Enteral nutrition combined with glutamine promotes recovery after ileal pouch-anal anastomosis in rats

Application of individualized nutrition support for adults with Stanford A aortic dissection

OBJECTIVES

Aortic dissection is a serious aortic pathological changes. Although the surgical technique for aortic dissection continues to improve, postoperative mortality and surgical complications are still high. This study aims to explore the effect of individualized nutritional support for the adult Stanford A aortic dissection.

METHODS

A total of 60 patients with Stanford A aortic dissection, who were treated in the Department of Cardiovascular Surgery at the First Affiliated Hospital of University of Science and Technology of China from January 2019 to February 2020, were selected. The subjects were divided into a control group (n=29) and an observation group (n=31) by random number table method. The control group received routine nutritional support, and the observation group received individualized nutritional support since the 1st day after surgery. The levels of serum nutritional indexes [albumin (Alb), prealbumin (PAB), hemoglobin (Hb), transferrin (TF)], immune function indexes [immunoglobulin G (IgG), immunoglobulin M (IgM), immunoglobulin A (IgA)], and inflammatory factors [tumor necrosis factor-α (TNF-α), interleukin-10 (IL-10), procalcitonin (PCT)] on the first day, the 5th day, and the 10th day after surgery were detected by Roche biochemical analyzer, immunoassay analyzer, and microplate reader, respectively. The acute physiology and chronic health evaluation II (APACHEII) was used to evaluate the prognosis on the first day, the 5th day, and the 10th day after surgery, and the incidence of complications was observed in the 2 groups.

RESULTS

There were significant differences between the 2 groups in Alb, PAB, Hb, TF, IgG, IgM, IgA, TNF-α, IL-10, and PCT (all P<0.01), and there were also significant differences in the APACHEII, the time factor and the group factor (all P<0.01). On the 5th day and the 10th day after surgery, the levels of Alb, PAB, Hb, TF, IgG, IgM and IgA were higher, and the levels of TNF-α and IL-10 while the scores of PCT and APACHEII were lower in the observation group than those in the control group (all P<0.01). The incidence of complications in the observation group was significantly lower than that in the control group (P<0.05).

CONCLUSIONS

For patients with Stanford A aortic dissection undergoing surgery, the postoperative individualized nutrition support can not only significantly improve nutritional level and immune function, but also effectively reduce levels of postoperative inflammatory factors, which is beneficial to their rapid recovery and has positive clinical significance for reducing postoperative complications and improving prognosis.

Bioinformatics Analysis of Differentially Expressed Genes and Protein-Protein Interaction Networks Associated with Functional Pathways in Ulcerative Colitis

Background

This bioinformatics study aimed to identify differentially expressed genes (DEGs) and protein–protein interaction (PPI) networks associated with functional pathways in ulcerative colitis based on 3 Gene Expression Omnibus (GEO) datasets.

Material/Methods

The GSE87466, GSE75214, and GSE48958 MINiML formatted family files were downloaded from the GEO database. DEGs were identified from the 3 datasets, and volcano maps and heat maps were drawn after R language standardization and analysis, respectively. Venn diagram software was used to identify common DEGs. PPI analysis of common DEGs was performed using the Search Tool for the Retrieval of Interacting Genes. Gene modules and hub genes were visualized in the PPI network using Cytoscape. Enrichment analysis was performed for all common DEGs, module genes, and hub genes.

Results

A total of 90 DEGs were selected, which included 3 functional modules and 1 hub gene module. CXCL8 module genes were mainly enriched in cytokine-mediated signaling pathways and interleukin (IL)-10 signaling. CCL20 module genes were mainly enriched in the IL-17 signaling pathway and cellular response to IL-1. Hub gene modules mainly involved IL-10, IL-4, and IL-13 signaling pathways. CXCL8, CXCL1, and IL-1β were the top 3 hub genes and were mainly involved in IL-10 signaling.

Conclusions

Bioinformatics analysis using 3 GEO datasets identified CXCL8, CXCL1, and IL-1β, which are involved in IL-10 signaling, as the top 3 hub genes in ulcerative colitis. The findings from this study remain to be validated, but they may contribute to the further understanding of the pathogenesis of ulcerative colitis.

