Physiology of Intestinal Absorption and Secretion

Virtually all nutrients from the diet are absorbed into blood across the highly polarized epithelial cell layer forming the small and large intestinal mucosa. Anatomical, histological, and functional specializations along the gastrointestinal tract are responsible for the effective and regulated nutrient transport via both passive and active mechanisms. In this chapter, we summarize the current state of knowledge regarding the mechanism of intestinal absorption of key nutrients such as sodium, anions (chloride, sulfate, oxalate), carbohydrates, amino acids and peptides, lipids, lipid- and water-soluble vitamins, as well as the major minerals and micronutrients. This outline, including the molecular identity, specificity, and coordinated activities of key transport proteins and genes involved, serves as the background for the following chapters focused on the pathophysiology of acquired and congenital intestinal malabsorption, as well as clinical tools to test and treat malabsorptive symptoms.     

Study of autosomal STR loci with IBS method in full sibling identification

Objective: We investigated the application of 51 autosomal short tandem repeat (STR) loci with the identity by state (IBS) method and a discriminant function algorithm in full-sib identification. Methods: A total of 342 pairs of full sibs (FSs) and 3900 pairs of unrelated individuals (UIs) were genotyped for 51 STR loci. Groups were formed in accordance with discrimination power (DP) values and the number of loci, and IBS scores of FSs and UIs were analyzed and compared. The discriminant functions of FS-UI were determined by using the Fisher discriminant with SPSS software. Results: All IBS in FSs and UIs groups showed normal distributions and there were significant differences between FS-UI. Receiver operating characteristic curves revealed that the detection efficiency of full-sib identification was affected by both the locus polymorphism and the number of loci detected. Comparing the rate of false positive and false negative of discriminant function between groups, a higher average DP value and larger number of loci detected were associated with a lower rate of miscarriage of justice and were more helpful for full-sib identification. Conclusion: STRs with higher DP values should be selected when additional autosomal markers are required for FS identification. Discriminant analysis with the IBS method is highly applicable for the FS-UI test.     

Surgical management and autologous intestinal reconstruction in short bowel syndrome

Short bowel syndrome (SBS) is a serious condition with considerable morbidity and mortality. When treatment with parenteral nutrition fails and life-threatening complications occur, autologous intestinal reconstruction (AIR) should be considered before intestinal transplantation (ITx). Single or combined ITx should be reserved for patients with severe liver disease and as last resort in the treatment of SBS. Longitudinal intestinal lengthening and tailoring (LILT) has proven its value in AIR, but its availability depends on the expertise of the surgeons. Serial transverse enteroplasty (STEP) has similar success rates as LILT and fewer patients progress to ITx. STEP is also applicable at small bowel dilatation in ultra-short bowel syndrome. The scope may be widened when duodenal dilatation can be treated as well. Spiral intestinal lengthening and tailoring (SILT) is a promising alternative. More research is needed to confirm these findings. Therefore we suggest an international data registry for all intestinal lengthening procedures.     

妇科手术后使用静脉镇痛泵持续时间的探讨

目的探讨妇科腹部手术后使用静脉给药式镇痛泵（PCIA）持续时间对患者疼痛程度、胃肠道功能等方面的影响。方法选择妇科腹部手术使用静脉给药式镇痛泵者，分为使用PCIA24，48，72h3组，各30例，比较3组停止使用镇痛泵后的疼痛情况、胃肠蠕动时间、肛门排气时间、起床时间、自行排尿时间和恶心呕吐的发生情况。结果3组患者疼痛VAS评分各时点比较差异无统计学意义；3组患者自行排尿时间比较差异无统计学意义；24h组患者肛门排气时间、起床时间均显著早于另外2组；24h组恶心、呕吐发生率均显著低于另外2组，差异均有统计学意义。结论镇痛泵应用能有效缓解手术后24h内的急性疼痛，而对急性疼痛过后（24h）由于活动引起的疼痛效果不明显，但由镇痛泵（麻醉药）引起的不良反应仍起作用，如呕吐、排气时间长、留置泵引起活动不便等。故应选择恰当的时间停止静脉镇痛泵的使用，减少并发症，有利于患者的术后康复。     

Desnutrición y desarrollo cognitivo en infantes de zonas rurales marginadas de México

ObjectiveTo analyze the relationship between nutritional status measured by anthropometry and the mental, psychomotor and language development of infants in marginalized rural areas of Mexico.MethodCross-sectional study with 576 infants aged from 7 to 26 months in four rural locations. Variables consisted of measures of anthropometric and cognitive development.ResultsInfants with short stature had a lower rate of language development, while birth weight was marginally associated with psychomotor development.ConclusionAlthough acute malnutrition (identified by underweight) is no longer a problem in rural areas of Mexico, chronic malnutrition (expressed as stunting) is still common and is associated with alterations in mental development in the child population.     

A quasi-cluster randomized controlled trial of a classroom-based mental health literacy educational intervention to promote knowledge and help-seeking/helping behavior in adolescents

IntroductionSchool-based education is a potentially effective approach for improving mental health literacy (MHL) in adolescents. This study evaluated the effects of the “Short MHL Program (SMHLP)”, a brief (50 min), school teacher-led program, on MHL in adolescents in a quasi-cluster randomized controlled trial.MethodsA total of 975 high school first graders (age 15–16) in Japan were allocated to classes such that gender and academic achievement ratios were almost equivalent at the time of admission to the high school. They were assigned at the class level to the SMHLP (n = 364 from 10 classes) or a control group (n = 611 from 17 classes). The program consisted of a 50-minute session and was delivered by a school teacher. The students completed a self-report questionnaire at 3 time points: pre-, (immediately) post- and 2-month follow-up. Outcomes included “Knowledge about mental health/illnesses”, “Recognition of the necessity to seek help”, “Intention to seek help”, and “Intention of helping peers”. Mixed effects modeling was employed for analyses.ResultsScores of all outcomes were significantly improved in the intervention group compared to the control group post-intervention (p < .001). These improvements were maintained at 2-months follow-up for all outcomes (p < .001–.05). Questionnaire scores did not differ between groups at baseline.ConclusionsThe effect of the SMHLP was confirmed in grade 10 students. Brief, yet effective programs can be a viable option to promote understanding of mental health problems and have the potential to be incorporated into regular school curriculum. "