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18. Ostling S, Wyckoff J, Ciarkowski SL, et al. The\nrelationship between diabetes mellitus and 30-day readmission rates. Clin Diabetes Endocrinol2017;3:3\n19. Rushakoff RJ, Sullivan MM, MacMaster HW,\net al. Association between a virtual glucose\nmanagement service and glycemic control in | [
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management service and glycemic control in\nhospitalized adult patients: an observational study.Ann Intern Med 2017;166:621– 627\n20. Magee MF, Baker KM, Bardsley JK, WesleyD, Smith KM. Diabetes to go-inpatient: pragmaticlessons learned from implementation of technology-enabled diabetes survival skills education within | [
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nursing unit workfl ow in an urban, tertiary care\nhospital. Jt Comm J Qual Patient Saf 2021;47:\n107– 119\n21. Pinkhasova D, Swami JB, Patel N, et al.\nPatient understanding of discharge instructionsfor home diabetes self-management and risk for\nhospital readmission and emergency department\nvisits. Endocr Pract 2021;... | [
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visits. Endocr Pract 2021;27:561– 566\n22. Society of Hospital Medicine. Glycemiccontrol for hospitalists. Accessed 21 August 2023.Available from https://www.hospitalmedicine.org/clinical-topics/glycemic-control/\n23. Arnold P, Scheurer D, Dake AW, et al.\nHospital guidelines for diabetes management | [
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Hospital guidelines for diabetes management\nand the Joint Commission-American DiabetesAssociation Inpatient Diabetes Certi fication. Am J\nMed Sci 2016;351:333– 341\n24. Association of British Diabetologists. JointBritish Diabetes Societies (JBDS) for Inpatient\nCare Group. Accessed 21 August 2023. Available\nfrom http... | [
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from https://abcd.care/jbds-ip\n25. Agiostratidou G, Anhalt H, Ball D, et al.\nStandardizing clinically meaningful outcomemeasures beyond HbA\n1cfor type 1 diabetes: a\nconsensus report of the American Association ofClinical Endocrinologists, the American Association\nof Diabetes Educators, the American Diabetes | [
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of Diabetes Educators, the American Diabetes\nAssociation, the Endocrine Society, JDRF International,The Leona M. and Harry B. Helmsley Charitable Trust,the Pediatric Endocrine Society, and the T1DExchange. Diabetes Care 2017;40:1622– 1630\n26. Cardona S, Gomez PC, Vellanki P , et al.\nClinical characteristics and outc... | [
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Clinical characteristics and outcomes of\nsymptomatic and asymptomatic hypoglycemiain hospitalized patients with diabetes. BMJOpen Diabetes Res Care 2018;6:e000607\n27. Van den Berghe G, Wouters P , Weekers F,\net al. Intensive insulin therapy in critically ill\npatients. N Engl J Med 2001;345:1359– 1367 | [
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patients. N Engl J Med 2001;345:1359– 1367\n28. Finfer S, Chittock DR, Su SY , et al.; NICE-\nSUGAR Study Investigators. Intensive versusconventional glucose control in critically illpatients. N Engl J Med 2009;360:1283 –1297\n29. Kansagara D, Fu R, Freeman M, Wolf F,Helfand M. Intensive insulin therapy in hospitalized | [
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patients: a systematic review. Ann Intern Med\n2011;154:268– 282\n30. Sathya B, Davis R, Taveira T, Whitlatch H, WuWC. Intensity of peri-operative glycemic controland postoperative outcomes in patients withdiabetes: a meta-analysis. Diabetes Res Clin Pract\n2013;102:8 –15\n31. Umpierrez G, Cardona S, Pasquel F, et al. | [
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2013;102:8 –15\n31. Umpierrez G, Cardona S, Pasquel F, et al.\nRandomized controlled trial of intensive versusconservative glucose control in patients undergoingcoronary artery bypass graft surgery: GLUCO-CABGtrial. Diabetes Care 2015;38:1665 –1672\n32. Furnary AP , Wu Y , Bookin SO. Effect of\nhyperglycemia and contin... | [
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hyperglycemia and continuous intravenous insulin\ninfusions on outcomes of cardiac surgical procedures:the Portland Diabetic Project. Endocr Pract 2004;10(Suppl. 2):21 –33\n33. Magaji V, Nayak S, Donihi AC, et al.Comparison of insulin infusion protocols targeting110-140 mg/dL in patients after cardiac surgery. | [
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Diabetes Technol Ther 2012;14:1013 –1017\n34. Flory JH, Aleman JO, Furst J, Seley JJ. Basal\ninsulin use in the non-critical care setting: isfasting hypoglycemia inevitable or preventable? JDiabetes Sci Technol 2014;8:427– 428diabetesjournals.org/care Diabetes Care in the Hospital S303\n©AmericanDiabetesAssociation | [
