Subjective assessment tools for anal function play a crucial role in understanding anal function status and evaluating treatment efficacy, holding significant value for clinical decision-making and scientific research. This review systematically summarizes three types of subjective assessment tools applied in clinical studies over the past five years. Descriptive assessments focus on qualitatively documenting patient symptoms; severity assessments emphasize quantifying the frequency and intensity of symptoms, serving as the primary basis for current clinical functional evaluation and efficacy judgment; impact assessments focus on the interference of symptoms with patients' quality of life and psychological status. Building on this foundation, this review further narrows the focus to severity assessment tools, comparing the similarities and differences between grading scales and summary scales. It elaborates in detail on their distinctions in framework design and evaluation dimensions, and comprehensively reviews their current clinical application in colorectal and anal diseases. Through in-depth analysis, the main limitations of existing tools are identified: some scales exhibit poor cross-cultural adaptability, the lack of a unified "gold standard" leads to high heterogeneity across studies, and certain tools’s discriminative ability are limited in specific patient populations. This review aims to synthesize the current status and existing problems to provide a reference for optimizing the application strategies of subjective assessment tools and enhancing the standardization and comparability of clinical research, ultimately promoting the development of an evaluation system with greater cultural adaptability and clinical sensitivity.

Purpose:This study aimed to evaluate the efficacy and safety of modified Ferguson hemorrhoidectomy (MFH) compared with conventional Milligan-Morgan hemorrhoidectomy (MMH) for grade II-IV hemorrhoids. Methods:A retrospective cohort of patients undergoing MFH or MMH between September 2020 and August 2021 was reviewed. The primary outcomes were healing time and recurrence after at least 24 months of follow-up. Secondary outcomes included Hemorrhoidal Disease Symptom Score (HDSS), postoperative complications, patient satisfaction, and quality-of-life assessment. Results:A total of 515 patients were enrolled (MFH, n = 254; MMH, n = 261) with a median follow-up of 29 months. The recurrence rate was significantly lower in the MFH group compared with MMH (1.2% vs. 5.0%, p = 0.013), with Kaplan-Meier analysis confirming superior recurrence-free survival (98.8% vs. 95.0% at 36 months). Healing time was shorter with MFH (26.3 ± 4.3 vs. 30.9 ± 3.5 days, p < 0.001). MFH reduced the risk of postoperative edema (2.4% vs. 9.6%, p = 0.01; OR 0.23, 95% CI 0.09-0.56) but showed a higher incidence of urinary retention (3.9% vs. 1.1%, p = 0.04). No anal stenosis or fecal incontinence was observed in either group. Patient satisfaction was higher in MFH (9.7 ± 0.7 vs. 9.4 ± 1.2, p = 0.002), and improvements in HDSS and SHSHD scores were sustained during long-term follow-up. Multivariate regression confirmed MFH as an independent protective factor against recurrence (adjusted OR 0.26, 95% CI 0.08-0.91, p = 0.035). Conclusion:Modified Ferguson hemorrhoidectomy is a safe and effective technique for grade II-IV hemorrhoids, offering lower recurrence, shorter healing, fewer complications, and higher satisfaction compared with Milligan-Morgan hemorrhoidectomy.

BACKGROUND:Inflammatory cloacogenic polyp (ICP) is a rare benign lesion that closely mimics hemorrhoids, frequently leading to clinical misdiagnosis. METHODS:We retrospectively reviewed patients who were preoperatively diagnosed with hemorrhoids and subsequently found to have ICP on histopathological examination, between April 2016 and April 2026. RESULTS:Among 19364 patients treated for hemorrhoids, 56 (0.29%;12 males, 44 females; median age 56.5 years, range 18-81) were histopathologically confirmed to have ICP. All 56 patients presented with a prolapsing anal mass, and 51 (91.1%) also had hematochezia. The median symptom duration was 5 years (range 0.25-50). Lesions detected on digital rectal examination or anoscopy were completely excised during hemorrhoid treatment and confirmed as ICP. CONCLUSIONS:ICP should be suspected in any chronic prolapsing anorectal mass presumed to be hemorrhoidal. Complete excision and routine histopathological evaluation are essential to avoid misdiagnosis.

