Managing Gastrointestinal Symptoms After Cancer Treatment

胃镜急危重患者抢救制度及流程英文回答：Gastrointestinal emergencies can be life-threatening and require immediate intervention. When a patient with a critical condition related to the gastrointestinal system, such as gastrointestinal bleeding or obstruction, presents, a rapid rescue system needs to be in place to provide timely and appropriate care. In this response, I will outline the rescue system and its process for managing such emergencies.The first step in the rescue system is recognizing the signs and symptoms of a gastrointestinal emergency. This includes assessing the patient's vital signs, such as blood pressure, heart rate, and oxygen saturation, as well as conducting a thorough physical examination. For example, if a patient presents with severe abdominal pain, vomiting blood, and low blood pressure, it may indicate a gastrointestinal bleeding emergency.Once the emergency is identified, the next step is to activate the rescue team. This team typically consists of healthcare professionals, including doctors, nurses, and technicians, who are trained in managing gastrointestinal emergencies. The team should be readily available and able to respond promptly to any emergency call. In some cases, a specialized gastroenterology team may be involved if the patient requires advanced endoscopic interventions.While waiting for the rescue team to arrive, immediate measures can be taken to stabilize the patient. For instance, intravenous fluid resuscitation may be initiated to address hypovolemia caused by bleeding. Medications, such as proton pump inhibitors or vasoactive drugs, may also be administered to control bleeding or improve hemodynamic stability.Once the rescue team arrives, they will conduct a more detailed assessment and determine the appropriate course of action. This may involve performing a diagnostic procedure, such as an emergency upper gastrointestinal endoscopy, toidentify the source of bleeding or obstruction. The teamwill also consider the patient's overall condition and medical history when making treatment decisions.Treatment options for gastrointestinal emergencies can vary depending on the specific condition. In cases of gastrointestinal bleeding, endoscopic interventions, suchas hemostasis with clips or injection of sclerosants, maybe performed to stop the bleeding. Surgical intervention may be necessary in severe cases or when endoscopic measures are unsuccessful. For gastrointestinal obstruction, endoscopic or surgical interventions may be required to relieve the obstruction and restore normal gastrointestinal function.Throughout the rescue process, effective communication and coordination among the rescue team members are essential. Clear and concise communication ensures that everyone is aware of the patient's condition, treatment plan, and any changes in the patient's status. This helpsto prevent delays in care and ensures that the patient receives the necessary interventions in a timely manner.In conclusion, a well-established rescue system is crucial for managing gastrointestinal emergencies in critically ill patients. Prompt recognition of the emergency, activation of the rescue team, stabilization of the patient, and appropriate diagnostic and treatment interventions are key components of this system. Effective communication and coordination among team members are vital for ensuring optimal patient outcomes.中文回答：胃肠道急危重症情况可能危及患者的生命，需要立即采取干预措施。

消化内科的英语Digestive system diseases are common in clinical practice, with a wide range of symptoms and presentations. In this article, we will focus on some of the most common diseases of the digestive system, specifically those related to the field of gastroenterology.One of the most common digestive system diseases is gastroesophageal reflux disease (GERD). GERD occurs when the lower esophageal sphincter relaxes abnormally or weakens, allowing stomach acid to flow back into the esophagus. This can cause symptoms such as heartburn, regurgitation, chest pain, and difficulty swallowing. Treatment for GERD typically involves lifestyle modifications, such as avoiding trigger foods and losing weight, as well as medications to reduce stomach acid production.Another common digestive system disease is peptic ulcer disease. Peptic ulcers are open sores that develop on the lining of the stomach, small intestine, or esophagus. The most common cause of peptic ulcers is infection with the bacterium Helicobacter pylori, although other factors such as NSAID use and excessive alcohol consumption can also contribute. Symptoms of peptic ulcers include abdominal pain, bloating, and nausea. Treatment for peptic ulcers involves antibiotics to eradicate H. pylori, as well as medications to reduce stomach acid production and promote healing of the ulcer.Inflammatory bowel disease (IBD) is a group of chronic inflammatory conditions of the gastrointestinal tract, including Crohn's disease and ulcerative colitis. IBD is characterized by inflammation of the digestive tract, leading to symptoms such as abdominal pain, diarrhea, weight loss, and fatigue. Treatment for IBD typically involves a combination of medications to reduce inflammation and suppress the immune system, as well as dietary modifications to manage symptoms.Irritable bowel syndrome (IBS) is another common digestive system disease that affects the large intestine. IBS is a functional disorder, meaning that there is no underlying structural abnormality, but rather a dysfunction in the way the intestines work. Symptoms of IBS include abdominal pain, bloating, gas, and changes in bowel habits.Treatment for IBS focuses on managing symptoms through dietary modifications, stress reduction techniques, and medications to relieve symptoms.Celiac disease is a digestive system disease that is characterized by an autoimmune reaction to gluten, a protein found in wheat, barley, and rye. In individuals with celiac disease, consuming gluten triggers an immune response that damages the lining of the small intestine, leading to malabsorption of nutrients. Symptoms of celiac disease can vary widely and may include diarrhea, weight loss, fatigue, and skin rashes. Treatment for celiac disease involves a strict gluten-free diet to prevent further damage to the intestine and alleviate symptoms.In conclusion, digestive system diseases are common and can have a significant impact on quality of life. Early recognition and appropriate management of these diseases are essential to prevent complications and improve outcomes for patients. By understanding the common diseases of the digestive system and their treatment options, healthcare providers can better care for patients with these conditions.。

