-
Scientific Reports Oct 2023Natural course of perianal abscess (PA) in infancy remains obscure. This study aimed to investigate the natural course of infants with PA after conservative treatment. A...
Natural course of perianal abscess (PA) in infancy remains obscure. This study aimed to investigate the natural course of infants with PA after conservative treatment. A retrospective cohort study was conducted in infants with PA who were treated conservatively (due to the parents' refusal of surgery), for more than 2 months between 2014 and 2020 at a single tertiary center. 153 patients (149 boys and 4 girls) were identified. The median follow-up was 5.3 years (range 3-8.2 years). Initially, 119 patients (77.8%) were completely cured by conservative treatment, and 34 (22.2%) failed. Among the 34 patients, 23 continued conservative treatment (20 cure, 3 fistula formation) and 11 underwent surgery. After conservative treatment, the rate of fistula formation, abscess recurrence, and new-onset abscess were 15.0%, 4.6%, and 6.5%, respectively. Overall, 139 patients (90.8%) were cured conservatively without surgery, and 11 (7.2%) underwent surgical management. In addition, 3 (2.0%) patients developed fistula-in-ano (under observation). PA in infants may be a time-limited and self-limited condition. Conservative management should be the first choice of treatment in most cases. Longer periods of conservative treatment may achieve better clinical outcomes in selected cases. There will be a percentage of patients (about 10%) that would require surgical treatment.
Topics: Male; Female; Humans; Infant; Retrospective Studies; Abscess; Treatment Outcome; Drainage; Anus Diseases; Rectal Fistula
PubMed: 37891236
DOI: 10.1038/s41598-023-45751-7 -
International Journal of Molecular... Mar 2024Elevated rates of human papillomavirus (HPV)-related anal high-grade squamous intraepithelial lesions (HSIL) and anal cancer (AC) in populations like men who have sex... (Meta-Analysis)
Meta-Analysis Review
Elevated rates of human papillomavirus (HPV)-related anal high-grade squamous intraepithelial lesions (HSIL) and anal cancer (AC) in populations like men who have sex with men (MSM) living with HIV underscore the need for effective screening. While high-resolution anoscopy-guided biopsy is the gold standard, limited provider availability poses a challenge. This has spurred interest in identifying biomarkers for improved AC prevention. Antibodies against HPV16 oncoprotein E6, known as markers for cervical and oropharyngeal cancers, are the focus of the current study. The systematic review and meta-analysis included six studies meeting inclusion criteria, assessing HPV16 E6 seroprevalence in individuals with anal HSIL or AC. A two-step meta-analysis estimated pooled odds ratios and 95% confidence intervals (CI) for HPV16 E6 seroprevalence and HSIL or AC. Pooled prevalence, sensitivity, specificity, and diagnostic odds ratios were also calculated. This meta-analysis revealed a 3.6-fold increased risk of HSIL for HPV16 E6 seropositive individuals, escalating to a 26.1-fold risk increase for AC. Pooled specificity and sensitivity indicated a high specificity (0.99; 95%CI: 0.99, 0.99) but lower sensitivity (0.19; 95%CI: 0.10, 0.34) for HPV16 E6 serostatus as an AC biomarker. In conclusion, while HPV16 E6 seroprevalence demonstrates specificity as a potential biomarker for HPV-related AC, its utility as a standalone screening tool may be limited. Instead, it could serve effectively as a confirmation test, particularly in high-risk populations, alongside other diagnostic methods. Further research is imperative to explore HPV16 E6 seroconversion dynamics and alternative screening algorithms.
Topics: Male; Humans; Homosexuality, Male; Human papillomavirus 16; Papillomavirus Infections; Early Detection of Cancer; Seroepidemiologic Studies; Sexual and Gender Minorities; Biomarkers, Tumor; Carcinoma in Situ; Anus Neoplasms; Papillomaviridae
PubMed: 38542409
DOI: 10.3390/ijms25063437 -
Journal of Gastrointestinal Cancer Jun 2024Ano-uro-genital (AUG) Mucosal Melanoma UK guidelines recommended a less radical surgical strategy for anorectal melanoma (ARM) where possible. We report our experience...
PURPOSE
Ano-uro-genital (AUG) Mucosal Melanoma UK guidelines recommended a less radical surgical strategy for anorectal melanoma (ARM) where possible. We report our experience of ARM consistent with that approach including clinical presentation, intervention undertaken and prognosis.
