Functional constipation is a common functional gastrointestinal disorder with a multifactorial and incompletely understood pathogenesis.Recent studies have revealed that its development involves the interplay of multiple mechanisms,including neurogenic and myogenic dysfunction of the colon,reduction and impairment of interstitial cells of Cajal(ICCs),outlet obstruction,dysregulation of the gut-brain axis,immune activation,and gut microbiota imbalance.Slow-transit constipation is mainly associated with enteric neural abnormalities,disruption of ICC signaling,and inflammation,whereas outlet obstruction constipation often results from pelvic floor dysfunction and rectal hyposensitivity.Dysregulation of the gut-brain axis plays a central role,involving impaired central regulation,hormonal imbalance,and enhanced local immune response.Additionally,gut microbial metabolites such as short-chain fatty acids,bile acids,and methane affect colonic motility and inflammation.This review summarizes the current understanding and research progress on the pathogenesis of functional constipation,providing insights for mechanism-based and individualized therapeutic approaches.

Functional constipation is a common functional gastrointestinal disorder with a multifactorial and incompletely understood pathogenesis.Recent studies have revealed that its development involves the interplay of multiple mechanisms,including neurogenic and myogenic dysfunction of the colon,reduction and impairment of interstitial cells of Cajal(ICCs),outlet obstruction,dysregulation of the gut-brain axis,immune activation,and gut microbiota imbalance.Slow-transit constipation is mainly associated with enteric neural abnormalities,disruption of ICC signaling,and inflammation,whereas outlet obstruction constipation often results from pelvic floor dysfunction and rectal hyposensitivity.Dysregulation of the gut-brain axis plays a central role,involving impaired central regulation,hormonal imbalance,and enhanced local immune response.Additionally,gut microbial metabolites such as short-chain fatty acids,bile acids,and methane affect colonic motility and inflammation.This review summarizes the current understanding and research progress on the pathogenesis of functional constipation,providing insights for mechanism-based and individualized therapeutic approaches.

Objective To explore the change in 25 hydroxyvitamin D[25 -(OH)D]level in school - aged children with orthostatic hypertension (OHT). Methods Nineteen cases of school - aged children with OHT confirmed diagnosis by head - up tilt table test at the Department of Pediatric Cardiovasology,Children′s Medical Center,the Second Xiangya Hospital,Central South University,from October 2014 to February 2017,were selected as OHT group, including 17 males and 2 females,and their ages were from 7 to 14(11. 21 ± 2. 70)years old. Nineteen healthy children including 17 males and 2 females and aged 8 to 14(11. 05 ± 2. 35)years old who had a healthy examination of child care at the hospital in the same period were selected as healthy control group. In two groups of children all possible basic diseases were eliminated,such as severe liver and kidney disease,abnormal thyroid function and metabolic bone disease and/ or the long - term use of 25 -(OH)D metabolism drugs,accepted the serum 25 -(OH)D detection. Results (1)There was no significant difference in age and gender between the OHT group and the healthy control group(t = 0. 559,P > 0. 05;χ2 = 0. 000,P > 0. 05). The 25 -(OH)D levels were significantly lower in the OHT group than those in the healthy control group [(39. 62 ± 10. 65)nmol/ L vs. (64. 83 ± 10. 28)nmol/ L,t = - 7. 422,P <0. 01]. (2)25 -(OH)D levels had no correlation with age,gender,height,body mass,systolic pressure,or diastolic blood pressure (r = 0. 254,0. 047,0. 195,0. 019,- 0. 191,- 0. 184,all P > 0. 05). Taking 25 -(OH)D level as dependent variable,age,gender,height,body mass,systolic pressure,diastolic blood pressure as independent variables, multiple stepwise regression equation to predict 25 -(OH)D level was not fit. Conclusion Lower level of 25 -(OH)D may be one of the mechanisms for the onset of the school - aged children with OHT.

Objective To explore the effects of "3+1+1" talent cultivation model on key competency in five-year higher vocational nursing students. Methods In March 2015, we selected five-year 80 higher vocational nursing students majoring in clinical nursing in 2013 of Wuxi Higher Health Vocational Technology School as subjects by convenience sampling. All of the 80 nursing students were divided into experimental group (n=38) and control group (n=42) according to classes. Nursing students of experimental group received the "3+1+1" talent cultivation model. Nursing students of control group were treated with the "4+1" cultivation model. The evaluation index system for key competency of five-year higher vocational nursing students was used to evaluated nursing students of two groups. We also compared the theoretical achievement and skills performance of nursing students between two groups. Results There were no statistical difference in key competency of nursing students between two groups at the end of the 2.5th school year (P＞0.05). The score of key competency of nursing students in experimental group was higher than that in control group at the end of the fourth school year with a significant difference (P＜ 0.05). There were no statistical differences in theoretical achievement and skills performance of nursing students between two groups at the end of the 2.5th school year (P＞0.05). The theoretical achievement and skills performance of nursing students in experimental group were higher than that in control group at the end of the fourth school year with significant differences (P＜ 0.05). Conclusions The "3+1+1" talent cultivation model can improve nursing students' key competency and school achievement.

