Laparoscopic surgery contributes to a decrease in short-term complications in surgical ulcerative colitis patients during 2008–2017: a multicenter retrospective study in China

Background/Aims@#The aim of this study was to analyze the chronological changes in postoperative complications in surgical ulcerative colitis patients over the past decade in China and to investigate the potential parameters that contributed to the changes. @*Methods@#Ulcerative colitis patients who underwent surgery during 2008–2017 were retrospectively enrolled from 13 hospitals in China. Postoperative complications were compared among different operation years. Risk factors for complications were identified by logistic regression analysis. @*Results@#A total of 446 surgical ulcerative colitis patients were analyzed. Fewer short-term complications (24.8% vs. 41.0%, P=0.001) and more laparoscopic surgeries (66.4% vs. 25.0%, P<0.001) were found among patients who received surgery during 2014–2017 than 2008–2013. Logistic regression suggested that independent protective factors against short-term complications were a higher preoperative body mass index (odds ratio [OR], 0.870; 95% confidence interval [CI], 0.785–0.964; P=0.008), laparoscopic surgery (OR, 0.391; 95% CI, 0.217–0.705; P=0.002) and elective surgery (OR, 0.213; 95% CI, 0.067–0.675; P=0.009). The chronological decrease in short-term complications was associated with an increase in laparoscopic surgery. @*Conclusions@#Our data revealed a downward trend of short-term postoperative complications among surgical ulcerative colitis patients in China during the past decade, which may be due to the promotion of minimally invasive techniques among Chinese surgeons.

Application value of CT/MRI examination in clinical diagnosis and treatment of Crohn's disease / 中华消化外科杂志

Accurate evaluation of Crohn's disease is critical for determination of a therapeutic plan.Computed tomography (CT)/magnetic resonance imaging (MRI) can not only display the intraluminal and intraperitoneal inflammation objectively,but also reveal accurately the affected mesentery and related complications comprehensively,which attracted more and more attention in recent years.This review discussed the choice of CT/MRI examination methods,their roles in determining the severity of intestinal and mesenteric inflammation,the nature of intestinal stenosis,the extent of fistula,abscess and cellulitis,and the value in diagnosing postoperative complications,in order to investigate the application value of CT/MRI examination in clinical diagnosis and treatment of Crohn's disease.

Application value of CT/MRI examination in clinical diagnosis and treatment of Crohn′s disease / 中华消化外科杂志

Accurate evaluation of Crohn′s disease is critical for determination of a therapeutic plan. Computed tomography (CT)/magnetic resonance imaging (MRI) can not only display the intraluminal and intraperitoneal inflammation objectively, but also reveal accurately the affected mesentery and related complications comprehensively, which attracted more and more attention in recent years. This review discussed the choice of CT/MRI examination methods, their roles in determining the severity of intestinal and mesenteric inflammation, the nature of intestinal stenosis, the extent of fistula, abscess and cellulitis, and the value in diagnosing postoperative complications, in order to investigate the application value of CT/MRI examination in clinical diagnosis and treatment of Crohn′s disease.

Operation timing of severe ulcerative colitis / 中华消化外科杂志

Acute severe ulcerative colitis (ASUC) is a potentially life-threatening condition.Inappropriate salvage therapy might delay the surgery and increase the mortality and postoperative complications in ulcerative colitis (UC).Timely surgical intervention for UC is the key to reduce the rate of mortality and postoperative complications via evaluating the effect of therapy combining with characters of patients' history,clinical symptoms,biochemical markers,radiological and endoscopic criteria.

