Health-related quality of life of patients with Crohn′s disease: A meta synthesis of qualitative studies / 医学研究生学报

Objective The article aimed to identify health-related quality of life(HRQOL) themes of patients with Crohn's disease(CD) and establish a HRQOL model by a meta synthesis of qualitative studies on CD patients′ HRQOL. Methods A retrieval of HRQOL-related qualitative studies on CD patients was conducted in databases including DirectPsycINFO, VIP, etc and the results were integrated by integrating method. Results A total of 8 researches were included to refine 44 results which were integrated into 15 themes. The themes were further grouped into 6 HRQOL domains: physical function, psychological function, social function, study and work skills, sexual function, perception of health and well-being. Conclusion HRQOL themes of CD have been identified and a preliminary HRQOL concept model has been established, which will provide a reference for the development of HRQOL evaluation tools in CD patients.

Berberine Prevents Intestinal Mucosal Barrier Damage During Early Phase of Sepsis in Rat through the Toll-Like Receptors Signaling Pathway

Our previous study has shown berberine prevents damage to the intestinal mucosal barrier during early phase of sepsis in rat through mechanisms independent of the NOD-like receptors signaling pathway. In this study, we explored the regulatory effects of berberine on Toll-like receptors during the intestinal mucosal damaging process in rats. Male Sprague-Dawlay (SD) rats were treated with berberine for 5 d before undergoing cecal ligation and puncture (CLP) to induce polymicrobial sepsis. The expression of Toll-like receptor 2 (TLR 2), TLR 4, TLR 9, the activity of nuclear factor-kappa B (NF-kappaB), the levels of selected cytokines and chemokines, percentage of cell death in intestinal epithelial cells, and mucosal permeability were investigated at 0, 2, 6, 12 and 24 h after CLP. Results showed that the tumor necrosis factor-alpha (TNF-alpha ) and interleukin-6 (IL-6) level were significantly lower in berberine-treated rats compared to the control animals. Conversely, the expression level of tight junction proteins, percentage of cell death in intestinal epithelial cells and the mucosal permeability were significantly higher in berberine-treated rats. The mRNA expression of TLR 2, TLR 4, and TLR 9 were significantly affected by berberine treatment. Our results indicate that pretreatment with berberine attenuates tissue injury and protects the intestinal mucosal barrier in early phase of sepsis and this may possibly have been mediated through the TLRs pathway.

Influence of preoperative nutritional support on surgical outcomes of chronic radiation enteritis patients complicated with intestinal obstruction / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of preoperative nutritional support in the management of patients with chronic radiation enteritis (CRE) with intestinal obstruction undergoing resectional surgery.</p><p><b>METHODS</b>Clinical data of 158 CRE patients undergoing diseased bowel resection from 2001 to 2011 were analyzed retrospectively. A total of 130 patients received preoperative nutritional support, including 28 patients with enteral nutrition support, 60 patients with total parenteral nutrition support, and 42 patients with combined nutritional support. The nutritional parameters, procedures, operation-related complications, and postoperative hospital stay were recorded.</p><p><b>RESULTS</b>After aggressive nutritional support in 130 patients, patients nutritional index, such as serum prealbumin, transferrin, serum albumin improved significantly preoperatively, while the change of body mass index and hemoglobin was not significant. Compared to those without preoperative nutritional support, those who received preoperative nutritional support had lower stoma rate (31.5% vs. 53.6%, P=0.027), less postoperative infection rate (13.8% vs. 32.1%, P=0.019), shorter postoperative hospital stay [(14.1±7.3) d vs. (18.8±15.8) d, P=0.013). Enteral nutrition group had less postoperative infection rate (7.1% vs. 21.7%, P=0.017), lower stoma rate (28.6% vs. 48.3%, P=0.02), and shorter postoperative hospital stay [(15.5±9.6) d vs. (21.7±19.0) d, P=0.025) as compared to total parenteral nutrition group.</p><p><b>CONCLUSIONS</b>Preoperative nutritional support can decrease the stoma rate, postoperative infection rate, and shorten hospital stay in CRE patients complicated with intestinal obstruction. If tolerated, enteral nutrition support should be chosen.</p>

Surgical treatment for idiopathic abdominal cocoon / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate diagnosis and treatment of abdominal cocoon.</p><p><b>METHODS</b>Clinical data of patients received treatment for abdominal cocoon from January 2000 to January 2011 was retrospectively analyzed.</p><p><b>RESULTS</b>A total of 67 patients underwent treatment in our hospital were analyzed, the preoperatively diagnosis rate was only 47.8% (32/67). Patients who received preoperatively nutrition support have a lower postoperative complication (8/27 vs.13/20, χ(2) = 5.815, P < 0.05) and patients with less extent of intestine involved had a lower early postoperative inflammatory ileus (EPII) rate (9/25 vs. 1/22, χ(2) = 6.912, P < 0.05) when compared with large extent.</p><p><b>CONCLUSIONS</b>Appropriate perioperative management play an important role in the prognosis of abdominal cocoon. The main treatment is surgery while preoperatively nutrition support can reduce postoperative complications.</p>

