<strong>Background:</strong> The question of where to hospitalize extremely malnourished patients with anorexia nervosa (AN) is a real dilemma. On one hand, psychiatrists have to deal with severe medical c...<strong>Background:</strong> The question of where to hospitalize extremely malnourished patients with anorexia nervosa (AN) is a real dilemma. On one hand, psychiatrists have to deal with severe medical complications that are not within their competences and that justify hospitalization in an internal medicine ward. On the other hand, medical doctors have to face psychic decompensations that would justify admission to a psychiatric ward. In this context, we share our experience of management of severely malnourished AN adult patients in a transdisciplinary specialized eating disorders (ED) unit, referral center for AN associated with somatic severity. <strong>Method:</strong> First, we described the modalities of care proposed to patients with AN hospitalized in the medical unit. Intensive medical care, both somatic and psychiatric, are provided thanks to a transdisciplinary therapeutic program, where objectives are to: medically stabilize the patient, initiate progressive refeeding and start supportive psychotherapy before being transferred to a psychiatric ED unit. Secondly, we conducted a retrospective descriptive study that included all adult patients with AN admitted for the first time to the unit, between November 1997 and January 2014, for severe malnutrition and/or complications of the ED. Objective was to specify patients’ characteristics: demographic, nutritional status, history of ED, care pathway. <strong>Results: </strong>Among a cohort of 386 adult patients with AN (21 males and 365 females) admitted for the first time in the unit, mean age was 29.4 (±11.5) years, mean BMI was 12.7 (±2.2) kg/m<sup>2</sup>. Before being supported in the unit, 78.2% of patients had already been hospitalized in other hospitals. Mean length of stay was 35.2 days. Patients were clinically serious and unstable because of life-threatening somatic complications due to a low BMI. During hospital stay, a temporary transfer to medical intensive care unit was necessary for 25.6% of patients. Average patient weight gain was 0.777 kg per week and 81.9% of patients benefited from enteral nutrition.<strong> Conclusion: </strong>This specialized transdisciplinary unit where physician nutritionists and psychiatrists coordinate medical care together, allow a better understanding and management of extreme malnutrition associated with AN. Thanks to their expertise, care teams are less critical and less rejecting towards patients. Thus, therapeutic alliance could be optimized.展开更多
Background Pectin is a heteropolysaccharide that acts as an intestinal immunomodulator,promoting intestinal development and regulating intestinal flora in the gut.However,the relevant mechanisms remain obscure.In this...Background Pectin is a heteropolysaccharide that acts as an intestinal immunomodulator,promoting intestinal development and regulating intestinal flora in the gut.However,the relevant mechanisms remain obscure.In this study,pigs were fed a corn-soybean meal-based diet supplemented with either 5%microcrystalline cellulose(MCC)or 5%pectin for 3 weeks,to investigate the metabolites and anti-inflammatory properties of the jejunum.Result The results showed that dietary pectin supplementation improved intestinal integrity(Claudin-1,Occludin)and inflammatory response[interleukin(IL)-10],and the expression of proinflammatory cytokines(IL-1β,IL-6,IL-8,TNF-α)was down-regulated in the jejunum.Moreover,pectin supplementation altered the jejunal microbiome and tryptophan-related metabolites in piglets.Pectin specifically increased the abundance of Lactococcus,Enterococcus,and the microbiota-derived metabolites(skatole(ST),3-indoleacetic acid(IAA),3-indolepropionic acid(IPA),5-hydroxyindole-3-acetic acid(HIAA),and tryptamine(Tpm)),which activated the aryl hydrocarbon receptor(AhR)pathway.AhR activation modulates IL-22 and its downstream pathways.Correlation analysis revealed the potential relationship between metabolites and intestinal morphology,intestinal gene expression,and cytokine levels.Conclusion In conclusion,these results indicated that pectin inhibits the inflammatory response by enhancing the AhR-IL22-signal transducer and activator of transcription 3 signaling pathway,which is activated through tryptophan metabolites.展开更多
Acute pancreatitis(AP)has varying severity,and moderately severe and severe AP has prolonged hospitalization and requires multiple interventions.These patients are at risk of malnutrition.There is no proven pharmacoth...Acute pancreatitis(AP)has varying severity,and moderately severe and severe AP has prolonged hospitalization and requires multiple interventions.These patients are at risk of malnutrition.There is no proven pharmacotherapy for AP,however,apart from fluid resuscitation,analgesics,and organ support,nutrition plays an important role in the management of AP.Oral or enteral nutrition(EN)is the preferred route of nutrition in AP,however,in a subset of patients,parenteral nutrition is required.EN has various physiological benefits and decreases the risk of infection,intervention,and mortality.There is no proven role of probiotics,glutamine supplementation,antioxidants,and pancreatic enzyme replacement therapy in patients with AP.展开更多
AIM:To investigate the prevalence of undernutrition,risk of malnutrition and obesity in the Italian gastroenterological population.METHODS:The Italian Hospital Gastroenterology Association conducted an observational,c...AIM:To investigate the prevalence of undernutrition,risk of malnutrition and obesity in the Italian gastroenterological population.METHODS:The Italian Hospital Gastroenterology Association conducted an observational,cross-sectional multicenter study.Weight,weight loss,and body mass index were evaluated.Undernutrition was defined as unintentional weight loss>10%in the last threesix months.Values of Malnutrition Universal Screening Tool(MUST)>2,NRS-2002>3,and Mini Nutritional Assessment(MNA)from 17 to 25 identified risk of malnutrition in outpatients,inpatients and elderly patients,respectively.A body mass index≥30 indicated obesity.Gastrointestinal pathologies were categorized into acute,chronic and neoplastic diseases.RESULTS:A total of 513 patients participated in the study.The prevalence of undernutrition was 4.6%in outpatients and 19.6%in inpatients.Moreover,undernutrition was present in 4.3%of the gastrointestinal patients with chronic disease,11.0%of those with acute disease,and 17.6%of those with cancer.The risk of malnutrition increased progressively and significantly in chronic,acute and neoplastic gastrointestinal diseases in inpatients and the elderly population.Logistical regression analysis confirmed that cancer was a risk factor for undernutrition(OR=2.7;95%CI:1.2-6.44,P=0.02).Obesity and overweight were more frequent in outpatients.CONCLUSION:More than 63%of outpatients and 80%of inpatients in gastroenterological centers suffered from significant changes in body composition and required specific nutritional competence and treatment.展开更多
Nutrient deficiencies are prevalent worldwide.Diseases and morbid conditions have been described to result from nutritional deficiencies.It is essential to address nutrient deficiencies as these may lead to chronic lo...Nutrient deficiencies are prevalent worldwide.Diseases and morbid conditions have been described to result from nutritional deficiencies.It is essential to address nutrient deficiencies as these may lead to chronic longterm health problems such as rickets,iron deficiency anemia,goiter,obesity,coronary heart disease,type2 diabetes,stroke,cancer and osteoporosis.In the present review we surveyed the extent and severity of nutritional deficiencies in Israel through a selective and comprehensive Medline review of previous reports and studies performed during the last 40 years.Israel populations have multiple nutritional deficiencies,including iron,calcium,zinc,folic acid,and vitamins B12,C,D and E,spanning all age groups,several minorities,and specific regions.In Israel,some of the nutrients are mandatorily implemented and many of them are implemented voluntarily by local industries.We suggest ways to prevent and treat the nutritional deficiencies,as a step to promote food fortification in Israel.展开更多