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17. Diabetes Advocacy: Standards\nof Care in Diabetes— 2024\nDiabetes Care 2024;47(Suppl. 1):S307 –S308 |https://doi.org/10.2337/dc24-S017American Diabetes Association\nProfessional Practice Committee *\nThe American Diabetes Association (ADA) “Standards of Care in Diabetes ”includes | [
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the ADA ’s current clinical practice recommendations and is intended to provide the\ncomponents of diabetes care, general treatment goals and guidelines, and tools to | [
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evaluate quality of care. Members of the ADA Professional Practice Committee, aninterprofessional expert committee, are responsible for updating the Standards ofCare annually, or more frequently as warranted. For a detailed description of ADA\nstandards, statements, and reports, as well as the evidence-grading system f... | [
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clinical practice recommendations and a full list of Professional Practice Committee\nmembers, please refer to Introduction and Methodology. Readers who wish to com-ment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.\nManaging the daily health demands of diabetes can be challenging. Peo... | [
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with diabetes should not have to face discrimination due to diabetes. By advocatingfor the rights of those with diabetes at all levels, the American Diabetes Association(ADA) can help to ensure that they live a healthy and productive life. A strategic goalof the ADA is for more children and adults with diabetes to live... | [
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more children and adults with diabetes to live free from the burdenof discrimination. The ADA is also focused on making sure cost is not a barrier to suc-cessful diabetes management. | [
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One tactic for achieving these goals has been to implement the ADA Standards of | [
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Care through advocacy-oriented position statements. The ADA publishes evidence-based, peer-reviewed statements on topics such as diabetes and employment, diabe-tes and driving, insulin access and affordability, and diabetes management in certainsettings such as schools, childcare programs, and detention facilities. In ... | [
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programs, and detention facilities. In addition to theADA’ s clinical documents, these advocacy statements are important tools in educating | [
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schools, employers, licensing agencies, policy makers, and others about the intersec-tion of diabetes management and the law and for providing scienti fically supported\npolicy recommendations.\nADVOCACY STATEMENTS | [
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policy recommendations.\nADVOCACY STATEMENTS\nThe following is a partial list of advocacy statements ordered by publication date, withthe most recent statement appearing first. A comprehensive list of advocacy state-\nments is available at professional.diabetes.org/content/key-statements-and-reports. | [
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Care of Young Children With Diabetes in the Childcare and Community\nSetting\nVery young children (aged <5 years) with diabetes have legal protections and can be\nsafely cared for by childcare professionals with appropriate training, access to resour-\nces, and a communication system with parents/guardians and the chil... | [
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health care professional. Refer to the published ADA advocacy statement for infor-mation on young children aged <5 years in settings such as childcare centers, pre-\nschools, camps, and other programs (1).*A complete list of members of the American | [
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Diabetes Association Professional Practice Committeecan be found at https://doi.org/10.2337/dc24-SINT.\nDuality of interest information for each author is\navailable at https://doi.org/10.2337/dc24-SDIS.\nSuggested citation: American Diabetes Association\nProfessional Practice Committee. 17. Diabetesadvocacy: Standards... | [
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Diabetes Care 2024;47(Suppl. 1):S307– S308\n© 2023 by the American Diabetes Association.Readers may use this article as long as thework is properly cited, the use is educationaland not for pro fit, and the work is not altered. | [
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More information is available at https://www.diabetesjournals.org/journals/pages/license.17. DIABETES ADVOCACYDiabetes Care Volume 47, Supplement 1, January 2024 S307\n©AmericanDiabetesAssociation | [
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Insulin Access and Affordability\nThe ADA ’s Insulin Access and Afford-\nability Working Group compiled public | [
