Relationship between chronic constipation and brain-gut microflora axis / 中华胃肠外科杂志

The role of the brain-gut microbiota axis in functional gastrointestinal diseases has been gradually recognized. According to the ROME IV diagnostic criteria, functional gastrointestinal diseases are classified as diseases caused by abnormal brain-gut interaction. This concept is of great significance to the change of diagnosis and treatment paradigm of functional gastrointestinal diseases. Chronic constipation is the most common functional gastrointestinal disease. The pathogenesis of chronic constipation is closely related to the imbalance of intestinal flora, the abnormality of enteric nervous system and neurotransmitter in brain. Therefore, in the diagnosis and treatment of chronic constipation, enough attention should be paid to the concept of integration of brain-gut microflora axis, but the clinical application of brain-gut microflora axis is still limited. This may be one of the factors for high incidence but poor treatment efficacy of chronic constipation. Based on the global research progress and our clinical experience, this article expounds the clinical significance of the brain-gut microbiota axis in chronic constipation.

Diagnosis and treatment of chronic intestinal pseudo-obstruction / 中国实用外科杂志

Chronic intestinal pseudo-obstruction(CIPO)is a rare but serious intestinal dyskinesia characterized by impaired bowel motor function in the absence of mechanical intestinal obstruction. CIPO may be caused by primary and secondary factors that damage the enteric nervous system(neuropathy),smooth muscle(myopathy),and/or Cajal interstitial cells(interstitial disease). CIPO is extremely easy to missed diagnosis and misdiagnosis.The treatment of CIPO is very difficult.It is based on nutritional support,medicine and surgical treatment.At present,the occurrence,development and treatment of intestinal micro-ecology in CIPO has gradually attracted attention and may become a new treatment method for CIPO.

Effect analysis of 71 cases of refractory diarrhea with severe malnutrition treated by fecal microbiota transplantation(FMT) combined with enteral nutrition / 中国实用外科杂志

OBJECTIVE: To investigate the therapeutic effect of fecal microbiota transplantation(FMT) combined with enteral nutrition on patients with refractory diarrhea and severe malnutrition.METHODS: Seventy-one patients with refractory diarrhea complicated with severe malnutrition in Department of Colorectal Disease,the Tenth People ' s Hospital of Tongji University and Department of General Surgery,General Hospital of Eastern Theater Command from June 2014 to October 2018 were prospectively collected for basic information,symptoms and signs,number of bowel movements,Bristol stool scores,and nutritional indicators,which were followed up after bacterial transplantation combined with enteral nutrition.RESULTS: After following up for 6 month,FMT combined with enteral nutrition in the treatment of severe diarrhea with severe malnutrition,the effective rate of treatment of diarrhea was 95.8%,of which the cure rate was 74.7%,and the remission rate was 21.1%.3 cases(4.2%) were ineffective,6 cases(8.5%) recurred.The frequency of bowel movements decreased from(8.3±2.2) before treatment to(5.3±1.3) after 1 month,(3.2±0.8)after 3 months,and(1.9±0.6) after 6 months.The Bristol score was reduced from(6.6±0.3) points before treatment to(4.8±0.7) points 1 month after treatment,(4.6±0.8)points after 3 months,and(4.3±0.8) points after 6 months.The body mass index(BMI) of the patients before treatment was 15.3±1.3,the BMI increased to 17.4±2.4 after 1 month of treatment,increased to 19.0±3.2 after 3 months,and 19.3±3.8 after 6 months.The total protein was increased from(48.6±4.7)g/L before treatment to(55.4±5.7)g/L after1 month of treatment,increased to(60.3±5.4) g/L after 3 months,and(68.4±6.9)g after 6 months.Albumin increased from(22.4±1.7)g/L before treatment to(31.7±2.4)g/L after 1 month of treatment,increased to(35.8±2.7)g/L after 3 months,and(37.5±3.7)g/L after 6 months.Fibrinogen increased from(1.6±0.4)g/L before treatment to(2.0±0.7)g/L after 1 month of treatment,increased to(2.4±0.8) g/L after 3 months,and(2.4±0.7) g/L after 6 months.Prealbumin increased from(82.0±18.6)mg/L before treatment to(178.3±25.3)mg/L after 1 month of treatment,increased to(235.7±28.2) mg/L after 3 months,and(259.6±33.5) mg/L after 6 months.The were significant differences before and after treatment(All P<0.05) CONCLUSION: After 6 months of follow-up,FMT combined with enteral nutrition can effectively reduce the number of diarrhea,improve stool characteristics,and improve nutritional indicators such as BMI,total protein,albumin,fibrinogen and prealbumin.

