Screening and experimental validation of diagnostic gene in ulcerative colitis with anti-TNF-α therapy.

In clinical practice, the diagnosis of ulcerative colitis (UC) mainly relies on a comprehensive analysis of a series of signs and symptoms of patients. The current biomarkers for diagnosis of UC and prognostic prediction of anti-TNF-α therapy are inaccurate. The present study aimed to perform an integrative analysis of gene expression profiles in patients with UC. A total of seven datasets from the GEO database that met our strict inclusion criteria were included. After identifying differentially expressed genes (DEGs) between UC patients and healthy individuals, the diagnostic and prognostic utility of the DEGs were then analyzed via least absolute shrinkage and selection operator and support-vector machine recursive feature elimination. Subgroup analyses of the treated and untreated groups, as well as the treatment-response group and non-response group, were also performed. Furthermore, the relationship between the expressions of UC-related genes and infiltration of immune cells in the course of treatment was also investigated. Immunohistochemical (IHC) assay was used to verify the gene expression in inflamed UC tissues. When considering all the applied methods, DUOX2, PI3, S100P, MMP7, and S100A8 had priority to be defined as the characteristic genes among DEGs. The area under curve (AUC) of the five genes, which were all consistently over-expressed, based on an external validation dataset, were all above 0.94 for UC diagnosis. Four of the five genes (DUOX2, PI3, MMP7, and S100A8) were down-regulated between treatment-responsive and nonresponsive patients. A significant difference was also observed concerning the infiltration of immune cells, including macrophage and neutrophil, between the two groups (treatment responsive and nonresponsive). The changes in the expression of DUOX2 and MMP7 based on the IHC assay were highly consistent with the results obtained in the current study. This confirmed the mild to moderate diagnostic and predictive value of DUOX2 and MMP7 in patients with UC. The conducted analyses showed that the expression profile of the five identified biomarkers accurately detects UC, whereas four of the five genes evidently predicted the response to anti-TNF-α therapy.

Intelligent Gas Detection: g-C3N4/Polypyrrole Decorated Alginate Paper as Smart Selective NH3/NO2 Sensors at Room Temperature.

Chemiresistive NH3/NO2 sensors are attracting considerable attention for use in air-conditioning systems. However, the existing sensors suffer from cross-sensitivity, detection limit, and power consumption, owing to the inadequate charge-transfer ability of gas-sensing materials. Herein, we develop a flexible NH3/NO2 sensor based on graphitic carbon nitride/polypyrrole decorated alginate paper (AP@g-CN/PPy). The flexible sensor can work at room temperature and exhibits a positive response of 23-246% and a negative response of 37-262% toward 0.1-5 ppm of NH3 and NO2, which is ∼4.5 times and ∼7.0 times higher than a pristine PPy sensor. Moreover, the sensor exhibits flexibility, reproducibility, long-term stability, anti-interference, and high resilience to humidity, indicating its promising potential in real applications. Using the 9 feature parameters extracted from the transient response, a matched deep learning model was developed to achieve qualitative recognition of different types of gases with distinguished decision boundaries. This work not only provides an alternative gas-sensing material for dual NH3/NO2 sensing but also establishes an intelligent strategy to identify hazardous gases under an interfering atmosphere.

Comparative efficacy of sequential treatment and open abdomen approaches for corrosive abdominal hemorrhage due to inadequate drainage of duodenal leakage: a cohort study.

