Dieta normocalórica e pobre em fibras, para preparo de colonoscopia, é melhor aceita e não inferior que uma dieta líquida hipocalórica: ensaio randomizado controlado / A normocaloric, low-fiber diet for colonoscopy preparation is more acceptable and non-inferior to a liquid, low-calorie diet: a randomized controlled trial

ABSTRACT Background: Several publications have shown greater acceptance of less restrictive diets for colonoscopy preparation, without impairing the quality of the preparation, when compared to the clear liquid diet. Objective: To evaluate the quality, tolerance and preference regarding the colonoscopy preparation of a low-fiber, normocaloric diet compared with a hypocaloric liquid diet. Methods: This is a randomized, controlled, observer-blind study to compare two low-fiber colonoscopy preparation diets (hypocaloric liquid diet vs. normocaloric diet). The Boston Bowel Preparation Scale was used to evaluate the qua­lity of the preparations, being considered adequate BBPS ≥6 in the global assessment and ≥2 in each segment. The same laxative was used in both groups as well as the "split-dose" regimen. Results: A total of 136 individuals were enrolled in each group. Adequate preparation was achieved in 90.4% of the individuals allocated to the liquid diet group and 92.6% to the normocaloric group. There was no significant difference in the quality of preparation and tolerance between groups. A higher patient acceptance to repeat the procedure if necessary was observed in the normocaloric diet group compared with the liquid diet group (P=0.005). Conclusion: The normocaloric diet has shown to be not inferior to the liquid diet regarding the quality of the colonoscopy preparation. Patient tolerance rates were similar between both diets, but a higher accep­tance rate was observed with the normocaloric diet as compared with the liquid diet.

RESUMO Contexto: Diversas publicações têm evidenciado uma maior aceitação de dietas menos restritivas para preparo de colonoscopia, sem prejuízo na sua qualidade, quando comparadas com a dieta de líquidos claros. Objetivo: Avaliar a qualidade, tolerância e preferência do preparo para colonoscopia de uma dieta líquida hipocalórica, quando comparada com uma dieta normocalórica, ambas pobres em fibras. Métodos: Trata-se de um estudo randomizado, controlado, observador "cego", para comparar duas dietas de preparo para colonoscopia (dieta líquida hipocalórica e dieta normocalórica, ambas pobres em fibras). Foi utilizada a escala de Boston para avaliar a qualidade do preparo, sendo considerado adequado BBPS ≥6 na avaliação global e ≥2 em cada segmento. Foram prescritos o mesmo laxativo e o regime "dose fracionada" para ambos os grupos. Resultados: Foram incluídos 136 indivíduos em cada grupo. O preparo adequado foi alcançado em 90,4% dos indivíduos alocados no grupo da dieta líquida e 92,6% da normocalorica. Não houve diferença significativa na qualidade do preparo e na tolerância entre ambas as dietas. Observou-se maior aceitação de repetir o procedimento se necessário, no grupo da dieta normocalórica quando comparado ao da dieta líquida (P=0,005). Conclusão: A dieta normocalórica não é inferior que à líquida na qualidade do preparo para colonoscopia, ambas apresentam tolerância similar, porém com maior aceitação da dieta normocalórica quando comparada à líquida.

Fitting Degrees of Cathartic Colon Animal Models with Disease Characteristics of Western Medicine and Syndrome Characteristics of Traditional Chinese Medicine / 中国实验方剂学杂志

