地佐辛对ERCP术患者镇痛、镇静效果及安全性

目的:评价地佐辛对经内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)术患者的镇痛、镇静效果和安全性.方法:将华中科技大学同济医学院附属同济医院消化内科2013-07/2014-06行ERCP术的140例患者随机分为地佐辛组(n=70)及杜冷丁组(n=70).ERCP术前30 min,地佐辛组患者给予地佐辛5 mg肌肉注射;杜冷丁组患者给予杜冷丁50 mg肌肉注射.分析患者ERCP术中及术后30 min、1、2、3、6 h的疼痛视觉模拟评分(visual analogue scales,VAS评分)、舒适度评分(Bruggrmann comfort scale,BCS评分)以及给药后30 min、1、2、3 h的镇静评分(Ramsay评分),同时观察两组患者腹痛、腹胀、恶心呕吐、头痛头晕、呼吸抑制等不良反应发生率,评价地佐辛对ERCP术患者的镇痛、镇静效果及其安全性.结果:两组患者均顺利完成ERCP检查及治疗,ERCP术中地佐辛组患者VAS评分明显低于杜冷丁组(P<0.05);ERCP术后地佐辛组患者BCS评分均高于杜冷丁组(术后30 min、2 h及3 h两组间B C S评分差异均有统计学意义,P<0.05);ERCP术前30 min肌肉注射地佐辛5 mg及杜冷丁50 mg后患者均能安静合作,两组间Ramsay评分无统计学差异(P>0.05).地佐辛组ERCP术后腹痛、腹胀、恶心呕吐等不良反应发生率均低于杜冷丁组,两组患者均无头痛头晕、呼吸抑制等严重不良反应,地佐辛组患者腹胀发生率明显低于杜冷丁组(P<0.05).结论:地佐辛可安全有效地应用于ERCP术患者的镇痛、镇静治疗,其临床疗效优于杜冷丁.     

地佐辛联合丙泊酚预防小儿全麻苏醒期躁动效果观察

目的探讨地佐辛联合小剂量丙泊酚对小儿七氟醚复合瑞芬太尼全麻苏醒期躁动的影响。方法选取择期行腹股沟斜疝修补术的患儿92例,随机分为观察组及对照组,各46例。两组均采用七氟醚复合瑞芬太尼麻醉,对照组于术毕前15 min给予地左辛0.1 mg/kg静脉注射,观察组于术毕前15 min给予地左辛0.1 mg/kg静脉注射后,于缝皮时给予丙泊酚1 mg/kg静脉注射。比较两组患儿手术时间、苏醒时间、拔出喉罩时间、PACU停留时间、苏醒后疼痛评分、苏醒后镇静满意率、苏醒后躁动评分、苏醒期间不良反应发生率。结果观察组患儿苏醒时、苏醒后15 min、苏醒后30 min镇静满意率均高于对照组（P均〈0.05）,躁动评分均低于对照组（P均〈0.05）。观察组、对照组患儿苏醒期间出现恶心呕吐分别为2例（4.3%）、8例（17.4%）,观察组恶心呕吐发生率低于对照组（P〈0.05）。结论地佐辛联合小剂量丙泊酚能有效减轻七氟醚复合瑞芬太尼麻醉患儿苏醒期的躁动反应,降低术后恶心呕吐发生率。     

地佐辛联合左布比卡因用于臂丛神经阻滞麻醉效果观察

目的 研究地佐辛联合左布比卡因肌间沟注射用于臂丛神经阻滞的临床效果.方法 ASA Ⅰ或Ⅱ级行上肢骨折手术患者90例,随机分为A、B、C组,各30例.三组均采用0.375％左布比卡因30 mL臂丛肌间沟注射麻醉,其中A组单用左布比卡因,B组在局麻药中加地佐辛5 mg,C组神经阻滞完成后即静注地佐辛5 mg.记录三组麻醉起效时间、镇痛持续时间及不良反应（恶心、呕吐、头晕、呼吸抑制、瘙痒等）情况.结果 三组患者感觉阻滞起效时间、痛觉消失时间B组明显短于A、C组（P均＜0.01）,镇痛持续时间B组＞C组＞A组（P均＜0.01）.三组患者均未出现瘙痒及呼吸抑制,B组患者恶心、呕吐及头晕发生例数少于A、C组（P均＜0.05）.结论 地佐辛联合左布比卡因肌间沟注射用于臂丛神经阻滞麻醉起效时间短,镇痛时间延长,不良反应较少.     