Clinical Analysis of Acute Severe Gastrointestinal Bleeding in Crohn's Disease / 胃肠病学

Background:Acute severe gastrointestinal bleeding is one of the severe complications of Crohn's disease (CD),and clinical data conceming its mechanism,characteristics and treatment are rare.Aims:To analyze the clinical characteristics and prognosis of acute severe gastrointestinal bleeding in CD.Methods:Clinical data of CD patients with acute severe gastrointestinal bleeding from January 2009 to April 2017 at Jinling Hospital were retrospectively analyzed,and the effect of various factors on rebleeding rate was analyzed.Results:Altogether 44 cases had acute severe gastrointestinal bleeding.Small intestine,ileocecum and anastomosis were the main bleeding sites,and 17 cases occurred with obscure bleeding site.History of enterectomy was found in 20 cases.Surgery was performed in 22 cases.Rebleeding occurred in 13 cases,including 11 cases within 1-year.No significant differences in rebleeding rate and 1-year rebleeding rate were found between patients received surgery and non-surgery treatment,patients with emergency surgery and selective surgery (P ＞0.05).Rebleeding rate was significantly lower in patients with bleeding site resected than in paitents with obscure bleeding stie (P ＜ 0.05),however,no significant difference in 1-year rebleeding rate was found betwwen the two groups (P =0.083).Conclusions:The incidence of acute severe gastrointestinal bleeding in CD is rather low,and the major bleeding sites are small intestine (among patients without enterectomy history) and anastomosis (among patients with enterectomy history).Surgery with bleeding site resected can decrease the recurrence of bleeding,which might be a protective factor for preventing rebleeding in CD patients.

Anti-mouse CD52antibody ameliorates colitis through suppressing Th1/17 mediated inflammation and promoting regulatory T cell response in interleukin-10 deficient mice / 中华内科杂志

In this study, we evaluated the therapeutic effects and possible mechanisms of anti-CD52 treatment on interleukin-10 (IL-10) deficient mice. Anti-mouse CD52 monoclonal antibody was administrated to C3H. IL-10-/-mice. The disease activity index, histological grading of colitis, serum Th1/17 related cytokines, percentage of CD25+Foxp3+T cells in colon as well as CD25, Foxp3 gene expression were measured. Our data suggested that anti-CD52 treatment inhibited colitis in C3H.IL-10-/-mice and it might be related to the suppression of Th1/17 related inflammation and the promotion of regulatory T cell differentiation.

Intraoperative inspection alone is a reliable guide to the choice of surgical procedure for enteroenteric fistulas in Crohn's disease

BACKGROUND/AIMS: Resection of the diseased segment and suture of the victim segment is recommended for enteroenteric fistula in Crohn's disease (CD). The main difficulty in this procedure remains reliable diagnosis of the victim segment, especially for fistulas found intraoperatively and inaccessible on endoscopic examination. We aimed to explore whether intraoperative inspection alone is reliable. METHODS: Patients undergoing conservative surgery between 2011 and 2016 for enteroenteric fistulas complicating CD were identified from a prospectively maintained database. Patients were divided according to whether the victim segment was evaluated by preoperative endoscopy + intraoperative inspection (PI group) or by intraoperative inspection alone (I group). Outcomes were compared. RESULTS: Of 65 patients eligible for the study, 37 were in in the PI group and 28 were in the I group. The baseline characteristics were similar between the groups, except for the rate of emergency surgery (0/37 in PI group vs. 5/28 in I group, P=0.012). Fistulas involved more small intestines (4/37 in PI group vs. 15/28 in I group, P 0.05). CONCLUSIONS: For fistulas found intraoperatively and inaccessible on endoscopic examination, intraoperative inspection was a reliable guide when choosing between en bloc resection and a conservative procedure.

