BACKGROUND & AIMS: OBJECTIVE:Hospital-onset Clostridium difficile-associated diarrhea (HO-CDAD) has been associated with longer length of stay (LOS) and higher hospital costs among patients in general. The burden of HO-CDAD is unknown among patients who may be at particular risk of poor outcomes: older patients, those with complex or chronic conditions (renal disease, cancer, inflammatory bowel disease [IBD]), and those with concomitant antibiotic (CAbx) use during treatment for CDAD. RESEARCH DESIGN AND METHODS:A retrospective analysis (2005-2011) of the Health Facts® database (Cerner Corp., Kansas City, MO) containing comprehensive clinical records from 186 US hospitals identified hospitalized adult patients with HO-CDAD based on a positive C. difficile toxin collected >48 h after admission. Control patients were required to have total hospital LOS ≥2 days. Separate logistic regression models to estimate propensities were developed for each study group, with HO-CDAD vs controls as the outcome. Differences in LOS and costs were calculated between cases and controls for each group. RESULTS:A total of 4521 patients with HO-CDAD were identified. Mean age was 70 years, 54% were female, and 13% died. After matching, LOS was significantly greater among HO-CDAD patients (vs controls) in each group except IBD. The significant difference in LOS ranged from 3.0 (95% CI = 1.4-4.6) additional days in older patients to 7.8 (95% CI = 5.7-9.9) days in patients with CAbx exposure. HO-CDAD was associated with significantly higher costs among older patients (p < 0.001) and among those with renal impairment (p = 0.012) or CAbx use (p < 0.001). LIMITATIONS:Missing cost data and potential misclassification of colonized patients as infected. CONCLUSIONS:Renal impairment, advanced age, cancer, and CAbx use are associated with significantly longer LOS among HO-CDAD patients, with CAbx users being the most resource intensive. Early identification and aggressive treatment of HO-CDAD in these groups may be warranted.

背景与目标： 目的：一般而言，医院发作的艰难梭菌相关性腹泻（HO-CDAD）与住院时间（LOS）延长和住院费用增加有关。 HO-CDAD的负担在可能具有不良预后的特别风险中的患者中未知：老年患者，患有复杂或慢性疾病的患者（肾脏疾病，癌症，炎性肠病[IBD]）和伴有抗生素的患者（CAbx） ）在CDAD治疗期间使用。
研究设计与方法：对HealthFacts®数据库（Cerner Corp.，堪萨斯城，密苏里州）进行的回顾性分析（2005-2011），其中包含来自美国186所医院的全面临床记录，根据正C值确定了住院的HO-CDAD成年患者入院后> 48 h收集到的艰难梭菌毒素。对照患者的总住院LOS≥2天。为每个研究组开发了单独的逻辑回归模型以估计倾向，以HO-CDAD vs对照作为结果。计算每组病例与对照之间的LOS和成本差异。
结果：共鉴定出4521例HO-CDAD患者。平均年龄为70岁，女性占54％，死亡13％。匹配后，除IBD外，其他各组的HO-CDAD患者（相对于对照）的LOS均显着升高。 LOS的显着差异范围从老年患者的3.0天（95％CI≥1.4-4.6）增加到CAbx暴露患者的7.8天（95％CI≥5.7-9.9）。 HO-CDAD与老年患者（p <0.001）和肾功能不全（p = 0.012）或CAbx使用（p <0.001）的患者费用显着相关。
局限性：缺少成本数据以及定居的受感染患者的误分类。
结论：HO-CDAD患者的肾功能不全，高龄，癌症和CAbx的使用与LOS明显延长有关，CAbx的使用者是最消耗资源的。在这些人群中，应及早发现和积极治疗HO-CDAD。

BACKGROUND & AIMS: OBJECTIVE:Gastrointestinal toxicity is one of the most common side effects of anticancer therapy. Measurement of intestinal permeability represents one of the potential methods of noninvasive laboratory assessment of gastrointestinal toxicity. The aim of the present study was to investigate intestinal permeability and vitamin A absorption in patients with chemotherapy-induced diarrhea (CID). METHODS:We have assessed intestinal permeability, by measuring absorption of lactulose, mannitol, xylose, and vitamin A absorption, in 11 patients with CID, 10 healthy controls, and 24 untreated patients with gastrointestinal tumors. Urinary lactulose, mannitol and xylose were measured by capillary gas chromatography and serum retinol and retinyl esters were determined by high performance liquid chromatography. The results obtained in patients and controls were compared by Mann-Whitney U test. RESULTS:Lactulose/mannitol and lactulose/xylose ratios were increased and retinol esters (retinyl palmitate and retinyl stearate) were decreased significantly in patients with CID. CONCLUSIONS:Measurements of intestinal permeability and vitamin A absorption may represent sensitive tools in the assessment of CID.