Current studies focus on the short-term efficacy of ustekinumab (UST) in perianal fistulizing Crohn’s disease (pfCD), but lack evaluations of fistula healing-related risk factors, long-term surgical efficacy, and safety in this population [1, 2]. This study aims to assess the long-term clinical efficacy and safety of UST combined with surgery for pfCD and identify risk factors and trough drug concentrations associated with magnetic resonance imaging (MRI)-assessed healing outcomes. A retrospective cohort study was conducted from July 2021 to May 2025. The primary efficacy endpoint was the rate of MRI-defined healing at the conclusion of the follow-up period. Secondary outcomes included changes in the Crohn’s Disease Activity Index (CDAI), Perianal Disease Activity Index (PDAI), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fecal calprotectin (FC) levels, Simplified Endoscopic Score for Crohn’s Disease (SES-CD), Van Assche MRI score, Wexner Incontinence Score, and anorectal manometry. A total of 106 patients were included in the analysis. The median healing time was 8 weeks (IQR, 2 weeks). At the 52-week follow-up, the MRI healing rate was 90.1% (73/81). At the 104-week follow-up, five patients experienced perianal fistula recurrence (5/50, 10%). All recurrent patients achieved clinical healing after reoperation. Forty-nine patients (49/50, 98%) achieved MRI healing at the 104-week follow-up. Significant reductions were observed in CDAI, PDAI, CRP, ESR, FC levels, Van Assche score, and SES-CD at week 52 (all P < 0.05). Anorectal manometry demonstrated functional improvement, with significant increases in anal resting pressure (ARP) and maximum anal contraction pressure (AMCP) (both P < 0.05). No significant differences were observed in the Wexner Incontinence Score, and no episodes of fecal incontinence were reported during the follow-up period. Multivariate regression analyses indicated that baseline Van Assche score (OR = 0.811, 95% CI: 0.703-0.935) and 16-week UST trough concentration (OR = 1.162, 95% CI: 1.002-1.347) were independent predictors of MRI healing (both P < 0.05). Baseline Van Assche score, with an optimal cut-off of 15 (AUC = 0.766, sensitivity = 92.0%, specificity = 52.9%), was negatively correlated with MRI healing. Therapeutic drug monitoring identified a 16-week UST trough concentration threshold of 4.4 μg/mL (AUC = 0.707, sensitivity = 72.9%, specificity = 66.7%). Surgical intervention combined with UST demonstrates favorable long-term clinical efficacy and safety in patients with pfCD, with high rates of radiological fistula closure. Baseline Van Assche score < 15 and UST trough concentration > 4.4 μg/mL at week 16 are positive predictors of MRI-defined healing. References: [1] Yao J, Zhang H, Su T, Peng X, Zhao J, Liu T, Wang W, Hu P, Zhi M, Zhang M. Ustekinumab Promotes Radiological Fistula Healing in Perianal Fistulizing Crohn’s Disease: A Retrospective Real-World Analysis. J Clin Med. 2023 Jan 25;12(3):939. [2] Xu Simin, Yao Yibo, Li Yikun, et al. Efficacy of surgery combined with ustekinumab in active Crohn’s disease patients with perianal fistula and its influence on anal function[J]. Chinese Journal of Inflammatory Bowel Diseases (English Edition), 2025, 9(1): 59-66. Conflict of interest: Dr. Yin, Lu: No conflict of interest Weng, Feiyang: No conflict of interest Yao, Yibo: No conflict of interest wang, chen: No conflict of interest

Objective: To explore the practical application effect of MRI 3D reconstruction technology of anal fistula in anorectal teaching. Methods: 30 doctors who received standardized resident training in the anorectal department in Longhua Hospital affiliated to Shanghai University of Traditional Chinese Medicine from January to June 2024 were selected as the research subjects. According to the order of entry, randomly divided into control group and 3 D group, 15 physicians in each group. The control group read only the two-dimensional images of the anal fistula MRI, and the 3 D group read both the two-dimensional MRI images and the 3 D reconstruction model. The two groups watched the imaging data of the same 10 patients with anal fistula, and compared the reading ability of doctors (the correct rate of fistula structured report, the time spent by reading), and the physician self-evaluation (the difficulty of reading, the help of 3 D reconstruction model). Results: In the report of fistula structure: internal and external mouth location of fistula, AGA classification, Parks classification, presence of branch duct, rectal scrotal sac / vaginal fistula, The accuracy of the 3 D group was higher than that of the control group (p <0.01); 3 D group average reading time 239.89s, The 409.28s was significantly shorter compared with the control group (p <0.01); The 3 D group had less self-rated of difficulty (p <0.01), And 73.08% of the doctors thought that the 3 D reconstruction model was very helpful for the reading film (73.08% was helpful), The main manifestations in the anal fistula fistula direction, fistula classification and whether there is a branch tube is more obvious. Conclusion: The three-dimensional reconstruction technology of anal fistula MRI can significantly improve the MRI reading ability of resident doctors in the standardized training of anorectal department, shorten the reading time, cultivate the spatial thinking ability, and improve the clinical teaching effect of anorectal department.