Treatment of 21 cases of chronic radiation intestinal injury by staging ileostomy and closure operation / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To summarize the application of staged ileostomy and closure operation combined with nutritional support therapy in the treatment of chronic radiation intestinal injury(CRII).</p><p><b>METHODS</b>Clinical data of patients with definite radiation history and pathological diagnosis of CRII receiving treatment at Department of General Surgery, Jinling Hospital from January 2012 to December 2016 were retrospectively analyzed. Patients who were diagnosed with tumor recurrence during operation or by postoperative pathology were excluded. Patients undergoing stageI( ileostomy and stageII( closure operation combined with nutrition support therapy were enrolled to the cohort. Detailed scheme of stage I( ileostomy and therapeutic time were determined by clinical symptoms and nutritional status. While performing ileostomy, the removal of intestinal lesions depended on range and degree of intestinal injury. Nutritional support therapy and other symptom-relieving therapy were offered after surgery. Timing for stageII( closure operation was decided according to nutritional status of patients. Lesions of remaining intestine were determined during operation, then necessary intestinal resection and closure operation were performed. Adhesion classification of radiation intestinal injury (total five levels) proposed by our center was adopted to evaluate the level and range of intestinal lesions. Level 0 indicated no adhesion between injured intestinal loop and surrounding organs; level 1 indicated that the adhesion and fibrosis were limited to right pelvis; level 2 indicated that the adhesion included all pelvis and the adhesion was severe and difficult to divide; level 3 was the forward extension of level 2 adhesion, which was between injured intestinal loop and anterior pelvic wall; level 4 was the upward extension of level 3 adhesion, which was between injured intestinal loop and anterior abdominal wall. Clavien-Dindo classification (lower level means milder symptom) and complication comprehensive index(CCI, lower CCI means milder symptom) calculated by on-line program (http:∕∕www.assessurgery. com) were applied to estimate postoperative complications. Resected intestinal length, adhesion classification of radiation intestinal injury, postoperative complications and time to total enteral nutritional (TEN) of both surgeries and nutritional status (body mass index and serum albumin) were compared between stageI( ileostomy and stageII( closure operation.</p><p><b>RESULTS</b>Twenty-one patients were enrolled in the research with 2 males and 19 females. Primary tumor included 14 cervical cancers, 3 rectal cancers, 1 endometrial cancer, 1 ovarian carcinoma, 1 seminoma and 1 mixed germ cell tumor. Median interval between the end of radiation and radiation intestinal injury was 7(2 to 91) months and median interval between the incidence of radiation intestinal injury and ileostomy was 5(<1 to 75) months. Operative indications for ileostomy were obstruction in 14 cases (66.7%), intestinal internal fistula in 1 case (4.8%), intestinal outer fistula in 2 cases (9.5%), radiation proctitis in 3 cases (14.3%) and acute intestinal perforation in 1 case (4.8%). Average age of patients undergoing stageI( ileostomy was 48 (18 to 60) years with BMI (17.0±2.7) kg/m and serum albumin (36.8±5.2) g/L. Patients undergoing stageII( closure operation had significantly higher BMI [(18.4±2.0) kg/m, t=-2.747, P=0.013] and higher serum albumin [(40.8±3.6) g/L, t=-3.505, P=0.002]. Average interval between stageI( ileostomy and stageII( closure surgery was (197±77) days. Resected intestinal length of stageI( ileostomy was which was significantly longer than that of stageII( closure surgery [(74.0±56.1) cm vs. (15.5±10.4) cm, t=4.547, P= 0.000]. Abdominal adhesion classification of stageII( ileostomy plus closure operation was significantly better as compared to stage I( ileostomy(Z=-3.347, P=0.001). Morbidity of postoperative complications in stageI( ileostomy was 52.4% (11/21), which decreased to 19.0% (4/21) in stageII( operation with significant difference (χ²=5.081, P=0.024). Postoperative complication Clavien-Dindo classification and CCI scores in stageII( operation were significantly lower than those in stageI( operation (P=0.006 and P=0.002). Till June 2017, 17 of 21 patients(81.0%) were followed-up for (28±18) months. Except for 2 cases of relapse, 15 patients recovered to normal diet.</p><p><b>CONCLUSIONS</b>Application of staged ileostomy and closure operation combined with nutritional support therapy to CRII is in accordance with the principle of injury control surgery. Furthermore, this staged approach is safe and effective, can reduce the morbidity and the severity of complications, and can also be helpful to decide the margin for intestinal resection.</p>

