小剂量红霉素联合微生态制剂治疗早产儿喂养不耐受的临床价值初评

目的：分析在喂养不耐受早产儿中联合应用小剂量红霉素、微生态制剂的临床治疗效果。方法选取2013年8月-2014年12月该院收治的102例喂养不耐受早产儿,采用随机数字表法分为对照组(采用微生态制剂予以治疗)和研究组(采用小剂量红霉素+微生态制剂予以治疗),每组各51例,比较两组早产儿的治疗效果。结果①研究组早产儿的治疗总有效率为90.33%(47/51),对照组为67.31%(35/51),研究组早产儿的疗效明显高于对照组(P<0.05);②两组早产儿均未见不良反应,安全性好。结论在喂养不耐受早产儿中联合应用小剂量红霉素和微生态制剂,效果显著,且具有良好的安全性,值得推广。     

Risk factors of enteral feeding intolerance in severe acute pancreatitis patients: A protocol for systematic review and meta-analysis

Background:Patients with severe acute pancreatitis (SAP) have gastrointestinal dysfunction, and enteral nutrition intolerance is easy to occur during the implementation of enteral nutrition, which leads to the suspension or termination of enteral nutrition. Enteral nutrition cannot tolerate the influence of many factors. At present, there is a lack of analysis on the influencing factors of enteral nutrition intolerance in patients with SAP. Therefore, this study analyzed the factors of enteral nutrition intolerance in patients with SAP by meta-analysis, to provide a basis for the protection of enteral nutrition in patients with SAP.Methods:Databases (PubMed, Embase, Cochrane Library, Web of Science, China Biology Medicine Database, China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang) were searched using index words to find relevant studies published before March 2021. Meta-analyses of relative risk were performed for the identification of risk factors.Results:We will disseminate the findings of this systematic review and meta-analysis via publications in peer-reviewed journals.Conclusion:This study systematically reviewed the existing evidence and determined the incidence and predictors of enteral nutrition intolerance in patients with SAP.     

Rifaximin in patients with lactose intolerance

BACKGROUND: Abdominal symptoms linked to lactose malabsorption may be caused by metabolic activity of colonic bacteria. Rifaximin, a non-absorbable rifampycin derivative, is active against colonic bacteria, it may be useful in the treatment of lactose intolerance. AIM: The aim of this study has been to evaluate short-term rifaximin therapy in patients with lactose intolerance. METHODS: Thirty-two patients with lactose intolerance diagnosed using the hydrogen lactose breath test were studied. Fourteen patients received rifaximin 800 mg/day for 10 days, 13 patients followed a diet without milk for 40 days and 5 patients received a placebo for 10 days. Total breath H(2) excretion expressed as area under the curve, and the symptom score were evaluated in all patients at the start, and subsequently after 10 and 40 days. RESULTS: In the 14 patients who received rifaximin for 10 days, area under the curve at day 10 and day 40 was statistically significantly lower than the one computed at basal (P<0.01). Diet reduced area under the curve progressively reaching statistical significance at day 40, while the placebo did not change area under the curve throughout the study. The total symptom score significantly improved after rifaximin and diet. CONCLUSION: In patients with lactose intolerance, a 10-day therapy with rifaximin as well as 40-day diet without lactose reduces the area under the curve and the symptom score.     

The association of physical activity with obesity,fat distribution and glucose intolerance in Pima Indians