Objective To evaluate the short-term and long-term efficacy of interventional therapy for acute hepatic artery thrombosis.Methods We analyzed retrospectively the interventional treatment and long-term follow-up data of 34 patients with acute hepatic artery thrombosis in Zhongshan hospital of Fudan University from March 2003 to October 2015.Results Thirty-four patients with acute hepatic artery thrombosis were performed with urokinase thrombolytic therapy.Twenty-one patients were implanted stents in the thrombolytic therapy.Splenic artery embolization were performed in 3 patient with splenic artery steal syndrome.Technical and clinical success rates were 91％ (31/34).The complication associated with interventional procedures were observed in 2 patients.The patency rates of hepatic artery in 1,2,3 and 5 years were 82％,73％,57％ and 57％ respectively.The median obstruction free time was 94 months.Conclusions Good short-term and long-term effect have been obtained in interventional treatment for acute hepatic artery thrombosis,which can be used as the first treatment for acute hepatic artery thrombosis after liver transplantation.

Objective To explore the protective effect of long non-coding RNA(lncRNA) metasta-sis associated in lung denocarcinoma transcript 1 (MALAT1) involved in hyperoxia-induced lung injury in preterm infants.Methods This study had downloaded chip data set GSE25286 (Mouse GEO Genome 430 2.0 Array) from gene expression database gene expression omnibus (GEO),according to the state of hyperoxia exposure,the MALAT1 mRNA expression in rats normal lung tissues and hyperoxic lung tissues was compared at day 14th and 29th.In chip data set GSE43830(Human Exon 1.0 ST Arrays) from GEO,the expression of multi-ple genes[cell division cycle 6(CDC6),death effector domain containing 2(DEDD2),and Cyclin B1 (CCNB1)] in WI38 cells(lung fibroblasts) was compared before and after MALAT1 was knockout.At the same time,the peripheral blood samples of premature infants were collected to verify.Totally 40 premature infants were hospitalized in the department of neonatology in our hospital from Jan 2015 to Dec 2016,the pe-ripheral blood samples of 40 premature infants were collected.RNA was extracted and Real time-PCR was performed after reverse transcription,clinical data of these 40 cases were retrospectively analyzed. Results (1) By using Affymetrix Expression console and Affymetrix Transcriptome analysis console software source files of the chip of pretreatment and difference expression gene screening,the expression of lncRNA MALAT1 gene in lung tissues of hyperoxia lung injury mice significantly upregulated[fold change(FC) =2.33,P=0.001].(2) After MALAT1 in WI38 cell was knockout,MALAT1 expression was significantly reduced(FC= -15.6,P=0.000),the expression of CDC6(FC= -2.37,P=0.001) and CCNB1(FC=-2.16,P=0.002) were down regulated,DEDD2 expression was up regulated(FC =2.46,P =0.000). (3) The results of peripheral blood samples from preterm infants showed that the expression of MALAT1 was significantly increased in preterm infants with hyperoxia-induced lung injury(0.375 5 ± 0.081 9,t =4.634, P=0.015),compared with normal preterm infants(0.273 4 ± 0.067 3).Conclusion Through inhibiting cell apoptosis,lncRNA MALAT1 can protect preterm infants with hyperoxia-induced lung injury,it may provide a new strategy for prevention and treatment of hyperoxia-induced lung injury in premature infants.

The automatic nervous system(ANS) has 2 main branches:the sympathetic nervous system and the parasympathetic nervous system.The ANS controls mainly automatic bodily functions that are engaged in homeostasis.Autonomic dysfunction lead to many diseases,for example,orthostatic intolerance etc.The relationship between vitamin D and cardiovascular disease has becomes the focus of study gradually in recent years.1,25-dihydroxy vitamin D participates in the regulation of renin-angiotensin axis,vascular effects.Vitamin D deficiency triggers secondary hyperparathyroidism,promotes the development of hypertension,diabetes,dyslipidemia which can influence the incidence and prognosis of cardiovascular disease as well.The study confirmed that vitamin D deficiency is one of the risk factors of cardiac autonomic dysfunction diseases such as orthostatic intolerance.The mechanism is still not very clear.Supplement of vitamin D can offer an effective method to decrease cardiovascular disease risk in populations with low vitamin D status.

