Gut dysfunction is defined as the impairment of intestinal parenchyma and(or) intestinal function leading to dyspepsia, malabsorption, and(or) intestinal barrier dysfunction. In the stress state, gastrointestinal tract contributes to the physiopathological change, which is considered as the "central organ after stress". Because of ischemia, anoxia and metabolic disturbance, critical illness is frequently complicated with intestinal dysfunction, which is one of the difficulties to treat critically ill patients. Undoubtedly, nutritional support is one of the indispensable therapies of intestinal dysfunction, which is also difficult to manage. This report was aimed to elaborate the definition, causes of intestinal dysfunction, assessment of nutritional status, and design of nutritional support in these patients.
Critical Illness ; Gastrointestinal Diseases ; etiology ; therapy ; Humans ; Multiple Organ Failure ; complications ; Nutritional Support

Objective To exploie the choices and timing of different treatment regimens of prostate cancer.Methods The complete clinical data of one case of localized high-risk prostate cancer was reported.The patient,aged 69 years old,was admitted to hospital with urinary frequency and dysuria for 2 years.Serum total PSA was 36.8ng/ml and prostate biopsy dignosed as prostate cancer.The Gleason score was 4 + 3,and the clinical stage was T2b N0M0.Results The patient underwent radical prostatectomy,salvage radiotherapy + androgen deprivation therapy,abiraterone,enzalutamide,Radium-223,docetaxel + prednisone chemotherapy and mitoxantrone + prednisone chemotherapy,which included almost all of the current domestic treatment regimens.The patient lived for 57 months from the initiation of treatment.Conclusions For the patients with high-risk prostate cancer,especially for elderly patients,they should firstly be recommended the treatment of radical radiotherapy + 2-3 years of androgen deprivation therapy.For young patients,radical prostatectomy + extended pelvic lymph node dissection as part of multi-modal therapies is considered to be a positive choice.However,for the patients with risk factors or recurrence after radical prostatectomy,the postoperative radiotherapy should be performed in order to reduce biochemical recurrence and improve local control.Currently,the order of choice of abiraterone,enzalutamide or docetaxel + prednisone chemotherapy,is based on the patient's situation,past history of treatment,symptoms,side effects as well as other related clinical features.

Objective To investigate the detection of anti-cyclic citrullinated peptide(anti-CCP)antibody,alkaline phosphatase (ALP),glucose-6-phosphate isomerase(G6PI)and rheumatoid factor(RF)in the diagnosis of rheumatoid arthritis(RA).Methods Serum RF,anti-CCP body,ALP and G6PI were detected in 206 cases of RA,68 cases of other autoimmune diseases and 48 persons with the healthy physical examination,at the same time the erythrocyte sedimentation rate(ESR)was measured;the sensitivity and specificity of each indicator and the relationship between each index and RA′s diagnosis.Results The serum level of each index in the RA group was significantly higher than that in the other two groups(P <0.05).The sensitivity of RF,anti-CCP antibody and G6PI for diagnosing RA is similar;the specificity of anti-CCP body was highest(94.8%),RF was similar to G6PI;ALP with rela-tively lower sensitivity and specificity also reflected the potential of RA to some extent.Conclusion The simultaneous detection of serum RF,anti-CCP body,G6PI and ALP can improve the accuracy of early diagnosis of RA,reduce the missed diagnosis and guide the clinical treatment.

Traditional treatments of gastrointestinal fistula include early drainage, maintaining nutrition and then resection of fistula at the proper time,which usually take three to four months or even longer. Rapid treatments of gastrointestinal fistula mean promoting rapid spontaneous closure of tract fistula and early primary resection of fistula within two weeks after fistula occurrence. Early diagnosis is the premise of early management, and fistulography and abdominal CT scan are important early diagnostic methods. Most of fistula could close spontaneously in the maintaining stage. To promote the rapid closure, however, special measures including sufficient drainage, somatostatin and total parenteral nutrition in the early stage should be implemented to avoid intra-abdominal collection of intestinal fluid and infection, control further leakage of intestinal fluid and improve nutritional status. In the late stage,when leakage of intestinal fluid could be controlled, recombine human growth hormone (rhGH) and enteral nutrition should be administered in place of somatostatin and total parenteral nutrition respectively. The fistula can reach rapid spontaneous closure in both stages. Fibrin glue and rhGH used at the same time can improve the curative rate and shorten the treatment time even more. In the 1960s and 1970s, early primary resection of the fistula and re-anastomosis often resulted in anastomosis failure. The reasons for this included poor nutritional status, uncontrolled secretion of intestinal fluid, severe intra-abdominal infection and multiorgan dysfunction syndrome. Such stage management policy has been proposed, developed and persisted since late 1960s. Nowadays, the advance of medical science provided the possibility to change or improve the current policy. Our research proved that early resection of the primary fistula and re-anastomosis of the small bowel could be performed successfully in some selected patients whose general conditions are good and intestinal adhesion were not severe within ten to fourteen days after fistula occurrence. More studies are still needed to define the indications and contradictions for early resection of the primary gastrointestinal fistula, and prove the feasibility and rationality of rapid treatments of gastrointestinal fistula.
Early Diagnosis ; Humans ; Intestinal Fistula ; diagnosis ; therapy ; Parenteral Nutrition, Total

