Chinese Medicine Regulates Intestinal Flora to Treat Ulcerative Colitis in Patients with Syndrome of Large Intestine Dampness-heat： A Review / 中国实验方剂学杂志

The clinical changes of ulcerative colitis （UC） with the main syndrome of large intestine dampness-heat and the alterations of intestinal flora in UC were summarized to reveal the underlying mechanism. After review of the treatment methods for UC with the syndrome of large intestine dampness-heat， we identified the representative traditional Chinese medicines and compound prescriptions and explored the treatment mechanisms. Furthermore， we probed into the associations of UC and the treatment methods with the intestinal flora. The related articles were retrieved from China National Knowledge Infrastructure （CNKI）. The available studies have shown that Akkermansia muciniphila， Escherichia coli， Enterococcus， and probiotics such as Bifidobacterium and Lactobacillus are closely associated with Chinese medicines in UC patients with the syndrome of large intestine dampness-heat. However， due to the shortcomings in clinical research and the susceptibility of intestinal flora to diverse factors， it is still challenging to accurately characterize the intestinal flora changes associated with diseases. Additionally， the research on the mechanisms of Chinese medicines in regulating intestinal flora in UC patients with the syndrome of large intestine dampness-heat remains to be improved. The feasibility of using Chinese medicines and compound prescriptions for precise regulation of intestinal flora in these patients is still debatable. In this regard， scientific issues such as the biological connotation of UC with the syndrome of large intestine dampness-heat and the correlation between syndrome and intestinal flora have become primary research tasks. Additionally， attention should also be paid to the interactions between the intestinal lumen exposure profile of Chinese medicines and intestinal flora. Finally， the thinking of traditional Chinese medicine （TCM） and the concepts of modern medicine should be combined for the research on the formulation of TCM regimens for regulating intestinal flora in treating UC.

Connotation of Traditional Chinese Medicine in Treatment of Chronic Obstructive Pulmonary Disease by Regulating Gut Microbiota Based on "Lung and Large Intestine Being Interior-exterior Related" / 中国实验方剂学杂志

Chronic obstructive pulmonary disease （COPD） is a heterogeneous lung condition characterized by persistent and often progressive airflow obstruction， including airway abnormalities （e.g.， bronchitis and bronchiolitis） and chronic respiratory symptoms （e.g.， dyspnea， cough， and expectoration）. It is one of the leading causes of death worldwide. According to the theory of traditional Chinese medicine （TCM）， the lung and large intestine are interior-exterior related. Therefore， COPD can be treated from both the lung and intestine by the methods of tonifying and invigorating lung， spleen， and kidney， dispelling phlegm， and expelling stasis. Gut microbiota plays a key role in human immunity， nerve， and metabolism and may act on COPD by affecting the structures and functions of lung and intestine tissue and regulating lung inflammation and immunity. TCM can restore the balance of gut microbiota， which is conducive to the recovery from COPD. For example， the treatment method of tonifying lung and invigorating kidney can regulate gut microbiota， alleviate pulmonary and intestinal injuries， and improve lung immunity. The treatment methods of dispelling phlegm and expelling stasis can regulate gut microbiota and reduce pulmonary inflammation. According to the TCM theory of lung and large intestine being interior-exterior related， this review elaborates on the connotation of TCM in the treatment of COPD by regulating gut microbiota， aiming to provide new ideas for the clinical treatment of COPD via gut microbiota.

Histopathological profile of small bowel cancers in the City of Kinshasa, Democratic Republic of the Congo, from March 2011 to March 2023

Contexte et objectifs. Le cancer de l'intestin grêle est très peu documenté. L'objectif du présent travail était de décrire le profil épidémiologique et histopathologique des cancers de l'intestin grêle dans la ville de Kinshasa. Méthodes. C'était une étude descriptive d'une série des cas colligés dans quatre laboratoires d'Anatomie Pathologique de la ville de Kinshasa et sur une période de 12 ans. Les patients ayant comme diagnostic histologique des cancers de l'intestin grêle ont été répertoriés de manière exhaustive à partir des registres des laboratoires sélectionnés. Les pièces biopsiques archivées ont été relues. Résultats. Sur 812 cancers digestifs enregistrés durant la période d'étude, 43 avaient le cancer de l'intestin grêle soit une fréquence relative de 3,5 ℅. Le sexe masculin prépondérant (58,1 ℅). Les ¾ de nos patients avaient un âge compris entre 6 ans et 58 ans. Les patients plus âgés avaient un grade histologique plus élevé. La quasi-totalité de cancers de l'intestin grêle était déjà invasifs au moment du diagnostic et l'adenocarcinome était le cancer le plus fréquent. Le type histologique influençait significativement le grade (p= 0.007). Conclusion. Le cancer de l'intestin grêle dont le type le plus courant est l'adenocarcinome était invasif et rendant ainsi le pronostic plus défavorable. Ceci montre qu'il y a un problème de retard diagnostic. L'âge et le type histologique exerçaient une influence sur le niveau d'invasion des cancers de l'intestin grêle