METHODS
We present a retrospective study of 15 consecutive patients with ARM surgically treated between November 2014 and April 2023. Patients were divided into the two surgery types: wide local excision (WLE, n = 9) and abdominoperineal resection (APR, n = 6). Data on demographics, diagnosis, treatment and oncological outcomes were assessed between the groups.
RESULTS
The mean age was 65.3 ± 17.4 years and 6 (40.0%) were female patients. Nine patients (60.0%) were diagnosed with stage I and six patients (40.0%) with stage II disease. R0 margins were achieved in all cases. The overall mean length of stay was lower following WLE compared to APR (2.6 ± 2.4 days versus 14.0 ± 9.8 days, p = 0.032). Two complications were observed in the WLE group compared to four complications after APR (p = 0.605). Five patients (55.5%) developed local/distant recurrence in the WLE group compared to three patients (50.0%) in the APR group (p = 0.707), with a median overall survival of 38.5 (12-83) months versus 26.5 (14-48) months, respectively.
CONCLUSIONS
Achieving clear margins by the least radical fashion may have equivalent oncological outcomes to radical surgery, potentially reducing patient morbidity and preserving function. In our experience, the surgical management of ARM consistent with the 'less is more' approach adhering to AUG guidelines has acceptable outcomes.
Topics: Humans; Melanoma; Female; Male; Aged; Retrospective Studies; Middle Aged; Anus Neoplasms; Rectal Neoplasms; Aged, 80 and over; Adult; Neoplasm Recurrence, Local; Margins of Excision; Prognosis; Proctectomy; Neoplasm Staging; Treatment Outcome
PubMed: 38180677
DOI: 10.1007/s12029-023-01009-z -
The Canadian Veterinary Journal = La... Nov 2023A 2-year-old female Vietnamese potbellied pig was referred to the Large Animal Teaching Hospital at the Ontario Veterinary College for anoplasty and rectovaginal fistula...
A 2-year-old female Vietnamese potbellied pig was referred to the Large Animal Teaching Hospital at the Ontario Veterinary College for anoplasty and rectovaginal fistula repair. The presence of atresia ani and rectovaginal fistula had been previously diagnosed. Contrast radiography was used to confirm the diagnosis and determine the position of the fistula and terminal rectum. Under general anesthesia, the urethra was catheterized. An incision was made at the anatomic location of the anus, the rectovaginal fistula was isolated through deep dissection, and a Penrose drain was placed around it for caudal retraction. Transvaginal catheter placement through the fistula and into the rectum assisted with anatomic location. Once the urogenital and gastrointestinal tracts were clearly identified, the fistula was transected as close to the vaginal cavity as possible. The vaginal defect was sutured, and the fistula tract was mobilized 90° and sutured to the skin, creating the anal canal. Postoperative complications included constipation and cystitis. The gilt passed feces 5 d after surgery and was discharged on Day 11 of hospitalization. Normal urination and defecation were observed at the time, and fecal incontinence was resolved. Six months after surgical intervention, the gilt remained continent and no complications were reported. Key clinical message: Anoplasty and rectovaginal fistula repair were completed successfully in a gilt. Preservation of the fistula and its use during anal reconstruction may provide an internal anal sphincter and may be associated with improved continence.
Topics: Humans; Female; Swine; Animals; Rectovaginal Fistula; Rectum; Anus, Imperforate; Digestive System Surgical Procedures; Anal Canal; Swine Diseases
PubMed: 37915787
DOI: No ID Found -
International Journal of Colorectal... Dec 2023Anal abscesses are common and, despite correct treatment with surgical drainage, carry the risk of developing fistulas. Studies identifying risk factors for the...
PURPOSE
Anal abscesses are common and, despite correct treatment with surgical drainage, carry the risk of developing fistulas. Studies identifying risk factors for the development of anal fistulas are sparse. This study aimed to identify the risk factors for anal fistulas after anal abscess surgery.
METHODS
This was a multicentre, retrospective cohort study of patients undergoing acute surgery for anal abscesses in the Capital Region of Denmark between 2018 and 2019. The patients were identified using ICD-10 codes for anal abscesses. Predefined clinicopathological factors and postoperative courses were extracted from patient records.
