The effect of stoma education class on peristomal dermatitis in colorectal cancer patients with defunctioning ileostomy-a retrospective study of 491 patients.

BACKGROUND: Ileostomy was widely used during colorectal cancer (CRC) surgery and peristomal dermatitis was one of the most common stoma-relative complications. Stoma education class may reduce the rate of peristomal dermatitis. METHODS: We enrolled patients who were diagnosed with rectal cancer and underwent surgery with ileostomy between January 2018 to December 2018 at a single tertiary hospital. The general demographic information of patients along with the participation in stoma education class and the occurrence of peristomal dermatitis were analyzed. RESULTS: A total of 491 patients were included in the study, and 162 patients (32.99%) participated in the stoma education class. Eighty-five patients (17.31%) suffered peristomal dermatitis within one month after ileostomy. The rate of peristomal dermatitis in the stoma education group was significantly lower than that in the control group (11.11% vs. 20.36%, P=0.011). Regardless of the education level, the risk of peristomal dermatitis in the education group was reduced (P<0.05). Lower peristomal dermatitis rates were found in patients who were younger than 60 years (P=0.012), whose stoma were taken care of by other people (P=0.014), or without diabetes (P=0.026). Univariate and Multivariate analysis showed that stoma education was the only factor associated with the decrease in rates of peristomal dermatitis (OR =0.458, P=0.008), while diabetes was an independent risk factor (OR =3.732, P<0.001). CONCLUSIONS: Postoperative stoma education class significantly decreased the rate of peristomal dermatitis in the early postoperative period in CRC patients with ileostomy, especially for those who were younger than 60 years, received stoma care from others or without diabetes.

Association of tumor differentiation and prognosis in patients with rectal cancer undergoing neoadjuvant chemoradiation therapy.

BACKGROUND AND OBJECTIVE: Neoadjuvant chemoradiation therapy (NCRT) followed by radical resection has been a common practice for patients with locally advanced rectal cancer. This study aimed to analyse the association of tumor differentiation and prognosis in rectal-cancer patients undergoing NCRT. METHODS: Patients with locally advanced, non-mucinous rectal cancer who underwent NCRT followed by radical resection between 2007 and 2017 were identified from an electronic health record system at the Sixth Affiliated Hospital of Sun Yat-sen University (Guangzhou, China). Multivariable logistic regression and multivariate Cox regression were performed to analyse the association of response to NCRT and survival with clinicopathological characteristics of all these patients. RESULTS: We identified 325 patients (241 males and 84 females; mean age, 54.4 ± 11.2 years) who underwent NCRT followed by radical resection, including 26 (8.0%) with poorly-differentiated rectal cancer, 182 (56.0%) with moderately-differentiated cancer and 117 (36.0%) with well differentiated cancer. Propensity score matching analysis and multivariable logistic regression analysis results showed that tumor differentiation was significantly associated with response to NCRT. In the poor differentiation and non-poor differentiation groups, the 3-year overall survival (OS) rates were 74.6 and 93.5%, respectively, whereas the 3-year local recurrence rates were 18.6 and 3.7%, respectively. Multivariable Cox regression analyses revealed that poor differentiation was an independent risk factor for local recurrence and OS. CONCLUSIONS: Among the patients with locally advanced, non-mucinous rectal cancer, the patients with poorly-differentiated cancer who underwent NCRT had a worse response to NCRT and poorer prognosis than those with moderately- and well-differentiated diseases.

Application value of nursing intervention combined with early nutritional support in preventive stoma reversion of low rectal cancer.