Managing gastric residual volumes in the critically ill patient: an updateMark H.DeLeggeIntroductionThe use of gastric residual volumes(GRVs)for monitoring the delivery of enteral nutrition in the ICU is very con-troversial.Despite the fact that measurement of GRVs is one of the most common practices in nutrition therapy, there is very little data in the literature supporting its use. Therearenoprospective,randomizedclinicaltrialsdemon-strating an improvement of patient outcomes in the ICU by the use of GRVs during enteral feeding[1].Using GRVs as a marker of gastric performance assumes that it reliably and accurately measures gastric contents.Thus,there would be a correlation between high GRVs,regurgitation and aspira-tionof gastric contentsduringenteral feeding.Surprisingly, there is little evidence in the literature to support the concept of GRVs directly correlating to the amount of gastric content or the risk of aspiration pneumonia. What is gastroparesisDelays in gastric emptying(gastroparesis)are a common problem seen in patients in the ICU[2].Gastrointestinal motility is governed by multiple control systems:the central,autonomic and enteric nervous system,endocrine cells,Interstitial cells of Cajal and smooth muscle[3]. The anatomy of the enteric nervous system consists of local circuits of sensory neurons,interneurons,excitatory motor neurons and inhibitory motor neurons[4]. Migrating motor complexes(MMC)are an important component of gastrointestinal motility.The MMC begin several hours after digestion of a meal in the antrum of the stomach and progress to the distal ileum.The key pace-makers for the MMC are located along the greater curvature of the stomach[5].The stomach plays a huge role in the overall motor function of the gastrointestinal tract.At the beginning of meals the fundus of the stomach relaxes.This is called accommodation and is a nitrous oxide-mediated process with the intention of allowing extra space to develop in the stomach to allow acid and enzyme food digestion[6]. Subsequent tonic contractions empty the fundus of the stomach and transfers material(chyme)to the antrum through the corpus.The chyme is broken into smallDigestive Disease Center,Medical University of South Carolina,Charleston,South Carolina,USA Correspondence to Mark H.DeLegge,MD Professor of Medicine,Digestive Disease Center,Medical University of South Carolina,25Courtenay St,STE 7100A,Charleston,SC29425,USAE-mail:deleggem@Current Opinion in Clinical Nutrition and Metabolic Care2011,14:193–196Purpose of reviewGastric residual volumes(GRVs)remain a major deterrent to adequately feeding patients with gastric-delivered enteral nutrition.The purpose of this review was to define the most up-to-date consensus of the utility of the use of GRVs for monitoring tube-feeding intolerance in gastric-fed patients.RecentfindingsThe paper summarizes the pathophysiology of gastroparesis,the techniques for measuring GRVs,the significance of a large GRV,other factors to consider when measuring GRVs,the correlation between GRVs and aspiration pneumonia,national guideline statements on GRVs,the use of prokinetic agents in the treatment of high GRVs and the clinical impact of tolerating larger GRVs.The utility of GRVs for prevention of aspiration events with tube feeding has been brought into question. SummaryLarge GRVs usually result from some impediment in gastrointestinal motility(e.g. gastroparesis).There are numerous methods for measuring GRVs,most of which have not been standardized.It appears that there is little correlation between large GRVs and the development of aspiration pneumonia when tube feeding patients.Prokinetic agents have an inconsistent effect on the GRV guidelines state that GRVs of less than 500ml should not result in termination of enteral feeding.Allowing larger GRVs will allow patients to receive more calories when gastric fed without a deleterious clinical impact.The use of GRVs as a marker of feeding tolerance is of questionable utility.Keywordsaspiration pneumonia,enteral feeding,gastric residual volume,gastroparesis, refractometryCurr Opin Clin Nutr Metab Care14:193–196ß2011Wolters Kluwer Health|Lippincott Williams&Wilkins1363-19501363-1950ß2011Wolters Kluwer Health|Lippincott Williams&Wilkins DOI:10.1097/MCO.0b013e328341ede7pieces by the coordinated contractions and relaxations of the antrum.When the pyloric sphincter relaxes,1–2mm chyme particles pass through the pylorus into the duodenum.In gastroparesis,the stomach fails to enlarge in response to distention by meals.Peristaltic contractions are weak and the stomach fails to break down particles of chyme. There is a tendency of the stomach to overfill leading to abdominal distention,nausea and vomiting.In the ICU, where patients are often debilitated and with impaired consciousness,the concern with feeding and vomiting is aspiration and the development of pneumonia.There-fore,feeding in the ICU is dictated by monitoring a patient’s gastrointestinal tolerance.Gastrointestinal tolerance can be described as a patient’s gut response to enteral nutrition and can include bowel sounds, abdominal distention and bowel movements.More com-monly,gastric residuals are used to determine