Diagnostic value of exfoliative cytology for chronic oral ulcers / 临床与实验病理学杂志

Purpose To evaluate the effectiveness of exfoliative cytology in chronic oral ulcers diagnosis.Methods To examined 107 cases of chronic oral ulcers which were difficult to determine the nature of the ulcer in exfoliaticve cytology,and compared postoperative histopathological results or clinical results,and made the final diagnosis with cytology.Results The qualitative diagnostic accuracy of cytology was 95.3％.The sensitivity and specificity for benign and malignant lesions was 94.6％ and 100％,respectively.False positive rate was 0,and false negative rate was 5.4％,and the coincidence rate of cytological examination with the final pathology was 67.0％.Conclusion Exfoliative cytology has important reference value in chronic oral ulcer diagnosis.It is characterized by simple,rapid procedure and less trauma.Doctors can develop next treatment plan based on the results of exfoliative cytology.

Impact of health resources allocation on healthcare seeking behavior among inpatients in China / 中国卫生政策研究

Objective:This study aims at exploring the impact of the health resources allocation on healthcare seeking behavior of inpatients with different income in China. Methods:Data at individual level were collected from China National Health Service Surveys conducted in 2008 and 2013 , interlinked with the data of health resources in county level. Multilevel zero-inflated negative binomial regression and multilevel multinomial logit model were respec-tively used to examine the impact of the health resources allocation on inpatient visits and the influence of the choice of healthcare providers by inpatients. Results: The results show that the increase of the number of beds in primary health centers ( PHCs) and physicians in county hospitals increased inpatient visits within counties. The investments in health resources in PHCs had greater impact on improving the likelihood of inpatient visits within counties for the low-income populations than that for the high-income populations. Conclusion: Investments in health resources in PHCs are vital to improve the healthcare seeking behaviors of the low-income populations in China.

Serial Frozen Fecal Microbiota Transplantation in the Treatment of Chronic Intestinal Pseudo-obstruction: A Preliminary Study

BACKGROUND/AIMS: Chronic intestinal pseudo-obstruction (CIPO) is a serious, life-threatening motility disorder that is often related to bacterial overgrowth. Fecal microbiota transplantation (FMT) results in restoration of the normal intestinal microbial community structure. We investigated the efficacy of FMT in the treatment of CIPO patients. METHODS: Nine patients (age 18–53 years) with CIPO were enrolled in this prospective, open-label study. Patients received FMT for 6 consecutive days through nasojejunal (NJ) tubes and were followed up for 8 weeks after treatment. We evaluated the rate of clinical improvement and remission, feeding tolerance of enteral nutrition, and CT imaging scores of intestinal obstructions. Lactulose hydrogen breath tests were performed before FMT and 8 weeks after FMT to evaluate for the presence small intestinal bacterial overgrowth (SIBO). RESULTS: FMT significantly alleviated bloating symptoms, and symptoms of pain were relieved 2 weeks after FMT. Enteral nutrition administered through a NJ tube after FMT was well-tolerated by 66.7% (6/9) of patients. CT scores of intestinal obstructions were significantly reduced after FMT (P = 0.014). SIBO was eliminated in 71.0% (5/7) of patients. CONCLUSIONS: This pilot study demonstrated the safety of using FMT. FMT may relieve symptoms in selected patients with CIPO. FMT may also improve patient tolerance of enteral nutrition delivered via a NJ tube.

