Anxiety and depression are common conditions among patients with irritable bowel syndrome(IBS)which may induce or aggravate intestinal symptoms. Psychological factors are considered to be involved in the pathogenesis of IBS via both central and peripheral pathways,and functional magnetic resonance imaging(fMRI)revealed that several brain areas,such as anterior cingulate cortex and prefrontal cortex,are associated with IBS,anxiety and depression. This article reviewed the use of fMRI for studying the correlation of IBS brain activity with anxiety and depression and its role in the central pathogenesis of IBS.

Objective To investigate the morphological responses of enteric nervous system (ENS) neurons of submucosal plexus (SMP) in distal colon of rat models with irritable bowel syndrome with diarrhea (IBS-D). Methods Rat models with IBS-D were established with chronic unpredictable mild stress and acute wrap restrain stress (CAS). Double staining with immunohistofluorescence for colonic whole mount preparations was used to evaluate the distribution and proportion of SMP neurons expressing specific neurochemical markers [choline acetyltransferase (CHAT), vasoactive intestinal polypeptide (VIP), and nitric oxide synthase (NOS)] and their colocalization with anti-Hu antibody, which is the hallmark for whole enteric neurons. Results There was no obvious difference in the total numbers of anti-Hu positive neurons and ganglia between IBS-D and control group. The proportions of both VIP-immunoreactive (VIP-IR) and NOS-IR neurons in colonic SMP were higher in IBS-D rats compared with controls (62.2%±6.2% vs 55.4% ±5.4%;15.0%±4.0%vs 10.5%±2.9%, P<0.05). There was no difference in the proportion of ChAT-IR neurons between two groups. Conclusions VIP is the most specific neurotransmitter for excitatory secretomotor neurons in rat SMP, the increase of VIP-IR neurons can promote intestinal mucosal secretion, which might play an important role in the pathophysiological mechanisms of IBS with diarrhea.

Objective To analyze the clinical characteristics of chronic intestinal pseudoobstruction (CIPO).Methods Clinical data of 43 patients with CIPO admitted in Peking Union Medical College Hospital from January 2012 to December 2016 were retrospectively reviewed.The clinical manifestations,laboratory examinations,images,treatment and prognosis of CIPO patients were analyzed.Results There were 14 males and 29 females with an mean age of (41.9 ± 16.1) years.Among 43 patients,32 were admitted in Gastroenterology Department,6 in General Medicine Department and 5 in Rheumatology Department.Twenty two cases were primary CIPO and 21 cases were secondary.The main clinical manifestations were abdominal distension (93.0％),abdominal pain (67.4％),vomiting (67.4％),diarrhea (46.5％) and constipation (41.9％).All 43 patients had decreased body weight and body mass index (BMI);23.3％ (10/43) patients were complicated with anxiety and depression.53.5％ (23/43) patients presented anemia and 55.8％ (24/43) patients presented hypoalbuminemia.All patients with CIPO underwent abdominal X-ray,which showed intestinal obstruction;but there was no evidence of mechanical obstruction.The average length of hospital stay was (28.4 ± 13.9) d.Twenty three cases underwent gastric decompression;28 cases (65.1％) received parenteral nutrition,and 21 cases (48.8％) received enteral nutrition;and 9 abdominal operations were performed in 8 patients.Conclusion When clinical symptoms of intestinal obstruction appear without mechanical cause,CIPO should be considered and secondary factors should be screened.Unnecessary surgery should be avoided in CIPO patients.

Objective To evaluate proximal gastric function in patients with functional dyspepsia (FD) met Rome Ⅲ criteria and its subtypes.Methods Thirty FD patients were enrolled,including 15 patients with postprandial distress syndrome (PDS) and 15 patients with epigastric pain syndrome (EPS).A total of 30 healthy volunteers were recruited as control.All the subjects received barostat examination.Minimal distending pressure (MDP),pressure and volume of thresholds for first sensation and maximal tolerance for gastric sensitivity were recorded.When the pressure level was MDP+2 mmHg (1 mmHg=0.133 kPa),average volume at 30 minutes before meal,averaged volume at 60 minutes after meal and maximum accommodation volume after meal were recorded,and receptive diastolic volume was calculated.The gastric hypersensitivity and impaired accommodation were observed.Student's t test or x2 test was performed for statistical analysis.Results MDP,pressure of first-sensation,maximum sensation pressure,volume of first sensation and maximal sensation volume of FD group were (6.17 ±1.95) mmHg,(8.44±2.01) mmHg,(14.62±3.72) mmHg,(123.59±53.26) mL and (451.26±140.44) mL,respectively; which were lower than those of healthy control group ((9.27±1.99) mmHg,(12.04±2.66) mmHg,(19.74±4.18) mmHg,(168.41±73.06) mL and (556.89±124.07) mL),and the differences were statistically significant (t=-6.080,-5.900,-5.011,-2.723 and-2.995,all P＜0.01).The averaged volume at 30 minutes before meal and 60 minutes after meal was (212.19±120.82) mL and (333.97±121.86) mL while those of healthy control group was (191.69±66.19) mL and (385.58±83.05) mL,and there were no significant differences between the two groups (both P＞0.05).The maximum postprandial accommodation volume and receptive diastolic volume of FD group were (405.10±111.29) mL and (190.16±97.22) mL,which were lower than those of healthy control group ((461.10±87.60) mL and (262.83±78.39) mL),and the differences were statistically significant (t=-2.599 and-3.187,both P＜0.05).The maximum postprandial accommodation volume of FD patients was at 15 to 20 minutes after meal and in healthy control it was at five to ten minutes after meal.Among the 30 FD patients,12 patients (40 ％) had gastric hypersensitivity,including eight PDS patients and four EPS patients,and there was no significant difference in the ratio between two groups (P＞0.05) ;nine patients (30 ％) had impaired accommodation,including five PDS patients and four EPS patients,and there was no significant difference in the ratio between two groups (P＞ 0.05).Conclusions Gastric hypersensitivity and impaired accommodation often appear in FD patients,and there is no significant difference between PDS and EPS subtypes.FD patients with different pathophysiologic mechanisms cannot be efficiently distinguished according to Rome Ⅲ criteria.