Context and objective. Cancer of the small intestine is poorly documented. The aim of this study was to describe the histopathological profile of small bowel cancers in the City of Kinshasa. Methods.This was a descriptive study of a series of cases collected in four Pathological Anatomy laboratories in the city of Kinshasa over a 12-year period. Records of patients with histological diagnoses of small bowel cancers were exhaustively collected from the registries of the selected laboratories. Results Out of 812 digestive tract cancers recorded in studied period, 43 had cancers of the small intestine, with a relative frequency of 3.5 ℅. Male gender predominated (58.1 ℅). The ¾ of patients with small bowel cancers were between 6 and 58 years old. Older patients had a higher histological grade. Histological type had a significant influence on cancer grade (p= 0.0072). Conclusion. Almost all small bowel cancers were diagnosed at the invasion's stage, making the prognosis poorer. The high number of invasive cancers suggests that the delayed diagnosis of cancers could be the culprit in Kinshasa

Giant Submucosal Lipoma of the Right Colon Spontaneously Expelled Rectally: Case Report

Colonic lipomas are benign tumors originating in mesenchymal tissue and are considered the second most common benign tumor in the colon after adenomatous polyps. They tend to affect women more; their most frequent location is the right colon. Generally, these lipomas do not exhibit symptoms, but when they reach a considerable size, they can cause manifestations. They can also result in complications such as obstruction, intussusception, and perforation. Since their radiological characteristics are similar to fat, they can be visualized using computed tomography. Still, the final diagnosis is made through colonoscopy, where a fatty mass with an oval shape and elastic capacity is observed. Lesions can be removed endoscopically or surgically. Spontaneous expulsion of a lipoma rectally is rare, and its mechanism is not yet fully understood. Although the literature establishes a cut-off point of 2 cm to decide between endoscopic or laparoscopic resection, the former is increasing and can extend this limit. Surgical resection is recommended in cases such as the one in this article. This case is the biggest reported colonic lipoma (13 cm) expelled spontaneously.

Los lipomas colónicos son tumores benignos que se originan en el tejido mesenquimal y se consideran el segundo tumor benigno más común en el colon, después de los pólipos adenomatosos. Tienden a afectar más a mujeres y su localización más frecuente es el colon derecho. Por lo general, estos lipomas no presentan síntomas, pero cuando alcanzan un tamaño considerable pueden causar manifestaciones. También pueden dar lugar a complicaciones como obstrucción, intususcepción y perforación. Dado que sus características radiológicas son similares a la grasa, pueden ser visualizados mediante tomografía computarizada, aunque el diagnóstico definitivo se realiza mediante colonoscopia, donde se observa una masa grasa con forma ovalada y capacidad elástica. Las lesiones pueden ser extirpadas endoscópicamente o quirúrgicamente. La expulsión espontánea de un lipoma por vía rectal es rara y su mecanismo aún no está completamente comprendido. Aunque la literatura establece un punto de corte de 2 cm para decidir entre resección endoscópica o laparoscópica, la primera está en aumento y puede ampliar este límite. En casos grandes, como el reportado en este artículo, se recomienda una resección quirúrgica. Este caso particular se destaca por ser el lipoma de colon más grande reportado hasta ahora (13 cm) expulsado espontáneamente.

Consenso colombiano de Falla Intestinal Crónica en Síndrome de Intestino Corto / Colombian Consensus on Chronic Intestinal Failure in Short Bowel Syndrome

Introducción. Los términos falla intestinal crónica, síndrome de intestino corto (SIC) y nutrición parenteral total son muy frecuentes en la práctica clínica cotidiana.El objetivo de esta guía fue establecer un marco de referencia de práctica clínica basado en el mejor de nivel de evidencia en pacientes con falla intestinal crónica secundaria a síndrome de intestino corto. Métodos. Se estableció un grupo de expertos interdisciplinarios en el manejo de la falla intestinal crónica quienes, previa revisión de la literatura escogida, se reunieron de manera virtual acogiendo el método Delphi para discutir una serie de preguntas seleccionadas, enfocadas en el contexto terapéutico de la falla intestinal crónica asociada al síndrome de intestino corto. Resultados. La recomendación del grupo de expertos colombianos es que se aconseje a los pacientes con SIC consumir dietas regulares de alimentos integrales que genere hiperfagia para compensar la malabsorción. Las necesidades proteicas y energéticas dependen de las características individuales de cada paciente; la adecuación del régimen debe ser evaluada a través de pruebas clínicas, antropométricas y parámetros bioquímicos. Se sugiere, especialmente a corto plazo después de la resección intestinal, el uso de análogos de somatostatina para pacientes con yeyunostomía de alto gasto en quienes el manejo de líquidos y electrolitos es problemático. En pacientes con SIC, que son candidatos a tratamiento con enterohormonas, Teduglutida es la primera opción. Conclusión. Existen recomendaciones en el manejo integral de la rehabilitación intestinal respaldadas ampliamente por este consenso y es importante el reconocimiento de alternativas terapéuticos enmarcadas en el principio de buenas prácticas clínicas.

