Gastrointestinal motility and neurogastroenterology

Abstract

Nordic research on gastrointestinal motility has since 1965 made substantial contributions to our current understanding of gastrointestinal function. During the last decade, the term neurogastroenterology has widened the concept of motility research into the study of gastrointestinal sensory-motor function, including the complex central nervous system interaction. The discovery of a non-adrenergic non-cholinergic (NANC) innervation of the gut in the sixties was made by considerable contributions from the Nordic countries with the Martinson group in Sweden as central innovators. Important discoveries regarding the intramural nerve ganglia as mediators of the autonomic nervous input has also been produced from this research. In clinical motility research, the study of the migrating motor complex in the small bowel has revealed its ability to act as a retroperistaltic pump in the proximal duodenum (Sweden) and its important role for gut microbial homeostasis (Norway). Also in the development of methodology to study gut sensory-motor function, the Nordic countries has contributed. Examples are the physical characteristics of the esophageal manometry catheter (Denmark), the use of ultrasound for assessment of gastric function (Norway), a temporary electrical stimulation method in patients with severe nausea and vomiting (Sweden), a rectal barostat method for clinical evaluation of recto-anal function and a colonic transit time method utilizing radio-opaque markers (Sweden). In later years, the research collaborations have increasingly become worldwide in a manner making it less easy to define pure Nordic contributions.     

血管性认知障碍的诊断

血管性认知障碍(vascular cognitive inpairment,VCI)是由脑血管危险因素(如高血压、糖尿病和高脂血症等)、明显(如脑梗死和脑出血等)或不明显的脑血管病(如白质疏松症和慢性脑缺血)引起的从轻度认知障碍到痴呆的一大类综合征.准确的早期诊断町提供最佳的治疗机会,并延缓病情的发展.近年来,对VCI的研究取得了很大进展.文章对VCI从病因、临床表现、神经心理学、影像学、神经电生理、生物学标志物和诊断标准等方面做了综述.     

广东省住院患者糖脂代谢状况与合并症调查

目的 了解住院病人糖和脂代谢状态、调脂达标现状及对合并症的影响,以提高临床医务工作者对糖、脂代谢紊乱认知意识和防治水平.方法 采用横断面调查方法,对广东省10家大学附属医院同期住院的8753例患者登记病史、空腹血糖(FBG),行体脂和血脂分析.已诊断糖尿病(PDM)和FBG≥5.6 mmo]/L未诊断精尿病患者填写病例报告表;5.6 mmol/L≤FBG≤6.9 mmol/L者行口服葡萄糖耐量试验(OGTT).结果 PDM和未诊断糖尿病FBG≥5.6 mmol/L资料完整者1067例.未诊断糖尿病5.6 mmol/L≤FBG≤6.9 mmol/L行OGTT检查者占65.8%(325/494).PDM 447例,占41.9%,新诊断糖尿病(NDM)占21.7%,糖调节异常(IGR)占29.1%,正常糖耐量(NGT)7.3%.TG水平NDM组和PDM组高于NGT组和IGR组(P值均<0.05),HDL-C水平NGT组高于糖耐最异常各组(P值均<0.05).血脂异常的比例IGR组52.5%,NGT组56.4%,糖尿病(NDM+PDM)组69.6%.22.8%PDM患者接受系统调脂治疗,达标率3.4%.IGR、NDM和PDM组BMI和腰围大于NGT组(P值均<0.05),腰围PDM组大于IGR组(P<0.01).PDM组合并1种以上血管病变者占72.8%,NDM患者9.7%并发糖尿病肾病,0.2%并发糖尿病视网膜病变.结论 住院糖尿病和IGR患者合并脂质代谢异常的比例显著高于NGT住院患者,以高TG和低HDL-C血症为主.住院PDM患者合并血管病变的比例显著高于其他患者,部分NDM和IGT患者已并发微血管病变.     

