早产儿肠内营养新概念

早产儿的营养支持是复杂和具有挑战性的系统工程。在早产儿肠内营养的实施过程中,应基于其生理特点,不仅从营养学而且从促进胃肠功能成熟的角度进行喂养,正确选择适合早产儿的喂养方法和乳类;不仅要关注营养对早期生长发育和对疾病反应方面的影响,更重要的是他们的远期健康。根据目前循证医学研究的证据来更新观念,走出误区,对于指导临床实践,改善早产儿的预后十分必要。     

胃管置入技术的研究进展

胃管置入是急诊科的一项基本护理操作技术.然而,由于病人病情不同,个体差异大,置管困难的现象屡见不鲜,为提高插管成功率,在插管研究与实践中,除了选择不同胃管外,近年来胃管置管技术和手段亦不断发展.现综述如下.     

Exclusion Diets in Functional Dyspepsia

Functional dyspepsia represents one of the most common and prevalent disorders of the brain–gut interaction, with a large number of widespread risk factors being identified. With an intricate pathogenesis and symptomatology, it heavily impacts the quality of life and, due to the limited efficacy of traditional pharmacological agents, patients are likely to seek other medical and non-medical solutions to their problem. Over the last few years, significant research in this domain has emphasized the importance of various psychological therapies and nutritional recommendations. Nevertheless, a correlation has been established between functional dyspepsia and food intolerances, with more and more patients adopting different kinds of exclusion diets, leading to weight loss, restrictive eating behaviour and an imbalanced nutritional state, further negatively impacting their quality of life. Thus, in this systematic review, we aimed at analysing the impact and efficiency of certain exclusion diets undertook by patients, more precisely, the gluten-free diet and the low-FODMAP diet.     

Gastroduodenal intussusception caused by gastric gastrointestinal stromal tumor in adults: a case report and literature review

Intussusception mostly occurs in childhood and is rare in adults. Although intussusception can occur in any part of the gastrointestinal tract, gastroduodenal intussusception caused by a gastric tumor is relatively uncommon in clinical practice. A PubMed search identified 24 published cases of gastroduodenal intussusception caused by gastric gastrointestinal stromal tumor (GIST); however, it is possible that we missed other cases not included in PubMed. Here we report a case of gastroduodenal intussusception caused by gastric GIST in an 85-year-old man. He came to the hospital because of recurrent black stools. Plain computed tomography (CT) scan indicated a mass in the gastric antrum, with slight enhancement in the arterial phase on enhanced CT scan. He was diagnosed with GIST. In addition, images indicated that the mass overlapped into the duodenum, and gastroduodenal intussusception was thus considered. Gastroscopy showed a huge mass in the gastric body. According to the gastroscopy and CT results, gastroduodenal intussusception caused by a gastric tumor was considered. The patient underwent complete surgical removal, which revealed a mass originating from the gastric antrum and overlapping into the duodenum. The postoperative pathological diagnosis was intermediate-risk gastric GIST. The patient was followed up for 4 months without tumor recurrence.     

多参数MRI联合临床危险因素术前预测直肠癌淋巴血管间隙侵犯的应用价值

目的 探讨多参数 MRI 联合临床危险因素术前预测直肠癌淋巴血管间隙侵犯（LSVI）的价值。 方法 回顾性分析池州市人民医院 2022 年 4 月至 2023 年 11 月经术后病理证实的 38 例直肠癌患者的临床及影像学资料,所有患者均行常规 MRI、合成 MRI及 IVIM-DWI 序列扫描。依据术后病理结果分为 LVSI 阳性组（n=14）和 LVSI 阴性组（n=24）。采用单因素和多因素 logistic 回归分析LVSI 阳性组和 LVSI 阴性组的临床资料,分析 LVSI 的临床危险因素;比较两组患者合成 MRI （T1 值、T₂ 值、PD 值）及 IVIM-DWI 参数（D值、D*值、f 值）,采用受试者工作特征（ROC）曲线评价各定量参数预测模型及联合临床危险因素预测模型的诊断效能。 结果 合成MRI 的 T₂ 值及 IVIM-DWI 的 D 值、f 值在直肠癌 LVSI 阳性组和阴性组中比较差异具有统计学意义（P＜0.05）。术前 CEA（OR=10.818,95%CI：1.391~84.124）及临床 N 分期（OR=11.852,95%CI：1.534~91.552）是直肠癌 LVSI 的独立危险因素（P＜0.05）。单独的 T₂ 值、D 值、f 值及三者联合的曲线下面积（AUC）分别为 0.801、0.747、0.766、0.807,联合临床危险因素的预测模型效能最高（AUC=0.845）,灵敏度为 78.58%,特异度为 100%。 结论 多参数 MRI 术前可有效预测直肠癌 LVSI 的状态,结合临床危险因素的联合预测模型可进一步提升预测效能,有助于临床医师制定个性化直肠癌治疗方案。     