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ability Working Group compiled public\ninformation and convened a series ofmeetings with stakeholders through-out the insulin supply chain to learnhow each entity affects the cost of insulinfor the consumer. Their conclusions andrecommendations are published in anADA statement (2).\nDiabetes Care in the School Setting | [
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Diabetes Care in the School Setting\nA sizable portion of a child ’sd a yi ss p e n t | [
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in school, so close communication withand training and cooperation of schoolpersonnel are essential to optimize diabe-tes management, safety, and access to allschool-sponsored opportunities. Refer tothe published ADA position statement fordiabetes management information forstudents with diabetes in elementaryand second... | [
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Diabetes and Driving\nPeople with diabetes who wish to oper-ate motor vehicles are subject to variouslicensing requirements applied by both\nstate and federal jurisdictions. For an\noverview of existing licensing rules forpeople with diabetes, factors that impactdriving for this population, and generalguidelines for as... | [
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determining appropriate licensing restric-tions, refer to the published ADA positionstatement (4).\nEditor ’s note: Federal commercial driv-\ning rules for individuals with insulin-treated\ndiabetes changed on 19 November 2018.\nThese changes will be re fle c t e di naf u t u r e\nupdated ADA statement.\nDiabetes and Em... | [
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updated ADA statement.\nDiabetes and Employment\nA n yp e r s o nw i t hd i a b e t e s ,w h e t h e ri n s u -lin treated or noninsulin treated, shouldbe eligible for any employment for whichthey are otherwise quali fied. Employ- | [
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ment decisions should never be based ongeneralizations or stereotypes regardingthe effects of diabetes. For a general setof guidelines for evaluating individuals | [
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with diabetes for employment, includinghow an assessment should be performedand what changes (accommodations) inthe workplace may be needed for an indi-vidual with diabetes, refer to the pub-lished ADA position statement (5).\nReferences\n1. March C, Serman J, Bannuru RR, et al. Care of | [
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References\n1. March C, Serman J, Bannuru RR, et al. Care of\nyoung children with diabetes in the childcareand community setting: a statement of theAmerican Diabetes Association. Diabetes Care2023;46:2102 –2111 | [
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2. Cefalu WT, Dawes DE, Gavlak G, et al.; InsulinAccess and Affordability Working Group. InsulinAccess and Affordability Working Group: conclusionsand recommendations [published correction appearsin Diabetes Care 2018;41:1831]. Diabetes Care2018;41:1299 –1311\n3. Jackson CC, Albanese-O ’Neill A, Butler KL, | [
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3. Jackson CC, Albanese-O ’Neill A, Butler KL,\net al. Diabetes care in the school setting: aposition statement of the American DiabetesAssociation. Diabetes Care 2015;38:1958– 1963\n4. Lorber D, Anderson J, Arent S, et al.; AmericanDiabetes Association. Diabetes and driving. DiabetesCare 2014;37(Suppl. 1):S97– S103 | [
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5. Anderson JE, Greene MA, Grif finJ WJ r ,e ta l . ;\nAmerican Diabetes Association. Diabetes andemployment. Diabetes Care 2014;37(Suppl. 1):S112–S117S308 Diabetes Advocacy Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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Introduction\nFood\tprovides\tenergy\tand\tbuilding\tmaterials\tfor\tcountless\tsubstances\tthat\tare\tessential\tfor\tthe\ngrowth\tand\tsurvival\tof\tevery\thuman\tbeing.\tThis\tsection\topens\twith\ta\tbrief\toverview\tof\tthe\tdigestion,\nabsorption,\ttransportation,\tand\texcretion\tof\tnutrients.\tThese\tremarkabl... | [
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molecules\tin\tfood\tinto\tindividual\tnutrients\tready\tto\tbe\tused\tin\tmetabolism.\tMacronutrients\t(proteins,\nfats,\tand\tcarbohydrates)\teach\tcontribute\tto\tthe\ttotal\tenergy\tpool,\tbut\tultimately\tthe\tenergy\tthey\nyield\tis\tavailable\tfor\tthe\twork\tof\tthe\tmuscles\tand\torgans\tof\tthe\tbody.\tThe\tw... | [
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0.0686185... |
integral\tparts\tof\tthe\tbody\tand\tcontribute\tto\tproper\tfunctioning\tdepends\theavily\ton\tthe\tphysiologic\nand\tbiochemical\tprocesses\tthat\tgovern\ttheir\tactions.\tIt\tis\tnow\tknown\tthat\tthese\tmetabolic\tprocesses\nare\n\taltered\tin\tthe\tpresence\tof\tacute\tand\tchronic\tinflammation.\tUnderstanding\tt... | [