Introduction. The terms chronic intestinal failure, short bowel syndrome (SBS), and total parenteral nutrition are very common in daily clinical practice. The objective of this guideline was to establish a reference framework for clinical practice based on the best level of evidence in patients with chronic intestinal failure secondary to short bowel syndrome. Methods. A group of interdisciplinary experts in the management of chronic intestinal failure was established who, after reviewing the selected literature, met virtually using the Delphi method to discuss a series of selected questions, focused on the therapeutic context of chronic intestinal failure associated with short bowel syndrome. Results. The recommendation of the Colombian expert group is that patients with SBS be advised to consume regular diets of whole foods that generate hyperphagia to compensate malabsorption. Protein and energy needs depend on the individual characteristics of each patient; the adequacy of the regimen must be evaluated through clinical, anthropometric tests and biochemical parameters. The use of somatostatin analogue is suggested, especially in the short term after bowel resection, for patients with high-output jejunostomy in whom fluid and electrolyte management is problematic. In SBS, who are candidates for enterohormonal therapy, Teduglutide is the first choice. Conclusion. There are recommendations on the comprehensive management of intestinal rehabilitation that are widely supported by this consensus and it is important to recognize therapeutic alternatives framed in the principle of good clinical practice.

Neumoperitoneo secundario a neumatosis intestinal masiva: un reporte de caso / Pneumoperitoneum secondary to massive intestinal pneumatosis: a case report

Introducción. La neumatosis intestinal se define como la presencia de quistes aéreos en la pared del tracto digestivo, a nivel submucoso o subseroso, que comprometen principalmente el intestino delgado. Las manifestaciones clínicas son inespecíficas y los hallazgos imagenológicos son fundamentales en el enfoque diagnóstico. El manejo puede ser médico o quirúrgico, dependiendo del compromiso intestinal y las complicaciones asociadas. Caso clínico. Hombre de 78 años, que ingresó por cuadro de dolor abdominal crónico, con hallazgos imagenológicos de neumoperitoneo. Al ser llevado a intervención quirúrgica se encontró neumatosis intestinal masiva del íleon, requiriendo resección intestinal. Resultado. El paciente presentó una evolución postoperatoria satisfactoria y fue dado de alta, sin complicaciones. Conclusión. La neumatosis intestinal es una enfermedad poco frecuente, que se presenta principalmente en hombres. La sospecha diagnóstica se confirma con imágenes tomográficas. Los pacientes candidatos para el manejo médico deben presentar causas con curso benigno, sin compromiso hemodinámico ni complicaciones. El manejo quirúrgico se reserva para pacientes con abdomen agudo o signos de sepsis.

Introduction. Intestinal pneumatosis is defined as the presence of air cysts in the wall of the digestive tract at the submucosal or subserosal level, mainly compromising the small intestine. The clinical manifestations of the disease are nonspecific, and the imaging findings are essential in the diagnostic approach. Management can be conservative and/or surgical depending on the intestinal compromise and associated complications. Clinical case. The following is the case of a 78-year-old man, who was admitted due to chronic abdominal pain with imaging findings of pneumoperitoneum. Patient underwent surgery and a massive ileum pneumatosis was found, requiring intestinal resection. Results. The patient ́s postoperative course was uneventful, and he was discharged without further complications. Conclusions. Intestinal pneumatosis is an uncommon disease, which mostly affect men population. Clinical suspicion of this condition should be confirmed with abdominal tomography. Candidates for medical management are those with benign course pathologies without hemodynamic compromise and/or complications. Surgical management should be reserved for patients with acute abdomen or sepsis.

Pneumatosis Cystoides Intestinalis with Non-surgical Encapsulated Pneumoperitoneum: Case Presentation and Literature Review

Introduction: Pneumatosis cystoides intestinalis (PCI) is a rare entity characterized by cysts or air bubbles in the intestinal wall, usually asymptomatic. Its uncomplicated forms are managed conservatively, and the severe ones require surgical intervention. The presence of pneumoperitoneum is a disturbing radiological finding but not an indicator of surgical intervention. Clinical case: A 23-year-old man presented with weight loss, diarrhea, and rectal bleeding; a colonoscopy showed multiple violaceous cysts in the sigmoid and descending colon that collapsed after puncture and biopsies. Computed tomography (CT) confirmed the diagnosis and the presence of an encapsulated pneumoperitoneum. The absence of signs of potential lethality allowed conservative treatment with clinical remission during the first eight months of follow-up. Discussion: The pathophysiology of PCI is not well defined. Our patient's diagnosis was incidental when performing a colonoscopy for rectal bleeding. Asymptomatic encapsulated pneumoperitoneum should be interpreted as an important but not decisive sign of surgical intervention. Its presence, along with the medical history and physical, biochemical, endoscopic, and imaging examination, can prevent unnecessary surgery.