Manipulative reduction and small splint fixation for treatment of three-part fractures of proximal humerus: a case-control study / 中国骨伤

<p><b>OBJECTIVE</b>To study Chinese medicine treatment in the three-part of the proximal humerus fractures.</p><p><b>METHODS</b>From January 2009 to February 2012, 118 cases of proximal humerus three-part fractures were used two methods of operation and manipulation treatment,that were all acute and closed. In operation group: there were 22 males and 37 females,the mean age of the patients was (65.80 +/- 10.62) years (ranged from 45 to 83 years), and the interval from injury to hospital was (22.58 +/- 22.11) hours (ranged from 1 to 96 hours), used open reduction and locking plate fixation surgery. In manipulation group: there were 21 males and 38 females, the mean age of the patients was (65.98 +/- 11.10)years (ranged from 45 to 85 years), and the interval from injury to hospital was (20.85 +/- 22.63) hours (ranged from 1 to 107 hours), used manipulative reduction and small splinting external fixation. All patients were evaluated with shoulder pain, function, activity and anatomical indicators after treatment.</p><p><b>RESULTS</b>All patients were followed up for 3 to 12 months with an average of 8.2 months. According to Neer Score, the total scores was 85.47 +/- 6.15 in operation group, 84.95 +/- 5.70 in manipulation group. The satisfaction rate of the operation group were 88.20%, and the manipulation group were 86.40%. The difference was not statistically significant between two groups (P > 0.05).</p><p><b>CONCLUSION</b>The two treatment were able to achieve satisfactory results. The manipulative reduction and splinting treatment has the advantage of avoiding the risk of surgery, less blood damage, ensureing the efficacy, and reducing costs. It can effectively treat the proximal humerus three-part fracture.</p>

Influence of preoperative nutritional support on surgical outcomes of chronic radiation enteritis patients complicated with intestinal obstruction / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of preoperative nutritional support in the management of patients with chronic radiation enteritis (CRE) with intestinal obstruction undergoing resectional surgery.</p><p><b>METHODS</b>Clinical data of 158 CRE patients undergoing diseased bowel resection from 2001 to 2011 were analyzed retrospectively. A total of 130 patients received preoperative nutritional support, including 28 patients with enteral nutrition support, 60 patients with total parenteral nutrition support, and 42 patients with combined nutritional support. The nutritional parameters, procedures, operation-related complications, and postoperative hospital stay were recorded.</p><p><b>RESULTS</b>After aggressive nutritional support in 130 patients, patients nutritional index, such as serum prealbumin, transferrin, serum albumin improved significantly preoperatively, while the change of body mass index and hemoglobin was not significant. Compared to those without preoperative nutritional support, those who received preoperative nutritional support had lower stoma rate (31.5% vs. 53.6%, P=0.027), less postoperative infection rate (13.8% vs. 32.1%, P=0.019), shorter postoperative hospital stay [(14.1±7.3) d vs. (18.8±15.8) d, P=0.013). Enteral nutrition group had less postoperative infection rate (7.1% vs. 21.7%, P=0.017), lower stoma rate (28.6% vs. 48.3%, P=0.02), and shorter postoperative hospital stay [(15.5±9.6) d vs. (21.7±19.0) d, P=0.025) as compared to total parenteral nutrition group.</p><p><b>CONCLUSIONS</b>Preoperative nutritional support can decrease the stoma rate, postoperative infection rate, and shorten hospital stay in CRE patients complicated with intestinal obstruction. If tolerated, enteral nutrition support should be chosen.</p>