Objectives: The aim of this study was to evaluate the effectiveness of injectable sclerotherapy using Polidocanol foam in patients with hemorrhoids and severe anemia during a 1-year follow-up period, while utilizing the Hemorrhoidal Disease Severity Score (HDSS) in conjunction with Short Health Scale (SHS) for assessment. Methods: A retrospective analysis was conducted on patients with severe anemia and hemorrhoids who underwent injectable sclerotherapy using Polidocanol foam between February 2022 and May 2023. Results: The bleeding symptoms in all patients resolved immediately after treatment. Hemoglobin levels increased rapidly within one month after treatment, and statistically significant improvements were observed in HDSS score, and SHS score (P<0.001) during the one-year follow-up. Two patients experienced recurrence of prolapse symptoms during the one-year follow-up period and subsequently underwent hemorrhoidectomy. Conclusions: The use of Polidocanol foam in injectable sclerotherapy demonstrates highly promising effects in patients suffering from severe anemia caused by hemorrhoids.

Background:Incision and drainage (I&D) for perianal abscesses is associated with high rates of fistula formation. Our study aimed to evaluate the effectiveness of a novel technique, trans-intersphincteric double seton (TRISDS), designed to preserve anal sphincter integrity and improve clinical outcomes compared to I&D. Methods:This prospective, randomized, non-blinded controlled study included adult patients with perianal abscesses located below the levator ani muscle with an internal opening. Patients were randomly assigned to either the TRISDS group (n = 55) or the I&D group (n = 51). The TRISDS technique involved two incisions: intersphincteric and drainage incisions with the placement of two loose setons. One seton was positioned to preserve the internal anal sphincter and facilitate drainage through the intersphincteric space, while the other seton aimed to protect the external anal sphincter to ensure comprehensive drainage. The I&D group underwent conventional I&D without damaging the anal sphincter complex. The primary outcome was the cure rate of perianal abscesses, which was defined as complete epithelialization of wounds without fistula or exudate and no recurrence within 12 months after surgery. Results:The TRISDS group achieved a significantly higher cure rate of 78.2% (43/55) compared to 41.2% (21/51) in the I&D group (P < 0.05). There were no significant differences in anal function at 2 months postoperatively between the groups (median Wexner score, IQR: 1.0 [0.0-1.0] vs 1.0 [0.0-1.0], P > 0.05). Conclusions:The study highlighted the effectiveness of TRISDS in improving cure rate without compromising anal function. The TRISDS technique represents a promising strategy for the treatment of perianal abscesses. Further multicenter studies are recommended to validate these findings and expand the application of TRISDS in diverse patient populations.

Patients with schizophrenia (SCZ) experience constipation at significantly higher rates compared with the general population. This relationship suggests a potential genetic overlap between these two conditions. We analyzed genome-wide association study (GWAS) data for both SCZ and constipation using a five-part approach. The first and second parts assessed the overall and local genetic correlations using methods such as linkage disequilibrium score regression (LDSC) and heritability estimation from summary statistics (HESS). The third part investigated the causal association between the two traits using Mendelian randomization (MR). The fourth part employed conditional/conjunctional false discovery rate (cond/conjFDR) to analyze the genetic overlap with different traits based on the statistical theory. Finally, an LDSC-specifically expressed gene (LDSC-SEG) analysis was conducted to explore the tissue-level associations. Our analyses revealed both overall and specific genetic correlations between SCZ and constipation at the genomic level. The MR analysis suggests a positive causal relationship between SCZ and constipation. The ConjFDR analysis confirms the genetic overlap between the two conditions and identifies two genetic risk loci (rs7583622 and rs842766) and seven mapped genes (GPR75-ASB3, ASB3, CHAC2, ERLEC1, GPR75, PSME4, and ACYP2). Further investigation into the functions of these genes could provide valuable insights. Interestingly, disease-related tissue analysis revealed associations between SCZ and constipation in eight brain regions (substantia nigra, anterior cingulate cortex, hypothalamus, cortex, hippocampus, cortex, amygdala, and spinal cord). This study provides the first genetic evidence for the comorbidity of SCZ and constipation, enhancing our understanding of the pathophysiology of both conditions.

