characterized by intestinal lactase deficiency. Primary lactose malabsorption is an inherited deficit present in the majority of the world＇s population, while secondary hypolactasia can be the consequence of an intestinal disease. The presence of malabsorbed lactose in the colonic lumen causes gastrointestinal symptoms. The condition is known as lactose intolerance. In patients with lactase nonpersistence, treatment should be considered exclusively if intolerance symptoms are present. In the absence of guidelines, the common therapeutic approach tends to exclude milk and dairy products from the diet. However, this strategy may have serious nutritional disadvantages. Several studies have been carried out to find alternative approaches, such as exogenous β-galactosidase, yogurt and probiotics for their bacterial lactase activity, pharmacological and non pharmacological strategies that can prolong contact time between enzyme and substrate delaying gastrointestinal transit time, and chronic lactose ingestion to enhance colonic adaptation. In this review the usefulness of these approaches is discussed and a therapeutic management with a flow chart is proposed.
文摘Hypervigilance and symptoms anticipation,visceral hypersensitivity and gastroduodenal sensorimotor abnormalities account for the varied clinical presentation of functional dyspepsia(FD)patients.Many patients recognize meals as the main triggering factor;thus,dietary manipulations often represent the first-line management strategy in this cohort of patients.Nonetheless,scarce quality evidence has been produced regarding the relationship between specific foods and/or macronutrients and the onset of FD symptoms,resulting in nonstandardized nutritional approaches.Most dietary advises are indeed empirical and often lead to exclusion diets,reinforcing in patients the perception of“being intolerant”to food and self-perpetuating some of the very mechanisms underlying dyspepsia physiopathology(i.e.,hypervigilance and symptom anticipation).Clinicians are often uncertain regarding the contribution of specific foods to dyspepsia physiopathology and dedicated professionals(i.e.,dietitians)are only available in tertiary referral settings.This in turn,can result in nutritionally unbalanced diets and could even encourage restrictive eating behaviors in severe dyspepsia.In this review,we aim at evaluating the relationship between dietary habits,macronutrients and specific foods in determining FD symptoms.We will provide an overview of the evidence-based nutritional approach that should be pursued in these patients,providing clinicians with a valuable tool in standardizing nutritional advises and discouraging patients from engaging into indiscriminate food exclusions.
文摘Celiac disease (CD) is a common autoimmune disorder characterized by an immune response to ingested gluten and has a strong HLA association with HLA- DQ2 and HLA-DQ8 molecules, but human HLA-DQ risk factors do not explain the entire genetic susceptibility to gluten intolerance. CD is caused by the lack of immune tolerance (oral tolerance) to wheat gluten. In this sense, the expression of soluble HLA-G in CD is of special interest because the molecule plays an important role in the induction of immune tolerance. The enhanced expression of soluble HLA-G found in CD may be part of a mechanism to restore the gluten intolerance. In this editorial, we review recent progress in understanding CD in relation to its prevalence, diagnosis and possible mechanisms of pathogenesis.
基金Supported by Chang Gung Medical Research Program 380711 Grant to Dr. Yeh CN
文摘AIM:To report preliminary results of the efficacy and safety of sunitinib in the management of Taiwan Residents gastrointestinal stromal tumors (GIST) patients facing imatinib mesylate (IM) intolerance or failure.METHODS:Between 2001 and May 2010,199 Taiwan Residents patients with metastatic GIST were treated at Chang Gung Memorial Hospital.Among them,23 (11.6%) patients receiving sunitinib were investigated.RESULTS:Sixteen male and 7 female patients with a median age of 59 years (range:24-83 years) received sunitinib.Twenty-two GIST patients changed to sunitinib because of IM failure and 1 because of intolerance.The median duration of sunitinib administration was 6.0 mo (range:2-29 mo).The clinical benefit was 65.2% [2 complete response (CR),4 partial response (PR),and 9 stationary disease (SD);15/23].In 12 patients harboring mutations of the kit gene at exon 11,the clinical benefit rate (CR,PR,and SD) was 75.0% and 6 patients with tumors containing kit exon 9 mutations had a clinical benefit of 50.0% (not significant,P=0.344).The progression free survival (PFS) and overall survival (OS) did not differ between patients whose GISTs had wild type,KIT exon 9,or KIT exon 11 mutations.Hand-foot syndrome was the most common cause of grade Ⅲ adverse effect (26.1%),followed by anemia (17.4%),and neutropenia (13.0%).During the median 7.5-mo follow-up after sunitinib use,the median PFS and OS of these 23 GIST patients after sunitinib treatment were 8.4 and 14.1 mo,respectively.CONCLUSION:Sunitinib appears to be an effective treatment for Taiwan Residents with IM-resistant/intolerant GISTs and induced a sustained clinical benefit in more than 50% of Taiwan Residents advanced GIST patients.