BACKGROUND: Intra-abdominal bleeding resulting from inadequate drainage of duodenal leakage (DL) is typically caused by the corrosiveness of duodenal fluid. Open abdomen (OA) treatment addresses both the drainage and bleeding simultaneously. However, a sequential treatment (ST) approach involving hemostasis through transcatheter arterial embolization (TAE) followed by percutaneous drainage of source control has emerged as an alternative method. This study aimed to evaluate the prognosis of ST in cases of DL-induced intra-abdominal bleeding. METHODS: This retrospective cohort study included 151 participants diagnosed with DL-induced intra-abdominal bleeding from January 2004 to December 2010, and January 2013 to December 2021. The ST and OA groups were established based on the treatment method applied. Propensity score-matching (PSM) matched patients in the ST group with those in the OA group. RESULTS: Among the 151 patients, 61 (40.4%) died within 90 days after the bleeding episode. ST was associated with a lower mortality rate (28.2% vs. 51.3% adjusted odds ratio [OR] = 0.34; 95% confidence interval [CI] 0.17-0.68; P = 0.003) compared to OA. Following PSM, ST remained the only factor associated with reduced mortality (OR = 0.32; 95% CI 0.13-0.75; P = 0.009). Moreover, ST demonstrated a higher rate of initial hemostasis success before (90.1% [64/71] vs. 77.5% [62/80]; adjusted OR = 2.84; 95% CI 1.07-7.60; P = 0.04) and after PSM (94.4% [51/54] vs. 77.8% [42/54], adjusted OR = 3.85; 95% CI 2.15-16.82; P = 0.04). Additionally, ST was associated with a lower incidence of rebleeding within 90 days after the initial bleeding, before (7 vs. 23; adjusted OR 0.41; 95% CI 0.18-0.92; P = 0.03) and after PSM (5 vs. 14; adjusted OR 0.37; 95% CI 0.15-0.93; P = 0.03). CONCLUSIONS: Applying ST involving TAE and subsequent percutaneous drainage might be superior to OA in lowering the mortality in DL-induced intra-abdominal hemorrhage.

Room-Temperature Optoelectronic Gas Sensor Based on Core-Shell g-C3N4@WO3 Heterocomposites for Efficient Ammonia Detection.

The ever-growing modern industry promotes the evolution of gas sensors for environmental monitoring and safety inspection. However, traditional chemiresistive gas sensors still suffer from drawbacks of high power consumption and detection limit, mainly due to the insufficient charge-transfer ability of gas-sensing materials. Here, an optoelectronic gas sensor that can detect ppb-level ammonia at room temperature is constructed based on core-shell g-C3N4@WO3 heterocomposites. The growth of WO3 nanosheets on graphitic g-C3N4 nanosheets was precisely controlled, achieving well-defined g-C3N4@WO3 core-shell architectures. Based on the synergism between light activation and the amplification effect of in situ-formed heterojunctions, the g-C3N4@WO3 sensor exhibits improved sensing characteristics for reliable ammonia detection. As compared with the pristine g-C3N4 sensor, the sensor response toward ammonia is enhanced 21 times and the detection limit is reduced from 308 to 108 ppb. This work provides a successful approach for the in situ formation of core-shell g-C3N4@WO3 interfacial composites and offers an easy solution for the rational design of advanced optoelectronic gas sensors.

Biomimetic Two-Dimensional Vermiculite Nanofluidic Membranes for Stable Salinity-Gradient Energy Conversion.

Aligned ion transport in the nanofluidic membrane is promising for efficient salinity-gradient energy conversion, while remaining rather challenging due to relatively inadequate mass transport and long-time durability. In this work, wet-chemically exfoliated and negatively charged vermiculite lamellas are readily restacked into free-standing membranes with massive arrays of nanochannels and a three-dimensional interface. The resulting vermiculite nanofluidic membranes possess excellent stability against harsh conditions including a wide pH range and high temperature and exhibit a different ion transport behavior from the macroscopic one due to the surface-charge-governed conductivity. The ionic conductivity is several orders of magnitude higher than that of the native solution at low concentrations. Moreover, the negatively charged lamellas create a space charge zone, making the nanofluidic membrane capable of coupling surface charge and space charge in confinement for salinity-gradient energy conversion from seawater and freshwater. Compared with other layered materials, the vermiculite-derived membranes have distinct advantages such as low cost, facile fabrication, and high stability. This work provides a new idea for designing nanofluidic membranes from phyllosilicate minerals, which offers opportunities for manufacturing nanofluidic devices.