Application value of nursing intervention combined with early nutritional support treatment in preventive stoma reversion of low rectal cancer was explored. Ninety-two cases of low rectal cancer patients undergoing preventive stoma reversion from January 2014 to December 2016 were retrospectively analyzed. All the patients had closed fistula 3 months after neostomy. Forty-four cases with routine nursing care were the control group; 48 cases with early nutritional support and nursing intervention were the experimental group. Nutritional status, psychological status, incidence of adverse reactions, wound infection rate, number of shaped and regular defecation were compared in the two groups. The levels of albumin, prealbumin and serum total protein in the experimental group were significantly higher than those in the control group after operation (P<0.05); the levels of albumin in the two groups after operation were significantly lower than those before operation (P<0.001). The SAS and SDS scores in the experimental group were significantly lower than those in the control group after operation (P<0.001); the SAS and SDS scores in the two groups after operation were significantly lower than those before operation (P<0.001). The number of abdominal pain, abdominal distention, diarrhea, incision infection and abdominal infection in the experimental group were less than those in the control group (P<0.05). The number of shaped and regular defecation cases in the experimental group was more than that in the control group (P<0.05). Nursing intervention combined with early nutritional support can improve the nutritional status, psychological anxiety-depression of the patients undergoing preventive stoma reversion, decrease the incidence of adverse reactions, and wound infection rate. It can also increase the shaped and regular defecation cases and is helpful for the recovery of intestinal function.

MicroRNA-143 Targets ATG2B to Inhibit Autophagy and Increase Inflammatory Responses in Crohn's Disease.

Background: Dysfunctional autophagy is recognized as a contributing factor in many chronic inflammatory diseases, including Crohn's disease (CD). Genetic analyses have found that microRNA (miRNA) levels are altered in the intestinal tissues of CD patients. Methods: The Sequencing Alternative Poly-Adenylation Sites (SAPAS) method was used to compare the 3' end of the total mRNA sequence of 3 surgical specimens of CD patients (including inflamed tissues and corresponding noninflamed tissues in each case). The levels of autophagy-related 2B (ATG2B), LC3, and miR-143 were compared between inflamed tissues and noninflamed tissues using immunoblot and quantitative reverse transcription polymerase chain reaction. Luciferase assays were used to verify the interactions between miR-143 and ATG2B. Autophagy was measured by immunoblot analyses of LC3 and transmission electron microscopy. Inflammatory cytokines and IκBα were analyzed to evaluate the effect of miR-143 on inflammatory response. Results: The tandem repeat 3'-UTR of ATG2B was longer in inflamed tissues than in corresponding noninflamed tissues and contained an miR-143 target site. miR-143 expression was elevated, whereas ATG2B and LC3-II were downregulated in inflamed tissues. The direct interaction between miR-143 and ATG2B was verified by a 3'-UTR dual-luciferase reporter assay. Constitutive expression of miR-143 or depletion of ATG2B in cultured intestinal epithelial cells inhibited autophagy, reduced IκBα levels, and increased inflammatory responses. Conclusions: miR-143 may induce bowel inflammation by regulating ATG2B and autophagy, suggesting that miR-143 might play a critical role in the development of CD. Therefore, miR-143 could be a promising novel target for gene therapy in CD patients.

Preoperative Percutaneous Drainage of Spontaneous Intra-Abdominal Abscess in Patients With Crohn's Disease: A Meta-Analysis.

GOALS: We aimed to compare clinical outcomes between percutaneous drainage (PD) with or without further elective surgery and initial surgery for patients with Crohn's disease (CD)-related spontaneous intra-abdominal abscess. BACKGROUND: Intra-abdominal abscess is common in patients with CD leading to significant morbidity. The role of PD before abdominal surgery in patients with CD remains controversial. STUDY: We performed a meta-analysis comparing PD and surgery as the initial approach to CD-related spontaneous intra-abdominal abscess. Overall complication and recurrent abscess were assessed. Subgroup analyses on initial PD were performed including preoperative PD and PD alone. RESULTS: A total of 9 studies including 513 patients with CD-related spontaneous intra-abdominal abscesses were included. The overall complication rate was significantly higher in patients undergoing initial surgery compared with those undergoing initial PD [odds ratio (OR)=0.58; 95% confidence interval (CI), 0.35-0.96; P=0.03]. In a subgroup analysis, preoperative PD was associated with a significant reduction in overall complication (OR=0.44; 95% CI, 0.23-0.83; P=0.01) as compared with initial surgery. The risk for recurrent abscess was higher in patients who underwent PD alone than those who underwent initial surgery (OR=2.16; 95% CI, 1.03-4.54; P=0.04). No significance difference in postoperative recurrent abscess was found between preoperative PD group and initial surgery group. CONCLUSION: Although abdominal surgery appeared to be inevitable in the majority of the patients with CD who develop intra-abdominal abscess, preoperative PD may decrease overall complication after surgery.