The objectives were to evaluate the effects of a liquid nutritional supplement formulated for dogs on water intakes and urine output. A liquid nutritional supplement was tested by way of a cross-over design in 8 exper...The objectives were to evaluate the effects of a liquid nutritional supplement formulated for dogs on water intakes and urine output. A liquid nutritional supplement was tested by way of a cross-over design in 8 experimental healthy Beagle dogs (4 males and 4 females, aged 9.3 years). The supplement (87 percent water, 2.7 percent protein, 2.6 percent fat, 0.4 percent crude fiber) was added to water and tested at 2 incorporation rates (50 or 70 ml/day/dog—D50 or D70) versus the control placebo (CO-water only). The dogs were kept in a controlled environment;water intakes and urine output were measured. Individual water intakes were characterised by large variations. Mean water intake increased significantly by 28 percent in dogs receiving the liquid nutritional supplement, in both genders, irrespectively of the dosage. Urine output was also increased, by 55 percent. Faeces scores remained unchanged. It was concluded that the liquid supplement increased water intake and urine output in a safe way, without increasing dramatically the daily dietary sodium chloride intake. The recommended dosage of the manufacturer—50 ml/day for dogs weighing 10 - 20 kg BW is efficient. Increasing the dosage had no advantage, nor adverse effects. Increased water intake and urine output is of interest for dogs suffering from urolithiasis.展开更多
Background: This study assessed the effect of a nutrition education intervention. This intervention aimed to improve the knowledge, attitudes, and practices of mothers on food safety in the peri-urban areas of Bobo-Di...Background: This study assessed the effect of a nutrition education intervention. This intervention aimed to improve the knowledge, attitudes, and practices of mothers on food safety in the peri-urban areas of Bobo-Dioulasso in Burkina Faso. Methods: A total of 243 mothers of children under 5 years in the peri-urban of Bobo-Dioulasso were administered the FAO questionnaire for food safety knowledge, attitudes, and practices assessment during two cross-sectional surveys, before and after the intervention, in January and October 2017. The intervention included two components consisting of a theoretical phase (counselling and discussion) and cooking demonstrations implemented for ten months. To account for the before-and-after design of the study, the McNemar’s test was used to assess the effect of the intervention on food safety KAP of mothers of children under 5 years. Results: The mean age of mothers was 29 ± 6.2 years and 50.6% of them were between 20 and 29 years old. One for knowledge (cooking thoroughly with, p-value = 0.0001) and another for attitudes (perceived benefits of reheating leftovers before eating them, p-value = 0.0001), significantly increased after the intervention. In terms of food safety practices, all the indicators (cleaning of dirty surfaces, plates and utensils and storage of perishable foods) significantly increased (all p = 0.0001 Conclusion: This study provided some evidence of an effective nutrition education intervention for improving maternal KAP on food safety for their child’s feeding.展开更多
This letter critically evaluates Jiang et al's article on the differentiation of benign and malignant liver lesions using Emax and platelet count.Despite notable findings,significant methodological and interpretat...This letter critically evaluates Jiang et al's article on the differentiation of benign and malignant liver lesions using Emax and platelet count.Despite notable findings,significant methodological and interpretative limitations are identified.The study lacks detailed assay conditions for Emax measurement,employs inadequate statistical methods without robust multivariate analysis,and does not provide clinically relevant threshold values.The nomogram's reliance on Emax as a major diagnostic contributor is questionable due to attenuation in hepatocellular carcinoma patients with cirrhosis.Moreover,the study's limitations,such as selection bias and confounding factors,are not adequately addressed.Future research should adopt more rigorous methodologies,including prospective studies with larger cohorts and standardized protocols for biomarker measurement,to enhance validity and clinical applicability.展开更多
BACKGROUND Refractory esophageal strictures(ES)are defined an anatomical restriction without an active endoscopic inflammation resulting in dysphagia after a minimum of five seriated dilatations in a 4-weeks interval....BACKGROUND Refractory esophageal strictures(ES)are defined an anatomical restriction without an active endoscopic inflammation resulting in dysphagia after a minimum of five seriated dilatations in a 4-weeks interval.Recurrent ES(REES)refer to the inability to maintain a satisfactory luminal diameter for four weeks once an ageappropriate feeding diameter was achieved.Seriated endoscopic dilations are the reference maintenance for ES in pediatric age.Iterative dilations increase the risk of complications and may cause significant organic and psychological consequences in children and excessive costs for families and health systems.Furthermore,fibrotic modifications can make the surgery even more challenging.The surgical approach is burdened by high morbidity,with prolonged hospitalization and delayed oral refeeding in fragile patients with comorbidities.AIM To evaluate the efficacy and safety of the most recent adjuvant treatments,with the aim of avoiding or,at least,postponing surgery.METHODS Intralesional steroids or mitomycin C injections with antiproliferative and antifibroblastic properties have been attempted,but have been abandoned because of systemic adsorption,local complications,or lack of efficacy.Self-expanding metal stents are generally designed for the palliation of neoplastic strictures in adults and rarely employed in pediatrics because of the high risk of complications,in terms of stent migration,local pain and perforation.Our group developed a customized dynamic esophageal stent to stabilize esophageal patency and promote continuous dilatation determined by the food passage between the stent and the REES wall,but it requires an appropriate diameter for placement.RESULTS Recently peroral endoscopic tunneling for restoration of the esophagus has been employed to treat esophageal obstructions exploiting the submucosal space.Re-absorbable self-expanding stents(like SX-ELLA Stent Esophageal Degradable BD-BD stent)and energy-delivering surgical devices(HARMONIC ACE^(TM)+7 Laparoscope)have also been proposed.CONCLUSION After an overview about the historically applied adjuvant therapies,we aim to update the common knowledge with our recent experience of these new minimally invasive options for pediatric REES and refractory ES in three exemplary cases,focusing on their mid-term effectiveness and safety for the purpose of maintain the patency after standard endoscopic dilations and avoiding or,at least,postponing an invasive replacement surgery.展开更多