Cathartic colon （CC） is a common and refractory digestive system disease， with the pathogenesis not fully clarified. The effective therapies other than laxatives and surgery remain to be developed for CC. Therefore， establishing the CC animal models that fit the disease characteristics of western medicine and syndrome characteristics of traditional Chinese medicine （TCM） is an important link to promote the research on this disease. The fitting degree of animal models with the latest Chinese and western medical diagnostic criteria is an indicator to assess the effectiveness of the animal models in simulating the disease characteristics of western medicine and syndrome characteristics of TCM. The literature review showed that the model animals， drugs and their dosage forms， doses， administration methods， and modeling period of CC varied in different studies， and the available CC animal models presented different fitting degrees with the disease characteristics of western medicine and syndrome characteristics of TCM. Rats were the preferred animals for the modeling of CC. Rhei Radix et Rhizoma preparations were commonly used for model inducing， which， however， may cause water electrolyte disorders， decreased immunity， and even death of animals at the late stage of modeling. The animals were modeled by gradually increasing the starting dose， while the starting dose and increasing dose varied. The maintenance dose was determined based on 50% of the animals having loose stools， and the end for a cycle was determined as the time when loose stools disappeared in 80% of animals. The modeling always lasted for 2-3 cycles， approximately 2-4 months. The CC models established with Rhei Radix et Rhizoma granules and rhein had high fitting degrees with the disease and syndrome characteristics. In addition， the CC animal models of TCM syndromes were still in the exploration stage. There were only the animal models of four TCM syndromes： liver depression and spleen deficiency， both Qi and Yin deficiency， Qi stagnation and blood stasis， and spleen and kidney deficiency. Efforts should be made to establish the animal models that meet the characteristics of disease of western medicine and syndromes of TCM， so as to facilitate the research on CC mechanism and drug development.

Role of Jiawei Shenqi-wan in Treatment of Cathartic Colon on the Basis of Interstitial Cells of Cajal / 胃肠病学

Background: Cathartic colon belongs to the category of 'constipation' in Traditional Chinese Medicine, and its pathogenesis is related to deficiency of kidney temperament and weak promotion ability, which has become a hot spot of global medical attention. Aims: To investigate the effect and possible mechanism of Jiawei Shenqi-wan (JSQW) on intestinal transmission function and pathological changes of interstitial cells of Cajal (ICCs) in rats with cathartic colon. Methods: Forty rats were randomly divided into blank group, model group, prucalopride group and JSQW group. Fecal moisture content, fecal particle number and intestinal transit rate were detected. The pathological changes of ICCs were observed under transmission electron microscope. RT-qPCR was used to detect the mRNA expressions of water channel proteins (AQP3 and AQP9) and SCF/c-kit pathway. Immunohistochemistry was used to measure the expressions of α-smooth muscle actin (α-SMA), inducible nitric oxide synthase (iNOS) and 5-hydroxytryptamine (5-HT)

Freud, Breuer y aristóteles: catarsis y el descubrimiento del edipo / Freud, Breuer and aristotle: catharsis and the discovery of oedipus

Psychoanalysis was originated from the cathartic method first practiced by Breuer and then by Freud. There are no hard data that can explain why Freud took so long in using it and why he associated it regularly with hypnosis rather than apply as the exclusive psychotherapeutic tool. It is argued that its creation was closely related to the concept of catharsis, as Aristotle understood it, that is to say, as the emotions that the audience discharge when attend a tragedy. The friendship and partnership between Breuer and Freud ended in a bitter breakup, delaying Freud's intellectual development. It is postulated that the breakdown was the result of an unresolved Oedipus complex of Freud in relation to an ambivalent father figure: a persecutory, tyrannical, angry one, that represented Breuer, and a good, sublimated, idealized one, that personified Freud's close friend Wilhelm FlieB.

El psicoanálisis nació a partir del método catártico practicado primero por Breuer y luego por Freud. No se tienen datos para saber porqué Freud demoró tanto tiempo en utilizarlo y también se desconoce porqué lo asoció regularmente a la hipnosis en lugar de aplicarlo como psicoterapia única. Se plantea que su creación estuvo estrechamente vinculada al concepto de catarsis desarrollada por Aristóteles, es decir, la descarga de emociones que los espectadores experimentan cuando acuden a presenciar una tragedia. La amistad y el trabajo conjunto entre Breuer y Freud terminaron en una áspera ruptura, la que retrasó el desarrollo intelectual de Freud. Se postula que el quiebre fue producto de un complejo de Edipo no resuelto de Freud en relación a una figura de padre escindida entre un objeto interno persecutorio, tiránico, rabioso que proyectó en Breuer, y otro bueno, sublimado, idealizado que desplazó en la persona de su amigo íntimo Wilhelm FlieB.

