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Objective:To investigate the efficacy of digital subtraction angiography combined with wire guidance versus gastroscopy in enteral nutrition catheterization in patients with special diseases of the upper gastrointestinal tract. Methods:We recruited 120 patients with special diseases of the upper gastrointestinal tract who underwent enteral nutrition catheterization in Yuyao People's Hospital from January 2016 to July 2020. These patients had gastric outlet obstruction ( n = 40), esophageal obstruction ( n = 39), tracheoesophageal fistula and mediastinal-esophageal fistula ( n = 26), or anastomotic fistula or anastomotic stenosis ( n = 15) after esophageal and gastric surgery. They were randomly allocated into the control and study groups ( n = 60/group). The control group was subject to enteral nutrition catheterization under the guidance of gastroscopy. The study group was subject to enteral nutrition catheterization using digital subtraction angiography combined with wire guidance. We compared the success rate of enteral nutrition catheterization, the time to successful enteral nutrition catheterization, changes in vital signs (such as heart rate, respiratory rate, mean arterial pressure, and blood oxygen saturation) after catheterization relative to before catheterization, and the incidence of adverse reactions between the two groups. Results:The success rate of enteral nutrition catheterization was significantly higher in the study group than in the control group (86.67% vs. 65.00%, χ2 = 7.68, P = 0.006). The time to successful enteral nutrition catheterization in the study group was significantly shorter than that in the control group [(28.61 ± 3.37) minutes vs. (39.75 ± 4.61) minutes, t = -8.92, P < 0.001]. During enteral nutrition catheterization, heart rate, respiratory rate, and mean arterial pressure in the control group were significantly increased compared with before enteral nutrition catheterization ( t = 5.07, 6.85, 4.96, all P < 0.001). During enteral nutrition catheterization, the heart rate and respiratory rate were significantly higher in the control group than in the study group ( t = 3.45, 3.29, both P < 0.001). After enteral nutrition catheterization, the incidence of adverse reactions was significantly lower in the study group than in the control group (13.33% vs. 33.33%, χ2 = 6.70, P = 0.010). Conclusion:Digital subtraction angiography combined with wire guidance can increase the success rate of enteral nutrition catheterization in patients with special diseases of the upper gastrointestinal tract, shorten the time to successful enteral nutrition catheterization, increase patient tolerance to catheterization, and reduce adverse reactions.
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Objective To compare effects of warm water infusion and air insufflation on patient tolerance and satisfaction during the insertion phase of unsedated colonoscopy.Methods In a single-center,prospective,single blind randomized trial,patients were randomly assigned to three groups (water infusion group,air insufflation group,or hybrid method group) during the insertion phase of colonoscopy.Main outcome measurements included insertion time,cecal intubation rate,adenoma detection rate,the rate of position change,the rate of abdominal compression,intraoperative pain and distension VAS scores,postoperative pain and distension VAS scores.Results A total of 180 cases were enrolled,60 in each group.Patients in water infusion group and hybrid method group required less abdominal compression or position change,longer insertion time,reported lower intraoperative pain and distension VAS scores than air insufflation group during the insertion phase of colonoscopy.There were no significant differences in cecal intubation rates,adenoma detection rates,postoperative pain and distension or VAS scores among three groups.Conclusion Water infusion significantly decreases patient abdominal pain and distension during the insertion phase of colonoscopy without affecting cecal intubation rate and adenoma detection rate.
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Objective To compare the safety and efficiency of nasogastric ( NG ) feeding with nasojejunal (NJ) feeding in treating severe acute pancreatitis ( SAP).Methods The terms NG tube,NJ tube,SAPand enteral nutritionwere used for literature search in PubMed , Embase, Cochrane Library, WanFang and CNKI databases and the publication deadline was June 1, 2016.Random effect model was used for Meta analysis .Results A total of 5 random clinical trials involving 264 patients ( 136 in NG group and 128 in NJ group ) were included .There was no statistical difference on the incidence of adverse events (mortality:RR=0.77, 95%CI 0.42~1.41, P=0.39; infection complications: RR=0.77, 95%CI 0.45~1.30, P=0.39; digestive complications: RR=1.26, 95%CI 0.73~2.16, P=0.41; stopping nasogastric proportion:RR=0.66, 95%CI 0.10~4.10, P=0.65;MODS rate:RR=0.98, 95%CI 0.71~1.35, P=0.90; the percentage of energy balance: RR=1.00, 95%CI 0.97~1.03, P=0.39 and the average length of hospital stay:RR=0.98, 95%CI 0.71~1.35, P=0.90).Conclusions NG feeding was safe and effective , which was comparable with NJ feeding .NG feeding was more convenient with a higher clinical value .
