In this editorial,we comment on an article by Liu et al.We focus specifically on the novel use of laparoscopic intracorporeal anastomosis(LIA)compared with open ileostomy reversal in patients with Crohn’s disease(CD)...In this editorial,we comment on an article by Liu et al.We focus specifically on the novel use of laparoscopic intracorporeal anastomosis(LIA)compared with open ileostomy reversal in patients with Crohn’s disease(CD),which is an innovative approach for improving postoperative outcomes and accelerating recovery in ileostomy reversal procedures.This study also highlights the limitations of the conventional open surgical technique,which is associated with higher rates of feeding intolerance,prolonged hospital stays,and delayed initiation of enteral nutrition.The chronic and recurrent nature of CD and the challenges posed by traditional surgical methods are issues addressed by LIA,which offers a minimally invasive approach that reduces surgical trauma,shortens recovery time,and improves tolerance to enteral nutrition,thereby enhancing postoperative outcomes.However,while LIA shows great promise,further prospective multicenter trials are needed to validate these findings and assess their broader application in other surgical scenarios.Overall,LIA represents a significant advancement in minimally invasive surgery for CD and has the potential to become the preferred standard approach for ileostomy reversal in patients requiring bowel reanastomosis.展开更多
BACKGROUND There is an increased maturation of laparoscopic intracorporeal anastomosis techniques.However,research on its application for small bowel stoma reversal in patients with Crohn's disease(CD)is limited.T...BACKGROUND There is an increased maturation of laparoscopic intracorporeal anastomosis techniques.However,research on its application for small bowel stoma reversal in patients with Crohn's disease(CD)is limited.Therefore,in this study,we compared the perioperative outcomes between laparoscopic intracorporeal ileostomy reversal(LIIR)and open ileostomy reversal(OIR).AIM To compare the safety,feasibility,bowel function recovery,and short-and longterm LIIR and OIR outcomes in patients with CD.METHODS This study included patients who underwent ileal reversal for CD between January 2021 and January 2023 at our institution.The baseline data,postoperative recovery,and complication indicators were retrospectively analyzed.Logistic regression analysis was conducted to explore factors that significantly influenced the development of enteral nutrition intolerance-related symptoms.RESULTS Notably,15 of the 45 patients in this study underwent OIR,and the remaining 30 received LIIR.Notably,no statistically significant differences were found between the two groups regarding clinical baseline characteristics,operation time,intraoperative hemorrhage,anastomotic site,enterolysis range,first postoperative flatus,postoperative complications,reoperation rate,or incidence of postoperative enteral nutrition intolerance.Compared with the OIR group,the LIIR group had a shorter postoperative hospital stay(P=0.045),lower incidence of enteral nutrition intolerance symptoms(P=0.019),and earlier postoperative total enteral nutrition initiation(P=0.033);however,it incurred higher total hospital costs(P=0.038).Furthermore,multivariate logistic regression analysis revealed that the duration of surgery and anastomotic technique were independent risk factors for postoperative symptoms of enteral nutrition intolerance(P<0.05).CONCLUSION Laparoscopic intracorporeal anastomosis for ileostomy reversal is safe and feasible.Patients who underwent this technique demonstrated improved tolerance to postoperative enteral nutrition and quicker resumption of total enteral nutrition.展开更多
Autism spectrum disorder(ASD)is a neurodevelopmental disorder where de novo mutations play a significant role.Although coding mutations in ASD have been extensively characterized,the impact of non-coding de novo mutat...Autism spectrum disorder(ASD)is a neurodevelopmental disorder where de novo mutations play a significant role.Although coding mutations in ASD have been extensively characterized,the impact of non-coding de novo mutations(ncDNMs)remains less understood.Here,we integrate cortex cell-specific cis-regulatory element annotations,a deep learning-based variant prediction model,and massively parallel reporter assays to systematically evaluate the functional impact of 227,878 ncDNMs from Simons Simplex Collection(SSC)and Autism Speaks MSSNG resource(MSSNG)cohorts.Our analysis identifies 238 ncDNMs with confirmed functional regulatory effects,including 137 down-regulated regulatory mutations(DrMuts)and 101 up-regulated regulatory mutations(UrMuts).Subsequent association analyses reveal that only DrMuts regulating loss-of-function(LoF)intolerant genes rather than other ncDNMs are significantly associated with the risk of ASD(Odds ratio=4.34;P=0.001).A total of 42 potential ASD-risk DrMuts across 41 candidate ASD-susceptibility genes are identified,including 12 recognized and 29 unreported genes.Interestingly,these noncoding disruptive mutations tend to be observed in genes extremely intolerant to LoF mutations.Our study introduces an optimized approach for elucidating the functional roles of ncDNMs,thereby expanding the spectrum of pathogenic variants and deepening our understanding of the complex molecular mechanisms underlying ASD.展开更多
Cow milk protein allergy(CMPA)is a prevalent food allergy in infancy.It often presents with symptoms that overlap with other conditions,such as gastroeso-phageal reflux disease,lactose intolerance,food protein-induced...Cow milk protein allergy(CMPA)is a prevalent food allergy in infancy.It often presents with symptoms that overlap with other conditions,such as gastroeso-phageal reflux disease,lactose intolerance,food protein-induced enterocolitis syndrome,and eosinophilic esophagitis.This diagnostic overlap makes distin-guishing CMPA from its mimics difficult,resulting in potential misdiagnoses and unnecessary dietary restrictions.This review aims to comprehensively analyze CMPA and its mimicking conditions,highlighting their clinical presentations,diagnostic approaches,and management strategies to enhance diagnostic accu-racy and optimize patient care.A systematic literature search was conducted using PubMed,Scopus,Web of Science,and Google Scholar,focusing on studies published within the last 20 years.Articles addressing CMPA and its mimicking conditions were selected,with data synthesized into comparative analyses of diagnostic methods and management strategies.Accurate differentiation between CMPA and its mimics requires a thorough clinical evaluation supported by diagnostic tests such as skin prick tests,serum-specific IgE,and oral food challenges.Misdiagnosis can lead to nutritional deficiencies,psychological stress,and increased healthcare costs.Emerging diagnostic technologies,including component-resolved diagnostics and cytokine profiling,offer promising avenues for improving accuracy.A multidisciplinary approach involving pediatricians,allergists,and dietitians is essential for precise diagnosis and effective management.Ongoing research and education are crucial to enhancing clinical outcomes and reducing the burden on families.展开更多
