Low serum albumin may predict poor efficacy in patients with perforated peptic ulcer treated nonoperatively.

BACKGROUND: Nonoperative management (NOM) is a promising therapeutic modality for patients with perforated peptic ulcer (PPU). However, the risk factors for poor efficacy and adverse events of NOM are a concern. AIM: To investigate the factors predictive of poor efficacy and adverse events in patients with PPU treated by NOM. METHODS: This retrospective case-control study enrolled 272 patients who were diagnosed with PPU and initially managed nonoperatively from January 2014 to December 2018. Of these 272 patients, 50 converted to emergency surgery due to a lack of improvement (surgical group) and 222 patients were included in the NOM group. The clinical data of these patients were collected. Baseline patient characteristics and adverse outcomes were compared between the two groups. Logistic regression analysis and receiver operating characteristic curve analyses were conducted to investigate the factors predictive of poor efficacy of NOM and adverse outcomes in patients with PPU. RESULTS: Adverse outcomes were observed in 71 patients (32.0%). Multivariate analyses revealed that low serum albumin level was an independent predictor for poor efficacy of NOM and adverse outcomes in patients with PPU. CONCLUSION: Low serum albumin level may be used as an indicator to help predict the poor efficacy of NOM and adverse outcomes, and can be used for risk stratification in patients with PPU.

The impact of microbial immune enteral nutrition on the patients with acute radiation enteritis in bowel function and immune status.

The aim of the study was to investigate the effect of microbial immune enteral nutrition by microecopharmaceutics and deep sea fish oil and glutamine and Peptisorb on the patients with acute radiation enteritis in bowel function and immune status. From June 2010 to January 2013, 46 acute radiation enteritis patients in Liaocheng People's Hospital were randomized into the microbial immune enteral nutrition group and the control group: 24 patients in treatment group and 22 patients in control group. The immune microbial nutrition was given to the study group, but not to the control group. The concentration of serum albumin and prealbumin and the number of CD3 (+) T cell, CD4 (+) T cell, CD8 (+) T cell, CD4 (+)/CD8 (+) and natural killer cell of the two groups were detected on the 1, 7 and 14 days after treatment. The arm muscle circumference and triceps skinfold thickness (TSF) were recorded, and the tolerance of the two groups for enteral nutrition and intestinal symptoms was collected and then comparing the two indicators and get results. The tolerance of microbial immune enteral nutrition group about abdominal pain, bloating and diarrhea was better than the control group (P values were 0.018, 0.04 and 0.008 after 7 days; P values were 0.018, 0.015 and 0.002 after 14 days); and the cellular immune parameters were better than the control group((△) P = 0.008,([Symbol: see text]) P = 0.039, (☆) P = 0.032); No difference was found in nutrition indicators. To the patients with acute radiation enteritis, microbial immune enteral nutrition could improve the patient's immune status, and the tolerance of enteral nutrition could be better for the bowel function and the patients' rehabilitation.

[Application of microbiological and immunological enteral nutrition in patients with gastrointestinal cancer complicated with diabetes mellitus].

OBJECTIVE: To investigate the effects of microbiological and immunological enteral nutrition using composition of probiotics, glutamine, fish oil, and peptisorb on patients with gastrointestinal cancer complicated with diabetes mellitus. METHODS: From January 2007 to October 2010, 67 patients with gastrointestinal cancer complicated with diabetes mellitus were admitted to the Liaocheng People's Hospital of Shandong Province and were randomized into the treatment group(n=33, enteral nutrition with probiotics, glutamine, and fish oil) and the routine group(n=34, regular enteral nutrition). Fasting blood glucose(FBG), insulin(FINS), number of lymphocytes(including CD3(+)T cell, CD4(+)T cell, CD8(+)T cell, CD4(+)/CD8(+)) and natural killer (NK) cells of the two groups were detected on the day before surgery and postoperative day 3 and 7. Insulin resistance index (InHOMA-IR) was calculated by using the homeostasis model assessment(HOMA). The incidence of nosocomial infections and intestinal function recovery time, and length of hospital stay were collected. RESULTS: On postoperative day 7, FINS[(8.4±3.7) mU/L vs. (13.7±5.4) mU/L, P<0.05] and InHOMA-IR(1.11±0.23 vs. 1.68±0.39, P<0.05) were lower in the treatment group than that in the routine group. The number of CD4(+)[(45.2±5.4)% vs. (38.1±2.9)%, P<0.05], CD4/CD8 (2.05±0.27 vs. 1.58±0.16, P<0.05), and NK cells [(19.5±6.6)% vs. (15.4±5.6)%, P<0.05] were higher in the treatment group. There were no significant differences in nosocomial infection [6.1%(2/33) vs. 17.6%(6/34), P>0.05] and intestinal function recovery time[(69.3±9.5) h vs. (70.1±11.6) h, P>0.05] between the two groups. However, the length of hospital stay [(17±3.8) d vs. (21±4.2) d, P<0.05] was significantly shorter in the treatment group. CONCLUSION: For patients with gastrointestinal cancer complicated with diabetes mellitus, microbiota enteral nutrition can reduce insulin resistance, improve the immune status, and promote postoperative recovery.