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du J, Zhang T, Hao C, Xu H, Luan H, Cheng Z, Ding M. Impact of transesophageal echocardiography dynamic monitoring of left ventricular preload on postoperative gastrointestinal function in colorectal cancer patients undergoing radical surgery. Ann Med Surg (Lond) 2024; 86:1977-1982. [PMID: 38576914 PMCID: PMC10990396 DOI: 10.1097/ms9.0000000000001776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/22/2024] [Indexed: 04/06/2024] Open
Abstract
Background Patients undergoing intestinal tumour surgery are fasted preoperatively for a series of bowel preparations, which makes it difficult to assess the patients' volume, posing a challenge to intraoperative fluid replacement. Besides, inappropriate fluid therapy can cause organ damage and affect the prognosis of patients, and it increases the burden of patients and has a certain impact on patients and families. Material and methods The authors designed a single-centre, prospective, single-blinded, randomized, parallel-controlled trial. Fifty-four patients undergoing elective radical resection of colorectal cancer were selected and divided into two groups according to whether transesophageal echocardiography (TEE) was used or not during the operation, that is the goal-directed fluid therapy (GDFT) group (group T) guided by TEE and the restrictive fluid therapy group (group C). Fluid replacement was guided according to left ventricular end-diastolic volume index (LVEDVI) in group T and according to restrictive fluid replacement regimen in group C. Results The first postoperative exhaust time and defecation time in group T [(45±21), (53±24) h] were significantly shorter (P<0.05) than those in group C [(63±26), (77±30) h]. There were no significant differences (P>0.05) in liquid intake time and postoperative nausea and vomiting incidences between the two groups. The total intraoperative fluid volume in group T was significantly higher (P<0.05) than that in group C. There was no significant difference (P>0.05) in urine volume between the two groups. There were no significant differences (P>0.05) in lactate content, mean arterial pressure, and heart rate at various time points between the two groups. The length of hospital stay in group C [(18±4) days] was significantly longer (P<0.05) than that in group T [(15±4) days]. Conclusions For patients undergoing colorectal cancer surgery, fluid therapy by monitoring LVEDVI resulted in faster recovery of gastrointestinal function and shorter hospital stay.
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Affiliation(s)
| | | | | | - Hai Xu
- Jinzhou Medical University
| | - Hengfei Luan
- Department of anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu, People’s Republic China
| | | | - Mengyao Ding
- Department of anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu, People’s Republic China
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Lai YC, Wang WT, Hung KC, Chen JY, Wu JY, Chang YJ, Lin CM, Chen IW. Impact of intravenous dexmedetomidine on postoperative gastrointestinal function recovery: an updated meta-analysis. Int J Surg 2024; 110:1744-1754. [PMID: 38085848 PMCID: PMC10942148 DOI: 10.1097/js9.0000000000000988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 11/27/2023] [Indexed: 03/16/2024]
Abstract
BACKGROUND Postoperative ileus (POI) is a complication that may occur after abdominal or nonabdominal surgery. Intravenous dexmedetomidine (Dex) has been reported to accelerate postoperative gastrointestinal function recovery; however, updated evidence is required to confirm its robustness. METHODS To identify randomized controlled trials examining the effects of perioperative intravenous Dex on gastrointestinal function recovery in patients undergoing noncardiac surgery, databases including MEDLINE, EMBASE, Google Scholar, and Cochrane Library were searched on August 2023. The primary outcome was time to first flatus. Secondary outcomes included time to oral intake and defecation as well as postoperative pain scores, postoperative nausea/vomiting (PONV), risk of hemodynamic instability, and length of hospital stay (LOS). To confirm its robustness, subgroup analyses and trial sequential analysis were performed. RESULTS The meta-analysis of 22 randomized controlled trials with 2566 patients showed that Dex significantly reduced the time to flatus [mean difference (MD):-7.19 h, P <0.00001), time to oral intake (MD: -6.44 h, P =0.001), time to defecation (MD:-13.84 h, P =0.008), LOS (MD:-1.08 days, P <0.0001), and PONV risk (risk ratio: 0.61, P <0.00001) without differences in hemodynamic stability and pain severity compared with the control group. Trial sequential analysis supported sufficient evidence favoring Dex for accelerating bowel function. Subgroup analyses confirmed the positive impact of Dex on the time to flatus across different surgical categories and sexes. However, this benefit has not been observed in studies conducted in regions outside China. CONCLUSIONS Perioperative intravenous Dex may enhance postoperative gastrointestinal function recovery and reduce LOS, thereby validating its use in patients for whom postoperative ileus is a significant concern.
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Affiliation(s)
- Yi-Chen Lai
- Department of Anesthesiology, Chi Mei Medical Center, Tainan city, Taiwan
| | - Wei-Ting Wang
- Department of Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan city, Taiwan
| | - Jen-Yin Chen
- Department of Anesthesiology, Chi Mei Medical Center, Tainan city, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Jheng-Yan Wu
- Department of Nutrition, Chi Mei Medical Center, Tainan City, Taiwan
| | - Ying-Jen Chang
- Department of Anesthesiology, Chi Mei Medical Center, Tainan city, Taiwan
| | - Chien-Ming Lin
- Department of Anesthesiology, Chi Mei Medical Center, Tainan city, Taiwan
| | - I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan city, Taiwan
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Zhang Y, Ou C, Luo X, Kang Y, Jiang L, Wu S, Ouyang H. Effectiveness of acupuncture for postoperative gastrointestinal recovery in patients undergoing thoracoscopic surgery: a prospective randomized controlled study. Acupunct Med 2024; 42:14-22. [PMID: 37800350 DOI: 10.1177/09645284231202807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
BACKGROUND Postoperative gastrointestinal dysfunction (PGD) is one of the most common complications among patients who have undergone thoracic surgery. Acupuncture has long been used in traditional Chinese medicine to treat gastrointestinal diseases and has shown benefit as an alternative therapy for the management of digestive ailments. This study aimed to explore the therapeutic effectiveness of acupuncture as a means to aid postoperative recovery of gastrointestinal function in patients undergoing thoracoscopic surgery. METHODS In total, 112 patients aged 18-70 years undergoing thoracoscopic surgery between 15 June 2022 and 30 August 2022 were randomized into two groups. Patients in the acupuncture group (AG) first received acupuncture treatment 4 h after surgery, and treatment was repeated at 24 and 48 h. Patients in the control group (CG) did not receive any acupuncture treatment. Both groups received the same anesthetic protocol. Ultrasound-guided thoracic paravertebral block (TPVB) was performed in the paravertebral spaces between T4 and T5 with administration of 20 mL of 0.33% ropivacaine. All patients received patient-controlled intravenous analgesia (PCIA) after surgery. RESULTS Median time to first flatus [interquartile range] in the AG was significantly less than in the CG (23.25 [18.13, 29.75] vs 30.75 [24.13, 45.38] h, p < 0.001). Time to first fluid intake after surgery was significantly less in the AG, as compared with the CG (4 [3, 7] vs 6.5 [4.13, 10.75] h, p = 0.003). Static pain, measured by visual analog scale (VAS) score, was significantly different on the third day after surgery (p = 0.018). Dynamic pain VAS scores were lower in the AG versus CG on the first three postoperative days (p = 0.014, 0.003 and 0.041, respectively). CONCLUSION Addition of acupuncture appeared to improve recovery of postoperative gastrointestinal function and alleviate posteoperative pain in patients undergoing thoracoscopic surgery. Acupuncture may represent a feasible strategy for the prevention of PGD occurrence. TRIAL REGISTRATION NUMBER ChiCTR2200060888 (Chinese Clinical Trial Registry).
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Affiliation(s)
- Yingjun Zhang
- Department of Anesthesiology, State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Chaopeng Ou
- Department of Anesthesiology, State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xiaolin Luo
- Department of Anesthesiology, State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yinqian Kang
- Department of Anesthesiology, State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Li Jiang
- Department of Integrative Medicine, State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Shaoyong Wu
- Department of Anesthesiology, State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Handong Ouyang
- Department of Anesthesiology, State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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Chen HT, Hung KC, Huang YT, Wu JY, Hsing CH, Lin CM, Chen IW, Sun CK. Efficacy of electroacupuncture in improving postoperative ileus in patients receiving colorectal surgery: a systematic review and meta-analysis. Int J Surg 2024; 110:1113-1125. [PMID: 37916930 PMCID: PMC10871621 DOI: 10.1097/js9.0000000000000848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/09/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND This meta-analysis aimed to evaluate the efficacy and safety of electroacupuncture (EA) in improving postoperative ileus after colorectal surgery. METHODS Electronic databases (e.g. Medline) were screened to identify randomized controlled trials that focused on the association between EA and postoperative ileus. Time to first flatus served as the primary outcome, while the secondary outcomes included time required for the recovery of other gastrointestinal functions (e.g. bowel sound recovery), time to tolerability of liquid/solid food, postoperative pain scores, risk of overall complications, and hospital length of stay. RESULTS Our meta-analysis focusing on 16 studies with a total of 1562 patients demonstrated positive associations of EA with shorter times to the first flatus [mean difference (MD): -10.1 h, P <0.00001, n =1562], first defecation (MD: -11.77 h, P <0.00001, n =1231), bowel sound recovery (MD: -10.76 h, P <0.00001, n =670), tolerability of liquid (MD: -16.44 h, P =0.0002, n =243), and solid food (MD: -17.21 h, P =0.005, n =582) than those who received standard care. The use of EA was also correlated with a lower risk of overall complications (risk ratio:0.71, P =0.04, n =1011), shorter hospital length of stay (MD: -1.22 days, P =0.0001, n =988), and a lower pain score on postoperative days two (standardized MD: -0.87, P =0.009, n =665) and three (standardized MD: -0.45, P <0.00001, n =795), without a difference in time to first ambulation. CONCLUSION Our findings showed an association between EA and enhanced gastrointestinal functional recovery and reduced pain severity following colorectal surgery, highlighting the potential benefits of incorporating EA into perioperative care to enhance recovery outcomes in this setting.
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Affiliation(s)
- Hsiao-Tien Chen
- Department of Chinese Medicine Chi Mei Medical Center, Tainan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung
| | - Yen-Ta Huang
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Jheng-Yan Wu
- Department of Nutrition, Chi Mei Medical Center Tainan
| | - Chung-Hsi Hsing
- Department of Anesthesiology, Chi Mei Medical Center, Tainan
- Department of Medical Research Chi Mei Medical Center, Tainan
| | - Chien-Ming Lin
- Department of Anesthesiology, Chi Mei Medical Center, Tainan
| | - I-Wen Chen
- Department of Anesthesiology Chi Mei Medical Center, Liouying, Tainan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Dachang Hospital, I-Shou University, Kaohsiung
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
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Hua Y, Hong X, Dai M, Li J, Yang S, Guo J, Wang W, Xu Q, Han X, Wang M, Huang N, Zheng H, Kleeff J, Liu Q, Wu W, Zhang T, Liao Q, Zhao Y. Local resection for solid pseudopapillary neoplasms of the pancreas shows improved postoperative gastrointestinal function and reduced mental stress: a multiquestionnaire survey from a large cohort. Int J Surg 2023; 109:3815-3826. [PMID: 37830944 PMCID: PMC10720864 DOI: 10.1097/js9.0000000000000702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/13/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare, low-grade malignant pancreatic tumor with a highly favorable prognosis. Most SPN patients are young and middle-aged women. The main controversial topic for SPN is local resection (LR) versus radical resection (RR). Theoretically, LR could lead to better gastrointestinal function (GIF) and less mental stress. However, no data is available to support this hypothesis. METHODS All SPN patients undergoing surgical treatment in Peking Union Medical College Hospital from 2001 to 2021 were included in the study. A cross-sectional online multiquestionnaire survey containing 110 questions was sent to them (Clinicaltrial.org, NCT05604716). This online multiquestionnaire survey focused on GIF and mental stress and consisted of eight questionnaires. Multiple linear regression analysis was conducted to identify independent factors impacting GIF and mental stress. RESULTS A total of 183 cases provided valid results. Among them, 46 patients (25.1%) underwent LR, and 137 (74.9%) underwent RR. Ninety-four cases (51.4%) underwent minimally invasive surgery (MIS), while 89 (48.6%) underwent open surgery. The average GSRS score of the patients was 1.9±0.7, indicating that most suffered from mild gastrointestinal dysfunction. The scores of PHQ-9 and GAD-7 in 16 patients (8.7%) and 27 (14.8%) patients, respectively, were beyond 10.0, which indicated clinical depression and anxiety. Additionally, 19 (10.4%) patients reported poor ability to work, and 31(16.9%) patients had significant body image concerns. Compared to other clinicopathological characteristics, LR (LR vs. RR: PHQ-9 score, P =0.018; WAI average score, P =0.010; EORTC QLQ-C30, nine subdomains, P <0.05; GSRS average score, P =0.006) and MIS (MIS vs. open surgery: EORTC QLQ-C30, three subdomains, P <0.05; GSRS average score, P =0.006) were the most significant factors predicting improved GIF and reduced mental stress. CONCLUSIONS This study systematically presents postoperative GIF and mental stress of SPN patients using validated multiquestionnaires for the first time. It provides solid evidence that LR and MIS can improve GIF and reduce mental stress after surgery for SPN patients, which could be helpful for the surgeons to make more personalized surgical plans for their patients.
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Affiliation(s)
- Yuze Hua
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Research in Pancreatic Tumors (CAMS), Peking Union Medical College
| | - Xia Hong
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Research in Pancreatic Tumors (CAMS), Peking Union Medical College
| | - Menghua Dai
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Research in Pancreatic Tumors (CAMS), Peking Union Medical College
| | - Jiayi Li
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Research in Pancreatic Tumors (CAMS), Peking Union Medical College
| | - Sen Yang
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Research in Pancreatic Tumors (CAMS), Peking Union Medical College
| | - Junchao Guo
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Research in Pancreatic Tumors (CAMS), Peking Union Medical College
| | - Weibin Wang
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Research in Pancreatic Tumors (CAMS), Peking Union Medical College
| | - Qiang Xu
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Research in Pancreatic Tumors (CAMS), Peking Union Medical College
| | - Xianlin Han
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Research in Pancreatic Tumors (CAMS), Peking Union Medical College
| | - Mengyi Wang
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Research in Pancreatic Tumors (CAMS), Peking Union Medical College
| | - Nan Huang
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Research in Pancreatic Tumors (CAMS), Peking Union Medical College
| | - Huaijin Zheng
- Department of Psychological Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Dongcheng District, Beijing, People’s Republic of China
| | - Jorg Kleeff
- Department of Visceral, Vascular and Endocrine Surgery, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Qiaofei Liu
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Research in Pancreatic Tumors (CAMS), Peking Union Medical College
| | - Wenming Wu
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Research in Pancreatic Tumors (CAMS), Peking Union Medical College
| | - Taiping Zhang
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Research in Pancreatic Tumors (CAMS), Peking Union Medical College
| | - Quan Liao
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Research in Pancreatic Tumors (CAMS), Peking Union Medical College
| | - Yupei Zhao
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Research in Pancreatic Tumors (CAMS), Peking Union Medical College
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Liu Y, Xiang J, Ren J, Gu L, Wang Y, Liu X, Wen J. Factors affecting gastrointestinal function recovery after cesarean section among Chinese mothers: A cross-sectional study. Medicine (Baltimore) 2023; 102:e35200. [PMID: 37746982 PMCID: PMC10519505 DOI: 10.1097/md.0000000000035200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/02/2023] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
This study was conducted to explore the influencing factors of gastrointestinal function recovery after cesarean section (CS), which could provide a reference for the enhanced recovery after surgery in obstetrics. This is a cross-sectional survey on Chinese mothers receiving CS. The participants's socio-demographic characteristics, perioperative diet, medical condition and gastrointestinal function after surgery were collected by a self-designed questionnaire. Binary logistic regression analysis was employed to explore the influencing factors of gastrointestinal function recovery after CS. A total of 1501 (94.76%) valid questionnaires were collected. The first borborygmus was 2.21 ± 0.63 hours, and the first anal exhaust was 35.73 ± 14.85 hours after the CS. The incidence of abdominal distension and intestinal obstruction were 15.1% and 0.7%, respectively. The parity, type of CS, 2-hours bleeding after surgery, time of first meal after surgery, whether taking peppermint water after surgery were the independent influencing factors for gastrointestinal function recovery after CS. We should pay more attention to the mothers with scarred uterus, manage the labor process strictly, and reduce 2-hours bleeding after surgery. The mothers with CS should also be encouraged to eat early and take peppermint water to promote intestinal peristalsis actively.