RESULTS
A total of 475 patients were included. At a median follow-up time of 1108 days (IQR 946-1320 days) following surgery, 164 (33.7%) patients were diagnosed with an anal fistula. Risk factors for developing fistulas were low intersphincteric (OR 2.77, 95CI 1.50-5.06) and ischioanal (OR 2.48, 95CI 1.36-4.47) abscesses, Crohn's disease (OR 5.96, 95CI 2.33-17.2), a history of recurrent anal abscesses (OR 4.14, 95CI 2.47-7.01) or repeat surgery (OR 5.96, 95CI 2.33-17.2), E. coli-positive pus cultures (OR 4.06, 1.56-11.4) or preoperative C-reactive protein (CRP) of more than 100 mg/L (OR 3.21, 95CI 1.57-6.71).
CONCLUSION
Several significant clinical risk factors were associated with fistula development following anal abscess surgery. These findings are clinically relevant and could influence the selection of patients for specialised follow-up, facilitate expedited diagnosis, and potentially prevent unnecessarily long treatment courses.
Topics: Humans; Abscess; Retrospective Studies; Escherichia coli; Anus Diseases; Rectal Fistula; Drainage; Treatment Outcome
PubMed: 38093036
DOI: 10.1007/s00384-023-04576-6 -
Journal of the Anus, Rectum and Colon 2023Despite the high incidence of urinary dysfunction (UD) after rectal surgery, it remains questionable whether UD causes future chronic kidney disease (CKD). This study...
OBJECTIVES
Despite the high incidence of urinary dysfunction (UD) after rectal surgery, it remains questionable whether UD causes future chronic kidney disease (CKD). This study aimed to clarify the long-term trends in renal function and risk factors for future CKD after rectal resection.
METHODS
For comparison, patients who underwent rectal resection (n = 129) and colectomy (n = 127) between 2006 and 2017 were identified. The estimated glomerular filtration rate (eGFR) ratio was calculated as the ratio to the baseline. "eGFR ratio < 0.75 at 3-year" was adopted as a surrogate indicator of future CKD.
RESULTS
eGFR ratio significantly decreased in the rectal cohort compared with the colon cohort at 1.5 years (0.9 vs. 0.95, = 0.008) and at 3 years (0.85 vs. 0.94, < 0.001). Although the preoperative prevalence of CKD was lower in the rectal than the colon cohort (13.9% vs. 23.6%, = 0.055), it was similar at 3 years (29.5% vs. 30.7%). In multivariate analysis, females, and cT4 were independent risk factors for future CKD, but UD itself was not.
CONCLUSIONS
Postoperative eGFR significantly decreased after rectal cancer surgery compared to colectomy. The prevalence of CKD more than doubled at 3 years after rectal resection. The female sex and cT4 tumor, instead of the UD, were independent risk factors for future CKD.
PubMed: 37496567
DOI: 10.23922/jarc.2022-059 -
Journal of Cachexia, Sarcopenia and... Jun 2024Body weight and its changes have been associated with cancer outcomes. However, the associations of short-term peridiagnosis weight dynamics in standardized, clinically...
BACKGROUND
Body weight and its changes have been associated with cancer outcomes. However, the associations of short-term peridiagnosis weight dynamics in standardized, clinically operational time frames with cancer survival remain largely unknown. This study aimed to screen for and evaluate the optimal indicator of short-term peridiagnosis weight dynamics to predict overall survival (OS) in patients with cancer.
METHODS
This multicentre cohort study prospectively collected data from 7460 patients pathologically diagnosed with cancer between 2013 and 2019. Body weight data were recorded 1 month before, at the time of and 1 month following diagnosis. By permuting different types (point value in kg, point height-adjusted value in kg/m, absolute change in kg or relative change in percentage) and time frames (prediagnosis, postdiagnosis or peridiagnosis), we generated 12 different weight-related indicators and compared their prognostic performance using Harrell's C-index, integrated discrimination improvement, continuous net reclassification improvement and time-dependent C-index. We analysed associations of peridiagnosis relative weight change (RWC) with OS using restricted cubic spine (RCS), Kaplan-Meier analysis and multivariable-adjusted Cox regression models.