Background:Patients with unrepaired Ebstein’s anomaly experience exercise intolerance,heart failure and premature mortality.Volumetric assessment of right ventricular function is difffcult due to the complex anatomy ...Background:Patients with unrepaired Ebstein’s anomaly experience exercise intolerance,heart failure and premature mortality.Volumetric assessment of right ventricular function is difffcult due to the complex anatomy of the right ventricle and tricuspid valve.Myocardial deformation indices are an early marker in other cardiac pathologies of ventricular dysfunction.Objectives:1.Assess myocardial deformation in unrepaired Ebstein’s compared to healthy controls.2.Investigate the relationships between myocardial deformation and exercise capacity.Methods:Myocardial deformation parameters(strain)were calculated using feature tracking from standard cardiac magnetic resonance cine images.Cardiopulmonary exercise results were included where available.Results:36 patients with unrepaired Ebstein’s and 36 matched controls were included.Right ventricular,right atrial,and left ventricular global longitudinal,as well as left ventricular circumferential strain were impaired in Ebstein’s patients compared to controls(p<0.05).In Ebstein’s patients right atrial peak strain correlated with their percentage predicted VO_(2) max(r=−0.448,p=0.022)and VE/VCO_(2) slope(r=0.435,p=0.026).There were no correlations between right ventricular ejection fraction and exercise parameters.When Ebstein’s patients were divided by severity into mild or severe according to the median total right/left index,those with severe demonstrated signiffcantly impaired right ventricular global longitudinal strain compared to those in the mild category(−17.5±5.4%vs.−21.4±4.4%,p=0.0017).Conclusions:Myocardial deformation parameters for both the right and left ventricle are impaired in patients with unrepaired Ebstein’s compared to healthy controls.Right atrial peak strain is related to impaired exercise capacity and warrants further investigation as an early prognostic marker in this patient cohort.展开更多
BACKGROUND Reflux esophagitis has an increasing prevalence and complex and diverse symptoms.Identifying its risk factors is crucial to understanding the etiology,prevention,and management of the disease.The occurrence...BACKGROUND Reflux esophagitis has an increasing prevalence and complex and diverse symptoms.Identifying its risk factors is crucial to understanding the etiology,prevention,and management of the disease.The occurrence of reflux esophagitis may be associated with food reactions,Helicobacter pylori(H.pylori)infection,and metabolic syndromes.AIM To investigate the risk factors for reflux esophagitis and analyze the effects of immunoglobulin(Ig)G-mediated food intolerance,H.pylori infection,and metabolic syndrome on reflux esophagitis.METHODS Outpatients attending the Second Medical Center of the PLA General Hospital between 2017 and 2021 were retrospectively enrolled.The patients’basic information,test results,gastroscopy results,H.pylori test results,and IgG-mediated food intolerance results were collected.Multivariate logistic regression analysis was used to analyze risk factors for reflux esophagitis.Statistical mediation analysis was used to evaluate the effects of IgG-mediated food intolerance and metabolic syndrome on H.pylori infection affecting reflux esophagitis.RESULTS A total of 7954 outpatients were included;the prevalence of reflux esophagitis,IgG-mediated food intolerance,H.pylori infection,and metabolic syndrome were 20.84%,61.77%,35.91%,and 60.15%,respectively.Multivariate analysis showed that the independent risk factors for reflux esophagitis included IgG-mediated food intolerance(OR=1.688,95%CI:1.497-1.903,P<0.00001)and metabolic syndrome(OR=1.165,95%CI:1.030-1.317,P=0.01484),and the independent protective factor for reflux esophagitis was H.pylori infection(OR=0.400,95%CI:0.351-0.456,P<0.00001).IgG-mediated food intolerance had a partially positive mediating effect on H.pylori infection as it was associated with reduced occurrence of reflux esophagitis(P=0.0200).Metabolic syndrome had a partially negative mediating effect on H.pylori infection and reduced the occurrence of reflux esophagitis(P=0.0220).CONCLUSION Patients with IgG-mediated food intolerance and metabolic syndrome were at higher risk of developing reflux esophagitis,while patients with H.pylori infection were at lower risk.IgG-mediated food intolerance reduced the risk of reflux esophagitis pathogenesis in patients with H.pylori infection;however,metabolic syndrome increased the risk of patients with H.pylori infection developing reflux esophagitis.展开更多
Objective:This study aimed to investigate the incidence of enteral nutrition intolerance(ENI)in patients with sepsis and explore potential risk factors.Methods:A case-control study was conducted in patients with sepsi...Objective:This study aimed to investigate the incidence of enteral nutrition intolerance(ENI)in patients with sepsis and explore potential risk factors.Methods:A case-control study was conducted in patients with sepsis who were receiving enteral nutrition(EN)at a tertiary hospital in China.The included patients were divided into the ENI group and the non-ENI group.Univariate and multivariate analyses were performed to identify the risk factors for ENI.Results:A total of 859 patients were included in the study.Among them,288(33.53%)patients experienced symptoms of ENI,including diarrhea,vomiting,bloating,and gastric retention.Logistic regression analysis revealed that the Acute Physiology and Chronic Health Evaluation H(APACHE H)score,thoracocentesis,and usage of cardiotonic drugs(namely,inotropes)were independent predictors of the ENI.Conclusion:The incidence of ENI is relatively high in patients with sepsis,especially in those who have higher APACHE H scores,have undergone thoracocentesis,and have received inotropes.展开更多