Systemic review of the safety and efficacy of fast-track surgery combined with laparoscopy in radical gastrectomy for gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To conduct a systemic review of the safety and efficacy of fast-track surgery combined with laparoscopy in radical gastrectomy for gastric cancer.</p><p><b>METHODS</b>The databases, including CNKI, Wangfang, VIP, PubMed, EMBASE and Cochrane Library, were searched to collect randomized controlled trials(RCTs) or clinical controlled trials(CCTs) on the comparison of fast-track surgery combined with laparoscopy versus fast-track surgery or laparoscopy separately used in radical gastrectomy for gastric cancer between January 1994 and December 2012. After data were extracted, meta-analysis was conducted by using RevMan 5.1.0 software.</p><p><b>RESULTS</b>A total of 3 RCTs and 2 CCTs, involving 524 patients, were included. There were 257 patients in the study group and 267 patients in the control group. Compared with the control group, the study group had earlier first flatus(SMD=-1.29, 95%CI:-2.17 to -0.40, P<0.05), shorter postoperative hospital stay(WMD=-1.72,95%CI:-2.56 to -0.89, P<0.05) and lower postoperative complication rate(OR=0.51, 95%CI:0.31 to 0.84, P<0.05). However, no significant differences were found in operation time, harvested lymph node number, intraoperative blood loss and hospital charge(P>0.05).</p><p><b>CONCLUSION</b>Fast-track surgery combined with laparoscopy in radical gastrectomy for gastric cancer can accelerate postoperative rehabilitation by promoting postoperative bowel function recovery, and decreasing postoperative hospital stay and complication rate.</p>

Case-control study on the manipulation reduction combined with small-splint fixation for the treatment of closed fracture of radius / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical effects of the manipulation reduction combined with small splint fixation for the treatment of fresh closed fracture of radius for shorten hospital stays and reduce medical cost.</p><p><b>METHODS</b>From July 2007 to December 2009, 200 patients (ranged the age from 40 to 80 years) with distal radius comminute fracture were treated and divided into CP group (including 21 males and 79 females, with a mean age of (62.98 +/- 0.85) years), and control group (including 20 males and 80 females, with a mean age of (63.19 +/- 0.88) years). All patients were treated manipulation reduction combined with small-splint fixation, control group removed small-splint 30 days after treatment, CP group removed 25 days after treatment. Two groups were checked by X-ray and took traditional chinese medicine (taking Yuanhu tablets, Chuangshangning tablets on the early stage; Guixiangzhenggu pill was taken on the middle stage; Shuanglongjie gu pill on the late stage), functional exercise was guided after removing of small splint. The condition of reduction and position of bone were evaluated and Gartland-Werlley scale was used to evaluate the function of wrist joint.</p><p><b>RESULTS</b>Treatment time in CP group was decreased from (30.08 +/- 3.06) to (25.06 +/- 1.07) days; treatment cost in CP group was decreased from (2 100.00 +/- 332.12) to (1 644.00 +/- 125.20) Yuan. There was no significant difference in reduction and function recover of wrist joint between two groups. The results showed the effects of TCM clinic can be promised.</p><p><b>CONCLUSION</b>Clinical pathway for outpatient can promote standardization of outpatient, short treatment time less medical economic burden, and worth widely used.</p>

To explore the relation between erythrocyte sedimentation rate and postoperative recurrence of spinal tuberculosis / 中国骨伤

<p><b>OBJECTIVE</b>To explore the relation between erythrocyte sedimentation rate(ESR) and postoperative recurrence of spinal tuberculosis.</p><p><b>METHODS</b>Eighty cases (36 males and 44 female,ranging from 20 to 71 years with an average of 38.2 years)of spinal tuberculosis treated with focus debridement were divided into two groups according to the preoperative value of ESR: Group A (ESR > or = 40 mm/h) and Group B (ESR < 40 mm/h). Patients in two groups were treated by the same method. The postoperative recurrences in two groups were analyzed.</p><p><b>RESULTS</b>All the patients were followed up. The recurred cases were 5 in Group A and 4 in Group B. There is no significant difference between two groups.</p><p><b>CONCLUSION</b>ESR is not the key factor to choose the right operative time to perform debridement.</p>