Reproducible lactulose hydrogen breath test as a measure of mouth-to-cecum transit time

Breath hydrogen monitoring after oral lactulose syrup is a conventional measure of mouth-to-cecum transit time (MCTT), but its reproducibility has been questioned. We compared the reproducibility of five measurements of MCTT after a conventional breakfast (380 kcal) taken with tea containing 20 g lactulose to five measurements of MCTT after 20 g lactulose in water in eight normal volunteers. Individual mean breakfast transit time was not significantly different from lactulose transit time in each of the seven subjects, but one had a breakfast transit time of 151±15 min and a lactulose transit time of 86±22 minutes (¯X ±sd, P<0.001). The coefficient of variation of breakfast transit time (11.6±5.3%, range: 6.9–24.2%) was less than that of lactulose transit time (30.7±7.8%, range: 22.1–50.0%, P<0.001). In a second set of experiments, the liquid phase marker ( ^99m Technetiumdiethylene triamine pentaacetic acid) emptied from the stomach more rapidly after the lactulose solution (T1/2 16.3±5.4) than after the breakfast (33.9±10.9 min, P<0.01) and MCTT was shorter after lactulose (77±32 vs 104±40 min, trespectively, P<0.05). There was no correlation between MCTT of lactulose and breakfast and between half-time gastric emptying and MCTT of either lactulose or breakfast. We conclude that the ingestion of inert lactulose induces an abnormally rapid MCTT and that breakfast MCTT is a much more reproducible investigation and should be employed in studies requiring serial measurements.     

Reproducibility of orocecal transit time and hydrogen production measured by breath tests]

The hydrogen breath test after a lactulose oral load in the fasting period is currently used to measure mouth to cecum transit time (MCTT). However, the reproducibility of this test is poor, and normal values are very scattered. The aim of the study was to determine the reproducibility of hydrogen breath test for MCTT measurement and hydrogen production after administration of 2 disaccharides: lactulose and lactitol ingested in the fasting state and postprandial period. Twelve healthy volunteers (6 men and 6 women; mean age = 34.6 +/- 9.6 years) were studied eight times in a random order, each disaccharide being studied twice in the fasting state and twice in the postprandial period. In the later, lactulose or lactitol was ingested 30 min after a liquid meal completely absorbed (400 kcal; glucide: 55 p. 100, lipid: 30 p. 100, protein: 15 p. 100; 400 ml of Inkopeptide). The MCTT was significantly increased with both disaccharides in the postprandial period as compared with the fasting state (P less than 0.0001). There was nos significant correlation between the 2 measurements of the MCTT in the fasting state, in contrast, the 2 measurements of the MCTT were closely related in the fed state (r = 0.62, P less than 0.05, et r = 0.79, P less than 0.003 for lactulose and lactitol respectively). During both periods no significant difference was found in the MCTT between lactulose and lactitol. As well, hydrogen production did not differ between the 2 disaccharides, but was significantly increased in the postprandial period, and in non methane producers.(ABSTRACT TRUNCATED AT 250 WORDS)     

The use of complex carbohydrates in barley groats for determination of the mouth-to-caecum transit time

Lactulose is often used as a substrate to estimate the mouth-to-caecum transit time (MCTT), but because of osmotic effects the outcome depends on the dose consumed. In this study, barley groats, a complex carbohydrate (CH) that produces a clear breath hydrogen response after consumption, were used. Eight volunteers consumed the same dose of softened barley groats (1.0 g CH/kg body weight) three times. Ten volunteers ate three different doses (0.75, 1.0, and 1.5 g CH/kg body weight). Breath samples were collected every 30 or 60 min for at least 12.5 h and analysed for hydrogen. To study the effect of the particle size of the barley groats or the addition of fat on the MCTT, 11 volunteers consumed barley groats (1.0 g CH/kg body weight) with cream cheese (0.25 g fat/kg body weight) and 5 volunteers ate crushed barley groats (particles of +/- 1 mm, 1.0 g CH/kg body weight). After consumption of 1.0 g CH/kg body weight a mean MCTT of 8.4 +/- 0.4 h was found. After consumption of the high dose, a mean MCTT of 9.0 +/- 0.5 h was found, and after the low dose, 8.5 +/- 0.6 h. Addition of fat resulted in a significantly increased MCTT, presumably caused by retarded stomach emptying (9.2 +/- 0.6 h versus 8.1 +/- 0.5 h in controls). Particle size did not significantly affect the MCTT (7.2 +/- 0.5 h at 1 mm versus 7.8 +/- 0.6 h at normal particle size).(ABSTRACT TRUNCATED AT 250 WORDS)     