In the retrospective study by Luo et al regarding clinical outcomes in gestational diabetes mellitus(GDM),the results are statistically significant in favour of the benefits of individualized nutrition interventions e...In the retrospective study by Luo et al regarding clinical outcomes in gestational diabetes mellitus(GDM),the results are statistically significant in favour of the benefits of individualized nutrition interventions enumerated therein.The study has provided important evidence to improve maternal and child health in the Asian population.The methods,however,appear to have considerable limi-tations,wherein the time point of diagnosis of GDM,severity of GDM,selection bias,compliance to therapy,important maternal covariates,observable microvascular abnormalities and the confounding effect of added insulin have not been considered.We have provided suggestions to improve the external validity of the study,including the use of Equator Network reporting guidelines and inclusion of overweight and obese patients in future studies.展开更多
The hypothesis that some children with attention-deficit hyperactivity disorder(ADHD)may show sensitivity or allergic reactions to various food items has led to the development of the the few-foods(or oligoantigenic)d...The hypothesis that some children with attention-deficit hyperactivity disorder(ADHD)may show sensitivity or allergic reactions to various food items has led to the development of the the few-foods(or oligoantigenic)diet.The rationale of the diet is to eliminate certain foods from the diet in order to exclude potential allergens contained either naturally in food or in artificial ingredients with allergenic properties.The oligoantigenic diet attempts to identify individual foods to which a person might be sensitive.First,ADHD symptoms are monitored while multiple foods are excluded from the diet.Subsequently,if symptoms remit,foods are re-introduced,while observing the individual for the return of symptoms.An advantage of the oligoantigenic diet is that it can be tailored to the individual.A growing body of evidence suggests that behavioral symptoms of subgroups of children with ADHD may benefit from the elimination of certain foods.The effect sizes of an oligoantigenic diet regarding improvement of ADHD symptoms have been found to be medium to large.Available evidence suggests that the investigation of the role of food hypersensitivities in ADHD is a promising avenue worthy of further exploration.Further large-scale,randomized controlled studies including assessment of long-term outcome are therefore warranted.展开更多
Periodontitis is independently associated with numerous lifestyle diseases.Diabetic patients have approximately threefold increased odds of periodontitis,which in turn increases the risk of systemic inflammation.The s...Periodontitis is independently associated with numerous lifestyle diseases.Diabetic patients have approximately threefold increased odds of periodontitis,which in turn increases the risk of systemic inflammation.The study by Thazhe Poyil et al is an effort to establish the inflammatory link between diabetic retinopathy(DR)and periodontitis based on the periodontal inflamed surface area in diabetic patients with and without DR.To further advance the study,we suggest refining the eligibility criteria to explicitly state the clinical correlates of periodontitis and DR,larger sample size and improved sampling methodology,matching of baseline characteristics of the two groups,as well as improved statistical approach and interpretation of the study findings.Measurement of hemoglobin A1c(HbA1c)in studies comparing type 2 diabetes mellitus patients with DR of matched severity with and without periodontitis could provide a clearer picture of whether HbA1c level is indeed influenced by periodontitis.展开更多
This published Meta-Analysis by Lin et al is an indirect comparison between two drugs Chiglitazar and Thiazolidinedione which are commonly used for glycemic control in type-Ⅱ diabetes mellitus.In terms of safety and ...This published Meta-Analysis by Lin et al is an indirect comparison between two drugs Chiglitazar and Thiazolidinedione which are commonly used for glycemic control in type-Ⅱ diabetes mellitus.In terms of safety and efficacy,this Meta-Analysis is inconclusive.展开更多
Crises in the past have caused devastating,long-lasting impacts on the global economy.The after-effects always bring some dynamic and rigorous challenges for businesses and governments.Such challenges have always been...Crises in the past have caused devastating,long-lasting impacts on the global economy.The after-effects always bring some dynamic and rigorous challenges for businesses and governments.Such challenges have always been a point of discussion for scholars.The recent COVID-19 pandemic emaciated the global economy,leaving everyone mired in uncertainty,fear,and psychological impairments.One of the headwind features utilized by consumers during pandemic was panic buying(PB),which must be explored in various contexts for policymakers and practitioners.To address this gap,this study deployed a moderated mediation mechanism,integrating the health belief model(HBM)and competitive arousal theory(CAT)to excavate the notions underlying PB with the intrusion of evolved real-time psychological disorders:intolerance of uncertainty(IU)and cyberchondria(CYC).The study was conducted as a natural experiment in a South Asian developing economy using online surveys.It found that health beliefs—perceived severity(PSV)and perceived susceptibility(PSC)—positively impact perceived arousal(PA),which causes PB,and that PA has a sturdy mediator role.Moreover,in the relationship between health beliefs and arousal,the different psychological disorders were found to have significant moderating roles The study findings can help mitigate risk uncertainties and panic situations and thus contribute to consumers’wellbeing.展开更多
