{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T06:19:17Z","timestamp":1787552357595,"version":"build-2736575974"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Acute severe ulcerative colitis (ASUC) is a life-threatening condition, and biologic-refractory patients may ultimately require surgery. The clinical role of individualised integrative management including traditional Chinese medicine (TCM) in surgery-intended ASUC remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-centre retrospective exploratory case series included 39 biologic-refractory, surgery-intended ASUC patients treated between January 2020 and June 2025. Eleven accepted adjunctive preoperative TCM and 28 did not. Five selected TCM-treated patients experienced remission after integrative management including TCM and surgery was cancelled; 6 underwent surgery and were compared descriptively with 28 non-TCM surgical patients. Baseline imbalance was summarised using absolute standardised mean differences (SMDs). Continuous postoperative outcomes were reported as Hodges-Lehmann location shifts with 95% confidence intervals (CIs), and binary outcomes as risk differences with Newcombe-Wilson 95% CIs. Clinically relevant postoperative outcomes were prioritised, whilst postoperative day (POD) 1 white blood cell count (WBC) and POD3 C-reactive protein (CRP) were retained as exploratory inflammatory markers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Important baseline imbalances were present in the surgical comparison cohort, including surgical scope, urinalysis, haemoglobin, haematocrit, albumin, platelet count, baseline WBC, and CRP. Thirty-day postoperative complications occurred in 10\/28 (35.7%) non-TCM patients and 1\/6 (16.7%) TCM surgical patients (risk difference -19.0 percentage points, 95% CI -42.0 to 23.4). The Hodges-Lehmann location shift was -4.00 days (95% CI -11.00 to 3.00) for length of stay, -3.17 mg\/L (95% CI -6.15 to 0.48) for POD3 CRP, and -2.59 \u00d710\n                      <jats:sup>9<\/jats:sup>\n                      \/L (95% CI -6.98 to 0.76) for POD1 WBC. No 95% CI excluded the null value. In the five selected remission cases, pre-treatment Mayo endoscopic subscore (MES) was 3 and post-treatment MES was 0 or 1; surgery was cancelled, four patients subsequently received infliximab maintenance therapy, and no subsequent surgery was recorded during 27\u201348 months of available follow-up.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This case series describes heterogeneous clinical trajectories after individualised integrative management including TCM in selected biologic-refractory, surgery-intended ASUC patients. The small non-randomised cohorts, major baseline imbalance, concomitant treatment, surgical heterogeneity, and imprecise effect estimates preclude efficacy or causal inference. The observations should be considered descriptive and hypothesis-generating.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1830986","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T05:28:09Z","timestamp":1787549289000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical trajectories after preoperative traditional Chinese medicine in biologic-refractory surgery- intended acute severe ulcerative colitis: an exploratory retrospective case series"],"prefix":"10.3389","volume":"17","author":[{"given":"Pengfei","family":"Tian","sequence":"first","affiliation":[{"name":"Department of General Surgery, Fuyang Hospital of Anhui Medical University","place":["Fuyang, Anhui, China"]},{"name":"Department of General Surgery, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zonglin","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of General Surgery, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of General Surgery, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biaojie","family":"Fang","sequence":"additional","affiliation":[{"name":"Department of General Surgery, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhengjian","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of General Surgery, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kexun","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of General Surgery, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingdian","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Fuyang Hospital of Anhui Medical University","place":["Fuyang, Anhui, China"]},{"name":"Department of General Surgery, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1093\/ecco-jcc\/jjab178","article-title":"Ecco guidelines on therapeutics in ulcerative colitis: Medical 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