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Affiliation(s)
- Yi Liu
- Department of Obstetrics Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Jie Xiang
- Department of Obstetrics Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Jianhua Ren
- Department of Obstetrics Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Li Gu
- Department of Obstetrics Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Yu Wang
- Department of Obstetrics Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Xiuping Liu
- Department of Obstetrics Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Jiao Wen
- Department of Obstetrics Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
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Martinez J, Rodriguez Hovnanian KM, Martinez EE. Biomarkers and Functional Assays of Epithelial Barrier Disruption and Gastrointestinal Dysmotility in Critical Illness-A Narrative Review. Nutrients 2023; 15:4052. [PMID: 37764835 PMCID: PMC10535972 DOI: 10.3390/nu15184052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
Enteral nutrition in critically ill children has been associated with improved clinical outcomes. Gastrointestinal dysfunction often impedes the timely initiation and advancement of enteral nutrition and can contribute to immune dysregulation and systemic inflammation. Therefore, assessing gastrointestinal function, at a cellular and functional level, is important to provide optimal enteral nutrition therapy and reduce the gastrointestinal tract's contribution to the inflammatory cascade of critical illness. In this narrative review, we present an overview of biomarker and functional assays for gastrointestinal dysfunction, including epithelial barrier disruption and gastrointestinal dysmotility, that have been considered for critically ill patients.
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Affiliation(s)
- Julianna Martinez
- Rutgers, Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA;
| | - K. Marco Rodriguez Hovnanian
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA 02129, USA;
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Enid E. Martinez
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA 02129, USA;
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA
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Chen J, Fu T, Liu L, Xie Y, Li Y. Effect of acupuncture inclusion in the enhanced recovery after surgery protocol on tumor patient gastrointestinal function: a systematic review and meta-analysis of randomized controlled studies. Front Oncol 2023; 13:1232754. [PMID: 37655096 PMCID: PMC10465796 DOI: 10.3389/fonc.2023.1232754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/31/2023] [Indexed: 09/02/2023] Open
Abstract
Introduction Acupuncture has been shown to be effective in restoring gastrointestinal function in tumor patients receiving the enhanced recovery after surgery (ERAS) protocol. The present systematic review and meta-analysis aimed to evaluate the rationality and efficacy of integrating acupuncture in the ERAS strategy to recuperate gastrointestinal function. Methods We searched eleven databases for relevant randomized clinical trials (RCTs) of acupuncture for the treatment of gastrointestinal dysfunction in tumor patients treated with the ERAS protocol. The quality of each article was assessed using the Cochrane Collaboration risk of bias criteria and the modified Jadad Scale. As individual symptoms, the primary outcomes were time to postoperative oral food intake, time to first flatus, time to first distension and peristaltic sound recovery time (PSRT). Pain control, adverse events, and acupoint names reported in the included studies were also investigated. Results Of the 211 reviewed abstracts, 9 studies (702 patients) met eligibility criteria and were included in the present systematic review and meta‑analysis. Compared to control groups, acupuncture groups showed a significant reduction in time to postoperative oral food intake [standardized mean difference (SMD) = -0.77, 95% confidence interval (CI) -1.18 to -0.35], time to first flatus (SMD=-0.81, 95% CI -1.13 to -0.48), time to first defecation (SMD=-0.91, 95% CI -1.41 to -0.41, PSRT (SMD=-0.92, 95% CI -1.93 to 0.08), and pain intensity (SMD=-0.60, 95% CI -0.83 to -0.37).The Zusanli (ST36) and Shangjuxu (ST37) acupoints were used in eight of the nine included studies. Adverse events related to acupuncture were observed in two studies, and only one case of bruising was reported. Discussion The present systematic review and meta‑analysis suggested that acupuncture significantly improves recovery of gastrointestinal function and pain control in tumor patients receiving the ERAS protocol compared to the control group. Moreover, ST36 and ST37 were the most frequently used acupoints. Although the safety of acupuncture was poorly described in the included studies, the available data suggested that acupuncture is a safe treatment with only mild side effects. These findings provide evidence-based recommendations for the inclusion of acupuncture in the ERAS protocol for tumor patients. Systematic review registration https://www.crd.york.ac.uk/prospero/ PROSPERO, identifier CRD42023430211.
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Affiliation(s)
- Jiu Chen
- Department of Traditional Chinese Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Tianxiao Fu
- Department of Traditional Chinese Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Li Liu
- Department of Library, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yirui Xie
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
- The Department of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Youdi Li
- Department of Traditional Chinese Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Wei XN, Cai WY, Wu KL, Zeng FG. Application effect of gastrointestinal bundle nursing on the protection of gastrointestinal function in patients with gastric cancer. Medicine (Baltimore) 2023; 102:e34308. [PMID: 37478274 PMCID: PMC10662839 DOI: 10.1097/md.0000000000034308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 06/22/2023] [Indexed: 07/23/2023] Open
Abstract
Evidence-based nursing practice was used to formulate the enhanced recovery surgery bundle nursing strategy and apply it to patients with gastric cancer, to explore its safety, effectiveness and feasibility in perioperative gastrointestinal function protection in patients with gastric cancer. Selected the clinical medical records of 100 gastric cancer patients treated in our hospital from June 2019 to June 2021 as the research objects, and divided them into the control group and the observation group with 50 cases in each group according to the random number table. Among them, the control group was given routine nursing measures for nursing intervention, and the observation group was given gastrointestinal enhanced recovery surgery cluster nursing on the basis of the control group. The differences in stress response, gastrointestinal function protection, negative emotions and pain scores of gastric cancer patients before and after nursing were compared between the 2 groups. The postoperative bowel sounds recovery time, first anal exhaust, and first defecation time in the observation group were lower than those in the control group, and the differences were statistically significant (P < .05). Before nursing, there was no significant difference in the scores of stress response changes between the 2 groups (P > .05). After nursing, heart rate (HR), mean arterial pressure (MAP), norepinephrine (NE), and epinephrine (E2) in the observation group were lower than those in the control group, and the difference was statistically significant (P < .05). The pain scores of the 2 groups were significantly improved at different time points, and the observation group was significantly less than the control group, and the difference was statistically significant (P < .05). Gastrointestinal enhanced recovery surgery bundle nursing can effectively improve the gastrointestinal function of patients with gastric cancer, improve the emotional response and stress response of patients, and has certain reference value for the nursing of patients with gastric cancer.
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Affiliation(s)
- Xiao-Ning Wei
- Department of Gastrointestinal Oncology Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Wen-Yan Cai
- Department of Gastrointestinal Oncology Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Kai-Ling Wu
- Department of Gastrointestinal Oncology Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Fei-Ge Zeng
- Department of Urology Surgery, the first affiliated hospital of Hainan Medical University, Haikou, Hainan, China
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10
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Zhang Y, Tao K, Yu J, Chen C, Zheng Q, Lei S, Zhong X, Liu L, Wang W, Wang Q, Li E, Luo Y, Zhang G, Feng X, Li Y, Wang J. Evaluation of early liquid drinking after radical gastrectomy in gastric cancer: a Chinese multicenter propensity score matching analysis. Gastroenterol Rep (Oxf) 2023; 11:goad029. [PMID: 37304556 PMCID: PMC10250079 DOI: 10.1093/gastro/goad029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 04/14/2023] [Indexed: 06/13/2023] Open
Abstract
Background Enhanced recovery after surgery is used in gastrointestinal surgery. This study aimed to access the effects of early liquid drinking (ELD) on gastrointestinal function recovery in patients with gastric cancer (GC) who underwent radical gastrectomy, as high-quality evidence on the outcomes of ELD after gastrectomy is currently lacking. Methods Clinicopathological data of patients with GC from 11 centers were retrospectively analysed. Clinical outcomes were investigated in 555 patients, including 225 who started drinking liquid within 48 h (ELD group) of surgery and 330 who started drinking liquid after flatus resumption (traditional liquid drinking [TLD] group). Propensity score matching (PSM) analysis was performed using a match ratio of 1:1 and 201 patients were selected from each group for the analysis. Primary outcome was time to first passage of flatus. Secondary outcomes included time to first defecation, post-operative hospitalization days, occurrence of short-term post-operative complications, and hospitalization costs. Results After PSM, baseline characteristics were not significantly different between the two groups. The time to first flatus (2.72 ± 1.08 vs 3.36 ± 1.39 days), first defecation (4.34 ± 1.85 vs 4.77 ± 1.61 days), and post-operative hospital stay (8.27 ± 4.02 vs 12.94 ± 4.43 days) were shorter in the ELD group than in the TLD group (all P < 0.05). The ELD group had lower hospitalization costs than the TLD group ([7.83 ± 2.44 vs 8.78 ± 3.41] × 104 RMB, P = 0.041). No significant differences were observed in the incidence of post-operative complications. Conclusions Compared with TLD, post-operative ELD could promote rapid recovery of gastrointestinal function and reduce hospitalization costs; moreover, ELD does not increase the risk of post-operative complications.
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Affiliation(s)
| | | | | | - Chao Chen
- Department of Gastrointestinal Surgery, Huizhou Municipal Central Hospital, Huizhou, Guangdong, P. R. China
| | - Quan Zheng
- Department of Gastrointestinal Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, P. R. China
| | - Sanlin Lei
- Department of Gastrointestinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, P. R. China
| | - Xiaogang Zhong
- Department of Surgical Treatment of Gastrointestinal Hernia and Fistula, The People’s Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, Guangxi, P. R. China
| | - Lixin Liu
- Department of General Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Wei Wang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, P. R. China
| | - Qiang Wang
- Department of Gastrointestinal Surgery, Guangzhou First People’s Hospital, Guangzhou, Guangdong, P. R. China
| | - En Li
- Department of Gastrointestinal Surgery, Meizhou People’s Hospital, Meizhou, Guangdong, P. R. China
| | - Yuwen Luo
- Department of General Surgery, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Guanrong Zhang
- lnformation and Statistics Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Xingyu Feng
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, P. R. China
- Shantou University Medical College, Shantou, Guangdong, P. R. China
| | - Yong Li
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, P. R. China
- Shantou University Medical College, Shantou, Guangdong, P. R. China
| | - Junjiang Wang
- Corresponding author. Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, No. 106 Zhongshan Second Street, Yuexiu District, Guangzhou 510080, Guangdong, P. R. China. Tel: +86-20-83827812;
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11
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Burkhard JP, Jardot F, Furrer MA, Engel D, Beilstein C, Wuethrich PY. Opioid-Free Anesthesia for Open Radical Cystectomy Is Feasible and Accelerates Return of Bowel Function: A Matched Cohort Study. J Clin Med 2023; 12:jcm12113657. [PMID: 37297852 DOI: 10.3390/jcm12113657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
The aim of this study was to evaluate the feasibility of opioid-free anesthesia (OFA) in open radical cystectomy (ORC) with urinary diversion and to assess the impact on recovery of gastrointestinal function. We hypothesized that OFA would lead to earlier recovery of bowel function. A total of 44 patients who underwent standardized ORC were divided into two groups (OFA group vs. control group). In both groups, patients received epidural analgesia (OFA group: bupivacaine 0.25%, control group: bupivacaine 0.1%, fentanyl 2 mcg/mL, and epinephrine 2 mcg/mL). The primary endpoint was time to first defecation. Secondary endpoints were incidence of postoperative ileus (POI) and incidence of postoperative nausea and vomiting (PONV). The median time to first defecation was 62.5 h [45.8-80.8] in the OFA group and 118.5 h [82.6-142.3] (p < 0.001) in the control group. With regard to POI (OFA group: 1/22 patients (4.5%); control group: 2/22 (9.1%)) and PONV (OFA group: 5/22 patients (22.7%); control group: 10/22 (45.5%)), trends but no significant results were found (p = 0.99 and p = 0.203, respectively). OFA appears to be feasible in ORC and to improve postoperative functional gastrointestinal recovery by halving the time to first defecation compared with standard fentanyl-based intraoperative anesthesia.
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Affiliation(s)
- John-Patrik Burkhard
- Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland
- Limmat Cleft- and Craniofacial Centre Zurich, 8005 Zurich, Switzerland
| | - François Jardot
- Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland
| | - Marc A Furrer
- Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland
- Department of Urology, Solothurner Spitäler AG, Kantonsspital Olten, Bürgerspital Solothurn, 4500 Solothurn, Switzerland
- Department of Urology, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland
| | - Dominique Engel
- Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland
| | - Christian Beilstein
- Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland
| | - Patrick Y Wuethrich
- Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland
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12
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Yin YN, Xie H, Ren JH, Jiang NJ, Dai L. The impact of gum-chewing on postoperative ileus following gynecological cancer surgery: A systematic review and meta-analysis of randomized controlled trials. Front Oncol 2023; 12:1059924. [PMID: 36733360 PMCID: PMC9887172 DOI: 10.3389/fonc.2022.1059924] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 12/28/2022] [Indexed: 01/18/2023] Open
Abstract
Objective To assess the effect and safety of gum-chewing on the prevention of postoperative ileus after gynecological cancer surgery. Methods We conducted a systematic review of randomized controlled trials (RCTs) published between 2000 and 2022 in English and Chinese, using the EBSCO, Web of Science, Scopus, Cochrane Central Register of Controlled Trials (Cochrane database), PubMed, Medline (via Ovid), Chinese National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database, and Wan Fang databases. A total of 837 studies were screened using Endnote software, and those that met the inclusion criteria were selected for analysis. The main outcome of interest was the incidence of postoperative ileus, and secondary outcomes included time to first flatus, time to first bowel movement, and length of hospital stay. Results Two authors extracted data and performed quality assessment independently. The review included six RCTs with a total of 669 patients. Compared with routine care, gum-chewing could significantly reduce the incidence of postoperative ileus (RR 0.46, 95% CI: 0.30, 0.72, P=0.0006), shorten the time to first flatus (WMD -9.58, 95% CI: -15.04, -4.12, P=0.0006), first bowel movement (WMD -11.31, 95% CI: -21.05, -1.56, P=0.02), and the length of hospital stay (WMD -1.53, 95% CI: -2.08, -0.98, P<0.00001). Conclusions Gum-chewing is associated with early recovery of gastrointestinal function after gynecological cancer surgery and may be an effective and harmless intervention to prevent postoperative ileus. Systemaic review registration https://www.crd.york.ac.uk/prospero/#searchadvanced, identifier CRD42022384346.