Consistency analysis between preoperative CT enterography and intraoperative findings in patients undergoing surgery for Crohn's disease / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the diagnostic value of preoperative CT enterography (CTE) on obstruction, fistula and abscess formation compared to intraoperative findings in patients undergoing surgery for Crohn's disease(CD), aiming to provide reference to clinical practice.</p><p><b>METHODS</b>Preoperative CTE data of 176 CD patients confirmed by clinic, endoscopy, imaging, operation and pathology at the Department of General Surgery in Nanjing Jinling Hospital from January 2013 to December 2015 were enrolled in retrospective cohort study. All the patients underwent enhanced full abdominal CT scan using SIMENS SOMATOM Definition Flash 64 row dual-source CT machine. CTE scans were performed from the dome of diaphragm to the symphysis pubis. The CT images in arterial and venous phase were reconstructed with 1.0 mm thin layer, and then processed in MMWP 4.0 workstation including multi-planar recombination, surface recombination and maximum density projection. The sensitivity, specificity, positive and negative predictive value, false negative rate and accuracy of preoperative CTE on obstruction, fistula and abscess were compared with intraoperative findings.</p><p><b>RESULTS</b>Among 176 patients, 122 were males and 54 were females with median age of 29 (18 to 65) years, median disease duration of 48 (1 to 240) months, median time interval from CT scan to operation of 16(1 to 30) days, and median body mass index of 17.8 (10.8 to 34.7) kg/m. Twenty-six cases (14.8%) had nutritional risk (NRS2002≥3); 23 cases (13.1%) had lesions limited to ileum; 19 cases (10.8%) had lesions limited to colon; 126 cases (71.6%) had simultaneous lesions of ileum and colon, and 8 cases (4.5%) had lesion in upper gastrointestinal tract. A total of 199 lesions of small intestine were identified by preoperative CTE, including 131 of obstruction (65.8%), 42 of fistula (21.1%), and 26 of abscess (13.1%), while 235 lesions were confirmed by operation, including 133 of obstruction (56.6%), 74 of fistula (31.5%), 28 of abscess (11.9%). The modification of planned surgical procedure due to unexpected intraoperative findings were found in 29(16.5%) patients. The sensitivity, specificity, positive predictive value and negative predictive value of preoperative CTE were 86.4%, 78.8%, 86.9% and 76.0% for obstruction; 83.8%, 79.1%, 67.5% and 90.4% for fistula; and 96.2%, 98.0%, 90.1% and 99.3 for abscess, respectively.</p><p><b>CONCLUSION</b>Preoperative CTE can effectively evaluate the lesions of intestinal obstruction, fistula and abscess in CD patients, with the highest accuracy of abscess, and has quite good consistency with intraoperative findings, which may be used as the first choice of imaging diagnosis of CD.</p>

Effect of a clinical pathway in patients with Crohn's disease complicated with intestinal obstruction / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the effect of a clinical pathway for Crohn disease (CD) complicated with intestinal obstruction.</p><p><b>METHODS</b>CD patients complicated with intestinal obstruction in Inflammatory Bowel Disease(IBD) Center of Jinling Hospital were enrolled. One hundred and nineteen CD patients from March 2014 to September 2015 received treatment with the clinical pathway (CP), which was developed based on medical evidence and experience of the IBD center in February 2014, as CP group. The other 108 CD patients from September 2012 to February 2014 received treatment according to the management strategy made by individual attending physician as non-CP group. Rate of operation, rate of stoma, morbidity of surgical complications, hospital stay, hospital cost, and 6-month unplanned re-admission were compared between two groups.</p><p><b>RESULTS</b>The baseline data were similar between the two group (all P > 0.05). No significant differences were noted between these the two groups in terms of rate of operation (73.9% vs. 77.8%, P = 0.605), rate of stoma (15.9% vs. 25.0%, P = 0.197), and morbidity of surgical complications (23.9% vs. 27.4%, P = 0.724). However, the mean postoperative hospital stay was shorter (10.9 d vs. 13.2 d, P = 0.000), the mean hospital cost was less (78 325 Yuan vs. 85 310 Yuan, P = 0.031) and the rate of 6-month unplanned re-admission was lower(3.4% vs. 11.1%, P = 0.035) in CP group.</p><p><b>CONCLUSION</b>Treatment based on this CP for CD patients complicated with intestinal obstruction can reduce the rate of 6-month unplanned re-admission, shorten the postoperative hospital stay and decrease the hospital cost in patients requiring surgery.</p>

Nutrition Therapy in Crohn’s Disease / 胃肠病学

Nutrition therapy is an important part of the treatment of Crohn’s disease(CD),which plays an important role in correcting malnutrition,inducing disease remission,and for the perioperative management. Nutrition therapy, especially enteral nutrition(EN),has been studied for its effect on CD. We have long been focusing on the use of nutrition therapy in the treatment of CD,especially the use of EN in the perioperative management of CD. Here,we reviewed the indications,effects,endpoints and the underlying mechanisms of preoperative nutrition therapy,through which we hope can shed light on improving the optimization of preoperative management as well as the standardization of preoperative nutrition therapy in CD.

