BACKGROUND:Anorectal abscess and cryptoglandular anal fistula are common conditions with high recurrence rates, reflecting an incomplete understanding of their pathophysiology. A classic, yet unproven hypothesis proposes that high androgen levels increase infection risk by stimulating anal gland secretion, potentially explaining the male predominance. However, direct evidence regarding sex hormone levels in patients remains scarce. We hypothesized that active perianal infection is associated with significantly altered testosterone (T) levels. AIM:To investigate the association between perianal diseases and sex hormone levels and to identify factors associated with T levels. METHODS:This cross-sectional study included 249 men: 64 with hemorrhoids, 64 with anorectal abscess, and 121 with anal fistula. Preoperative serum sex hormone levels were measured. Multivariate linear regression identified factors associated with T levels. RESULTS:There were no significant differences in age among the three groups at baseline. T levels differed significantly among the groups (P < 0.001). Multivariate regression analysis revealed that in the overall study population, anorectal abscess (B = -2.999, P < 0.001) and body mass index (BMI; B = -0.368, P < 0.001) negatively correlated with T levels. In the abscess group, white blood cell count (B = -0.565, P < 0.001) and BMI (B = -0.298, P = 0.011) negatively correlated with T levels. In the fistula group, BMI (B = -3.866 P < 0.001) and internal opening above the dentate line (B = -4.479, P = 0.048) were associated with lower T levels. CONCLUSION:Patients with active perianal infections exhibited a significantly lower T level compared to those with hemorrhoids or fistulas, which is independently associated with systemic inflammation severity and obesity.

ObjectiveTo analyze the characteristics and research hotspots of perianal lesions associated with Crohn's disease (CD) based on the currently published literature.MethodsWe conducted a comprehensive search of all relevant literature on “Crohn's disease” and “Perianal” from the inception of PubMed, Web of Science Core Collection and Scopus database up to December 31, 2024. Using the bibliometric analysis software CiteSpace 6.4. R1, we visualized and scientifically interpreted the authors, countries, and keywords of the included studies.ResultsA total of 4,286 papers were retrieved using the subject terms “Crohn's disease” and “Perianal”. According to exclusion criteria, 2,134 papers were included in the final analysis. These studies involved 130 researchers, 360 research institutions, and 148 keywords. The analysis revealed that the number of publications on CD with perianal lesions has increased annually since 1979, indicating growing attention to this condition. The United States led in the number of publications, with 452 related papers. The most prolific authors were Ye, Byong Duk and Lightner, Amy L, with 21 published papers each on the topic. The top five keywords were Crohn's disease (357 times), Inflammatory Bowel Disease (202 times), Perianal Fistula (110 times), Ulcerative Colitis (81 times), and Perianal Disease (37 times).ConclusionCurrent research on CD with perianal lesions is primarily focused on mesenchymal stem cells, intestinal inflammation, and biologic therapies. However, further comprehensive studies are needed to improve the early diagnosis and treatment of CD, particularly when perianal symptoms are the initial manifestation.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease with limited treatment options and frequent drug resistance. Novel therapeutic targets are urgently needed. We performed a druggable genome-wide Mendelian randomization (MR) analysis using blood cis-expression quantitative trait locus (eQTL) and HS genome-wide association study (GWAS) data. Colocalization, transcriptomic validation, single-cell RNA sequencing, and cell-cell communication analyses were integrated to explore gene function and cell-type specificity. We identified eight genes that showed significant associations with HS through MR analysis. Colocalization analysis further prioritized PSMA4 and MAST3 as the most promising druggable targets for HS. Specifically, PSMA4 (single nucleotide polymorphisms [SNPs] = 10; inverse-variance weighted [IVW] OR = 1.912, 95% CI: 1.492-2.450, p < 0.001; PP.H4 = 0.975) and MAST3 (SNPs = 15; IVW OR = 0.557, 95% CI: 0.453-0.686, p < 0.001; PP.H4 = 0.832) exhibited strong statistical associations. Transcriptomic validation revealed that PSMA4 was upregulated and MAST3 was downregulated in HS lesions. Further single-cell analysis revealed that PSMA4 was predominantly enriched in CD4+ T cells and involved in pro-inflammatory signaling, particularly the tumor necrosis factor (TNF) pathway. PSMA4 and MAST3 are potential therapeutic targets for HS. PSMA4 may promote inflammation via CD4+ T cell-mediated signaling, offering a novel avenue for treatment development.