RESULTS
The study enrolled 5012 males and 2448 females, with a median age of 59 years. During a median follow-up of 37 months, 1026 deaths occurred. Peridiagnosis (1 month before diagnosis to 1 month following diagnosis) RWC showed higher prognostic performance (Harrell's C-index = 0.601, 95% confidence interval [CI] = [0.583, 0.619]) than other types of indicators including body mass index (BMI), absolute weight change, absolute BMI change, prediagnosis RWC and postdiagnosis RWC in the study population (all P < 0.05). Time-dependent C-index analysis also indicated that peridiagnosis RWC was optimal for predicting OS. The multivariable-adjusted RCS analysis revealed an N-shaped non-linear association between peridiagnosis RWC and OS (P < 0.001, P < 0.001). Univariate survival analysis showed that the peridiagnosis RWC groups could represent distinct mortality risk stratifications (P < 0.001). Multivariable survival analysis showed that, compared with the maintenance group (weight change < 5%), the significant (gain >10%, hazard ratio [HR] = 0.530, 95% CI = [0.413, 0.680]) and moderate (gain 5-10%, HR = 0.588, 95% CI = [0.422, 0.819]) weight gain groups were both associated with improved OS. In contrast, the moderate (loss 5-10%, HR = 1.219, 95% CI = [1.029, 1.443]) and significant (loss >10%, HR = 1.280, 95% CI = [1.095, 1.497]) weight loss groups were both associated with poorer OS.
CONCLUSIONS
The prognostic performance of peridiagnosis RWC is superior to other weight-related indicators in patients with cancer. The findings underscore the importance of expanding the surveillance of body weight from at diagnosis to both past and future, and conducting it within clinically operational time frames, in order to identify and intervene with patients who are at risk of weight change-related premature deaths.
Topics: Humans; Male; Female; Neoplasms; Middle Aged; Prognosis; Body Weight; Aged; Cohort Studies; Adult
PubMed: 38644549
DOI: 10.1002/jcsm.13467 -
Journal of Community Health Aug 2023Human Papillomavirus (HPV) vaccination is effective at preventing anal cancer, which disproportionally impacts gay/bisexual men (GBM) and transgender women (TGW)....
Human Papillomavirus (HPV) vaccination is effective at preventing anal cancer, which disproportionally impacts gay/bisexual men (GBM) and transgender women (TGW). Vaccine coverage among GBM/TGW is insufficient to reduce anal cancer disparities. Federally qualified health centers (FQHCs) can increase reach and uptake of HPV vaccination by integrating and promoting HPV vaccination in ongoing HIV preventive care (e.g., Pre-exposure Prophylaxis [PrEP]). The purpose of the current study was to assess the feasibility and potential impact of integrating HPV vaccination with PrEP care. We conducted a mixed methods study of PrEP providers and staff (qualitative interviews, N = 9) and PrEP patients (quantitative survey, N = 88) at an FQHC in Philadelphia, Pennsylvania. Qualitative thematic analysis of PrEP provider/staff interviews was informed by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to identify and describe barriers and facilitators to HPV vaccination implementation. Quantitative analysis of PrEP patient survey was informed by the Information-Motivation-Behavioral Skills Model. Quantitative interviews resulted in 16 themes related to characteristics of the inner and outer clinic context. Barriers among providers included lack of focus on HPV in PrEP management guidelines, in metrics mandated by funding agencies, and in electronic medical record templates. Lack of anal cancer specific knowledge and motivation was identified in both PrEP patients and providers/staff. Providing HPV vaccination during routine PrEP visits was highly acceptable to both patients and providers. Based on these findings, we recommend several multi-level strategies to increase HPV vaccine uptake among PrEP patients.
Topics: Male; Humans; Female; Feasibility Studies; Papillomavirus Infections; Vaccination; Papillomavirus Vaccines; Anus Neoplasms; Philadelphia; HIV Infections; Homosexuality, Male
PubMed: 36894796
DOI: 10.1007/s10900-023-01202-y -
Cancer Research and Treatment Apr 2024This study aimed to assess the prognostic significance of bulky nodal involvement in patients with anal squamous cell carcinoma treated with definitive chemoradiotherapy.
PURPOSE
This study aimed to assess the prognostic significance of bulky nodal involvement in patients with anal squamous cell carcinoma treated with definitive chemoradiotherapy.
MATERIALS AND METHODS
We retrospectively analyzed medical records of patients diagnosed with anal squamous cell carcinoma who underwent definitive chemoradiotherapy at three medical centers between 2004 and 2021. Exclusion criteria included distant metastasis at diagnosis, 2D radiotherapy, and salvage treatment for local relapse. Bulky N+ was defined as nodes with a long diameter of 2 cm or greater.