背景与目标： 目的：胃肠道毒性是抗癌治疗最常见的副作用之一。肠通透性的测量代表了胃肠道毒性的非侵入性实验室评估的潜在方法之一。本研究的目的是研究化疗引起的腹泻（CID）患者的肠道通透性和维生素A吸收。
方法：我们通过测量11名CID患者，10名健康对照和24名未经治疗的胃肠道肿瘤患者的乳果糖，甘露醇，木糖和维生素A吸收来评估肠通透性。用毛细管气相色谱法测定尿中的乳果糖，甘露醇和木糖，用高效液相色谱法测定血清视黄醇和视黄酯。通过Mann-Whitney U检验比较了患者和对照组获得的结果。
结果：CID患者的乳果糖/甘露醇和乳果糖/木糖比增加，视黄醇酯（棕榈酸视黄酯和硬脂酸视黄酯）显着降低。
结论：肠道通透性和维生素A吸收的测定可能是评估CID的敏感工具。

BACKGROUND & AIMS: :The objective of this study was to evaluate an algorithm for the management of children with persistent/chronic diarrhea at a community level hospital. The study was carried out in the pediatric OPD of a 150 bed trust hospital catering to children from poor, rural and urban slums. Fifty clinically stable children (6 months-5 years old, mean = 19.7 months) with persistent or chronic diarrhea refusing admission, being managed on an outpatient basis, were enrolled prospectively. A detailed history and physical examination were done for each child to ascertain the cause of diarrhea. They were managed using a pre-tested simplified algorithm and monitored for symptom improvement using a questionnaire 15 days, 1 month and 3 months after initiation of therapy. The average cost for treatment of each child was also calculated. Twenty-one (42%) children had persistent diarrhea. Seven (14%) infants with a typical history of lactose malabsorption responded to a trial of WHO feeding protocols or lactose/sucrose free milk. Four (8%) infants had chronic non-specific diarrhea. A total of 71.8% (28/39) of children were treated satisfactorily with albendazole or metronidazole and Cotrimaxazole along with hematinics and multivitamins. Three (6%) children were diagnosed with abdominal tuberculosis. Four (8%) had raised anti-tissue tranglutaminase antibodies (age 18-34 months). The algorithm used was successful in managing all the children with chronic diarrhea. The average cost per managed case was US$10. Further, multi-center evaluations of similar algorithms are needed to validate the observations in the present study.

背景与目标： ：这项研究的目的是评估社区级医院持续/慢性腹泻儿童的治疗算法。该研究是在一家有150张床位的信托医院的儿科OPD中进行的，该医院为贫困，农村和城市贫民窟的儿童提供服务。前瞻性入组了50名临床稳定的儿童（6个月至5岁，平均= 19.7个月），因其持续或慢性腹泻而拒绝入院，由门诊治疗。对每个孩子进行了详细的病史和体格检查，以确定腹泻的原因。在开始治疗后的15天，1个月和3个月，使用预先测试的简化算法对他们进行管理，并使用问卷调查症状的改善。还计算了每个孩子的平均治疗费用。 21名儿童（42％）持续腹泻。七名（14％）具有典型的乳糖吸收不良病史的婴儿对WHO喂养方案或不含乳糖/蔗糖的牛奶进行了试验。四（8％）例婴儿患有慢性非特异性腹泻。共有71.8％（28/39）的儿童接受了阿苯达唑或甲硝唑和Cotrimaxazole以及血色素和多种维生素的满意治疗。三名（6％）儿童被诊断出患有腹部结核病。四个（8％）的抗组织转谷氨酰胺酶抗体升高（年龄18-34个月）。所使用的算法成功地解决了所有患有慢性腹泻的儿童。每个管理案例的平均成本为10美元。此外，需要类似算法的多中心评估来验证本研究中的观察结果。

BACKGROUND & AIMS: PURPOSE OF REVIEW:Travelers' diarrhea affects 20-60% of travelers to low-income regions of the world. Much of the evidence for the clinical description and management of travelers' diarrhea was generated years ago, however, there is new information on geographic and host risk, etiology, and prevention strategies. RECENT FINDINGS:Travel to South Asia, followed by sub-Saharan Africa and South America, carries the highest risk for diarrheal syndromes in returned travelers. Women are more susceptible to travel-related diarrhea than men. Host genetic studies have demonstrated that single nucleotide polymorphisms in the lactoferrin, osteoprotegerin, and IL-10 genes are associated with small but increased risks for diarrhea and enteric pathogens. Enterotoxigenic Bacteroides fragilis is likely to be a new agent identified as causing travelers' diarrhea, and heat-stable toxin-producing Escherichia coli appears to be more common than heat-labile toxin E. coli. Overall levels of sanitation at the travel destination, including individual eating establishments, are strong predictors for acquisition of travelers' diarrhea. A new transdermal LT vaccine shows promise in modifying the severity of travelers' diarrhea. It remains uncertain whether prophylaxis or prompt self-treatment of travelers' diarrhea will prevent late-onset irritable bowel syndrome. For self-treatment, azithromycin is the drug of choice in travelers to areas where there is a high risk of fluoroquinolone-resistant Campylobacter spp., such as South and Southeast Asia and possibly North Africa, Central and South America. SUMMARY:There is increased understanding of the determinants of travelers' diarrhea. Despite this travelers' diarrhea remains one of the most common illnesses in travelers. Continued focus on intervention strategies may ultimately lead to decreased incidence.