舒芬太尼应用于非体外循环冠状动脉旁路移植术后镇痛效果的研究

目的:评价舒芬太尼应用于非体外循环冠状动脉旁路移植术(OPCABG)后镇痛的效果。方法:选择行OPCABG术患者130例,随机分成2组,试验组:舒芬太尼(Sufentanil)镇痛组(A组,n=65例)和对照组:地佐辛(Dezocin)镇痛组(B组,n=65例)。A组静脉持续输注舒芬太尼镇痛液2 mL/h,2.5μg/mL,B组持续静脉输注地佐辛镇痛液2 mL/h,25μg/mL。观察指标:疼痛评分:术后16 h、24 h、48 h、拔除镇痛泵后12 h,采用视觉模拟评分法(VAS)进行镇痛效果评分、镇静效果评分(Ramsay)。结果:1.手术后VAS法评分:2组都在4分以下,差异无统计学意义(P>0.05)。2.手术后2组患者的镇静评分(Ramsay评分):差异无统计学意义(P>0.05)。拔泵以后舒芬组有5例轻微躁动,地佐辛组有3例,但差异无统计学意义(P>0.05)。3.2组患者PCA次数在手术后16 h:地佐辛组比舒芬太尼组多,差异有统计学意义(P<0.05)。4.镇痛期间不良反应:2组患者恶心、呕吐、尿储留的发生率差异无统计学意义(P>0.05),A组中有17例患者有眩晕,B组中有9例,差异有统计学意义(P<0.05)。结论:舒芬太尼用于OPCABG患者术后镇痛效果优于地佐辛,其恶心、呕吐、尿潴留的发生率差异无统计学意义,但患者术后眩晕的发生率舒芬太尼高于地佐辛。     

复方角菜酸酯栓在直肠隆起病变经内镜下黏膜切除或剥离术后的应用价值

[目的]观察复方角菜酸酯栓应用在直肠黏膜及黏膜下隆起病变经内镜下黏膜切除术(EMR)或内镜下黏膜剥离术(ESD)后的疗效及安全性。[方法]60例患者随机分为A组和B组,各30例。A组在术后常规处理的基础上加用复方角菜酸酯栓塞肛,1次/d;B组在术后仅用常规处理;2组疗程均为1周。观察2组术后便血、大便隐血以及术后即刻、1周创面愈合情况。[结果]A组术后出血率明显低于B组(P0.05),术后1周A组创面愈合评分优于B组(P0.05)。[结论]复方角菜酸酯栓可有效预防直肠隆起病变EMR及ESD后出血并发症,并可以促进术后创面愈合,且安全有效,无不良反应。     

不同剂量地佐辛复合异丙酚在PPH麻醉中的应用效果比较

目的比较不同剂量地佐辛复合异丙酚在PPH麻醉中的应用效果,寻找最佳剂量。方法 100例ASAⅠ~Ⅱ级PPH术患者,随机分为A、B、C、D组,各25例。A组予地佐辛100μg/kg,B组予地佐辛150μg/kg,C组予地佐辛200μg/kg,D组予芬太尼2μg/kg。四组患者术中均辅以2μg/m l的异丙酚靶控持续输注。术中监测血压（BP）、心率（HR）、血氧饱和度（SpO2）、心电图（ECG）和体动情况,比较呼吸、循环稳定性;记录苏醒后的VAS和Ram say评分和恶心、烦躁等不良反应及术后要求镇痛的时间间隔,比较术后镇痛效果及其不良反应。结果 C、D两组术中镇痛效果明显好于A、B两组,C组术中呼吸抑制发生率明显低于D组（P均〈0.05）;D组术后要求镇痛时间间隔时间最短,不良反应发生率高于其他三组（P均〈0.05）。结论 200μg/kg地佐辛复合异丙酚是用于PPH麻醉的适宜剂量。     

地佐辛天枢穴注射在无痛肠镜中的应用及作用机制的研究

[目的]观察预先地佐辛天枢穴肌肉注射联合丙泊酚在无痛肠镜中应用的临床疗效及对5-羟色胺(5-HT)、β-内啡肽(β-EP)、脑源性神经因子(BDNF)因子表达的影响。[方法]按随机数字表法将无痛肠镜患者分为观察组[地佐辛(天枢穴注射,无痛肠镜前15min)+丙泊酚]、对照组1[地佐辛(臀部肌注,无痛肠镜前15min)+丙泊酚]、对照组2(丙泊酚)。以平均动脉压(MAP)、呼吸(R)、心率(HR)、血样饱和度(SPO2)、RSS躁动评分、VAS疼痛评分、5-HT、BDNF、β-EP水平作为评价疗效的指标。[结果](1)对照组2中MAP、R、HR、SPO2均低于其余2组,丙泊酚用量高于其他2组(P0.05),且观察组中丙泊酚用量低于对照组1(P0.05)。(2)观察组、对照组1在无痛肠镜通过脾曲时、退镜结束后RSS躁动评分、VAS疼痛评分均低于对照组2,且治疗组更低(P0.05)。(3)观察组、对照组1中5-HT、BDNF、β-EP水平高于对照组2,观察组最高(P0.05)。[结论]无痛肠镜前地佐辛肌注联合丙泊酚效果确切,天枢穴注射效果更好,可能通过上调5-HT、β-EP、BDNF表达水平达到镇静镇痛作用。     