Objective To investigate the impacts of soluble dietary fiber (SDF) on gastric emptying,postprandial blood glucose and insulin in patients with type 2 diabetes mellitus (T2DM).Methods Totally 30 T2DM patients and 10 healthy subjects (control group) were randomized to receive SDF-free liquid (500 ml,2092 kJ) and isocalorie SDF liquid (at β-glucan 7.5 g,500 ml,2092 kJ) on two separate days based on a Cross-over order.Gastric emptying was monitored by ultrasomography at intervals of 30 min for 2 hours.Fasting and postprandial blood samples were collected at intervals of 30-60 min for 180 min to determine blood glucose and insulin.Results The proximal gastric emptying was delayed in SDF both in T2DM group (P =0.001)and control group (P =0.037).SDF significantly decreased the area under the curve of postprandial glucose (P =0.001) and insulin (P =0.001) in T2DM group.Postprandial glucose (r=-0.547,P =0.047) and insulin (r =-0.444,P =0.030) had negative correlation with distal emptying of SDF in T2DM patients.The distal gastric emptying was delayed significantly in T2DM patients with HbAlc≥6.5％ (n =13,P =0.021)by SDF.Conclusions SDF can improve the postprandial glucose level,which may be related with the delayed gastric emptying.T2DM patients with higher average blood glucose has remarkably delayed gastric emptying after the administration of SDF.

Objective To investigate the changes of the expression of HIF-1α (hypoxia induciblefactor-1a) mRNA in myocardium of rats after cardiopulmonary resuscitation (CPR) and the intervention effects of exogenous hydrogen sulfide on it. Method Forty five male SD rats were randomly divided into three groups: control group ( n = 15 ), cardiopulmonary resuscitation group ( CPR group, n = 15 ) and NaHS + CPR group (n = 15 ) . Rats of control group were anesthetized and intubated without asphyxia and cardiac arrest. The rats of CPR group and NaHS + CPR group were operated to induce cardiac arrest by asphyxiation. In the rats of NaHS + CPR group, NaHS in dose of 50 ug/kg was administrated via the femoral venous line 1 minute before CPR. Hemodynamic was monitored continuously. The expression of HIF - lα mRNA in myocardium of rats in each group was determined by using RT-PCR and the activity of myeloperoxidase (MPO) in the myocardium of rats in each group was assayed by using a patent reagent box 6 h after CPR. The histopathological changes of myocardium were also observed. The t- test was used for statistical analysis. Results There was no statistically significant difference in hemodynamic changes between CPR group and CPR + NaHS group ( P ＞ 0. 05 ) . When compared with the control group, the activity of MPO and the expression of HIF-1α mRNA in CPR group and CPR + NaHS group were both increased, and those increased in CPR + NaHS group was more significant (P ＜ 0. 05) . When compared with CPR group, the expression of HIF-1α mRNA in CPR + NaHS group was higher, however, the activity of MPO in CPR + NaHS group was lower ( P ＜ 0. 05) . There were various histopathological changes of myocardium of rats found in CPR group and CPR + NaHS group, and the damage of myocardium of rats in CPR group was more obvious than that in CPR + NaHS group. Conclusions The expression of HIF-1α mRNA in myocardium of rats was increased after CPR. Exogenous hydrogen sulfide can protect myocardium cells from resuscitation-perfusion injury, and the protection is associated with increase in expression of HIF 1 αmRNA.