北京双井社区居民血管性认知功能障碍知识知晓率调查

目的 初步了解北京双井社区居民对血管性认知功能障碍(VCI)知识的知晓率.方法在双井12个社区中,随机抽取5个,共512例,其中男性197例,女性315例,平均年龄(64.7±8.2)岁;初中及以上文化程度占87.9％;在2013年1月至3月,采用发放问卷方法进行VCI自制问卷调查. 结果 虽然对血管性痴呆的知晓率仅36.9％,但对记忆力、定向力、语言、执行功能、计算力、视空间能力及判断力等症状的知晓率为43.8％～89.3％.对痴呆患者4个就诊门诊的知晓率为21.5％～38.9％,而对痴呆不可以根治的知晓率仅47.5％.在脑卒中5个危险因素中,其知晓率达54.5％～83.4％,但对低血压和低血糖损害认知功能的知晓率分别为42.8％和43.2％.在预防知识中,对VCI高危人群、认知筛查及一级预防等知识的知晓率为35.5％～95.5％.双井社区居民获取健康知识的主要途径是电视和报纸,分别占86.9％和60.2％;赞成健康教育对生活有帮助的达85.9％.多元线性回归分析结果显示,VCI知识积分与性别和文化程度相关性差异有统计学意义(P＜0.05). 结论 双井社区居民对VCI危险因素、诊治及预防等部分知识知晓率低,这需要加大VCI健康教育的力度.     

急性缺血性脑卒中后认知障碍患者精神行为症状的特征性分析

目的探讨急性缺血性脑卒中后认知障碍(PSCI)患者精神行为症状(BPS)发生的特征。方法纳入2018年1月~2019年5月苏北人民医院神经内科住院的急性脑梗死患者105例,PSCI患者73例分为脑卒中后痴呆(PSD)组28例和脑卒中后认知障碍非痴呆(PSCI-ND)组45例,脑卒中后非认知障碍(非PSCI)组32例。PSCI患者又分为BPS组50例和非BPS组23例。根据英国牛津郡社区脑卒中规划分型,将急性脑梗死患者分为部分前循环梗死型(PACI)、后循环梗死型和腔隙性脑梗死型(LACI)。认知功能评估采用简易智能状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA),BPS评估采用神经精神问卷(NPI)。评价患者日常生活活动能力量表(ADL),并收集相关临床资料。结果PSD组和PSCI-ND组NIHSS评分、NPI总分、BPS发生率均明显高于非PSCI组,教育年限明显低于非PSCI组(P<0.05)。PSD组年龄明显高于PSCI-ND组(P<0.05)。BPS组ADL总分、MMSE总分和MoCA总分明显低于非BPS组[(86.90±10.50)分vs(92.61±10.10)分,P=0.032;(24.39±2.13)分vs(20.36±4.27)分,P=0.000;(17.04±4.23)分vs(22.00±2.65)分,P=0.000]。与非BPS组比较,BPS组PACI发生率明显升高(52.0%vs 4.3%,P=0.000),LACI发生率明显降低(20.0%vs 56.5%,P=0.002)。PSD组和PSCI-ND组幻觉、激越、抑郁、淡漠、异常运动和睡眠行为障碍比例明显高于非PSCI组(P<0.05)。PSD组激越、抑郁、淡漠和睡眠行为障碍比例明显高于PSCI-ND组(P<0.05)。结论PSCI患者较易出现BPS,其认知水平不同BPS发生率及表现不同,揭示了PSCI的临床异质性特点,为PSCI的治疗提供临床依据。     

广东省斗门县老年人视力障碍及病因的流行病学调查

目的 通过人群横断面抽样调查，探讨６０岁以上老年人群的视力分布、盲和低视力的患病率及其致病原因。方法 在广东省斗门县，以村为单位，通过重组随机整群抽样确定检查对象，使用视力表检查裸眼视力，常戴镜视力、针孔视力，并检查外眼、前房、晶体、眼底、眼压等，然后对视力低于０．３的患眼进行主要致病原因诊断。结果 在６０岁以上的４２０８人中，实际检查３９０８人，受检率９２．９％。在能完成视力检查的３８５５人中，     