Background: Gestational diabetes mellitus (GDM) is a temporary form of insulin resistance during pregnancy and is linked to adverse outcomes for both mothers and offspring. Maternal risks include an increased prevalen...Background: Gestational diabetes mellitus (GDM) is a temporary form of insulin resistance during pregnancy and is linked to adverse outcomes for both mothers and offspring. Maternal risks include an increased prevalence of pre-eclampsia, cesarean delivery, and the development of type 2 diabetes within five to ten years post-delivery. For offspring, exposure to elevated maternal glucose levels is associated with macrosomia. A significant challenge in evaluating the prevalence of GDM in Puerto Rico is the lack of recent research quantifying this condition in pregnant women living in Puerto Rico. Objective: This study aimed to estimate the prevalence of Gestational Diabetes Mellitus from 2016 to 2021 by analyzing data collected by Puerto Rico’s Department of Health. Methods: We obtained publicly accessible data from the Division of Children, Mothers, and Adolescents from Puerto Rico’s Department of Health to estimate the prevalence of GDM across the island. Additionally, we correlated the prevalence with socioeconomic, educational, and demographic variables using beta regression models to assess their significance. Results: The prevalence of GDM ranged from 3.2% to 4.5% for the six years studied, with an average prevalence of 3.68%. Regression analysis revealed a significant positive relationship between maternal age and educational level. Higher educational attainment was associated with a reduced risk of GDM, while increasing maternal age was linked to a higher prevalence of the condition. Conclusion: This statistical analysis provides evidence of a steady increase in the prevalence of GDM in Puerto Rico from 2016 to 2021, highlighting the importance of ongoing surveillance and specific interventions to mitigate risk factors.展开更多
With the continuous progress of medical care, the survival rate of preterm infants is increasing year by year, and adequate nutrition is crucial for the growth and development of preterm infants. Enteral nutrition (EN...With the continuous progress of medical care, the survival rate of preterm infants is increasing year by year, and adequate nutrition is crucial for the growth and development of preterm infants. Enteral nutrition (EN) is a nutritional support method that provides metabolically required nutrients and various other nutrients through the gastrointestinal tract, which is the best way to supply nutrition to preterm infants. A reasonable EN strategies can help improve the quality of survival, and long-term prognosis of preterm infants. This article summarizes and discusses the literature reports on EN for preterm infants at home and abroad in recent years, and reviews the research progress of EN strategies for preterm infants, personalized feeding programs, and related clinical problems affecting the establishment of EN, to provide reference for clinical work. EN for preterm infants requires the comprehensive use of a variety of research strategies and continuous exploration and innovation to provide better nutritional support for preterm infants and promote their healthy growth.展开更多
Objective:To summarize the evidence of tube feeding intolerance in critically ill children,aiming to provide evidence-based information for clinical nursing staff.Methods:Evidence search was done in Chinese and Englis...Objective:To summarize the evidence of tube feeding intolerance in critically ill children,aiming to provide evidence-based information for clinical nursing staff.Methods:Evidence search was done in Chinese and English databases to guide network and professional associations at home and abroad.The search time limit was from January 2014 to January 2024,nearly 10 years of relevant literature,mainly including guidelines,consensus,expert advice,best practice,evidence summary,system evaluation,and meta-analysis.Literature quality evaluation and evidence extraction were independently performed by two researchers.Results:This paper included 13 articles,including three guidelines,three systematic evaluations,three expert opinions,and four expert consensus.Twenty-six pieces of evidence were summarized from 10 aspects of feeding intolerance definition,team building,nutritional assessment,nutritional preparation,feeding protocol,feeding route,feeding management,pipeline management,gastric residual volume,and drug application.Conclusion:This paper summarized the evidence of tube feeding intolerance in critically ill children,which can provide evidence-based information for clinical practice.The abdominal signs should be closely observed when evaluating feeding intolerance,focusing on the prevention and reduction of feeding interruption.展开更多
Hypervigilance and symptoms anticipation,visceral hypersensitivity and gastroduodenal sensorimotor abnormalities account for the varied clinical presentation of functional dyspepsia(FD)patients.Many patients recognize...Hypervigilance and symptoms anticipation,visceral hypersensitivity and gastroduodenal sensorimotor abnormalities account for the varied clinical presentation of functional dyspepsia(FD)patients.Many patients recognize meals as the main triggering factor;thus,dietary manipulations often represent the first-line management strategy in this cohort of patients.Nonetheless,scarce quality evidence has been produced regarding the relationship between specific foods and/or macronutrients and the onset of FD symptoms,resulting in nonstandardized nutritional approaches.Most dietary advises are indeed empirical and often lead to exclusion diets,reinforcing in patients the perception of“being intolerant”to food and self-perpetuating some of the very mechanisms underlying dyspepsia physiopathology(i.e.,hypervigilance and symptom anticipation).Clinicians are often uncertain regarding the contribution of specific foods to dyspepsia physiopathology and dedicated professionals(i.e.,dietitians)are only available in tertiary referral settings.This in turn,can result in nutritionally unbalanced diets and could even encourage restrictive eating behaviors in severe dyspepsia.In this review,we aim at evaluating the relationship between dietary habits,macronutrients and specific foods in determining FD symptoms.We will provide an overview of the evidence-based nutritional approach that should be pursued in these patients,providing clinicians with a valuable tool in standardizing nutritional advises and discouraging patients from engaging into indiscriminate food exclusions.展开更多