文摘Optimal bowel preparation increases the cecal intubation rate and detection of neoplastic lesions while decreasing the procedural time and procedural-related complications. Although high-volume polyethylene glycol(PEG) solution is the most frequently used preparation for bowel cleansing, patients are often unwilling to take PEG solution due to its large volume, poor palatability, and high incidence of adverse events, such as abdominal bloating and nausea. Other purgatives include osmotic agents(e.g., sodium phosphate, magnesium citrate, and sodium sulfate), stimulant agents(e.g., senna, bisacodyl, and sodium picosulfate), and prokinetic agents(e.g., cisapride, mosapride, and itopride). A combination of PEG with an osmotic, stimulant, or prokinetic agent could effectively reduce the PEG solution volume and increase patients' adherence. Some such solutions have been found in several published studies to not be inferior to PEG alone in terms of bowel cleansing quality. Although combination methods showed similar efficacy and safety, the value of these studies is limited by shortcomings in study design. New effective and well-tolerated combination preparations are required, in addition to rigorous new validated studies.
文摘During the last 100 years in medical literature,there are only 54 reports,including the report of Pasaoglu et al(World J Gastroenterol 2008;14:2915-2916),with clinical descriptions of agenesis of the dorsal pancreas in humans.Agenesis of the dorsal pancreas,a rare congenital pancreatic malformation,is associated with some other medical conditions such as hyperglycemia,abdominal pain,pancreatitis and a few other diseases.In approximately 50% of reported patients with this congenital malformation,hyperglycemia was demonstrated.Evaluation of hyperglycemia and diabetes mellitus in all patients with agenesis of the dorsal pancreas including description of fasting blood glucose,oral glucose tolerance test,glycated hemoglobin and medical treatment would be a future goal.Since autosomal dominant transmission has been suggested in single families,more family studies including imaging technologies with demonstration of the pancreatic duct system are needed for evaluation of this disease.With this letter to the editor,we aim to increase available information for the better understanding of this rare disease.
文摘Irritable bowel syndrome(IBS) is one of the most common gastrointestinal disorders in Western countries. Despite the high prevalence of this disorders, the therapeutic management of these patients is often unsatisfactory. A number of factors have been suggested to be involved in the pathogenesis of IBS, including impaired motility and sensitivity, increased permeability, changes in the gut microbiome and alterations in the brain-gut axis. Also food seems to play a critical role: the most of IBS patients report the onset or the exacerbation of their symptoms after the meals. Recently, an increasing attention has been paid to the role of food in IBS. In this review we summarize the most recent evidences about the role of diet on IBS symptoms. A diet restricted in fermentable, poorly absorbed carbohydrates and sugar alcohols has beneficial effects on IBS symptoms. More studies are needed to improve our knowledge about the relationship between food and IBS. However, in the foreseeable future, dietary strategies will represent one of the key tools in the therapeutic management of patients with IBS.
文摘BACKGROUND Enteral nutrition(EN)is essential for critically ill patients.However,some patients will have enteral feeding intolerance(EFI)in the process of EN.AIM To develop a clinical prediction model to predict the risk of EFI in patients receiving EN in the intensive care unit.METHODS A prospective cohort study was performed.The enrolled patients’basic information,medical status,nutritional support,and gastrointestinal(GI)symptoms were recorded.The baseline data and influencing factors were compared.Logistic regression analysis was used to establish the model,and the bootstrap resampling method was used to conduct internal validation.RESULTS The sample cohort included 203 patients,and 37.93%of the patients were diagnosed with EFI.After the final regression analysis,age,GI disease,early feeding,mechanical ventilation before EN started,and abnormal serum sodium were identified.In the internal validation,500 bootstrap resample samples were performed,and the area under the curve was 0.70(95%CI:0.63-0.77).CONCLUSION This clinical prediction model can be applied to predict the risk of EFI.
基金a scientific research grant from Health Bureau of Sichuan Province (No. F0201)
文摘Objective To construct four recombinant Lactococcus lactis strains exhibiting high β-galactosidase activity in fusion or non-fusion ways, and to study the influence factors for their protein expression and secretion. Methods The gene fragments encoding β-galactosidase from two strains of Loctobacillus bulgaricus, wch9901 isolated from yogurt and 1.1480 purchased from the Chinese Academy of Sciences, were amplified and inserted into lactococcal expression vector pMG36e. For fusion expression, the open reading frame of the β-galactosidase gene was amplified, while for non-fusion expression, the open reading frame of the β-galactosidase gene was amplified with its native Shine-Dalgarno sequence upstream. The start codon of the β-galactosidase gene partially overlapped with the stop codon of vector origin open reading frame. Then, the recombinant plasmids were transformed into Escherichia coli DH5α and Lactococcus lactis subsp, lactis MG1363 and confirmed by determining β-galactosidase activities. Results The non-fusion expression plasmids showed a significantly higher β-galactosidase activity in transformed strains than the fusion expression plasmids. The highest enzyme activity was observed in Lactococcus lactis transformed with the non-fusion expression plasmids which were inserted into the β-galactosidase gene from Lactobacillus bulgaricus wch9901. The β-galactosidase activity was 2.75 times as high as that of the native counterpart. In addition, β-galactosidase expressed by recombinant plasmids in Lactococcus lactis could be secreted into the culture medium. The highest secretion rate （27.1%） was observed when the culture medium contained 20 g/L of lactose. Conclusion Different properties of the native bacteria may have some effects on the protein expression of recombinant plasmids. Non-fusion expression shows a higher enzyme activity in host bacteria. There may be a host-related weak secretion signal peptide gene within the structure gene of Lb. bulgaricus β-galactosidase, and its translation product may introduce the enzyme secretion out of cells in special hosts.