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Affiliation(s)
- Ya-Nan Yin
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China,West China School of Nursing, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Hong Xie
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China,West China School of Nursing, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Jian-Hua Ren
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China,West China School of Nursing, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Ni-Jie Jiang
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China,West China School of Nursing, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Li Dai
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China,National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, Sichuan, China,*Correspondence: Li Dai,
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13
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Dior UP, Reddington C, Cheng C, Levin G, McInerney C, Moss A, Healey M. Lower gastrointestinal function after surgery for deep endometriosis: A prospective cohort study. Int J Gynaecol Obstet 2023; 160:280-288. [PMID: 35841391 PMCID: PMC10088011 DOI: 10.1002/ijgo.14350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 05/06/2022] [Accepted: 07/07/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To prospectively compare long-term lower gastrointestinal function before and after laparoscopic surgery for deep endometriosis (DE). METHODS In this prospective observational study we followed 149 patients with confirmed DE who were treated surgically. Patients completed the International Consultation on Incontinence Questionnaire Anal Incontinence Symptoms and Quality of Life Module (ICIQ-B) before surgery, and 6 weeks, 6 months, and 12 months after surgery. Bowel pattern, bowel control, and bowel impact on quality of life summary scores were compared before and after surgery. RESULTS Bowel pattern score showed an increasing improvement at all time points after surgery, from a mean pre-operation score of 4.8 ± 2.0 to 4.4 ± 1.8 at 6 weeks, 4.2 ± 1.8 at 6 months, and 4.2 ± 1.2 at 12 months. Bowel impact on quality of life significantly improved from pre-surgery mean score of 5.5 ± 6.0 to 4.2 ± 5.5 at 6 weeks and 4.4 ± 5.4 at 6 months. Direct lower gastrointestinal endometriosis involvement and worse initial function were associated with larger improvements in scores following surgery. CONCLUSIONS Lower gastrointestinal function significantly improved after surgical treatment of DE. Further research is needed to confirm our findings and to better characterize the sub-groups of patients for whom surgery will have a beneficial effect on their bowel function.
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Affiliation(s)
- Uri P Dior
- Gynaecology Endometriosis and Pelvic Pain Unit, The Royal Women's Hospital, Parkville, Victoria, Australia.,Endometriosis Centre, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | - Charlotte Reddington
- Gynaecology Endometriosis and Pelvic Pain Unit, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Claudia Cheng
- Gynaecology Endometriosis and Pelvic Pain Unit, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Gabriel Levin
- Endometriosis Centre, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | - Carmel McInerney
- Gynaecology Endometriosis and Pelvic Pain Unit, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Alan Moss
- Department of Gastroenterology, Western Health, Melbourne, Victoria, Australia.,Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Martin Healey
- Gynaecology Endometriosis and Pelvic Pain Unit, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
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14
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Mysonhimer AR, Holscher HD. Gastrointestinal Effects and Tolerance of Nondigestible Carbohydrate Consumption. Adv Nutr 2022; 13:2237-2276. [PMID: 36041173 PMCID: PMC9776669 DOI: 10.1093/advances/nmac094] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/11/2022] [Accepted: 08/25/2022] [Indexed: 01/29/2023] Open
Abstract
Nondigestible carbohydrates (NDCs) are food components, including nonstarch polysaccharides and resistant starches. Many NDCs are classified as dietary fibers by the US FDA. Because of their beneficial effects on human health and product development, NDCs are widely used in the food supply. Although there are dietary intake recommendations for total dietary fiber, there are no such recommendations for individual NDCs. NDCs are heterogeneous in their chemical composition and physicochemical properties-characteristics that contribute to their tolerable intake levels. Guidance on tolerable intake levels of different NDCs is needed because overconsumption can lead to undesirable gastrointestinal side effects, further widening the gap between actual and suggested fiber intake levels. In this review, we synthesize the literature on gastrointestinal effects of NDCs that the FDA accepts as dietary fibers (β-glucan, pectin, arabinoxylan, guar gum, alginate, psyllium husk, inulin, fructooligosaccharides and oligofructose, galactooligosaccharides, polydextrose, cellulose, soy fiber, resistant maltodextrin/dextrin) and present tolerable intake dose recommendations for their consumption. We summarized the findings from 103 clinical trials in adults without gastrointestinal disease who reported gastrointestinal effects, including tolerance (e.g., bloating, flatulence, borborygmi/rumbling) and function (e.g., transit time, stool frequency, stool consistency). These studies provided doses ranging from 0.75-160 g/d and lasted for durations ranging from a single-meal tolerance test to 28 wk. Tolerance was NDC specific; thus, recommendations ranged from 3.75 g/d for alginate to 25 g/d for soy fiber. Future studies should address gaps in the literature by testing a wider range of NDC doses and consumption forms (solid compared with liquid). Furthermore, future investigations should also adopt a standard protocol to examine tolerance and functional outcomes across studies consistently.
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15
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Buffone F, Monacis D, Tarantino AG, Dal Farra F, Bergna A, Agosti M, Vismara L. Osteopathic Treatment for Gastrointestinal Disorders in Term and Preterm Infants: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2022; 10. [PMID: 36011182 DOI: 10.3390/healthcare10081525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 11/24/2022] Open
Abstract
The aim of this systematic review and meta-analysis is to evaluate the effectiveness of osteopathic manipulative treatment (OMT) for gastrointestinal disorders in term and preterm infants. Eligible studies were searched on PubMed, Scopus, Embase, Cochrane, Cinahl, and PEDro. Two reviewers independently assessed if the studies were randomized controlled trials (RCTs) and retrospective studies with OMT compared with any kind of control in term or preterm infants to improve gastrointestinal disorders. Nine articles met the eligibility criteria, investigating OMT compared with no intervention, five involving term infants, and the remaining treating preterm infants. Five studies showed low risk of bias. In the meta-analysis, two studies were included to analyze the hours of crying due to infantile colic, showing statistically significant results (ES = −2.46 [−3.05, −1.87]; p < 0.00001). The quality of evidence was “moderate”. The other outcomes, such as time to oral feeding, meconium excretion, weight gain, and sucking, were presented in a qualitative synthesis. OMT was substantially safe, and showed efficacy in some cases, but the conflicting evidence and lack of high-quality replication studies prevent generalization. High-quality RCTs are recommended to produce better-quality evidence.
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Mai V, Burns AM, Solch RJ, Dennis-Wall JC, Ukhanova M, Langkamp-Henken B. Resistant Maltodextrin Consumption in a Double-Blind, Randomized, Crossover Clinical Trial Induces Specific Changes in Potentially Beneficial Gut Bacteria. Nutrients 2022; 14:nu14112192. [PMID: 35683992 PMCID: PMC9183109 DOI: 10.3390/nu14112192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 12/02/2022] Open
Abstract
Background: We have previously reported that the addition of resistant maltodextrin (RMD), a fermentable functional fiber, to the diet increases fecal weight as well as the amount of fecal bifidobacteria. Here, we report on the targeted analysis of changes in potentially beneficial gut bacteria associated with the intervention. Objective: The primary objective of this study was to determine the effect of adding 0, 15 and 25 g RMD to the diets of healthy free-living adults on potentially beneficial gut bacteria. Methods: We expanded on our previously reported microbiota analysis in a double-blind, placebo-controlled feeding study (NCT02733263) by performing additional qPCR analyses targeting fecal lactic acid bacteria (LAB), Akkermansia muciniphila, Faecalibacterium prausnitzii and Fusicatenibacter saccharivorans in samples from 49 participants. Results: RMD resulted in an approximately two-fold increase in fecal Fusicatenibacter saccharivorans (p = 0.024 for 15 g/day RMD and p = 0.017 for 25 g/day RMD). For Akkermansia muciniphila and Faecalibacterium prausnitzii, we obtained borderline evidence that showed increased amounts in participants that had low baseline levels of these bacteria (p < 0.1 for 25 g/day RMD). We did not detect any effects of RMD on LAB. Conclusions: RMD supplementation in healthy individuals increases Fusicatenibacter saccharivorans. Albeit to a lesser extent, RMD at the higher intake level may also increase Akkermansia muciniphila and Faecalibacterium prausnitzii in individuals with low baseline levels of those two species. Potential benefits associated with these microbiota changes remain to be established in studies with quantifiable health-related endpoints.
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Affiliation(s)
- Volker Mai
- Department of Epidemiology, Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610, USA; (J.C.D.-W.); (M.U.); (B.L.-H.)
- Correspondence: ; Tel.: +1-352-273-9398; Fax: +1-352-273-9399
| | - Alyssa M. Burns
- Food Science and Human Nutrition Department, University of Florida, 572 Newell Drive, Gainesville, FL 32611, USA; (A.M.B.); (R.J.S.)
| | - Rebecca J. Solch
- Food Science and Human Nutrition Department, University of Florida, 572 Newell Drive, Gainesville, FL 32611, USA; (A.M.B.); (R.J.S.)
| | - Jennifer C. Dennis-Wall
- Department of Epidemiology, Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610, USA; (J.C.D.-W.); (M.U.); (B.L.-H.)
| | - Maria Ukhanova
- Department of Epidemiology, Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610, USA; (J.C.D.-W.); (M.U.); (B.L.-H.)
| | - Bobbi Langkamp-Henken
- Department of Epidemiology, Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610, USA; (J.C.D.-W.); (M.U.); (B.L.-H.)
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17
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Zheng H, Li Z, Su R, Li J, Zheng S, Yang J, Zhao E. Clinical effects of prophylactic transverse colostomy in patients undergoing completely laparoscopic transabdominal approach partial intersphincteric resection. J Int Med Res 2022; 50:3000605221094526. [PMID: 35469476 PMCID: PMC9087253 DOI: 10.1177/03000605221094526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective To investigate the clinical effects of prophylactic transverse colostomy on
gastrointestinal function recovery and complications in patients undergoing
completely laparoscopic transabdominal approach partial intersphincteric
resection (CLAPISR) of low rectal cancer. Methods We retrospectively analyzed the data of 74 patients with low rectal cancer
who were treated with prophylactic transverse colostomy (Group A, n = 34) or
without prophylactic transverse colostomy (Group B, n = 40). Surgery-related
indicators, nutritional status indicators, systemic stress response
indicators, and complications were compared between the two groups. Results On postoperative day 5, the C-reactive protein concentration and white blood
cell count were not significantly different between the two groups; however,
the serum concentrations of total protein and albumin were higher in Group A
than in Group B. Within 26 months postoperatively, the total incidence rate
of complications was not significantly different, but the incidence rate of
anastomotic leakage was lower in Group A than in Group B. Conclusion Prophylactic transverse colostomy based on CLAPISR can lead to faster
recovery of gastrointestinal function, better improvement of postoperative
nutritional indicators, and a lower incidence of anastomotic leakage. These
characteristics are conducive to the rapid recovery of patients, making this
procedure worthy of clinical application.
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Affiliation(s)
- Honghong Zheng
- Department of Gastrointestinal Surgery, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Zhehong Li
- Department of Orthopedic, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Rui Su
- Department of Gastrointestinal Surgery, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Jianjun Li
- Department of Gastrointestinal Surgery, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Shuai Zheng
- Department of Gastrointestinal Surgery, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Ji Yang
- Department of Gastrointestinal Surgery, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Enhong Zhao
- Department of Gastrointestinal Surgery, Affiliated Hospital of Chengde Medical University, Chengde, China
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18
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Hu J, Wang LL, Li Y. Effects of high-quality nursing intervention on negative emotions, postoperative complications and gastrointestinal function in patients with gastric cancer surgery. Am J Transl Res 2022; 14:1652-1662. [PMID: 35422953 PMCID: PMC8991151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/30/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate the effects of high-quality nursing intervention on negative emotions, postoperative complications and gastrointestinal function of patients underwent gastric cancer (GC) surgery. METHODS From November 2017 to February 2019, a total of 164 GC patients who underwent operative treatment in our hospital were selected as the research subjects. Thereinto, 86 patients were given high-quality nursing intervention (research group, RG), and the other 78 received routine nursing intervention (control group, CG). The hospitalization time, expenses and the incidence of postoperative complications were compared between the two groups. After operation, the gastrointestinal function, negative emotions, postoperative pain, quality of life, nursing satisfaction, and ESCA and PSQI scores were compared between the two groups. RESULTS The hospitalization time was significantly shorter and expenses were obviously lower in patients of the RG than those in the CG. The incidence of postoperative complications in the RG was obviously lower than that in the CG. The gastrointestinal function indexes (time to anal exhaust, time to defecation, time to start eating, recovery time of bowel sounds, indwelling time of gastric tube, time of getting out of bed) of patients in the RG were obviously better. The SAS, SDS, PSQI scores and VAS scores at 24 h after operation of patients in the RG were obviously lower than those in the CG. The score of quality of life, scores of ESCA and nursing satisfaction of patients in the RG were obviously higher than those in the CG. CONCLUSION High-quality nursing intervention can dramatically improve negative emotions, reduce postoperative complications, ameliorate sleep quality, enhance self-care ability, relieve postoperative pain and improve quality of life and nursing satisfaction for patients undergoing GC surgery.
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Affiliation(s)
- Jie Hu
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University Zhengzhou 450052, Henan Province, China
| | - Lu-Lu Wang
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University Zhengzhou 450052, Henan Province, China
| | - Ya Li
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University Zhengzhou 450052, Henan Province, China
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李 小, 姜 玉, 古 翠, 马 沙, 程 向. [Ultrasound-guided stellate ganglion block accelerates postoperative gastrointestinal function recovery following laparoscopic radical gastrectomy for gastric cancer]. Nan Fang Yi Ke Da Xue Xue Bao 2022; 42:300-304. [PMID: 35365457 PMCID: PMC8983366 DOI: 10.12122/j.issn.1673-4254.2022.02.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To explore the effects of ultrasound-guided stellate ganglion block (SGB) on perioperative stress response, gastrointestinal hormones and postoperative gastrointestinal function recovery in patients undergoing laparoscopic radical gastrectomy for gastric cancer. METHODS This study was conducted among 60 American Society of Anesthesiologists (ASA) class II-III patients with gastric cancer (regardless of gender, aged 35-75 years with BMI of 18.5-26 kg/m2) undergoing elective laparoscopic radical gastrectomy. The patients were randomized into experimental group (S group, n=30) and control group (NS group, n=30). In S group, SGB at the C6 level of the right cervical spine was performed under ultrasound guidance 15 min before induction of anesthesia by injection of 7 mL 0.5% ropivacaine; the patients in NS group received injections of normal saline in the same manner. Peripheral venous blood samples were collected before SGB (T1), after surgery (T2), and on the 2nd and 6th days after surgery (T3 and T4) for determination of the levels of motitin (MOT), vasoactive intestinal peptide (VIP), cortisol (COR), and blood glucose (GLU). Intraoperative usage of sufentanil, recovery rate of intestinal sounds at 36, 48, 60, 72, 84 and 96 h after operation and the time of first passage of flatus were recorded and compared between the two groups. RESULTS There was no significant difference in the total amount of sufentanil consumption between the two groups. Compared with those in NS group, the patients in S group had significant lower COR and VIP levels (P < 0.05) and higher MOT level (P < 0.05) at T2, T3 and T4. Glu level at T2 and T3 was also significantly lower in S group (P < 0.05). The recovery rates of intestinal sounds at 36, 48, 60, 72 and 84 h after surgery were significantly higher (P < 0.05) and the time of the first passage of flatus was earlier in S group than in NS group (P < 0.05). CONCLUSION In patients with gastric cancer undergoing laparoscopic radical gastrectomy, ultrasound-guided SGB can reduce postoperative stress level, promote the recovery of gastrointestinal hormone secretion, and accelerate postoperative recovery of gastrointestinal functions.