Introducción: la neumatosis quística intestinal es una entidad infrecuente, caracterizada por la presencia de quistes o burbujas de aire en la pared intestinal, usualmente asintomática. Sus formas no complicadas son manejadas conservadoramente y las graves requieren intervención quirúrgica. La presencia de neumoperitoneo es un hallazgo radiológico inquietante, pero no es indicador de intervención quirúrgica. Caso clínico: hombre de 23 años con pérdida de peso, diarrea y rectorragia, la colonoscopia mostró múltiples quistes violáceos localizados en el sigmoide y descendente que colapsaron tras la punción y biopsias, la tomografía axial computarizada (TAC) confirmó el diagnóstico y la presencia de un neumoperitoneo encapsulado. La ausencia de signos de potencial letalidad permitió un tratamiento conservador con remisión clínica durante los primeros 8 meses de seguimiento. Discusión: la fisiopatología de la neumatosis quística intestinal no está bien definida. En el paciente presentado el diagnóstico se realizó de forma incidental al realizar una colonoscopia por una rectorragia. El neumoperitoneo asintomático encapsulado debe interpretarse como un signo importante pero no determinante de intervención quirúrgica y su presencia junto con los antecedentes médicos, examen físico, bioquímico, endoscópico e imagenológico puede evitar cirugías innecesarias.

Congenital Paraduodenal Hernia: A Case Report

Paraduodenal hernia is a rare congenital anomaly that arises from an alteration in the midgut rotation during embryogenesis. Consequently, the small intestine becomes trapped in a sac of the posterior mesentery of the colon. This entity can compromise the intestinal segment's viability and the patient's life. Its diagnosis is difficult, rarely suspected, and often confused with other causes of abdominal pain. We present the case of a 29-year-old male patient with a documented paraduodenal hernia during surgery, its correction, and follow-up, in which no complications were reported.

La hernia paraduodenal es una anomalía congénita poco frecuente que surge de una alteración en la rotación del intestino medio durante la embriogénesis. En consecuencia, el intestino delgado queda atrapado en un saco del mesenterio colónico posterior. Dicha entidad puede comprometer la viabilidad del segmento intestinal y la vida del paciente. Su diagnóstico es difícil, pocas veces sospechado y muchas veces confundido con otras causas de dolor abdominal. Presentamos el caso de un paciente de 29 años con una hernia paraduodenal documentada durante la cirugía, su corrección y seguimiento, en el cual no se documentaron complicaciones.

Proteínas oxidadas de origen animal y su impacto sobre la salud intestinal / Oxidized proteins of animal origin and their impact on intestinal health / Proteínas oxidadas de origem animal e seu impacto na saúde intestinal

Los alimentos de origen animal como la carne de pollo, res, pescado y cerdo poseen una amplia demanda en todo el mundo debido, entre otros aspectos, a su valor nutricional, asociado al alto contenido proteico. No obstante, este tipo de proteínas son susceptibles de sufrir reacciones de oxidación, las cuales pueden mediar procesos de fragmentación, agregación, pérdida de solubilidad, funcionalidad y digestibilidad proteica; eventos implicados en la pérdida de su valor nutricional. En este sentido, las proteínas agrega­das tienden a no ser digeridas en el tracto gastrointestinal y acumularse en el intestino (colon), donde la microbiota colónica las degrada a productos mutagénicos como fenol y p-cresol, lo que incrementa el riesgo de cáncer colorrectal. Por otra parte, los ami­noácidos o péptidos oxidados liberados en la digestión podrían incorporarse en las vías de señalización celular intestinal y favorecer o exacerbar procesos intestinales crónicos como colon irritable o enfermedad de Crohn. Debido al gran interés de esta temática en los últimos años, el objetivo de esta revisión es realizar una descripción general del impacto de proteínas oxidadas de origen animal sobre la salud intestinal.

Animal foods such as chicken, beef, fish and pork are in wide demand throughout the world due, among other things, to their nutritional value, associated with their high protein content. However, this type of protein is susceptible to oxidation reactions, which can mediate processes of fragmentation, aggregation, loss of solubility, functionality, and protein digestibility, which are events involved in the loss of their nutritional value. In this sense, aggregated proteins tend not to be digested in the gastrointestinal tract and accumulate in the intestine (colon), where the colonic microbiota degrades them into mutagenic products such as phenol and p-cresol, which increases the risk of colorectal cancer. On the other hand, the oxidized amino acids or peptides released in digestion could be incorporated into intestinal cell signaling pathways and favor or exacerbate chronic intestinal processes such as irritable bowel syndrome or Crohn's disease. Due to the great interest in this topic in recent years, the objective of this review is to provide a general overview of the impact of oxidized proteins of animal origin on intestinal health.

Alimentos de origem animal como frango, carne bovina, peixe e carne suína são muito procurados em todo o mundo devido, entre outros fatores, ao seu valor nutricional, associado ao seu alto teor de proteínas. No entanto, esse tipo de proteína é suscetível a reações de oxidação, que podem mediar processos de fragmentação, agregação, perda de solubilidade, funcionalidade e digestibilidade da proteína; eventos envolvidos na perda de seu valor nutritivo. Nesse sentido, as proteínas agregadas tendem a não ser digeridas no trato gastrointestinal e se acumulam no intestino (cólon), onde a microbiota colônica as degrada em produtos mutagênicos como fenol e p - cresol, aumentando o risco de câncer colorretal. Por outro lado, os aminoácidos ou peptídeos oxidados liberados na digestão poderiam ser incorporados às vias de sinalização das células intestinais e favorecer ou exacerbar processos intestinais crônicos, como a síndrome do intestino irritável ou a doença de Crohn. Devido ao grande interesse neste tema nos últimos anos, o objetivo desta revisão é fornecer uma descrição geral do impacto das proteínas oxidadas de origem animal na saúde intestinal.

