Impact of total parenteral nutrition v. exclusive enteral nutrition on postoperative adverse outcomes in patients with penetrating Crohn's disease undergoing surgical resection: a retrospective cohort study.

Achieving optimal nutritional status in patients with penetrating Crohn's disease is crucial in preparing for surgical resection. However, there is a dearth of literature comparing the efficacy of total parenteral nutrition (TPN) v. exclusive enteral nutrition (EEN) in optimising postoperative outcomes. Hence, we conducted a case-matched study to assess the impact of preoperative EEN v. TPN on the incidence of postoperative adverse outcomes, encompassing overall postoperative morbidity and stoma formation, among penetrating Crohn's disease patients undergoing bowel surgery. From 1 December 2012 to 1 December 2021, a retrospective study was conducted at a tertiary centre to enrol consecutive patients with penetrating Crohn's disease who underwent surgical resection. Propensity score matching was utilised to compare the incidence of postoperative adverse outcomes. Furthermore, univariate and multivariate logistic regression analyses were conducted to identify the risk factors associated with adverse outcomes. The study included 510 patients meeting the criteria. Among them, 101 patients in the TPN group showed significant improvements in laboratory indicators at the time of surgery compared with pre-optimisation levels. After matching, TPN increased the occurrence of postoperative adverse outcomes (92·2 % v. 64·1 %, P = 0·001) when compared with the EEN group. In the multivariate analysis, TPN showed a significantly higher OR for adverse outcomes than EEN (OR = 4·241; 95 % CI 1·567-11·478; P = 0·004). The study revealed that penetrating Crohn's disease patients who were able to fulfil their nutritional requirements through EEN exhibited superior nutritional and surgical outcomes in comparison with those who received TPN.

Long-term outcomes of intestinal penetrating Crohn's disease following successful nonoperative management.

There is a paucity of data on the surgical or medical treatment for abscess/fistula complicating Crohn's disease after successful nonsurgical management. We conducted a cohort study to investigate the long-term outcomes and the risk factors for the requirement of subsequent surgical intervention in Crohn's disease patients with complicating fistulas/abscess following successful nonsurgical management. Data were collected on penetrating Crohn's disease experiencing successful nonsurgical treatment between December 2012 and December 2021. Long-term outcomes and risk factors of surgery were assessed by univariate and multivariate analysis, and subgroup analysis was performed based on penetrating phenotype including abscess, fistula, and phlegmon. A total of 523 penetrating Crohn's disease patients; there were 390, 125, and 60 patients complicated with fistulas, abscess, and phlegmon, respectively. Long-term outcomes showed that BMI < 18.5 (kg/m 2 ), the recurrent abscess, and stricture were independent risk factors of surgery. Biologics and resolution of abscess were independent protective factors of surgery. Furthermore, in 399 patients undergoing early surgery, stricture and BMI < 18.5 (kg/m 2 ) were independent risk factors, and biologics and abscess resolution were protective of the early surgery. Subgroup analysis based on fistula, abscess, and phlegmon phenotype also demonstrated that concomitant stricture was an independent risk factor and the use of biologics was protective of surgical resection. Our data indicate that biologics can delay the requirement of surgery and may be given to patients with penetrating complicating Crohn's disease who have been successfully treated nonoperatively, but surgical resection should be considered in the setting of malnutrition and stenosis formation.

A nomogram to predict stoma creation in elective surgical resection for penetrating Crohn's disease.

BACKGROUNDS: The decision to perform a stoma during surgical resection of penetrating Crohn's disease (CD) is a critical consideration. The objective of this study was to identify factors that influence stoma creation and develop a predictive nomogram model to assist surgeons in making optimal surgical decisions. METHODS: A retrospective study was conducted at a tertiary center from December 1, 2012, to December 1, 2021, involving consecutive patients with penetrating CD who underwent elective surgical resection. The LASSO regression method was used to select preoperative predictors, and a nomogram was constructed using multivariate logistic regression. The performance of the nomogram was validated in an internal cohort by assessing its discrimination, calibration, and clinical usefulness. RESULTS: The study included 405 cases in the training group and 135 cases in the validation group. Nine risk factors for stoma formation were identified, including disease location, fistula resulted from previous anastomosis, absence of preoperative exclusive enteral nutrition support, albumin levels below 35 g/L, C-reactive protein levels above 10 mg/L, hemoglobin levels below 100 g/L, perianal disease, internal fistula, and surgical approach. These risk factors were selected using the LASSO regression method, and a nomogram was developed based on them. The area under the curve and the coefficient of determination (R2) of the nomogram were 0.821 and 0.394, respectively. And the nomogram demonstrated good performance in the validation cohort. CONCLUSIONS: The nomogram exhibited good predictive ability for stoma formation during elective surgical resection for penetrating CD, which can assist surgeons in making informed clinical decisions.