Effect of placing double-lumen irrigation-suction tube on closure of anastomotic defect following rectal cancer surgery.

PURPOSE: This study aimed to investigate the effect of placement of double-lumen irrigation-suction tubes (DLIST) on the closure of anastomotic defect (AD) after rectal cancer surgery. METHODS: The study was carried out at two centers managed by one surgeon, both adopted the same treatments. Patients with postoperative AD after rectal cancer surgery from January 2011 to June 2020 were eligible and were divided into a passive drainage (PD) group and a DLIST group according to whether the PD, placed in the rectal cancer surgery, had been replaced with the DLIST. The effect of DLIST on the AL was evaluated. RESULT: There distributed 76 patients in the DLIST group and 52 in the PD group. A higher closure rate was reported in the DLIST group (46 patients in DLIST group, for a closure rate of 60.5%, and 21 patients in PD group, for a closure rate of 40.4%. HR = 3.05; 95% CI: 1.79-5.19; P < 0.001). Both length of stay and costs of the treatment in the DLIST group were lower (54 days [interquartile range, IQR: 41-17] days vs. 112 days [IQR: 66-27] days, P = 0.005; and $18,721 [IQR: $14,982-4,960] vs. $40,840 [IQR: $20,932-50,529], P < 0.001). CONCLUSION: Placement of DLIST might serve as an effective method for treating AD following rectal cancer surgery. In comparison with PD, it costs lower to apply DLIST in the treatment of AD and the length of stay is shorter.

Duration of postoperative hyperlactatemia has predictive value in recurrent fistula after major definitive surgery for intestinal fistula.

PURPOSE: The present study aimed to identify the predictive value of duration of postoperative hyperlactatemia in screening patients at high risk of recurrent fistula after major definitive surgery (DS) for intestinal fistula. METHODS: If the initial postoperative lactate (IPL) > 2 mmol/L, DS was defined as major definitive surgery. The 315 enrolled patients with major DS were divided into group A (2 mmol/L < IPL ≤ 4 mmol/L), group B (mmol/L < IPL ≤ 6 mmol/L), and group C (IPL > 6 mmol/L). The characteristics of patients were collected, and the duration of postoperative hyperlactatemia was analyzed. According to the occurrence of recurrent fistula (RF), patients were further divided into RF group A, and Non-RF group A; RF group B, and Non-RF group B; and RF group C, and Non-RF group C. RESULTS: The duration of postoperative hyperlactatemia was comparable between the RF group A and the Non-RF group A [12 (IQR: 12-24) vs 24 (IQR: 12-24), p = 0.387]. However, the duration of hyperlactatemia was associated with RF in group B (adjusted OR = 1.061; 95% CI: 1.029-1.094; p < 0.001) and group C (adjusted OR = 1.059; 95% CI: 1.012-1.129; p = 0.017). In group B, the cutoff point of duration of 42 h had the optimal predictive value (area under ROC = 0.791, sensitivity = 0.717, specificity = 0.794, p < 0.001). In group C, the cutoff point of duration of 54 h had the optimal predictive value (area under ROC = 0.781, sensitivity = 0.730, specificity = 0.804, p < 0.001). CONCLUSION: The duration of postoperative hyperlactatemia has a value in predicting RF in patients with an IPL of more than 4 mmol/L after major definitive surgery for intestinal fistula.

Early Enteral Nutrition Could Reduce Risk of Recurrent Leakage After Definitive Resection of Anastomotic Leakage After Colorectal Cancer Surgery.