Gastrointestinal Transit after Spinal Cord Injury: Effect of Cisapride

Heartburn, bloating, and abdominal discomfort are common problems in patients with spinal cord injury but, despite its clinical significance, little is known about the gastrointestinal effects of spinal transections. To address the potential gastrointestinal pathophysiology of spinal cord injury, we measured mouth-to-cecum transit time (MCTT) in seven subjects with paraplegia and seven with quadriplegia. Gastric emptying was studied in six subjects with quadriplegia. MCTT was significantly prolonged in patients with quadriplegia, an abnormality corrected by the administration of cisapride. Patients with paraplegia, in contrast to those with quadriplegia, have normal mouth-to-cecum transit time. In addition, patients with quadriplegia had neither a prolonged gastric emptying time nor a change in gastric emptying time, with cisapride. Changes in gastrointestinal transit after spinal cord injury and the improvement of mouth-to-cecum transit time in subjects with quadriplegia, but not in those with paraplegia, may be explained by an imbalance between parasympathetic and sympathetic outflows to the gastrointestinal tract in this group of subjects.     

Effect of a long-acting somatostatin analogue (SMS 201-995) on postprandial gastric emptying of 99mTc-tin colloid and mouth-to-caecum transit time in man

The effect on gut motility of a single subcutaneous injection of 50 micrograms of the long-acting somatostatin analogue, SMS 201-995, was investigated in 8 normal volunteers who took a drink containing 99mTc and lactulose with a mixed meal. The rate of gastric emptying was assessed by disappearance of the isotope from the stomach area as measured by a gamma camera, and mouth-to-caecum transit time (MCTT) was measured by the appearance of hydrogen in the breath. Gastric emptying was accelerated, with a significant reduction of the time taken to 50% isotope disappearance (37.2 +/- 3.3 min during control study vs 23.3 +/- 3.4 min after SMS injection; p less than 0.01). In contrast, MCTT was prolonged from 57.3 +/- 9.4 min (control) to 203.6 +/- 14.7 min after SMS (p less than 0.001).     

Breath hydrogen determination in patients following partial gastrectomy

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The effect of octreotide on gastric emptying at a dosage used to prevent complications after pancreatic surgery: a randomised, placebo controlled study in volunteers

Background—Octreotide is used in many centres toprevent complications after pancreatic surgery. Delayed gastricemptying is a another complication occurring in around 30% of patients after pancreatoduodenectomy (PD) and causes prolonged hospital stay.The influence of octreotide on this complication is doubtful.
Aims—To assess the effect of octreotide, at theclinical dosage used after pancreatic surgery, on gastric emptying inhealthy volunteers.
Subjects and methods—Eight healthy malevolunteers (mean age 22.5 years) participated in this double blind,placebo controlled study. On day 1 subjects received 100 µg ofoctreotide or placebo subcutaneously, three times daily and on day 2, one hour after the fourth injection, gastric emptying, postprandialcholecystokinin (CCK) release, and mouth to caecum transit time (MCTT)were measured. This protocol was repeated after one week, in acrossover design. On the test day subjects received a liquid test meal(1.57 MJ/300 ml) and gastric emptying measurements were performed withapplied potential tomography, a non-invasive, validated technique which measures gastric emptying through impedance differences. From thegastric emptying curves, lag time, t₅₀, and postlagemptying rate were measured. MCTT was measured using the hydrogenbreath test.
Results—Lag time decreased from 29.6 (6.3) (mean(SEM)) to 12.2 (4.6) minutes (p<0.05) during octreotide treatment;t₅₀ decreased from 87.8 (12.0) to 47.5 (8.2) minutes(p<0.02) and there was a trend towards an increased postlag emptyingrate (0.8 to 1.6% per minute; p=0.07). MCTT increased from 150 (12.7)to 229 (17.9) minutes during octreotide treatment (p<0.01). Octreotidesuppressed postprandial CCK release (p<0.05).
Conclusions—MCTT was delayed by octreotide,suggesting impairment of small bowel transit. Octreotide administeredat the clinical dosage for pancreatic surgery accelerates gastricemptying, mainly by shortening the lag time. Suppression ofpostprandial CCK release may be involved in this process. Octreotideadministration is therefore not a contributing factor in thepathogenesis of delayed postoperative gastric emptying after PD andmight even play a role in preventing this complication.

