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Providing adequate and balanced nutrition for preterm infants, especially extremely/very preterm infants, is the material basis for promoting their normal growth and development and improving long-term prognosis. Enteral nutrition is the best way to feed preterm infants. Previous systematic reviews have shown that using evidence-based standardized feeding management strategies can effectively promote the establishment of full enteral feeding, reduce the duration of parenteral nutrition, improve the nutritional outcomes of preterm infants, and not increase the risk of necrotizing enterocolitis or death. Based on relevant research in China and overseas, the consensus working group has developed 20 recommendations in 5 aspects including the goal of enteral nutrition, transitioning to enteral nutrition, stable growth period enteral nutrition, supplementation of special nutrients, and monitoring of enteral nutrition for preterm infants, using the Grading of Recommendations Assessment, Development and Evaluation. The aim is to provide recommendations for healthcare professionals involved in the management of enteral nutrition for preterm infants, in order to improve the clinical outcomes of preterm infants. [ABSTRACT FROM AUTHOR]

Glucagon-like peptide-1 receptor agonists (GLP-1RA) have been widely used in the treatment of adult type 2 diabetes, and recent studies have shown that GLP-1RA can also be used in the treatment of children with obesity and short bowel syndrome. This review focuses on the progress of GLP-1RA in clinical use in children. GLP-1RA improves metabolic abnormalities and cardiovascular disease risk in children with obesity by improving insulin sensitivity, reducing weight, lowering blood pressure, and reducing the risk of developing metabolic syndrome. In short bowel syndrome, GLP-1RA can increase intestinal absorption of nutrients and can stimulate insulin secretion, thereby promoting glucose utilization and reducing exogenous glucose use, increasing fat utilization. Although GLP-1RA are safe and well tolerated in clinical use, there are risks of hypoglycemia, nausea and vomiting, pancreatitis, and thyroid cancer, so it is necessary to closely monitor the adverse drug reactions and to further carry out more systematic and in-depth studies. [ABSTRACT FROM AUTHOR]

The relationship between intestinal flora and diseases is currently a hot topic of research, but most studies tend to explain causality and pathogenesis, and there is still a lack of studies of the traditional Chinese medicine (TCM) characteristics of intestinal microecological disorders from the perspective of etiology. The TCM pathogenic characteristics of hybrid flora need to be further clarified. The intestinal flora is an important bridge between the internal and the external environment of body, and plays an important and complex role in the diagnosis, prognosis, and treatment of diseases. Based on the etiology theory of TCM, this paper discusses the scientific connotation of changes of wind, fire, dryness, dampness, and cold caused by intestinal microecological disorder from the aspects of basic concepts, formation causes, and pathogenic nature and characteristics, combined with the nervous system, immune system, gland secretion, and nutritional metabolism, based on clinical manifestations, using the method of examining symptoms and seeking causes. This paper provides a new idea for the study of intestinal flora in TCM, and supplements and enriches the theory of etiology. At the same time, it provides an innovative theoretical basis for the understanding and research that intestinal microecological disorders can promote the occurrence and development of various complex diseases. [ABSTRACT FROM AUTHOR]

From January 2015 to February 2021, retrospective review was conducted for 24 USBS infants. Clinical characteristics, treatments and outcomes were recorded. There were 17 boys and 7 girls with a gestational age of (26-39+5) week and a range of birth weight (720-3 600) gram. The infants were premature (n=20) and full-term (n=4). Results Among them, 7 infants of temporary USBS were discharged upon completing short-term nutritional therapy after closing stoma; 7/17 infants of non-temporary USBS were weaned off parenteral nutrition to achieve intestinal adaptation; 5/17 relinquished further treatments during operation; 5/17 required continued parenteral nutrition. Among 19 survivors, there were intravenous nutrition-related cholestasis (n=9), catheter infection (n=9), acquired zinc deficiency dermatitis (n=3), vitamin D deficiency (n=6) and metabolic bone disease (n=2). All symptoms improved after symptomatic measures. Conclusions It is rather troublesome to manage USBS children and there are numerous complications. After proper treatments, some infants may finally achieve intestinal adaptation without parenteral nutrition. [ABSTRACT FROM AUTHOR]