An animal research on the application of drag-and-bond anastomosis in the anastomosis between bladder and intestine / 中华泌尿外科杂志

Objective:To explore the feasibility of anastomosis between bladder and intestine of experimental rabbit by drag anastomosis.Methods:In this study 40 Japanese big-eared rabbits were randomly divided into two groups through random number table, the experimental group and the control group, each group with 20 rabbits. In the experimental group, the bladder neck was fixed to the catheter and then the catheter was drawn outward. With the traction of the catheter, the bladder neck was anastomosed with the distal intestinal tube by means of suture free. The control group was anastomosed by regular interrupted suture of bladder and intestine. The operation time, anastomosis time, intraoperative blood loss, postoperative urinary leakage rate and postoperative anastomotic healing of rabbits in the two groups were compared.Results:The operation time of the experimental group was shorter than that of the traditional interrupted suture anastomosis group [(33.26±2.79)min vs. (35.25±1.83)min, P=0.014]. The anastomosis time of the experimental group was significantly shorter than that of the traditional interrupted suture anastomosis group[(7.55±1.2)min vs. (8.65±1.03 min), P=0.005]. The intraoperative blood loss in the experimental group was similar to that in the control group[(6.47±2.41) ml vs. (6.75±1.83) ml, P=0.691]. The event of contrast media extravasation occurred in 2 of the 10 experimental rabbits after receiving cystography in the experimental group, and the urinary leakage rate was 20%(2/10). In the control group, contrast media extravasation occurred in 1 of the 9 experimental rabbits after receiving cystography, and the urinary leakage rate was 11.1%(1/9), and the difference of the two groups was not statistically significant ( P=0.348). Anastomotic healing score was (2.0±0.7) in the experimental group, and (2.1±0.74) in the control group ( P=0.767). Conclusions:The bladder-intestine drag-and-bond anastomosis technique, with significantly shorter anastomosis time, was feasible, easy and convenient. Our research provides an experimental and theoretical basis for the clinical application of drag-and-bond anastomosis technique in clinic.

Nutritional evaluation and implementation of enteral nutrition in PICU / 中国小儿急救医学

Most critically ill children are in a state of severe stress and prone to malnutrition, which lead to a decline in the body′s resistance to disease and repair ability, thus aggravating the condition of children.After the initial support treatment of multiple organ functions, nutritional support should be considered as soon as possible to improve the metabolic status and supplement the metabolic needs of children, which can improve the nutritional status of children.Reasonable nutritional support treatment can not only improve nutritional status of the body, but also benefit the recovery and prognosis of the disease.Enteral nutrition is highly valued because it conforms to the gastrointestinal physiology and improves the mucosal barrier function of gastrointestinal tract.

Regulation of gluconeogenesis in liver, kidney and intestine by glucagon / 中国药理学通报

Aim To investigate the regulatory effect of glucagon on gluconeogenesis in liver, kidney and intes¬tine during different fasting periods and the underlying mechanism. Methods The 8-week-old male C57BIV 6J mice were randomly divided into six groups ( n = 6) :control group, control + glucagon group, fasting 18 h group, fasting 18 h + glucagon group, fasting 36 h group, and fasting 36 h + glucagon group. Glucose, triglyceride ( TG) and free fatty acids ( FFAs ) kits were used to detect their serum contents in mouse in-traperitoneal injection of glucagon at different fasting time points. Besides, liver/muscle glycogen assay kit and PAS staining were used to detect the glycogen con¬tents in liver tissue. RT-PCR method was used to observe the effects of glucagon on the gene expressions of peroxisome proliferators-activated receptor y coactivator la (PGC-1α), glucose-6-phosphatase (G6Pase) and phosphoenol pyruvate carboxykinase 1 (PEPCK) in liver, kidney and intestine of mice at different fasting time. Western blot was employed to detect the protein expressions of PGC-1α, G6Pase, PEPCK, phosphoryl-ase protein kinase A ( p-PKA) , protlein kinase A (PKA) , phosphorylase cAMp-response element binding protein (p-CREB) and cAMp-response element binding protein (CREB) in liver, kidney and intestine of mice were. Results (1) Glucagon increased the serum glucose level, reduced serum TG and FFAs levels, and reduced the hepatic glycogen content. (2) Glucagon promoted gluconeogenesis via upregulation of PGC-1α. On the stimulation of glucagon, PGC-1α gene and protein expressions in liver were significantly raised by glucagon when the mice were fasted 18 h and 36 h, while the gene and protein expressions of PGC-1α in kidney were obviously up-regulated by glucagon after fasting 18 h. However, PGC-1α gene and protein expressions in intestine were significantly elevated by glucagon at 36 h after fasting. (3 ) Glucagon induced gene and protein expressions of gluconeogenesis-related enzymes G6Pase and PEPCK in liver, kidney and intestine after fasting. (4 ) Glucagon upregulated p-PKA/PKA and p-CREB/CREB in liver. Conclusions Glucagon shows temporal difference in the gluconeo-genic response of liver, kidney and intestine in mice. Glucagon promotes the gene and protein expressions of key gluconeogenic enzymes G6Pase and PEPCK by increasing PGC-1α gene and protein expression, and thus increasing fasting blood glucose. Besides, glucagon promotes hepatic gluconeogenesis via PKA/CREB signaling pathway.