BACKGROUND Shear wave elastography, an ultrasound-based technique, has been widely used in China to assess tissue stiffness, but its application in perianal tissues remains limited. This study investigates its potential for diagnosing anal fistulas and evaluating perianal tissue characteristics. METHOD Between January 1st, 2022, and April 30th, 2023, shear wave elastography was performed in 152 patients with single-site simple anal fistulas to evaluate normal perianal tissue, fistula tissue, and postoperative scar tissue following lay-open surgery. Statistical analyses, including receiver operating characteristic (ROC) curve analysis and logistic regression, were employed to establish reference thresholds for differentiating among these tissue types. RESULTS Young’s modulus can serve as a key indicator for differentiating perianal tissues of different types, including normal tissue, fistula tissue, and scar tissue, and its values are not affected by sex, age, or BMI. However, the measurement location significantly influenced the results. When distinguishing normal tissue from fistula tissue, a measurement at the 7 ~ 5 o’clock position (lithotomy position) yielded a threshold of > 40.08 kPa for identifying fistula tissue (preset threshold = 0.45), whereas a measurement at the 5 ~ 7 o’clock position suggested fistula tissue at a threshold of > 54.95 kPa. For scar tissue, Young’s modulus was independent of measurement location, with values > 104.34 kPa indicating fistula tissue. CONCLUSION Shecar wave elastography shows potential for diagnosing anal fistulas, differentiating tissues of different types, and evaluating postoperative prognosis, enhancing diagnostic accuracy and providing a convenient tool for clinical assessment.

OBJECTIVE:Shenkang injection (SKI), a Traditional Chinese Medicine formulation, is widely used in China for diabetic nephropathy (DN). This systematic review and meta-analysis aimed to evaluate the efficacy and safety of SKI combined with renin-angiotensin-aldosterone system (RAAS) blockers in patients with DN. METHODS:A comprehensive search of seven databases was conducted up to September 18, 2024, for randomized controlled trials (RCTs) comparing SKI plus RAAS blockers versus RAAS blockers alone in DN patients. Meta-analysis was performed using RevMan 5.3 and Stata 17.0, with effect sizes expressed as weighted mean differences (WMDs) or odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS:A total of 18 RCTs involving 1,497 patients were analyzed. Combination therapy significantly improved total effective rate (TER) (MD 2.61, 95% CI 1.62-2.64) and reduced key renal and metabolic markers. Urinary protein excretion rate (UPER), serum creatinine (SCr), blood urea nitrogen (BUN), 24-hour urinary protein (24h-UTP), total cholesterol (TC), and triglyceride (TG) levels all significantly decreased in the combination group. Subgroup analysis showed that patients aged ≤55 years had greater reductions in SCr (WMD -25.62, 95% CI -29.41 to -21.83) and BUN (WMD -2.51, 95% CI -2.75 to -2.27). Sensitivity analysis confirmed the robustness of findings. No publication bias was detected for TER, SCr, BUN, 24h-UTP, TG, and adverse reactions, though UPER and TC showed potential bias. CONCLUSION:SKI combined with RAAS blockers may enhance renal function and metabolic profiles in DN patients. Further high-quality RCTs are needed to validate these findings and assess long-term safety.

BackgroundKidney disease represents a significant global health concern. Stem cell therapy has gained attention as a potential solution for chronic kidney disease, acute kidney injury, and end-stage renal disease. This study aims to provide a comprehensive overview of the status of stem cell therapy for kidney disease through a systematic review of the literature.MethodsThe literature included in this study was exclusively sourced from the Web of Science Core Collection. CiteSpace, VOSviewer, R-Bibliometrix, and the Literature Data Governance and Analysis System to evaluate factors such as publication quantity, author contributions, institutional involvement, geographic distribution, and keyword usage.ResultsThis study on stem cell therapy for kidney disease included 1,874 articles. A significant number of publications came from China and the United States. The Mayo Clinic had the highest publication output, while Stem Cell Research & Therapy was the leading journal in terms of publication volume. Additionally, Lerman LO was the most prolific author in this field. Currently, there is a growing focus on mesenchymal stem cells and acute kidney injury models in this field. Future research is likely to explore topics such as extracellular vesicle-based therapies, various stem cell types, diabetic nephropathy, and membranous nephropathy.ConclusionThis study applied bibliometric methods to assess the application and development of stem cell therapy for kidney disease over the past decade. It identified key research areas and forecasted future trends. The findings offer valuable insights for guiding future investigations into stem cell therapy for kidney disease.