Lactose malabsorption is a very common condition characterized by intestinal lactase deficiency. Primary lactose malabsorption is an inherited deficit present in the majority of the world＇s population, while secondar...Lactose malabsorption is a very common condition characterized by intestinal lactase deficiency. Primary lactose malabsorption is an inherited deficit present in the majority of the world＇s population, while secondary hypolactasia can be the consequence of an intestinal disease. The presence of malabsorbed lactose in the colonic lumen causes gastrointestinal symptoms. The condition is known as lactose intolerance. In patients with lactase nonpersistence, treatment should be considered exclusively if intolerance symptoms are present. In the absence of guidelines, the common therapeutic approach tends to exclude milk and dairy products from the diet. However, this strategy may have serious nutritional disadvantages. Several studies have been carried out to find alternative approaches, such as exogenous β-galactosidase, yogurt and probiotics for their bacterial lactase activity, pharmacological and non pharmacological strategies that can prolong contact time between enzyme and substrate delaying gastrointestinal transit time, and chronic lactose ingestion to enhance colonic adaptation. In this review the usefulness of these approaches is discussed and a therapeutic management with a flow chart is proposed.展开更多
文摘In this editorial,we comment on an article by Liu et al.We focus specifically on the novel use of laparoscopic intracorporeal anastomosis(LIA)compared with open ileostomy reversal in patients with Crohn’s disease(CD),which is an innovative approach for improving postoperative outcomes and accelerating recovery in ileostomy reversal procedures.This study also highlights the limitations of the conventional open surgical technique,which is associated with higher rates of feeding intolerance,prolonged hospital stays,and delayed initiation of enteral nutrition.The chronic and recurrent nature of CD and the challenges posed by traditional surgical methods are issues addressed by LIA,which offers a minimally invasive approach that reduces surgical trauma,shortens recovery time,and improves tolerance to enteral nutrition,thereby enhancing postoperative outcomes.However,while LIA shows great promise,further prospective multicenter trials are needed to validate these findings and assess their broader application in other surgical scenarios.Overall,LIA represents a significant advancement in minimally invasive surgery for CD and has the potential to become the preferred standard approach for ileostomy reversal in patients requiring bowel reanastomosis.
基金Supported by Chongqing Municipal Health Commission Medical Research Project,No.2023WSJK104.
文摘BACKGROUND There is an increased maturation of laparoscopic intracorporeal anastomosis techniques.However,research on its application for small bowel stoma reversal in patients with Crohn's disease(CD)is limited.Therefore,in this study,we compared the perioperative outcomes between laparoscopic intracorporeal ileostomy reversal(LIIR)and open ileostomy reversal(OIR).AIM To compare the safety,feasibility,bowel function recovery,and short-and longterm LIIR and OIR outcomes in patients with CD.METHODS This study included patients who underwent ileal reversal for CD between January 2021 and January 2023 at our institution.The baseline data,postoperative recovery,and complication indicators were retrospectively analyzed.Logistic regression analysis was conducted to explore factors that significantly influenced the development of enteral nutrition intolerance-related symptoms.RESULTS Notably,15 of the 45 patients in this study underwent OIR,and the remaining 30 received LIIR.Notably,no statistically significant differences were found between the two groups regarding clinical baseline characteristics,operation time,intraoperative hemorrhage,anastomotic site,enterolysis range,first postoperative flatus,postoperative complications,reoperation rate,or incidence of postoperative enteral nutrition intolerance.Compared with the OIR group,the LIIR group had a shorter postoperative hospital stay(P=0.045),lower incidence of enteral nutrition intolerance symptoms(P=0.019),and earlier postoperative total enteral nutrition initiation(P=0.033);however,it incurred higher total hospital costs(P=0.038).Furthermore,multivariate logistic regression analysis revealed that the duration of surgery and anastomotic technique were independent risk factors for postoperative symptoms of enteral nutrition intolerance(P<0.05).CONCLUSION Laparoscopic intracorporeal anastomosis for ileostomy reversal is safe and feasible.Patients who underwent this technique demonstrated improved tolerance to postoperative enteral nutrition and quicker resumption of total enteral nutrition.
基金supported by the National Natural Science of China(82322032 and 82221005)the Outstanding Youth Foundation of Jiangsu Province(BK20220050)+4 种基金the National Key Research&Development(R&D)Program of China(2024YFC2706800 and 2021YFC2700600)the Major Project of Changzhou Medical Center(CZKY1040101)the Major Project of Taizhou Clinical Medical College(TZKY20240003)the Major Program of Gusu School(GSKY20210102)the China Postdoctoral Science Foundation(2024M760296).
文摘Autism spectrum disorder(ASD)is a neurodevelopmental disorder where de novo mutations play a significant role.Although coding mutations in ASD have been extensively characterized,the impact of non-coding de novo mutations(ncDNMs)remains less understood.Here,we integrate cortex cell-specific cis-regulatory element annotations,a deep learning-based variant prediction model,and massively parallel reporter assays to systematically evaluate the functional impact of 227,878 ncDNMs from Simons Simplex Collection(SSC)and Autism Speaks MSSNG resource(MSSNG)cohorts.Our analysis identifies 238 ncDNMs with confirmed functional regulatory effects,including 137 down-regulated regulatory mutations(DrMuts)and 101 up-regulated regulatory mutations(UrMuts).Subsequent association analyses reveal that only DrMuts regulating loss-of-function(LoF)intolerant genes rather than other ncDNMs are significantly associated with the risk of ASD(Odds ratio=4.34;P=0.001).A total of 42 potential ASD-risk DrMuts across 41 candidate ASD-susceptibility genes are identified,including 12 recognized and 29 unreported genes.Interestingly,these noncoding disruptive mutations tend to be observed in genes extremely intolerant to LoF mutations.Our study introduces an optimized approach for elucidating the functional roles of ncDNMs,thereby expanding the spectrum of pathogenic variants and deepening our understanding of the complex molecular mechanisms underlying ASD.