Gut microbiota in various childhood disorders: Implication and indications

Gut microbiota has a significant role in gut development, maturation, and immune system differentiation. It exerts considerable effects on the child's physical and mental development. The gut microbiota composition and structure depend on many host and microbial factors. The host factors include age, genetic pool, general health, dietary factors, medication use, the intestine's pH, peristalsis, and transit time, mucus secretions, mucous immunoglobulin, and tissue oxidation-reduction potentials. The microbial factors include nutrient availability, bacterial cooperation or antagonism, and bacterial adhesion. Each part of the gut has its microbiota due to its specific characteristics. The gut microbiota interacts with different body parts, affecting the pathogenesis of many local and systemic diseases. Dysbiosis is a common finding in many childhood disorders such as autism, failure to thrive, nutritional disorders, coeliac disease, Necrotizing Enterocolitis, helicobacter pylori infection, functional gastrointestinal disorders of childhood, inflammatory bowel diseases, and many other gastrointestinal disorders. Dysbiosis is also observed in allergic conditions like atopic dermatitis, allergic rhinitis, and asthma. Dysbiosis can also impact the development and the progression of immune disorders and cardiac disorders, including heart failure. Probiotic supplements could provide some help in managing these disorders. However, we are still in need of more studies. In this narrative review, we will shed some light on the role of microbiota in the development and management of common childhood disorders.     

驻京部队离退休干部神经系统疾病现况调查

目的 调查驻京部队离退休干部认知、运动、情感和睡眠障碍的患病率.方法 采用系统神经心理检查,自行编制的运动功能及睡眠调查表,综合医院焦虑抑郁量表,评价被访者神经系统疾病现况.结果 老年认知障碍、锥体外系疾病总患病率为32.7%和8.8%;轻度认知障碍、痴呆、帕金森病、特发性震颤、焦虑、抑郁症状的患病率分别为26.2%、6.5%、2.0%、6.1%、1.4%、4.1%;各种睡眠障碍症状的患病率为10.3%～53.9%.老年认知障碍的患病率性别无统计学意义,但与年龄和受教育程度之间呈显著正相关和负相关,相关系数分别为0.326、-0.221(P<0.01).结论 驻京部队离退休干部老年认知障碍、锥体外系疾病及睡眠障碍患病率较高,情感障碍患病率较低.     

Radiation exposure in patients with inflammatory bowel disease and irritable bowel syndrome in the years 2001–2011

Objectives: To compare cumulative ionizing radiation in patients with inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) for the years 2001–2011. To study how radiation exposure change over time in patients with newly diagnosed IBD and factors associated with radiation exposure.

Material and methods: All radiological investigations performed between 1 January 2001 and 31 December 2011 were retrospectively recorded in patients with Crohn’s disease (CD) (n?=?103), ulcerative colitis (UC) (n?=?304) and IBS (n?=?149). Analyses were done with Mann–Whitney and Chi-Square test.

Results: The median total cumulative radiation exposure in mSv for CD (20.0, inter quartile range (IQR) 34.8), UC (7.01, IQR 23.8), IBS (2.71, IQR 9.15) and the proportion of patients who had been exposed for more than 50 mSv during the study period (CD 19%, UC 11%, IBS 3%) were significantly higher in the patients with CD compared to patients with UC (p?<?.001) and IBS (p?<?.001), respectively. In turn, patients with UC had significantly higher doses than patients with IBS (p?=?.005). Risk factors for radiation exposure were female gender (CD), early onset (UC), ileocolonic location (CD), previous surgery (CD and UC), depression (IBS) and widespread pain (IBS). In newly diagnosed CD, there was a significant decline in median cumulative radiation dose in mSv (17.2 vs. 12.0; p?=?.048) during the study period.