BACKGROUND: The present study aimed to evaluate the effect of early enteral nutrition (EEN) after definitive resection of anastomotic leakage (DRAL) resulting from a sigmoid colon or rectal cancer radical resection. METHODS: This was a prospective cohort study performed at our center. From January 2014 to May 2016, every patient received a standard postoperative nutritional protocol (SPNP) after DRAL and was included into SPNP group. From June 2016 to December 2018, all patients received an EEN after DRAL and were included into EEN group. The effect of postoperative EEN was evaluated. RESULTS: There were a final total of 133 patients enrolled in our study. There were 70 patients in the SPNP group, and 63 patients in the EEN group. There were 12 cases (19.05%) with a recurrent leakage in the EEN group, and 28 cases (40%) in the SPNP group. The recurrent rate was associated with EEN (HR = 0.417, 95% CI 0.196-0.890, p = 0.024). The median defecation time in the EEN group was 5(4-7) days, while in the SPNP group was 7(6-8.25) days. The defecation was associated with EEN (HR = 1.588, 95% CI 1.080-2.336, p = 0.019), as well. CONCLUSION: EEN could reduce the recurrent leakage rate and defecation time after definitive resection of anastomotic leakage resulting from sigmoid colon or rectal cancer radical resection.

Effects of different preoperative enteral nutrition feeding routes on the duration of gastrointestinal decompression after definitive surgery for small intestinal fistula.

PURPOSE: The purpose of this study is to investigate the effects of different preoperative enteral nutrition feeding routes on the duration of gastrointestinal decompression after definitive surgery for small intestinal fistula. METHODS: From January 2015 to June 2019, patients with small intestinal fistula and receiving a definitive surgery were enrolled. According to the feeding route, patients were divided into a nasointestinal tube group and a nasogastric tube group. Clinical characteristics of the two groups were analyzed, and the influence of the two route on the recovery of gastrointestinal function was evaluated. RESULT: A total of 151 patients were enrolled in our study. There were 49 patients in the nasogastric tube group, and 102 patients in the nasointestinal tube group. Enteral nutrition via nasogastric feeding route had a positive effect on shortening the duration of gastrointestinal decompression (adjusted HR = 2.488, 95% CI: 1.692-3.659, P < 0.001). After propensity matching (PM), 44 patients were enrolled (22 vs 22). EN via nasogastric tube was a positive factor for getting rid of gastrointestinal decompression (adjusted HR = 3.563, 95% CI: 1.639-7.746, P = 0.001). CONCLUSION: Preoperative enteral nutrition via nasogastric route can reduce the duration of gastrointestinal decompression after definitive surgery for small intestinal fistula.

Open necrosectomy combined with continuous positive drainage and prophylactic diverting loop ileostomy for late infected pancreatic necrosis: a retrospective cohort study.

BACKGROUND: To evaluate an innovative open necrosectomy strategy with continuous positive drainage and prophylactic diverting loop ileostomy for the management of late infected pancreatic necrosis (LIPN). METHODS: Consecutive patients were divided into open necrosectomy (ON) group (n = 23), open necrosectomy with colonic segment resection (ON+CSR) group (n = 8) and open necrosectomy with prophylactic diverting loop ileostomy (ON+PDLI) group (n = 11). Continuous positive drainage (CPD) via double-lumen irrigation-suction tube (DLIST) was performed in ON+PDLI group. The primary endpoints were duration of organ failure after surgery, postoperative complication, the rate of re-surgery and mortality. The secondary endpoints were duration of hospitalization, cost, time interval between open surgery and total enteral nutrition (TEN). RESULTS: The recovery time of organ function in ON+PDLI group was shorter than that in other two groups. Colonic complications occurred in 13 patients (56.5%) in the ON group and 3 patients (27.3%) in the ON+PDLI group (p = 0.11). The length of stay in the ON+PDLI group was shorter than the ON group (p = 0.001). The hospitalization cost in the ON+PDLI group was less than the ON group (p = 0.0052). CONCLUSION: ON+PDLI can avoid the intestinal dysfunction, re-ileostomy, the resection of innocent colon and reduce the intraoperative trauma. Despite being of colonic complications before or during operation, CPD + PDLI may show superior effectiveness, safety, and convenience in LIPN.