     

Bacterial Overgrowth,Intestinal Transit,and Nutrition after Total Gastrectomy: Comparison of a Jejunal Pouch with Roux-en-Y Reconstruction in a Prospective Random Study

Background: Jejunal pouches after total gastrectomy have been introduced to diminish postgastrectomy symptoms and improve nutrition. However, the effect of a pouch on the intestinal bacteriology and transit is controversial. Methods: Bacterial overgrowth was measured with the glucose breath test and the mouth-to-caecum transit time (MCTT) by means of the lactulose breath test after total gastrectomy and Roux-en-Y reconstruction in 24 patients with a pouch (Pouch group) and in 22 patients without a pouch (Roux-en-Y group). Postoperative symptoms were evaluated with a standard questionnaire, and nutrition was measured by blood chemistry and weight loss. Results     

Colonic transit influences deoxycholic acid kinetics

BACKGROUND & AIMS: Prolonged large bowel transit, and an increase in the proportion of deoxycholic acid (DCA), have been implicated in the pathogenesis of cholesterol gallstones-including those developing in acromegalics treated with octreotide. However, there are few data on the effects of intestinal transit on bile acid kinetics. METHODS: We therefore measured the kinetics of DCA and cholic acid (CA) using stable isotopes, serum sampling, and mass spectrometry. The results were related to mouth-to-caecum (MCTT) and large bowel transit times (LBTTs) in 4 groups of 8 individuals: (1) non-acromegalic controls, (2) acromegalics untreated with octreotide, (3) acromegalics on long-term octreotide, and (4) patients with constipation. Paired, before and during octreotide, studies were performed in 5 acromegalics. RESULTS: In the unpaired and paired studies, octreotide significantly prolonged MCTT and LBTT. In the paired studies, the octreotide-induced prolongation of LBTT caused an increase in the DCA input rate (6.4 +/- 2.8 to 12 +/- 2.6 micromol. kg. d, P < 0.05) and pool size (18 +/- 12 to 40 +/- 13 micromol/kg, P < 0.05), and a decrease in CA pool size (45 +/- 15 to 25 +/- 11 micromol/kg, P < 0.05). Furthermore, during octreotide treatment, the mean conversion of 13C-CA to 13C-DCA (micromoles) was greater (P < 0.05) on study days 3, 4, and 5. There were also positive linear relationships between LBTT and DCA input rate (r = 0.78), pool size (r = 0.82, P < 0.001), and a weak (r = -0.49) negative linear relationship between LBTT and CA pool size (P < 0.01). CONCLUSIONS: These data support the hypothesis that, by increasing DCA formation and absorption, prolongation of large bowel transit is a pathogenic factor in the formation of octreotide-induced gallstones.     

Women with early rheumatoid arthritis are referred later than men

OBJECTIVE: To evaluate lag times between disease onset and rheumatological encounter in patients with early rheumatoid arthritis (RA). METHODS: All referred patients with early RA over a 1 year period were prospectively registered. The lag time between disease onset and the first encounter with a physician was recorded as the "patient's delay". The time between this encounter and the referral to our department was recorded as the "physician's delay". The lag time between referral and rheumatological encounter was recorded as the "hospital's delay". RESULTS: The median total lag time between onset of RA and rheumatological encounter was 16 weeks, with no difference between men and women. Women were referred significantly later than men ("physician's delay" median 10 weeks v 3 weeks). The "patient's delay" and the "hospital's delay" were a median of 4 weeks each. CONCLUSION: Women with early RA were referred later than men and the total lag time between disease onset and rheumatological encounter was quite long for both sexes.     