if someone is ready for enteral tube feeding,especially gastric feed-ings,and whether these tube feedings should be tempor-arily held or discontinued once initiated.Methods for assessment of gastric emptying in the critically illMoreira and McQuiggan[7]recently reviewed methods for assessing gastric emptying.The authors explained that the rationale for monitoring GRVs was based on the belief that this represented a delay in gastric emptying. However,this review underscored that the correlation between GRVs and gastric emptying was weak.These authors reviewed all methods published between2007 and2008with reference to GRV measurement.Aspirated gastric contents represent a mixture of enteral feedings, gastric and salivary secretions and duodenal reflux.On an average,these endogenous secretions can reach up to 4500ml/day.The position of the patient,the type and size of the syringe and the size and position of the tip of the feeding tube can affect gastric residual quantities. One survey revealed that the definition of‘high’GRVs ranged from as low as50ml to greater than400ml[8]. Other methods for determining gastric emptying in the critically ill were described.This included scintigraphy, paracetamol absorption,stable radioisotope breath test, gastric ultrasound and gastric impedance monitoring. These tests were found to be either cumbersome,labor intensive and/or lacking standardization preventing them from providing clinical utility for measuring gastric emp-tying in the ICU patient.However,the article did com-ment on the use of refractometry,a device to measure refraction of a beam of light when passed obliquely through a solution.Refractometers are inexpensive hand-held devices.A decrease in refractometer measurements (brix value)over time of gastric contents containing enteral formula could be indicative of a steady emptyingof enteral formula from the stomach.Chang et al.[9]conducted a prospective study of36patients receivingcontinuous enteral feeding.Patients with low GRVsgenerally had a low brix value.McQuiggan et al.[10].also confirmed this correlation of GRVs to brix value in16critically ill patients being fed by an nasogastric tube Do large gastric residual volumes correlate to aspiration pneumonia events?The question of the relationship of GRV to the actual riskof aspiration of gastric contents remains a question.Thewhole premise of monitoring GRVs would be in anattempt to monitor for gastrointestinal intolerance,vomiting and aspiration.Metheny et al.[11]prospectivelystudied206critically ill patients receiving gastric tubefeedings for three consecutive days.GRVs weremeasured every4h.Measured volumes were dividedinto quantities of less than150ml,150–200ml,200–250ml or greater than250ml.Tracheal secretions weremonitored for the presence of pepsin in these patients.Pepsin was being used as the marker of gastric-trachealaspiration.The mean percentage of tracheal pepsin-positive secretions was36.2%.Most(92.7%)patientshad at least one tracheal secretion positive for pepsinduring the3-day study period.Pepsin-positive trachealsecretions occurred at GRVs between0and50ml33.7%of the time.Patients with higher GRVs did have morepepsin-positive tracheal secretions.However,no defini-tive relationship between increasing GRVs and pepsin-positive tracheal secretions could be found.In addition,there was no attempt to document whether having pep-sin-positive tracheal secretions lead to any clinical aspira-tion pneumonia events.In an expert letter reviewing thisarticle,a statement by Parrish and McClave[12]noteduntil better data are available,it may be appropriate tocheck GRVs in the critically ill patient when initiating thedelivery of enteral nutrition.After48–72h of successfulfeeding,if the GRVs are consistently low,it may beappropriate to stop checking GRVs[13].What do national guidelines say about gastric residual volumes?Recent critical care nutrition guidelines have been devel-oped by a team effort between the American Society ofParenteral and Enteral Nutrition and the Society ofCritical Care Medicine[14 ].These guidelines were graded A-E with grade A being the strongest and gradeE being the weakest.The guidelines said that inappropri-ate holding of tube feedings should be avoided(grade E).Holding enteral nutrition for GRVs less than500ml inthe absence of other signs of intolerance should beavoided(grade B).The guidelines also stated that makingthe patient nil per os surrounding the time of diagnostic194Nutrition and the intensive care unittests or procedures should be minimized to preventinadequate delivery of nutrients and prolonged periodsof ileus.An ileus may be propagated by the nil per osstatus.(grade B)Use of enteral-feeding protocolsincreases the overall percentage of goal calories providedand should be implemented.(grade C).Are there any other factors to consider when measuring gastric residual volumes?A recent correspondence form Umbrello et al.