Blood gas analysis, anion gap, and strong ion difference in horses treated with polyethylene glycol balanced solution (PEG 3350) or enteral and parenteral electrolyte solutions / Hemogasometria, anion gap e diferença de íons fortes em equinos tratados com solução balanceada contendo polietilenoglicol (PEG 3350) ou soluções eletrolíticas enteral e parenteral

Large volumes of different electrolytes solutions are commonly used for ingesta hydration in horses with large colon impaction, but little is known about their consequences to blood acid-base balance. To evaluate the effects of PEG 3350 or enteral and parenteral electrolyte solutions on the blood gas analysis, anion gap and strong ion difference, five adult female horses were used in a 5x5 latin square design. The animals were divided in five groups and distributed to each of the following treatments: NaCl (0.9% sodium chloride solution); EES (enteral electrolyte solution), EES+LR (EES plus lactated Ringer's solution); PEG (balanced solution with PEG 3350) and PEG+LR (PEG plus lactated Ringer's solution). Treatments PEG or PEG + LR did not change or promoted minimal changes, while the EES caused a slight decrease in pH, but its association with lactated Ringer's solution induced increase in AG and SID values, as well as caused hypernatremia. In turn, the treatment NaCl generated metabolic acidosis. PEG 3350 did not alter the acid-base balance. Despite it's slight acidifying effect, the enteral electrolyte solution (EES) did not cause clinically relevant changes.

Grandes volumes de diferentes soluções eletrolíticas são comumente usados na hidratação da ingesta em equinos com compactação, mas pouco se sabe sobre suas consequências sobre o equilíbrio ácido base sanguíneo. Para avaliar os efeitos do PEG 3350 e soluções eletrolíticas enterais e parenterais sobre a hemogasometria, anion gap e diferença de íons fortes, foram utilizadas cinco fêmeas adultas em um quadrado latino 5x5. Os animais foram distribuídos em cinco grupos e submetidos a cada um dos seguintes tratamentos: solução NaCl (cloreto de sódio 0,9%); EES (solução eletrolítica enteral); EES + RL (solução eletrolítica enteral mais Ringer lactato); PEG 3350 (solução balanceada com PEG 3350) e PEG + RL (PEG 3350 mais Ringer lactato). Os tratamentos PEG ou PEG + RL não alteraram ou promoveram alterações mínimas, enquanto a EES ocasionou discreta diminuição no pH, mas sua associação com Ringer lactato induziu o aumento nos valores do AG e DIF, além de ocasionar hipernatremia. Por sua vez, o tratamento NaCl resultou em acidose metabólica hiperclorêmica. O PEG 3350 não alterou o equilíbrio ácido base. Apesar do seu discreto efeito acidificante, a solução eletrolítica enteral (EES) não promoveu alteração clínica relevante.

Sobre o legado de Breuer e Anna O / On the legacy of Breuer and Anna O

Este artigo parte da investigação do laço de trabalho entre Freud e Breuer em torno do caso de Anna O. para se perguntar sobre o legado de Breuer, que situamos em duas modalidades: uma vertente técnica, representada pelos procedimentos do método catártico; outra, dos resultados, caracterizada pelo produto da aplicação dessa técnica. A respeito dos resultados, destacamos o interesse maior de Freud por indicações fragmentadas e laterais que emergem do relato de Breuer do que por sua teorização. Nessa transmissão, equívocos, lacunas e lapsos são de extrema importância. Freud, ao seu turno, não só foi capaz de escutar essas indicações, como também de acolhê-las e elaborá-las a partir de sua práxis.

This paper investigates the association between Breuer and Freud around the treatment of Anna O. We situate Breuer's legacy in two modalities: a technical modality, represented by the cathartic method's procedures, and a result's modality, characterized by the product of the application of this technique. Regarding the results, we underline a more intensive interest of Freud for fragmented and lateral indications that emerge from Breuer's text rather than for Breuer's theorization itself. In this transmission, mistakes, gaps and lapses are extremely important. Freud, for his part, was not only able to hear these statements, but also to accept them and elaborate them in his practice.