The accuracy of subjective sleep time in sleep apnoea recordings

Total sleep time is important in investigations of obstructive sleep apnoea, since the diagnosis is usually based on the average number of apnoeas per hour of sleep. Sleep estimates instead of exact EEG-recorded total sleep time is often used in the clinical setting. However, an overestimated sleep time would underestimate the degree of the disease and vice versa. The purpose of this study was to investigate the accuracy of subjective sleep time and time-in-bed as sleep estimates. One hundred patients undergoing diagnostic polysomnography for suspected obstructive sleep apnoea were asked to estimate their sleep time in a questionnaire. Seventy-five patients were diagnosed as suffering from obstructive sleep apnoea syndrome. The mean difference between self-scored and EEG-recorded total sleep time was 4 +/- 74 min. However, 30% scored with a difference greater than 1 h. The intra-class correlation coefficient was fair (0.58, CI: 0.43-0.70). Fifty-three patients overestimated their sleep time and 47 patients underestimated it. All but four patients underestimated their number of awakenings (P<0.001). The mean difference between time-in-bed and EEG-recorded total sleep time was 110 +/- 63 min. This difference was significantly larger than the difference between subjective sleep time and EEG-recorded total sleep time (P<0.001). The intra-class correlation coefficient was poor (0.38, CI: 0.20-0.54). Mean AHI was 27 +/- 27 using subjective sleep time and did not change significantly compared with the mean AHI of 25 +/- 21 based on EEG-recorded total sleep time. Mean AHI decreased significantly to 20 +/- 17 (P<0.001) when time-in-bed was used. In conclusion, 'time-in-bed' time is a poor predictor of total sleep time and should not be used when calculating the apnoea-hypopnoea index. Subjective sleep time is better as an approximation, but the individual differences are large.     

Nucleolar organizer regions, nuclear DNA content, and proliferative activity in adenocarcinoma of the lung]

The relationship between the quantity of silver-binding nucleolar organizer regions (AgNORs), nuclear DNA content, and proliferative activity was studied in 61 patients with adenocarcinoma of the lung. The proliferative activity of adenocarcinoma was estimated by tumor volume doubling time based on chest X-ray findings. There was a high, inverse correlation between the AgNORs and the tumor doubling time (p less than 0.001, r = -0.815), and the contribution rate was high value (2 = 0.664). However, the AgNORs value was an independent prognostic factor for survival time. A better 5-year survival rate was observed in patients with DNA diploidy than in DNA aneuploidy, but there was no statistical difference between the two groups. There was an inverse correlation between the DNA index and tumor doubling time (p less than 0.05, r = -0.565), but the contribution rate had a low value (r2 = 0.319). These results indicate that the AgNORs value is important in providing an estimate of the proliferative activity of adenocarcinoma.     

Diastolic perfusion time and exercise posture in coronary artery disease patients: correlation with ST segment changes.

The relationship between either heart rate or diastolic time and ST segment depression has been evaluated during supine and upright exercise in 16 coronary artery disease patients. Diastolic perfusion time and ST segment depression were related by a linear regression, which was independent of exercise posture. The entity of ST segment depression was greater during supine than in upright exercise for the same heart rate. The assessment of the relationship between heart rate and diastolic perfusion time during two exercises showed that at the same heart rate, diastolic perfusion time was shorter in supine posture. In conclusion, the greater entity of ST segment depression induced by supine rather than upright exercise might be explained by the effect of supine posture on diastolic perfusion time.     

The time from anaerobic threshold (AT) to respiratory compensation point reflects the rate of aerobic and anaerobic metabolism after the AT in chronic heart failure patients.