背景与目标： 审查目的：旅行者的腹泻影响到世界低收入地区的旅行者的20-60％。关于旅行者腹泻的临床描述和管理的许多证据是在多年前产生的，但是，有关地理和宿主风险，病因和预防策略的新信息已经出现。
最近的调查结果：前往南亚，其次是撒哈拉以南非洲和南美，在返回的旅客中腹泻综合症的风险最高。女人比男人更容易因旅行引起的腹泻。宿主基因研究表明，乳铁蛋白，骨保护素和IL-10基因中的单核苷酸多态性与腹泻和肠道病原体的风险较小但增加了风险。脆弱的肠毒素细菌可能被认为是引起旅行者腹泻的新药，产热毒素的大肠杆菌似乎比不耐热毒素的大肠杆菌更为普遍。包括个人饮食场所在内的旅行目的地的整体卫生水平是旅行者腹泻的有力预测指标。一种新的经皮LT疫苗有望改善旅行者腹泻的严重程度。预防或及时自我治疗旅行者的腹泻是否能够预防迟发性肠易激综合征尚不确定。对于自我治疗，阿奇霉素是前往耐氟喹诺酮弯曲杆菌属的高风险地区（例如南亚和东南亚以及可能的北非，中美洲和南美洲）旅行者的首选药物。
摘要：人们对旅行者腹泻的决定因素有了越来越多的了解。尽管这样，旅行者的腹泻仍然是旅行者中最常见的疾病之一。持续关注干预策略可能最终导致发病率降低。

BACKGROUND & AIMS: :Despite the prepdominat agent causing severe entero-pathogenic diarrhea in swine, there are no effective therapeutical treatment of porcine epidemic diarrhea virus (PEDV). In this study, we evaluated the antiviral activity of five phlorotannins isolated from Ecklonia cava (E. cava) against PEDV. In vitro antiviral activity was tested using two different assay strategies: (1) blockage of the binding of virus to cells (simultaneous-treatment assay) and (2) inhibition of viral replication (post-treatment assay). In simultaneous-treatment assay, compounds 2-5 except compound 1 exhibited antiviral activities of a 50% inhibitory concentration (IC₅₀) with the ranging from 10.8 ± 1.4 to 22.5 ± 2.2 μM against PEDV. Compounds 1-5 were completely blocked binding of viral spike protein to sialic acids at less than 36.6 μM concentrations by hemagglutination inhibition. Moreover, compounds 4 and 5 of five phlorotannins inhibited viral replication with IC₅₀ values of 12.2 ± 2.8 and 14.6 ± 1.3 μM in the post-treatment assay, respectively. During virus replication steps, compounds 4 and 5 exhibited stronger inhibition of viral RNA and viral protein synthesis in late stages (18 and 24 h) than in early stages (6 and 12 h). Interestingly, compounds 4 and 5 inhibited both viral entry by hemagglutination inhibition and viral replication by inhibition of viral RNA and viral protein synthesis, but not viral protease. These results suggest that compounds isolated from E. cava have strong antiviral activity against PEDV, inhibiting viral entry and/or viral replication, and may be developed into natural therapeutic drugs against coronavirus infection.

背景与目标： ：尽管主要的药物引起猪严重的肠病性腹泻，但尚无有效的治疗猪流行性腹泻病毒（PEDV）的方法。在这项研究中，我们评估了从Ecklonia cava（E. cava）分离得到的五种环戊宁对PEDV的抗病毒活性。使用两种不同的测定策略测试了体外抗病毒活性：（1）阻断病毒与细胞的结合（同时治疗测定）和（2）抑制病毒复制（治疗后测定）。在同时处理试验中，除化合物1外，化合物2-5显示出对PEDV的50％抑制浓度（IC 50）的抗病毒活性，范围为10.8±1.4至22.5±2.2μM。通过血凝抑制，化合物1-5以低于36.6μM的浓度完全阻断了病毒刺突蛋白与唾液酸的结合。而且，在后处理测定中，五个苯环单宁的化合物4和5抑制病毒复制，IC 50值分别为12.2±2.8和14.6±1.3μM。在病毒复制步骤中，化合物4和5在晚期（18和24小时）比早期（6和12小时）表现出对病毒RNA和病毒蛋白质合成的更强抑制作用。有趣的是，化合物4和5通过血凝抑制作用抑制病毒进入，并通过抑制病毒RNA和病毒蛋白质合成抑制病毒复制，但不抑制病毒蛋白酶。这些结果表明，从大肠杆菌分离的化合物对PEDV具有很强的抗病毒活性，抑制病毒的进入和/或病毒复制，并且可以发展成为抗冠状病毒感染的天然治疗药物。

BACKGROUND & AIMS: :Acute diarrhea is a burdensome disease with potentially harmful consequences, especially in childhood. Despite its large use in clinical practice, the efficacy of the probiotic Bacillus clausii in treating acute childhood diarrhea remains unclear. Our objective was to systematically review the efficacy of Bacillus clausii in the treatment of acute childhood diarrhea. The following electronic databases were systematically searched up to October 2017: MEDLINE (via PubMed/OVID), EMBASE (via OVID), Cochrane Central Database of Controlled Trials (via CENTRAL), Google Scholar, and ClinicalTrials.gov. Only randomized controlled trials were included. The overall effect for the meta-analysis was derived by using a random effects model. Six randomized controlled trials (1298 patients) met the eligibility criteria. Data arising from pooled analysis showed that Bacillus clausii significantly reduced the duration of diarrhea (mean difference = -9.12 h; 95% confidence interval [CI]: -16.49 to -1.75, p = 0.015), and the duration of hospitalization (mean difference = -0.85 days; 95% CI: -1.56 to -0.15, p = 0.017), compared with control. There was a trend of decreasing stool frequency after Bacillus clausii administration compared with the control group (mean difference = -0.19 diarrheal motions; 95% CI: -0.43 to -0.06, p = 0.14). Bacillus clausii may represent an effective therapeutic option in acute childhood diarrhea, with a good safety profile.