[15]repeated the concern of the development of upper diges-tive intolerance(UDI)with enteral feeding.Theydescribed that a GRV of150–500ml on two consecutivemeasurements,one GRV more than500ml or vomitingwas presumed to be indicative of UDI.The authors dopoint out that there have been no reports dealing with thepresence of air in the stomach as a co-factor when measur-ing GRVs as a marker of UDI.In their general ICU patientpopulation,2695patients were checked for GRVs.On339occasions,GRVs were found with an average volume of158ml.On226occasions air was decompressed with anaverage volume of140ml.The presence of air was notassociated with UDI.The development of pneumonia,during these patients’ICU stay,was not associated withUDI.Their conclusion included a statement that‘UDI is apoor indicator for the development of aspiration pneumo-nia in the critically ill population’.Do you need to return or discard gastric residual volumes?It is a known fact that some nurses after checking GRVsdiscard gastric contents,whereas others reintroduce it topatients,partially or completely,depending on their bed-side assessment.Juve-Udina et al.[16 ]performed a randomized,prospective study in125critically ill patientsassigned to either a return or discard group regarding theirgastric residuals.GRVs were characterized as light(151–250ml),moderate(251–350ml)or severe(>350).The majority of both groups had a‘0’GRV.Interestingly,patients in the discard group had greater,light or moderateGRVs(less volume).The complication rate was similarbetween both groups(nil for nausea or pulmonary aspira-tion and insignificant for vomiting).There was no differ-ence in days of diarrhea or abdominal distention episodes.In addition,there were no differences in serum electrolyteor glucose between the two groups.The obvious limitationin this study is with the lack of a standardized tool tomonitor and record patient discomfort in the ICU.What is the impact of a more‘liberal’tolerance to gastric residual volumes?The use of early enteral nutrition has become a priority for changing clinical outcomes of critically ill patients.We know that gastric enteral access is easier to obtain thansmall bowel enteral access.We also know that the deliveryof nutrients can be delayed or terminated by the interpret-ation of the nurse or physician at the bedside with regardsto gastrointestinal intolerance.Higher gastric residualvolume tolerances result in a higher delivery of enteralnutrition calories in a gastric-fed population.Recently,White et al.[17]performed a prospective,randomizedstudy of gastric versus small bowel feedings in104patients.GRVs of less than200ml were tolerated.Those with aGRV over200ml received a promotility agent.Interest-ingly,with this higher GRV tolerance by the nurses it wasfound that gastric feeders were quicker to initiate feedingsand quicker to reach target calorie goals.There was nodifference in patient length of stay or ventilator daysbetween the gastric and postpyloric-fed groups.Do prokinetic agents reduce gastric residual volumes?The ideal prokinetic agent would increase fundal toneand wave frequency,stimulate antral wave amplitude andreduce pyloric-wave frequency while abolishing pylorictone[18 ].Metoclopramide is a commonly used anti-emetic and prokinetic agent.It acts at the dopaminereceptor with both central and peripheral events.It alsoweakly inhibits the5HT3receptor.Metoclopramideaccelerates gastric emptying by triggering an intenseburst of gastric contractions.Unfortunately,tachyphy-laxis sets in early reducing its effects as a promotilityagent for chronic use.The effect of metoclopramide onreducing GRVs are unclear as small crossover trials havebeen inconsistent in results.There is also concern aboutthe central nervous system effect of metoclopramide. Erythromycin is a macrolide antibiotic and an active agonist of the motilin receptors,which are found pre-dominantly in the antrum and the proximal duodenum. Erythromycin does increase antral motility in critically ill patients.However,the effect is quickly attenuated over time.There are no prospective,randomized trials specifi-cally evaluating the effect of erythromycin on GRVs.Should gastric residual volumes be checked at all?The overall utility of checking GRVs for clinical practice and prevention of aspiration pneumonia was called into question in a study of205nasogastric tube-fed ICU patients[19].This was a retrospective analysis.In a1-year period,102patients were followed who were receiv-ing nasogastric feedings.GRVs tolerated were250ml before an action was required on the part of the physician (promotility agent,reducing enteral nutrition infusion rate,discontinuing enteral nutrition).Tube feeding was initiated at25ml/hr and increased to afinal rate of Managing gastric residual volumes DeLegge19585ml/hr.Patients were maintained in a semi-recumbent position with their head elevated.In a separate group of 103patients enteral feedings progressed in the same manner and the patients were maintained in the same position in bed.However,in this group,no GRVs were checked.Patients not receiving GRV checks had a higher daily delivery of enteral nutrition than the group receiv-ing GRV checks(P¼0.002).Both groups had similar recorded vomiting episodes(P¼0.32)and clinical aspira-tion events(P¼0.86).There appeared to be no clinical benefit with the use of GRVs while delivering nasogastric enteral nutritionConclusionThe physiology of gastric emptying is very complex.The stomach plays a