文摘Cow milk protein allergy(CMPA)is a prevalent food allergy in infancy.It often presents with symptoms that overlap with other conditions,such as gastroeso-phageal reflux disease,lactose intolerance,food protein-induced enterocolitis syndrome,and eosinophilic esophagitis.This diagnostic overlap makes distin-guishing CMPA from its mimics difficult,resulting in potential misdiagnoses and unnecessary dietary restrictions.This review aims to comprehensively analyze CMPA and its mimicking conditions,highlighting their clinical presentations,diagnostic approaches,and management strategies to enhance diagnostic accu-racy and optimize patient care.A systematic literature search was conducted using PubMed,Scopus,Web of Science,and Google Scholar,focusing on studies published within the last 20 years.Articles addressing CMPA and its mimicking conditions were selected,with data synthesized into comparative analyses of diagnostic methods and management strategies.Accurate differentiation between CMPA and its mimics requires a thorough clinical evaluation supported by diagnostic tests such as skin prick tests,serum-specific IgE,and oral food challenges.Misdiagnosis can lead to nutritional deficiencies,psychological stress,and increased healthcare costs.Emerging diagnostic technologies,including component-resolved diagnostics and cytokine profiling,offer promising avenues for improving accuracy.A multidisciplinary approach involving pediatricians,allergists,and dietitians is essential for precise diagnosis and effective management.Ongoing research and education are crucial to enhancing clinical outcomes and reducing the burden on families.
基金This observational retrospective study was approved by the local Clinical Governance Committee(RRK6237)conformed to the principles of Good Clinical Practice guidelines.Additionally,healthy controls were identiffed from a national ethics board approved observational CMR study(NCT01028703).
文摘Background:Patients with unrepaired Ebstein’s anomaly experience exercise intolerance,heart failure and premature mortality.Volumetric assessment of right ventricular function is difffcult due to the complex anatomy of the right ventricle and tricuspid valve.Myocardial deformation indices are an early marker in other cardiac pathologies of ventricular dysfunction.Objectives:1.Assess myocardial deformation in unrepaired Ebstein’s compared to healthy controls.2.Investigate the relationships between myocardial deformation and exercise capacity.Methods:Myocardial deformation parameters(strain)were calculated using feature tracking from standard cardiac magnetic resonance cine images.Cardiopulmonary exercise results were included where available.Results:36 patients with unrepaired Ebstein’s and 36 matched controls were included.Right ventricular,right atrial,and left ventricular global longitudinal,as well as left ventricular circumferential strain were impaired in Ebstein’s patients compared to controls(p<0.05).In Ebstein’s patients right atrial peak strain correlated with their percentage predicted VO_(2) max(r=−0.448,p=0.022)and VE/VCO_(2) slope(r=0.435,p=0.026).There were no correlations between right ventricular ejection fraction and exercise parameters.When Ebstein’s patients were divided by severity into mild or severe according to the median total right/left index,those with severe demonstrated signiffcantly impaired right ventricular global longitudinal strain compared to those in the mild category(−17.5±5.4%vs.−21.4±4.4%,p=0.0017).Conclusions:Myocardial deformation parameters for both the right and left ventricle are impaired in patients with unrepaired Ebstein’s compared to healthy controls.Right atrial peak strain is related to impaired exercise capacity and warrants further investigation as an early prognostic marker in this patient cohort.
基金This study was reviewed and approved by the Ethics Committee of the PLA General Hospital(Ethics audits No.S2022-414-01).
文摘BACKGROUND Reflux esophagitis has an increasing prevalence and complex and diverse symptoms.Identifying its risk factors is crucial to understanding the etiology,prevention,and management of the disease.The occurrence of reflux esophagitis may be associated with food reactions,Helicobacter pylori(H.pylori)infection,and metabolic syndromes.AIM To investigate the risk factors for reflux esophagitis and analyze the effects of immunoglobulin(Ig)G-mediated food intolerance,H.pylori infection,and metabolic syndrome on reflux esophagitis.METHODS Outpatients attending the Second Medical Center of the PLA General Hospital between 2017 and 2021 were retrospectively enrolled.The patients’basic information,test results,gastroscopy results,H.pylori test results,and IgG-mediated food intolerance results were collected.Multivariate logistic regression analysis was used to analyze risk factors for reflux esophagitis.Statistical mediation analysis was used to evaluate the effects of IgG-mediated food intolerance and metabolic syndrome on H.pylori infection affecting reflux esophagitis.RESULTS A total of 7954 outpatients were included;the prevalence of reflux esophagitis,IgG-mediated food intolerance,H.pylori infection,and metabolic syndrome were 20.84%,61.77%,35.91%,and 60.15%,respectively.Multivariate analysis showed that the independent risk factors for reflux esophagitis included IgG-mediated food intolerance(OR=1.688,95%CI:1.497-1.903,P<0.00001)and metabolic syndrome(OR=1.165,95%CI:1.030-1.317,P=0.01484),and the independent protective factor for reflux esophagitis was H.pylori infection(OR=0.400,95%CI:0.351-0.456,P<0.00001).IgG-mediated food intolerance had a partially positive mediating effect on H.pylori infection as it was associated with reduced occurrence of reflux esophagitis(P=0.0200).Metabolic syndrome had a partially negative mediating effect on H.pylori infection and reduced the occurrence of reflux esophagitis(P=0.0220).CONCLUSION Patients with IgG-mediated food intolerance and metabolic syndrome were at higher risk of developing reflux esophagitis,while patients with H.pylori infection were at lower risk.IgG-mediated food intolerance reduced the risk of reflux esophagitis pathogenesis in patients with H.pylori infection;however,metabolic syndrome increased the risk of patients with H.pylori infection developing reflux esophagitis.