Children with short bowel syndrome (SBS) are unable to meet the demands of growth and development due to a severe reduction in digestive and absorptive area of small bowel. Parenteral and enteral nutritional supports are required for promoting intestinal adaptation to achieve total enteral nutrition. However, oral aversion and feeding difficulties are prominent during a transition to feeding, seriously affecting quality-of-life. Currently there is a lack of clinical guidance on oral feeding difficulties and proper interventions. The objective of this review was exploring the reasons for the occurrence of oral feeding difficulties and oral aversion. Existing studies were analyzed for formulating potentially effective interventions. It would guide clinical practices to achieve complete oral feeding in SBS children. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of different proportions of enteral combined with parenteral nutrition treatment on patients with severe traumatic brain injury (s TBI). Methods: The subjects of study were s TBI patients admitted to the Neurointensive Care Unit of Chongqing Emergency Medical Center from October 2020 to August 2022. 70 patients who met the inclusion and exclusion criteria were randomly divided into the experimental group and the control group with 35 cases each. Calculate the daily caloric requirements of patients and provide nutritional support according to different proportion of enteral and parenteral nutrition programs. The experimental group was given enteral and parenteral nutrition support at a ratio of 2:1, while the control group was given enteral and parenteral nutrition support at a ratio of 1:1. The differences of nutritional status indicators (hemoglobin, albumin, prealbumin, total protein), immune function indicators [CD3, CD4, CD4/CD8, immunoglobulin (Ig)A, Ig M, Ig G], inflammatory indicators [C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6)] and complications between the two groups were statistically compared. Results: In terms of immune function, the levels of CD4, CD4/CD8 and Ig A in the experimental group were significantly higher than those in the control group 14 d after nutritional support (P＜0. 05); There was no significant difference between the two groups in nutritional status, inflammatory indicators and complications (P＞0. 05). Conclusions: Enteral nutrition-based combined nutritional support can promote the recovery of immune function in patients with s TBI, but there is no significant difference in nutritional status, inflammatory indicators and complications between different proportions of enteral combined parenteral nutrition treatment. [ABSTRACT FROM AUTHOR]

This paper summarized the nursing of integrated Traditional Chinese and western medicine for a patient undergoing thrombolytic therapy for acute mesenteric venous thrombosis. The emergency interventional surgery was performed, and patient’s hemorrhage condition and vital signs were observed during thrombolytic therapy. Comprehensive nursing interventions were carried out to enhance the catheter maintenance, anticoagulant therapy and prevention of short bowel syndrome. In the mean time, Traditional Chinese Medicine external treatment such as acupoint massage; auricular acupoint pressing therapy, Chinese herbal medicine external application were carried out to improve the prognosis and quality of life of the patient. (本文回顾1例急性肠系膜静脉血栓患者溶栓后的中西医结合护理经验。给予患者急诊介入置管溶栓术, 密切观察患者在使用溶栓药物时的出血情况及生命体征; 溶栓后完善导管护理和抗凝治疗的护理, 积极预防短肠综合征; 同时配合穴位按摩、耳穴贴压、中药贴敷等中医外治法, 加强饮食和情志调护, 改善患者预后和生活质量。)