Fournier Gangrene (FG) and Generalized Perianal Abscess (GPA) have similar clinical features. But FG has a high mortality and disability rate and needs to be identified and treated as early as possible. This study utilized machine learning methods to integrate clinical and metabolic features to promote early diagnosis of FG. Serological characteristics were screened for patients with FG (n = 20) and GPA (n = 16). The metabolomic changes of FG were described based on untargeted metabolomics. We used machine learning tools to combine demographic data, clinical serology, and metabolomics data to establish disease-specific boundary points. There were significant differences in the serum metabolic profiles between the FG and GPA groups. 118 different metabolites were detected, mainly fatty acids. Based on machine learning integration of metabolic and clinical features, a differential diagnosis combination of Myo-inositol (MI), Procalcitonin (PCT) and Bistris was established for early identification and diagnosis of FG. The diagnostic performance was evaluated using GBDT, SVM, and LR algorithms, demonstrating robust discriminative ability (AUC: 0.80, 0.82, and 0.95; sensitivity: 0.90, 0.92, and 1.00). In addition, we identified 14 differential metabolic pathways. The activation of Necroptosis may lead to the occurrence of explosive perianal and perineal infections. Our findings provide a biomarker combination for early diagnosis of FG in clinical applications. On the other hand, it provides important insights into the pathological mechanism differences between FG and GPA.

BackgroundRectal neuroendocrine tumors (NET) are thought to originate from the diffuse neuroendocrine system. The lack of apparent signs of illness and the patient’s non-specific presentations often cause a delay in diagnosis, until in their final stages of cancer. Thus, rectal NETs pose a significant challenge to most physicians.Case presentationThis article presents three cases of rectal NETs discovered during anorectal surgery. Owing to their atypical symptoms, they were initially diagnosed as mixed hemorrhoids or perianal fistulas. However, the patients were diagnosed with rectal NETs and thus underwent endoscopic dissection or transanal endoscopic microsurgery. Histological analysis revealed three rectal NETs, one G1 and two G2. All patients were followed-up for more than 6 months, with excellent outcomes without recurrence.ConclusionsThe etiology, pathogenesis, therapeutic methods, prevention, and prognosis of rectal NETs remain challenging. Given the variable understanding of the most appropriate operative approaches for rectal NETs, our objective was to broaden the perspective of this infrequent disease by delivering distinctive individual experiences and emphasizing the therapeutic significance of delicate surgery.

BACKGROUND:Mood swings and irritable bowel syndrome (IBS) are closely related. However, the reason for the clinical concurrence of this phenomenon is unknown, and maybe it is because the two share genetic underpinnings. METHODS:Genome-wide association studies (GWAS) of mood swings and IBS data were used for the study. Genetic correlation was assessed using the linkage disequilibrium score regression (LDSC), genetic covariance analyzer (GNOVA), and SUPERGNOVA method. Two-sample Mendelian randomization (TwoSampleMR) was used to explore the causal relationship between the two conditions. The conditional/conjoint false discovery rate (cond/conjFDR) was used for genetic overlap analysis. Finally, LDSC applied to specific expression gene analysis was performed to identify tissues associated with the two conditions. RESULTS:At the genomic level, mood swings and IBS have global and local genetic correlations. Analysis of the two traits by Mendelian randomization revealed a bidirectional causal relationship. We identified 21 genetic risk loci (concFDR < 0.05) shared by mood swings and IBS, which acted in the same direction on the two traits. Additionally, mood swings and IBS shared 11 sites in the brain tissues as origins. CONCLUSION:The present study suggests the existence of polygenic overlap between mood swings and IBS and provides novel insights into the genetic underpinnings and mechanisms of comorbidities occurring in these two conditions.

