简介：少年polyposis症候群是多重不同少年息肉在胃肠的道和colorectal癌症的增加的风险描绘的稀罕正染色体的主导的症候群。colorectal癌症的累积一生风险是39%，相对风险是34。少年息肉把特殊组织学被有煽动性的房间和膀胱地扩大的腺的薄板propria排队了由的许多edematous描绘了对有反应变化的圆柱的上皮立方形。临床上，少年polyposis症候群被5的存在或更多的少年息肉在colorectum，在整个胃肠的道的少年息肉或少年息肉的任何数字和少年polyposis的积极家庭历史定义。在大约与少年polyposis症候群诊断的病人的50%-60%，在SMAD4或BMPR1A基因的一个germline变化被发现。两基因在表明小径的BMP/TGF-beta起一个作用。在少年polyposis的癌症可以通过反常stromal环境导致邻近的上皮并且最后的肿瘤的转变的所谓的landscaper机制发展，这被建议了侵略的癌。这稀罕混乱的识别关于治疗为病人和他们的家庭是重要的，后续并且屏蔽在风险个人。与少年息肉的诊断面对的每位临床医生应该因此考虑少年polyposis症候群的可能性。另外，少年polyposis症候群提供一个独特模型一般来说学习colorectal癌症致病并且在癌症的分子的基因基础给卓见。这评论讨论少年polyposis症候群的临床的表明，遗传，致病和管理。

简介：Gutmicrobiotaexertsasignificantroleinthepathogenesisofthemetabolicsyndrome,asconfirmedbystudiesconductedbothonhumansandanimalmodels.Gutmicrobialcompositionandfunctionsarestronglyinfluencedbydiet.Thiscomplexintestinal'superorganism'seemstoaffecthostmetabolicbalancemodulatingenergyabsorption,gutmotility,appetite,glucoseandlipidmetabolism,aswellashepaticfattystorage.Animpairmentofthefinebalancebetweengutmicrobesandhost’simmunesystemcouldculminateintheintestinaltranslocationofbacterialfragmentsandthedevelopmentof'metabolicendotoxemia',leadingtosystemicinflammationandinsulinresistance.Dietinducedweight-lossandbariatricsurgerypromotesignificantchangesofgutmicrobialcomposition,thatseemtoaffectthesuccess,ortheinefficacy,oftreatmentstrategies.Manipulationofgutmicrobiotathroughtheadministrationofprebioticsorprobioticscouldreduceintestinallowgradeinflammationandimprovegutbarrierintegrity,thus,amelioratingmetabolicbalanceandpromotingweightloss.However,furtherevidenceisneededtobetterunderstandtheirclinicalimpactandtherapeuticuse.

简介：Symptomatichepato-diaphragmaticinterpositionofabowellooporChilaiditi'ssyndromeisapeculiaranatomicalconditionmostoftenfoundbychance.Itsdescribedsymptomsrangefromintermittent,mildabdominalpainanddyspepsiatoacuteintestinalobstruction.Wereportacaseofhepato-diaphragmaticmigrationofthehepaticflexureofthecolonassociatedtoanunusual,heretoforeunreported,angina-likepainexclusivelyevokedbytheleftlateraldecubitus.Tomaximizethechanceofobservinganatomicalchangesindifferentpostures,computedtomographyofthechestandabdomenwasperformedafterairinsufflationintothecolon.Whilefrankherniationintothechestwasexcluded,thescanshowedthatthehepaticflexure-withtheinterpositionofthediaphragm-cameincontactwiththerightsideoftheheartintheleftlateral,butnotinthesupine,decubitus.Thisfindingwasreproducedbyechocardiographywhichalsoshowedvirtuallyunalteredhemodynamicsafterthechangeofposture.ECG,leftandrightventricularglobalandregionalfunctionaswellascardiacinjurymarkersalsoremainedunchangedduringthemaneuver,indicatingthatthepainevokedbythelatterwasunlikelyduetomyocardialischemia.ThiscasesuggeststhatChilaiditi'ssyndromeshouldbeincludedamongthepossible,althoughrare,causesofunexplainedangina-likesymptoms.