基金supported by the National Key Research and Development Program of China(No.2021YFC2501800)the National Natural Science Foundation of China(Nos.82272182 and 82072202)+1 种基金the Zhejiang Provincial Natural Science Foundation of China(No.LHDMD22H02001)the Zhejiang University Horizontal Program(No.K-Horizontal 20202295).
文摘Objective:This study aimed to investigate the incidence of enteral nutrition intolerance(ENI)in patients with sepsis and explore potential risk factors.Methods:A case-control study was conducted in patients with sepsis who were receiving enteral nutrition(EN)at a tertiary hospital in China.The included patients were divided into the ENI group and the non-ENI group.Univariate and multivariate analyses were performed to identify the risk factors for ENI.Results:A total of 859 patients were included in the study.Among them,288(33.53%)patients experienced symptoms of ENI,including diarrhea,vomiting,bloating,and gastric retention.Logistic regression analysis revealed that the Acute Physiology and Chronic Health Evaluation H(APACHE H)score,thoracocentesis,and usage of cardiotonic drugs(namely,inotropes)were independent predictors of the ENI.Conclusion:The incidence of ENI is relatively high in patients with sepsis,especially in those who have higher APACHE H scores,have undergone thoracocentesis,and have received inotropes.
文摘In the retrospective study by Luo et al regarding clinical outcomes in gestational diabetes mellitus(GDM),the results are statistically significant in favour of the benefits of individualized nutrition interventions enumerated therein.The study has provided important evidence to improve maternal and child health in the Asian population.The methods,however,appear to have considerable limi-tations,wherein the time point of diagnosis of GDM,severity of GDM,selection bias,compliance to therapy,important maternal covariates,observable microvascular abnormalities and the confounding effect of added insulin have not been considered.We have provided suggestions to improve the external validity of the study,including the use of Equator Network reporting guidelines and inclusion of overweight and obese patients in future studies.
文摘The hypothesis that some children with attention-deficit hyperactivity disorder(ADHD)may show sensitivity or allergic reactions to various food items has led to the development of the the few-foods(or oligoantigenic)diet.The rationale of the diet is to eliminate certain foods from the diet in order to exclude potential allergens contained either naturally in food or in artificial ingredients with allergenic properties.The oligoantigenic diet attempts to identify individual foods to which a person might be sensitive.First,ADHD symptoms are monitored while multiple foods are excluded from the diet.Subsequently,if symptoms remit,foods are re-introduced,while observing the individual for the return of symptoms.An advantage of the oligoantigenic diet is that it can be tailored to the individual.A growing body of evidence suggests that behavioral symptoms of subgroups of children with ADHD may benefit from the elimination of certain foods.The effect sizes of an oligoantigenic diet regarding improvement of ADHD symptoms have been found to be medium to large.Available evidence suggests that the investigation of the role of food hypersensitivities in ADHD is a promising avenue worthy of further exploration.Further large-scale,randomized controlled studies including assessment of long-term outcome are therefore warranted.
文摘Periodontitis is independently associated with numerous lifestyle diseases.Diabetic patients have approximately threefold increased odds of periodontitis,which in turn increases the risk of systemic inflammation.The study by Thazhe Poyil et al is an effort to establish the inflammatory link between diabetic retinopathy(DR)and periodontitis based on the periodontal inflamed surface area in diabetic patients with and without DR.To further advance the study,we suggest refining the eligibility criteria to explicitly state the clinical correlates of periodontitis and DR,larger sample size and improved sampling methodology,matching of baseline characteristics of the two groups,as well as improved statistical approach and interpretation of the study findings.Measurement of hemoglobin A1c(HbA1c)in studies comparing type 2 diabetes mellitus patients with DR of matched severity with and without periodontitis could provide a clearer picture of whether HbA1c level is indeed influenced by periodontitis.
文摘This published Meta-Analysis by Lin et al is an indirect comparison between two drugs Chiglitazar and Thiazolidinedione which are commonly used for glycemic control in type-Ⅱ diabetes mellitus.In terms of safety and efficacy,this Meta-Analysis is inconclusive.
基金supported by the National Natural Science Foundation of China(Grant Nos.72272136 and 72172024)Humanities and Social Science Project from the Ministry of Education of China(20YJA630061).
文摘Crises in the past have caused devastating,long-lasting impacts on the global economy.The after-effects always bring some dynamic and rigorous challenges for businesses and governments.Such challenges have always been a point of discussion for scholars.The recent COVID-19 pandemic emaciated the global economy,leaving everyone mired in uncertainty,fear,and psychological impairments.One of the headwind features utilized by consumers during pandemic was panic buying(PB),which must be explored in various contexts for policymakers and practitioners.To address this gap,this study deployed a moderated mediation mechanism,integrating the health belief model(HBM)and competitive arousal theory(CAT)to excavate the notions underlying PB with the intrusion of evolved real-time psychological disorders:intolerance of uncertainty(IU)and cyberchondria(CYC).The study was conducted as a natural experiment in a South Asian developing economy using online surveys.It found that health beliefs—perceived severity(PSV)and perceived susceptibility(PSC)—positively impact perceived arousal(PA),which causes PB,and that PA has a sturdy mediator role.Moreover,in the relationship between health beliefs and arousal,the different psychological disorders were found to have significant moderating roles The study findings can help mitigate risk uncertainties and panic situations and thus contribute to consumers’wellbeing.