Impact of disease activity on postoperative recurrence and complications after bowel resection for Crohn's disease / 中华外科杂志

<p><b>OBJECTIVE</b>To determine whether the perioperative disease activity is associated with recurrence and complications after bowel resection for Crohn's disease (CD).</p><p><b>METHODS</b>Clinical data of patients underwent bowel resection for CD at the Nanjing General Hospital of Nanjing Military Command from January 2002 to January 2011 was retrospectively analyzed. Postoperative recurrence and complications in patients with active disease were compared with those in patients with remission.</p><p><b>RESULTS</b>A total of 90 patients underwent bowel resection for CD, active disease were seen in 43 patients at the time of surgery, while the rest 47 patients were in remission. The postoperative cumulative endoscopic recurrence rate was 8.5% at 1 year, 27.7% at 2 years and 44.7% at 3 years in the patients with remission, and was 27.9% at 1 year, 37.2% at 2 years and 53.5% at 3 years in patients with active disease. Data indicated the endoscopic recurrence were statistically significant in the first year after surgery (χ² = 4.605, P = 0.032). Additional, the postoperative complication rates in patients with remission (14.9%) was significantly lower than that in patients with active disease (51.2%) (χ² = 6.979, P < 0.001).</p><p><b>CONCLUSION</b>Patients with active disease at the time of surgery were encountered with early postoperative recurrence and increased complications after intestinal resection for CD.</p>

Damage control surgery for acute mesenteric ischemia / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To examine the outcome of damage control surgery (DCS) in patients with acute mesenteric ischemia (AMI).</p><p><b>METHODS</b>Clinical data of 15 consecutive AMI cases treated with DCS from May 2001 to March 2009 at the Research Institute of General Surgery, Jinling Hospital were retrospectively analyzed. Eleven patients had acute superior mesenteric vein thrombosis (MVT) on admission, and 4 suffered from acute mesenteric arterial embolism/thrombosis (MAE/MAT). The staged damage control approach included immediate resection of the involved bowel (but no attempts to restore gastrointestinal continuity), open thrombectomy, transfer of the patients to ICU for resuscitation, and thrombolysis prior to the planned definitive reconstructive procedure.</p><p><b>RESULTS</b>Of 15 patients, 10 (66.7%) survived. The mean remnant small bowel length was (209.0+/-53.8) cm (120 to 280 cm). None of the survived patients was parenteral nutrition-dependent. Of the 5 deaths, 2 died of recurrence of thrombosis and necrosis of the remaining bowel,1 of massive gastrointestinal bleeding. One patient abandoned treatment intra-operatively, and another with total small bowel resection abandoned treatment postoperatively.</p><p><b>CONCLUSIONS</b>Damage control approach improves the survival of patients with AMI. Thrombectomy and thrombolysis are necessary for AMI management to prevent progression or further development of the thrombosis.</p>

Effects of perioperative combined nutritional support in Crohn disease / 中华外科杂志

<p><b>OBJECTIVE</b>To observe the efficacy of perioperative combined nutritional support in patients with Crohn disease.</p><p><b>METHODS</b>From January 2000 to June 2008, 165 patients with Crohn disease receiving perioperative nutritional support were included in this retrospective analysis. The patients were divided into three groups according to the ways of nutritional support: total enteral nutrition group, total parenteral nutrition group and combined nutrition group; there were 55 patients in each group. Each group had the same treatment except for nutritional support. The efficacy of different approaches of nutritional support was analyzed and compared among the groups.</p><p><b>RESULTS</b>Compared with total enteral and total parenteral nutrition, combined nutrition supplied more sufficient energy, the nutritional status improved more significant in short time; pre-albumin, transferrin, lymphocytes and platelet count increased significantly. The disease remission rate in combined nutrition group was 80.0%, better than 76.4% in total enteral nutrition group and 74.5% in total parenteral nutrition group. The morbidity rate was 10.9% in combined nutrition group, and it was lower than that in total enteral nutrition group and total parenteral nutrition group (25.4% and 18.2%, respectively). The length of hospital stay was shorter and the treatment was more cost-effective in combined nutrition group.</p><p><b>CONCLUSION</b>For patients with Crohn disease, perioperative combined nutritional support is more efficient than total enteral or parental nutrition support.</p>