huge role in the gastrointestinal motility process.Aspiration pneumonia associated with enteral feeding is of great concern to clinicians.The actual incidence of tube-feeding-related regurgitation and aspiration with subsequent pneumonia development is unknown.Many clinicians attempt to monitor for signs of gastrointestinal intolerance when using enteral nutrition. This includes monitoring GRVs.However,there is little-to-no-data that monitoring GRVs prevents the develop-ment of aspiration pneumonia and in fact may often preclude the adequate delivery of nutrition to patients. GRVs below500ml do not appear to be harmful.When measuring GRVs,the volume of gastric contents aspi-rated can be returned to the stomach without causing significant complications.It is unclear if prokinetic agents are useful in reducing the size of GRVs.The use of GRVs for prevention of aspiration events may be of no clinical utility and often results in a reduction in the daily delivery of enteral nutrition. AcknowledgementsThe author is a consultant for Nestle Nutrition,CORAM Healthcare and Baxter Healthcare.References and recommended readingPapers of particular interest,published within the annual period of review,have been highlighted as:of special interestof outstanding interestAdditional references related to this topic can also be found in the Current World Literature section in this issue(p.217).1Hurt RT,Mcclave SA.Gastric residual volumes in critical illness:what do they really mean?Crit Care Clin2010;26:481–490.2Khayyam U,Sachdeva P,Gomez J,et al.Assessment of symptoms during gastric emptying scintigraphy to correlate symptoms to delayed gastric emptying.Neurogastroenterol Motil2010;22:539–545.3Holzer P,Schicho R,Holzer-Petsche U,Lippe I.The gut is a neurological organ.Wien Klin Wochenschr2001;13:647–660.4Burns AJ,Thapar N.Advances in ontogeny of the enteric nervous system.Neurogastroenterol Motil2006;18:876–887.5Dong K,You XJ,Wen EG,et al.Advances in mechanisms of postsurgical gastroparesis syndrome and its diagnosis and treatment.Chin J Dig Dis2006;7:76–82.6Costa M,Brooks SJ,Heening GW.Anatomy and physiology of the enteric nervous system.Gut2000;S47:15–19.7Moreira TV,McQuiggan M.Methods for the assessment of gastric emptying in the critically ill enterally fed adults.Nutr Clin Pract2009;24:261–273.8Marshal AP,West SH.Enteral feeding in the critically ill:are nursing practices contributing to hypocaloric feeding?Intensive Crit Care Nurs2006;22:95–105.9Chang WK,Mc Calve SA,Lee MS,Chao YC.Monitoring bolus nasogastric tube feeding by the Brix value determination and residual volume measure-ment of gastric contents.JPEN J Parenter Enteral Nutr2004;28:105–112.10McQuiggan M,Koaazr R,Sailors M,et al.Techniques for determining gastric residual volume;is newer better.JPEN J Parenter Enteral Nutr2008;32:341A.11Metheny NA,Schallom L,Oliver DA,Clouse RL.Gastric residual volume and aspiration in critically ill patients receiving gastric feedings.Am J Crit Care 2008;17:512–519.12Parrish CR,McClave SA.Checking gastric residual volumes:a practice in search of science.Pract Gastroenterol2008;32:33–47.13Johnson AD.Ask the experts.Assessing gastric residual volumes.Crit Care Nurse2009;29:72–73.14Martindale RG,McClave SA,Vanek VW,et al.,American College of Critical Care Medicine and the ASPEN Board of Directors..Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient:Society of Critical Care Medicine and American Society of Par-enteral and Enteral Nutrition–executive summary.Crit Care Med2009;37:1757–1761.This is a must read article that puts together a consensus amongst the American society of Parenteral and Enteral Nutrition and the Society of Critical Care Medicine regarding nutritional interventions in the ICU with a graded scoring system.This is wherein we learn about a500ml gastric residual volume being acceptable.15Umbrello M,Elia G,Destrebecq ALL,Iapichino G.Tolerance of enteral feeding:from quantity to quality of gastric residual volume?Intensive Care Med2009;35:1651–1652.16Juve-Udina M-E,Vallas-Miro C,Carreno-Granero A,et al.To return or discard?Randomised trial on gastric residual volume management.Intensive Crit Care Nurs2009;25:258–267.This article answers a very common question about what nurses should do with GRV,discard or place back into the stomach.Returning the residual to the stomach appears to have no deleterious effect.17White H,Sosnowski K,Reeves A,Jones M.A randomized,controlled comparison of early postpyloric versus gastric feeding to meet nutritional targets in ventilated intensive care patients.Crit Care2009;13:1–8.18Deane AM,Fraser RJ,Chapman MJ.Prokinetic drugs for feed intolerance in critical illness:current and potential therapies.Crit Care Resusc2009;11:132–143.This article creates a good review of the promotility drugs available in the ICU for treatment of high GRV and concludes that we have very poor available evidence for a clinically significant effect.19Poulard F,Dimet J,Martin-Lefevre L,et al.Impact of not measuring residual gastric volume in mechanically ventilated patients receiving early enteral feeding:a prospective before-after study.JPEN J Parenter Enteral Nutr 2010;34:125–130.196Nutrition and the intensive care unit。