背景与目标： 急性腹泻是一种负担很重的疾病，具有潜在的有害影响，尤其是在儿童时期。尽管其在临床实践中得到广泛使用，但益生菌克劳氏芽孢杆菌在治疗急性儿童腹泻中的功效仍不清楚。我们的目标是系统地审查克劳氏芽孢杆菌在治疗儿童急性腹泻中的疗效。截至2017年10月，系统地搜索了以下电子数据库：MEDLINE（通过PubMed / OVID），EMBASE（通过OVID），Cochrane对照试验中央数据库（通过CENTRAL），Google Scholar和ClinicalTrials.gov。仅包括随机对照试验。荟萃分析的总体效果是通过使用随机效应模型得出的。六项随机对照试验（1298例患者）符合入选标准。汇总分析得出的数据表明，克劳氏芽孢杆菌显着缩短了腹泻持续时间（平均差异= -9.12 h； 95％置信区间[CI]：-16.49至-1.75，p = 0.015）和住院时间（平均差异） ＝ -0.85天； 95％CI：-1.56至-0.15，p ＝ 0.017）。与对照组相比，克劳氏芽孢杆菌给药后大便次数有降低的趋势（平均差异= -0.19腹泻运动； 95％CI：-0.43至-0.06，p = 0.14）。克劳氏芽孢杆菌可代表急性儿童腹泻的有效治疗选择，并具有良好的安全性。

BACKGROUND & AIMS: BACKGROUND:Diarrhea and acute respiratory infection (ARI) are major causes of child mortality. We aimed to identify risk factors associated with diarrhea and ARI among children under 2 years of age in rural northern Bangladesh. METHOD:We collected information on diarrhea and ARI in the previous 14 days and the previous 6 months at 6, 12, 18 and 24 months of age as part of a longitudinal, cluster randomized effectiveness trial, the Rang-Din Nutrition Study which enrolled 4011 pregnant women at ≤20 gestational weeks. Women and their children were followed up until 2 years postpartum. Information on household socioeconomic status, type of toilet, garbage disposal system, food insecurity, number of under-five children in the household, type of family, maternal characteristics and child characteristics was collected at baseline and/or at 6, 12, 18 and 24 months postpartum. Data on newborn health and feeding behaviors were collected within 72 h of delivery. Associations between potential risk factors and morbidity prevalence outcomes were assessed using logistic regression controlling for potential confounders. RESULTS:Out of 3664 live born children, we collected information from ~ 3350 children at 6, 12, 18 and 24 months of age. Diarrhea in the previous 14 days, and in the previous 6 months, was associated with maternal depression score and food insecurity; diarrhea in the previous 6 months was also associated with family type (nuclear vs. joint). ARI in the previous 14 days was associated with maternal depression score, type of toilet and garbage disposal, household food insecurity and sex. Cough or nasal discharge in the past 6 months was associated with maternal depression score, type of toilet and garbage disposal, household food insecurity, sex and perceived overall physical condition of the infant after birth. CONCLUSION:Maternal depression and food insecurity appear to be important risk factors for diarrhea and respiratory infection among children under 2 years of age in this setting. These findings suggest that policies and programs that include strategies to address maternal mental health and household food insecurity may contribute to improved child health. TRIAL REGISTRATION:The trial was registered with the US National Institutes of Health at ClinicalTrials.gov, # NCT01715038 , with registration completed October 26, 2012.

背景与目标： 背景：腹泻和急性呼吸道感染（ARI）是儿童死亡的主要原因。我们旨在确定孟加拉国北部农村地区2岁以下儿童与腹泻和ARI相关的危险因素。
方法：我们进行了纵向，整群随机有效性试验（Rang-Din营养研究，纳入4011），收集了前14天和前6个月（分别在6、12、18和24个月时）的腹泻和ARI信息。 ≤20个孕周的孕妇。对妇女及其子女进行随访，直到产后2年。有关家庭社会经济状况，厕所类型，垃圾处理系统，粮食不安全状况，家庭中五岁以下儿童数量，家庭类型，孕产妇特征和儿童特征的信息是在基线和/或在6、12、18和产后24个月。在分娩后72h之内收集了有关新生儿健康和喂养行为的数据。潜在危险因素与发病率结果之间的关联使用对潜在混杂因素的逻辑回归控制进行了评估。
结果：在3664名活产儿中，我们从6、12、18和24月龄的〜3350名儿童中收集了信息。前14天和前6个月的腹泻与孕产妇抑郁评分和食物不安全相关；前6个月的腹泻也与家庭类型（核与关节）有关。前14天的ARI与孕产妇抑郁评分，厕所和垃圾处理类型，家庭粮食不安全状况以及性别有关。在过去的六个月中，咳嗽或鼻涕与母体抑郁评分，厕所和垃圾处理类型，家庭食物不安全状况，性别以及出生后婴儿的整体身体状况有关。
结论：在这种情况下，母亲抑郁和食物不安全似乎是2岁以下儿童腹泻和呼吸道感染的重要危险因素。这些发现表明，包括解决孕产妇精神健康和家庭粮食不安全问题的战略在内的政策和计划可能有助于改善儿童健康。
试验注册：该试验已在美国国立卫生研究院的ClinicalTrials.gov上注册，编号为NCT01715038，注册于2012年10月26日完成。