Objective: To investigate the effects of different enteral nutrition solutions on nutritional status, intestinal barrier function, immune function and inflammatory factors in elderly patients with severe chronic obstructive pulmonary disease in severe exacerbation(AECOPD). Methods: 90 elderly patients with severe AECOPD hospitalized in our hospital from October 2019 to October2021 were included as the research object. They were randomly divided into dietary fiber enteral nutrition group (FEN group) and non dietary fiber enteral nutrition group(NFEN group) by sealed envelope method, 45 cases each. Both groups received standard treatment for severe AECOPD and mechanical ventilation. FEN group was given full nutrition support treatment, NFEN group was given full nutrition support treatment, and both groups received enteral nutrition for 30 days. The nutritional status indexes serum albumin(ALB),prealbumin(PA), hemoglobin(HB), intestinal barrier function indexes D-lactic acid (DLA), bacterial endotoxin(BE), diamine oxidase(DAO), T lymphocyte subsets(CD4+, CD8+, CD4+/CD8+), humoral immune function indexes immunoglobulin(Ig) g, Ig M and Ig A were compared between the two groups before and 30 d after treatment, The changes of inflammatory factors procalcitonin(PCT) and interleukin-6 (IL-6), as well as the differences of ICU hospitalization days, mechanical ventilation time and complications were caompared between the two groups. Results: 30 d after treatment, the levels of ALB, PA and Hb in FEN group were significantly higher than those in NFEN group(P<0.05). The levels of DLA, BE and DAO in FEN group were significantly lower than those in NFEN group (P<0.05). The levels of CD4+, CD4+/CD8+, Ig G and Ig A in FEN group were significantly higher than those in NFEN group (P<0.05). PCT and IL-6 levels in FEN group were significantly lower than those in NFEN group(P<0.05). The ICU length of stay, mechanical ventilation time and complications in Fen group were significantly less than those in nfen group (P<0.05). Conclusion: Enteral nutrition with dietary fiber is helpful to improve the nutritional status of elderly patients with severe AECOPD, repair the intestinal mucosal barrier function, improve immune function, reduce inflammatory reaction, so as to improve the prognosis. Enteral nutrition with dietary fiber has a better therapeutic effect. [ABSTRACT FROM AUTHOR]

Objective: To observe the effects of enteral nutrition on nutritional status, intestinal mucosal barrier function and intestinal flora in patients with active ulcerative colitis（UC） with malnutrition. Methods: 120 patients with active UC with malnutrition who were treated in Shanghai Changzheng Hospital from August 2019 to September 2021 were selected, they were randomly divided into control group（60 cases, treated with total parenteral nutrition） and study group（60 cases, treated with enteral nutrition）. The total clinical effective rate of the two groups 3 weeks after treatment were observed, the nutritional status, intestinal mucosal barrier function index and intestinal flora of the two groups before and 3 weeks after treatment were compared, and the incidence of adverse reactions during the treatment of the two groups were recorded. Results: The total clinical effective rate of the study group（90.00%） was higher than that of the control group（68.33%）（P<0.05）. The levels of D-lactic acid（D-LA）, diamine oxidase（DAO） and endotoxin（ET） in the study group were lower than those in the control group at 3 weeks after treatment（P<0.05）. The levels of serum albumin and hemoglobin in the study group were higher than those in the control group at 3 weeks after treatment（P<0.05）. The number of Lactobacillus and Bifidobacterium in the study group was higher than that in the control group, while the number of Escherichia coli was lower than that in the control group at 3 weeks after treatment（P<0.05）. There was no significant difference in the incidence of adverse reactions between the two groups（P>0.05）. Conclusion: Enteral nutrition can promote the improvement of nutritional status and intestinal mucosal barrier function, regulate the structure of intestinal flora, which is safe and effective. [ABSTRACT FROM AUTHOR]