BACKGROUND:The transanal opening of intersphincteric space (TROPIS) is a new surgical modality for treating anal fistulas. This procedure involves a transanal incision between the sphincters to promote drainage, excision of the infected areas, and maintenance of sphincter patency. In this meta-analysis, we evaluated the efficacy and safety of TROPIS in treating high complex anal fistula. METHODS:We searched the PubMed (NLM), LISTA (EBSCO), and Web of Science Core Collection (Clarivate) databases for all related clinical research literature on highly complex anal fistulas treated with TROPIS from the time of database creation to 31 December 2024, with inclusion restricted to studies published in English. All included articles follow the PICO principle. Data on surgical one-time cure rate, recurrence rate after the first surgery, final cure rate, and occurrence of adverse events were extracted for further analysis. RESULTS:Six studies involving 499 patients were included. The heterogeneity test revealed no heterogeneity, and results for one-time cure rate showed I 2 = 0.00% < 50%, and Q test P = 0.81 > 0.1 (effect size [ES] = 0.80, 95% confidence interval [CI] (0.77, 0.84), Z = 45.96, P = 0.00), where the one-time cure rate was 80%; recurrence rate after first surgery I 2 = 0.00% < 50%, and Q test P = 0.81 > 0.1 (ES = 0.20, 95% CI (0.16, 0.23), Z = 17.49, P = 0.00), and the recurrence rate is 20%; final cure rate I 2 = 0.00% < 50%, and Q test P = 0.82 > 0.1 (ES = 0.89, 95% CI (0.86, 0.92), Z = 51.21, P = 0.00), and the final cure rate was 89%. No adverse events were reported in any of the patients. Sensitivity analyses showed excellent stability of the surgical cure results in all studies. No publication bias was detected in any of the included studies. CONCLUSIONS:The TROPIS procedure for highly complex anal fistulas exhibits a high one-time cure rate, low recurrence rate, and high overall cure rate and is not associated with any adverse events.

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.

The current study aims to comprehensively evaluate the surgical impact on anal function in pediatric patients with anal fistulas, incorporating anorectal manometry, histopathological examination, and various rating scales. The study focuses on infants and toddlers diagnosed with anal fistulas who underwent surgical intervention at Longhua Hospital, Shanghai University of Traditional Chinese Medicine, between November 2020 and January 2024. The participants were divided into two age cohorts: infants (0–12 months) and toddlers (13–36 months). Data were meticulously collected for both cohorts, with anal function assessed through intraoperative anorectal manometry, Masson staining of fistula tissue, and the Heikkinen clinical continence scoring (CCS) scale during the postoperative period (1) Both cohorts demonstrated a 100

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.

Data from observational and clinical studies indicate an association between skin microbiota and hidradenitis suppurativa (HS). However, the causal relationship between skin microbiota and HS remains to be elucidated. We obtained data on skin microbiota and HS from summary statistics of genome-wide association studies and applied Mendelian randomization (MR) statistical methods to assess causality. Specifically, we employed both full MR and inverse MR methods, utilizing five statistical approaches, including inverse variance weighting, to evaluate causality. Furthermore, sensitivity analyses were conducted to validate the MR findings. Inverse variance weighted analysis revealed that the order Burkholderiales (OR = 0.922, 95

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.

This systematic review and meta-analysis of nonrandomized studies (NRSs) aimed to evaluate the clinical efficacy and safety of two types of surgical interventions (respectively drainage alone and drainage with primary fistula treatment) for perianal abscesses (PAs) in children. Studies from 1992 to July 2022 were searched in 10 electronic databases. All relevant NRSs with available data which compared surgical drainage with or without primary fistula treatment were included. Patients with underlying diseases which led to abscess formation were excluded. The Newcastle-Ottawa Scale was used to assess the risk of bias and quality of the included studies. The outcomes were the healing rate, fistula formation rate, fecal incontinence, and wound healing duration. A total of 16 articles with 1,262 patients were considered suitable for the final meta-analysis. Primary fistula treatment was associated with a significantly higher healing rate when compared with incision and drainage alone (odds ratio [OR]: 5.76, 95% confidence interval [CI]: 4.04-8.22). This aggressive procedure for PA resulted in an 86% reduction in the fistula formation rate (OR: 0.14, 95% CI: 0.06-0.32). Limited data showed patients who underwent primary fistula treatment have a minor effect on postoperative fecal incontinence. Primary fistula treatment demonstrates a better clinical efficacy in promoting the healing rate and decreasing the formation of fistulas in PAs in children. The available evidence for a minor impact on anal function after this intervention is less strong.