The impact of delayed closure of ileostomy on postoperative complications in patients with Crohn's disease: a case-matched study.

Ileostomy creation is a common procedure to mitigate postoperative complications in Crohn's disease (CD) patients. However, the optimal timing for ileostomy closure remains controversial. This study aims to investigate whether delayed ileostomy closure (> 6 months post formation) affects postoperative complications compared to early closure (≤ 6 months post formation). Consecutive CD patients who underwent ileostomy reversal at a tertiary care center between January 1, 2013, and December 1, 2021, were included. The study compared patients who underwent early ileostomy closure to matched patients undergoing delayed ileostomy closure. The 90-day postoperative complications were compared between the two groups. The study included 352 eligible patients for ileostomy reversion. Our data showed that patients undergoing delayed ileostomy closure had higher incidence of ileostomy-related infectious complications (12% vs. 4%, p = 0.008), a longer postoperative hospital stay (10 days with an IQR of 7-12 days versus 8 days with an IQR of 7-11 days, p = 0.024), and increased rate of ileus (28% versus 15%, p = 0.003). There were 256 patients included after 1:1 propensity score matching. The results revealed no significant differences in postoperative hospital stay, infectious or non-infectious complications except for a statistically significant increase in the incidence of ileus in the delayed closure group (p = 0.01). Patients undergoing delayed ileostomy closure has similar outcomes to early closure in terms of postoperative complications, except for a higher incidence of ileus.

Comparison of endoscopic balloon dilation and surgery for duodenal stricture in patients with Crohn's disease.

BACKGROUND: Few studies have compared endoscopic balloon dilation (EBD) and surgery in the treatment of duodenal stricture in patients with Crohn's disease (CD). METHODS: We performed a retrospective study to compare the efficacy and safety among patients with CD-associated duodenal stricture treated with EBD or surgery from October 2013 to December 2021. Univariate and multivariate analyses were performed to evaluate factors associated with recurrence-free or surgery-free survival. RESULTS: A total of 48 eligible patients were included, including 30 patients treated with EBD only and 18 patients treated with surgery. Patients treated with surgery experienced more symptomatic improvement (100% vs. 63.33%, p = 0.003) and significantly longer recurrence-free survival (6.31 [IQR: 3.00-8.39] years vs. 2.96 [IQR: 1.06-5.42] years, p = 0.01) but suffered more postprocedural adverse events (16.67% vs. 0.74% per procedure, p = 0.001). In patients initially treated with EBD (n = 41), a total of 11 (26.83%) required subsequent surgical intervention. Younger age at CD diagnosis (HR = 0.90, 95% CI: 0.81-1.00, p = 0.04) was associated with a higher risk for subsequent surgery. CONCLUSIONS: Surgery for CD-associated duodenal strictures was associated with a longer recurrence-free survival. EBD was safe and effective with minimal postprocedural adverse events but led to a high frequency of recurrence.

Biologic use is not associated with postoperative complications in patients with Crohn's disease undergoing stoma reversion.