Conclusions: Patients with CD are at greatest risk for high cumulative radiation exposure, but there is a decline in exposure during the late 2000s. Non-colectomized patients with UC and patients with IBS have a relatively low risk of cumulative radiation exposure.     

肠内营养对急性假性球麻痹临床疗效的研究

目的 探讨肠内营养对急性假性球麻痹（APBP）并发症的影响及神经功能恢复的疗效。方法 将80例APBP随机分成对照组和营养组，观察两组患者吞咽用难改善率、肺部感染发生率、神经功能提高率和治疗前后患者T淋巴亚群的变化。结果 两组患者经10d治疗后，营养组和对照组吞咽困难改善率、肺部感染发生率、神经功能改善率分别为82．5％和55％（P〈0．05）；15％和40％（P〈0．05）；77．5％和45％（P〈0．05）。肠内营养组治疗后抑制性免疫指标CD8％较治疗前和对照组治疗后下降（P〈0．05），而增强性免疫指标CD3％、CD4％和CD4／CD8较治疗前和对照组治疗后提高（P〈0．05）。结论 肠内营养能提供肌体所需要的蛋白、碳水化合物和脂盼等成分。营养支持对于APBP患者存在的吞咽困难、营养不良不仅能提高人体细胞免疫功能，而且能减少并发症、提高疗效、从而改善预后。     

Use of Clostridium botulinum toxin in gastrointestinal motility disorders in children

More than a century has elapsed since the identification of Clostridia neurotoxins as the cause of paralytic diseases. Clostridium botulinum is a heterogeneous group of Gram-positive, rod-shaped, spore-forming, obligate anaerobic bacteria that produce a potent neurotoxin. Eight different Clostridium botulinum neurotoxins have been described(A-H) and 5 of those cause disease in humans. These toxins cause paralysis by blocking the presynaptic release of acetylcholine at the neuromuscular junction. Advantage can be taken of this blockade to alleviate muscle spams due to excessive neural activity of central origin or to weaken a muscle for treatment purposes. In therapeutic applications, minute quantities of botulinum neurotoxin type A are injected directly into selected muscles. The Food and Drug Administration first approved botulinum toxin(BT) type A in 1989 for the treatment of strabismus and blepharospasm associated with dystonia in patients 12 years of age or older. Ever since, therapeutic applications of BT have expanded to other systems, including the gastrointestinal tract. Although only a single fatality has been reported to our knowledge with use of BT for gastroenterological conditions, there are significant complications ranging from minor pain, rash and allergic reactions to pneumothorax, bowel perforation and significant paralysis of tissues surrounding the injection(including vocal cord paralysis and dysphagia). This editorial describes the clinical experience and evidence for the use BT in gastrointestinal motility disorders in children.     

The place of esophageal manometry in the diagnosis of dysphagia

Esophageal manometry allows to quantify intraluminal pressure changes as the basis of normal or abnormal esophageal motility. It is a complementary diagnostic procedure which should only be performed after endoscopic and fluoroscopic examinations and may be helpful in the detection of various motility disorders like diffuse esophageal spasm, nutcracker esophagus and vigorous achalasia. Manometry is recommendable for therapy control after medical and surgical therapy, and mandatory prior to surgical reflux therapy.     

单唾液酸四己糖神经节苷脂治疗血管性认知障碍的疗效观察

目的 观察单唾液酸四己糖神经节苷脂(GM1)治疗血管性认知障碍(vascular cognitive impairment,VCI)的疗效.方法 60例VCI患者随机分为治疗组和对照组,其中对照组接受常规治疗,治疗组在常规治疗基础上加用GM1(80mg/d)连续静脉滴注2周.在治疗前和治疗后采用蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)评定疗效,并观察治疗安全性.结果 治疗2周后两组MoCA评分均显著高于治疗前(P均＜0.05),治疗组MoCA评分显著高于对照组(20.82±1.96对19.61±2.02,t=2.315,P=0.023),未发现明显不良反应.结论 单唾液酸四己糖神经节苷脂治疗VCI的疗效肯定,且无严重不良反应,值得临床推广使用.