47 Managing In a Global Environment在全球环境中进行管理1. Assume for a moment<此刻>that you're a manager going to work for a branch of<分支> a global organization in a foreign country. You know that your environment will differ from the one at home, but how? What should you be looking for?1. 此刻假设你是一位美国经理，你准备到一家全球组织的国外分支机构工作。

你知道你的环境将与国内的不同，但二者的差异会达到什么程度呢？你应当注意些什么？2. Any manager who finds himself or herself in a foreign country faces new challenges. In this section, we'll look at<考察> some of those challenges and offer guidelines<指导> for responding. Although our discussion is presented<展开> through the eyes of a U.S. manager, our analytical framework could be used by any manager who has to manager in a foreign environment, regardless of national origin.2.任何一位发觉自己处于一个陌生国家的管理者都面临着新的挑战。

促进胃肠蠕动的方法One way to promote gastrointestinal motility is by incorporating dietary fiber into one's meals. 膳食纤维是促进胃肠蠕动的一种方法。

This can be done by consuming a variety of fruits, vegetables, whole grains, and legumes. 这可以通过食用各种水果、蔬菜、全谷物和豆类来实现。

Fiber adds bulk to the stool, which stimulates the muscles in the gastrointestinal tract to move. 纤维可以增加粪便的体积，从而刺激胃肠道中的肌肉运动。

Moreover, it also helps to regulate bowel movements and prevent constipation. 此外，它还有助于调节排便并预防便秘。