Disease-specific protein corona formed in pathological intestine enhances the oral absorption of nanoparticles

Protein corona (PC) has been identified to impede the transportation of intravenously injected nanoparticles (NPs) from blood circulation to their targeted sites. However, how intestinal PC (IPC) affects the delivery of orally administered NPs are still needed to be elucidated. Here, we found that IPC exerted "positive effect" or "negative effect" depending on different pathological conditions in the gastrointestinal tract. We prepared polystyrene nanoparticles (PS) adsorbed with different IPC derived from the intestinal tract of healthy, diabetic, and colitis rats (H-IPC@PS, D-IPC@PS, C-IPC@PS). Proteomics analysis revealed that, compared with healthy IPC, the two disease-specific IPC consisted of a higher proportion of proteins that were closely correlated with transepithelial transport across the intestine. Consequently, both D-IPC@PS and C-IPC@PS mainly exploited the recycling endosome and ER-Golgi mediated secretory routes for intracellular trafficking, which increased the transcytosis from the epithelium. Together, disease-specific IPC endowed NPs with higher intestinal absorption. D-IPC@PS posed "positive effect" on intestinal absorption into blood circulation for diabetic therapy. Conversely, C-IPC@PS had "negative effect" on colitis treatment because of unfavorable absorption in the intestine before arriving colon. These results imply that different or even opposite strategies to modulate the disease-specific IPC need to be adopted for oral nanomedicine in the treatment of variable diseases.

Versatile flexible micelles integrating mucosal penetration and intestinal targeting for effectively oral delivery of paclitaxel

The extremely low bioavailability of oral paclitaxel (PTX) mainly due to the complicated gastrointestinal environment, the obstruction of intestinal mucus layer and epithelium barrier. Thus, it is of great significance to construct a coordinative delivery system which can overcome multiple intestinal physicochemical obstacles simultaneously. In this work, a high-density PEGylation-based glycocholic acid-decorated micelles (PTX@GNPs) was constructed by a novel polymer, 9-Fluorenylmethoxycarbonyl-polyethylene glycocholic acid (Fmoc-PEG-GCA). The Fmoc motif in this polymer could encapsulate PTX via π‒π stacking to form the core of micelles, and the low molecular weight and non-long hydrophobic chain of Fmoc ensures the high-density of PEG. Based on this versatile and flexible carriers, PTX@GNPs possess mucus trapping escape ability due to the flexible PEG, and excellent intestine epithelium targeting attributed to the high affinity of GCA with apical sodium-dependent bile acid transporter. The in vitro and in vivo results showed that this oral micelle could enhance oral bioavailability of PTX, and exhibited similar antitumor efficacy to Taxol injection via intravenous route. In addition, oral PTX@GNPs administered with lower dosage within shorter interval could increase in vivo retention time of PTX, which supposed to remodel immune microenvironment and enhance oral chemotherapy efficacy by synergistic effect.

Effect of Porcine Large Intestine-processed Dahuang （Radix et Rhizoma Rhei） on Defecation and Colon Pathological Changes in Constipation Model Mice / 中医杂志

ObjectiveTo investigate the effect of porcine large intestine-processed Dahuang （Radix et Rhizoma Rhei） on defecation in constipation model mice and the possible mechanism. MethodsFifty Kunming mice were randomized to blank group （n=10） and model group （n=40）. Loperamide suspension at the dose of 8 mg/（kg·d） was given by gavage for four consecutive days to establish a model of constipation. The 24 successfully modeled mice were randomly divided into model group， processed Dahuang group， lactulose group， raw Dahuang group， with six mice in each group. Moreover， six randomly selected mice were chosen as control group. Since the fifth day， 8 mg/（kg·d） of loperamide suspension by gavage was given to the model group， processed Dahuang group， raw Dahuang group， and lactulose group； two hours later， the processed and raw Dahuang groups were administered with 0.6 g/（kg·d） of processed and raw Dahuang suspension， respectively， while the lactulose group was given 0.6 g/（kg·d） of latulose suspension， and the blank group and the model group were given 0.2 ml/10 g of distilled water by gavage， all for four days. The general condition， body weight after the last gavage， number of fecal particles within six hours， fecal wet weight， fecal water content ratio， intestinal propulsion rate and colonic histology changes by HE staining of each group were detected. ResultsThe body weight of the mice in the raw Dahuang group was significantly lighter than that in the other groups （P＜0.05 or P＜0.01）. The number of fecal particles， fecal wet weight and intestinal propulsion rate of mice significantly decreased in the model group than in the blank group （P＜0.05 or P＜0.01）. Compared to those in the model group， the number of fecal particles and fecal wet weight in the processed Dahuang group， lactulose group and raw Dahuang group significantly increased， and the fecal water content ratio in the raw Dahuang group increased as well （P＜0.05 or P＜0.01）. Compared to those in the processed Dahuang group， the number of fecal particles and fecal wet weight in the raw Dahuang group decreased， while the fecal water content ratio increased （P＜0.05 or P＜0.01）， and the fecal water content ratio in the lactulose group increased significantly （P＜0.05）. The intestinal propulsion rate in the processed Dahuang group was higher than that in the model group， lactulose group and raw Dahuang group （P＜0.05 or P＜0.01）. Histopathological analysis showed that the colonic crypts and goblet cells in the blank group were normal and clear， and the colonic muscular layer was thicker. The colonic crypts of the mice in the model group were damaged， with reduced goblet cells to varying degrees and changed colonic muscularis. In the lactulose group and raw Dahuang group， part of the crypts were broken， and the goblet cells were damaged to varying degrees， while in the processed Dahuang group， still the colonic tissue structure of the mice was relatively clear， and the colonic crypts and goblet cells were relatively normal， with thickened muscular layer of the colon. ConclusionPorcine large intestine-processed Dahuang could improve defecation in constipation model mice， and reduce the drastic purgation function of raw Dahuang， for which the mechanism may be related to the protection of colon histopathological damage.