Functional gastrointestinal disorders,now termed“disorders of gut-brain interaction”(DGBI),are characterized by a spectrum of chronic gastrointestinal symptoms driven by dysregulated gut-brain interaction.DGBIs freq...Functional gastrointestinal disorders,now termed“disorders of gut-brain interaction”(DGBI),are characterized by a spectrum of chronic gastrointestinal symptoms driven by dysregulated gut-brain interaction.DGBIs frequently coexist with liver diseases,including cirrhosis,thereby exacerbating clinical manifestations and complicating management;this overlap is underpinned by shared mechanisms,including gut dysbiosis,increased intestinal permeability,systemic inflammation,and altered neuroimmune signaling.Portal hypertension in cirrhosis promotes small intestinal bacterial overgrowth and microbial translocation,thereby triggering inflammatory pathways that worsen gut and liver function.This minireview explores the gut-liver axis as a central mediator in the interplay between DGBIs and liver disease/cirrhosis.Clinically,these interactions manifest as refractory gastrointestinal symptoms,nutritional deficiencies,and impaired quality of life.Emerging research emphasizes the need for integrative diagnostic approaches,such as combining advanced imaging,microbiome analysis,and biomarker profiling,to unravel the complex interplay between DGBIs and liver disease/cirrhosis.Therapeutic interventions targeting the gut microbiome,neuroimmune pathways,and lifestyle modification can mitigate disease burden.This review underscores the importance of a multidisciplinary framework for enhancing patient outcomes and guiding future research in this intersectional field.展开更多
Background Hatch weight(HW)affects broiler growth and low HW(LHW)often leads to suboptimal performance.Sodium butyrate(SB)has been shown to promote growth through enhanced intestinal health.This study investi-gated ho...Background Hatch weight(HW)affects broiler growth and low HW(LHW)often leads to suboptimal performance.Sodium butyrate(SB)has been shown to promote growth through enhanced intestinal health.This study investi-gated how broilers with different HW responded to in ovo SB injection and whether SB could enhance gut health and performance in LHW chicks.Ross 308 broiler eggs were injected on incubation d 12 with physiological saline(control)or SB at 0.1%(SB1),0.3%(SB3),or 0.5%(SB5).Post-hatch,male chicks from each treatment were categorized as high HW(HHW)or LHW and assigned to 8 groups in a 4×2 factorial design.Production parameters were recorded periodically.Intestinal weight,length,and gene expression related to gut barrier function and immune response were examined on d 14 and 42.Cecal microbiota dynamics and predicted functionality were analyzed using 16S rRNA gene sequencing.Results SB treatments did not affect hatchability.HHW-control group exhibited consistently better weight gain and FCR than LHW-control group.SB dose-dependently influenced performance and gut health in both HW catego-ries,with greater effects in LHW broilers at 0.3%.LHW-SB3 group attained highest body weight on d 42,exceeding controls but not significantly differing from HHW-SB3 group.LHW-SB3 group showed upregulation of gut-barrier genes CLDN1 in ileum,TJP1 in jejunum and anti-inflammatory cytokine IL-10 in both jejunum and ileum on d 14.Addi-tionally,LHW-SB3 group upregulated mucin-producing MUC6 gene in ileum,while HHW-SB5 group increased pro-inflammatory IL-12p40 cytokine in caecum on d 42.LHW-SB3 group demonstrated shorter relative intestinal lengths,while HHW-SB5 had longer lengths.HHW-control group had higher bacterial diversity and growth-promoting bacte-ria while LHW-control group harbored the potential pathogen Helicobacter.SB reshaped gut microbiota biodiversity,composition,and predicted metabolic pathways in both HW categories.The LHW-SB3 group exhibited highest alpha diversity on d 14 and most beneficial bacteria at all timepoints.HHW-SB5 group presented increased pathogenic Escherichia-Shigella and Campylobacter on d 42.Conclusions HW significantly affects subsequent performance and SB has differential effects based on HW.LHW chicks benefited more from 0.3%SB,showing improvements in growth,intestinal development,health,and gut microbiota characteristics.展开更多
Once considered a concern solely for the gut,gluten is now recognized as an important factor in the pathogenesis of metabolic dysfunction-associated steatotic liver disease.Studies estimate that 18%-40%of individuals ...Once considered a concern solely for the gut,gluten is now recognized as an important factor in the pathogenesis of metabolic dysfunction-associated steatotic liver disease.Studies estimate that 18%-40%of individuals with gluten-related diseases have elevated liver enzyme levels,with 9%of patients with unexplained hypertransaminasemia ultimately diagnosed with gluten sensitivity.Hepatic manifestations of gluten sensitivity range from mild transaminase elevations to autoimmune liver diseases,metabolic dysfunction-associated steatotic liver disease,and even cirrhosis.Up to 50%of untreated cases of gluten-induced liver dysfunction show significant hepatic injury,which can lead to liver failure in severe cases.The pathophysiology is multifaceted and involves increased intestinal permeability,immune dysregulation,and shared genetic risk factors.A gluten-free diet leads to normalized liver enzymes in 75%-90%of cases within 1 year.Long-term gluten-free diet adherence has been paradoxically linked to higher body mass index,insulin resistance and increased hepatic steatosis risk,which raise concerns about its metabolic impact.Our review dissects the gluten-liver axis,emphasizing a need for early recognition,targeted screening,and personalized dietary interventions.Ultimately,given the increasing global burden of metabolic and autoimmune liver diseases,understanding gluten’s role is essential for optimizing liver health and preventing progressive hepatic injury.展开更多
Hepatocellular carcinoma(HCC) is the fourth cause of cancer related mortality, and its incidence is rapidly increasing. Viral hepatitis, alcohol abuse, and exposure to hepatotoxins are major risk factors, but nonalcoh...Hepatocellular carcinoma(HCC) is the fourth cause of cancer related mortality, and its incidence is rapidly increasing. Viral hepatitis, alcohol abuse, and exposure to hepatotoxins are major risk factors, but nonalcoholic fatty liver disease(NAFLD) associated with obesity, insulin resistance, and type 2 diabetes, is an increasingly recognized trigger, especially in developed countries. Older age, severity of insulin resistance and diabetes, and iron overload have been reported to predispose to HCC in this context. Remarkably, HCCs have been reported in non-cirrhotic livers in a higher proportion of cases in NAFLD patients than in other etiologies. Inherited factors have also been implicated to explain the different individual susceptibility to develop HCC, and their role seems magnified in fatty liver, where only a minority of affected subjects progresses to cancer. In particular, the common I148 M variant of the PNPLA3 gene influencing hepatic lipid metabolism influences HCC risk independently of its effect on the progression of liver fibrosis. Recently, rare loss-of-function mutations in Apolipoprotein B resulting in very low density lipoproteins hepatic retention and in Telomerase reverse transcriptase influencing cellular senescence have also been linked to HCC in NAFLD. Indeed, hepatic stellate cells senescence has been suggested to bridge tissue aging with alterations of the intestinal microbiota in the pathogenesis of obesity-related HCC. A deeper understanding of the mechanisms mediating hepatic carcinogenesis during insulin resistance, and the identification of its genetic determinants will hopefully provide new diagnostic and therapeutic tools.展开更多