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Affiliation(s)
- 小雨 李
- />蚌埠医学院第一附属医院麻醉科,安徽 蚌埠 233000Department of Anesthesiology, First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - 玉玉 姜
- />蚌埠医学院第一附属医院麻醉科,安徽 蚌埠 233000Department of Anesthesiology, First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - 翠方 古
- />蚌埠医学院第一附属医院麻醉科,安徽 蚌埠 233000Department of Anesthesiology, First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - 沙沙 马
- />蚌埠医学院第一附属医院麻醉科,安徽 蚌埠 233000Department of Anesthesiology, First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - 向阳 程
- />蚌埠医学院第一附属医院麻醉科,安徽 蚌埠 233000Department of Anesthesiology, First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
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He Y, Lu LY, Chen MJ, Wen Q, Li N. [Postoperative ileus after laparotomy for gastrointestinal cancer treated with electroacupuncture: a randomized controlled trial]. Zhongguo Zhen Jiu 2022; 42:45-48. [PMID: 35025157 DOI: 10.13703/j.0255-2930.20210125-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To observe the effect of electroacupuncture (EA) on postoperative ileus after laparotomy for gastrointestinal cancer. METHODS A total of 90 patients with postoperative ileus after laparotomy for gastrointestinal cancer were randomized into an EA group and a conventional treatment group, 45 cases in each one. In the conventional treatment group, the postoperative fast track surgical regimen was accepted. In the EA group, on the base of the treatment as the conventional treatment group, acupuncture was applied to Zusanli (ST 36), Shangjuxu (ST 37), Yinlingquan (SP 9) and Taichong (LR 3) and electric stimulation was attached on Zusanli (ST 36) and Yinlingquan (SP 9), with continuous wave, 2 Hz in frequency and 3-5 mA in intensity. Acupuncture was provided once daily till the onset of postoperative exhaust and defecation. The first postoperative exhaust time, the first postoperative defecation time, the postoperative hospital stay and the wound pain under standing on the next morning after entering group were compared in the patients between the two groups. The impact of the EA expectation was analyzed on the first postoperative exhaust time, the first postoperative defecation time and the postoperative hospital stay separately. RESULTS The first postoperative exhaust time and the first postoperative defecation time in the EA group were earlier than the conventional treatment group (P<0.05), the postoperative hospital stay was shorter than the conventional treatment group (P<0.05), and the rate of wound pain in the postoperative standing was lower than the conventional treatment group (P<0.05). EA expectation had no obvious correlation with the clinical therapeutic effect (P>0.05). CONCLUSION EA can relieve postoperative ileus symptoms, alleviate pain and shorten hospital stay in the patients after laparotomy for gastrointestinal cancer.
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Affiliation(s)
- Ying He
- Department of Integrated Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Ling-Yun Lu
- Department of Integrated Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Ming-Jin Chen
- Department of Integrated Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qian Wen
- Department of Integrated Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Ning Li
- Department of Integrated Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
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Löffel LM, Engel DA, Beilstein CM, Hahn RG, Furrer MA, Wuethrich PY. Dehydration before Major Urological Surgery and the Perioperative Pattern of Plasma Creatinine: A Prospective Cohort Series. J Clin Med 2021; 10:jcm10245817. [PMID: 34945113 PMCID: PMC8706637 DOI: 10.3390/jcm10245817] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/17/2021] [Accepted: 12/09/2021] [Indexed: 11/30/2022] Open
Abstract
Preoperative dehydration is usually found in 30–50% of surgical patients, but the incidence is unknown in the urologic population. We determined the prevalence of preoperative dehydration in major elective urological surgery and studied its association with postoperative outcome, with special attention to plasma creatinine changes. We recruited 187 patients scheduled for major abdominal urological surgery to participate in a single-center study that used the fluid retention index (FRI), which is a composite index of four urinary biomarkers that correlate with renal water conservation, to assess the presence of dehydration. Secondary outcomes were postoperative nausea and vomiting (PONV), return of gastrointestinal function, in-hospital complications, quality of recovery, and plasma creatinine. The proportion of dehydrated patients at surgery was 20.4%. Dehydration did not correlate with quality of recovery, PONV, or other complications, but dehydrated patients showed later defecation (p = 0.02) and significant elevations of plasma creatinine after surgery. The elevations were also greater when plasma creatinine had increased rather than decreased during the 24 h prior to surgery (p < 0.001). Overall, the increase in plasma creatinine at 6 h after surgery correlated well with elevations on postoperative days one and two. In conclusion, we found preoperative dehydration in one-fifth of the patients. Dehydration was associated with delayed defecation and elevated postoperative plasma creatinine. The preoperative plasma creatinine pattern could independently forecast more pronounced increases during the early postoperative period.
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Affiliation(s)
- Lukas M. Löffel
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, CH 3010 Bern, Switzerland; (L.M.L.); (D.A.E.); (C.M.B.)
| | - Dominique A. Engel
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, CH 3010 Bern, Switzerland; (L.M.L.); (D.A.E.); (C.M.B.)
| | - Christian M. Beilstein
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, CH 3010 Bern, Switzerland; (L.M.L.); (D.A.E.); (C.M.B.)
| | - Robert G. Hahn
- Research Unit, Södertälje Hospital, Södertälje, Karolinska Institutet at Danderyds Hospital (KIDS), 18288 Stockholm, Sweden;
| | - Marc A. Furrer
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, CH 3010 Bern, Switzerland;
| | - Patrick Y. Wuethrich
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, CH 3010 Bern, Switzerland; (L.M.L.); (D.A.E.); (C.M.B.)
- Correspondence: ; Tel.: +41-31-632-0554
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Liang Y, Yan X, Liao Y. The effect of shortening the preoperative fasting period on patient comfort and gastrointestinal function after elective laparoscopic surgery. Am J Transl Res 2021; 13:13067-13075. [PMID: 34956525 PMCID: PMC8661208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 02/02/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To explore the influence of shortening preoperative fasting on the comfort and gastrointestinal function of patients undergoing elective laparoscopic surgery. METHODS a total of 179 patients undergoing elective laparoscopic cholecystectomies (LC) in our hospital from March, 2019 to August, 2020 were recruited as the study cohort and placed into the research group (n=97) or the control group (n=82) according to different fasting periods assigned to each patient. In the control group, the patients were subjected to 12-h fasting and 6-h water deprivation before their surgeries, and the patients in the research group were subjected to 6-h fasting and 2-h water deprivation. The preoperative hunger and thirst, comfort, anxiety, and intraoperative aspiration, as well as the postoperative hospital stay durations, the blood glucose levels, the nausea and vomiting, the pain levels, and the times to the recovery of gastrointestinal function were compared between the two groups. RESULTS The research group had shorter hospital stay durations and decreased blood glucose levels. No intraoperative aspiration occurred in either group, and the incidence of postoperative nausea and vomiting in the research group was lower than it was in control group. The patients in the research group were less hungry and thirsty and were more comfortable in the preoperative period, and their preoperative self-rating anxiety scale (SAS) and postoperative visual analog scale (VAS) scores were lower than the corresponding scores in the control group. The times to first oral feeding, ambulation, anal flatus, defecation, and bowel sounds in the research group were earlier than they were in the control group. CONCLUSION Shortening preoperative fasting improves the comfort levels of patients undergoing elective LC, alleviates thirst and hunger, promotes the recovery of gastrointestinal function, and relieves preoperative anxiety, postoperative pain, and adverse reactions.
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Affiliation(s)
- Yin Liang
- Operating Room, People's Hospital of Changshou District Chongqing 401220, China
| | - Xiaoqin Yan
- Operating Room, People's Hospital of Changshou District Chongqing 401220, China
| | - Yan Liao
- Operating Room, People's Hospital of Changshou District Chongqing 401220, China
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Zhang C, Xiong B, Chen L, Ge W, Yin S, Feng Y, Sun Z, Sun Q, Zhao Y, Shen W, Zhang H. Rescue of male fertility following faecal microbiota transplantation from alginate oligosaccharide-dosed mice. Gut 2021; 70:2213-2215. [PMID: 33443023 PMCID: PMC8515102 DOI: 10.1136/gutjnl-2020-323593] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/09/2020] [Accepted: 12/12/2020] [Indexed: 12/08/2022]
Affiliation(s)
- Cong Zhang
- State Key Laboratory of Animal Nutrition, Institute of Animal Sciences, Chinese Academy of Agricultural Sciences, Haidian District, China,College of Life Sciences, Qingdao Agricultural University, Qingdao, China
| | - Bohui Xiong
- State Key Laboratory of Animal Nutrition, Institute of Animal Sciences, Chinese Academy of Agricultural Sciences, Haidian District, China,College of Life Sciences, Qingdao Agricultural University, Qingdao, China
| | - Liang Chen
- State Key Laboratory of Animal Nutrition, Institute of Animal Sciences, Chinese Academy of Agricultural Sciences, Haidian District, China
| | - Wei Ge
- College of Life Sciences, Qingdao Agricultural University, Qingdao, China
| | - Shen Yin
- College of Life Sciences, Qingdao Agricultural University, Qingdao, China
| | - Yanni Feng
- College of Veterinary Medicine, Qingdao Agricultural University, Qingdao, PR China
| | - Zhongyi Sun
- Center for Reproductive Medicine, Urology Department, Peking University Shenzhen Hospital, Shenzhen, China
| | - Qingyuan Sun
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China
| | - Yong Zhao
- State Key Laboratory of Animal Nutrition, Institute of Animal Sciences, Chinese Academy of Agricultural Sciences, Haidian District, China .,College of Life Sciences, Qingdao Agricultural University, Qingdao, China
| | - Wei Shen
- College of Life Sciences, Qingdao Agricultural University, Qingdao, China
| | - Hongfu Zhang
- State Key Laboratory of Animal Nutrition, Institute of Animal Sciences, Chinese Academy of Agricultural Sciences, Haidian District, China
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Seow-En I, Chok AY, Matchar DB, Yoon S, Chong DQ, Tan EKW. Long-term quality of life, sexual health and gastrointestinal function following colorectal cancer resection in an Asian cohort. Colorectal Dis 2021; 23:2348-2360. [PMID: 34097342 DOI: 10.1111/codi.15768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/15/2021] [Accepted: 05/31/2021] [Indexed: 01/22/2023]
Abstract
AIM As populations age and cancer management improves, long-term survivorship and quality-of-life (QOL) outcomes are becoming equally important as oncological results. Data from Asian populations are scarce. We aimed to evaluate the sexual health, gastrointestinal function and QOL amongst colorectal cancer survivors in a tertiary referral centre in Singapore. METHOD Adults who had undergone elective curative surgery for non-metastatic colorectal cancer at least 2 years prior were included. Exclusion criteria were cognitive disease, serious postoperative complications or recurrent cancer. Participants were invited to complete the European Organization for Research and Treatment of Cancer Quality of Life Questionnaires EORTC-QLQ-C30 and QLQ-CR29. Using multiple bivariate analysis, r scores were used to examine relationship trends between QOL domains and survivor sociodemographic and disease-specific characteristics. RESULTS From February 2017 to July 2019, 400 responses were recorded. Median age and follow-up duration were 64 years (range 32-90) and 78 months (interquartile range 49-113) respectively. Patients who had Stage III cancer had better overall QOL scores compared to Stage I/II. Rectal (vs. colon) cancer negatively influenced sexual health and gastrointestinal function, but did not appear to affect overall QOL. Amongst our cohort, 57% (n = 129) of men and 43% (n = 75) of women were sexually active. Markers of socioeconomic status, including employment, education and housing type, were found to significantly impact perception of various aspects of QOL. CONCLUSION Knowledge of factors which influence well-being can identify individuals who may benefit from tailored management strategies. Regular patient-doctor contact may play a role in building and maintaining positive perspectives of cancer survivors. Normative data should be obtained from local populations to facilitate future comparative research.
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Affiliation(s)
- Isaac Seow-En
- Department of Colorectal Surgery, Singapore General Hospital, Singapore City, Singapore
| | - Aik Yong Chok
- Department of Colorectal Surgery, Singapore General Hospital, Singapore City, Singapore
| | - David Bruce Matchar
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore City, Singapore.,Department of Medicine, Duke University Medical School, Durham, NC, USA
| | - Sungwon Yoon
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore City, Singapore
| | - Dawn Qingqing Chong
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore City, Singapore
| | - Emile Kwong-Wei Tan
- Department of Colorectal Surgery, Singapore General Hospital, Singapore City, Singapore
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Li S, Bai J, Wei W, Liu X, Shen Y. Effect of systematic nursing on the stress response and recovery of gastrointestinal function in patients undergoing laparoscopic cholecystectomy. Am J Transl Res 2021; 13:9647-9654. [PMID: 34540091 PMCID: PMC8430183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/19/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To explore the effect of systematic nursing on the stress response and recovery of gastrointestinal function in patients undergoing laparoscopic cholecystectomy. METHODS A retrospective study was conducted among 102 patients with gallbladder system disease. They were divided into an observation group (n=51, perioperative systematic care) and a control group (n=51, perioperative conventional care) according to a random number table. The clinical indicators, postoperative recovery of gastrointestinal function, and patients' stress response, psychological status and quality of life before and after intervention were compared between the two groups. RESULTS Compared with the control group, the time to get out of bed for the first time after operation, the recovery time of bowel sounds, and the time of first gas/defecation after operation in the observation group were significantly earlier (all P<0.01), and the hospital stay was significantly shorter (P<0.001). Compared with 12 hours before operation, the serum adrenaline and cortisol levels of the two groups were significantly higher at 48 hours after operation, and the levels in the observation group were lower than the control group (all P<0.001). Compared with 1 day before the operation, the scores of Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) in both groups were reduced when they were discharged from the hospital, and the scores in the observation group were lower than that of the control group (all P<0.01). Three months after the operation, the scores of Generic Quality of Life Inventory-74 (GQOLI-74) in the two groups increased in all dimensions, and the scores in the observation group were higher than the control group (all P<0.05). CONCLUSION Systematic care during the perioperative period of laparoscopic cholecystectomy can alleviate the degree of stress, promote the recovery of postoperative gastrointestinal function, relieve the level of anxiety and depression, and improve the quality of life of patients after discharge from the hospital.