Objective To evaluated the clinical significance of embolization of arterio-portal venous shunt (APVS) in hepatocellular carcinoma (HCC) patients with main portal vein tumor thrombus (MPVTT) treated by transcatheter arterial chemoembolization (TACE) and portal vein stenting. Methods Twenty-six HCC patients with MPVTT and marked APVS, who were treated with TACE and portal vein stenting, were enrolled in this study. Portal vein stenting was performed via percutaneous transhepatic approach, which was followed by the embolization of the feeding arteries of APVS by using suitable embolic agents. The portal vein pressure levels were separately measured before, after portal vein stenting and after APVS embolization. The results were statistically analyzed. Results Both the portal vein stenting and APVS embolization were successfully accomplished in all the 26 patients. Hepatic angiography and portal venography performed before portal vein stenting revealed bidirectional portal flow in 16 cases and hepatofugal portal flow in 10 cases. Among the 16 patients with bidirectional portal flow, remarkable improvement of portal vein to liver blood flow after portal vein stenting was seen in 14, and obvious recovery of main portal vein to liver blood flow after APVS embolization in 2. Obvious recovery of main portal vein to liver blood flow after APVS embolization was also demonstrated in 10 cases with hepatofugal portal flow. The portal vein pressure determined before, after portal vein stenting and after APVS embolization was (50.1±6.3) cmH2O,(43.5± 7.5) cmH2O and (36.9 ±8.2) cmH2O respectively. After portal vein stenting the portal vein pressure was significantly decreased when compared with the preoperative pressure, and the difference was statistically significant (P<0.05); after APVS embolization the portal vein pressure was further decreased (P<0.05). Conclusion For HCC patients with MPVTT and marked APVS, portal vein stenting can effectively restore the portal blood flow and reduce the portal vein pressure; and embolization of APVS can further reduce the pressure of portal vein, thus the bidirectional portal flow or hepatofugal portal flow will return to normal hepatopetal flow.

Objective:To evaluate the application of three‐dimensional(3D) rotational digital subtraction angiography(DSA) and three‐dimensional reconstruction technique in the interventional treatment of visceral artery aneurysm .Methods:A total of 25 patients with visceral artery aneurysm ,who underwent 3D rotational DSA and reconstruction before the interventional embolization treatment in the Department of Interventional Radiology ,Zhongshan Hospital ,Fudan University during Jan 2007 and Aug 2015 ,were selected .3D rotational DSA and reconstruction was performed by using Siemens Artis DTA or Philips Allura F20 DSA equipment ,and the results were compared with that of conventional 2D DSA .Results:There were 8 hepatic artery aneurysms ,10 splenic artery aneurysms ,3 renal artery aneurysms ,3 gastroduodenal artery aneurysms ,and 1 inferior pancreaticoduodenal artery aneurysm among the 25 patients .The 3D rotational DSA procedures were successful in all patients , and the success rate was 100% .Anatomical morphology including the diameter ,neck and cavity of aneurysm was exhaustively demonstrated .A total of 30 aneurysms were diagnosed by 3D rotational DSA among the 25 patients .Among the 30 aneuryms , only 27 aneurysms were confirmed by conventional 2D DSA ,and the aneurysm necks of 15 aneurysms were not exhaustively demonstrated due to the anatomical overlapping of the large aneurysm cavity , or the vessel tortuosity . Conclusions: As compared to the conventional 2D DSA ,the 3D rotational DSA and reconstruction can demonstrate anatomical information of visceral artery aneurysms more precisely , especially the aneurysm neck , so as to provide more precise images for the interventional diagnosis and treatment .

Objective To discuss the technical skill of super-selective catheterization for “one-way valve occlusion” of the common hepatic artery during transcatheter arterial chemoembolization (TACE). Methods A total of 128 patients with “one-way valve occlusion”of the common hepatic artery were enrolled in this study, who were admitted to authors’ department to receive TACE during the period from 2000 to 2011. The lesions included hepatocellular carcinoma (n = 110), cholangiocellular carcinoma (n = 3) and hepatic metastasis (n=15). “One-way valve occlusion”of the common hepatic artery occurred in 90 patients (70.3%, 90/128) after 2-5 times of TACE had been carried out, and in the other 38 patients (29.7%, 39/128) the “one- way valve occlusion” of the common hepatic artery was recognized at the initial TACE procedure. Super-selective hepatic catheterization was performed via the superior mesenteric artery (SMA) approach or celiac artery (CA) approach using coaxial micro-catheter catheterization technique. The success rate and fluoroscopy time of super-selective catheterization were recorded, and the results were compared between the two approaches. Results A total of 337 times of hepatic super-selection catheterization were performed in 128 patients, with a mean of 2.6 times for each case. The success rate was 100%. Of the 337 procedures, the catheterization was via CA approach in 148 (43.9%, 148/337) and via SMA approach in 189 (56.1%, 189/337). The mean fluoroscopy time in CA approach group was 3.2 minutes(ranged 1-6 minutes), and in SMA group was 15.3 minutes(ranged 5-40 minutes). The difference between the two groups was statistically significant (P < 0.05). Conclusion Super- selective hepatic catheterization for “one-way valve occlusion” of the common hepatic artery can be achieved through SMA approach or CA approach by using coaxial micro-catheter catheterization. Compared with SMA approach, the technique of hepatic catheterization through CA approach is much simpler and the fluoroscopy time is significantly shorter.