The 148 Isoleucine to Methionine protein variant(I148M)of patatin-like phospholipase domain-containing 3(PNPLA3),a protein is expressed in the liver and is involved in lipid metabolism,has recently been identified as ...The 148 Isoleucine to Methionine protein variant(I148M)of patatin-like phospholipase domain-containing 3(PNPLA3),a protein is expressed in the liver and is involved in lipid metabolism,has recently been identified as a major determinant of liver fat content.Several studies confirmed that the I148M variant predisposes towards the full spectrum of liver damage associated with fatty liver:from simple steatosis to steatohepatitis and progressive fibrosis.Furthermore,the I148M variant represents a major determinant of progression of alcohol related steatohepatitis to cirrhosis,and to influence fibrogenesis and related clinical outcomes in chronic hepatitis C virus hepatitis,and possibly chronic hepatitis B virus hepatitis,hereditary hemochromatosis and primary sclerosing cholangitis.All in all,studies suggest that the I148M polymorphism may represent a general modifier of fibrogenesis in liver diseases.Remarkably,the effect of the I148M variant on fibrosis was independent of that on hepatic steatosis and inflammation,suggesting that it may affect both the quantity and quality of hepatic lipids and the biology of non-parenchymal liver cells besides hepatocytes,directly promoting fibrogenesis.Therefore,PNPLA3 is a key player in liver disease progression.Assessment of the I148M polymorphism will possibly inform clinical practice in the future,whereas the determination of the effect of the 148M variant will reveal mechanisms involved in hepatic fibrogenesis.展开更多
Pain is a common symptom of pancreatic disease and is frequently difficult to manage. Pain relief provided by narcotics is often suboptimal and is associated with significant side effects. An alternative approach to p...Pain is a common symptom of pancreatic disease and is frequently difficult to manage. Pain relief provided by narcotics is often suboptimal and is associated with significant side effects. An alternative approach to pain management in pancreatic disease is the use of celiac plexus block (CPB) or neurolysis (CPN). Originally performed by anesthesiologists and radiologists via a posterior approach,recent advances in endoscopic ultrasonography (EUS) have made this technique an attractive alternative. EUS guided celiac plexus block/ neurolysis is simple to perform and avoids serious complications such as paraplegia or pneumothorax that are associated with the posterior approach. EUS guided CPN should be considered first line therapy in patients with pain due to pancreatic cancer. It provides superior pain control compared to traditional management with narcotics. A trend for improved survival in pancreatic cancer patients treated with CPN has been reported,but larger studies are needed to confirm this finding. At this time,the use of EUS guided CPB cannot be recommended as routine therapy for pain in chronic pancreatitis since only one-half of the patients experience pain reduction and the beneficial effect tends to be short lived. EUS guided CPB and CPN should be used as part of a multidisciplinary team approach for pain management.展开更多
AIM: To investigate the effect of proton pump inhibitors (PPIs) on glycemic control (HbA1c) in type 2 diabetic patients. METHODS: A crosssectional study of consecutive in-patients admitted to hospital in any departmen...AIM: To investigate the effect of proton pump inhibitors (PPIs) on glycemic control (HbA1c) in type 2 diabetic patients. METHODS: A crosssectional study of consecutive in-patients admitted to hospital in any department during the fi rst semester of the year 2010 who had a recent HbA1c measurement. The study excluded those with a diagnosis of hyperglycemic decompensation, diabetic onset or pregnancy. It compared HbA1c levels of those taking PPIs and those not. RESULTS: A total of 97 patients were recruited. The average HbA1C level was 7.0% ± 1.2%. Overall PPI consumption was 55.7%. HbA1c was signif icantly lower in individuals who took PPIs: -0.6%, 95% CI: -0.12 to-0.83. People who used PPIs with some type of insulin therapy had a HbA1c reduction by -0.8%, 95% CI: -0.12 to -1.48. For the rest of subgroup analysis based on the antidiabetic drug used, PPI consumption always exhibited lower HbA1c levels. CONCLUSION: PPIs seems to be consistently associated with better glycemic control in type 2 diabetes. HbA1c reduction observed is similar to incretin-based therapies.展开更多
Bowel preparation is a core issue in colonoscopy,as it is closely related to the quality of the procedure.Patients often find that bowel preparation is the most unpleasant part of the examination.It is widely accepted...Bowel preparation is a core issue in colonoscopy,as it is closely related to the quality of the procedure.Patients often find that bowel preparation is the most unpleasant part of the examination.It is widely accepted that the quality of cleansing must be excellent to facilitate detecting neoplastic lesions.In spite of its importance and potential implications,until recently,bowel preparation has not been the subject of much study.The most commonly used agents are high-volume polyethylene glycol(PEG)electrolyte solution and sodium phosphate.There has been some confusion,even in published meta-analyses,regarding which of the two agents provides better cleansing.It is clear now that both PEG and sodium phosphate are effectivewhen administered with proper timing.Consequently,the timing of administration is recognized as one of the central factors to the quality of cleansing.The bowel preparation agent should be administered,at least in part,a few hours in advance of the colonoscopy.Several low volume agents are available,and either new or modified schedules with PEG that usually improve tolerance.Certain adjuvants can also be used to reduce the volume of PEG,or to improve the efficacy of other agents.Other factors apart from the choice of agent can improve the quality of bowel cleansing.For instance,the effect of diet before colonoscopy has not been completely clarified,but an exclusively liquid diet is probably not required,and a low-fiber diet may be preferable because it improves patient satisfaction and the quality of the procedure.Some patients,such as diabetics and persons with heart or kidney disease,require modified procedures and certain precautions.Bowel preparation for pediatric patients is also reviewed here.In such cases,PEG remains the most commonly used agent.As detecting neoplasia is not the main objective with these patients,less intensive preparation may suffice.Special considerations must be made for patients with inflammatory bowel disease,including safety and diagnostic issues,so that the most adequate agent is chosen.Identifying neoplasia is one of the main objectives of colonoscopy with these patients,and the target lesions are often almost invisible with white light endoscopy.Therefore excellent quality preparation is required to find these lesions and to apply advanced methods such as chromoendoscopy.Bowel preparation for patients with lower gastrointestinal bleeding represents a challenge,and the strategies available are also reviewed here.展开更多
Reverse cholesterol transport (RCT) is a complex process which transfers cholesterol from peripheral cells to the liver for subsequent elimination from the body via feces. Thyroid hormones (THs) affect growth, develop...Reverse cholesterol transport (RCT) is a complex process which transfers cholesterol from peripheral cells to the liver for subsequent elimination from the body via feces. Thyroid hormones (THs) affect growth, develop- ment, and metabolism in almost all tissues. THs exert their actions by binding to thyroid hormone receptors (TRs). There are two major subtypes of TRs, TRα and TRβ, and several isoforms (e.g. TRα1, TRα2, TRβ1, and TRβ2). Activation of TRα1 affects heart rate, whereas activation of TRβ1 has positive effects on lipid and lipoprotein metabolism. Consequently, particular interest has been focused on the development of thyromimetic compounds targeting TRβ1, not only because of their ability to lower plasma cholesterol but also due their ability to stimulate RCT, at least in pre-clinical models. In this review we focus on THs, TRs, and on the effects of TRβ1-modulating thyromimetics on RCT in various animal models and in humans.展开更多