Basic principles and goals of surgical treatment for complications of Crohn's disease / 中华消化外科杂志

Crohn's disease (CD) has gradually become a common disease in China,more and more patients need surgical treatment.But the result of operation varied,as the surgical outcome is hampered by the poor general condition of the patients and risk factors of postoperative complications.The present review has summerized the objectives and goals of surgical treatment of CD,including saving lives,relieving clinical symptoms,improving the quality of life and postponing recurrence.Based on the clinical experiences of author,the common risk factors of postoperative complications were also listed,including malnutrition,complicating infection and preoperative immunosuppressive therapy.Basic principles of surgical treatment for CD mainly consist of psycological preparation of the patients and surgeons,correcting malnutrition and nutrition risks,controlling infection and other measures.Meanwhile,the rules of surgery should be simplistic,minimally traumatic and gut-saving,and clinical pathways should be followed to improve the surgical outcomes.

Prevention and management of intestinal obstruction after gastrointestinal surgery / 中华胃肠外科杂志

Intestinal obstruction is the most common complication after gastrointestinal surgery, and will endanger the patients if not managed properly. The key to the management of intestinal obstruction includes not only the selection of treatment, but also adequate judgment of the cause, location, extent and the probability of reoperation by detailed inquiry of the history, thorough physical examination, and imaging studies, which will guide the treatment. Non-operative therapy is the mainstay of treatment for incomplete obstruction, whilebowel decompression the gut by small intestinal decompression tube, preoperative procedures including restoration of systemic homeostasis should be performed. Efforts should be made to avoid emergency laparotomy without any preparations. Procedures to avoid intestinal obstruction include all the efforts to protect the gut and the intra-abdominal viscera during laparotomy, and to clear all the foreign body and tissues by thorough lavage of the abdominal cavity with saline before closing the abdomen.

Outcomes of laparoscopy combined with enhanced recovery pathway for Crohn's disease: a case-matched analysis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare short-term outcomes of laparoscopic vs. open intestinal resection in patients with Crohn's disease (CD) under enhanced recovery after surgery(ERAS) program.</p><p><b>METHODS</b>Clinical data of 51 CD patients receiving laparoscopic surgery under ERAS program at our IBD center between January 2013 and March 2014 were retrospectively analyzed. Laparoscopic cases were matched to those undergoing open surgery from June 2011 to December 2012 with age, gender, location and behavior of disease. Intraoperative and postoperative data were collected.</p><p><b>RESULTS</b>Fifty-one laparoscopic cases were matched with 51 open cases. Laparoscopic group had a shorter median length of postoperative hospital stay (7 d vs. 9 d, P=0.034), shorter median time to first passage of gas(45 h vs. 59 h, P=0.024), shorter time to bowel movement(58 h vs. 76 h, P=0.018), less intraoperative estimated blood loss (35 ml vs. 75 ml, P=0.034) and longer median operative time (145 min vs. 105 min, P=0.003). Postoperative complications, reoperation and 30-day re-admission rates were similar and there was no mortality in the two groups.</p><p><b>CONCLUSION</b>Laparoscopic surgery is a safe and acceptable option for CD patients, and it promotes recovery of gastrointestinal movement and shortens postoperative hospital stay.</p>

Implementation and effect of home enteral nutrition in outpatients with Crohn's disease / 中华临床营养杂志