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Objective To evaluate the influence of the preparation-to-colonoscopy interval, diet control and excise on bowel preparation quality in the split-dose method for colonoscopy. Methods Observational study, prospective cohort study design, three bowel preparation methods were set up in different departments for A, B, C 3 groups, each group of 110 cases. In group A, no movement was required. Diet preparation was 3 days earlier than the examination, and take all the medicine in once at 20:00 the day before examination, group B, 1 L medicine required for 20 minutes movement, diet preparation was 1 day earlier than the examination, and take the medicine in twice the day before examination at 14:00, group C, keep walking during taking the medicine, diet preparation was 1 day earlier than the examination, and took all the medicine in once the day before examination at 20:00. The Boston Bowel Preparation Scale was used to evaluate the bowel cleansing quality. A questionnaire was administered to investigate patients′tolerability and safety. Results A total of 330 consecutive patients undergoing colonoscopy. There was no significance among three groups on bowel cleansing quality(P>0.05). However, the number ofexcellently cleanedwas higher in group B than the others, in group A,B and C respectively 30, 46, 29 cases, the difference was significant (χ2=7.627, P=0.022). Group B was superior to the others in terms of comfort, sleep quality, hunger, and discomfort, the difference was significant (χ2=19.425, 6.687 and 8.130, P < 0.01 or 0.05). Group B was also superior to the others in terms of the compliance of completing the preparation under the doctors′advice (χ2=14.756, P=0.001) and exercises (χ2=11.848, P=0.001). Conclusions The new method shortened the time of the diet control and set the exercises time to 20 minutes. So it was found to have a higher level of safety, bowel preparation quality and tolerability.
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Atherosclerosis is a chronic inflammatory immune disease,which is one of the causes of human lower limb disability.Dendritic cells are the most powerful professional antigen presenting cell in immune system,and dendritic cells have the dual role of immunogenicity and tolerability.As a professional antigen presenting cell,the immunogenicity of dendritic cells present self abnormal antigen and course immune system disorder,which may be one role of dendritic cells participate in atherosclerosis.However,the tolerability of dendritic cells can course the generation of immune tolerance,which makes dendritic cells exert a regulatory role in atherosclerosis.This paper makes an introduction about how dendritic cells are involved and play a regulatory role in the pathogenesis of atherosderosis.
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Autoimmunity can be defined as an immune response against self –antigens so called self-tolerance. The etiology is considered as multifactorial. Humoral or cellular immune mechanisms are responsible for various systemic and organ specific autoimmune diseases. Advances made in this field to know the immunopathology of autoimmune diseases affecting the oral tissues.
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La función primaria del sistema inmune es resguardar al individuo de los patógenos potencialmente dañinos que invaden el medio ambiente en el cual nos desarrollamos. Este cuenta con dos grandes ramas, la inmunidad innata y la adaptativa, ambas con la propiedad de diferenciar lo peligroso de aquello inofensivo. Estos procesos se hallan regulados por mecanismos homeostáticos que constituyen la tolerancia inmunológica, a los fines de limitar aquellos procesos prolongados y silenciar los potencialmente autoagresivos. Ante la falla de estos mecanismos de control, surgen las enfermedades autoinmunes. Avances en el conocimiento de la fisiopatología de estas entidades, han abierto un nuevo capítulo en el terreno de la inmunofarmacología. Su prometedor potencial actualmente nos ofrece novedosas herramientas terapéuticas para controlar y atenuar el daño causado por este tipo de respuestas. No obstante, debe continuarse la investigación en el campo de los agentes biológicos, ya que ninguno de ellos se encuentra libre de inconvenientes. Seguramente, futuros hallazgos se concretarán en futuros aciertos. Y los aciertos, en Medicina, equivalen a esperanza.
The main function of the immune system is to protect the individual against potentially dangerous pathogens. It comprises innate and adaptive cellular and soluble components, both with the capacity to discriminate between harmful and harmless. These processes are regulated by homeostatic mechanisms that constitute the so-called immunological tolerance, which aims to limit the prolonged action of immune mediators and to silence the generation of potentially autoaggressive components. Failure to silence self-reactive T and B cells results in the generation of autoimmune disease. Recent advances in our knowledge of these pathological entities have opened a new chapter in the pharmacology of the immune system. Its promising potential currently offers new therapeutic agents to control and attenuate pathological tissue damage. Nevertheless, further research regarding these biologic agents is required, since they are not free from inconveniences. It is without question that upcoming findings in this field will instill hope into the quest for the "magic bullet".
Subject(s)
Humans , Autoimmune Diseases/immunology , Autoimmunity/immunology , Communicable Diseases/immunology , Immune Tolerance/immunology , Autoimmune Diseases/drug therapy , Autoimmunity/drug effects , Communicable Diseases/drug therapy , Immune Tolerance/drug effectsABSTRACT
Self/non-self discrimination and unresponsiveness to self is the fundamental properties of the immune system. Self-tolerance is a state in which the individual is incapable of developing an immune response to an individual's own antigens and it underlies the ability to remain tolerant of individual's own tissue components. Several mechanisms have been postulated to explain the tolerant state. They can be broadly classified into two groups: central tolerance and peripheral tolerance. Several mechanisms exist, some of which are shared between T cells and B cells. In central tolerance, the recognition of self-antigen by lymphocytes in bone marrow or thymus during development is required, resulting in receptor editing (revision), clonal deletion, anergy or generation of regulatory T cells. Not all self-reactive B or T cells are centrally purged from the repertoire. Additional mechanisms of peripheral tolerance are required, such as anergy, suppression, deletion or clonal ignorance. Tolerance is antigen specific. Generating and maintaining the self-tolerance for T cells and B cells are complex. Failure of self-tolerance results in immune responses against self-antigens. Such reactions are called autoimmunity and may give rise to autoimmune diseases. Development of autoimmune disease is affected by properties of the genes of the individual and the environment, both infectious and non-infectious. The host's genes affect its susceptibility to autoimmunity and the environmental factors promote the activation of self-reactive lymphocytes, developing the autoimmunity. The changes in participating antigens (epitope spreading), cells, cytokines or other inflammatory mediators contribute to the progress from initial activation to a chronic state of autoimmune diseases.