BACKGROUND & AIMS: :The high incidence of anemia of infection among children in developing countries is not well characterized. We investigated the relationship between diarrhea, fever and other risk factors for anemia in young children in the community. The relationship between risk factors for anemia was examined in a cross-sectional study of 85 229 children, aged 6-59 months, from impoverished families in rural areas of Indonesia. The prevalence of anemia was 56.1% among the study subjects. Those considered anemic were more likely to be younger, male, stunted, underweight, wasted, to have low maternal and paternal education and to have current diarrhea or history of diarrhea in the previous 7 days compared with children without anemia (all P < 0.0001). In separate multivariate models adjusted for age, sex, stunting, maternal age and education, and weekly per capita household expenditure, current diarrhea (OR 1.15, 95% CI 1.07-1.325, P < 0.0001) and a history of diarrhea in the previous 7 days (OR 1.16, 95% CI 1.09-1.25, P < 0.0001) were associated with an increased risk of anemia. In similar models, current fever had a borderline association with anemia (OR 1.14, 95% CI 0.98-1.32, P = 0.09). We conclude that diarrhea is a contributing factor of anemia among young children living in rural areas in Indonesia.

背景与目标： ：发展中国家儿童感染性贫血的高发率尚未得到很好的表征。我们调查了社区幼儿中腹泻，发烧和其他贫血危险因素之间的关系。在一项针对印度尼西亚农村地区贫困家庭的85 229名6至59个月大的儿童的横断面研究中，检查了贫血危险因素之间的关系。在研究对象中，贫血的患病率为56.1％。与没有贫血的儿童相比，那些被认为贫血的人更可能是年龄更小，男性，发育不良，体重过轻，消瘦，孕产妇和父亲的教育程度低，并且在过去7天中有当前的腹泻或腹泻史（所有P <0.0001） 。在针对年龄，性别，发育迟缓，产妇年龄和受教育程度以及每周人均家庭支出进行调整的单独的多元模型中，当前腹泻（OR 1.15，95％CI 1.07-1.325，P <0.0001）和过去7年的腹泻病史天（OR 1.16，95％CI 1.09-1.25，P <0.0001）与贫血风险增加相关。在相似的模型中，当前的发热与贫血之间存在临界关联（OR 1.14，95％CI 0.98-1.32，P = 0.09）。我们得出的结论是，腹泻是印度尼西亚农村地区年幼儿童贫血的一个促成因素。

BACKGROUND & AIMS: :Fecal specimens from 517 infants and young children admitted to the Civil Karachi Hospital, Dow Medical College, Karachi city, Pakistan with acute gastroenteritis from 1990 to 1994 were collected and screened by RT-PCR for human astrovirus (AstV), norovirus (NV), and sapovirus (SV). The specific epidemiological data for illness caused by these viruses in Pakistan are not available. AstV, NV, and SV were detected in 58, 51, and 17 of 517 fecal specimens, and this represented 11.2, 9.9, and 3.2%, respectively. An outbreak of gastroenteritis attributable to AstV serotype 1 was identified during September and October 1990. Moreover, one specimen with a triple mixed infection between AstV (serotypes 1 and 3) and NV GII was found. NV and SV were subjected to molecular analysis by sequencing. One of the sequenced specimens positive for SV turned out to be similar to a strain tentatively called a genogroup IV. The result underscores the importance of these viruses in association with acute gastroenteritis in Karachi city, Pakistan.

背景与目标： 收集1990年至1994年巴基斯坦卡拉奇市陶氏医学院民事卡拉奇医院收治的517例婴幼儿的粪便标本，并进行RT-PCR筛查人类天体病毒（AstV），诺如病毒（NV）和Sapovirus（SV）。尚无有关巴基斯坦由这些病毒引起的疾病的具体流行病学数据。在517个粪便样本中的58、51和17中检测到了AstV，NV和SV，分别代表11.2％，9.9％和3.2％。在1990年9月至10月期间，确认爆发了由1型AstV血清型引起的肠胃炎。此外，还发现了一个标本，其中AstV（1型和3型血清型）与NV GII发生了三重混合感染。通过测序对NV和SV进行分子分析。证实对SV呈阳性的测序标本之一类似于暂定为基因组IV的菌株。结果强调了这些病毒与巴基斯坦卡拉奇市急性胃肠炎有关的重要性。