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0.050088... |
other\tindicators\tof\tinflammation\tis\ta\tcritical\tcomponent\tof\tnutrition\tassessment.\nFor\tthe\thealth\tprovider,\tnutrition\tassessment\tis\tthe\tfirst\tstep\tin\tthe\tnutrition\tcare\tprocess.\tTo\nimplement\ta\tsuccessful\tnutrition\tplan,\tthe\tassessment\tmust\tinclude\tkey\telements\tof\tthe\tpatient’s\ncl... | [
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clinical,\tmedical,\tand\tsocial\n\thistory,\tanthropometric\tmeasurements,\tbiochemical\tand\tlaboratory\nvalues,\tinformation\ton\tmedication\tand\therbal\tsupplement\tuse\tfor\tpotential\tfood–drug\tinteractions,\nplus\ta\tthorough\tfood\tand\tnutrition\tintake\thistory.\tGenetic\tresearch\tis\trapidly\tclarifying\t... | [
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and\tnutrition\tare\tinterrelated.\tNutrigenomics\tis\tthe\tstudy\tof\tthe\teffects\tof\tfoods\tand\tnutrients\ton\ngene\texpression\tand\tthus\tnutritional\n\trequirements.\tThus\tthe\tchapters\tin\tPart\tI\tprovide\tan\torganized\nway\tto\tdevelop\tthe\tskills\tneeded\tto\tmake\tan\tassessment\tin\tthe\tnutrition\tca... | [
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1\nIntake:\tGastrointestinal\ndigestion,\tabsorption,\tand\nexcretion\tof\tnutrients\nKelly\tA.\tTappenden,\tPhD,\tRDN,\tFASPEN\nKEY\tTERMS\namylase,\tpancreatic\namylase,\tsalivary\nbrush\tborder\tmembrane\nchelation\ncholecystokinin\t(CCK)\nchyme\ncolonic\tsalvage\ncrypts\ndiffusion,\tfacilitated\ndiffusion,\tpassive... | [
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dysbiosis\nenterocytes\nenterohepatic\tcirculation\nenterokinase\nenzymatic\thydrolysis\nepithelial\tcells\ngastrin\nghrelin\nglucagon-like\tpeptide\t2\t(GLP-2)\ngut–brain\taxis\nisomaltase\nlactase\nlipase,\tgastric\nlipase,\tpancreatic\nlipase,\tsalivary\nlipolytic\tenzymes\nmaltase\nmicelle\nmicrobiome\nmicrobiota\n... | [
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microvilli\nmotilin\nmucosa\nparietal\tcells\npepsin\nperistalsis\nprebiotic\nprobiotic | [
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proteolytic\tenzymes\nsecretin\nsegmentation\nsomatostatin\nsucrase\nsynbiotic\ntransport,\n\tactive\ntransport,\tpassive\ntrypsin\ntrypsinogen\nunstirred\twater\tlayer\t(UWL)\nvilli\nOne\tof\tthe\tprimary\tconsiderations\tfor\ta\tcomplete\tnutrition\tassessment\tis\tto\tconsider\tthe\tthree-step | [
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model\tof\t“ingestion,\tdigestion,\tand\tutilization.”\tIn\tthis\tmodel,\tconsideration\tis\tgiven\tto\teach\tstep\tto\nidentify\tall\tareas\tof\tinadequacy\tor\texcess.\tIf\tthere\tis\tany\treason\twhy\ta\tstep\tis\taltered\tfrom\tphysical,\nbiochemical,\tor\tbehavioral-environmental\tcauses,\tthe\tnutrition\tprovider... | [
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nutrition\tdiagnosis\tfor\twhich\tintervention\tis\trequired.\tIntake\tand\tassimilation\tof\tnutrients\tshould\nlead\tto\tnutritional\tand\toverall\thealth.\nThe\tgastrointestinal\ttract\nThe\tGIT\tis\tone\tof\tthe\tlargest\torgans\tin\tthe\tbody,\thas\tthe\tgreatest\tsurface\tarea,\thas\tthe\tlargest\nnumber\tof\timm... | [
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number\tof\timmune\tcells,\tand\tis\n\tone\tof\tthe\tmost\tmetabolically\tactive\ttissues\tin\tthe\tbody.\tThe\tunique\nstructure\tof\tthe\tGIT\tenables\tample\tnutrient-processing\tcapacity\tin\thealthy\thumans.\tThe\thuman\tGIT\nis\tabout\t9\tmeters\tlong,\textending\tfrom\tthe\tmouth\tto\tthe\tanus\tand\tincluding\t... | [
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structures,\tesophagus,\tstomach,\tliver\tand\tgallbladder,\tpancreas,\tand\tsmall\tand\tlarge\tintestine\t(\nFig.\n1.1\n).\nFIG.\t1.1\nThe\tdigestive\tsystem.\nThe\tGIT\tis\tdesigned\tto\t(1)\tdigest\tthe\tmacronutrients\tprotein,\tcarbohydrates,\tand\tlipids\tfrom\ningested\tfoods\tand\tbeverages;\t(2)\tabsorb\tfluid... | [
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elements;\t(3)\tprovide\ta\tphysical\tand\timmunologic\tbarrier\tto\tpathogens,\tforeign\tmaterial,\tand\npotential\tantigens\tconsumed\twith\tfood\tor\tformed\tduring\tthe\tpassage\tof\tfood\n\tthrough\tthe\tGIT;\t(4)\ncoordinate\ta\tresponse\tto\tmicrobes\tand\tantigens\twith\tthe\tsystemic\timmune\tsystem,\tresultin... | [
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0.01190... |
controlled\tlevels\tof\ttolerance\tor\tinflammation;\tand\t(5)\tprovide\tregulatory\tand\tbiochemical\tsignaling\nto\tthe\tnervous\tsystem,\toften\tinvolving\tthe\tintestinal\tmicrobiota,\tvia\ta\tpathway\tknown\tas\tthe\t\ngut–\nbrain\taxis\n. | [
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The\thuman\tGIT\tis\twell\tsuited\tfor\tdigesting\tand\tabsorbing\tnutrients\tfrom\n\ta\ttremendous\tvariety\tof\nfoods,\tincluding\tmeats,\tdairy\tproducts,\tfruits,\tvegetables,\tgrains,\tcomplex\tstarches,\tsugars,\tfats,\tand\noils.\tDepending\ton\tthe\tnature\tof\tthe\tdiet\tconsumed,\t90%\tto\t97%\tof\tfood\tis\t... | [