简介：Percutaneousendoscopicgastrostomy（PEG）isawidelyusedmethodofnutritiondeliveryforpatientswithlongterminsufficiencyoforalintake.ThePEGcomplicationratevariesfrom0.4%to22.5%ofcases,withminorcomplicationsbeingthreetimesmorefrequent.Buriedbumpersyndrome（BBS）isaseverecomplicationofthismethod,inwhichtheinternalfixationdevicemigratesalongsidethetractofthestomaoutsidethestomach.ExcessivecompressionoftissuebetweentheexternalandinternalfixationdeviceofthegastrostomytubeisconsideredthemainetiologicalfactorleadingtoBBS.IncidenceofBBSisestimatedataround1%（0.3%-2.4%）.Inabilitytoinsert,lossofpatencyandleakagearoundthePEGtubeareconsideredtobeatypicalsymptomatictriad.GastroscopyisindicatedinallcasesinwhichBBSissuspected.Thedepthofdiscmigrationinrelationtothelaminamuscularispropriaofthestomachiscriticalforfurthertherapyandcanbeestimatedbyendoscopicortransabdominalultrasound.BBScanbecomplicatedbygastrointestinalbleeding,perforation,peritonitis,intra-abdominalandabdominalwallabscesses,orphlegmon,andthesecomplicationscanleadtofataloutcomes.Themostimportantpreventivemeasureisadequatepositioningoftheexternalbolster.Aconservativeapproachshouldbeappliedonlyinpatientswithhighoperativeriskanddismalprognosis.ChoiceofthemethodofreleaseisbasedonthetypeofthePEGsetanddepthofdiscmigration.Adiscretainedinsidethestomachandcompletelycoveredbytheovergrowingtissuecanbereleasedusingsometypeofendoscopicdissectiontechnique（needleknife,argonplasmacoagulation,orpapillotomethroughthecannula）.Properpatientselectionanddissectionoftheovergrowingtissuearethemajordeterminantsforsuccessfulendoscopictherapy.Adisclocalizedoutofthestomach（laminamuscularispropria）shouldbetreatedbyasurgeon.

简介：AIM:Toinvestigatethelatentstructureofanirritablebowelsyndrome(IBS)symptomseverityscaleinapopulationofhealthyadults.METHODS:TheBirminghamIBSsymptomquestionnairewhichconsistsofthreesymptomspecificscales(diarrhea,constipation,pain)wasevaluatedbymeansofstructuralequationmodeling.Wecomparedtheoriginal3-factorsolutiontoageneralfactormodelandabifactorsolutioninalargeinternetsampleofcollegestudents(n=875).Statisticalcomparisonsofcompetingmodelswereconductedbymeansofχ2differencetests.Regardingtheevaluationofmodelfit,weexaminedthecomparativefitindex(CFI)andtheRootMeanSquareErrorofApproximation(RMSEA).RESULTS:ResultsclearlyfavoredabifactormodelofIBSsymptomseverity(CFI=0.99,RMSEA=0.05)whichconsistedofastronggeneralIBSsomatizationfactorandthreesymptomspecificfactors(diarrhea,constipation,pain)basedonthesubscalesoftheBirminghamIBSsymptomquestionnaire.Thefitindicesofthecompetingonefactormodel(CFI=0.85,RMSEA=0.17)andthreefactormodel(CFI=0.97,RMSEA=0.08)wereclearlyinferior.χ2differencetestsshowedthatthedifferencesbetweenthemodelswereindeedsignificantinfavorofthebifactormodel(P<0.001).Correlationsofthefourlatentfactorswithmeasuresofpainsensitivity,somatoformdissociation,fatigueseverity,anddemographicvariablessupportthevalidityofourbifactormodelofIBSspecificsymptomseverity.CONCLUSION:ThefindingssuggestthatIBSsymptomseveritymightbestbeunderstoodasacontinuousandmultidimensionalconstructwhichcanbereliablyandvalidlyassessedwiththeB-IBS.

简介：Thenasogastrictube(NGT)hasbecomeafrequentlyuseddevicetoalleviategastrointestinalsymptoms.Nasogastrictubesyndrome(NTS)isanuncommonbutpotentiallylife-threateningcomplicationofanindwellingNGT.NTSischaracterizedbyacuteupperairwayobstructionduetobilateralvocalcordparalysis.Wereportacaseofa76-year-oldmanwithNTS,inducedbyanindwellinglongintestinaltube.Hewasadmittedtoourhospitalfortreatmentofsigmoidcoloncancer.Heunderwentsigmoidectomytoreleaseabowelobstruction,andhadalongintestinaltubeinsertedtodecompresstheintestinaltract.Hepresentedacutedyspneafollowingprolongedintestinalintubation,andbronchoscopyshowedbilateralvocalcordparalysis.TheNGTwasremovedimmediately,andtracheotomywasperformed.Thepatientwasfinallydischargedinafullyrecoveredstate.NTSbeconsideredinpatientscomplainingofacuteupperairwayobstruction,notonlywithaNGTinsertedbutalsowithalongintestinaltube.