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Affiliation(s)
- Sha Li
- Department of Anesthesiology and Surgery, Affiliated Hospital of Gansu University of Chinese MedicineLanzhou 730020, Gansu Province, China
| | - Jing Bai
- Department of Anesthesiology and Surgery, Affiliated Hospital of Gansu University of Chinese MedicineLanzhou 730020, Gansu Province, China
| | - Wanxia Wei
- Department of Anesthesiology and Surgery, Affiliated Hospital of Gansu University of Chinese MedicineLanzhou 730020, Gansu Province, China
| | - Xiaoqin Liu
- Department of Nursing, Affiliated Hospital of Gansu University of Chinese MedicineLanzhou 730020, Gansu Province, China
| | - Yanping Shen
- Department of Anesthesiology and Surgery, Affiliated Hospital of Gansu University of Chinese MedicineLanzhou 730020, Gansu Province, China
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Han Q, Wu S, Chen H, Wang L, Zhang C. The choice of anesthesia for acute abdomen surgery patients and its influence on gastrointestinal function recovery. Am J Transl Res 2021; 13:9621-9626. [PMID: 34540087 PMCID: PMC8430078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 03/10/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To study the clinical anesthesia options for patients undergoing acute abdomen surgery and its effect on the recovery of patients' gastrointestinal function. METHODS 120 patients who underwent abdomen surgery in our hospital from January 2018 to January 2019 were recruited as the research cohort and placed into group A (n=40) or group B (n=80) according to different anesthesia method each underwent. Group A was administered combined spinal-epidural anesthesia, and group B was administered general anesthesia with tracheal intubation. The anesthesia-related time indicators, the postoperative analgesia, the complication rates (CR), the gastric function indicators, and the gastrointestinal function recovery times were compared between the two groups. RESULTS Group A's anesthesia-related time indicators were significantly lower than group B's (P<0.001). The visual analogue scale (VAS) postoperative pain score in group A was (2.21±0.41), which was observably lower than the corresponding score in group B (P<0.001). There was no significant difference in the CR between the two groups (7.5% vs 17.5%) (P>0.05). The motilin and ghrelin levels in group A were significantly higher than they were in group B (P<0.05). The gastrointestinal function recovery time in group A was notably less than it was in group B (P<0.05). CONCLUSION Spinal-epidural anesthesia is a preferred technique because of its strengths in gastric function and operation success rates by taking patients' actual situations into consideration.
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Affiliation(s)
- Qian Han
- Department of Anesthesiology I, Cangzhou Central Hospital16 West Xinhua Road, Yunhe District, Cangzhou, China
| | - Shuishui Wu
- Department of Anesthesiology I, Cangzhou Central Hospital16 West Xinhua Road, Yunhe District, Cangzhou, China
| | - Haijun Chen
- Department of Anesthesiology I, Cangzhou Central Hospital16 West Xinhua Road, Yunhe District, Cangzhou, China
| | - Lei Wang
- Department of Anesthesiology I, Cangzhou Central Hospital16 West Xinhua Road, Yunhe District, Cangzhou, China
| | - Chuansuo Zhang
- Department of Interventional Radiology, Cangzhou Central Hospital16 West Xinhua Road, Yunhe District, Cangzhou, China
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Wang W, Huang Y, Lan Y, Wang L. The application of a structural nutritional care management model in severe acute pancreatitis patients undergoing early enteral nutrition via nasal jejunal nutrition tubes. Am J Transl Res 2021; 13:8200-8206. [PMID: 34377306 PMCID: PMC8340253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/25/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate the advantages of a structural nutritional care management model (hereafter referred to as structural management) in severe acute pancreatitis (SAP) patients undergoing early enteral nutrition via nasal jejunal nutrition tubes. METHODS A total of 88 patients with SAP diagnosed and treated in our hospital were recruited as the study cohort and underwent enteral nutrition treatment. A random number table was used for the random grouping. The control group was routinely managed, and the study group was also administered structural management. In the study, we observed and compared the differences and changes in the relevant nutritional indexes (albumin (ALB), prealbumin (PA), and transferrin (TRF)) and the gastrointestinal hormone indexes (gastrin (MTL), vasoactive peptide (VIP), and 5-hydroxytryptamine (5-HT)) before and after the treatment. Between the two groups, we also compared the times required for the recovery of the relevant gastrointestinal physiological function indexes, the mechanical ventilation times, the hospitalization durations in the ICU, the complications, the satisfaction indexes and the satisfaction rates. RESULTS After the treatment, the relevant nutritional indicators, including ALB (35.26±3.35 g/L), PA (25.19±5.64 g/L), and TRF (2.82±0.54 g/L) in the study group were higher than the ALB (28.19±2.74 g/L), PA (21.29±4.32 g/L), and TRF (2.26±0.32 g/L) in the control group (all P<0.05). After the treatment, the relevant gastrointestinal hormone indicators, including MTL (269.72±37.18 pg/mL) and 5-HT (2214.61±432.95 ng/mL) in the study group were higher than the MTL (231.25±32.63 pg/mL) and 5-HT (1914.26±391.53 ng/mL) in the control group (all P<0.05). Moreover, the VIP in the study group was 53.13±6.17 pg/mL, which was significantly lower than the VIP in the control group (65.29±9.35 pg/mL, P<0.05). The time required for the recovery of the gastrointestinal function indexes in the study group was less than it was in the control group (P<0.05). The duration of the mechanical ventilation (8.16±1.93 days) and the hospitalization durations in the ICU (9.24±0.77 days) in the study group were significantly shorter than the duration of the mechanical ventilation (12.24±1.65 days) and the hospitalization durations in the ICU (13.23±0.88 days) in the control group (all P<0.05). The overall complication rate in the study group was significantly lower than it was in the control group (P<0.05), and the satisfaction rate in the study group was significantly higher than it was in the control group (P<0.05). CONCLUSION The combined use of structural management in SAP patients undergoing enteral nutrition treatment significantly improved the relevant nutritional indicator and gastrointestinal hormone indicator levels. It also contributed to the recovery of the gastrointestinal function indicators in the SAP patients, reduced the durations of their mechanical ventilation, their hospitalization durations in the ICU, and their complications and contributed to a significant increase in their satisfaction with the nursing.
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Affiliation(s)
- Wenjie Wang
- Department of Critical Care Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of ChinaChengdu, Sichuan Province, China
| | - Yanting Huang
- Department of Hepatobiliary and Pancreatic Surgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of ChinaChengdu, Sichuan Province, China
- Center for Cell Transplantation, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of ChinaChengdu, Sichuan Province, China
| | - Yunping Lan
- Department of Critical Care Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of ChinaChengdu, Sichuan Province, China
| | - Le Wang
- Department of Cardiac Surgery One, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of ChinaChengdu, Sichuan Province, China
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Ju S, Sun J, Yang W, Tian G. Study on parental satisfaction and clinical treatment outcomes of 128 diarrheic children receiving comprehensive nursing. Am J Transl Res 2021; 13:8102-8109. [PMID: 34377293 PMCID: PMC8340235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/03/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To explore the clinical treatment outcomes and parental satisfaction of children with diarrhea receiving comprehensive nursing intervention. METHODS A total of 128 diarrheic children treated in our hospital from June 2016 to June 2017 were recruited and divided into a control group (n=64) receiving conventional nursing and an observation group (n=64) receiving comprehensive nursing intervention, as per a random number table. The clinical outcomes, electrolyte disorders, recovery of gastrointestinal function, quality of life and parental satisfaction were compared between the two groups after nursing. RESULTS The overall response rate of the observation group was higher than that of the control group (81.25% vs. 51.56%) (P < 0.05). Nursing satisfaction in the observation group was higher than that in the control group (100.00% vs. 75.00%) (P < 0.05). However, the time to resolution of clinical symptoms and time to return of bowel sounds in the observation group were shorter than those in the control group (P < 0.05). After nursing, the incidence of electrolyte disorders in the observation group was lower than that in the control group. The scores of physical symptoms, physical functioning, emotional functioning, cognitive functioning and social functioning in PedsQLTM Measurement Model were higher than those in the control group, and the electrolyte index monitoring results were better than those in the control group (P < 0.05). CONCLUSION Comprehensive nursing intervention can effectively reduce the incidence of electrolyte disorders, improve parental satisfaction, accelerate the recovery of gastrointestinal function and improve the quality of life in the treatment of pediatric diarrhea.
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Affiliation(s)
- Shumei Ju
- The Second Department of Pediatrics and Internal Medicine, Linyi Central HospitalLinyi 276400, Shandong Province, China
| | - Jie Sun
- Department of Nursing, Dongying People’s HospitalDongying 257091, Shandong Province, China
| | - Wenjing Yang
- Department of Nursing, Jinan HospitalJinan 250013, Shandong Province, China
| | - Guiying Tian
- Department of Pediatrics, Dongying People’s HospitalDongying 257091, Shandong Province, China
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Zhang L, Pan W. Effect of a nursing intervention strategy oriented by Orem's self-care theory on the recovery of gastrointestinal function in patients after colon cancer surgery. Am J Transl Res 2021; 13:8010-8020. [PMID: 34377283 PMCID: PMC8340249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 01/22/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate the effect of nursing intervention strategies based on the Orem self-care theory on the recovery of gastrointestinal function in patients after colon cancer surgery. METHODS In this prospective study, a total of 115 patients with colon cancer who had radical resection of the colon cancer tissue were selected as the research subjects and randomized into two groups: an Orem group (59 cases), which was given nursing based on the Orem self-care model and a control group (56 cases), which was given regular nursing. The postoperative recovery of the two groups was compared. RESULTS After the intervention, the time to first getting out of bed, gastric tube removal, first postoperative flatus, first fluid food intake and general food intake were significantly earlier than those of the control group. Time of intestinal peristalsis and the average length of hospital stay of the Orem group were much shorter than those of the control group (all P<0.001). The cost of nutrient supply of the Orem group was significantly lower than that of the control group (P<0.001), and the postoperative pain and incidence of complications of patients in the Orem group were significantly lower than those in the control group (P<0.05). After 3 months of follow-up, the scores of positive attitude, intimacy and total score of hope in the hope level of the patients in the Orem group were significantly higher than those in the control group (all P<0.01). There was no significant difference in the positive action scores (P>0.05). Besides, the scores of the Orem group in all dimensions of the quality of life were significantly higher than those of the control group (all P<0.01). CONCLUSION Nursing intervention based on the Orem self-care theory can promote the recovery of patients with colon cancer after surgery, speed up the recovery of their gastrointestinal function, and ultimately improve their level of hope and quality of life. Therefore, it is worthy of promotion in clinical practice.
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Affiliation(s)
- Lianhong Zhang
- Admission and Discharge Management Center, Huzhou Central Hospital, Affiliated Hospital of Huzhou Normal UniversityHuzhou, Zhejiang Province, China
| | - Wenyan Pan
- Department of General Surgery, Huzhou Central Hospital, Affiliated Hospital of Huzhou Normal UniversityHuzhou, Zhejiang Province, China
- Department of Oncology, Huzhou Central Hospital, Affiliated Hospital of Huzhou Normal UniversityHuzhou, Zhejiang Province, China
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Chu L, Wang H, Qiu S, Shao B, Huang J, Qin Q, He Y, Xue J, Li X, Huang X, Huang R. Risk Factors of Delayed Recovery of Gastrointestinal Function After Ileostomy Reversal for Rectal Cancer Patients. Cancer Manag Res 2021; 13:5127-5133. [PMID: 34234556 PMCID: PMC8254522 DOI: 10.2147/cmar.s311715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/21/2021] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The aim of this study was to identify the risk factors associated with delayed recovery of gastrointestinal function after ileostomy reversal for rectal cancer patients. METHODS In this retrospective study, the data of rectal cancer patients who underwent ileostomy reversal from January 2018 to December 2019 at the Sixth Affiliated Hospital of Sun Yat-sen University were assessed to investigate potential risk factors of delayed flatus after ileostomy reversal. RESULTS A total of 282 patients were eligible for this study. Postoperative first flatus time ranged from 1 to 9 days, of which 58.8% patients presented with delayed flatus that was longer than 3 days. Univariate analysis showed that delayed postoperative flatus was significantly associated with the length of postoperative hospital stay (P<0.001) and postoperative complications (P=0.037). Multivariate analysis showed that intravenous fluid infusion at postoperative day 1 (POD1) (OR=1.001, 95% CI: 1.001-1.002, P=0.001) and duration of stoma ≥6 months (OR=2.005, 95% CI:1.155-3.657, P=0.014) were independent risk factors for delayed flatus. CONCLUSION Increased intravenous fluid infusion at POD1 and duration of stoma ≥6 months were related to delayed recovery of gastrointestinal function after ileostomy reversal for rectal cancer patients.
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Affiliation(s)
- Lili Chu
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, People’s Republic of China
| | - Hui Wang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, People’s Republic of China
- Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, People’s Republic of China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, People’s Republic of China
| | - Suyu Qiu
- Department of General Surgery, Shunde New Rongqi Hospital, Foshan, Guangdong, 510655, People’s Republic of China
| | - Biyan Shao
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, People’s Republic of China
| | - Jia Huang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, People’s Republic of China
| | - Qiyuan Qin
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, People’s Republic of China
- Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, People’s Republic of China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, People’s Republic of China
| | - Yanjiong He
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, People’s Republic of China
| | - Jing Xue
- Department of Pharmacy, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, People’s Republic of China
| | - Xiaoyan Li
- Department of Pharmacy, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, People’s Republic of China
| | - Xiaoyan Huang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, People’s Republic of China
- Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, People’s Republic of China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, People’s Republic of China
| | - Rongkang Huang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, People’s Republic of China
- Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, People’s Republic of China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, People’s Republic of China
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Wang X, Lan Y, Zeng Z, Ge L. Therapeutic mechanism of steaming umbilical cord therapy with Chinese herbal medicine on a rat model of IBS-D via the PAR-2/TRVP1 pathway. Am J Transl Res 2021; 13:6288-6296. [PMID: 34306368 PMCID: PMC8290801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/19/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This study aimed to investigate the PAR-2/TRVP1-based mechanism of steaming umbilical cord therapy with Chinese Herbal Medicine (SUCT-CHM) in IBS-D rat models. METHODS Sixty-two IBS-D modeled rats were established, and were randomly assigned to the control group (n = 31) and the experimental group (n = 31). The model group did not receive intervention measures, and the experimental group was treated with SUCT-CHM. After 14 days of intervention, the two groups of rats were compared in terms of body weight, gastrointestinal function, Bristol stool score, wet/dry weight ratio of rat stool, and abdominal withdrawal reflex scores. The transient receptor potential vanilloid receptor 1 (TRPV1), protease-activated receptors-2 (PAR-2), calcitonin gene related peptide (CGRP) and Substance P (SP) protein expression were detected using ELISA. RESULTS After 14 d of intervention, compared to the control group, the rats in the experimental group showed a significant increase in body mass indexes (P < 0.05); decreased Bristol stool scores (P < 0.05); less stagnation of the intestinal contents and greater intestine propulsion rate (P < 0.05), lower wet/dry weight ratio of rat stool (P < 0.05), abdominal withdrawal reflex scores (P < 0.05) as well as PAR-2, TRVP1, CGRP and SP expression levels (P < 0.05). CONCLUSION SUCT-CHM was effective in treating IBS-D in rats. It improved gastrointestinal function and reduced visceral hypersensitivity in rats possibly via the PAR-2/TRVP1 pathway.