Feasibility and efficacy of home rectal irrigation in neonates and early infancy with Hirschsprung disease

PURPOSE

A single-stage pull-through (SSPT) is the most commonly performed procedure for Hirschsprung disease (HSCR) and has been shown to be better than multi-stage procedures. However, performing a SSPT in the neonatal period or early in infancy is a risk factor for an inaccurate diagnosis, post-operative enterocolitis, and a protracted post-operative recovery. The present study was primarily designed to evaluate the feasibility and efficacy of home rectal irrigation in the neonatal period and early in infancy, followed by a delayed and planned SSPT in a prospective cohort with HSCR.

METHODS

Between January 2014 and December 2016, a total of 147 neonates diagnosed with HSCR were enrolled in the study. Six patients were excluded as a result of ganglion cells found in second rectal biopsies after the neonatal period. One hundred twenty-two patients successfully underwent 2-4 months of home rectal irrigation during the neonatal period, followed by a SSPT procedure after the neonatal period (group A, n = 122). Nineteen patients were not candidates for home rectal irrigation, and thus, colostomies were performed during the neonatal period followed by multi-stage procedures after the neonatal period (group B, n = 19). One hundred twenty-two healthy children, age- and gender-matched to group A were enrolled as the healthy control group for assessment of nutrition status (group C, n = 122). The birth weight, gender ratio, aganglionic segment, age, and Hirschsprung-associated enterocolitis (HAEC) score at the time of HSCR diagnosis were measured to evaluate the feasibility of home rectal irrigation in neonates and early in infancy. The nutritional indices, including weight, body length, serum albumin, serum prealbumin, serum retinol-binding protein, and incidence of HAEC after 2-4 successful home rectal irrigation, were used to assess the efficacy of home rectal irrigation. Anastomotic strictures or leakage, perianal excoriation, frequency of defecation, and morbidity of post-operative HAEC were recorded to evaluate the beneficial effects to pull through (PT), which were facilitated by home rectal irrigation.

RESULTS

Higher HAEC scores and older age at the time of diagnosis of HSCR were associated with group B, compared to group A (4.34 ± 1.25 vs. 11.0 ± 2.56 [t = 18.20, p < 0.05] and 2.8 ± 1.46 days vs. 12.1 ± 5.3 days [t = 16.10, p < 0.05], respectively). The ratio of rectosigmoid HSCR to non-rectosigmoid HSCR was higher in group A than group B (104/18 vs. 4/15 [χ² = 34.29, p < 0.05]). There were no differences in birth weight, weight at the time of diagnosis of HSCR, and gender ratio between groups A and B. There were no differences in birth weight, birth length, post-home rectal irrigation age, post-home rectal irrigation weight, post-home rectal irrigation length, and post-home rectal irrigation serum albumin between groups A and C (3.47 ± 0.42 kg vs. 3.48 ± 0.40 kg [t = 0.10, p > 0.05], 50.02 ± 0.49 cm vs. 50.05 ± 0.46 cm [t = 0.61, p > 0.05], 98.59 ± 13.34 days vs. 97.83 ± 13.58 days [t = 0.44, p > 0.05], 6.77 ± 0.66 kg vs. 6.97 ± 0.87 kg [t = 1.95, p > 0.05], 61.55 ± 2.14 cm vs. 61.70 ± 2.07 cm [t = 0.59, p > 0.05], and 41.78 ± 2.42 g/L vs. 41.85 ± 2.37 g/L [t = 0.22, p > 0.05], respectively). The rate of HAEC in the period of home rectal irrigation in group A was low; however, the post-home rectal irrigation serum prealbumin level and retinol-binding protein were significantly lower in group A than group C (0.15 ± 0.04 g/L vs. 0.17 ± 0.05 g/L [t = 3.50, p < 0.05] and 22.51 ± 7.53 g/L vs. 30.57 ± 9.26 g/L [t = 7.46, p < 0.05], respectively). There were no anastomotic strictures or leakage after definitive PT performed in group A. The frequency of defecation ranged from 2-6 times per day, 10 patients had perianal excoriation 3 months after PT, and 11 patients had post-operative HAEC during 6 months of follow-up after PT.

CONCLUSION

Home rectal irrigation in neonates and early in infancy, followed by a delayed and planned SSPT is feasible and effective in patients with HSCR, and could be beneficial to definitive PT. However, for patients with an extended aganglionic segment, older age, or high HAEC score at the time of diagnosis of HSCR, rectal irrigation maybe not suitable.

TRIAL REGISTRATION

This was a prospective comparative study designed to evaluate the effects of home rectal irrigation for facilitating and enhancing recovery after PT, and was registered at Clinical Trials.gov as NCT02776176.