Ulcerative colitis (UC) is a chronic, idiopathic inflammatory disease affecting the gastrointestinal tract. Hongyuyin (HYY), a traditional Chinese botanical formulation, has been effectively treating UC for over three decades; however, its underlying biological mechanism of action in UC-associated intestinal fibrosis (IF) remains unclear. This study investigated the mechanisms of action of HYY on IF through in vivo experiments using a dextran sulfate sodium (DSS)-induced mouse colitis model. Clinical symptoms, colonic pathological damage, inflammation, and fibrosis were monitored across all groups. Both transcriptomic analysis and network pharmacology (NP) techniques were utilized to elucidate the mechanistic insights. HYY treatment substantially reduced inflammation, fibroblast activation, and collagen deposition in UC mice. KEGG analyses suggested that HYY treatment modulated multiple signaling pathways, notably the TNF, IL-17, and PI3K-Akt signaling pathways. Combined analysis identified the PI3K-Akt signaling pathway as a major contributor, with high enrichment factors and numerous enrichment genes involved (IL-6, CSF3, SPP1, AKT1, PIK3CA, and so on) in UC-associated IF. Western blotting confirmed significant reductions in both p-AKT/AKT and p-mTOR/mTOR ratios after HYY treatment. Collectively, HYY alleviates UC-associated IF by reducing the phosphorylation of PI3K-Akt pathway factors, thereby inhibiting fibroblast activation and collagen deposition. This research provides novel insights into HYY's mechanism of action in UC-associated IF management.

ETHNOPHARMACOLOGICAL RELEVANCE:Shen-Shuai-II-Recipe (SSR), a clinically effective Chinese herbal formula for chronic kidney disease (CKD) management, has shown potential anti-hypoxia and anti-fibrosis properties in rat models of CKD. However, the underlying molecular mechanisms of its renoprotection warrant further elucidation. AIM OF THE STUDY:This study investigated the mechanisms of SSR's renoprotective actions under chronic hypoxia condition of CKD. MATERIALS AND METHODS:In vivo, 5/6 renal ablation/infarction (A/I) rat models of CKD were established and administered with SSR or losartan for eight weeks. In vitro, NRK-52E cells underwent chronic hypoxia induction and were treated with SSR-medicated serum and (or) Nrf2 inhibitor (ML385). Renal hypoxia, oxidative stress, ferroptosis, and fibrosis were assessed via blood oxygenation level-dependent MRI, histopathology, colorimetry, immunoblotting, and fluorometry. RESULTS:SSR significantly suppressed oxidative stress and ferroptosis in 5/6 (A/I) kidneys, concomitant with alleviated hypoxia and fibrosis, which was associated with the up-regulated expression of Nrf2 protein. Hypoxic NRK-52E cells exhibited time-dependent increases in fibrosis and hypoxia-related proteins and suppression of the Nrf2 pathway. Furthermore, SSR significantly improved antioxidant capacity, attenuated lipid peroxidation and fibrosis in chronic hypoxia induced NRK-52E cells by activating the Keap1-Nrf2/xCT/GPX4 axis, while the effect was diminished by Nrf2 inhibition. CONCLUSIONS:SSR inhibits hypoxia-induced oxidative stress and ferroptosis to ameliorate renal fibrosis in CKD via Nrf2 activation.

Background: Diagnosing perianal fistulizing Crohn's disease (pfCD) typically depends on costly and time-intensive endoscopic and radiographic procedures. Compelling evidence indicates that neutrophil gelatinase-associated lipocalin (NGAL) plays a role in the pathophysiology of Crohn's disease (CD) and may serve as a noninvasive biomarker for its diagnosis. This study aimed to evaluate NGAL's potential as a noninvasive diagnostic biomarker between pfCD and cryptoglandular (CG) perianal fistula, and its correlation with disease severity in pfCD. Methods: Serum, fecal, and fistula tissue samples were collected from 96 patients with pfCD and 97 patients with CG perianal fistula as controls. Serum NGAL levels were quantified through ELISA and fistula tissue NGAL levels were quantified through immunohistochemical staining, while pfCD disease severity was evaluated using the Crohn's Disease Activity Index (CDAI) and Perianal Disease Activity Index (PDAI). Additional laboratory parameters, including NGAL, fecal calprotectin (FC), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR), were analyzed, and their correlations were assessed. Receiver operating characteristic (ROC) analysis was conducted to evaluate NGAL's diagnostic potential for pfCD. Results: Levels of serum NGAL, FC, CRP, and ESR in patients with pfCD were significantly elevated compared to the control group (p < 0.001); Spearman correlation analysis indicated a positive correlation between serum NGAL and FC, CRP, ESR, CDAI, and PDAI scores. The area under the ROC curve (AUC) for serum NGAL in diagnosing pfCD was 0.927 (95% CI: 0.890-0.964). The AUC for FC in diagnosing pfCD were 0.887 (95% CI: 0.839-0.935). Additionally, serum and fistula tissue NGAL levels were positively correlated with disease complexity in pfCD according to the Montreal classification. Conclusion: These findings suggest that serum NGAL is associated with pfCD severity and may offer a promising noninvasive biomarker for diagnosing and assessing pfCD.