Summary The relationships between physical activity, obesity, fat distribution and glucose tolerance were examined in the Pima Indians who have the highest documented incidence of non-insulin-dependent diabetes. Fasting and 2-h post-load plasma glucose concentrations, body mass index, and waist-to-thigh circumference ratios were determined in 1054 subjects aged 15–59 years. Current (during the most recent calendar year) and historical (over a lifetime) leisure and occupational physical activity were determined by questionnaire. Current physical activity was inversely correlated with fasting and 2-h plasma glucose concentrations, body mass index and waist-to-thigh ratios for most sex-age groups even when diabetic subjects were excluded. Controlled for age, obesity and fat distribution, activity remained significantly associated with 2-h plasma glucose concentrations in males. In subjects aged 37–59 years, individuals with diabetes compared to those without reported significantly less leisure physical activity during the teenage years (median hours per week of activity, 9.1 vs 13.2 for men; 1.0 vs 2.2 for women). Controlled for body mass index, sex, age and waist-to-thigh ratio, subjects who reported low levels of historical leisure physical activity had a higher rate of diabetes than those who were more active. In conclusion, current physical activity was inversely related to glucose intolerance, obesity and central distribution of fat, particularly in males. Subjects with diabetes were currently less active and reported less historical physical activity than non-diabetic subjects. These findings suggest that activity may protect against the development of non-insulin-dependent diabetes both directly and through an influence on obesity and fat distribution.     

早产儿喂养不耐受

早产儿喂养不耐受可导致早期营养不良、生长受限,对以后的行为和认知产生影响,是目前新生儿科医生面临的重要问题。喂养不耐受与早产儿胃肠功能不成熟、围生期窒息、感染等疾病因素相关。临床治疗常采用微量喂养,促胃肠动力药、口服益生菌等方法,但目前尚无统一的预防和治疗指南。     

Contribution of Colonic Fermentation and Fecal Water Toxicity to the Pathophysiology of Lactose-Intolerance

Whether or not abdominal symptoms occur in subjects with small intestinal lactose malabsorption might depend on differences in colonic fermentation. To evaluate this hypothesis, we collected fecal samples from subjects with lactose malabsorption with abdominal complaints (LM-IT, n = 11) and without abdominal complaints (LM-T, n = 8) and subjects with normal lactose digestion (NLD, n = 15). Lactose malabsorption was diagnosed using a ¹³C-lactose breath test. Colonic fermentation was characterized in fecal samples at baseline and after incubation with lactose for 3 h, 6 h and 24 h through a metabolomics approach using gas chromatography-mass spectrometry (GC-MS). Fecal water cytotoxicity was analyzed using a colorimetric assay. Fecal water cytotoxicity was not different between the three groups (Kruskall-Wallis p = 0.164). Cluster analysis of the metabolite patterns revealed separate clusters for NLD, LM-T and LM-IT samples at baseline and after 24 h incubation with lactose. Levels of 5-methyl-2-furancarboxaldehyde were significantly higher in LM-IT and LM-T compared to NLD whereas those of an unidentified aldehyde were significantly higher in LM-IT compared to LM-T and NLD. Incubation with lactose increased short chain fatty acid (SCFA) concentrations more in LM-IT and LM-T compared to NLD. In conclusion, fermentation patterns were clearly different in NLD, LM-IT and LM-T, but not related to differences in fecal water cytotoxicity.     

早产儿喂养不耐受肠道菌群多样性研究

目的：采用变性梯度凝胶电泳聚合酶链反应（ PCR－DGGE）技术从微生物生态学的角度分析比较喂养不耐受（ FI）与健康早产儿肠道细菌群落结构的多样性及相似性。方法以2013年11月至2014年9月在第四军医大学附属唐都医院儿科新生儿病房诊断为FI的早产儿为FI组。选择与FI组胎龄、日龄、出生体重相匹配的非FI早产儿作为对照组。采集出现FI时和同时间段对照组的粪便标本,进行16SrDNAV3区扩增和变性梯度凝胶电泳（DGGE）,从而分析比较两组间肠道菌群多样性指数及相似性。结果细菌多样性检测显示FI组的肠道菌群多样性指数香农－维纳指数（H）、丰度（S）、均衡度指数（E）和辛普森多样性指数（D）均低于对照组（均P＜0．05）;相似性矩阵图及聚类分析结果显示组内菌群相似性较组间高（P＜0．05）;PCA结果同聚类分析一致。结论肠道微生物群落多样性的改变及群落结构紊乱可能是引起早产儿FI的重要因素。