Transcatheter Arterial Embolization in the Treatment of Abdominal Bleeding in Patients Being Treated with Open Abdomen Due to Duodenal Fistula.

BACKGROUND: This study aimed to investigate the transcatheter arterial embolization (TAE) in treatment of abdominal bleeding in patients being treated with open abdomen due to duodenal fistula. METHODS: This was a retrospective study performed at our center. From January 2005 to November 2010, all patients with abdominal bleeding were treated with surgical hemostasis (SH) and included in SH group. From January 2012 to December 2018, all patients with a bleeding were treated with TAE and included in the TAE group. Clinical data were reviewed and compared between the two groups. The effect of TAE in the management of abdominal bleeding was evaluated. RESULTS: A total of 131 patients were enrolled, and there were 64 in the SH group and 67 in the TAE group. The success rate of hemostasis was higher in the TAE group (89.55% vs. 73.44%, adjusted OR = 4.065, 95% CI 1.336-12.336, P = 0.013). Moreover, the recognition rate of hemorrhagic vessels in the TAE group was higher (91.04 vs. 51.56; P < 0.001). The re-bleeding occurred in 20 patients, 7(11.67%) in the TAE group and 13(27.66%) in the SH group. The re-bleeding rate in SH group was higher (adjusted HR = 2.564, 95% CI 1.023-6.428, P = 0.045) CONCLUSIONS: TAE is an effective method in treatment of abdominal bleeding in patients being treated with open abdomen due to duodenal fistula.

Colloid Mill-Assisted Ultrasonic-Fractional Centrifugal Purification of Low-Grade Attapulgite and Its Modification for Adsorption of Congo Red.

Attapulgite (APT) is widely used in wastewater treatment due to its exceptional adsorption and colloidal properties, as well as its cost-effectiveness and eco-friendliness. However, low-grade APT generally limits its performance. Here, a colloid mill-assisted ultrasonic-fractional centrifugal purification method was developed to refine low-grade APT. This process successfully separated and removed impurity minerals such as quartz and dolomite from the raw ore, resulting in a refined APT purity increase from 16.9% to 60% with a specific surface area of 135.5 m2∙g-1. Further modifying of the refined APT was carried out through the hydrothermal method using varying dosages of cetyltrimethylammonium chloride (CTAC), resulting in the production of four different APT adsorbents denoted as QAPT-n (n = CTAC mole number) ranging from 0.5 to 5 mmol. Using Congo red (CR) as the target pollutant, the QAPT-5 sample exhibited the best adsorption capacity with the maximum quantity of 1652.2 mg∙g-1 in a neutral solution at 30 °C due to the highest surface charge (zeta potential = 8.25 mV). Moreover, the QAPT-5 pellets (~2.0 g adsorbent) shaped by the alginate-assisted molding method removed more than 96% of 200 mL aqueous solution containing 200 mg∙L-1 CR and maintained this efficiency in 10 adsorption-elution cycles, which exhibited the promising practical application.

A MOF nanoparticle@carbon aerogel integrated photothermal catalytic microreactor for CO2 utilization.

A practical carbon dioxide (CO2) conversion and utilization system shows great potential for ameliorating the greenhouse effect. Herein, an integrated carbon aerogel-based photothermal catalysis microreactor with photothermal conversion, enhanced mass transfer adsorption and a thermal catalytic reactor is designed. As a solar-powered CO2 utilization module, this microreactor can conveniently convert CO2 into economically valuable products without elaborate equipment and operation processes.

Nomogram for predicting intolerable postoperative early enteral nutrition following definitive surgery for small intestinal fistula: a cohort study.