Advances in the study on brain-gut axis mechanism of common mental disorders and clinical intervention / 四川精神卫生

There are a large number of microbial communities in human intestine， which play an important role in many physiological processes of the body. It has been found that intestinal microorganisms can act on brain diseases through brain-gut axis mechanism. The purpose of this paper is to summarize the mechanism of intestinal microorganisms in schizophrenia， bipolar disorder and depression， and to provide new ideas for the prevention and treatment of psychiatric disorders.

Mechanism of Ethyl Acetate Extract of Gentianopsis paludosa in Treatment of Ulcerative Colitis Based on Bcl-2/Bax Signaling Pathway / 中国实验方剂学杂志

ObjectiveTo investigate the mechanism of ethyl acetate extract of Tibetan medicine dampness bud Gentianopsis paludosa in the prevention and treatment of recurrent ulcerative colitis （UC） in rats with dampness-heat in large intestine syndrome based on the apoptotic pathway mediated by the B-cell lymphoma-2 （Bcl-2） and Bcl-2-associated X protein （Bax）. MethodUsing the disease-syndrome combination method， a recurrent UC model of dampness-heat in large intestine syndrome was constructed in rats. Seventy SPF-grade male SD rats were randomly divided into control group， model group， high-， medium-， and low-dose ethyl acetate of G.paludosa groups （150， 75， 37.5 mg·kg-1）， and mesalazine group （135 mg·kg-1）. The rats were orally administered with respective drugs for 14 days. The general conditions of the rats were recorded， and colon length and mucosal damage were observed. The colon wet weight index and organ coefficients of the liver， spleen， and thymus were calculated. Enzyme-linked immunosorbent assay （ELISA） was used to measure the levels of interleukin-6 （IL-6） and interleukin-1β （IL-1β） in the serum of each group. Hematoxylin-eosin （HE） staining was performed to observe pathological changes in the colon. Terminal deoxynucleotidyl transferase dUTP nick end labeling （TUNEL） was used to detect apoptosis in colonic epithelial cells. Western blot was used to measure the expression levels of Bcl-2， Bax， Caspase-3， Caspase-9， Zona Occludens-1 （ZO-1）， Claudin3， and Occludin in colonic tissue. Immunohistochemistry （IHC） was used to observe the expression of Bax and Caspase-3 in colonic epithelial cells. ResultCompared with the control group， the model group showed significant increases in the disease activity index （DAI） score， colonic mucosal damage index （CMDI）， intestinal epithelial apoptosis， liver and spleen indexes， and levels of inflammatory factors IL-1β and IL-6 in the serum （P<0.01）， decreased expression of intestinal mucosal protective proteins ZO-1， Claudin3， and Occluding （P<0.01）， increased expression of pro-apoptotic proteins Bax， Caspase-3， and Caspase-9 （P<0.01）， and decreased expression of anti-apoptotic protein Bcl-2 （P<0.01）. Compared with the model group， the high-， medium-， and low-dose ethyl acetate of G.paludosa groups all significantly improved the general condition of the rats， reduced colonic lesions， decreased intestinal epithelial cell apoptosis， reduced liver and spleen indexes， upregulated the expression of ZO-1， Claudin3， Occludin， and Bcl-2 proteins， and downregulated the expression of Bax， Caspase-3， and Caspase-9 proteins， with the high- and medium-dose ethyl acetate of G.paludosa groups showing the superior effects （P<0.05， P<0.01）. ConclusionEthyl acetate of G.paludosa can alleviate colonic mucosal damage and exert a therapeutic effect on UC by regulating the Bcl-2/Bax signaling pathway.

Intestinal intussusception of Meckel's diverticulum, a case report and literature review of the last five years

ABSTRACT Meckel's diverticulum is the most common gastrointestinal tract anomaly. It arises from the incomplete closure of the omphalomesenteric conduit, which is a true diverticulum at the antimesenteric border of the ileum. Although the majority of patients are asymptomatic, they can present with inflammation, hemorrhage, intussusception, intestinal obstruction, and perforation, among others; this constitutes an important differential diagnosis for acute abdomen. A 19-year-old female sought medical attention because of intermittent diffuse abdominal pain for two months, nausea, and diarrhea. In the requested imaging tests, tomography, and enterotomography, a diagnosis of Meckel's diverticulum with some degree of intussusception was suggested. The patient underwent elective surgical treatment without complications and was discharged on the second postoperative day with clinical improvement. In this section, we review publications on similar cases published in the last five years.