BACKGROUND & AIMS: BACKGROUND:Diarrhea is an important complication in critically ill patients undergoing enteral feeding. The occurrence of diarrhea may lead to systemic and local complications and negatively impacts on nursing workload and patient's wellbeing. An enteral feeding based on blenderized natural food could be beneficial in reducing the risk of diarrhea. No study has compared natural and commercial enteral feedings in critically ill cardiac surgery patients. OBJECTIVE:The aim of this study was to compare the risk of diarrhea occurrence in two cohorts of patients fed a blenderized natural food diet or commercial enteral feeding preparations, respectively. DESIGN:Retrospective cohort study. SETTING:Cardiac-Surgery Intensive Care Unit of a University Hospital. PARTICIPANTS:Two-hundred and fifteen patients admitted to the postoperative cardiac surgery intensive care unit were included, 103 fed blenderized natural enteral feeding and 112 fed commercial formulas. METHODS:Commercial enteral formulas were delivered by continuous pump administration, while natural enteral feeding by bolus 3 times per day. Diarrhea was documented in the presence of three or more evacuations of loose or watery stool (or an amount above 250 ml) per day. The presence of diarrhea was recorded daily from the beginning to the end of the enteral feeding, up to a maximum of 8 days. The unadjusted time to the first event of diarrhea between the two enteral feeding groups was compared. Adjusted comparison was then performed by fitting a multivariable Cox Proportional-Hazards model, adjusted for potential confounders for diarrhea occurrence (i.e. administration of inotropes, vasopressors, prokinetics, antibiotics, oral nutritional supplements, antifungal agents, sedatives, opioids, probiotics, laxatives). RESULTS:In unadjusted survival analysis the probability of diarrhea was significantly lower in the natural enteral feeding group (log rank test: p = 0.023). In the multivariable model patients in natural enteral feeding cohort showed a non-significant trend towards an almost halved risk of experiencing diarrhea (hazard ratio: 0.584; 95% confidence interval: 0.335-1.018; p = 0.058) compared to those fed commercial enteral feeding. CONCLUSIONS:Administration of a blenderized diet based on natural food for enteral feeding can reduce the incidence of diarrhea in cardiac surgery critically ill patients. This strategy may reduce the risk of diarrhea-associated malnutrition and systemic and local complications, also having a positive impact on nursing workload and patient wellbeing.

背景与目标： 背景：腹泻是重症患者接受肠内喂养的重要并发症。腹泻的发生可能导致全身和局部并发症，并对护理工作量和患者的健康产生负面影响。以混合天然食品为基础的肠内喂养可能会减少腹泻的风险。尚无研究比较重症心脏手术患者的天然和商业性肠内喂养。
目的：本研究的目的是比较分别接受混合天然食物饮食或市售肠内喂养制剂的两个队列中发生腹泻的风险。
设计：回顾性队列研究。
单位：大学医院心脏外科重症监护室。
参与者：包括255名入院后心脏外科重症监护病房的患者，103例混合自然肠饲喂食和112例商业配方奶粉。
方法：商业性肠内配方是通过连续泵给药来实现的，而天然肠内则是每天推注3次。每天有3次或更多次疏散或水样大便（或250ml以上的量）排泄，证明腹泻。从肠内喂养开始至结束，每天记录腹泻的发生情况，最长不超过8天。比较了两个肠内进食组之间第一次腹泻事件的未调整时间。然后通过拟合多变量Cox比例危害模型进行校正后的比较，该模型针对腹泻发生的潜在混杂因素进行了校正（即，正性肌力药，升压药，促动力学药，抗生素，口服营养补品，抗真菌药，镇静剂，阿片类药物，益生菌，泻药）。
结果：在未经调整的生存分析中，天然肠内喂养组腹泻的可能性显着降低（对数秩检验：p = 0.023）。在多变量模型中，天然肠内喂养人群的腹泻风险几乎没有减低的趋势（危险比：0.584; 95％置信区间：0.335-1.018; p = 0.058）几乎没有一半; 。
结论：以天然食物为基础的混合饮食用于肠内喂养可减少心脏外科危重患者腹泻的发生率。该策略可以减少与腹泻相关的营养不良以及全身和局部并发症的风险，也可以对护理工作量和患者健康产生积极影响。

BACKGROUND & AIMS: OBJECTIVES:Between January and March of 2006, over 35 000 diarrhea cases and 532 deaths were reported among children aged <5 years in Botswana. We conducted an investigation to characterize the outbreak, identify risk factors for diarrhea, and recommend control strategies. METHODS:We enrolled children <5 years of age presenting to the emergency department between March 2 and March 20, 2006. Cases had ≥3 loose stools per day and no antecedent diarrhea among household members. Controls had had no diarrhea since January 1, 2006. We conducted a multivariate logistic regression analysis controlling for socioeconomic status, age, and maternal HIV status. RESULTS:Forty-nine cases with median age of 12 months (range 0-45 months) and 61 controls with median age of 24 months (range 0-59 months) were enrolled; 33 (30%) were born to HIV-positive mothers. Case-parents were more likely to report storing household drinking water (adjusted odds ratios (AOR) 3.9, 95% confidence interval (CI) 1.2-15.7). Lack of hand washing after using the toilet or latrine (AOR 4.2, 95% CI 1.1-20.4) was more likely to be reported by case-parents. Case-children were less likely to be currently breastfeeding (AOR 30.3, 95% CI 2.0-1000.0). Five (10%) case-patients and no control-patients died. Multiple causal pathogens were identified. CONCLUSIONS:During this diarrhea outbreak in a country with a national program to prevent mother-to-child transmission of HIV, ill children were less likely to be breastfed and more likely to have been exposed to environmental factors associated with fecal contamination. These findings underscore the importance of adequate access to safe water, sanitation, hygiene, and nutrition education among populations using breast milk substitutes.