Therapeutic effects of combined enteral nutrition with Tripterygium Wilfordii poly-glycoside in remission induction of active adult Crohn's disease / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the potential role of enteral nutrition (EN) combined with Tripterygium Wilfordii Poly-glycoside (TWP) for remission induction of active adult Crohn's disease (CD).</p><p><b>METHODS</b>Clinical data of 62 adult patients with active CD treated with EN and TWP in combination (n = 42) or TWP alone (n = 20) from March 2001 to September 2008 were retrospectively analyzed. All the patients had a Crohn's Disease Activity Index (CDAI) > 150 and < 450. In TWP group, subjects received TWP tablets (1.0 - 1.5 mg x kg(-1) x d(-1)) with uncontrolled diets; while in the group of combination therapy, the patients were given total enteral nutrition (TEN) through tube feeding in addition to TWP tablets. Clinical response was defined by a decrease of at least 70 points in the CDAI from baseline after treatment, and clinical remission was defined as the absolute value of CDAI (less than 150). Patients' nutritional and disease activity index, such as CDAI score, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), were determined at 0, 4, and 12 weeks after treatment.</p><p><b>RESULTS</b>The ratio of clinical response (78.6% vs. 40.0%, P = 0.003) and clinical remission (69.1% vs. 30.0%, P = 0.004) were both significantly higher in the combined treatment group than in those the TWP group at week 4. At week 12, the clinical response ratio was significantly higher in the combined treatment group (90.5% vs. 65.0%, P = 0.014); the remission ratio was also higher in the combined treatment group (76.2% vs. 55.0%, P = 0.091). The nutritional parameters improved from baseline at week 4 and 12 in the combined treatment group but not in TWP group. At week 4, blood albumin, prealbumin, and transferrin levels was higher in the combined treatment group than those in TWP group (P < 0.05); at week 12, patients in combined treatment group also had significantly higher body mass index (BMI), blood albumin, prealbumin, transferrin and hemoglobin levels (P < 0.05).</p><p><b>CONCLUSIONS</b>Treatment with enteral nutrition and TWP in combination are superior to TWP alone for induction of clinical response and remission in adult Crohn's Disease. This strategy also improves patient's nutritional status and avoids the adverse effects of traditional therapy.</p>

Serum citrulline: a potential marker for intestinal epithelial mass and absorption capacity in short bowel syndrome patients / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the potential role of serum citrulline level in evaluating the intestinal absorptive area and capacity in patients with short bowel syndrome (SBS).</p><p><b>METHODS</b>Serum citrulline concentration was determined using high performance liquid chromatography (HPLC) in SBS patients (n=22) and healthy controls (n=33). In SBS patients, the remnant small bowel lengths and diameters were measured by radiography, and their 5- hour urine D- xylose excretion and intestinal protein absorption were also determined. The correlationship of serum citrulline level with remnant small bowel length, surface area, protein and D- xylose absorption was analyzed. The 6 patients receiving intestinal rehabilitative therapy, serum citrulline level, protein and D- xylose absorption after therapy were also measured.</p><p><b>RESULTS</b>Serum citrulline level of SBS patients was significantly lower than that of healthy controls [(5.94+/- 2.65) vs [(16.87 +/- 5.97) micromol/L, P < 0.01]. In SBS patients, serum citrulline was positively correlated with remnant small bowel length and surface area (r=0.82 and r=0.86 respectively). There was also a significant correlationship of serum citrulline level with 5- hour D- xylose excretion (r=0.56) and intestinal protein absorption (r=0.48). Serum citrulline, 5- hour D- xylose excretion and intestinal protein absorption were all significantly raised in patients after rehabilitative therapy, although no correlation of increasing percentage was found among above three parameters.</p><p><b>CONCLUSIONS</b>Serum citrulline concentration is positively correlated with intestinal absorptive area and capacity in SBS patients. It is a potential marker for evaluating the severity of intestinal failure and the efficacy of rehabilitative therapy in short bowel patients.</p>

Experience on enteral nutrition in short bowel syndrome / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the significance, effects and precautions of enteral nutritional support in patients with short bowel syndrome (SBS).</p><p><b>METHODS</b>Clinical data of 40 SBS patients who were maintained on enteral nutrition (EN) for more than 2 years were retrospectively summarized. The cost of EN and parenteral nutrition (PN), the PN-free duration, and the current nutritional status of these patients were analyzed.</p><p><b>RESULTS</b>The mean length of the remnant small bowel was (50.8 +/- 29.4) cm. All the patients currently lived on high-carbohydrate low-fat diet supplemented with EN (3284.0 +/- 1408.8) kJ/d, the cost was significantly lower than that of PN (P < 0.01). Mean PN-free duration was (29.1 +/- 9.2) months for these patients. The current defecation frequency and volume were (3.4 +/- 1.7) times/d and (720.2 +/- 350.3) ml/d, respectively. As for the patients' nutritional index, mean BMI, blood hemoglobin and serum albumin level were (17.8 +/- 3.2) kg/m(2), (113.3 +/- 14.8) g/L and (35.0 +/- 4.1) g/L, respectively.</p><p><b>CONCLUSIONS</b>Enteral nutrition is a cost-effective method for maintaining the nutritional status in patients with short bowel syndrome, but proper management in clinical practice to avoid diarrhea or other complications should be ensured.</p>