Alginate oligosaccharides(AOS), belonging to the class of functional marine oligosaccharides, are low-molecular polymers linked by β-1,4-mannuronic acid(M) and α-1,4-guluronic acid(G), which could be classically obt...Alginate oligosaccharides(AOS), belonging to the class of functional marine oligosaccharides, are low-molecular polymers linked by β-1,4-mannuronic acid(M) and α-1,4-guluronic acid(G), which could be classically obtained by enzymatic hydrolysis of alginate. With low viscosity and good water solubility, as well as anti-oxidant, immune regulation, anti-bacterial and antiinflammatory activities, AOS have been widely used in medical science and functional food, green agriculture and other fields. As new bio-feed additives, AOS have broad potential applications in animal husbandry. In this review, the sources of alginate, chemical structure and preparation methods of AOS, and their biological activities and application in livestock and poultry are summarized. We expect this review could contribute to lay a foundation of application and further research for AOS in livestock and poultry.展开更多
文摘<strong>Background:</strong> The question of where to hospitalize extremely malnourished patients with anorexia nervosa (AN) is a real dilemma. On one hand, psychiatrists have to deal with severe medical complications that are not within their competences and that justify hospitalization in an internal medicine ward. On the other hand, medical doctors have to face psychic decompensations that would justify admission to a psychiatric ward. In this context, we share our experience of management of severely malnourished AN adult patients in a transdisciplinary specialized eating disorders (ED) unit, referral center for AN associated with somatic severity. <strong>Method:</strong> First, we described the modalities of care proposed to patients with AN hospitalized in the medical unit. Intensive medical care, both somatic and psychiatric, are provided thanks to a transdisciplinary therapeutic program, where objectives are to: medically stabilize the patient, initiate progressive refeeding and start supportive psychotherapy before being transferred to a psychiatric ED unit. Secondly, we conducted a retrospective descriptive study that included all adult patients with AN admitted for the first time to the unit, between November 1997 and January 2014, for severe malnutrition and/or complications of the ED. Objective was to specify patients’ characteristics: demographic, nutritional status, history of ED, care pathway. <strong>Results: </strong>Among a cohort of 386 adult patients with AN (21 males and 365 females) admitted for the first time in the unit, mean age was 29.4 (±11.5) years, mean BMI was 12.7 (±2.2) kg/m<sup>2</sup>. Before being supported in the unit, 78.2% of patients had already been hospitalized in other hospitals. Mean length of stay was 35.2 days. Patients were clinically serious and unstable because of life-threatening somatic complications due to a low BMI. During hospital stay, a temporary transfer to medical intensive care unit was necessary for 25.6% of patients. Average patient weight gain was 0.777 kg per week and 81.9% of patients benefited from enteral nutrition.<strong> Conclusion: </strong>This specialized transdisciplinary unit where physician nutritionists and psychiatrists coordinate medical care together, allow a better understanding and management of extreme malnutrition associated with AN. Thanks to their expertise, care teams are less critical and less rejecting towards patients. Thus, therapeutic alliance could be optimized.
基金supported by National Natural Science Foundation of China(NSFC)(31802072)China Scholarship Council(CSC NO.202103250006)+1 种基金the Central Public-interest Scientific Institution Basal Research Fund(No.Y2022GH02&PJ01618301)State Key Laboratory of Animal Nutrition(2004DA125184G2102)。
文摘Background Pectin is a heteropolysaccharide that acts as an intestinal immunomodulator,promoting intestinal development and regulating intestinal flora in the gut.However,the relevant mechanisms remain obscure.In this study,pigs were fed a corn-soybean meal-based diet supplemented with either 5%microcrystalline cellulose(MCC)or 5%pectin for 3 weeks,to investigate the metabolites and anti-inflammatory properties of the jejunum.Result The results showed that dietary pectin supplementation improved intestinal integrity(Claudin-1,Occludin)and inflammatory response[interleukin(IL)-10],and the expression of proinflammatory cytokines(IL-1β,IL-6,IL-8,TNF-α)was down-regulated in the jejunum.Moreover,pectin supplementation altered the jejunal microbiome and tryptophan-related metabolites in piglets.Pectin specifically increased the abundance of Lactococcus,Enterococcus,and the microbiota-derived metabolites(skatole(ST),3-indoleacetic acid(IAA),3-indolepropionic acid(IPA),5-hydroxyindole-3-acetic acid(HIAA),and tryptamine(Tpm)),which activated the aryl hydrocarbon receptor(AhR)pathway.AhR activation modulates IL-22 and its downstream pathways.Correlation analysis revealed the potential relationship between metabolites and intestinal morphology,intestinal gene expression,and cytokine levels.Conclusion In conclusion,these results indicated that pectin inhibits the inflammatory response by enhancing the AhR-IL22-signal transducer and activator of transcription 3 signaling pathway,which is activated through tryptophan metabolites.
文摘Acute pancreatitis(AP)has varying severity,and moderately severe and severe AP has prolonged hospitalization and requires multiple interventions.These patients are at risk of malnutrition.There is no proven pharmacotherapy for AP,however,apart from fluid resuscitation,analgesics,and organ support,nutrition plays an important role in the management of AP.Oral or enteral nutrition(EN)is the preferred route of nutrition in AP,however,in a subset of patients,parenteral nutrition is required.EN has various physiological benefits and decreases the risk of infection,intervention,and mortality.There is no proven role of probiotics,glutamine supplementation,antioxidants,and pancreatic enzyme replacement therapy in patients with AP.
文摘AIM:To investigate the prevalence of undernutrition,risk of malnutrition and obesity in the Italian gastroenterological population.METHODS:The Italian Hospital Gastroenterology Association conducted an observational,cross-sectional multicenter study.Weight,weight loss,and body mass index were evaluated.Undernutrition was defined as unintentional weight loss>10%in the last threesix months.Values of Malnutrition Universal Screening Tool(MUST)>2,NRS-2002>3,and Mini Nutritional Assessment(MNA)from 17 to 25 identified risk of malnutrition in outpatients,inpatients and elderly patients,respectively.A body mass index≥30 indicated obesity.Gastrointestinal pathologies were categorized into acute,chronic and neoplastic diseases.RESULTS:A total of 513 patients participated in the study.The prevalence of undernutrition was 4.6%in outpatients and 19.6%in inpatients.Moreover,undernutrition was present in 4.3%of the gastrointestinal patients with chronic disease,11.0%of those with acute disease,and 17.6%of those with cancer.The risk of malnutrition increased progressively and significantly in chronic,acute and neoplastic gastrointestinal diseases in inpatients and the elderly population.Logistical regression analysis confirmed that cancer was a risk factor for undernutrition(OR=2.7;95%CI:1.2-6.44,P=0.02).Obesity and overweight were more frequent in outpatients.CONCLUSION:More than 63%of outpatients and 80%of inpatients in gastroenterological centers suffered from significant changes in body composition and required specific nutritional competence and treatment.