背景与目标： 目标：2006年1月至3月，博茨瓦纳5岁以下儿童的腹泻病例超过35000例，死亡532例。我们进行了调查，以特征化爆发，确定腹泻的危险因素并建议控制策略。
方法：我们招募了在2006年3月2日至3月20日期间到急诊室就诊的5岁以下儿童。病例每天粪便≥3例，家庭成员之前没有腹泻。自2006年1月1日起，对照组没有腹泻。我们进行了多因素logistic回归分析，控制社会经济状况，年龄和孕产妇艾滋病毒状况。
结果：入组中位年龄为12个月（0-45个月）的49例和中位年龄为24个月（0-59个月）的61例对照。 33名（30％）出生于艾滋病毒呈阳性的母亲。病例父母更有可能报告储存家庭饮用水（调整后的优势比（AOR）为3.9，95％置信区间（CI）为1.2-15.7）。病例父母更容易报告在使用厕所或厕所后缺乏洗手（AOR 4.2，95％CI 1.1-20.4）。案例儿童目前不太可能进行母乳喂养（AOR 30.3，95％CI 2.0-1000.0）。五例（10％）病例患者死亡，无对照组患者死亡。确定了多种因果病原体。
结论：在该国制定了预防母婴传播艾滋病毒的国家计划的腹泻暴发期间，患病的儿童不太可能进行母乳喂养，更有可能接触与粪便污染相关的环境因素。这些发现强调了使用母乳代用品的人群中充分获得安全饮水，卫生，卫生和营养教育的重要性。

BACKGROUND & AIMS: :Introduction: Irritable bowel syndrome with diarrhea (IBS-D) is among the most common functional gastrointestinal (GI) disorders and is associated with impaired quality of life, increased health-care utilization, and significant costs to patients and society. The treatment of IBS is typically hierarchal with initial therapies consisting of dietary and lifestyle modifications. Pharmacotherapy with over-the-counter and prescription medications is also commonly used for symptomatic control in the course of therapy.Areas covered: Three medications are approved by the United States Food and Drug Administration (FDA) for IBS-D, with all of them demonstrating efficacy in randomized, placebo-controlled trials. In this review, the authors discuss the clinical trial data applicable to the current FDA approved IBS-D therapies as well as review data related to new and emerging therapies for this condition.Expert opinion: Clinicians should be familiar with emerging therapies for IBS-D as they may provide benefit to some IBS-D patients. The exact mechanisms of action of many of the emerging agents for IBS-D remain unknown. Despite substantial differences and limitations in the design and quality of supporting studies, there is an increasing body of evidence suggesting that emerging agents may promote meaningful symptom improvement in patients with IBS-D.

背景与目标： ：Introduction：肠易激惹综合征腹泻（IBS-D）是最常见的胃肠功能紊乱（GI）疾病之一，与生活质量下降，医疗保健利用率提高以及患者和社会付出巨大代价有关。 IBS的治疗通常是分层的，最初的疗法包括饮食和生活方式的改变。在治疗过程中，通常还使用带有非处方药和处方药的药物疗法来控制症状。覆盖范围：美国食品药品监督管理局（FDA）批准了三种药物用于IBS-D，所有这些药物在随机，安慰剂对照试验中证明疗效。在这篇综述中，作者讨论了适用于当前FDA批准的IBS-D疗法的临床试验数据，以及与针对这种情况的新疗法和新兴疗​​法相关的综述数据。专家意见：临床医生应熟悉IBS-D的新兴疗法因为它们可能为某些IBS-D患者带来益处。许多新兴的IBS-D病原体的确切作用机制仍不清楚。尽管支持研究的设计和质量存在重大差异和局限性，但越来越多的证据表明，新兴药物可能会促进IBS-D患者的有意义的症状改善。

BACKGROUND & AIMS: BACKGROUND:Although the pentavalent rotavirus vaccine was highly efficacious against rotavirus diarrhea in clinical trials, the effectiveness of vaccine under field conditions in the developing world is unclear. In October 2006, Nicaragua became the first developing nation to implement universal infant immunization with the pentavalent rotavirus vaccine. To assess the effect of the immunization program, we examined the incidence of diarrhea episodes between 2003 and 2009 among children in the state of León, Nicaragua. METHODS:We extracted data on diarrhea episodes from health ministry records. We used scaled Poisson regression models to estimate diarrhea incidence rate ratios for the period following the program's implementation to the period before implementation. RESULTS:Following implementation of the immunization program, diarrhea episodes among infants were reduced (incidence rate ratios: 0.85, 95% confidence interval: 0.71-1.02) during the rotavirus season, but appear to have increased during other months. CONCLUSIONS:Although the immunization program appears effective in reducing diarrhea episodes during the rotavirus season, a large burden of diarrhea still persists during the remainder of the year.

背景与目标： 背景：尽管五价轮状病毒疫苗在临床试验中对轮状病毒腹泻非常有效，但在发展中国家野外条件下疫苗的有效性尚不清楚。 2006年10月，尼加拉瓜成为第一个使用五价轮状病毒疫苗进行婴儿通用免疫的发展中国家。为了评估免疫程序的效果，我们检查了尼加拉瓜莱昂州儿童在2003年至2009年之间腹泻的发生率。
方法：我们从卫生部的记录中提取了腹泻发作的数据。我们使用规模化的Poisson回归模型来估计该计划实施后至实施前期间的腹泻发生率。
结果：在实施免疫程序后，轮状病毒季节婴儿的腹泻发作有所减少（发生率：0.85，95％置信区间：0.71-1.02），但在其他月份似乎有所增加。
结论：尽管在轮状病毒季节中免疫程序似乎可以有效减少腹泻发作，但在该年剩余时间里腹泻负担仍然很大。