ETHNOPHARMACOLOGICAL RELEVANCE:The clinical efficacy of the Yiqi Kaimi prescription has been confirmed in slow transit constipation. However, the effects and biological mechanism of Yiqi Kaimi prescription are still unclear.AIMS OF THE STUDY:To identify the effects of Yiqi Kaimi prescription on intestinal motility; To reveal the potential key targets and pathways of Yiqi Kaimi prescription for the treatment of slow transit constipation.MATERIALS AND METHODS:The effects of Yiqi Kaimi prescription on slow transit constipation were investigated in a mouse model. The terminal ink propulsion experiment and fecal indocyanine green imaging was used to measure the intestinal transit time. Protein phosphorylation changes in colon tissues treated with Yiqi Kaimi prescription were detected using a Phospho Explorer antibody microarray. Bioinformatic analyses were performed using the Database for Annotation Visualization and Integrated Discovery (DAVID) and the Search Tool for the Retrieval of Interacting Genes (STRING). Western blot analysis and immunohistochemistry confirmed the observed changes in phosphorylation.RESULT:s: Yiqi Kaimi prescription significantly increased the intestinal transit rate (P < 0.05 vs. model) and reduced the time to first discharge of feces containing fecal indocyanine green imaging in mice (P < 0.05 vs. model). The administration of Yiqi Kaimi prescription induced phosphorylation changes in 41 proteins, with 9 upregulated proteins and 32 downregulated proteins. Functional classification of the phosphorylated proteins with DAVID revealed that the critical biological processes included tyrosine protein kinases, positive regulation of calcium-mediated signaling and response to muscle stretch. The phosphorylation of the spleen tyrosine kinase (SYK) at Tyr348 increased 2.19-fold, which was the most significant change. The phosphorylation level of the transcription factor p65 (RELA) at Thr505 was decreased 0.57-fold. SYK was a hub protein in the protein-protein interaction network and SYK and RELA formed the core of the secondary subnetwork. The key protein phosphorylation after treatment with Yiqi Kaimi prescription were verified by Western blot analysis and immunohistochemistry.CONCLUSION:Yiqi Kaimi prescription significantly enhanced intestinal motility. This effect was attributed to alterations in the phosphorylation levels of various target proteins. The observed changes in protein phosphorylation, including SYK and RELA, may serve as crucial factors in the treatment of slow transit constipation.

Abstract Objectives To investigate the preoperative levels of sex hormones in patients with anorectal abscesses and anal fistula. Design and methods: Male patients with anorectal abscesses, anal fistula, and hemorrhoids were preoperatively admitted to the Department of Anorectal Medicine, Longhua Hospital, Shanghai University of Traditional Chinese Medicine(SHUTCM) between October 2021 and March 2023. Patients are grouped according to disease. For each group, sex hormones were evaluated before the operation. Results A total of 249 male patients were eligible for the study, including 64 patients in the hemorrhoid group, 64 patients with anorectal abscesses, and 121 patients with anal fistula. Patients with anorectal abscesses had significantly lower testosterone(T) levels than patients with hemorrhoids and fistula (P = 0.003, P < 0.001), and luteinizing hormone (LH) levels were higher than those in the fistula group (P = 0.027). Tlevels are even lower in patients with anorectal abscesses when the following conditions are present: leukocytes above the normal range abscesses greater than or equal to 2 quadrants in extent, no fistula formation, and duration of disease less than 7 days. In patients with fistulas, T levels were lower in overweight patients and those with fistulas with internal openings above the dentate line, while diabetes, hypertension, type of fistula, number of fistulas, and presence of inflammatory bowel manifestations were not significantly associated with T levels. Conclusions Low T levels suggest early, severely infected, unformed fistula disease features in patients with anorectal abscesses, as well as high internal openings in patients with anal fistulas.

BACKGROUND When an anorectal foreign body is found, its composition and shape should be evaluated, and a timely and effective treatment plan should be developed based on the patient's symptoms to avoid serious complications such as intestinal perforation caused by displacement of the foreign body. CASE SUMMARY A 54-year-old male was admitted to our outpatient clinic on June 3, 2023, due to a rectal foreign body that had been embedded for more than 24 h. The patient reported using a glass electrode tube to assist in the recovery of prolapsed hemorrhoids, however, the electrode tube was inadvertently inserted into the anus and could not be removed by the patient. During hospitalization, the patient underwent surgery, and the foreign body was dragged into the rectum with the aid of colonoscopy. The anus was dilated with a comb-type pulling hook and an anal fistula pulling hook to widen the anus and remove the foreign body, and the local anal symptoms were then relieved with topical drugs. The patient was allowed to eat and drink, and an entire abdominal Computed tomography (CT) and colonoscopy were reviewed 3 d after surgery. CT revealed no foreign body residue and colonoscopy showed no metal or other residues in the colon and rectum, and no apparent intestinal tract damage. CONCLUSION The timeliness and rationality of the surgical and therapeutic options for this patient were based on a literature review of the clinical signs and conceivable conditions in such cases. The type, material and the potential risks of rectal foreign bodies should be considered.