It has not yet been proven whether sepsis affects the tissue around the anal canal. To address this issue, we established three-dimensional models for various types of anorectal abscesses and utilize 3D reconstruction of Magnetic Resonance Imaging scans to assess the extent of muscle damage caused by anorectal abscesses. Patients diagnosed with anorectal abscess, selected from January 2019 to January 2022 underwent pre- and post-operative scanning of pelvic floor and perianal tissues. The aforementioned structures were segmented for the reconstruction of a three-dimensional visual model and measurement of volumes for the abscess as well as the internal and external sphincters and levator ani muscle. The study included a total of 42 patients. Three-dimensional visualization models were created for different types of anorectal abscesses, including perianal, intersphincteric, ischiorectal, and supralevator abscesses. No statistically significant differences were observed in the volume of the internal sphincter, external sphincter, and levator ani muscle between pre- and post-operative patients. The 3D model of anorectal abscess, reconstructed from MRI data, offers a precise and direct visualization of the anatomical structures associated with various types of anorectal abscesses. The infection did not result in any damage to the internal and external anal sphincter and levator ani muscle.

BackgroundInflammatory bowel disease (IBD) poses a complex challenge due to its intricate underlying mechanisms, and curative treatments remain elusive. Consequently, there is an urgent need to identify genes causally associated with IBD.MethodsWe extracted blood eQTL data from the GTExv8.ALL.Whole_Blood database, genome-wide association studies (GWAS) summary statistics of IBD from the IEU GWAS database, and performed a three-fold analysis protocol, including transcriptome-wide association analysis, Mendelian randomisation analysis, Bayesian colocalisation, and subsequent potential therapeutic agents identification.ResultsWe identified four pathogenic genes, namely CARD9, RTEL1, STMN3 and ARFRP1, that promote the development of IBD, encompassing both ulcerative colitis (UC) and Crohn's disease (CD). Notably, ARFRP1 exhibited the ability to suppress IBD (encompassing UC and CD) development. Regarding drug prediction, cyclophosphamide emerged as a promising novel therapeutic option for IBD, encompassing UC and CD.ConclusionWe identified several potential genes related to IBD (UC and CD), including CARD9, RTEL1, STMN3 and ARFRP1, warranting further investigation in functional studies to elucidate underlying disease mechanisms. Additionally, clinical studies exploring the potential of cyclophosphamide as a treatment avenue for IBD are warranted.

BACKGROUND:Limited data are available regarding the risk factors for fistula-in-ano (FIA) in infants and toddlers, potentially affecting their daily lives.OBJECTIVES:The purpose of this study was to identify potential risk factors for FIA in infants and toddlers, in order to implement early preventive interventions, avoid disease progression, and develop therapeutic strategies.DESIGN AND SETTINGS:A retrospective case-control study was conducted, comparing 41 infants and toddlers diagnosed with FIA with 41 healthy controls, between August 2020 and December 2021.INDEPENDENT VARIABLES:(a) maternal characteristics during pregnancy and delivery, (b) perinatal characteristics, dietary behaviors, and defecation-related behaviors in infants and toddlers, (c) family dietary behaviors.RESULTS:Mothers of infants and toddlers with FIA had given birth more times in the past, while the infants and toddlers themselves had less mealtime, a higher rate of exclusive breastfeeding, frequent loose stools, and a larger proportion of used wipes, experiencing perianal skin anomalies. The logistic regression analysis revealed that there are four significant risk factors associated with the development of FIA in infants and toddlers, including the number of previous deliveries by the mother (OR 6.327), defecation frequency score (OR 5.351), stool consistency score (OR 5.017), and cleaning with wipes after defecation (OR 8.089).CONCLUSION:Based on our data, it appeared that FIA in infants and toddlers could be attributed to several factors. These included an increased number of previous deliveries by mothers, frequent loose stools, and repeated wipe use. To prevent the occurrence and worsening of the disease, it is important to improve the frequency and consistency of stooling and provide proper care. Further research is required to verify these findings in other clinical settings.