RESULTS
A total of 104 patients were included, comprising 51 with N0, 46 with non-bulky N+, and 7 with bulky N+. The median follow-up duration was 54.0 months (range, 6.4-162.2 months). Estimated 5-year progression-free survival (PFS), loco-regional recurrence-free survival (LRRFS), and overall survival (OS) rates for patients with bulky N+ were 42.9%, 42.9%, and 47.6%, respectively. Bulky N+ was significantly associated with inferior PFS, LRRFS and OS compared to patients without or with non-bulky N+, even after multivariate analysis. We proposed a new staging system incorporating bulky N+ as N2 stage, with estimated 5-year LRRFS, PFS, and OS rates of 81.1%, 80.6%, and 86.2% for stage I, 67.7%, 60.9%, and 93.3% for stage II, and 42.9%, 42.9%, and 47.6% for stage III disease, enhancing the predictability of prognosis.
CONCLUSION
Patients with bulky nodal disease treated with standard chemoradiotherapy experienced poor survival outcomes, indicating the potential necessity for further treatment intensification.
PubMed: 38605662
DOI: 10.4143/crt.2024.258 -
Plant Disease Aug 2023Black nightshade () typically grows as a weed species, but it is also widely used as an herb to treat stomach ulcers and dermal infections in many countries...
Black nightshade () typically grows as a weed species, but it is also widely used as an herb to treat stomach ulcers and dermal infections in many countries (Jabamalairaj et al. 2019). In April 2023, extensive root galls similar to those associated with by root-knot nematodes (RKNs), spp., were observed on the roots of black nightshade in several commercial fields in Lufeng county (22°55'57.44″N, 115°33'10.31″E), Guangdong Province, China. Upon inspection, there were one to several female RKN in each gall, and egg masses protruding through the root surface. The disease incidence rate was more than 90% in each field using the random sampling method. The nematode population densities in the samples ranged from 279 to 656 eggs and second-stage juveniles (J2s) per gram of fresh roots. Females and egg masses were collected from the roots, and egg masses were incubated in sterile water at 25°C to obtain J2s. Males were not collected in root galling or soil samples. The J2 tail is thin with a broad, bluntly pointed tip, and a clearly defined hyaline tail terminus. Measurements of J2 (n = 20) included: L= 440 ± 30.5 (384 to 500) µm, stylet = 12.3 ± 0.7 (11.3 to 13.7) µm, tail = 51.6 ± 2.4 (47.9 to 57.0) µm. For females (n = 15), vulval slit length = 25.5 ±1.9 (23.6 to 29.1) µm, vulval slit to anus distance = 22.1 ± 3.0 (18.2 to 27.0) µm. Stylet knobs in females are divided longitudinally by a groove so that each knob appears as two. The perineal patterns are round to ovoid, with coarse and smooth striae, moderate to high dorsal arch and mostly lacking distinct lateral lines. Morphological characteristics from J2s and perineal patterns from adult females fit the original description of (Yang and Eisenback 1983). Furthermore, species identity was explored by sequencing the D2-D3 region of the 28S rRNA gene using primers D2A/D3B (Vrain et al. 1992), and the mtDNA cytochrome c oxidase I (COI) genes using primers JB3/JB5 (Derycke et al. 2005). The sequences for the target genes were 759 bp (GenBank Accession No. OR046056) and 447 bp (GenBank Accession No. OR042802), respectively. The BLAST analysis suggested 98.17~99.78% similarities to other available sequences in GenBank. Species identity was further confirmed with the species-specific primer pair Me-F/Me-R (Long et al. 2006). An approximately 240 bp PCR product was produced, which was previously reported only for , whereas no product was obtained from control populations of or . The pathogenicity test was conducted in a greenhouse at 28°C using seedlings of maintained in pots containing 500 cm sterilized soil. Ten replicates were inoculated with 800 eggs and J2s of the original population of , while another 10 replicates of control plants were not inoculated. After 7 weeks, the inoculated plants exhibited galling symptoms similar to plants observed in the field, and females and egg masses were obtained by dissecting galls. No galling symptoms were observed on control plants. These results confirmed the nematode's pathogenicity. To our knowledge, this is the first record of parasitizing black nightshade. stands out as a highly deleterious variant among the species of RKNs owing to its extensive repertoire of host plants, pathogenicity, and proficiency in thriving and multiplying even on crops possessing resistance genes (Sikandar, 2022). In addition to being a medicinal plant, is a widespread weed found in fields throughout China. This report also showed that could play an important role as a reservoir host of aiding its survival, reproduction, spread, and increasing the potential damage for host crops.
PubMed: 37578363
DOI: 10.1094/PDIS-07-23-1316-PDN