High-resolution anorectal manometry for diagnosing obstructed defecation syndrome associated with moderate rectocele compared to healthy individuals.

BACKGROUND: Few studies have investigated healthy female individuals (HFI) and those with obstructed defecation syndrome associated with moderate rectocele in women (MRW), identified using three-dimensional high-resolution anorectal manometry (3D HRAM) parameters that correlate with age stratification. OBJECTIVE: We aimed to explore the clinical diagnostic values of the MRW and HFI groups using 3D HRAM parameters related to age stratification. METHODS: A prospective non-randomized controlled trial involving 128 cases from the MRW (treatment group, 68 cases) and HFI (control group, 60 cases) groups was conducted using 3D HRAM parameters at Tianjin Union Medical Center between January 2017 and June 2022, and patients were divided into two subgroups based on their ages: the ≥50 and < 50 years subgroups. RESULTS: Multivariate binary logistic regression analysis showed that age (P = 0.024) and rectoanal inhibitory reflex (P = 0.001) were independent factors affecting the disease in the MRW group. Compared to the HFI group, the receiver operating characteristic (ROC) curve demonstrated that the 3D HRAM parameters exhibited a higher diagnostic value for age (Youden index = 0.31), urge to defecate (Youden index = 0.24), and rectoanal pressure differential (Youden index = 0.21) in the MRW group. CONCLUSIONS: Compared to the HFI group, the ROC curve of the 3D HRAM parameters suggests that age, urge to defecate, and rectoanal pressure differential in the MRW group have a significant diagnostic value. Because the Youden index is lower, 3D HRAM cannot be considered the gold standard method for diagnosing MRW.

[Vertical Spatial Distribution of Denitrification Intensity in the Vadose Zone of Typical Sections of Chaobai River Alluvial Fan].

In this study, the Chaobai River alluvial fan area, Beijing City, was chosen as the study area, and two typical profiles (S6 and S8) were selected to determine the denitrification intensity value of the vadose zone at different sampling depths (0-10 m). The vertical spatial distribution of denitrification in the vadose zone was analyzed, and the influencing factors of the vertical distribution of denitrification strength in the aeration zone were identified. The results showed that the NO3--N concentrations in the denitrification process of soil samples in different vadose zones experienced three main stages:rising, falling, and rising. The vadose zone denitrification intensities in S6 and S8 ranged from 0.0026 to 0.0185 mg·(kg·d)-1 and 0.0017 to 0.0233 mg·(kg·d)-1, respectively. That the overall denitrification intensity was low. The denitrification intensity of the vertical space showed an "S"-type trend. The main controlling factors for denitrification intensity in S6 and S8 vadose zones included clay, nitrate, and nitrite and showed significant correlations with the diversity of microorganisms, such as the ACE and Shannon indices, and the nitrate reductase (nirK) gene of denitrifying bacteria at a certain depth range.

Meta-analysis of elective surgical complications related to defunctioning loop ileostomy compared with loop colostomy after low anterior resection for rectal carcinoma.

Introduction Defunctioning loop ileostomy (LI) and loop colostomy (LC) are used widely to protect/treat anastomotic leakage after colorectal surgery. However, it is not known which surgical approach has a lower prevalence of surgical complications after low anterior resection for rectal carcinoma (LARRC). Methods We conducted a literature search of PubMed, MEDLINE, Ovid, Embase and Cochrane databases to identify studies published between 1966 and 2013 focusing on elective surgical complications related to defunctioning LI and LC undertaken to protect a distal rectal anastomosis after LARRC. Results Five studies (two randomized controlled trials, one prospective non-randomized trial, and two retrospective trials) satisfied the inclusion criteria. Outcomes of 1,025 patients (652 LI and 373 LC) were analyzed. After the construction of a LI or LC, there was a significantly lower prevalence of sepsis (p=0.04), prolapse (p=0.03), and parastomal hernia (p=0.02) in LI patients than in LC patients. Also, the prevalence of overall complications was significantly lower in those who received LIs compared with those who received LCs (p<0.0001). After closure of defunctioning loops, there were significantly fewer wound infections (p=0.006) and incisional hernias (p=0.007) in LI patients than in LC patients, but there was no significant difference between the two groups in terms of overall complications. Conclusions The results of this meta-analysis show that a defunctioning LI may be superior to LC with respect to a lower prevalence of surgical complications after LARRC.

[Pathological factors associated with staging of metastatic lymph node ratio and metastatic lymph node number in advanced gastric carcinoma].

OBJECTIVE: To explore the association of pathologic factors with the staging of metastatic lymph node ratio (rN) and metastatic lymph node number (pN), and to provide evidence for reasonable tumor staging in advanced gastric carcinoma (AGC). METHODS: The clinicopathological data of 555 patients, who received radical resection for primary tumor of AGC between November 2003 and December 2011 in The First Affiliated Hospital of Xinjiang Medical University, were reviewed retrospectively. The clinicopathological factors influencing rN and pN were analyzed. RESULTS: Univariate analysis showed that differentiation degree, vascular invasion, tumor diameter, gross type and invasion depth were significantly associated with rN or pN (all P<0.05). Histological type was significantly associated with rN (P<0.05), but not with pN. Logistic regression analysis revealed that vascular invasion, tumor diameter≥4 cm and invasion depth were independent risk factors for lymph node distant metastasis in AGC (all P<0.05). ROC curves showed that rN was consistent with pN in evaluating the diagnostic value of lymph node distant metastasis for tumor staging in AGC (P>0.05). CONCLUSIONS: Vascular invasion tumor diameter≥4 cm and invasion depth are independent risk factors for lymph node metastasis in AGC based on either metastatic lymph node ratio (rN) or metastatic lymph node number (pN). The rN staging is consistent with the pN staging in evaluating the diagnostic value of metastatic lymph node for tumor staging in AGC.