文摘Nutrient deficiencies are prevalent worldwide.Diseases and morbid conditions have been described to result from nutritional deficiencies.It is essential to address nutrient deficiencies as these may lead to chronic longterm health problems such as rickets,iron deficiency anemia,goiter,obesity,coronary heart disease,type2 diabetes,stroke,cancer and osteoporosis.In the present review we surveyed the extent and severity of nutritional deficiencies in Israel through a selective and comprehensive Medline review of previous reports and studies performed during the last 40 years.Israel populations have multiple nutritional deficiencies,including iron,calcium,zinc,folic acid,and vitamins B12,C,D and E,spanning all age groups,several minorities,and specific regions.In Israel,some of the nutrients are mandatorily implemented and many of them are implemented voluntarily by local industries.We suggest ways to prevent and treat the nutritional deficiencies,as a step to promote food fortification in Israel.
文摘The objectives were to evaluate the effects of a liquid nutritional supplement formulated for dogs on water intakes and urine output. A liquid nutritional supplement was tested by way of a cross-over design in 8 experimental healthy Beagle dogs (4 males and 4 females, aged 9.3 years). The supplement (87 percent water, 2.7 percent protein, 2.6 percent fat, 0.4 percent crude fiber) was added to water and tested at 2 incorporation rates (50 or 70 ml/day/dog—D50 or D70) versus the control placebo (CO-water only). The dogs were kept in a controlled environment;water intakes and urine output were measured. Individual water intakes were characterised by large variations. Mean water intake increased significantly by 28 percent in dogs receiving the liquid nutritional supplement, in both genders, irrespectively of the dosage. Urine output was also increased, by 55 percent. Faeces scores remained unchanged. It was concluded that the liquid supplement increased water intake and urine output in a safe way, without increasing dramatically the daily dietary sodium chloride intake. The recommended dosage of the manufacturer—50 ml/day for dogs weighing 10 - 20 kg BW is efficient. Increasing the dosage had no advantage, nor adverse effects. Increased water intake and urine output is of interest for dogs suffering from urolithiasis.
文摘Background: This study assessed the effect of a nutrition education intervention. This intervention aimed to improve the knowledge, attitudes, and practices of mothers on food safety in the peri-urban areas of Bobo-Dioulasso in Burkina Faso. Methods: A total of 243 mothers of children under 5 years in the peri-urban of Bobo-Dioulasso were administered the FAO questionnaire for food safety knowledge, attitudes, and practices assessment during two cross-sectional surveys, before and after the intervention, in January and October 2017. The intervention included two components consisting of a theoretical phase (counselling and discussion) and cooking demonstrations implemented for ten months. To account for the before-and-after design of the study, the McNemar’s test was used to assess the effect of the intervention on food safety KAP of mothers of children under 5 years. Results: The mean age of mothers was 29 ± 6.2 years and 50.6% of them were between 20 and 29 years old. One for knowledge (cooking thoroughly with, p-value = 0.0001) and another for attitudes (perceived benefits of reheating leftovers before eating them, p-value = 0.0001), significantly increased after the intervention. In terms of food safety practices, all the indicators (cleaning of dirty surfaces, plates and utensils and storage of perishable foods) significantly increased (all p = 0.0001 Conclusion: This study provided some evidence of an effective nutrition education intervention for improving maternal KAP on food safety for their child’s feeding.
文摘This letter critically evaluates Jiang et al's article on the differentiation of benign and malignant liver lesions using Emax and platelet count.Despite notable findings,significant methodological and interpretative limitations are identified.The study lacks detailed assay conditions for Emax measurement,employs inadequate statistical methods without robust multivariate analysis,and does not provide clinically relevant threshold values.The nomogram's reliance on Emax as a major diagnostic contributor is questionable due to attenuation in hepatocellular carcinoma patients with cirrhosis.Moreover,the study's limitations,such as selection bias and confounding factors,are not adequately addressed.Future research should adopt more rigorous methodologies,including prospective studies with larger cohorts and standardized protocols for biomarker measurement,to enhance validity and clinical applicability.
文摘BACKGROUND Refractory esophageal strictures(ES)are defined an anatomical restriction without an active endoscopic inflammation resulting in dysphagia after a minimum of five seriated dilatations in a 4-weeks interval.Recurrent ES(REES)refer to the inability to maintain a satisfactory luminal diameter for four weeks once an ageappropriate feeding diameter was achieved.Seriated endoscopic dilations are the reference maintenance for ES in pediatric age.Iterative dilations increase the risk of complications and may cause significant organic and psychological consequences in children and excessive costs for families and health systems.Furthermore,fibrotic modifications can make the surgery even more challenging.The surgical approach is burdened by high morbidity,with prolonged hospitalization and delayed oral refeeding in fragile patients with comorbidities.AIM To evaluate the efficacy and safety of the most recent adjuvant treatments,with the aim of avoiding or,at least,postponing surgery.METHODS Intralesional steroids or mitomycin C injections with antiproliferative and antifibroblastic properties have been attempted,but have been abandoned because of systemic adsorption,local complications,or lack of efficacy.Self-expanding metal stents are generally designed for the palliation of neoplastic strictures in adults and rarely employed in pediatrics because of the high risk of complications,in terms of stent migration,local pain and perforation.Our group developed a customized dynamic esophageal stent to stabilize esophageal patency and promote continuous dilatation determined by the food passage between the stent and the REES wall,but it requires an appropriate diameter for placement.RESULTS Recently peroral endoscopic tunneling for restoration of the esophagus has been employed to treat esophageal obstructions exploiting the submucosal space.Re-absorbable self-expanding stents(like SX-ELLA Stent Esophageal Degradable BD-BD stent)and energy-delivering surgical devices(HARMONIC ACE^(TM)+7 Laparoscope)have also been proposed.CONCLUSION After an overview about the historically applied adjuvant therapies,we aim to update the common knowledge with our recent experience of these new minimally invasive options for pediatric REES and refractory ES in three exemplary cases,focusing on their mid-term effectiveness and safety for the purpose of maintain the patency after standard endoscopic dilations and avoiding or,at least,postponing an invasive replacement surgery.