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most\tof\tthe\tunabsorbed\tmaterial\tis\tof\tplant\torigin.\tCompared\twith\truminants\tand\tanimals\twith\ta\nvery\tlarge\tcecum,\thumans\tare\tconsiderably\tless\tefficient\tat\textracting\tenergy\tfrom\n\tgrasses,\tstems,\nseeds,\tand\tother\tcoarse\tfibrous\tmaterials.\tHumans\tlack\tthe\tenzymes\tto\thydrolyze\tth... | [
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bonds\tthat\tlink\tthe\tmolecules\tof\tsugars\tthat\tmake\tup\tplant\tfibers.\tHowever,\tfibrous\tfoods\tand\tany\nundigested\tcarbohydrates\tare\tfermented\tto\tvarying\tdegrees\tby\tbacteria\tin\tthe\thuman\tcolon;\tthis\nprocess\tcan\tcontribute\t5%\tto\t10%\tof\tthe\tenergy\tneeded\tby\thumans.\nThe\tstructure\tof\... | [
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0.0... |
The\tstructure\tof\tthe\tsmall\tintestine\n\tis\tcarefully\tdesigned\tto\tallow\tfor\ta\tvery\tlarge\tsurface\tarea\tthat\npermits\tthe\tadequate\tdigestion\tand\tabsorption\tof\tthe\tnutrients\tfrom\tfood.\tThe\tlining\tof\tthis\thollow\ntube,\tcalled\tthe\t\nmucosa\n,\tis\tconfigured\tin\ta\tpattern\tof\tfolds\tthat\... | [
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0.0903187245130539,
-0.021223947405815125,
0.06028362363576889,
0.00... |
crypts\nand\tfingerlike\tprojections\tcalled\t\nvilli\n\t(\nFig.\t1.2\n).\tThese\tcrypt-villus\tunits\tare\tlined\twith\ta\tsingle\tlayer\nof\t\nepithelial\tcells\n,\tmany\tof\twhich\tare\t\nenterocytes\n\tthat\tcontain\teven\tsmaller\tcylindrical\textensions\ncalled\t\nmicrovilli\n.\tThe\tepithelial\tcells\tlining\tth... | [
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5\tdays,\tand\tthen\tthey\tare\tsloughed\tinto\tthe\tlumen\tand\t“recycled,”\tadding\tto\tthe\tpool\tof\tavailable\nnutrients.\tAs\tthe\tcells\tmigrate\tfrom\tthe\tcrypt\talong\tthe\tvillus,\tthey\tmature\tand\tdevelop\tgreater\ndigestive\tand\n\tabsorptive\tfunction.\nFIG.\t1.2\nStructure\tof\tthe\thuman\tintestine\ts... | [
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The\thealth\tof\tthe\tbody\tdepends\ton\ta\thealthy,\tfunctional\tGIT.\tBecause\tof\tthe\tunusually\thigh\nturnover\trate\tand\tmetabolic\trequirements\tof\tthe\tepithelial\tcells,\tgastrointestinal\tfunctions\tare\nparticularly\tsusceptible\tto\timpairment\tdue\tto\tmicronutrient\tdeficiencies,\tprotein-energy\nmalnut... | [
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malnutrition,\n\tand\tdamage\tresulting\tfrom\ttoxins,\tdrugs,\tirradiation,\tfood\tallergy\treactions,\tor\ninterruption\tof\tits\tblood\tsupply.\tApproximately\t45%\tof\tthe\tenergy\trequirement\tof\tthe\tsmall\tintestine\nand\t70%\tof\tthe\tenergy\trequirement\tof\tcells\tlining\tthe\tcolon\tare\tsupplied\tby\tnutri... | [
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0.03714074939... |
through\tits\tlumen.\tAfter\tonly\ta\tfew\tdays\tof\tstarvation\tor\tintravenous\tfeeding\t(parenteral\tnutrition),\nthe\tintestinal\tmucosa\n\tatrophies\t(i.e.,\tthe\tsurface\tarea\tdecreases\tand\tsecretions,\tsynthetic\tfunctions,\nblood\tflow,\tand\tabsorptive\tcapacity\tare\tall\treduced).\tResumption\tof\tfood\ti... | [
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0.04232712835... |
cell\tproliferation\tand\treturn\tof\tnormal\tGI\tfunction\tafter\tonly\ta\tfew\tdays.\tThis\tknowledge\tjustifies\tthe\nclinical\tpractice\tof\tfeeding\tan\tindividual\torally\tand/or\tenterally\t(via\ttube),\tas\topposed\tto\nintravenously\t(or\n\tparenterally),\twhen\tadequate\tGIT\tfunction\tis\tpresent\t(see\t\nCh... | [
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0.03640823... |
Chapter\t12\n).\nBrief\toverview\tof\tdigestive\tand\tabsorptive\tprocesses\nThe\tsight,\tsmell,\ttaste,\tand\teven\tthought\tof\tfood\tstarts\tthe\tsecretions\tand\tmovements\tof\tthe\tGIT.\tIn\nthe\tmouth,\tchewing\treduces\tthe\tsize\tof\tfood\tparticles,\twhich\tare\tmixed\twith\tsalivary\tsecretions\tthat\nprepare... | [
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0.11017946153879166,
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0.04561261087656021,
-0.02666... |
by\t\nsalivary\tamylase\n,\tbut | [
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digestion\tin\tthe\tmouth\tis\tminimal.\tThe\tesophagus\ttransports\tfood\tand\tliquid\tfrom\tthe\toral\tcavity\tand\npharynx\tto\tthe\tstomach.\tIn\tthe\tstomach,\tfood\tis\tmixed\twith\tacidic\tfluid\tthat\tcontains\t\nproteolytic\n\tand\nlipolytic\tenzymes\n.\tSmall\tamounts\tof\tlipid\tdigestion\ttake\tplace;\tsome... | [
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0.03268874... |
due\tto\tdenaturation\tand\tpartial\tdigestion.\tWhen\tfood\treaches\tthe\tappropriate\n\tconsistency\tand\nconcentration,\tit\tis\tnow\tcalled\t\nchyme\n\tand\tpasses\tfrom\tthe\tstomach\tinto\tthe\tsmall\tintestine,\twhere\nmost\tdigestion\ttakes\tplace.\nThe\tfirst\t100\tcm\tof\tthe\tsmall\tintestine\tis\thighly\tac... | [