Objective To guide the implementation of home enteral nutrition (EN) for outpatients with Crohn's disease, and to observe its effect.Methods In this observational study, 26 patients at active period of Crohn's disease were collected between April 2014 and June 2015 in the clinic of Clinical Nutrition Center of Nanjing General Hospital of Nanjing Military Command.Home EN combined with medication was administered.The nutritional status, Crohn's Disease Activity Index (CDAI), and quality of life before and after EN were compared.Results After home EN therapy, body mass index (BMI) of the patients increased from (17.7 ± 2.1) kg/m2 to (19.8 ± 2.0) kg/m2 (P ＜ 0.001), proportion of lymphocytes from (0.216 ± 0.066) to (0.305 ± 0.106) (P =0.007), albumin level from (40.3 ± 5.9) g/L to (43.7 ± 5.4) g/L (P =0.038), prealbumin from (233.1 ± 71.5) mg/L to (306.0 ± 72.1) mg/L (P =0.009), and transferrin from (2.7 ± 0.6) g/L to (3.1 ±0.7) g/L (P =0.038).In the indicators reflecting the activity of Crohn's disease, CDAI declined from 197.0 ±55.8 to 113.2 ±33.4 (P ＜0.001) after EN, C-reactive protein from 28.50 (18.00-32.80) mg/L to 2.00 (0.58-6.33) mg/L (P ＜0.001), erythrocyte sedimentation rate from (29.6 ± 9.9) mm/h to (9.4 ± 7.6) mm/h (P ＜ 0.001).The patient's disease activity scores and inflammatory reaction indexes all reached the normal levels after EN, show that the patients were in remission stage.In inflammatory bowel disease quality of life score, the score of intestinal symptoms rose from 41.2 ± 13.3 to 57.0 ±9.6 (P ＜ 0.001), the score of systemic symptom from 20.7 ± 5.5 to 28.9 ± 4.2 (P ＜ 0.001), emotional ability from 43.6±16.1 to 61.0 ± 15.9 (P=0.002), and social ability from 20.6 ±4.9 to 28.4 ±5.6 (P＜0.001), all showing statistical significance.Conclusions Standardized home enteral nutrition in patients at active period of Crohn's disease, when implemented under professional guidance of nutritional support team and well followed up, may improve nutritional status, induce remission, and improved quality of life.

Impacts of health care alliance on the visiting rate of NRCMS patients within the county:Case study of Huangzhong county, Qinhai province / 中国卫生政策研究

Objective:After examining the changes in medical expenses and flows of hospitalized patients with-in and outside the county under the New Rural Cooperative Medical Scheme ( NRCMS ) before and after the imple-mentation of health care alliance reform, this paper analyzes the impacts of health care alliance reform on the visiting rate of NRCMS patients within the county and explores their causes and channels. Methods:This paper uses the hos-pitalization data of NRCMS patients in 2013 and 2014 collected from Huangzhong county Qinghai province and inter-views with key informants and analyzes the hospitalization expenses, visiting flows and other indicators of patients. Results:After starting health care alliance reform, the total number of hospitalized patients to seek treatment outside the county decreased by 6 . 38%, the total hospitalization expenses to seek treatment outside the county decreased by 22 . 13%, and the hospitalization expenses per inpatient day to seek treatment within and outside the county increased by 14. 41% and 20. 69% respectively. Conclusions: By improving service capabilities of township health centers and increasing synergies between county-township-village health institutions, the county health care alliance reform has suc-cessfully enhanced the service capabilities of health care systems in the whole county and reasonably helped patients with common diseases to be hospitalized outside the county and frequently hospitalized people to return back to the county.

The practice of health care alliance in Huangzhong county, Qinghai province / 中国卫生政策研究

The fragmentation of health care system within a county and serious capacity constraints of health-care services in township health centers are generally the most significant problems facing underdeveloped counties in western China. Under constraints of limited public financial resources, how to increase service capability of township health centers and improve service quality, continuity and convenience of health care system has become one of the most severe challenges in implementing China’s county health care system reform. This paper takes Huangzhong coun-ty, Qinghai province as a case study. It investigates how the locals use health care alliance to vertically integrate county health care resources during reform implementation, analyzes various aspects of reform measures and the corre-sponding structural characteristics such as the integration of administrative management, integration of human re-sources, dual diagnosis referral, interoperability of information systems, sharing of resources and test results, etc. , and provides similar China’s counties with a case study to be used for reference.