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Affiliation(s)
- Xiaohui Wang
- Department of Gastroenterology, The Second Affiliated Hospital of Jiangxi University of TCMNanchang, Jiangxi, China
| | - Yang Lan
- Jiangxi University of Traditional Chinese MedicineNanchang, Jiangxi, China
| | - Zhongping Zeng
- Department of Gastroenterology, The Second Affiliated Hospital of Jiangxi University of TCMNanchang, Jiangxi, China
| | - Laian Ge
- Department of Hepatology, The Affiliated Hospital of Jiangxi University of TCMNanchang, Jiangxi, China
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Thompson AJ, Bourke CD, Robertson RC, Shivakumar N, Edwards CA, Preston T, Holmes E, Kelly P, Frost G, Morrison DJ. Understanding the role of the gut in undernutrition: what can technology tell us? Gut 2021; 70:gutjnl-2020-323609. [PMID: 34103403 PMCID: PMC8292602 DOI: 10.1136/gutjnl-2020-323609] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 05/04/2021] [Indexed: 12/22/2022]
Abstract
Gut function remains largely underinvestigated in undernutrition, despite its critical role in essential nutrient digestion, absorption and assimilation. In areas of high enteropathogen burden, alterations in gut barrier function and subsequent inflammatory effects are observable but remain poorly characterised. Environmental enteropathy (EE)-a condition that affects both gut morphology and function and is characterised by blunted villi, inflammation and increased permeability-is thought to play a role in impaired linear growth (stunting) and severe acute malnutrition. However, the lack of tools to quantitatively characterise gut functional capacity has hampered both our understanding of gut pathogenesis in undernutrition and evaluation of gut-targeted therapies to accelerate nutritional recovery. Here we survey the technology landscape for potential solutions to improve assessment of gut function, focussing on devices that could be deployed at point-of-care in low-income and middle-income countries (LMICs). We assess the potential for technological innovation to assess gut morphology, function, barrier integrity and immune response in undernutrition, and highlight the approaches that are currently most suitable for deployment and development. This article focuses on EE and undernutrition in LMICs, but many of these technologies may also become useful in monitoring of other gut pathologies.
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Affiliation(s)
- Alex J Thompson
- Hamlyn Centre for Robotic Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Claire D Bourke
- Blizard Institute, Barts & The London School of Medicine, Queen Mary University of London, London, UK
| | - Ruairi C Robertson
- Blizard Institute, Barts & The London School of Medicine, Queen Mary University of London, London, UK
| | - Nirupama Shivakumar
- Division of Nutrition, St John's National Academy of Health Sciences, Bangalore, Karnataka, India
| | | | - Tom Preston
- Stable Isotope Biochemistry Laboratory, Scottish Universities Environmental Research Centre, East Kilbride, UK
| | - Elaine Holmes
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Paul Kelly
- Blizard Institute, Barts & The London School of Medicine, Queen Mary University of London, London, UK
- Tropical Gastroenterology and Nutrition Group, University of Zambia School of Medicine, Lusaka, Zambia
| | - Gary Frost
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Douglas J Morrison
- Stable Isotope Biochemistry Laboratory, Scottish Universities Environmental Research Centre, East Kilbride, UK
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Southren DL, Nardone AD, Haastrup AA, Roberts RJ, Chang MG, Bittner EA. An examination of gastrointestinal absorption using the acetaminophen absorption test in critically ill patients with COVID-19: A retrospective cohort study. Nutr Clin Pract 2021; 36:853-862. [PMID: 34101267 PMCID: PMC8242470 DOI: 10.1002/ncp.10687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE Gastrointestinal (GI) dysfunction is prevalent in critically ill patients with coronavirus disease 2019 (COVID-19). The acetaminophen absorption test (AAT) has been previously described as a direct method for assessment of GI function. Our study determines whether the AAT can be used to assess GI function in critically ill COVID-19 patients, compared with traditional measures of GI function. DESIGN Retrospective observational study of critically ill patients with COVID-19. SETTING Three intensive care units at a tertiary care academic medical center. PATIENTS Twenty critically ill patients with COVID-19. INTERVENTIONS The results of AAT and traditional measures for assessing GI function were collected and compared. MEASUREMENTS AND MAIN RESULTS Among the study cohort, 55% (11 of 20) of patients had evidence of malabsorption by AAT. Interestingly, all patients with evidence of malabsorption by AAT had clinical evidence of bowel function, as indicated by stool output and low gastric residuals during the prior 24 h. When comparing patients with a detectable acetaminophen level (positive AAT) with those who had undetectable acetaminophen levels (negative AAT), radiologic evidence of ileus was less frequent (20 vs 88%; P = .03), tolerated tube-feed rates were higher (40 vs 10 ml/h; P =.01), and there was a trend toward lower gastric residual volumes (45 vs 830 ml; P =.11). CONCLUSION Malabsorption can occur in critically ill patients with COVID-19 despite commonly used clinical indicators of tube-feeding tolerance. The AAT provides a simple, rapid, and cost-effective mechanism by which enteral function can be efficiently assessed in COVID-19 patients.
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Affiliation(s)
- Daniel L Southren
- Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexa D Nardone
- Department of Pharmacy, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Adeniran A Haastrup
- Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Russel J Roberts
- Department of Pharmacy, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marvin G Chang
- Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Edward A Bittner
- Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Botticelli L, Micioni Di Bonaventura E, Ubaldi M, Ciccocioppo R, Cifani C, Micioni Di Bonaventura MV. The Neural Network of Neuropeptide S (NPS): Implications in Food Intake and Gastrointestinal Functions. Pharmaceuticals (Basel) 2021; 14:293. [PMID: 33810221 DOI: 10.3390/ph14040293] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 02/07/2023] Open
Abstract
The Neuropeptide S (NPS), a 20 amino acids peptide, is recognized as the endogenous ligand of a previously orphan G protein-coupled receptor, now termed NPS receptor (NPSR). The limited distribution of the NPS-expressing neurons in few regions of the brainstem is in contrast with the extensive expression of NPSR in the rodent central nervous system, suggesting the involvement of this receptor in several brain functions. In particular, NPS promotes locomotor activity, behavioral arousal, wakefulness, and unexpectedly, at the same time, it exerts anxiolytic-like properties. Intriguingly, the NPS system is implicated in the rewarding properties of drugs of abuse and in the regulation of food intake. Here, we focus on the anorexigenic effect of NPS, centrally injected in different brain areas, in both sated and fasted animals, fed with standard or palatable food, and, in addition, on its influence in the gastrointestinal tract. Further investigations, regarding the role of the NPS/NPSR system and its potential interaction with other neurotransmitters could be useful to understand the mechanisms underlying its action and to develop novel pharmacological tools for the treatment of aberrant feeding patterns and obesity.
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Xie T, Jiang Z, Wen C, Shen D, Bian J, Liu S, Deng X, Zha Y. Blood metabolomic profiling predicts postoperative gastrointestinal function of colorectal surgical patients under the guidance of goal-directed fluid therapy. Aging (Albany NY) 2021; 13:8929-8943. [PMID: 33714948 PMCID: PMC8034902 DOI: 10.18632/aging.202711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 02/08/2021] [Indexed: 11/25/2022]
Abstract
Postoperative gastrointestinal function influences postoperative recovery and length of hospital stay for patients undergoing colorectal surgery. Goal-directed fluid therapy (GDFT) restricts fluid administration to an amount required to prevent dehydration. Although the fluid management of GDFT could decrease the incidence of postoperative complications in patients who undergo high-risk surgery, certain patients may not respond to GDFT. Thus, to achieve optimal treatment, identification of patients suitable for GDFT is necessary. Metabolomic profiling of 48 patients undergoing surgery for colorectal cancer was performed. Patients were divided into delayed- and enhanced-recovered groups based on gastrointestinal function within 72 hours, and the results of omics analysis showed differential serum metabolites between the two groups of patients in the post anesthesia care unit 24 hours after surgery. A support vector machine model was applied to evaluate the curative effects of GDFT in different patients. Four metabolites, oleamide, ubiquinone-1, acetylcholine, and oleic acid, were found to be highly associated with postoperative gastrointestinal function and could be used as potential biomarkers. Moreover, four pathways were found to be highly related to postoperative gastrointestinal recovery. Among them, the vitamin B6 metabolism pathway may be a common pathway for improving postoperative recovery in various diseases. Our findings proposed a novel method to predict postoperative recovery of gastrointestinal function based on metabolomic profiling and suggested the potential mechanisms contributing to gastrointestinal function after surgical resection of colorectal cancer under the fluid management of GDFT.
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Affiliation(s)
- Tao Xie
- Faculty of Anesthesiology, Changhai Hospital, Naval Medical University/ Second Military Medical University, PLA, Shanghai 200433, China
| | - Zhengyu Jiang
- Faculty of Anesthesiology, Changhai Hospital, Naval Medical University/ Second Military Medical University, PLA, Shanghai 200433, China.,Department of Anesthesiology, Naval Medical Center, Naval Medical University/ Second Military Medical University, PLA, Shanghai 200052, China
| | - Cen Wen
- Department of Anesthesiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610072, China
| | - Du Shen
- Department of Anesthesiology, The Affiliated Hospital of Medical School, Ningbo University, Ningbo 315020, China
| | - Jinjun Bian
- Faculty of Anesthesiology, Changhai Hospital, Naval Medical University/ Second Military Medical University, PLA, Shanghai 200433, China
| | - Shanshan Liu
- Department of Anesthesiology, Chenggong Hospital, Xiamen University, Xiamen 361001, China
| | - Xiaoming Deng
- Faculty of Anesthesiology, Changhai Hospital, Naval Medical University/ Second Military Medical University, PLA, Shanghai 200433, China
| | - Yanping Zha
- Faculty of Anesthesiology, Changhai Hospital, Naval Medical University/ Second Military Medical University, PLA, Shanghai 200433, China
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Jesus F, Castela I, Silva AM, Branco PA, Sousa M. Risk of Low Energy Availability among Female and Male Elite Runners Competing at the 26th European Cross-Country Championships. Nutrients 2021; 13:873. [PMID: 33800051 DOI: 10.3390/nu13030873] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/18/2021] [Accepted: 03/03/2021] [Indexed: 02/08/2023] Open
Abstract
Low energy availability (LEA) causes impaired physiological functioning. Cross-country running is a weight-sensitive sport, making athletes more prone to LEA. We aimed to estimate the prevalence of elite European cross-country athletes at risk of LEA using the LEA in Females Questionnaire (LEAF-Q) and to analyze demographic and physical characteristics that are associated with LEA. Athletes ≥ 18 years competing at the 26th European Cross-Country Championships (n = 602) were invited to complete a questionnaire (sociodemographic, training, anthropometric characteristics, and LEAF-Q). A total of 207 valid surveys were collected (83 females, 22.1 (4.0) years, and 124 males, 22.3 (4.1) years), and 16 surveys were excluded. A high prevalence of athletes at risk of LEA (64.3%) was observed, being higher in females than in males (79.5 and 54.0% respectively, p < 0.001). More than half of athletes (54.1%, n = 112) reported bowel movements once a week or more rarely, while 33 female athletes (41.3%) did not report normal menstruation. Overall, cross-country athletes are at high risk of LEA. Moreover, a high prevalence of gastrointestinal and menstrual impairments was reported. Hence, athletes should be followed by multidisciplinary teams to inform, prevent, and treat LEA and its effects.
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Li H, Chen Y, Hu Z, Jiang J, Li R, Qiu Q, Ye J. Effectiveness of acupuncture for the recovery of gastrointestinal function of patients with gastric cancer in the postoperative period: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e23950. [PMID: 33607762 PMCID: PMC7899872 DOI: 10.1097/md.0000000000023950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 12/01/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Gastric cancer (GC) is the most common malignant tumors in the world and surgical resection remains the primary treatment for it. Postoperative patients often suffer from gastrointestinal dysfunction as the most common side effects of surgery for GC patients. Acupuncture has a regulatory effect on gastrointestinal function. We conducted this study to assess the effectiveness of acupuncture on the restoration of gastrointestinal function of postoperative patients with GC. METHODS Seven electronic databases will be searched from inception to November 2020 to identify any relevant study: Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Infrastructure (CNKI), Wanfang Database, Chinese Biomedical Literature Database (CBM), and Chinese Scientific Journal Database (VIP database). No restriction on time and language. The primary outcome measure will be the Time to First Flatus and secondary outcome measures include the time of first defecation and the quality of life (QOL) and the number of patients with abdominal distention. We will use EndNote V.9.1 to screen the eligible literature and the I2 statistic to assess heterogeneity in the included studies. The meta-analysis will be conducted using the Review Manager (RevMan) software (V.5.3). RESULTS Our study aims to systematically assess whether the pooled effects of currently available trials prove effects of acupuncture in improving gastrointestinal function of patients with GC in the postoperative period. CONCLUSION This study will conduct an evaluation about the efficacy of acupuncture for the recovery of gastrointestinal function of patients with GC in the postoperative period, making up for the lack of relevant clinical evidence. INPLASY REGISTRATION NUMBER INPLASY2020110066.
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Affiliation(s)
- Huaiyu Li
- Jiangxi University of Traditional Chinese Medicine, Nanchang
| | - Yun Chen
- First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Ziyi Hu
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine
| | - Jiawang Jiang
- Jiangxi University of Traditional Chinese Medicine, Nanchang
| | - Renliang Li
- Jiangxi University of Traditional Chinese Medicine, Nanchang
| | - Qianjie Qiu
- Jiangxi University of Traditional Chinese Medicine, Nanchang
| | - Jing Ye
- Jiangxi University of Traditional Chinese Medicine, Nanchang
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Zhou X, Cao SG, Tan XJ, Liu XD, Li ZQ, Kong LX, Tian YL, Liu D, Shen S, Sun YQ, Jiang HT, Zhou YB. Effects of Transcutaneous Electrical Acupoint Stimulation (TEAS) on Postoperative Recovery in Patients with Gastric Cancer: A Randomized Controlled Trial. Cancer Manag Res 2021; 13:1449-1458. [PMID: 33603487 PMCID: PMC7886100 DOI: 10.2147/cmar.s292325] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/14/2021] [Indexed: 01/18/2023] Open
Abstract
Purpose Transcutaneous electrical acupoint stimulation (TEAS) is an innovative choice for postoperative pain management. However, the safety and effectiveness of this traditional Chinese medicine (TCM) therapy for patients who underwent gastrectomy is largely unknown. So, the purpose of this study is to evaluate the safety and effectiveness of TEAS for patients who underwent gastrectomy. Patients and Methods We recruited 96 patients with gastric cancer from May 2019 to November 2019; 82 patients were enrolled, and 81 patients completed. Patients were randomly assigned to TEAS group (TG) received TEAS on postoperative day (POD) 1–3 or control group (CG) at a 1:1 ratio. The primary outcomes were pain score and consumption of analgesics. The secondary were the time of first postoperative flatus and defecation, frequency of postoperative nausea, vomiting, distention, diarrhea, comfort of semi-fluid diet, Clavien-Dindo grade (C-D grade) and length of postoperative day. We performed hematological analysis to explore the possible mechanisms. Results Overall, 81 patients were enrolled included in the analysis. Compared with CG, pain scores in TG were lower on POD 1–5 (average: 2.55±0.21 vs 3.10±0.42, P<0.001), and the use rate of opioids was lower (43.9 vs 75.0, P=0.004); time of first postoperative flatus (55.63±16.74 vs 72.60±20.92, P<0.001) and defecation (72.20±16.24 vs 95.78±17.75, P<0.001) were shorter; the frequency of nausea were fewer (1.88±1.09 vs 2.58±0.77, P=0.029) and patients were more comfortable with semi-fluid diet (7.63±0.63 vs 6.93±0.69, P<0.001); among the hematologic results, β-endorphin (β-End), interleukin-2 (IL-2), motilin (MTL) on POD 3, POD 5 were lower, 5-hydroxytryptamine (5-HT), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) were higher. And no adverse event was reported. Conclusion TEAS can relieve postoperative pain and promote the recovery of gastrointestinal function. Consequently, it can be an adjunctive therapy to enhance postoperative recovery for patients after gastrectomy.