Suplementação de glutamina na recuperação da flora intestinal / Glutamine supplementation in gut flora recovery / La suplementación con glutamina en la recuperación de la flora intestinal

Objetivo: evidenciar através de uma revisão integrativa os resultados clínicos atuais da suplementação de glutamina na melhora da saúde intestinal, através de sintomas e exames bioquímicos. Método: Revisão integrativa da literatura realizada no período de setembro de de 2021 nas bases de dados Pubmed e Scielo. Resultados: Foi realizado uma busca pelos descritores em saúde determinados e foram selecionadas 08 produções cientificas que atenderam os critérios de inclusão. Conclusão: Sugere-se novas pesquisas que elucidem as dosagens, efeitos colaterais e respostas terapêuticas da glutamina sobre parâmetros de saúde intestinal.

Objective: to evidence through an integrative review the current clinical results of glutamine supplementation in the improvement of intestinal health, through symptoms and biochemical tests. Method: Integrative review of the literature conducted in the period of September 2021 in the Pubmed and Scielo databases. Results: A search was performed for the defined health descriptors and 08 scientific productions were selected that met the inclusion criteria. Conclusion: Further research is suggested to elucidate the dosages, side effects and therapeutic responses of glutamine on intestinal health parameters.

Objetivo: evidenciar a través de una revisión integradora los resultados clínicos actuales de la suplementación con glutamina en la mejora de la salud intestinal, a través de síntomas y pruebas bioquímicas. Método: Revisión integradora de la literatura realizada en el periodo de septiembre de 2021 en las bases de datos Pubmed y Scielo. Resultados: Se realizó una búsqueda de los descriptores de salud definidos y se seleccionaron 08 producciones científicas que cumplieron con los criterios de inclusión. Conclusión: Se sugiere investigación adicional para dilucidar las dosis, los efectos secundarios y las respuestas terapéuticas de la glutamina en los parámetros de salud intestinal.

Melanoma metastásico en intestino delgado: causa infrecuente de perforación: reporte de caso / Metastatic melanoma in the small intestine: infrequent cause of perforation: case report / Melanoma metastático em intestino delgado: causa rara de perfuração: relato de caso

El intestino delgado es el sitio de asiento más frecuente del melanoma metastásico. Su diagnóstico es un desafío por cursar asintomático o con síntomas inespecíficos. Son pocos los casos que presentan complicaciones, siendo infrecuente la peritonitis por perforación. El objetivo del trabajo es comunicar el caso clínico de una peritonitis por perforación de una metástasis de melanoma en intestino delgado. Caso clínico: Paciente de sexo masculino de 66 años con diagnóstico de melanoma de cuello y secundario óseo, encefálico y pulmonar, fue intervenido de urgencia por peritonitis aguda por perforación de metástasis en intestino delgado. El estudio histológico confirmó secundarismo de melanoma cutáneo. Conclusión: Sabiendo que el yeyuno íleon es el sitio de asiento más frecuente de las metástasis de melanoma, ante la presencia de síntomas digestivos inespecíficos o anemia se debe sospechar su compromiso y evaluar posibles alternativas terapéuticas.

The small intestine is the most frequent site of metastatic melanoma. However, its diagnosis continues to be a challenge since it is usually asymptomatic or with non-specific symptoms. Few cases result in complications, peritonitis due to perforation being infrequent. The objective of the work is to report a clinical case of peritonitis due to perforation of a melanoma metastasis in the small intestine. Clinical case: A 66-year-old male patient diagnosed with melanoma of the neck and secondary bone, brain and lung melanoma, underwent emergency surgery for acute peritonitis due to perforation of metastasis in the small intestine, which was resected and anastomosed. The histology confirmed the secondary nature of the cutaneous melanoma. Conclusion: Knowing that the jejunum-ileum is the most frequent site of melanoma metastases, in the presence of non-specific digestive symptoms or anemia, its involvement should be suspected and possible therapeutic alternatives should be evaluated.

O intestino delgado é o local mais frequente de melanoma metastático. O diagnóstico é um desafio por ser assintomático ou apresentar sintomas inespecíficos. Há poucos casos que apresentam complicações, sendo pouco frequente a peritonite por perfuração. O objetivo deste trabalho é relatar um caso clínico de peritonite por perfuração de metástase de melanoma no intestino delgado. Caso clínico: Paciente do sexo masculino, 66 anos, diagnosticado com melanoma no pescoço com metástase óssea, cefálica e pulmonar. Foi submetido a cirurgia de emergência por peritonite aguda por perfuração de metástases do intestino delgado. O estudo histológico confirmou melanoma cutâneo. Conclusão: Sabendo que o jejuno e o íleo é o local mais frequente de metástase de melanoma, na presença de sintomas digestivos inespecíficos ou anemia deve-se suspeitar de seu acometimento e avaliar possíveis alternativas terapêuticas.