文摘Functional gastrointestinal disorders,now termed“disorders of gut-brain interaction”(DGBI),are characterized by a spectrum of chronic gastrointestinal symptoms driven by dysregulated gut-brain interaction.DGBIs frequently coexist with liver diseases,including cirrhosis,thereby exacerbating clinical manifestations and complicating management;this overlap is underpinned by shared mechanisms,including gut dysbiosis,increased intestinal permeability,systemic inflammation,and altered neuroimmune signaling.Portal hypertension in cirrhosis promotes small intestinal bacterial overgrowth and microbial translocation,thereby triggering inflammatory pathways that worsen gut and liver function.This minireview explores the gut-liver axis as a central mediator in the interplay between DGBIs and liver disease/cirrhosis.Clinically,these interactions manifest as refractory gastrointestinal symptoms,nutritional deficiencies,and impaired quality of life.Emerging research emphasizes the need for integrative diagnostic approaches,such as combining advanced imaging,microbiome analysis,and biomarker profiling,to unravel the complex interplay between DGBIs and liver disease/cirrhosis.Therapeutic interventions targeting the gut microbiome,neuroimmune pathways,and lifestyle modification can mitigate disease burden.This review underscores the importance of a multidisciplinary framework for enhancing patient outcomes and guiding future research in this intersectional field.
基金financially supported article publication charges under the program"Regional Initiative of Excellence"(RID/SP/0017/2024/01)funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie Grant Agreement No. 955374。
文摘Background Hatch weight(HW)affects broiler growth and low HW(LHW)often leads to suboptimal performance.Sodium butyrate(SB)has been shown to promote growth through enhanced intestinal health.This study investi-gated how broilers with different HW responded to in ovo SB injection and whether SB could enhance gut health and performance in LHW chicks.Ross 308 broiler eggs were injected on incubation d 12 with physiological saline(control)or SB at 0.1%(SB1),0.3%(SB3),or 0.5%(SB5).Post-hatch,male chicks from each treatment were categorized as high HW(HHW)or LHW and assigned to 8 groups in a 4×2 factorial design.Production parameters were recorded periodically.Intestinal weight,length,and gene expression related to gut barrier function and immune response were examined on d 14 and 42.Cecal microbiota dynamics and predicted functionality were analyzed using 16S rRNA gene sequencing.Results SB treatments did not affect hatchability.HHW-control group exhibited consistently better weight gain and FCR than LHW-control group.SB dose-dependently influenced performance and gut health in both HW catego-ries,with greater effects in LHW broilers at 0.3%.LHW-SB3 group attained highest body weight on d 42,exceeding controls but not significantly differing from HHW-SB3 group.LHW-SB3 group showed upregulation of gut-barrier genes CLDN1 in ileum,TJP1 in jejunum and anti-inflammatory cytokine IL-10 in both jejunum and ileum on d 14.Addi-tionally,LHW-SB3 group upregulated mucin-producing MUC6 gene in ileum,while HHW-SB5 group increased pro-inflammatory IL-12p40 cytokine in caecum on d 42.LHW-SB3 group demonstrated shorter relative intestinal lengths,while HHW-SB5 had longer lengths.HHW-control group had higher bacterial diversity and growth-promoting bacte-ria while LHW-control group harbored the potential pathogen Helicobacter.SB reshaped gut microbiota biodiversity,composition,and predicted metabolic pathways in both HW categories.The LHW-SB3 group exhibited highest alpha diversity on d 14 and most beneficial bacteria at all timepoints.HHW-SB5 group presented increased pathogenic Escherichia-Shigella and Campylobacter on d 42.Conclusions HW significantly affects subsequent performance and SB has differential effects based on HW.LHW chicks benefited more from 0.3%SB,showing improvements in growth,intestinal development,health,and gut microbiota characteristics.
文摘Once considered a concern solely for the gut,gluten is now recognized as an important factor in the pathogenesis of metabolic dysfunction-associated steatotic liver disease.Studies estimate that 18%-40%of individuals with gluten-related diseases have elevated liver enzyme levels,with 9%of patients with unexplained hypertransaminasemia ultimately diagnosed with gluten sensitivity.Hepatic manifestations of gluten sensitivity range from mild transaminase elevations to autoimmune liver diseases,metabolic dysfunction-associated steatotic liver disease,and even cirrhosis.Up to 50%of untreated cases of gluten-induced liver dysfunction show significant hepatic injury,which can lead to liver failure in severe cases.The pathophysiology is multifaceted and involves increased intestinal permeability,immune dysregulation,and shared genetic risk factors.A gluten-free diet leads to normalized liver enzymes in 75%-90%of cases within 1 year.Long-term gluten-free diet adherence has been paradoxically linked to higher body mass index,insulin resistance and increased hepatic steatosis risk,which raise concerns about its metabolic impact.Our review dissects the gluten-liver axis,emphasizing a need for early recognition,targeted screening,and personalized dietary interventions.Ultimately,given the increasing global burden of metabolic and autoimmune liver diseases,understanding gluten’s role is essential for optimizing liver health and preventing progressive hepatic injury.
文摘Hepatocellular carcinoma(HCC) is the fourth cause of cancer related mortality, and its incidence is rapidly increasing. Viral hepatitis, alcohol abuse, and exposure to hepatotoxins are major risk factors, but nonalcoholic fatty liver disease(NAFLD) associated with obesity, insulin resistance, and type 2 diabetes, is an increasingly recognized trigger, especially in developed countries. Older age, severity of insulin resistance and diabetes, and iron overload have been reported to predispose to HCC in this context. Remarkably, HCCs have been reported in non-cirrhotic livers in a higher proportion of cases in NAFLD patients than in other etiologies. Inherited factors have also been implicated to explain the different individual susceptibility to develop HCC, and their role seems magnified in fatty liver, where only a minority of affected subjects progresses to cancer. In particular, the common I148 M variant of the PNPLA3 gene influencing hepatic lipid metabolism influences HCC risk independently of its effect on the progression of liver fibrosis. Recently, rare loss-of-function mutations in Apolipoprotein B resulting in very low density lipoproteins hepatic retention and in Telomerase reverse transcriptase influencing cellular senescence have also been linked to HCC in NAFLD. Indeed, hepatic stellate cells senescence has been suggested to bridge tissue aging with alterations of the intestinal microbiota in the pathogenesis of obesity-related HCC. A deeper understanding of the mechanisms mediating hepatic carcinogenesis during insulin resistance, and the identification of its genetic determinants will hopefully provide new diagnostic and therapeutic tools.