The significance of the time from anaerobic threshold to respiratory compensation point (RCP-AT time) in patients with chronic heart failure was investigated. Thirty-seven patients with chronic heart failure (New York Heart Association class II or III) were enrolled into the study. Cardiopulmonary exercise testing was performed using breath-by-breath gas sampling. A bicycle ergometer was used, and incremental exercise testing was carried out. Anaerobic threshold, respiratory compensation point (RCP), and the slope of oxygen uptake (VO2) as a function of work rate (deltaVO2/deltaWR) were measured. A positive correlation (r=0.53) between RCP-AT time and deltaVO2/deltaWR was found. RCP-AT time was corrected for the whole exercise period (ramp exercise-RCP point), and the correlation between corrected RCP-AT time and deltaVO2/deltaWR was still present (r=0.46). There was no correlation between RCP-AT time and anaerobic threshold. These findings suggest that RCP-AT time is a new parameter that reflects the rate of the aerobic and anaerobic metabolism after AT.     

呼吸机流量时间曲线判断气管插管后导管位置

目的比较以呼吸机流量时间曲线和传统方法判断保留自主呼吸的患者气管插管后导管位置的快捷性和准确性。方法选择82例保留自主呼吸的急诊气管插管成年患者,随机分为流量时间曲线组和传统方法组,各41例,分别以呼吸机流量时间曲线和传统方法判断气管插管后导管位置,比较两种方法的判断时间和判断准确率。结果判断时间:流量时间曲线组3.24±1.28 s,传统方法组12.81±9.21 s,P<0.0001。准确率:流量时间曲线组100%,传统方法组97.56%,P=0.314。结论对于保留自主呼吸的气管插管患者,以呼吸机流量时间曲线判断气管插管后导管位置的快捷性优于传统方法,同时具有高度的准确性。     

日本血吸虫幼虫寄生对钉螺生存影响的研究

目的　了解日本血吸虫幼虫寄生对湖北钉螺生存的影响程度。方法　采集安徽贵池江滩无血吸虫感染的钉螺 ,在室内进行人工感染 ,将获得的感染性钉螺和对照组阴性钉螺同时放回现场环境饲养 ,每间隔 10 d观察钉螺生存情况 ,记录不同时间钉螺的存活率和死亡率 ,用动物生存寿命表法计算钉螺被血吸虫寄生后在现场环境中期望生存时间的变化。结果　在现场自然环境中 ,有血吸虫寄生钉螺的死亡高峰为 6 0～ 70 d时间段 ,推算期望生存时间为 6 3.4 6 d,最长生存时间为135 d;无血吸虫寄生钉螺的死亡高峰为 80～ 90 d时间段 ,推算期望生存时间为 83.5 4 d,最长生存时间为 15 5 d。感染了血吸虫的钉螺比无血吸虫感染的钉螺期望生存时间缩短了 2 4 .0 4 %。结论　感染了血吸虫的钉螺在自然环境中的死亡率增高 ,生存时间缩短     

Effect of ketorolac and low-molecular-weight heparin individually and in combination on haemostasis.

Low-molecular-weight heparins, when used in surgical patients for thromboprophylaxis, may be used concurrently with ketorolac, a non-steroidal anti-inflammatory drug that is used for analgesia. Because these two agents can influence the haemostatic system, it is important to identify any such effect. The haemostatic interaction between dalteparin and ketorolac was assessed in a double-blind, placebo-controlled, randomized, crossover study of healthy male volunteers each given all four combinations of ketorolac/placebo and dalteparin/placebo. The effect of ketorolac and dalteparin on haemostasis was assessed by measuring in-vitro platelet aggregation, anti-factor-Xa, activated partial thromboplastin times and skin bleeding time. The results were analysed for evidence of an interaction between ketorolac and dalteparin. Ketorolac inhibited platelet aggregation in whole blood and platelet-rich plasma. The administration of dalteparin led to a significant increase in levels of anti-factor-Xa and a significant prolongation in the activated partial thromboplastin time, although it remained within the range of the normal population. There was no evidence of any interaction between ketorolac and dalteparin with regard to platelet aggregation, anti-factor-Xa activity or activated partial thromboplastin time. The administration of ketorolac significantly prolonged the skin bleeding time. There was a significant interaction between ketorolac and dalteparin to prolong the bleeding time, although dalteparin alone had no effect on bleeding time. There was an interaction between ketorolac and dalteparin, which affected bleeding times. Such an interaction raises the possibility of haemorrhagic complications developing perioperatively when these agents are used concomitantly. Further studies are required to examine the clinical importance of this interaction.     