简介：Asubstantialproportionofpatientswithirritablebowelsyndrome(IBS)associatetheirsymptomswiththeingestionofspecificfoods.Therefore,inrecentyears,scientificresearchhasincreasinglyfocusedontheroleofdietinIBSanddietarymanagementisnowconsideredanimportanttoolinIBStreatment.ThisarticlereviewsthemaindietaryapproachesinIBSemphasizingevidencefromexperimentalandobservationalstudiesandsummarizingthemaindietandlifestylerecommendationsprovidedbydietaryguidelinesandscientificliterature.Despitethelimitedevidenceforabeneficialrole,generaladviceonhealthyeatingandlifestyleisrecommendedasthefirst-lineapproachinthedietarymanagementofIBS.Standardrecommendationsincludeadheringtoaregularmealpattern,reducingintakeofinsolublefibers,alcohol,caffeine,spicyfoods,andfat,aswellasperformingregularphysicalactivityandensuringagoodhydration.Second-linedietaryapproachshouldbeconsideredwhereIBSsymptomspersistandrecommendationsincludefollowingalowFODMAPdiet,tobedeliveredonlybyahealthcareprofessionalwithexpertiseindietarymanagement.Theefficacyofthisdietissupportedbyagrowingbodyofevidence.Incontrast,theroleoflactoseorglutendietaryrestrictioninthetreatmentofIBSremainssubjecttoongoingresearchwithalackofhigh-qualityevidence.Likewise,furtherclinicaltrialsareneededtoconcludetheefficacyofprobioticsonIBSsymptoms.

简介：Thisreviewaimsatevaluatingtheexistingevidenceregardingpostreperfusionsyndrome,providingadescriptionofthepathophysiologicmechanismsinvolvedandpossiblemanagementandpreventivestrategies.APubMedsearchwasconductedusingtheMeSHdatabase,＂Reperfusion＂AND＂livertransplantation＂werethecombinedMeSHheadings;EMBASEandtheCochranelibrarywerealsosearchedusingthesameterms.52relevantstudiesandoneongoingtrialwerefound.Theconceptofpostreperfusionsyndromehasevolvedthroughyearstoamultisystemicdisorder.Theimplicationsofthemainorgan,recipientandprocedurerelatedfactorsinthegenesisofthiscomplexsyndromearediscussedinthetextasthenovelpharmacologicandtechnicalapproachestoreduceitsincidence.Howevertheavailableevidenceaboutriskfactors,physiopathologyandpreventivemeasuresisstillconfusing,thepresenceoftwomaindefinitionsandthenumerosityofpossibleconfoundingfactorsgreatlycomplicatestheinterpretationofthestudies.

简介：AIM:Toevaluategutmicrobialdysbiosisintwovisceralhypersensitivemodelsincomparisonwithirritablebowelsyndrome(IBS)patientsandtoexploretheextenttowhichthesemodelscapturethedysbiosisofIBSpatients.METHODS:Visceralhypersensitivitywasdevelopedusingthematernalseparation(MS)ratmodelandpost-inflammatoryratmodel.Thevisceralsensitivityofthemodelgroupsandcontrolgroupwasevaluatedusingtheabdominalwithdrawreflexscoreandelectromyographyinresponsetogradedcolorectaldistention.The16SribosomalRNAgenefromfecalsampleswaspyrosequencedandanalyzed.Thecorrelationbetweendysbiosisinthemicrobiotaandvisceralhypersensitivitywascalculated.PositivefindingswerecomparedtosequencingdatafromapublishedhumanIBScohort.RESULTS:Dysbiosistriggeredbyneonatalmaternalseparationwaslastingbutnotstatic.BothMSandpostinflammatoryratfecalmicrobiotadeviatedfromthatofthecontrolratstoanextentthatwaslargerthantheco-housingeffect.Twoshortchainfattyacidproducinggenera,FusobacteriumandClostridiumXI,weresharedbythehumanIBScohortandbythematernalseparationratsandpost-inflammatoryrats,respectively,todifferentextents.FusobacteriumwassignificantlyincreasedintheMSgroup,anditsabundancepositivelycorrelatedwiththedegreeofvisceralhypersensitivity.Porphyromonadaceaewasaprotectivebiomarkerforboththeratcontrolgroupandhealthyhumancontrols.CONCLUSION:ThedysbiosisMSratmodelandthepost-inflammatoryratmodelcapturedsomeofthedysbiosisfeaturesofIBSpatients.Fusobacterium,ClostridiumXIandPorphyromonadaceaewereidentifiedastargetsforfuturemechanisticresearch.