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0.0055469... |
most\tingested\tfood\t(\nFig.\t1.3\n).\tHere\tthe\tpresence\tof\tfood\tstimulates\tthe\trelease\tof\thormones\tthat\nstimulate\tthe\tproduction\tand\trelease\tof\tpowerful\tenzymes\n\tfrom\tthe\tpancreas\tand\tbile\tfrom\tthe\ngallbladder.\tStarches\tand\tproteins\tare\treduced\tto\tsmall-molecular-weight\tcarbohydrate... | [
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0.02... |
medium-size\tpeptides.\tDietary\tfats\tare\treduced\tfrom\tvisible\tglobules\tof\tfat\tto\tmicroscopic\tdroplets\tof\ntriglycerides,\tthen\tto\tfree\tfatty\tacids\tand\tmonoglycerides.\tEnzymes\tlocated\ton\tthe\tbrush\tborder\nmembrane\tof\tthe\tenterocytes\tfurther\treduce\tthe\tremaining\tcarbohydrates\n\tto\tmonosa... | [
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0.0... |
to\tmonosaccharides\tand\nthe\tremaining\tpeptides\tto\tsingle\tamino\tacids,\tdipeptides,\tand\ttripeptides.\nFIG.\t1.3\nSites\tof\tsecretion,\tdigestion,\tand\tabsorption.\nLarge\tvolumes\tof\tfluid\tare\tused\tto\tdigest\tand\tabsorb\tnutrients.\tTogether\twith\tsalivary\tand\tgastric | [
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secretions,\tsecretions\tfrom\tthe\tpancreas,\tsmall\tintestine,\tand\tgallbladder\tsecrete\t7\tL\tof\tfluid\tinto\tthe\nGIT\tlumen\teach\tday—far\tmore\tthan\tthe\t2\tL\tingested\tthrough\tdietary\tintake\teach\tday.\tAll\tbut\t100\tmL\nof\tthe\ttotal\tfluid\tentering\tthe\tlumen\n\tis\treabsorbed:\tabout\t7\tL\tin\tt... | [
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0.02... |
the\tlarge\tintestine.\nAlong\tthe\tremaining\tlength\tof\tthe\tsmall\tintestine,\talmost\tall\tthe\tmacronutrients,\tminerals,\nvitamins,\ttrace\telements,\tand\tfluid\tare\tabsorbed\tbefore\treaching\tthe\tcolon.\tThe\tcolon\tand\trectum\nabsorb\tmost\tof\tthe\tremaining\tfluid\tdelivered\tfrom\tthe\tsmall\tintestine... | [
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0.02416... |
and\tonly\ta\tsmall\tamount\n\tof\tremaining\tnutrients.\tThe\tmovement\tof\tingested\tand\tsecreted\tmaterial\tin\nthe\tGIT\tis\tregulated\tprimarily\tby\thormones,\tnerves,\tand\tenteric\tmuscles.\nMost\tnutrients\tabsorbed\tfrom\tthe\tGIT\tenter\tthe\tportal\tvein\tfor\ttransport\tto\tthe\tliver\twhere\tthey | [
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0.0266667027... |
may\tbe\tstored,\ttransformed\tinto\tother\tsubstances,\tor\treleased\tinto\tcirculation.\tHowever,\tend\nproducts\tof\tmost\tdietary\tfats\tare\ttransported\tinto\tthe\tbloodstream\n\tvia\tthe\tlymphatic\tcirculation\nbecause\tthey\tare\tnot\twater\tsoluble\tprior\tto\tlipoprotein\tmetabolism\tin\tthe\tliver\t(see\t\n... | [
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0.0... |
Chapter\t28\n).\nNutrients\treaching\tthe\tdistal\tsmall\tintestine\tand\tlarge\tintestine,\tmost\tnotably\tfermentable\tdietary\nfiber\tand\tresistant\tstarches,\tare\tfermented\tby\tthe\tmicrobiota\tlocated\twithin\tthe\tlumen\tof\tthese\nintestinal\tsegments.\tFermentation\tproduces\tshort-chain\tfatty\tacids\t(SCFA... | [
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0.0... |
and\tgas.\tSCFAs\tprovide\na\tpreferred\tfuel\tsource\tfor\tcells\tof\tthe\tintestine,\tstimulate\tintestinal\tcell\trenewal\tand\tfunction,\nenhance\timmune\tfunction,\tand\tregulate\tgene\texpression.\tIn\taddition,\tsome\tcarbohydrates\thave\n“prebiotic”\tfunctions\tthat\tinduce\tthe\tgrowth\tand\tactivity\tof\tbene... | [
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0.10267025232315063,
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0.022306665778160095,
0.07569... |
microbiota.\tThe\tlarge\tintestine\talso\tprovides\ttemporary\tstorage\tfor\twaste\tproducts.\n\tThe\tdistal\tcolon,\nrectum,\tand\tanus\tcontrol\tdefecation.\nEnzymes\tin\tdigestion\nHumans\tdigest\tfood\tusing\tthe\tchemical\tprocess\tcalled\t\nenzymatic\thydrolysis\n.\tCofactors\tsuch\tas\nhydrochloric\tacid,\tbile,... | [
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0.06460171192884445,
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0.04735878109931946,
0.07760... |
synthesized\tin\tspecialized\tcells\tof\tthe\tmouth,\tstomach,\tand\tpancreas\tare\treleased\tinto\tthe\tGIT | [
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lumen,\twhereas\tdigestive\tenzymes\tsynthesized\n\tin\tenterocytes\tof\tthe\tsmall\tintestine\tremain\nembedded\twithin\tthe\tbrush\tborder\tmembrane.\tExcept\tfor\tfiber\tand\tresistant\tcarbohydrates,\ndigestion\tand\tabsorption\tof\tfood\tis\tcompleted\tessentially\tin\tthe\tsmall\tintestine.\t\nTable\t1.1\n\tsumma... | [
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0.02... |