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Affiliation(s)
- Xin Zhou
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People's Republic of China
| | - Shou-Gen Cao
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People's Republic of China
| | - Xiao-Jie Tan
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People's Republic of China
| | - Xiao-Dong Liu
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People's Republic of China
| | - Ze-Qun Li
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People's Republic of China
| | - Ling-Xin Kong
- Department of Rehabilitation, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People's Republic of China
| | - Yu-Long Tian
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People's Republic of China
| | - Dan Liu
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People's Republic of China
| | - Shuai Shen
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People's Republic of China
| | - Yu-Qi Sun
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People's Republic of China
| | - Hai-Tao Jiang
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People's Republic of China
| | - Yan-Bing Zhou
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People's Republic of China
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Selimoglu MA, Kansu A, Aydogdu S, Sarioglu AA, Erdogan S, Dalgic B, Yuce A, Cullu Cokugras F. Nutritional Support in Malnourished Children With Compromised Gastrointestinal Function: Utility of Peptide-Based Enteral Therapy. Front Pediatr 2021; 9:610275. [PMID: 34164352 PMCID: PMC8215107 DOI: 10.3389/fped.2021.610275] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 05/07/2021] [Indexed: 12/20/2022] Open
Abstract
This review focuses on nutritional support in malnourished children with compromised gastrointestinal function addressing the interplay between malnutrition and gastrointestinal dysfunction, and the specific role of peptide-based enteral therapy in pediatric malnutrition. Malnutrition is associated with impaired gut functions such as increased intestinal permeability, malabsorption, and diarrhea, while pre-existing functional gastrointestinal disorders may also lead to malnutrition. Presence of compromised gastrointestinal function in malnourished children is critical given that alterations such as malabsorption and increased intestinal permeability directly interfere with efficacy of nutritional support and recovery from malnutrition. Appropriate nutritional intervention is the key step in the management of malnutrition, while alterations in gastrointestinal functions in malnourished children are likely even in those with mild degree malnutrition. Therefore, nutritional therapy in children with compromised gastrointestinal function is considered to involve gut-protective interventions that address the overlapping and interacting effects of diarrhea, enteropathy and malnutrition to improve child survival and developmental potential in the long-term. Peptide-based enteral formulas seem to have clinical applications in malnourished children with compromised gastrointestinal function, given their association with improved gastrointestinal tolerance and absorption, better nitrogen retention/ balance, reduced diarrhea and bacterial translocation, enhanced fat absorption, and maintained/restored gut integrity as compared with free amino acid or whole-protein formulas.
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Affiliation(s)
- Mukadder Ayse Selimoglu
- Department of Pediatric Gastroenterology, Atasehir and Bahcelievler Memorial Hospitals, Istanbul, Turkey
| | - Aydan Kansu
- Department of Pediatric Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Sema Aydogdu
- Department of Pediatric Gastroenterology, Ege University Faculty of Medicine, Izmir, Turkey
| | | | | | - Buket Dalgic
- Department of Pediatric Gastroenterology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Aysel Yuce
- Department of Pediatric Gastroenterology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Fugen Cullu Cokugras
- Department of Pediatric Gastroenterology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
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Hu Y, Cheng X, Su X, Fu Y. Auricular therapy improves gastrointestinal function in patients with gynecological laparoscopic surgery: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2020; 99:e23421. [PMID: 33285735 PMCID: PMC7717805 DOI: 10.1097/md.0000000000023421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 10/30/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Gynecological laparoscopic surgery is the main method to treat gynecological diseases, but postoperative gastrointestinal reactions are more common in patients. Auricular therapy, as a characteristic therapy of Traditional Chinese Medicine, can improve gastrointestinal symptoms such as nausea and vomiting by stimulating the conduction of acupoints through the nervous system on internal organs, but there are studies questioning the efficacy of auricular therapy. Therefore, the purpose of this study is to prove the efficacy and safety of auricular therapy in promoting gastrointestinal function recovery after gynecological laparoscopic surgery, and to provide reference value for future clinical practice. METHODS To search English databases (PubMed, Excerpta Medical Database [Embase], Web of Science, the Cochrane Library) and Chinese databases (Chinese National Knowledge Internet [CNKI], WanFang, Viper, Chinese Biomedical Literature Database) by computer, and conduct a randomized controlled trial on the effect of aural point therapy on gastrointestinal function recovery of patients after gynecological laparoscopic surgery from the establishment of the database to October 2020. Two researchers independently evaluate the quality of the included studies and extract the data, and meta-analysis of the included literature is carried out using RevMan5.3 software. RESULTS In this study, the efficacy and safety of auricular therapy in the recovery of gastrointestinal function after gynecological laparoscopic surgery are evaluated from the aspects of first anal exhaust time, bowel sound recovery time, and incidence of gastrointestinal complications. CONCLUSION This study will provide reliable evidence-based evidence for auricular therapy in the treatment of gastrointestinal function after gynecologic laparoscopic surgery. ETHICS AND DISSEMINATION Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval was not required. The results may be published in a peer-reviewed journal or disseminated at relevant conferences. OSF REGISTRATION NUMBER DOI 10.17605 / OSF.IO / ZSPGA.
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Affiliation(s)
| | | | - Xinglin Su
- Sandun District Zhejiang Hospital, Hangzhou, Zhejiang Province, China
| | - Yun Fu
- Sandun District Zhejiang Hospital, Hangzhou, Zhejiang Province, China
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Camilleri M, Chedid V. Actionable biomarkers: the key to resolving disorders of gastrointestinal function. Gut 2020; 69:1730-1737. [PMID: 32269066 DOI: 10.1136/gutjnl-2019-320325] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/12/2020] [Accepted: 02/15/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Michael Camilleri
- Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA
| | - Victor Chedid
- Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA
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Zhi MW, Dai XJ, Jiang ZW, Xu SS, Li M, Xie RY. [Effect of acupoint application therapy at different timing points on gastrointestinal function recovery and heart rate variability after laparoscopic resection of colorectal cancer]. Zhongguo Zhen Jiu 2020; 40:947-52. [PMID: 32959589 DOI: 10.13703/j.0255-2930.20200327-k0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To observe the effect of acupoint application therapy at different timing points on the gastrointestinal function recovery and heart rate variability (HRV) after laparoscopic resection of colorectal cancer under the instruction of enhanced recovery after surgery (ERAS). METHODS A total of 105 patients for the selective laparoscopic resection of colorectal cancer were selected and randomized into a preoperative acupoint application group (35 cases, 3 cases dropped off), a postoperative acupoint application group (35 cases, 1 case dropped out) and a control group (35 cases, 2 cases dropped off). In the control group, ERAS interventions were provided, such as health education, fluid supplementation and multi-mode analgesia. On the base of the treatment as the control group, in the preoperative acupoint application group and the postoperative acupoint application group, 3 days before operation and 6 h after operation, the acupoint application therapy was given respectively. The acupoints were Zusanli (ST 36), Shangjuxu (ST 37), Sanyinjiao (SP 6), Neiguan (PC 6) and Xiajuxu (ST 39). The acupoint application was exerted for 6 h each time, once daily till the first postoperative exhaust and defecation presented. It was to observe the time of the first postoperative exhaust, defecation and food intake, the score of visual analogue scale (VAS) 1 to 3 days after operation, the total score of gastrointestinal symptom rating scale (GSRS) before and 1 week after operation, as well as the related indicators of HRV [standard deviation of NN intervals (SDNN) and the ratio of low-frequency power and high frequency power (LF/HF)] in the three groups successively. Besides, the adverse reactions were recorded during intervention in the three groups. RESULTS Compared with the control group, the time of the first postoperative exhaust and the time of the first postoperative defecation were all earlier in the preoperative acupoint application group and the postoperative acupoint application group respectively (P<0.05), and VAS scores 1 to 3 days after operation and total GSRS scores 1 week after operation were all reduced (P<0.05); the time of first food intake was earlier after operation (P<0.05), and SDNN and LF/LF were increased 1 day and 3 days after operation in the preoperative acupoint application group (P<0.05). Compared with the postoperative acupoint application group, in the preoperative acupoint application group, the time of the first postoperative exhaust and the time of the first postoperative defecation were all earlier (P<0.05), VAS scores were reduced in 1 to 3 days after operation (P<0.05), and SDNN 1 day and 3 days after operation and LF/HF 1 day after operation were all increased (P<0.05). No adverse reaction was detected in patients of the three groups. CONCLUSION Under the instruction of ERAS, the preoperative acupoint application effectively promotes the postoperative gastrointestinal function recovery, improves HRV and autonomous nerve function in the patients after laparoscopic resection of colorectal cancer. The therapeutic effect of this therapy is better than the postoperative acupoint application.
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Affiliation(s)
- Meng-Wei Zhi
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Xin-Juan Dai
- Department of Nursing, 3Department of General Surgery, Jiangsu Provincial TCM Hospital, Nanjing 210029
| | - Zhi-Wei Jiang
- Department of General Surgery, Jiangsu Provincial TCM Hospital, Nanjing 210029
| | - Shan-Shan Xu
- Department of Nursing, 3Department of General Surgery, Jiangsu Provincial TCM Hospital, Nanjing 210029
| | - Min Li
- Department of Nursing, 3Department of General Surgery, Jiangsu Provincial TCM Hospital, Nanjing 210029
| | - Rui-Yi Xie
- Department of Nursing, 3Department of General Surgery, Jiangsu Provincial TCM Hospital, Nanjing 210029
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Dehghan M, Malakoutikhah A, Ghaedi Heidari F, Zakeri MA. The Effect of Abdominal Massage on Gastrointestinal Functions: a Systematic Review. Complement Ther Med 2020; 54:102553. [PMID: 33183670 DOI: 10.1016/j.ctim.2020.102553] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 07/19/2020] [Accepted: 09/03/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION abdominal massage with regular and rhythmic movements has been used to treat some symptoms of diseases. OBJECTIVES to review data collected from randomized controlled trials regarding the effect of abdominal massage (AM) on gastrointestinal functions (GFs). METHODS we conducted a systematic review of articles accessible through PubMed, Scopus, Science Direct, Google Scholar, and Web of Science. All eligible English RCT- published articles related to the effect of AM on GFs were included in the study from the time of their acceptance until June 2019. RESULTS ten studies with 464 patients met the inclusion criteria. Three studies reported that AM alleviated constipation symptoms in patients with multiple sclerosis, cancer, and elderly adults. In three studies, AM increased bowel movements in people with constipation and patients undergoing skeletal traction. The results of three studies conducted on intensive care patients showed that AM improved GFs, and decreased abdominal circumference and distension. Two studies showed the effectiveness of AM in reducing the gastric residual volume. However, one study indicated no significant difference between the intervention and control groups. The results of two studies showed that AM did not affect laxative intake, nausea or vomiting, frequency of defecation, and food intake. Furthermore, AM did not decrease ventilator-associated pneumonia in patients undergoing mechanical ventilation. The studies reported no adverse effects of AM. CONCLUSIONS there was promising evidence for the effect of AM on GFs. However, further studies are needed to measure the unknown dimensions of AM in patients.
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Affiliation(s)
- Mahlagha Dehghan
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran.
| | - Alireza Malakoutikhah
- Student Research Center, School of Nursing, Kerman University of Medical Sciences, Kerman, Iran.
| | - Fatemeh Ghaedi Heidari
- Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Mohammad Ali Zakeri
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
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Liu J, Cui M, Yang T, Yao P. Correlation between gastrointestinal symptoms and disease severity in patients with COVID-19: a systematic review and meta-analysis. BMJ Open Gastroenterol 2020; 7:bmjgast-2020-000437. [PMID: 32665397 PMCID: PMC7359194 DOI: 10.1136/bmjgast-2020-000437] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 12/18/2022] Open
Abstract
Objective To study the correlation between gastrointestinal (GI) symptoms and disease severity in patients with COVID-19. Design We searched six databases including three Chinese and three English databases for all the published articles on COVID-19. Studies were screened according to inclusion and exclusion criteria. The relevant data were extracted and all the statistical analyses were performed using Revman5.3. Result In a meta-analysis of 9 studies, comprising 3022 patients, 479 patients (13.7%, 95% CI 0.125 to 0.149) had severe disease and 624 patients (14.7%, 95% CI 0.136 to 0.159) had GI symptoms. Of 624 patients with GI symptoms, 118 patients had severe disease (20.5%, 95% CI 0.133 to 0.276) and of 2397 cases without GI symptoms, 361 patients had severe disease (18.2%, 95% CI 0.129 to 0.235). Comparing disease severity of patients with and without GI symptoms, the results indicated: I²=62%, OR=1.21, 95% CI 0.94 to 1.56, p=0.13; there was no statistically significant difference between the two groups. The funnel plot was symmetrical with no publication bias. Conclusion Current results are not sufficient to demonstrate a significant correlation between GI symptoms and disease severity in patients with COVID-19.