氟比洛芬酯联合地佐辛静脉镇痛在前列腺穿刺活检术中的应用

目的观察氟比洛芬酯联合地佐辛镇痛在经直肠超声引导下前列腺穿刺活检术中的效果。方法 60例择期行经直肠超声引导下前列腺穿刺患者随机分为两组。氟比洛芬酯联合地佐辛组(F+D组):预先静脉注射氟比洛芬酯1 mg/kg,手术开始前5 min,静脉注射地佐辛0.1 mg/kg,随后注射丙泊酚1～2 mg/kg。舒芬太尼组(S组):手术开始前5 min,静脉注射舒芬太尼0.1μg/kg,随后注射丙泊酚1～2 mg/kg。观察并记录用药前(T0)、用药后(T1)、手术中(T2)、手术结束结束后5 min (T3)的心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO_2)、脑电双频指数(BIS)及术中体动、呼吸抑制[呼吸频率(RR)8次/min]、恶心呕吐及丙泊酚注射痛例数、丙泊酚用量、手术时间、麻醉苏醒时间和苏醒时VAS评分、镇静评分及躁动评分。结果患者均未发生术中知晓,镇痛完善。F+D组苏醒时间较S组明显缩短(P0.05);F+D组丙泊酚注射痛发生率较S组亦明显减少(P0.05)。两组T1时点MAP均明显低于T0时点(P0.05);F+D组T1时点MAP明显高于S组(P0.05);两组T1、T2时点BIS明显低于T0时点(P0.05)。结论氟比洛芬酯联合地佐辛可安全有效地应用于经直肠超声引导下前列腺穿刺活检术的静脉镇痛。     

老年髋关节置换患者术后镇痛方案研究

目的探讨老年髋关节置换术后最佳镇痛方案。方法选取在我院行髋关节置换手术的老年患者400例作为研究对象,随机分为A、B、C、D组,每组100例。镇痛方案:A组采用0.6 mg/kg地佐辛,B组采用0.3 mg/kg地佐辛联合1.0μg/kg舒芬太尼,C组采用0.3 mg/kg地佐辛联合1.5μg/kg舒芬太尼,D组采用0.3mg/kg地佐辛联合2.0μg/kg舒芬太尼。记录患者手术后1 h、4 h、8 h、12 h、1 d以及2 d的疼痛视觉模拟评分法(VAS)评分,镇痛药物使用总量,补用镇痛药物患者的例数和不良反应的发生情况。结果 C组患者使用镇痛药物的总量和补用镇痛药物患者的例数最少;C和D组患者在术后1 h、4 h以及8 h的疼痛VAS评分明显低于A和B组,差异有统计学意义(P0.05)。D组患者恶心、出汗、尿潴留的发生率明显高于其他组,C组患者不良反应的发生率较低。结论 0.3 mg/kg地佐辛联合1.5μg/kg舒芬太尼用于老年髋关节置换患者术后镇痛的效果较好,不良反应少。     

常规外科切除术与内镜黏膜下剥离术对消化道早期肿瘤疗效和并发症的影响

[目的]探讨常规外科切除术与内镜黏膜下剥离(ESD)术对消化道早期肿瘤患者围手术期临床指标、肿物切除效果及并发症的影响。[方法]入选消化道早期肿瘤患者共120例,按照患者意愿分为A组、B组,每组60例,分别采用常规外科切除术、ESD术治疗,比较2组患者围手术期临床指标、肿物整块切除率及并发症发生率等。[结果]B组患者手术时间、胃肠功能恢复时间、住院时间及治疗费用均显著优于A组(P0.05);2组患者肿物治愈性切除率比较差异无统计学意义(P0.05);B组患者肿物切缘阴性率显著低于A组(P0.05);同时2组患者并发症发生率比较差异无统计学意义(P0.05)。[结论]常规外科切除术与ESD术用于消化道早期肿瘤患者治疗在肿物切除效果和并发症方面基本接近;但ESD术应用可有效缩短手术时间,促进术后机体康复进程,并有助于减轻经济负担。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.