BACKGROUND & AIMS: :Patients exposed to the toxic dinoflagellate Pfiesteria develop an illness characterized by secretory diarrhea, conjunctival irritation, skin lesions, and varying degrees of neurologic manifestations. The anion-exchange resin, cholestyramine has been reported in one small case series to be an effective treatment of severe diarrhea associated with Pfiesteria intoxication. A 54-year-old man traveled to the Dominican Republic where he went swimming in what he describes as "dirty ocean water". Within an hour, he noted a generalized burning and itching of his skin. Later on, he noted pruritic vesicular skin lesions, intense frontal headache, and conjunctivitis. A few days later, he complained of abdominal cramping, nausea, and hourly episodes of watery, non-bloody diarrhea. Due to the constellation of symptoms, Pfiesteria intoxication was suspected. On arrival in the United States, he sought medical care for continued symptoms. Physical examination was remarkable for conjunctival injection, linear vesicular lesions (5 cm in length) over his right ankle and left orbit as well as erythema over foreskin of his penis. Mental status and memory were normal. Laboratory studies revealed an elevated serum creatinine, which eventually normalized, and stool studies were negative for leukocytes, blood, and enteric pathogens. Intense diarrhea persisted until he was started on cholestyramine (4 g PO tid). The diarrhea resolved within 2 hours of starting treatment. The headache was initially treated with narcotic agents but only resolved with IV diphenhydramine (25 mg q 4 h). Cholestyramine and diphenhydramine appear to be effective therapeutic agents for tropical-related diarrhea and headache, respectively.

背景与目标： ：暴露于有毒的鞭毛鞭毛藻的患者会发展为以分泌性腹泻，结膜刺激性，皮肤病变和不同程度的神经系统表现为特征的疾病。阴离子交换树脂消胆胺在一个小病例系列中已被报道是一种有效的治疗与非典菌中毒有关的严重腹泻的药物。一名54岁的男子前往多米尼加共和国，在那里游泳时他称其为“肮脏的海水”。在一个小时内，他注意到皮肤普遍烧灼和发痒。后来，他注意到瘙痒性水疱性皮肤病变，剧烈的额头头痛和结膜炎。几天后，他抱怨腹部绞痛，恶心，每小时出现水样非血性腹泻。由于症状群，怀疑有非斯贝特霉素中毒。到达美国后，他就继续出现症状寻求医疗服务。体检对于结膜注射，右脚踝和左眼眶上的线性水疱性病变（长度为5 cm）以及阴茎包皮上的红斑都非常显着。精神状态和记忆力正常。实验室研究发现血清肌酐升高，并最终恢复正常，大便研究对白细胞，血液和肠道病原体呈阴性。剧烈腹泻一直持续到他开始服用消胆胺（4 g PO tid）。腹泻在开始治疗后的2小时内消失。最初使用麻醉剂治疗头痛，但仅用静脉苯海拉明（25 mg q 4 h）缓解。胆甾胺和苯海拉明似乎分别是热带相关性腹泻和头痛的有效治疗剂。

BACKGROUND & AIMS: PURPOSE:One of the significant dose-limiting toxicities of irinotecan hydrochloride (CPT-11) is severe diarrhea due to impairment of the intestinal membrane induced by the excreted CPT-11 and its metabolites. AST-120 (Kremezin) is a prominent oral adsorbent that consists of porous spherical carbonic particles. To evaluate whether Kremezin can prevent the diarrhea induced by CPT-11, we investigated the adsorption characteristics of CPT-11 and its metabolites onto Kremezin in vitro and in vivo. METHODS:For in vitro studies, Kremezin was added to each solution containing one of the camptothecin drugs (CPT-11, SN-38, and SN-38-glucuronide), and adsorption activities were determined under various conditions. For in vivo studies, CPT-11 was consecutively administered, and the occurrence of diarrhea was compared between Kremezin-treated and non-treated rats. RESULTS:Kremezin drastically adsorbed the camptothecin drugs in vitro, and the adsorption percentages of the camptothecin drugs for 60 min were more than 85%. In addition, the frequency of diarrhea in Kremezin-treated rats decreased by approximately half of that in the non-treated rats. CONCLUSION:Kremezin showed potent adsorption capacities for the camptothecin drugs and mitigated the symptoms of diarrhea in rats. These results suggest that Kremezin is useful to prevent the diarrhea in clinical CPT-11 chemotherapy.

背景与目标： 用途：盐酸依立替康（CPT-11）的显着剂量限制性毒性之一是由于排泄的CPT-11及其代谢物引起的肠膜受损引起的严重腹泻。 AST-120（Kremezin）是一种杰出的口服吸附剂，由多孔球形碳颗粒组成。为了评估Kremezin是否能预防CPT-11引起的腹泻，我们研究了CPT-11及其代谢物在Kremezin体内和体外的吸附特性。
方法：为了进行体外研究，将Kremezin添加到每种含有喜树碱药物（CPT-11，SN-38和SN-38-葡糖醛酸）的溶液中，并在各种条件下测定吸附活性。为了进行体内研究，连续施用CPT-11，并比较了用Kremezin治疗和未治疗的大鼠的腹泻发生率。
结果：Kremezin在体外对喜树碱类药物有很强的吸附作用，喜树碱类药物在60 min内的吸附百分数超过85％。另外，用Kremezin治疗的大鼠的腹泻频率降低了未治疗大鼠的腹泻频率的一半。
结论：Kremezin对喜树碱类药物具有很强的吸附能力，可减轻大鼠的腹泻症状。这些结果表明，Kremezin可用于预防临床CPT-11化疗中的腹泻。