Objective: To observe the effects of different incremental infusion speed of enteral nutrition on feeding tolerance,quality of life and gastrointestinal function recovery in patients with severe acute pancreatitis（SAP）. Methods: 120 patients with SAP who were treated in our hospital from March 2019 to February 2021 were selected, and they were randomly divided into low-speed group, medium-speed group and high-speed group, with 40 cases in each group, the increasing range of infusion rate was from low to high, and enteral nutrition was given. The intra-abdominal pressure, feeding tolerance, quality of life and gastrointestinal function recovery of the three groups were compared. Results: 8 h after intervention, 16 h after intervention and 20 h after intervention, the intra-abdominal pressure in low-speed group was lower than that in high-speed group and medium-speed group, while that in medium-speed group was lower than that in high-speed group（P<0.05）. The exhaust and defecation recovery time, bowel sound recovery time, oral feeding time and abdominal distension relief time in low-speed group were shorter than those in medium-speed group and high-speed group, while those in medium-speed group were shorter than those in high-speed group（P<0.05）. 7 d after intervention, the scores of all dimensions of the world health organization the quality of life-BREF（WHO-QOL-BREF） in the low-speed group were higher than those in the medium-speed group and the high-speed group, while those in the medium-speed group were higher than those in the high-speed group（P<0.05）. The incidence of feeding intolerance in low-speed group was lower than that in medium-speed group and high-speed group, and that in medium-speed group was lower than that in high-speed group（P<0.05）. Conclusion: The low-speed incremental infusion of enteral nutrition is helpful to prevent the increase of intra-abdominal pressure, improve the feeding tolerance of patients with SAP, promote the gastrointestinal function recovery, and then improve the quality of life of patients. [ABSTRACT FROM AUTHOR]

Objective: To investigate the diagnosis and treatment of acute mesenteric ischemia (AMI). Methods: Clinical data of36 patients with AMI were collected and analyzed retrospectively. All patients were treated with MDT, vascular surgery and gastrointestinal surgery. Surgical exploration was performed in all treated cases. Intraoperative fluorescence endoscopy was used to determineintestinal blood supply in 3 patients. The relevant data of abdominal CT, white blood cell count and D-dimer during the diagnosis andtreatment were counted, and the correlation between them and intestinal necrosis was analyzed by SPSS software. Results: The specificfeatures of abdominal CT and the increase of white blood cell count were correlated with intestinal necrosis. Among the treated patients,11 underwent intestinal resection and 8 underwent postoperative rehabilitation therapy in our hospital after surgical treatment in anotherhospital. Postoperative short bowel syndrome occurred in 8 cases. 1 patient was discharged automatically. One death occurred. Postoper-ative intestinal necrosis and intestinal fistula occurred in 1 patient. 3 months later, the patient underwent intestinal fistula resection, andthe postoperative recovery was good. Five patients underwent ostomy for retraction 6 months after operation. Fluorescent endoscopyshowed good results in determining intestinal blood supply and vitality. Conclusion: AMI is a dangerous disease, improving the under-standing of the disease, early diagnosis, early reconstruction of small intestinal blood circulation is the key to improve the efficacy andprognosis. Precision therapy after multidisciplinary discussion can improve the therapeutic effect. Preoperative abdominal CTA has im-portant significance for the diagnosis of AMI and the judgment of intestinal necrosis. Intraoperative use of indoliclegreen fluorescentimaging agent, coupled with fluorescence navigation endoscopy, to determine the extent of intestinal ischemia, it is worth further discus-sion. Double abdominal wall ostomy is conducive to timely detection of intestinal blood supply recovery, and distal ostomy can be usedfor early enteral nutrition, which is worthy of promotion. [ABSTRACT FROM AUTHOR]