Liver biopsy bleeding time: An unpredictable event

The aim of this study was to observe the correlation between liver biopsy bleeding time, prothrombin time ratio and platelet count. The subjects were 51 consecutive patients referred for laparoscopic liver biopsy. The intervention was laparoscopy under local anaesthetic and liver biopsy with observation of post biopsy bleeding time. No correlation was found between observed liver biopsy bleeding time and platelet count or prothrombin time ratio. Thus, mild to moderate coagulopathy does not appear to be associated with prolonged bleeding following liver biopsy. Equally, normality of these coagulation studies does not indicate an absence of risk for post liver biopsy bleeding.     

曲前列尼尔在高原地区先天性心脏病并发重度肺动脉高压围术期中的应用

目的 探讨静脉持续注射曲前列尼尔在高原地区先天性心脏病（先心病）并发重度肺动脉高压（S-PAH）患儿围术期应用的安全性和有效性。 方法 分别选择2015年1月~2016年10月和2017年1~-2018年10月入我院的高原地区先心病并S-PAH患儿各33例,前后两个住院时期的患儿按围术期是否使用曲前列尼尔分别设为试药组（33例,2017年1月~2018年10月入院）和对照组（33例,2015年1月~2016年10月入院）。对照组仅口服西地那非治疗,试药组在口服西地那非治疗的同时,给予曲前列尼尔静脉微泵注射给药至出院前,观察并评估每组患儿的一般临床指标、超声心动图、脑钠尿肽（BNP）等指标。 结果 两组患儿一般临床指标和超声指标比较均无统计学意义,与入院时比较,两组患儿出院前肺动脉收缩压（PASP）和末梢氧饱和度明显下降,且试药组患儿PASP显著低于对照组（P<0.05）,但末梢氧饱和度组间比较无显著差异;试药组患儿体外循环时间、呼吸机带管时间和ICU住院时间与对照组比较显著缩短（均P<0.05）,两组患儿主动脉阻闭时间比较无明显差异;两组患儿出院前心排指数（CI）及BNP与术前比较差异显著（P<0.05）,且出院前试药组BNP和CI与对照组比较有显著差异（均P<0.05）,而左室射血分数两组比较差异不显著。 结论 持续静脉注射曲前列尼尔在高原地区S-PAH患儿中能够安全、有效的控制PAH,减少患儿呼吸机带管时间和住院时间。     

Difference in myocardial characteristics between hypertrophic cardiomyopathy and myocardial hypertrophy due to essential hypertension

To investigate the qualitative difference in myocardial hypertrophy that exists between hypertrophic cardiomyopathy (HCM) and essential hypertension (HT), we measured the mean wall thickness (MWT), the early diastolic time intervals (IIA-MVO time: from the second heart sound to the point of mitral valve opening, MVO-O time: from MVO to the O point of apexcardiogram) and the MVO-O/IIA-MVO ratio. The MWT in HCM and HT was measured by biventriculogram and echocardiogram, respectively. The MWT showed no significant difference between HT (13.1 +/- 3.0 mm) and non-obstructive type of HCM (14.8 +/- 3.7), but the MWT in obstructive type (1.08 +/- 0.24) was significantly thinner than that in HT. As the MWT increased, both IIA-MVO and MVO-O time were prolonged in both groups. But the mode of prolongation was quite different. In HT, the prolongation of the IIA-MVO time was almost always greater than that of the MVO-O time. In HCM, the prolongation of the latter was greater than that of the former. The MVO-O/IIA-MVO ratio in HT was significantly less than that in normal subjects, but those in HCM were significantly greater. These findings suggest that the differences in the early diastolic time intervals between HCM and HT are not due to the magnitude of the left ventricular hypertrophy, but due to myocardial characteristics.