文摘Background: Gestational diabetes mellitus (GDM) is a temporary form of insulin resistance during pregnancy and is linked to adverse outcomes for both mothers and offspring. Maternal risks include an increased prevalence of pre-eclampsia, cesarean delivery, and the development of type 2 diabetes within five to ten years post-delivery. For offspring, exposure to elevated maternal glucose levels is associated with macrosomia. A significant challenge in evaluating the prevalence of GDM in Puerto Rico is the lack of recent research quantifying this condition in pregnant women living in Puerto Rico. Objective: This study aimed to estimate the prevalence of Gestational Diabetes Mellitus from 2016 to 2021 by analyzing data collected by Puerto Rico’s Department of Health. Methods: We obtained publicly accessible data from the Division of Children, Mothers, and Adolescents from Puerto Rico’s Department of Health to estimate the prevalence of GDM across the island. Additionally, we correlated the prevalence with socioeconomic, educational, and demographic variables using beta regression models to assess their significance. Results: The prevalence of GDM ranged from 3.2% to 4.5% for the six years studied, with an average prevalence of 3.68%. Regression analysis revealed a significant positive relationship between maternal age and educational level. Higher educational attainment was associated with a reduced risk of GDM, while increasing maternal age was linked to a higher prevalence of the condition. Conclusion: This statistical analysis provides evidence of a steady increase in the prevalence of GDM in Puerto Rico from 2016 to 2021, highlighting the importance of ongoing surveillance and specific interventions to mitigate risk factors.
文摘With the continuous progress of medical care, the survival rate of preterm infants is increasing year by year, and adequate nutrition is crucial for the growth and development of preterm infants. Enteral nutrition (EN) is a nutritional support method that provides metabolically required nutrients and various other nutrients through the gastrointestinal tract, which is the best way to supply nutrition to preterm infants. A reasonable EN strategies can help improve the quality of survival, and long-term prognosis of preterm infants. This article summarizes and discusses the literature reports on EN for preterm infants at home and abroad in recent years, and reviews the research progress of EN strategies for preterm infants, personalized feeding programs, and related clinical problems affecting the establishment of EN, to provide reference for clinical work. EN for preterm infants requires the comprehensive use of a variety of research strategies and continuous exploration and innovation to provide better nutritional support for preterm infants and promote their healthy growth.
文摘Objective:To summarize the evidence of tube feeding intolerance in critically ill children,aiming to provide evidence-based information for clinical nursing staff.Methods:Evidence search was done in Chinese and English databases to guide network and professional associations at home and abroad.The search time limit was from January 2014 to January 2024,nearly 10 years of relevant literature,mainly including guidelines,consensus,expert advice,best practice,evidence summary,system evaluation,and meta-analysis.Literature quality evaluation and evidence extraction were independently performed by two researchers.Results:This paper included 13 articles,including three guidelines,three systematic evaluations,three expert opinions,and four expert consensus.Twenty-six pieces of evidence were summarized from 10 aspects of feeding intolerance definition,team building,nutritional assessment,nutritional preparation,feeding protocol,feeding route,feeding management,pipeline management,gastric residual volume,and drug application.Conclusion:This paper summarized the evidence of tube feeding intolerance in critically ill children,which can provide evidence-based information for clinical practice.The abdominal signs should be closely observed when evaluating feeding intolerance,focusing on the prevention and reduction of feeding interruption.
文摘Hypervigilance and symptoms anticipation,visceral hypersensitivity and gastroduodenal sensorimotor abnormalities account for the varied clinical presentation of functional dyspepsia(FD)patients.Many patients recognize meals as the main triggering factor;thus,dietary manipulations often represent the first-line management strategy in this cohort of patients.Nonetheless,scarce quality evidence has been produced regarding the relationship between specific foods and/or macronutrients and the onset of FD symptoms,resulting in nonstandardized nutritional approaches.Most dietary advises are indeed empirical and often lead to exclusion diets,reinforcing in patients the perception of“being intolerant”to food and self-perpetuating some of the very mechanisms underlying dyspepsia physiopathology(i.e.,hypervigilance and symptom anticipation).Clinicians are often uncertain regarding the contribution of specific foods to dyspepsia physiopathology and dedicated professionals(i.e.,dietitians)are only available in tertiary referral settings.This in turn,can result in nutritionally unbalanced diets and could even encourage restrictive eating behaviors in severe dyspepsia.In this review,we aim at evaluating the relationship between dietary habits,macronutrients and specific foods in determining FD symptoms.We will provide an overview of the evidence-based nutritional approach that should be pursued in these patients,providing clinicians with a valuable tool in standardizing nutritional advises and discouraging patients from engaging into indiscriminate food exclusions.
文摘Lactose malabsorption is a very common condition characterized by intestinal lactase deficiency. Primary lactose malabsorption is an inherited deficit present in the majority of the world＇s population, while secondary hypolactasia can be the consequence of an intestinal disease. The presence of malabsorbed lactose in the colonic lumen causes gastrointestinal symptoms. The condition is known as lactose intolerance. In patients with lactase nonpersistence, treatment should be considered exclusively if intolerance symptoms are present. In the absence of guidelines, the common therapeutic approach tends to exclude milk and dairy products from the diet. However, this strategy may have serious nutritional disadvantages. Several studies have been carried out to find alternative approaches, such as exogenous β-galactosidase, yogurt and probiotics for their bacterial lactase activity, pharmacological and non pharmacological strategies that can prolong contact time between enzyme and substrate delaying gastrointestinal transit time, and chronic lactose ingestion to enhance colonic adaptation. In this review the usefulness of these approaches is discussed and a therapeutic management with a flow chart is proposed.