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Objective: To observe the changes in immune function, intestinal mucosal barrier function and nutritional status of patients with severe head injury after the intervention of dietary fiber enteral nutrition combined with probiotics. Methods: A total of 136 patients with severe head injury admitted to our hospital from June 2016 to May 2020 were selected. According to the odd-even method of admission order, they were divided into 68 cases in the control group and 68 cases in the study group. The control group was given dietary fiber enteral nutrition intervention, and the study group was combined with probiotic intervention on the basis of the control group. The two groups were compared with the Glasgow Coma Scale (GCS). ) Score, nutritional status, immune function, intestinal mucosal barrier function and complications. Results: The albumin (ALB), hemoglobin (Hb), and transferrin (TR) of the two groups were higher than before the intervention for 14 days, and the study group was higher than the control group (P<0.05). After 14 days of intervention, the levels of immunoglobulin G (IgG), immunoglobulin A (IgA), and immunoglobulin M (IgM) were higher in the two groups than before the intervention, and the study group was higher than the control group (P<0.05). After 14 days of intervention, the total superoxide dismutase (T-SOD) and glutathione peroxidase (GSH-PX) of the two groups were higher than before the intervention, and the study group was higher than the control group (P<0.05), Malondialdehyde (MDA) was lower than before the intervention, and the study group was lower than the control group (P<0.05). The GCS scores of the two groups increased after 14 days of intervention, and the study group was higher than the control group (P<0.05). The incidence of complications in the study group was lower than that in the control group (P<0.05). Conclusion: The enteral nutrition intervention of probiotics combined with dietary fiber can effectively improve the nutritional status, immune function and intestinal mucosal barrier function of patients with severe head injury after surgery. At the same time, it can also reduce the incidence of complications and improve the prognosis of patients. [ABSTRACT FROM AUTHOR]

Intestinal failure is a syndrome characterized by a diminished intestinal function that is inadequate to maintain normal digestion and absorption, leading to systemic metabolic disorder and requiring long-term nutritional supplementation to sustain health and growth. Short bowel syndrome (SBS) is one of the primary causes of intestinal failure. Given the significant differences among SBS patients, nutritional treatment strategies should emphasize individualization. This review focuses on SBS, combining its anatomical and pathological characteristics, to introduce nutritional support treatment plans and experiences for patients with intestinal failure.

In this study, we report the experience of providing nursing care for an adult patient with short bowel syndrome who underwent small intestine transplantation. We used Orem's theory to perform the nursing evaluation. During the surgical period, the patient experienced perioperative anxiety, had potential risks of perioperative positioning injury and wound infection, lacked knowledge of the condition, and had other issues. During the preoperative period, nurses provided assistance and implemented educational measures. Likewise, visiting, listening, and accompanying the patient helped to establish a positive relationship between the patient and nurses and alleviate the patient's anxiety. To maintain patient safety and prevent unnecessary injury during the surgical period, systemic siliceous fat pads and cotton were used to protect the skin. Before surgery, we administered antibiotics and followed the principle of asepsis to prevent potential wound infection. During surgery, we pasted a waterproof film and plastic wrap around the surgical site to maintain skin integrity and prevent skin infiltration. Patients and caregivers were provided with an explanation regarding the identification of acute rejection symptoms after transplantation, the purpose of intestinal fistula retention, and home care. [ABSTRACT FROM AUTHOR]

Intestinal failure (IF) is defined as the critical reduction of functional intestines below the minimum needed to absorb nutrients and fluids, so that intravenous supplementation with parenteral nutrition (PN) is required to maintain health and/or growth. Although the benefits are evident, patients receiving PN can suffer from serious cholestasis due to lack of enteral feeding and small intestinal bacterial overgrowth (SIBO). One such complication that may arise is intestinal failure-associated liver disease (IFALD). Evidences from recent studies suggest that alterations in the intestinal microbiota, as well as intraluminal bile acid driven signaling, may play a critical role in both hepatic and intestinal injury. Since Marshall first proposed the concept of the gut-liver axis in 1998, the role of gut-liver axis disorders in the development of IFALD has received considerable attention. The conversation between gut and liver is the key to maintain liver metabolism and intestinal homeostasis, which influences each other and is reciprocal causation. However, as a "forgotten organ" , intestinal microbiota on the pathogenesis of IFALD has not been well reflected. As such, we propose, for the first time, the concept of gut-microbiota-liver axis to emphasize the importance of intestinal microbiota in the interaction of gut-liver axis. Analysis and research on gut-microbiota-liver axis will be of great significance for understanding the pathogenesis of IFALD and improving the prevention and treatment measures.