基金Supported by Associazione Malattie Metaboliche del Fegato ONLUS(Non-profit organization for the Study and Care of Metabolic Liver Diseases)Centro Studi Malattie Metaboliche del Fegato,Universitàdegli Studi di Milano
文摘The 148 Isoleucine to Methionine protein variant(I148M)of patatin-like phospholipase domain-containing 3(PNPLA3),a protein is expressed in the liver and is involved in lipid metabolism,has recently been identified as a major determinant of liver fat content.Several studies confirmed that the I148M variant predisposes towards the full spectrum of liver damage associated with fatty liver:from simple steatosis to steatohepatitis and progressive fibrosis.Furthermore,the I148M variant represents a major determinant of progression of alcohol related steatohepatitis to cirrhosis,and to influence fibrogenesis and related clinical outcomes in chronic hepatitis C virus hepatitis,and possibly chronic hepatitis B virus hepatitis,hereditary hemochromatosis and primary sclerosing cholangitis.All in all,studies suggest that the I148M polymorphism may represent a general modifier of fibrogenesis in liver diseases.Remarkably,the effect of the I148M variant on fibrosis was independent of that on hepatic steatosis and inflammation,suggesting that it may affect both the quantity and quality of hepatic lipids and the biology of non-parenchymal liver cells besides hepatocytes,directly promoting fibrogenesis.Therefore,PNPLA3 is a key player in liver disease progression.Assessment of the I148M polymorphism will possibly inform clinical practice in the future,whereas the determination of the effect of the 148M variant will reveal mechanisms involved in hepatic fibrogenesis.
文摘Pain is a common symptom of pancreatic disease and is frequently difficult to manage. Pain relief provided by narcotics is often suboptimal and is associated with significant side effects. An alternative approach to pain management in pancreatic disease is the use of celiac plexus block (CPB) or neurolysis (CPN). Originally performed by anesthesiologists and radiologists via a posterior approach,recent advances in endoscopic ultrasonography (EUS) have made this technique an attractive alternative. EUS guided celiac plexus block/ neurolysis is simple to perform and avoids serious complications such as paraplegia or pneumothorax that are associated with the posterior approach. EUS guided CPN should be considered first line therapy in patients with pain due to pancreatic cancer. It provides superior pain control compared to traditional management with narcotics. A trend for improved survival in pancreatic cancer patients treated with CPN has been reported,but larger studies are needed to confirm this finding. At this time,the use of EUS guided CPB cannot be recommended as routine therapy for pain in chronic pancreatitis since only one-half of the patients experience pain reduction and the beneficial effect tends to be short lived. EUS guided CPB and CPN should be used as part of a multidisciplinary team approach for pain management.
文摘AIM: To investigate the effect of proton pump inhibitors (PPIs) on glycemic control (HbA1c) in type 2 diabetic patients. METHODS: A crosssectional study of consecutive in-patients admitted to hospital in any department during the fi rst semester of the year 2010 who had a recent HbA1c measurement. The study excluded those with a diagnosis of hyperglycemic decompensation, diabetic onset or pregnancy. It compared HbA1c levels of those taking PPIs and those not. RESULTS: A total of 97 patients were recruited. The average HbA1C level was 7.0% ± 1.2%. Overall PPI consumption was 55.7%. HbA1c was signif icantly lower in individuals who took PPIs: -0.6%, 95% CI: -0.12 to-0.83. People who used PPIs with some type of insulin therapy had a HbA1c reduction by -0.8%, 95% CI: -0.12 to -1.48. For the rest of subgroup analysis based on the antidiabetic drug used, PPI consumption always exhibited lower HbA1c levels. CONCLUSION: PPIs seems to be consistently associated with better glycemic control in type 2 diabetes. HbA1c reduction observed is similar to incretin-based therapies.
文摘Bowel preparation is a core issue in colonoscopy,as it is closely related to the quality of the procedure.Patients often find that bowel preparation is the most unpleasant part of the examination.It is widely accepted that the quality of cleansing must be excellent to facilitate detecting neoplastic lesions.In spite of its importance and potential implications,until recently,bowel preparation has not been the subject of much study.The most commonly used agents are high-volume polyethylene glycol(PEG)electrolyte solution and sodium phosphate.There has been some confusion,even in published meta-analyses,regarding which of the two agents provides better cleansing.It is clear now that both PEG and sodium phosphate are effectivewhen administered with proper timing.Consequently,the timing of administration is recognized as one of the central factors to the quality of cleansing.The bowel preparation agent should be administered,at least in part,a few hours in advance of the colonoscopy.Several low volume agents are available,and either new or modified schedules with PEG that usually improve tolerance.Certain adjuvants can also be used to reduce the volume of PEG,or to improve the efficacy of other agents.Other factors apart from the choice of agent can improve the quality of bowel cleansing.For instance,the effect of diet before colonoscopy has not been completely clarified,but an exclusively liquid diet is probably not required,and a low-fiber diet may be preferable because it improves patient satisfaction and the quality of the procedure.Some patients,such as diabetics and persons with heart or kidney disease,require modified procedures and certain precautions.Bowel preparation for pediatric patients is also reviewed here.In such cases,PEG remains the most commonly used agent.As detecting neoplasia is not the main objective with these patients,less intensive preparation may suffice.Special considerations must be made for patients with inflammatory bowel disease,including safety and diagnostic issues,so that the most adequate agent is chosen.Identifying neoplasia is one of the main objectives of colonoscopy with these patients,and the target lesions are often almost invisible with white light endoscopy.Therefore excellent quality preparation is required to find these lesions and to apply advanced methods such as chromoendoscopy.Bowel preparation for patients with lower gastrointestinal bleeding represents a challenge,and the strategies available are also reviewed here.
基金Supported by Research Award from KaroBio AB, Sweden (to Parini P)
文摘Reverse cholesterol transport (RCT) is a complex process which transfers cholesterol from peripheral cells to the liver for subsequent elimination from the body via feces. Thyroid hormones (THs) affect growth, develop- ment, and metabolism in almost all tissues. THs exert their actions by binding to thyroid hormone receptors (TRs). There are two major subtypes of TRs, TRα and TRβ, and several isoforms (e.g. TRα1, TRα2, TRβ1, and TRβ2). Activation of TRα1 affects heart rate, whereas activation of TRβ1 has positive effects on lipid and lipoprotein metabolism. Consequently, particular interest has been focused on the development of thyromimetic compounds targeting TRβ1, not only because of their ability to lower plasma cholesterol but also due their ability to stimulate RCT, at least in pre-clinical models. In this review we focus on THs, TRs, and on the effects of TRβ1-modulating thyromimetics on RCT in various animal models and in humans.
基金the National Key R&D Program of China (2016YFD0500501)the National Natural Science Foundation of China (31772641)the Basic Science and Research Funding of Institute of Animal Sciences of Chinese Academy of Agricultural Sciences, China (2018-YWF-YB-11)。
文摘Alginate oligosaccharides(AOS), belonging to the class of functional marine oligosaccharides, are low-molecular polymers linked by β-1,4-mannuronic acid(M) and α-1,4-guluronic acid(G), which could be classically obtained by enzymatic hydrolysis of alginate. With low viscosity and good water solubility, as well as anti-oxidant, immune regulation, anti-bacterial and antiinflammatory activities, AOS have been widely used in medical science and functional food, green agriculture and other fields. As new bio-feed additives, AOS have broad potential applications in animal husbandry. In this review, the sources of alginate, chemical structure and preparation methods of AOS, and their biological activities and application in livestock and poultry are summarized. We expect this review could contribute to lay a foundation of application and further research for AOS in livestock and poultry.