By making these dietary changes, individuals can effectively promote healthy gastrointestinal motility. 通过进行这些饮食改变，个体可以有效地促进健康的胃肠蠕动。

In addition to dietary modifications, regular physical activity can also contribute to promoting gastrointestinal motility. 除了饮食修改外，定期进行体育锻炼也可以有助于促进胃肠蠕动。

Exercise helps to stimulate the muscles in the abdomen, including those in the gastrointestinal tract. 锻炼有助于刺激腹部肌肉，包括胃肠道中的肌肉。

10.1038/s41575-022-00593-y.［38］陈文轩，张哲，周川，等. 色氨酸及其衍生物在炎症性肠病中的研究进展［J］.胃肠病学和肝病学杂志，2022，31（12）：1424-1427. CHEN W X， ZHANG Z， ZHOU C，et al. Research progress of tryptophan and its derivatives in inflammatory bowel disease ［J］. Chin J Gastroenterol Hepatol，2022，31（12）：1424-1427. doi：10.3969/j.issn.1006-5709.2022.12.021.［39］崔灿，李盈，杨豪杰，等. 色氨酸代谢与炎性肠病相关研究进展［J］. 医学综述，2021，27（14）：2726-2730. CUI C，LI Y，YANG H J，et al. Research progress of tryptophan metabolism and inflammatory bowel disease ［J］. Medical Recapitulate，2021，27（14）：2726-2730. doi：10.3969/j.issn.1006-2084.2021.14.005.［40］TAKEDA T，ASAOKA D，NOJIRI S，et al. Usefulness of bifidobacterium longum BB536 in elderly individuals with chronic constipation：a randomized controlled trial ［J］. Am J Gastroenterol，2023，118（3）：561-568. doi：10.14309/ajg.0000000000002028.［41］孙晓红. 慢性便秘诊治面临的挑战［J］. 中国中西医结合消化杂志，2023，31（6）： 418-420. SUN X H. Challenges in the diagnosis and treatment of chronic constipation ［J］. Chin J Integr Tradit West Med Dig，2023，31（6）：418-420. doi：10.3969/j.issn.1671-038X.2023.06.04.［42］丁雨，王艳，林琳，等. 慢性便秘患者的肠道菌群分析［J］. 中国医师杂志，2022，24（7）：1066-1068. DING Y，WANG Y，LIN L，et al. Analysis of intestinal flora in patients with chronic constipation［J］. Journal of Chinese Physician，2022，24（7）：1066-1068. doi：10.3760/431274-20210729-00823.［43］刘启鸿，柯晓，骆云丰，等. 基于"脑-肠-菌"轴观察理气通便方对气滞证慢传输型便秘患者的影响［J］. 中华中医药杂志，2021，36（6）：3324-3328. LIU Q H，KE X，LUO Y F，et al. Observation of liqi tongbian decoction on patients with qi stagnation syndrome slow transit constipation based on the“brain-intestine-bacteria”axis ［J］. China Journal of Traditional Chinese Medicine and Pharmacy，2021，36（6）：3324-3328.［44］BHARUCHA A E，LACY B E. Mechanisms，evaluation，and management of chronic constipation ［J］. Gastroenterology，2020，158（15）：1232-1249.e3. doi：10.1053/j.gastro.2019.12.034.［45］GWEE K A，LEE Y Y，SUZUKI H，et al. Asia-pacific guidelines for managing functional dyspepsia overlapping with other gastrointestinal symptoms ［J］. J Gastroenterol Hepatol，2023，38（2）：197-209. doi：10.1111/jgh.16046.［46］CHEN S H，ZHU L J，ZHI Y H，et al. Pitongshu alleviates the adverse symptoms in rats with functional dyspepsia through regulating visceral hypersensitivity caused by 5-HT overexpression ［J］. Comb Chem High Throughput Screen，2023，26（7）：1424-1436. doi：10.2174/1386207325666220827152654.（2023-09-11收稿　2023-10-30修回）　（本文编辑　陈丽洁）　SIRT1在糖尿病心肌病发病中的研究进展解有成1，2，3，4，王菲2，徐进2，于晓辉2△摘要：糖尿病心肌病（DCM）是糖尿病患者的一种严重的心血管并发症。

第一部分通用英语Part OneEnglish for General PurposesUNIT 1 How to be Happy如何获得幸福ExercisesA. Translate the following sentences into English.1．吵闹的邻居的确对我们家庭不和(domestic upset)有很大影响。