Study on SP,VIP expression in the 'cathartic colon' rats / 中国医师杂志

ObjectiveObserving the distribution and the change of the quantity of SP,VIP in the colon tissue of 'cathartic colon'rats.MethodsWe divided the 32 wistar rats weighted (200 ±10)g into 2 groops randomly:the blank group( n =8) and model group( n =8).we induced the 'cathartic colon'rats with the suspension of dahuang.The blank group were given the distilled water for contrast.After one week during the time Dahuang was stopped.We killed them,measured the carbon powder propulsion rates in the intestine and then took Specimen after the 8 rats were fasted 24 hours as well as the blank group,but water were given.We compared the variation of SP,VIP distribution between two groups.ResultsThe carbon powder propulsion rates in the model group were slower than that in the saline control group.The distribution of SP,VIP are all more than that in the blank group.ConclusionThe distribution of SP,VIP are all more than that in the blank group.

A Case of Falling of Taiki from the Upper Aspect of the Body Caused by Taking a Kind of Cathartic Drug / 日本東洋医学雑誌

Taiki is a kind of fundamental vital energy filling the upper aspect of the body, and it can fall because of stress, heavy labor, diarrhea, excessive intake of drugs for regulating the flow of vital energy, or extreme deficiency in vital energy.We report the case of a 39 year old female patient who complained of dyspnea, psychic enervation, and other symptoms of falling taiki from the upper aspect of the body, caused by taking a cathartic drug (mashiningan) for constipation, while being treated for agitation and emotional incontinence. Shokanto improved this state of falling taiki from the upper aspect of the body.

The changes of electrophysiology of the rat with cathartic colon and reaction to acetylcholine / 第三军医大学学报

Objective To explore the etiopathology of slow transit constipation(STC). Methods The model of rat with cathartic colon was established and the changes of colonic electromyography and reaction to acetylcholine(Ach) were examined. Result The frequency, amplitude of slow wave and colon reaction to Ach of rats with cathartic colon decreased markedly. Conclusion Long term abuse of stimulant laxatives could damage enteric nervous system(ENS) and accelerate the pathological changes of STC.

The study on expression of nerve growth factor and its receptor in the rat catha rtic colon / 中华消化杂志

Objective To investigate the action and the mechanisms of nerve growth factor(NGF) and its receptor(p75、TrkA) on the pathological alterations of the enteric nervous syst em in the rats cathartic colon. Methods The experimental animal model of cathartic colon was established by using rhubar b and phenolphthalein. Thirty Sprague Dawley (SD) rats were randomly divided int o the control group(10 rats) and cathartic colon model groups(10 rats with rhuba r b group; 10 rats with phenolphthalein group). The model group rats were fed with stimulant laxatives rhubarb and phenolphthalein respectively, and the control g roup rats were fed with distilled water. The rats were killed and the colon samp les were taken after 3 months. The expressions of the mRNA of NGF, p75 and TrkA in the colonic tissues were detected by semi-quantitive reverse transcription- polymerase chain reaction(RT-PCR) technique. Results The expressional levels of NGF mRNA were lower in the rhubarb group and phenolph thalein group than that in control group (P

Effect of endomorphin on colonic electromyography activity in endomorphin cathartic colon rats / 中华老年医学杂志

Objective To determine the effect of endomorphin (EM) on colonic electromyography activity and investigate the pathogenesis of slow transit constipation (STC). Methods An experimental rat model of slow transit constipation was constructed by contract laxatives mixed with the feed. The changes of colonic electromyography and reaction to endomorphin 1 and endomorphin 2 were examined. Results Compared with the control group, the frequency and amplitude of slow wave in cathartic colon rats were decreased significantly. Endomorphin 1 and endomorphin 2 significantly decreased the amplitudes of slow wave, but did not change the frequencies of slow wave. The effect of endomorphin 1 was more pronounced than that of endomorphin 2, which could be reversed by the morphine antagonist Naloxone in concentration-dependent manner. Endomorphin could not block the stimulating effect of acetylcholine. Conclusions Endomorphin can influence the colonic electromyography activity and intestine motility of cathartic colon rats, and may be involved in the pathologic mechanism of slow transit constipation.