Effects of quercetin on the gastrointestinal tract in rats and mice

Intraperitoneal administration of quercetin (6.25–50 mg/kg) significantly (p<0.5-0.01) reduced intestinal transit in mice and this effect was antagonized by yohimbine and phentolamine but not by atropine or naloxone. Quercetin (12.5–50 mg/kg) reduced also (p<0.05-0.01) intraluminal accumulation of fluid and diarrhoea induced by castor oil and these effects were antagonized by yohimbine. Finally quercetin (12.5–50 mg/kg) reduced the area of gastric ulcer but not the number. It is suggested that α2-adrenergic receptors mediate the effect of quercetin on intestinal motility and secretion.     

Multiple gastrointestinal atresias result from disturbed morphogenesis

 Multiple gastrointestinal atresias (MGA) have been reported to account for 6% to 32% of all intestinal atresias. Controversy exists regarding the pathogenesis. Many investigators believe MGA to be the result of multiple ischemic infarctions of the intestinal tract. However, some have suggested that MGA results from a malformative process early in fetal life. Prenatal exposure to adriamycin in a rat model has been reported to lead to a spectrum of tracheoesophageal and associated malformations of the gastrointestinal tract, including intestinal atresias, identical to these observed in humans. The aim of this study was to determine the incidence and histopathologic findings of MGA in order to understand the pathogenesis. Timed-pregnant Sprague-Dawley rats were injected with adriamycin (1.75 mg/kg) in nine different gestational-day protocols. MGA was only seen in those rats who received adriamycin on gestational days 7, 8, and 9. The litters were recovered on day 21 by cesarean section. The digestive tracts (DT) of the fetuses were harvested for macroscopic and microscopic examination. Ten rats who received adriamycin on gestational days 7, 8, and 9 produced 87 newborns; 1 was damaged during dissection. DT anomalies occurred in 80 (93%) of the 86 newborns; 94% of these demonstrated MGA. There was a very high incidence of associated anomalies in newborns with MGA. Histologically, the blind-ending atresias showed different degrees of villous hyperplasia with or without intraluminal material. This is the first report demonstrating a high rate of occurrence of MGA in the adriamycin rat model. The injection of adriamycin early in gestation, the high incidence of associated malformations, and the anatomic and histologic findings in MGA indicate that MGA is a result of a malformative rather than an ischemic process. Accepted: 22 September 2000     

Growth and Gastrointestinal Tolerance in Healthy Term Infants Fed Milk-Based Infant Formula Supplemented with Five Human Milk Oligosaccharides (HMOs): A Randomized Multicenter Trial

Background: Five of the most abundant human milk oligosaccharides (HMOs) in human milk are 2′-fucosyllactose (2′-FL), 3-fucosyllactose (3-FL), lacto-N-tetraose (LNT), 3′-sialyllactose (3′-SL) and 6′-sialyllactose (6′-SL). Methods: A randomized, double-blind, controlled parallel feeding trial evaluated growth in healthy term infants fed a control milk-based formula (CF; n = 129), experimental milk-based formula (EF; n = 130) containing five HMOs (5.75 g/L; 2′-FL, 3-FL, LNT, 3′-SL and 6′-SL) or human milk (HM; n = 104). Results: No significant differences (all p ≥ 0.337, protocol evaluable cohort) were observed among the three groups for weight gain per day from 14 to 119 days (D) of age, irrespective of COVID-19 or combined non-COVID-19 and COVID-19 periods. There were no differences (p ≥ 0.05) among the three groups for gains in weight and length from D14 to D119. Compared to the CF group, the EF group had more stools that were soft, frequent and yellow and were similar to the HM group. Serious and non-serious adverse events were not different among groups, but more CF-fed infants were seen by health care professionals for illness from study entry to D56 (p = 0.044) and D84 (p = 0.028) compared to EF-fed infants. Conclusions: The study demonstrated that the EF containing five HMOs supported normal growth, gastrointestinal (GI) tolerance and safe use in healthy term infants.