PURPOSE: Stoma creation is a common procedure in patients with Crohn's disease (CD), and early prophylaxis with biologics is recommended for high-risk patients. However, the effect of biologic exposure on morbidity after stoma closure remains unknown. Therefore, this study aimed to investigate the impact of biologic use on the occurrence of complications in CD patients following stoma closure. METHODS: Consecutive patients diagnosed with CD who underwent ileostomy reversal at a tertiary care centre between 1 January 2013 and 1 December 2021, were included in the study. The primary outcome was the occurrence of 90-day postoperative complications. RESULTS: The study included 347 eligible patients who underwent ileostomy reversal. There was no significant difference in terms of infectious complications, overall complications or length of postoperative stay between the biologic and non-biologic groups. Multivariate logistic regression analysis identified several predictors of postoperative morbidity, including preoperative haemoglobin levels below 100 g/L, CRP levels above 10 mg/L, anastomotic site, ileostomy-related infectious complications and albumin levels below 35 g/L. CONCLUSIONS: This study demonstrated that the use of biologics is not associated with adverse outcomes. However, such as high CRP levels, ileostomy-related infectious complications, hypoproteinemia, and hemoglobinemia, should be optimized prior to surgery to reduce postoperative morbidities.

Intelligent triggering of nanomicelles based on a ROS-activated anticancer prodrug and photodynamic therapy (PDT)-synergistic therapy for lung cancers.

The intelligent triggering of drug release at targeted sites is essential for the safety and efficacy of cancer therapies. This study aimed to design and synthesize a novel prodrug (DHA-S-CA) using a reactive oxygen species (ROS)-responsive moiety, thioacetal, to bridge cinnamaldehyde (CA) and dihydroartemisinin (DHA). As ROS are highly expressed in tumor tissues, the design uses the ROS-responsive moiety as an effective target for the nanodrug delivery system. Furthermore, the near-infrared dye IR808 and the prodrug were adopted to prepare co-loaded Soluplus®/TPGS nanomicelles (IR808/DHA-S-CA NMs). The photosensitized agent IR808 exhibited both tumor accumulation and cancer imaging properties while generating ROS during laser irradiation. Intracellular ROS detection indicated that the prodrug DHA-S-CA could degrade via the high concentration of ROS in cancer cells induced by laser irradiation, and the released CA stimulated mitochondria to regenerate additional ROS to further improve the antitumor effect of DHA. Combined with photodynamic therapy (PDT), IR808/DHA-S-CA (+) NMs outperformed free DHA, DHA NMs, and IR808/DHA-S-CA (-) in a comparison of their pharmacokinetic profiles because it had a longer circulation time and a greater area under the curve (AUC). Compared with other DHA groups, the ROS-responsive IR808/DHA-S-CA (+) micelles had comparable cytotoxic activity. Furthermore, the ROS-responsive IR808/DHA-S-CA (+) micelles exhibited markedly higher anticancer efficiency on lung cancer cells than the other DHA groups. Overall, these results indicated that the therapeutic strategy of our novel small-molecule prodrug combined with PDT has great potential for the treatment of tumors.

Association between vascular endothelial growth factor +936C/T polymorphism and breast cancer risk: a meta-analysis of 18 case-control studies.

Important in angiogenesis, vascular endothelial growth factor (VEGF) acts as a biomarker in the growth of and prognosis for breast cancer. Evidence suggests that single nucleotide polymorphisms of VEGF such as +936C/T (rs3025039) effects VEGF levels; however, current studies on the association between +936C/T and breast cancer risk are inconsistent. This meta-analysis was conducted to reach a more precise conclusion about this association. PubMed was searched for case-control studies on the association between +936C/T levels and breast cancer risk. The quality of each study was scoring in term of some important criteria. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were used to assess the strength of this association. Subgroup analysis stratified by ethnicity and quality score was also conducted. Eighteen studies with 10,694 cases and 11,199 controls in accord with the selection criteria were included in our meta-analysis. When all eligible studies were pooled, our meta-analysis showed that there was no significant association between +936C/T and breast cancer risk in the all ethnic group; however, in the subgroup analysis, we found that +936C/T was associated with reduced breast cancer risk in the Asian population. When stratified by the quality score, no significant association was found between +936C/T and breast cancer risk either in studies scored <8 or studies scored >7. Our findings suggested that +936C/T is not associated with breast cancer risk but may reduce the risk in the Asian population.

Synergistic effect of photocatalysis and adsorption of nano-TiO2 self-assembled onto sulfanyl/activated carbon composite.