summarizes\nkey\tenzymes\tinvolved\tin\thuman\tdigestion.\nTABLE\t1.1\nSummary\tof\tEnzymatic\tDigestion\tand\tAbsorption\nSecretion\tand\nSource\nEnzymes\nSubstrate\nAction\tand\nResulting\tProducts\nFinal\tProducts\nAbsorbed\nSaliva\tfrom\nsalivary\nglands\tin\nmouth\nα-amylase\nStarch\t(α-linked\npolysaccharides)\nH... | [
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0.011569475755095482,
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0.02829822339117527,
0.04215239733457565,
0.05666140839457512,
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0.0456993393599987,
0.07635627686977386,
-0.006292286328971386,
-0.018191708251833916,
0.031... |
Hydrolysis\tto\tform\ndextrins\tand\nmaltose\n—\nLingual\tlipase\nTriglyceride\nHydrolysis\tto\tform\ndiglyceride\tand\nfree\tfatty\tacids\n__\nGastric\tsecretion\nfrom\tgastric\nglands\tin\nstomach\nmucosa\nPepsin\t(activated\tfrom\npepsinogen\n\tin\tthe\npresence\tof\nhydrochloric\tacid)\nProtein\nHydrolysis\tof\tpep... | [
0.000011226810784137342,
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0.01324862614274025,
0.02972443960607052,
0.06261953711509705,
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0.061566270887851715,
0.11778988689184189,
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0... |
bonds\tto\tform\npeptides\tand\namino\tacids\n—\nGastric\tlipase\nTriglyceride\nHydrolysis\tto\tform\ndiglyceride\tand\nfree\tfatty\tacids\n—\nExocrine\nsecretions\nfrom\npancreatic\nacinar\tcells,\nacting\tin\nduodenum\nLipase\nFat\t(in\tthe\tpresence\nof\tbile\tsalts)\nHydrolysis\tto\tform\nmonoglycerides\nand\tfatty... | [
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0.05405179411172867,
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0.04464954882860184,
0.10244972258806229,
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-0.03688230738043785,
0.0487... |
incorporated\tinto\nmicelles\nFatty\tacids\n\tinto\nmucosal\tcells;\nreesterified\tas\ntriglycerides\nCholesterol\testerase\nSterols\t(such\tas\ncholesterol)\nHydrolysis\tto\tform\nesters\tof\ncholesterol\tand\nfatty\tacids;\nincorporated\tinto\nmicelles\nCholesterol\tinto\nmucosal\tcells;\ntransferred\tto\nchylomicron... | [
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0.009255778044462204,
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-0.018773533403873444,
0.012110590003430843,
0.03835199773311615,
0.017850620672106743,
-0.005615310277789831,
0.12128514796495438,
-0.024402007460594177,
-0.04925050958991051,
0.0... |
α-Amylase\nStarch\tand\tdextrins\nHydrolysis\tto\tform\ndextrins\tand\nmaltose\n—\nTrypsin\t(activated\ntrypsinogen)\nProteins\tand\npolypeptides\nHydrolysis\n\tof\tinterior\npeptide\tbonds\tto\nform\tpolypeptides\n—\nChymotrypsin\t(activated\nchymotrypsinogen)\nProteins\tand\npeptides\nHydrolysis\tof\tinterior\npeptid... | [
-0.030023537576198578,
-0.10916583985090256,
-0.05190981552004814,
-0.0033607291989028454,
0.014589572325348854,
0.029229402542114258,
0.09244021028280258,
0.053871672600507736,
-0.016197748482227325,
0.045356977730989456,
0.06314151734113693,
0.019814718514680862,
-0.07840094715356827,
0.... |
peptide\tbonds\tto\nform\tpolypeptides\n—\nCarboxypeptidase\n(activated\nprocarboxypeptidase)\nPolypeptides\nHydrolysis\tof\nterminal\tpeptide\nbonds\t(carboxyl\nend)\tto\tform\namino\tacids\nAmino\tacids\nRibonuclease\tand\ndeoxyribonuclease\nRibonucleic\tacids\n(RNA)\tand\ndeoxyribonucleic\nacids\t(DNA)\nHydrolysis\t... | [
-0.0500248521566391,
-0.10128428786993027,
-0.05565010383725166,
-0.07347409427165985,
-0.027575943619012833,
0.013721666298806667,
-0.008654803968966007,
0.04501545429229736,
-0.005896491929888725,
0.08286751806735992,
0.08106756210327148,
0.00013080744247417897,
-0.07743148505687714,
0.0... |
Hydrolysis\tto\tform\nmononucleotides\nMononucleotides\nElastase\nFibrous\tprotein\n(elastin)\nHydrolysis\tto\tform\npeptides\tand\namino\tacids\n—\nSmall\tintestine\nenzymes\n(embedded\tin\nthe\tbrush\nborder\nmembrane)\nEnterokinase\nTrypsinogen\nActivates\ttrypsin\nDipeptides\tand\ntripeptides\nAminopeptidase\tand\n... | [
-0.051822759211063385,
-0.11047398298978806,
-0.005933820735663176,
-0.024937888607382774,
-0.012102658860385418,
0.0012993025593459606,
0.03221754729747772,
0.057372018694877625,
-0.014673193916678429,
0.06311430037021637,
0.08101681619882584,
-0.02053975686430931,
-0.04742816463112831,
0... |
dipeptidase\t(also\nlocated\twithin\tthe\nenterocyte\tcytosol)\nPolypeptides\nCleavage\tof\tamino\nacids\n\tfrom\tthe\namino\tterminus\tof\nprotein\t(N-\nterminus)\tor\npeptide\tsubstrates\nAmino\tacids\nSucrase\nSucrose\nHydrolysis\tto\tform\nGlucose\tand | [
-0.017297174781560898,
-0.11045536398887634,
-0.01469721831381321,
0.010194286704063416,
-0.032319534569978714,
0.014902716502547264,
0.054396852850914,
0.061762675642967224,
0.04182308167219162,
0.05545039474964142,
0.10067377239465714,
0.01380964182317257,
-0.028667012229561806,
0.051790... |