2．在职场上，如果一个同事对我们表示威吓的话，会造成难以言表的抑郁情绪(unwretchedness)。

3．我们不可能适应这种敌对关系，这种不良的人际关系会损害身心健康。

4．如果这种坏情绪长时间留在人们的心里，会让人陷入无法解决的恶性心理困境。

5．我们不应当回避这些问题，而是要正确面对它们。

B. Read the text and translate it into Chinese.There are many benefits to being happy. Happier people tend to be healthier, live longer and eam more. They also tend to volunteer more, be better at relationships and smile more of what psychologists call “Duchenne" or genuine smiles. What is less well understood is why happiness is contagious.According to James Fowler and Nicholas Christakis, authors of the international bestseller Connected, people surrounded by many happy friends, family members and neighbours who are central to their social network become significantly happier in the future. More specificallyi they say we will become 25 per cent happier with our life if a friend who lives within a mile of us becomes significantly happier with his or her life.Similar effects are seen in co-resident spouses (8 per cent happier); siblings who live within a mile of each other (14 per cent); and next-door neighbours (34 per cent). What this implies is that the magnitude of happiness spread seems to depend more on frequent social contact (due to physical proximity) than on deep social connections. Alas, for some reason this doesn't translate to the workplace.So, why is happiness contagious? One reason may be that happy people share their good fortune with their friends and family (for example, by being pragmatically helpful or financially generous). Another reason could be that happy people tend to change their behaviour for the better by being nicer or less hostile to those close to them. Or it could just be that positive emotions are highly contagious.【参考答案】阅读理解1. The formula refers to H (happiness) = S (your biological set point for feeling happy) + C (the conditions of your life) + V (the voluntary choices you make).2. Loud noises trigger one of our most primitive fear responses and we can never fully relax if we are surrounded by intrusive noise.3. If we need our TV, radio or music up loud, wearing headphones demonstrates our kindness and consideration to our neighbors.4. Our unhappiness often comes from poor relationships with others.5. What you can do is to either mend the relationship by confronting what is going wrong or learn to move on.【练习参考答案】A．汉译英1. Noisy neighbors are one of the major causes of domestic upset.2. A colleague at work who bullies or dismisses us creates untold wretchedness.3. We can never fully adapt to hostile relationships, which inevitably damage our wellbeing.4. If this bad mood stays inside our mind, it will lead us to an unresolved destructive depression.5. We should not avoid these problems but face them instead. B．英译汉幸福有许多好处。

Text B How Does FDA Approve New Drugs?Under current law, all new drugs need proof that they are effective, as well as safe, before they can be approved for marketing. But it’s important to realize that no drug is absolutely safe. There is always some risk of an adverse reaction. It’s when the benefits outweigh the risks that FDA considers a drug safe enough to approve.1.outweigh [a u tˊweɪ] vt. 在重量上超过；在重要性或价值方面超过根据现行法规，对于所有新药，只有经确认安全、有效，才会被批准上市。

但是，我们应该意识到没有所谓绝对安全的药物，认识到这一点是很重要的。

任何药物都可能有不良反应。

因此，只有认定某种药物的益处大于其风险时，FDA 才会认为某种药物足够安全，可批准其上市。

In fact, it was only 25 years ago that U.S. drug law first embraced the idea of risk vs. benefit that now the key to new drugs approval. Providing evidence of safety before marketing was first required by Federal Food, Drug and Cosmetic Act in 1938, but not until the Drug Amendments of 1962 did firms also have to show a drug’s effectiveness before marketing. Before any drug gets on the market today, FDA decides—as quickly as a thorough evaluation allows—whether the studies submitted by the drug’s sponsor(usually the manufacturer) show it to be safe and effective for its intend use.1.embrace [im'breis] vt. 包括; 包含；接受；信奉, 皈依vt. & vi.拥抱n.拥抱, 怀抱2.cosmetic [kɔz'metik]n.化妆品adj.化妆用的; 美容的；装点门面的Federal Food, Drug and Cosmetic Act联邦食品、药品和化妆法案3.Drug Amendments [ə'mendmənts] 药品法修正案4.thorough ['θʌrəu] adj.彻底的；十足的；考虑周到的5.sponsor ['spɔnsə] vt.赞助, 发起, 主办n. 申办者事实上，直到25年前美国药品管理法才刚刚引入“风险-益处评估”的概念。