We report a significant synergistic effect of photocatalysis and adsorption by depositing 3-6 nm TiO2 particles onto sulfanyl (HS)/activated carbon composite using molecular self-assemble method in low-temperature aqueous system. The synergistic effect was studied by comparing pure TiO2 and TiO2/sulfanyl/activated carbon composite to photocatalytic degrade methylene blue (MB) in a quartz glass reactor. The results showed that the photocatalytic activity of the TiO2/HS/AC composite compared to pure TiO2 has been greatly enhanced calculated from a simulated first-order kinetics model. The synergistic enhancement at low MB concentration was significantly stronger than that at high concentration, and the synergistic effect calculated from the model at initial concentration of 1 mg/L was approximately 64 times than at initial concentration of 15 mg/L. This is because when the adsorption rate was much faster than the photocatalytic degradation rate, strong adsorption of MB molecules may inhibit subsequent photocatalytic degradation reaction. The enhancement was found mainly due to the strong synergistic effect of the adsorption of MB of sulfanyl/activated carbon substrate and the photocatalysis of TiO2 nanoparticles.

[FTIR study of adsorption of PCP on hematite surface].

The adsorption of pentachlorophenol on hematite was studied through adsorption experiments and FTIR analysis. The pH adsorption isotherms of pentachlorophenol onto hematite were obtained by the static state experiments. The largest adsorption quantity occurred at about pH 6. The adsorption quantity at pH 8.5 of the isoelectric point of hematite was about 31% of the largest adsorption quantity. Fourier transform infrared (FTIR) spectroscopy was used to analyse the change of hematite before and after PCP adsorption, and the species of PCP on hematite. It was discovered that: (1) the typical peak at 565 cm(-1) of the Fe-O bond in alpha-Fe2O3 did not change before and after adsorption, and the adsorption occurred on the surface of hematite. (2) At pH 6.0, the stretching vibration peak at 3 438 cm(-1) due to the hydrogen bond formed between O-H on the surface of alpha-Fe2O3 and water molecules shifted to 3 417 cm(-1). The bending vibration peak of H-O-H+ on the surface at 1 643 cm(-1) was weakened because of complex reaction. The peak owing to Fe-OH bond was displaced from 1 050-1 100 cm(-1) to 950 cm(-1) with increased intensity. The C-O bond stretching vibration peak of PCP was displaced from 1 215 to 1 122 cm(-1). The main interaction between PCP and hematite was static electric interaction. (3) At pH 8.5, the stretching vibration peak of the hydrogen bond formed between O-H on the surface of alpha-Fe2O3 and water molecules was displaced from 3 438 to 3 428 cm(-1). The bending vibration peak at 1 643 cm(-1) was obviously weakened because of the hydrogen bonding. The H-O-H+ bending vibration peak at 1 050-1 100 cm(-1) was displaced to 947 cm(-1) with obviously increased intensity, indicating that the interaction was mainly through hydrogen bond.

[FTIR study of nano-iron oxyhydroxides' decoloration on the azo dye].

IR spectra were used to analyse the azo dye solution decoloration action by two kinds of iron oxyhydroxides. It was discovered that: (1) Acid Red G and methyl orange are apt to form complex on the surface of iron oxyhydroxides > FeOH, especially Acid Red G. which possesses two -SO3Na structures has a relatively high decoloration efficiency as a result of complexation reaction; (2) after 2 hours adsorption, the IR spectra of iron oxyhydroxides show characteristic wave numbers at 1 033 and 1 030 cm(-1) which belong to -SO3Na, whereas the peaks at wave numbers between 1 450 and 1 400 cm(-1), which belong to azo dye, disappear. These phenomena indicate that azo dye molecules are adsorbed on the surface of iron oxyhydroxides due to the negative -SO3Na structure, and at the moment azo dye molecules are adsorbed on the surface of iron oxyhydroxides, the electron transfer occurs between the azo dye molecules and the iron oxyhydroxides surface's Fe3+ centre, which could lead to the rupture of azo bond. It can be infered that the decoloration of azo dye molecules is the co-effect of the selective chemical absorption and the oxidation-deoxidation effect on the surface of iron oxyhydroxides.