glucose\tand\nfructose\nfructose\nα-Dextrinase\n(isomaltase)\nDextrin\n(isomaltose)\nHydrolysis\tto\tform\nglucose\nGlucose\nMaltase\nMaltose\nHydrolysis\tto\tform\nglucose\nGlucose\nLactase\nLactose\nHydrolysis\tto\tform\nglucose\tand\ngalactose\nGlucose\tand\ngalactose\nNucleotidases\nNucleic\tacids\nHydrolysis\tto\t... | [
-0.057167161256074905,
-0.09608226269483566,
-0.040442392230033875,
0.010663637891411781,
-0.016249077394604683,
0.011368145234882832,
0.0011433074250817299,
0.033966775983572006,
-0.032706357538700104,
0.07516060769557953,
0.051957450807094574,
0.0007812281255610287,
-0.08694726973772049,
... |
nucleotides\tand\nphosphates\nNucleotides\nNucleosidase\tand\nphosphorylase\nNucleosides\nHydrolysis\tto\tform\npurines,\npyrimidines,\tand\npentose\tphosphate\nPurine\tand\npyrimidine\nbases\nRegulators\tof\tgastrointestinal\tactivity:\tNeural\tand\thormonal\tmechanisms\nMultiple\tlayers\tof\tsmooth\tmuscle\tcontract\... | [
-0.008296717889606953,
-0.11720699071884155,
-0.009776569902896881,
-0.055807579308748245,
-0.05599743127822876,
0.005235616117715836,
0.03830775246024132,
0.08395085483789444,
-0.04817911237478256,
0.08478730916976929,
0.05356385186314583,
0.0070611899718642235,
-0.014487724751234055,
0.0... |
along\tthe\n\tGIT.\tThese\tsmooth\tmuscle\tmovements\tare\tregulated\tby\tthe\tenteric\tnervous\tsystem\tand\nenteroendocrine\thormones\tand\tfacilitate\tmixing\tof\tchyme\tand\tdigestive\tsecretions\t(\nsegmentation\n)\nor\tpropulsion\tof\tluminal\tcontents\talong\tthe\tlength\tof\tthe\tGIT\t(\nperistalsis\n).\tTo\ten... | [
0.052454955875873566,
-0.0844259262084961,
0.035643793642520905,
0.00020995415979996324,
-0.11611701548099518,
0.017570123076438904,
0.10589495301246643,
0.024239500984549522,
0.01694156415760517,
0.049974922090768814,
0.13540203869342804,
-0.02768995799124241,
0.0272884052246809,
0.044107... |
peristalsis\n).\tTo\tenable\tsuch\ncoordinated\tactions,\tthe\tenteric\tnervous\tsystem\tis\tintegrated\tthroughout\tthe\tlining\tof\tthe\tGIT\tand\nresponds\tto\tmucosal\treceptors\n\tthat\tsense\tthe\tcomposition\tof\tchyme\tand\tdistention\tof\tthe\tlumen\t(i.e.,\nfullness)\tand\tsend\timpulses\tthat\tcoordinate\tth... | [
0.05417940393090248,
-0.09075868874788284,
0.02641054056584835,
-0.02266695536673069,
-0.12184227257966995,
-0.012725436128675938,
0.07638472318649292,
0.029567917808890343,
0.03445843234658241,
0.0837058424949646,
0.10447327792644501,
-0.002887931652367115,
0.048088788986206055,
0.0399297... |
immunity.\nNeurotransmitters\tfrom\tthe\tcentral\tnervous\tsystem\tinterface\twith\tthe\tenteric\tnervous\tsystem\tto\ncoordinate\tgastrointestinal\tfunctions\tsuch\tas\tmotility,\tsecretion,\tand\tblood\tflow.\tThe\tGIT\tthen\tlargely\nregulates\tits\town\n\tmotility\tand\tsecretory\tactivity.\tHowever,\tsignals\tfrom... | [
0.029903769493103027,
-0.06887630373239517,
0.045031480491161346,
-0.011184950359165668,
-0.09108984470367432,
0.04867412894964218,
0.08300815522670746,
0.00980105996131897,
-0.05017709359526634,
0.091013103723526,
0.08294375240802765,
-0.056287091225385666,
0.006827936507761478,
0.0706490... |
can\toverride\tthe\tenteric\tsystem\tand\taffect\tGIT\tfunction.\tHormones,\tneuropeptides,\tand\nneurotransmitters\tin\tthe\tGIT\tnot\tonly\taffect\tintestinal\tfunction\tbut\talso\thave\tan\teffect\ton\tother\nnerves\tand\ttissues\tin\tmany\tparts\tof\tthe\tbody.\tSome\texamples\tof\tneurotransmitters\treleased\tfrom... | [
0.01653803139925003,
-0.08196098357439041,
0.06466617435216904,
-0.019938316196203232,
-0.05606013908982277,
0.011263291351497173,
0.10984023660421371,
0.00881208386272192,
-0.0017572706565260887,
0.05036650598049164,
0.07368967682123184,
-0.018845628947019577,
0.048555053770542145,
0.0329... |
enteric\tnerve\tendings\tare\tlisted\tin\t\nTable\t1.2\n.\tIn\tpeople\twith\tgastrointestinal\tdisease\t(e.g.,\tinfections,\ninflammatory\tbowel\tdisease,\tirritable\tbowel\tsyndrome),\tthe\tenteric\tnervous\tsystem\tmay\tbe\noverstimulated,\tresulting\tin\tabnormal\tsecretion,\taltered\tblood\tflow,\tincreased\tpermea... | [
0.04449719190597534,
-0.09477265179157257,
0.061977140605449677,
-0.014855326153337955,
-0.10937058925628662,
-0.013706840574741364,
0.09078101068735123,
0.029444236308336258,
-0.03519018739461899,
0.05922101438045502,
0.09466970711946487,
-0.03862093761563301,
0.03266020119190216,
0.05494... |
altered\timmune\tfunction.\nTABLE\t1.2\nExamples\tof\tNeurotransmitters\tand\tTheir\tActions\nNeurotransmitter\nSite\tof\tRelease\nPrimary\tAction\nGABA\nCentral\tnervous\tsystem\nRelaxes\tlower\tesophageal\tsphincter\nNorepinephrine\nCentral\tnervous\tsystem,\tspinal\ncord,\tsympathetic\tnerves\nDecreases\tmotility,\t... | [
0.05578536167740822,
-0.12167023122310638,
0.04439730569720268,
-0.019120344892144203,
-0.14691174030303955,
0.015752039849758148,
0.0530889518558979,
0.045151300728321075,
-0.023091156035661697,
0.09803891181945801,
0.07356858998537064,
-0.03675779700279236,
-0.010236271657049656,
0.07138... |
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