Antineoplastic Agents ; therapeutic use ; Chemotherapy, Adjuvant ; methods ; China ; Glioblastoma ; drug therapy ; surgery ; Humans ; Neurosurgery ; Physicians

AIM To study the effect of genistein (GST), a protein tyrosine kinases inhibitor, on L-type calcium channel currents (Iba,L or Ica,L, dependent on permeating ion used) in freshly dispersed colon smooth muscle cells from guinea-pig. METHODS Single colon smooth muscle cells were enzymatically dissociated from guinea-pig. L-type calcium currents were measured by conventional whole-cell patch-clamp techniques. RESULTS The peak amplitudes of Iba,L elicited to 10 mV test potential from a holding potential of -80 mV, were reversibly and dose-dependently reduced by GST (10-100 μmol·L-1) with an IC50 value of (39.9±3.6)μmol·L-1. Bath application of GST shifted the steady-state inactivation curves of Iba,L in a hyperpolarized direction (about 10 mV, P＜0.01) without altering their slopes. The peak amplitudes of Iba,L were also inhibited but to a less extent by daidzein, an inactive analogue of GST. Sodium orthovanadate 1 mmol·L-1, a potent inhibitor of protein tyrosine phosphatases, blocked GST-induced inhibition of Ica,L. CONCLUSION GST can block L-type calcium channel activity in guinea-pig colon smooth muscle cells via tyrosine kinase pathway.

Peripheral nerve injury of a limb usually causes functional reorganization of the contralateral somatosensory cortex.However, the patients with an operation of the contralateral seventh cervical nerve (C7) transfer to an injured arm with brachial plexus root avulsions usually have the sole tactile sensibility of the healthy hand when the injured hand is touched at the early stage after the operation. Then, at later stage they gradually get normal sense from the injured and the normal hands independently. Mimicked the process in a rat model based on the above operation, representations of the injured forepaw and the healthy forepaw in the somatosensory cortex were studied by means of somatosensory evoked potential (SEP) recording. Somatosensory function shown in SEP response amplitude and peak latency of the injured forepaw gradually recovered with time after the operation due to the contralateral C7 regeneration toward the injured limb, accompanied with the recovery process of limb movement. The somatosensory representation of the injured forepaw was observed exclusively in the ipsilateral somatosensory cortex since the 5th month after the operation. Accordingly, the overlapped representation of the injured and healthy forepaws emerged in the ipsilateral somatosensory cortex of 13 rats studied except one with separated representation though the SEP latency and response amplitude were different in responding to stimuli on the two forepaws. It is concluded that the contralateral peripheral nerve transfer to the injured arm can cause dynamically functional reorganization in the ipsilateral somatosensory cortex suggesting a remarkable plasticity of the brain function induced by an alteration of sensory input between two sides of the body in adult rats.

Peripheral nerve injury of a limb usually causes functional reorganization of the contralateral somatosensory cortex.However, the patients with an operation of the contralateral seventh cervical nerve (C7) transfer to an injured arm with brachial plexusroot avulsions usually have the sole tactile sensibility of the healthy hand when the injured hand is touched at the early stage after theoperation. Then, at later stage they gradually get normal sense from the injured and the normal hands independently. Mimicked theprocess in a rat model based on the above operation, representations of the injured forepaw and the healthy forepaw in thesomatosensory cortex were studied by means of somatosensory evoked potential (SEP) recording. Somatosensory function shown inSEP response amplitude and peak latency of the injured forepaw gradually recovered with time after the operation due to thecontralateral C7 regeneration toward the injured limb, accompanied with the recovery process of limb movement. The somatosensoryrepresentation of the injured forepaw was observed exclusively in the ipsilateral somatosensory cortex since the 5th month after theoperation. Accordingly, the overlapped representation of the injured and healthy forepaws emerged in the ipsilateral somatosensorycortex of 13 rats studied except one with separated representation though the SEP latency and response amplitude were different inresponding to stimuli on the two forepaws. It is concluded that the contralateral peripheral nerve transfer to the injured arm can causedynamically functional reorganization in the ipsilateral somatosensory cortex suggesting a remarkable plasticity of the brain functioninduced by an alteration of sensory input between two sides of the body in adult rats.

Objective To observe the effect of low molecular weight heparin(LMWH) in treatment of diabetic foot.Methods Fifty-four patients were divided into test group and control group randomly.Both two groups were given routine therapy including mediating blood glucose with Insulin,anti-infection and changing dressings,while the test group were givon LMWH 5000IU once datly every 12 hours for 15 days besides the routine treatment.Then the endothelin(ET),thromboxaneB2(TXB2),hemorheology,ankle-brachial index(ABI),ulcer healing,fibrinogen(FIB),prothrombin time(PT) and avtivated parital thromboplastin time(APTT) were observed.Results Compared to that of before treatment,there are ET,TXB2,hemorheology and better ulcer heals after treatment,The improvement in test group patients was superior to that of control group(P0.05) after treatment in two groups.No hemorrhage and other complications occurred.Conclusion LMWH is effective and safe for treatment of diabetic foot.

China ; epidemiology ; Humans ; Occupational Diseases ; epidemiology ; prevention & control