BACKGROUND: This study was designed to develop and validate a nomogram for predicting intolerable early enteral nutrition (EEN) following definitive surgery (DS) for small intestinal fistula. METHODS: A total of 377 patients, recruited from January 2016 to September 2023, was randomly allocated into development (n=251) and validation (n=126) groups in a 2:1 ratio. Risk factors were identified using the nomogram. Its performance was assessed based on calibration, discrimination, and clinical utility, with validation confirming its effectiveness. RESULTS: Of the 377 patients, 87 (23.1%) were intolerant to EEN, including 59 (23.1%) in the development cohort and 28 (22.1%) in the validation cohort (P=0.84). Four factors were identified as predictive of intolerable EEN: severe abdominal adhesion, deciliter of blood loss during DS, human serum albumin (Alb) input >40 g during and within 48 hours post-DS, and the visceral fat area (VFA)/total abdominal muscle area index (TAMAI) ratio. The model demonstrated excellent discrimination, with a C-index of 0.79 (95% CI, 0.74-0.87, including internal validation) and robust calibration. In the validation cohort, the nomogram showed strong discrimination (C-index=0.77; 95% CI, 0.64-0.87) and solid calibration. Decision curve analysis affirmed the nomogram's clinical utility. CONCLUSION: This research introduces a nomogram that enables the individualized prediction of intolerable EEN following DS for small intestinal fistula, demonstrating a possible clinical utility.

Fenton-like Degradation of Methylene Blue on Attapulgite Clay Composite by Loading of Iron-Oxide: Eco-Friendly Preparation and Its Catalytic Activity.

The continuous discharge of organic dyes into freshwater resources poses a long-term hazard to aquatic life. The advanced oxidation Fenton process is a combo of adsorption and degradation of pollutants to detoxify toxic effluents, such as anti-bacterial drugs, antibiotics, and organic dyes. In this work, an activated attapulgite clay-loaded iron-oxide (A-ATP@Fe3O4) was produced using a two-step reaction, in which attapulgite serves as an enrichment matrix and Fe3O4 functions as the active degrading component. The maximum adsorption capacity (qt) was determined by assessing the effect of temperature, pH H2O2, and adsorbent. The results showed that the A-ATP@Fe3O4 achieves the highest removal rate of 99.6% under optimum conditions: 40 °C, pH = 3, H2O2 25 mM, and 0.1 g dosage of the composite. The dye removal procedure achieved adsorption and degradation equilibrium in 120 and 30 min, respectively, by following the same processes as the advanced oxidation approach. Catalytic activity, kinetics, and specified surface characteristics suggest that A-ATP@Fe3O4 is one of the most promising candidates for advanced oxidation-enrooted removal of organic dyes.

Enhanced dispersion of prussian blue via intercalation into layered double hydroxides for efficient solar seawater evaporation.

Prussian blue (PB) is favored for its photothermal absorption capability in solar vapor generation applications. However, the photothermal conversion efficiency of current PB-based devices is limited by the material's poor dispersion. Herein, we report a method of incorporating PB in the interlayers of layered double hydroxides (LDHs) to prevent its aggregation. The dispersion is further enhanced and stabilized by the addition of sodium dodecyl sulfate (SDS). The thermal and water stability of PB is improved due to the rigid structure of LDHs and interactions between layers and anions. Elemental analysis confirms that with the increase of molar ratio of Mg/Al and the introduction of SDS, concentrations of PB are decreased accordingly. As a result, the rate of solar vapor generation is increased by 35.9% for powders containing 50 mg of equivalent PB. Of note, converting this material into a three-dimensional structure of high rebound foam further enhances solar water evaporation rate, from 0.79 kg m-2 h-1 to 0.98 kg m-2 h-1, with only 20 mg of equivalent PB, increasing the corresponding photothermal conversion efficiency from 53.8% to 66.3%.

Defect-Engineered WO3-x Architectures Coupled with Random Forest Algorithm Enables Real-Time Seafood Quality Assessment.