Abstract：

Objective To observe the efficacy of monosialotetrahexosy lganglioside (GM1) in the treatment of vascular cognitive impairment (VCI). Methods Sixty patients with VCI were randomly divided into either a treatment group or a control group. The patients in the control group received conventional treatment and those in the treatment control group were treated with conventional treatment plus continuous intravenous infusion of GM1 (80 mg/d) for 2 weeks. The efficacy was evaluated by the Montreal Cognitive Assessment (MoCA) before and after the treatment, and the safety of the treatment was observed. Results After 2 weeks of treatment, the MoCA scores were significantly higher than those before treatment in both groups (all P ＜ 0. 05). The MoCA scores of the treatment group were significantly higher than those of the control group (20. 82 ± 1. 96 vs. 19. 61 ±2. 02, t =2. 315, P =0. 023). No obvious adverse reactions were found. Conclusions The efficacy of GM1 is positive in the treatment of vascular cognitive impairment, and there is no obvious adverse reactions. It is worthy of using widely in clinical practice.     

Serum transferrin receptor measurements in hematologic malignancies

An enzyme-linked immunosorbent assay using specific monoclonal antibodies was used to measure circulating transferrin receptor (TR) in 87 patients with various hematologic malignancies. The mean serum TR was significantly elevated in patients with myeloproliferative disorders (15.47 +/- 12.54 micrograms/ml), whereas there were no differences in chronic granulocytic leukemia (7.89 +/- 3.56 micrograms/ml), myelodysplastic disorders (9.25 +/- 4.73 micrograms/ml), and acute nonlymphocytic leukemia (3.85 +/- 3.50 micrograms/ml) as compared to normal (5.63 +/- 1.42 micrograms/ml). Among patients with lymphoproliferative disorders, the mean level was normal in lymphoma (5.73 +/- 2.59 micrograms/ml), multiple myeloma (5.47 +/- 1.31 micrograms/ml), and hairy cell leukemia (7.04 +/- 3.69 micrograms/ml). The serum TR was significantly elevated in chronic lymphocytic leukemia (CLL; 14.17 +/- 12.29 micrograms/ml), and the serum levels reflected the clinical stage of the disease. These findings suggest that serum TR measurement may provide a useful laboratory index of disease activity in certain disorders such as CLL, whereas it most likely reflects the intensity of erythropoiesis in the remaining hematological disorders that were evaluated in this study.     

血管性认知障碍研究进展

血管性认知障碍是由脑血管危险因素、临床或无症状脑血管病引起的从轻度认知障碍到痴呆的一大类综合征.其发病率日益增高,但发病机制尚不明确,也缺乏有效的治疗手段,因此各方面的研究日益受到重视.文章主要从概念、分型、诊断和防治等方面对血管性认知障碍的研究进展做了综述.     

小鼠学习记忆行为与脑内脂褐素含量的关系

目的探讨鼠脑老化过程中学习记忆能力的增龄性减退与脑内脂褐素积累的关系。方法检测昆明品系２、７及１５月龄小鼠的学习记忆行为，包括开场行为的自发活动、Ｙ－迷宫分辨学习和一次性被动回避反应，用荧光光度计测定脑脂褐素含量。结果（１）１５月龄组小鼠在新异环境中自发活动和探究行为减少，学习记忆能力显著减退，与２和７月龄组比较差异有显著性（Ｐ＜０．０５或０．０１），而２月龄与７月龄组比较，差异性无显著性；（２）小鼠脑内脂褐素含量与学习记忆行为之间有对应关系，即１５月龄组脑脂褐素含量比７和２月龄组显著升高（Ｐ＜０．０５和０．０１），７月龄和２月龄组之间差异无显著性。结论小鼠学习记忆衰退与脑脂褐素积累的增加有对应平行关系。