Objective To investigate the effects of hydrogen sulfide on sepsis-induced cardiac dysfunction in rats.Methods Male SD rats were randomly ( random number) divided into 4 groups:control group ( Ⅰ group),sepsis group ( Ⅱ group),sepsis + NaHS group (Ⅲ group),sepsis + PAG group (Ⅳ group). Cecal ligation and puncture technique was used in Ⅱ, Ⅲ, Ⅳ group. Hemodynamic was observed,and H2S synthesis,CSE (cystathionine-r-lyase) mRNA,MPO activity and the level of TNF-α,IL-1β were determined.The morphological changes and infiltration of inflammatory cells in myocardium were also observed.Results Compared with Ⅰ group,H2S synthesis,the levels of TNF-α,IL-1 β,the activity of MPO increased ( P ＜ 0.05 or P ＜ 0.01 ),and the expression of CSE-mRNA increased,and blood pressure of rats decreased significantly in Ⅱ group.Compared with Ⅱ group,H2S synthesis,the levels of TNF-α,IL-1β and the activity of MPO increased (P ＜ 0.05),the expression of CSE mRNA did not change noticeably ( P ＞ 0.05),and blood pressure of rats decreased more significantly in Ⅲ group.Compared with Ⅱ group, H2S level decreased,the levels of TNF-α,IL-1β and the activity of MPO decreased significantly,the expression of CSE mRNA decreased and blood pressure of rats decreased in Ⅵ group (P ＜0.05).Histopathological changes of myocardium were aggravated in the following severity order: Ⅰ ＜ Ⅳ ＜＜ Ⅲ.Conclusions CSE/H2S system of the myocardium was upregulated in sepsis rats.Hydrogen sulfide could raise the levels of MPO,TNF-α,IL-1β,aggravating myocardial injury. Contrarily,the inhibitor of H2S could counteract it.

Objective To express nonstructural protein 2 transactivated protein (NS2TP) of hepatitis C virus (HCV) in the prokaryotic expression system and prepare polyclonal antibody,and to study the expressions in different liver tissues.Methods NS2TP gene was amplified by polymerase chain reaction (PCR) technique and cloned into the prokaryotic expression vector pET-32a(+),which was transformed into E.coli BL21.The protein was induced by isopropyl thiogalactose (IPTG) and analyzed with sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and confirmed by Western blotting assay.The recombinant protein were expressed and purified in a large amount.The rabbit was immunized with the purified protein to prepare polyelonal antibody.The liver tissues of patients with chronic HCV infection and healthy controls were detected by immunohistochemistry method.Results The recombinant NS2TP protein (relative molecular mass:33×103 ) and polyclonal antibody with high titer and specificity were successfully prepared.NS2TP expressions in the liver of patients with chronic HCV infection were higher than those of healthy controls,and were mainly distributed in the nucleus of hepatocytes.Conclusions The NS2TP expression level and intracellular location in liver tissue of patients with chronic HCV infection are understanded,which could bring new clues for further study of the biological function of NS2TP and the pathogenesis of HCV infection.

Objective To increase the understanding in protein-losing enteropathy (PLE).Methods Sixty-one PLE patients were enrolled in the study and the clinical characteristics, complicated disease, diagnosis and treatment were analyzed. Results The age of the patients was 16-77 (40±15)years, and the gender ratio was 35:26 (female: male). The main clinical manifestations were bilateral lower limb edema in 51 cases, ascites in 41 cases, bilateral pleural effusion in 23 cases, pericardial effusion in 13cases, abdominal pain in 16 cases and diarrhea in 33 cases. The prominent abnormality in laboratory examinations was hypoalbuminemia. The underlying diseases include systemic lupus erythematosus (SLE) in 28 cases, intestinal lymphangiectasia in 12 cases, hepatic cirrhosis in 5 cases, heart diseases in 5 cases,Crohn's disease in 3 cases, membranous nephropathy in 2 cases, Budd-Chiari syndrome in 1 case. Four cases happened after abdominal operation and 1 case after radiation therapy of gastric cardia cancer. Thirtyseven cases were diagnosed by 99Tcm-labelled human serum albumin scintigraphy and 24 cases were diagnosed clinically. Treatment was focused on underlying diseases. The clinical manifestations in 21 cases of SLE improved after SLE was controlled. In 2 cases of intestinal lymphangiectasia and one with Crohn's disease, the clinical manifestations improved after surgery. The other patients had no improvement.Conclusions PLE was not uncommon in clinical practice. Its predominant characteristics were severe hypoalbuminemia, edema and dropsy of serous cavity. PLE can complicate other diseases such as SLE,intestinal lymphangiectasia. Treatment should be focused on primary disease.

Aim To study the effect of rosiglitazone(RGZ)on expression and excretion of connective tissue growth factor(CTGF) in renal tissue and urinary of diabetic nephropathy rats.Methods Three groups of rats were studied:normal control group(n=8),STZ-induced diabetic model group(n=8),diabetes RGZ-treatment group(n=8).Urinary CTGF was measured at the 1 st,4 th,6 th and 8 th week,as well as the expressions of CTGF protein(by histochemical staining)at the 8 th week by ELISA.Results The urinary excretion rates of CTGF at 4 th、6 th、8 th weeks and the expressions of CTGF protein in renal cortex at 8th weeks significantly increased in STZ-induced model group compared with those in normal group(P