Reliable and real-time monitoring of seafood decay is attracting growing interest for food safety and human health, while it is still a great challenge to accurately identify the released triethylamine (TEA) from the complex volatilome. Herein, defect-engineered WO3-x architectures are presented to design advanced TEA sensors for seafood quality assessment. Benefiting from abundant oxygen vacancies, the obtained WO2.91 sensor exhibits remarkable TEA-sensing performance in terms of higher response (1.9 times), faster response time (2.1 times), lower detection limit (3.2 times), and higher TEA/NH3 selectivity (2.8 times) compared with the air-annealed WO2.96 sensor. Furthermore, the definite WO2.91 sensor demonstrates long-term stability and anti-interference in complex gases, enabling the accurate recognition of TEA during halibut decay (0-48 h). Coupled with the random forest algorithm with 70 estimators, the WO2.91 sensor enables accurate prediction of halibut storage with an accuracy of 95%. This work not only provides deep insights into improving gas-sensing performance by defect engineering but also offers a rational solution for reliably assessing seafood quality.

Designing a bi-layer multifunctional hydrogel patch based on polyvinyl alcohol, quaternized chitosan and gallic acid for abdominal wall defect repair.

In abdominal wall defect repair, surgical site infection (SSI) remains the primary cause of failure, while complications like visceral adhesions present significant challenges following patch implantation. We designed a Janus multifunctional hydrogel patch (JMP) with antibacterial, anti-inflammatory, and anti-adhesive properties. The patch comprises two distinct layers: a pro-healing layer and an anti-adhesion layer. The pro-healing layer was created by a simple mixture of polyvinyl alcohol (PVA), quaternized chitosan (QCS), and gallic acid (GA), crosslinked to form PVA/QCS/GA (PQG) hydrogels through GA's self-assembly effect and hydrogen bonding. Additionally, the PVA anti-adhesive layer was constructed using a drying-assisted salting method, providing a smooth and dense physical barrier to prevent visceral adhesion while offering essential mechanical support to the abdominal wall. The hydrogel patch demonstrates widely adjustable mechanical properties, exceptional biocompatibility, and potent antimicrobial properties, along with a sustained and stable release of antioxidants. In rat models of skin and abdominal wall defects, the JMP effectively promoted tissue healing by controlling infection, inhibiting inflammation, stimulating neovascularization, and successfully preventing the formation of visceral adhesions. These compelling results highlight the JMP's potential to improve the success rate of abdominal wall defect repair and reduce surgical complications.

Visceral to subcutaneous fat area ratio predicts severe abdominal adhesions in definitive surgery for anastomotic fistula after small intestine resection.

Abdominal adhesions manifests following abdominal infections triggered by intestinal fistulas. The severity of such adhesions depends on the extent of fiber deposition and peritoneal fibrinolysis following peritoneal injury, which may be influenced by sustained inflammation within the abdominal cavity. In this regard, the visceral-to-subcutaneous fat area (VFA/SFA) ratio has been implicated as a potential marker of inflammation. This study aimed to explore the relationship between VFA/SFA and abdominal adhesions. This multicenter study was conducted across four tertiary institutions and involved patients who had undergone definitive surgery (DS) for intestinal fistula from January 2009 and October 2023. The presence of abdominal adhesions was determined intraoperatively. VFA/SFA was investigated as a potential risk factor for severe adhesions. The study comprised 414 patients with a median age of 50 [interquartile range (IQR) 35-66] years and a median body mass index of 20.0 (IQR 19.2-22.4) kg/m2, including 231 males with a median VFA/SFA of 1.0 (IQR 0.7-1.2) and 183 females a median VFA/SFA of 0.8 (0.6-1.1). VFA/SFA was associated with severe abdominal adhesions in males [odds ratio (OR) = 3.34, 95% CI 1.14-9.80, p = 0.03] and females (OR = 2.99, 95% CI 1.05-8.53, p = 0.04). J-shaped association between VFA/SFA ratio and severe adhesions was revealed in both sex. The increasing trend can be revealed when OR more than 0.8, and 0.6 in males and females respectively. Preoperative VFA/SFA demonstrates predictive value for statues of severe abdominal adhesions in DS for anastomotic fistula after small intestine resection.