Parenteral n-3 polyunsaturated fatty acids supplementation improves postoperative recovery for patients with Crohn's disease after bowel resection: a randomized, unblinded controlled clinical trial.

BACKGROUND: The postoperative inflammatory response is associated with postoperative recovery in surgery. n-3 (ω-3) polyunsaturated fatty acids have been reported to lower inflammation. The postoperative role of parenteral n-3 polyunsaturated fatty acids supplementation on outcomes in Crohn's disease after bowel resection is unclear. OBJECTIVES: We aimed to investigate the effects of postoperative parenteral n-3 polyunsaturated fatty acids supplementation in Crohn's disease. METHODS: A prospective randomized, unblinded controlled clinical trial was conducted for patients with Crohn's disease who underwent bowel resection between May 2019 and February 2022. Postoperative complications, complete blood count, serum biochemical values, and cytokine concentrations were compared in patients with and without parenteral n-3 polyunsaturated fatty acids supplementation for 5 d postoperatively. RESULTS: There were 268 patients randomly assigned in the analysis, with 134 in the control group (a mix of long-chain and medium-chain fats at 1.0 g/kg/d) and 134 in the treatment group (long-chain, medium-chain, and n-3 polyunsaturated fats at 1.2 g/kg/d). Twenty-six did not complete the allocated treatment, and 8 patients were lost to follow-up. The intention-to-treat analysis and the per-protocol analysis showed that there were a significant reduction in overall complication rates (22.4% compared with 49.3%; P < 0.001 and 21.8% compared with 38.2%; P = 0.006) and postoperative stay (8.8 ± 4.5 d compared with 11.2 ± 6.8 d; P = 0.001 and 8.7 ± 4.0 d compared with 11.5 ± 7.3 d; P < 0.001) in patients with parenteral n-3 polyunsaturated fatty acids supplementation compared with patients in the control group. In the secondary outcomes, the mean ± standard deviation of interleukin (IL)-6 (17.11 ± 2.14 pg/mL compared with 30.50 ± 5.14 pg/mL; P = 0.014), IL-1ß (2.01 ± 0.05 pg/mL compared with 2.24 ± 0.09 pg/mL; P = 0.019), tumor necrosis factor-α (2.09 ± 0.06 pg/mL compared with 2.29 ± 0.06 pg/mL; P = 0.029), and C-reactive protein concentrations (51.3 ± 4.2 mg/L compared with 64.4 ± 5.3 mg/L; P = 0.050) on postoperative day 5 in the treatment group were much lower than those in the control group. CONCLUSIONS: Parenteral n-3 polyunsaturated fatty acids supplementation promotes postoperative recovery in patients with Crohn's disease following bowel resection, with fewer complications and reduced inflammatory cytokines. This trial was registered at clinicaltrials.gov as NCT03901937 at https://classic. CLINICALTRIALS: gov/ct2/show/NCT03901937?term=NCT03901937&cond=Crohn+Disease&draw=2&rank=1.

An observational study of the effects of ω-3 polyunsaturated fatty acid-supplemented parenteral nutrition on postoperative complications in patients with Crohn's disease.

BACKGROUND: Crohn's disease (CD) is a chronic inflammatory disease. Most patients with CD require surgery but exhibit an elevated incidence of postoperative complications. Omega-3 polyunsaturated fatty acids (ω-3 PUFAs) are considered beneficial for nutrition, anti-inflammation, immunity, and intestinal microflora balance in humans. This study assessed the effects of ω-3 PUFA-supplemented parenteral nutrition (PN) on postoperative complications in CD patients. METHODS: Overall, 186 CD patients undergoing bowel resection were recruited for this study. The patient data were collected from a prospectively maintained database. After surgery, 83 patients received ω-3 PUFA-supplemented PN, and 103 did not. The postoperative complications were compared between the groups. Complication risk factors were identified by univariate and multivariate analyses. RESULTS: Patients who received ω-3 PUFA-supplemented PN after surgery had lower C-reactive protein (CRP) levels on postoperative day 3 (57.2±5.3 vs. 43.5±3.9 mg/L, P=0.047) and shorter postoperative hospital stays (12.1±1.1 vs. 9.3±0.6 days, P=0.041) than those who did not. The ω-3 PUFA group exhibited significantly fewer overall complications (40.8% vs. 24.1%, P=0.016) and major complications (23.3% vs. 9.6%, P=0.014) than the control group. Postoperative complications were associated with infliximab, ω-3 PUFAs, CRP levels, operative time, and laparoscopic surgery. The multivariate regression revealed that preoperative infliximab use was a positive risk factor and postoperative ω-3 PUFA-supplemented PN was a negative risk factor for postoperative complications. CONCLUSIONS: ω-3 PUFA-supplemented PN reduced post-surgery inflammatory response of CD patients, which in turn decreased the postoperative complications and accelerated recovery.

Chemical constituents of the aerial part of Derris elliptica.

A new coumaronochromone, 6,4'-dihydroxy-7,5' -dimethoxy-coumaronochromone (1), together with eleven known flavonoids (2-12) were isolated from the ethanol extract of the aerial part of Derris elliptica. Their structures were elucidated on the basis of spectroscopic analysis. Compounds 2, 4, 7, 8 and 9 exhibited moderate insecticidal activities against larvae of Aedes albopictus. All compounds showed strong cytotoxic activities against Spodoptera litura (SL) and Trichoplusia ni BTI-Tn-5B1-4 (Hi-5) cells comparison to positive control of rotenone.