Radiation intestinal injury (RII) refers to the intestinal complication resulting from radiation therapy of pelvic, abdominal or retroperitoneal tumor, which involves the small intestine, colon and rectum. Although the advances in radiotherapy technology have decreased the injury of adjacent tissues, 90% of the patients receiving radiotherapy have acute symptoms, the quality of life is affected due to gastrointestinal symptoms in 50% of patients, and 20%-40% of patients have moderate to severe symptoms. Based on the pathological stage, characteristics and clinical manifestations, RII can be divided into acute and chronic types, generally 3 to 6 months as the cutoff in clinical history. The main preventions of RII include reducing the radiation doses and narrowing the exposure fields. Acute RII is characterized by mucosal inflammation and self-limitation, and its treatment includes symptomatic and nutritional management. As the chronic ischemia and fibrosis in chronic RII are irreversible, bowel resection is the ideal treatment. The surgical indications for chronic RII are grade 3 and 4 intestinal injuries, including obstruction, bleeding, intestinal necrosis, perforation, and fistula. The current surgical procedure is definitive intestinal resection with stage I or II gastrointestinal reconstruction. The optimal time for definitive surgery is still controversial. Based on our experiences, 1 year after the end of radiation therapy is optimal. Under the circumstances of emergency surgery, severe malnutrition, abdominal infection, extensive intestinal injury, and abdominal adhesions that cannot be mobilized, ostomy and abdominal drainage are recommended, and definitive surgery can be considered after the return to enteral nutrition and extinction of intestinal inflammation. Preoperative setting of ureteral catheter, imaging assessment of colorectal position and iliac vascular injury, and preoperative nutritional support can reduce the risk of systemic complications effectively.

Objective: To evaluate the application of intestinal stomas in mesenteric ischemia (MI) according to the concept of damage control surgery. Methods: Clinical data of 59 MI patients received intestinal stomas at Jinling Hospital, Nanjing University School of Medicine from January 2010 to June 2017 were analyzed retrospectively. There were 41 male and 18 female patients aging of (51±14) years (ranging from 20 to 86 years). All the patients were divided to two groups according to the degree of bowel ischemia: acute MI group (AMI, bowel necrosis, n =43) and chronic MI group (CMI, bowel stricture, n =16). The medium time from onset to consult of AMI was 7(12) days ( M ( Q(R) )) and the time of CMI was 80(51) days. After the resection of irreversible ischemic intestine, ostomy was carried out for all 59 patients. Patients received oral anticoagulation, enteral nutrition and succus entericus reinfusion therapy for about 6 months after discharge. Then definite surgery to restore digestive tract was preferred. Results: In AMI group, APACHEⅡ score in admission was (16±3). The length of infarcted intestine resected was (160±95) cm, normal bowel left was (220±106) cm. Twelve patients had complications during first post-operation period including sepsis ( n =8), acute renal failure ( n =4), acute respiratory distress syndrome ( n =4), short bowel syndrome ( n =4). 30-day mortality was 18.6%. Total 30 patients received operation to restore the continuity of intestinal tract after 202(42) days and APACHEⅡ score was 4±2. Two patients suffered from sepsis and were cured after anti-infection. In CMI group, APACHEⅡ score was 16±3 and NRS2002 score was more than 3. The length of infarcted intestine resected was (43±33) cm. All patients had restored the continuity of intestinal tract after 176 (47) days. No major complications occurred during the first and second post-operation period. Conclusions: According to damage control surgery, after early revascularization, patients with acute intestinal necrosis should be treated with infarcted bowel resection and stomas. Besides, second operation to restore the continuity of intestinal tract should be conducted after nutritional support for 6 months. Patients with ischemic enteropathy who cannot be corrected with severe malnutrition should achieve stomas during first operation.