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Affiliation(s)
- Jing Liu
- Gastroenterology, Xinjiang Medical University Affiliated First Hospital, Urumqi, Xinjiang, China
| | - Min Cui
- Gastroenterology, Xinjiang Medical University Affiliated First Hospital, Urumqi, Xinjiang, China
| | - Tao Yang
- Gastroenterology, Xinjiang Medical University Affiliated First Hospital, Urumqi, Xinjiang, China
| | - Ping Yao
- Gastroenterology, Xinjiang Medical University Affiliated First Hospital, Urumqi, Xinjiang, China
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Kountouras J, Gavalas E, Papaefthymiou A, Tsechelidis I, Polyzos SA, Bor S, Diculescu M, Jadallah Κ, Tadeusz M, Karakan T, Bochenek A, Rozciecha J, Dabrowski P, Sparchez Z, Sezgin O, Gülten M, Farsakh NA, Doulberis M. Trimebutine Maleate Monotherapy for Functional Dyspepsia: A Multicenter, Randomized, Double-Blind Placebo Controlled Prospective Trial. ACTA ACUST UNITED AC 2020; 56:medicina56070339. [PMID: 32650518 PMCID: PMC7404657 DOI: 10.3390/medicina56070339] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/20/2020] [Accepted: 06/30/2020] [Indexed: 12/12/2022]
Abstract
Background and Objectives: Functional dyspepsia (FD) is one of the most common functional gastrointestinal disorders; it has a great impact on patient quality of life and is difficult to treat satisfactorily. This study evaluates the efficacy and safety of trimebutine maleate (TM) in patients with FD. Materials and Methods: Α multicenter, randomized, double-blind, placebo controlled, prospective study was conducted, including 211 patients with FD. Participants were randomized to receive TM 300 mg twice per day (BID, 108 patients) or placebo BID (103 patients) for 4 weeks. The Glasgow Dyspepsia Severity Score (GDSS) was used to evaluate the relief of dyspepsia symptoms. Moreover, as a pilot secondary endpoint, a substudy (eight participants on TM and eight on placebo) was conducted in to evaluate gastric emptying (GE), estimated using a 99mTc-Tin Colloid Semi Solid Meal Scintigraphy test. Results: Of the 211 patients enrolled, 185 (87.7%) (97 (52.4%) in the TM group and 88 (47.6%) in the placebo group) completed the study and were analyzed. The groups did not differ in their demographic and medical history data. Regarding symptom relief, being the primary endpoint, a statistically significant reduction in GDSS for the TM group was revealed between the first (2-week) and final (4-week) visit (p-value = 0.02). The 99 mTc-Tin Colloid Semi Solid Meal Scintigraphy testing showed that TM significantly accelerated GE obtained at 50 min (median emptying 75.5% in the TM group vs. 66.6% in the placebo group, p = 0.036). Adverse effects of low to moderate severity were reported in 12.3% of the patients on TM. Conclusion: TM monotherapy appears to be an effective and safe approach to treating FD, although the findings presented here warrant further confirmation.
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Affiliation(s)
- Jannis Kountouras
- Second Medical Clinic, School of Medicine, Aristotle University of Thessaloniki, Ippokration Hospital, 54642 Thessaloniki, Macedonia, Greece; (E.G.); (A.P.); (I.T.); (S.A.P.); (M.D.)
- Correspondence:
| | - Emmanuel Gavalas
- Second Medical Clinic, School of Medicine, Aristotle University of Thessaloniki, Ippokration Hospital, 54642 Thessaloniki, Macedonia, Greece; (E.G.); (A.P.); (I.T.); (S.A.P.); (M.D.)
| | - Apostolis Papaefthymiou
- Second Medical Clinic, School of Medicine, Aristotle University of Thessaloniki, Ippokration Hospital, 54642 Thessaloniki, Macedonia, Greece; (E.G.); (A.P.); (I.T.); (S.A.P.); (M.D.)
- Department of Gastroenterology, University General Hospital of Larissa, Mezourlo, 41334 Larissa, Thessaly, Greece
| | - Ioannis Tsechelidis
- Second Medical Clinic, School of Medicine, Aristotle University of Thessaloniki, Ippokration Hospital, 54642 Thessaloniki, Macedonia, Greece; (E.G.); (A.P.); (I.T.); (S.A.P.); (M.D.)
| | - Stergios A. Polyzos
- Second Medical Clinic, School of Medicine, Aristotle University of Thessaloniki, Ippokration Hospital, 54642 Thessaloniki, Macedonia, Greece; (E.G.); (A.P.); (I.T.); (S.A.P.); (M.D.)
- First Laboratory of Pharmacology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Macedonia, Greece
| | - Serhat Bor
- Division of Gastroenterology, Ege University School of Medicine, 35330 Izmir, Turkey;
| | - Mircea Diculescu
- Gastroenterology and Hepatology Department, Clinic Fundeni Institute, 4204003 Bucharest, Romania;
| | - Κhaled Jadallah
- Department of Internal Medicine, King Abdullah University Hospital, 22110 Irbid, Jordan; (K.J.); (N.A.F.)
| | - Mazurek Tadeusz
- Medicor Centrum, ul. Jabłoskiego 2/4, 35-068 Rzeszów, Poland;
| | - Tarkan Karakan
- Department of Gastroenterology, Gazi University School of Medicine, 06560 Ankara, Turkey;
| | - Anna Bochenek
- Centrum Badawcze Wspolczesnej Terapii, 02679 Warszawa, Poland;
| | - Jerzy Rozciecha
- LexMedica, Rudolfa Weigla 12, Krzyki, 53114 Wrocław, Poland;
| | - Piotr Dabrowski
- Department of Rheumatology of Clinical Hospital 2, University of Rzeszow, Lwowska 60, 35-301 Rzeszow, Poland;
| | - Zeno Sparchez
- Third Medical Clinic, University of Medicine and Pharmacy, Croitorilor Street no.19-21, 400162 Cluj-Napoca, Romania;
| | - Orhan Sezgin
- Department of Gastroenterology, Faculty of Medicine, Mersin University, 33343 Mersin, Turkey;
| | - Macit Gülten
- Department of Gastroenterology, Uludag University, 16059 Bursa, Turkey;
| | - Niazy Abu Farsakh
- Department of Internal Medicine, King Abdullah University Hospital, 22110 Irbid, Jordan; (K.J.); (N.A.F.)
| | - Michael Doulberis
- Second Medical Clinic, School of Medicine, Aristotle University of Thessaloniki, Ippokration Hospital, 54642 Thessaloniki, Macedonia, Greece; (E.G.); (A.P.); (I.T.); (S.A.P.); (M.D.)
- First Laboratory of Pharmacology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Macedonia, Greece
- Division of Gastroenterology and Hepatology, Medical University Department, Kantonsspital Aarau, 5001 Aarau, Switzerland
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Abstract
Enhance recovery after surgery (ERAS) is an emerging discipline aiming to reduce perioperative stress response and postoperative complications and promote better and faster recovery of patients. In this study, the potential value and feasibility of acupuncture in ERAS is discussed from three aspects: acupuncture can reduce the demand of perioperative analgesic drugs, improve the postoperative gastrointestinal function, and prevent and treat postoperative complications. The combination of acupuncture and ERAS can better promote the rehabilitation of patients, complement the advantages of acupuncture and ERAS, and promote the development of acupuncture and ERAS.
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Affiliation(s)
- Chen Xin
- Department of Acupuncture-Moxibustion and Rehabilitation, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
| | - Jian-Hua Sun
- Department of Acupuncture-Moxibustion and Rehabilitation, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
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Sansome DJ, Xie C, Veedfald S, Horowitz M, Rayner CK, Wu T. Mechanism of glucose-lowering by metformin in type 2 diabetes: Role of bile acids. Diabetes Obes Metab 2020; 22:141-148. [PMID: 31468642 DOI: 10.1111/dom.13869] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/07/2019] [Accepted: 08/28/2019] [Indexed: 02/05/2023]
Abstract
Type 2 diabetes mellitus (T2DM) is an increasingly prevalent chronic condition, characterized by abnormally elevated blood glucose concentrations and, as a consequence, increased risk of micro- and macrovascular complications. Metformin is usually the first-line glucose-lowering medication in T2DM; however, despite being used for more than 60 years, the mechanism underlying the glucose-lowering action of metformin remains incompletely understood. Although metformin reduces hepatic glucose production, there is persuasive evidence that the gastrointestinal tract is crucial in mediating this effect, particularly via secretion of the incretin hormone glucagon-like peptide 1 (GLP-1). It is now well recognized that bile acids, in addition to their established function in fat digestion and absorption, are important regulators of glucose metabolism. Exposure of the small and large intestine to bile acids induces GLP-1 secretion, modulates the composition of the gut microbiota, and reduces postprandial blood glucose excursions in humans with and without T2DM. Metformin reduces intestinal bile acid resorption substantially, such that intraluminal bile acids may, at least in part, account for its glucose-lowering effect. The present review focuses on the conceptual shift in our understanding as to how metformin lowers blood glucose in T2DM, with a particular emphasis on the role of intestinal bile acids.
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Affiliation(s)
- Daniel J Sansome
- Adelaide Medical School and Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Cong Xie
- Adelaide Medical School and Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Simon Veedfald
- Adelaide Medical School and Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael Horowitz
- Adelaide Medical School and Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Christopher K Rayner
- Adelaide Medical School and Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Tongzhi Wu
- Adelaide Medical School and Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
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Yuan HC, Xiang Q, Zhang N, Qin WJ, Cai W. Acupuncture Combined with Early Enteral Nutrition on Patients with Postoperative Laparoscopic Common Bile Duct Exploration: A Prospective Randomized Trial. Chin J Integr Med 2019; 26:769-775. [PMID: 31848889 DOI: 10.1007/s11655-019-3048-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To assess the efficiency of acupuncture combined with early enteral nutrition (EEN) in patients with postoperative laparoscopic common bile duct exploration. METHODS A total of 200 patients with postoperative laparoscopic bile duct exploration was randomized using sealed envelopes and assigned to the convenitional, EEN, acupuncture plus convenitional and acupuncture plus EEN groups, 50 cases in each group. Twelve hours after operation, the patients in EEN groups began to receive oral enteral nutrition, and the acupuncture approach was performed by acupuncturist in acupuncture plus conventional and acupuncture plus EEN groups. Acupuncture was given at Zusanli (ST 36), Shangjuxu (ST 37) and Xiajuxu (ST 39) with a depth of 15-20 mm, using the lifting-thrusting and twisting method to obtain Deqi sensation. The needles were maintained for 30 min. Treatment was given once daily, 3 times per section. After the intervention, the patients' characteristics, operation time, bleeding volume, postoperative time to first anal exhaust, postoperative complications including abdominal distension, diarrhea, gastric dilatation, intestinal obstruction, pharyngodynia, incision, abdominal and pulmonary infection and postoperative hospitalization days were assessed and compared in patients among 4 groups. RESULTS Postoperative time to first anal exhaust in the convenitional group was longer compared with the other 3 groups (P<0.05), and was shorter in the acupuncture plus EEN group than those of the convenitional, acupuncture plus convenitional and EEN groups (P<0.01). The acupuncture plus EEN group showed significant decrease in the incidence of complications and less postoperative hospitalization days compared with the other groups (P<0.05 or P<0.01). There was no readmission. CONCLUSION After laparoscopic bile duct exploration, acupuncture combined with EEN treatment significantly improves the patients' gastrointestinal function, reduces complications, and shortens postoperative hospitalization days.
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Affiliation(s)
- Hai-Cheng Yuan
- Department of Minimally Invasive Surgery, Tianjin Nankai Hospital, Tianjin, 300100, China.,Department of Gastrointestinal Surgery, Tianjin Nankai Hospital, Tianjin, 300100, China
| | - Qi Xiang
- Department of Nutrition, Tianjin Nankai Hospital, Tianjin, 300100, China
| | - Nan Zhang
- Department of Gastrointestinal Surgery, Tianjin Nankai Hospital, Tianjin, 300100, China.
| | - Wei-Jing Qin
- Department of Acupuncture, Tianjin Nankai Hospital, Tianjin, 300100, China
| | - Wang Cai
- Department of Minimally Invasive Surgery, Tianjin Nankai Hospital, Tianjin, 300100, China
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Mu L, Gao H, Zhao ML, Ren HF, Ma HS. [Effect of transcutaneous electrical acupoint stimulation on recovery of gastrointestinal function after cesarean section]. Zhongguo Zhen Jiu 2019; 39:259-62. [PMID: 30942011 DOI: 10.13703/j.0255-2930.2019.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To explore the effect on the recovery of gastrointestinal function after cesarean section treated with transcutaneous electrical acupoint stimulation at Zusanli (ST 36) on the basis of routine treatment. METHODS A total of 110 primiparas after cesarean section were randomized into an observation group and a control group, 55 cases in each one. The conventional treatment was applied in the two groups, after operation, transcutaneous electrical acupoint stimulation at Zusanli (ST 36) was used immediately in the observation group, the skin electrode of disposable anti-magnetic buckle was attached to Zusanli (ST 36) and the corresponding part of the inner lower leg, with disperse-dense wave, 30 Hz/60 Hz and 15-20 mA. The treatment was given for 30 min every time, once every 8 h, until the end of the first bowel movement. The recovery of gastrointestinal function after cesarean section (the restoring time of borborygmus, the time of first anal exsufflation and the first defecation time), the time of secretion of foremilk, complications (abdominal distension, abdominal pain, nausea etc.), hospital stays after operation and the satisfaction of primiparas after bowel movement were compared between the two groups. RESULTS The observation group was superior to the control group in the restoring time of borborygmus, the time of first anal exsufflation, the first defecation time and the time of secretion of foremilk (P<0.01, P<0.05). In the observation group, the incidence of postoperative complications such as abdominal pain, abdominal distension and nausea was 3.6% (2/55), which was lower than 16.4% (9/55) in the control group (P<0.05). Compared with the control group, the observation group had shorter hospital stays (P<0.01). The satisfaction of effect was 89.1% (49/55) in the observation group, which was superior to 72.7% (40/55) in the control group (P<0.05). CONCLUSION Transcutaneous electrical acupoint stimulation at Zusanli (ST 36) can speed up the recovery of gastrointestinal function after cesarean section, reduce complications such as abdominal pain, abdominal distension, shorten hospital stays, promote patient nutrition intake and lactation, and improve comfort level and satisfaction of primiparas.
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Affiliation(s)
- Li Mu
- Derpartment of Surgery, Xingtai People's Hospital, Xingtai 054001, Hebei Province, China
| | - Hui Gao
- Derpartment of Emergency, Xingtai People's Hospital, Xingtai 054001, Hebei Province, China
| | - Mai-Liang Zhao
- Derpartment of Emergency, Xingtai People's Hospital, Xingtai 054001, Hebei Province, China
| | - Hong-Fen Ren
- Derpartment of Emergency, Xingtai People's Hospital, Xingtai 054001, Hebei Province, China
| | - Hua-Shu Ma
- Derpartment of Emergency, Xingtai People's Hospital, Xingtai 054001, Hebei Province, China
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Song J, Ge Z, Liu Y, Yin J, Yao H, Zhang Z. Gastrointestinal motility should be emphasized after laparotomy treatment for complete small intestinal volvulus in older adults: A case report. Medicine (Baltimore) 2019; 98:e16365. [PMID: 31335682 PMCID: PMC6709113 DOI: 10.1097/md.0000000000016365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Complete small intestinal volvulus is a rare entity in adults, unlike partial intestinal volvulus. Although prompt surgical intervention is the mainstay of treatment, attention should also be paid to recovery of intestinal function postoperatively. Ignoring this issue during the postoperative recovery process can have serious consequences. We report the case of an 82-year-old woman with complete small intestinal volvulus at the root of the superior mesenteric vessel. PATIENTS CONCERNS The patient was admitted for acute onset (22 hours) of abdominal pain and distention. Nausea and vomiting also developed during this period. DIAGNOSES Abdominal physical examination was suspicious for peritoneal irritation. Computed tomography scan showed anticlockwise swirl of the mesenteric vessels at the lower margin of the pancreas with distension of the entire small intestine. A complete small intestinal volvulus was diagnosed. INTERVENTIONS Laparotomy and detorsion of the volvulus were performed after early diagnosis. OUTCOMES The patient developed intestinal wall edema because of ischemic-reperfusion damage. She exhibited severe abdominal distention and absent intestinal motility. Two days later, she went into septic shock; she died 19 days after surgical intervention. LESSONS Because complete small intestinal volvulus involves the entire intestine, ischemic-reperfusion intestinal damage after detorsion may be severe and can predict prognosis.
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