Incomplete Evacuation Research Articles

Urinary Symptoms and Bladder Dysfunction in Patients with Neuromyelitis Optica Spectrum Disorders: Evaluation with Urodynamics and Management.

Objective To assess lower urinary tract symptoms (LUTSs) in patients with neuromyelitis optica spectrum disorders (NMOSDs) and bladder dysfunction through urodynamics (filling and voiding phase of cystometrography) and management based on findings. Patients and Methods The study included 42 (34 females) patients admitted to the rehabilitation department. Neurologic evaluation was performed and severity of myelitis was assessed using the American Spinal Injury Association Impairment Scale. All patients underwent urodynamics, and management was based on the findings. Results Mean age was 34.5 years (range: 11–64 years; standard deviation: 13.1). Twenty-three (54.8%) patients had a first episode of myelitis, whereas 19 patients had relapses (number of episodes varying from 2 to 7). Eleven (26%) patients had increased frequency, 16 (37%) had urgency, 12 (28%) had urge incontinence, 8 (18.6%) had stress incontinence, 22 (52.4%) had nocturia, 31 (72%) had retention of urine, 22 (52.4%) had incomplete evacuation, and 14 (33.3%) patients had mixed urinary complaints. The common urodynamic findings were neurogenic detrusor overactivity (NDO) with detrusor-sphincter dyssynergia (DSD) in 14 (33.3%) patients, NDO without DSD in 8 (19%), and acontractile detrusor in 20 (47.6%). Pharmacotherapy was advised to 22 (52.4%) patients, whereas clean intermittent catheterization (CIC)/self-catheterization was advised to 39 (92.9%) patients. Conclusions Urinary retention was observed to be the most common urinary complaint in patients with NMOSD followed by NDO with or without sphincter dyssynergia. Urodynamics should be performed in all patients with LUTSs for best management. CIC remains the gold standard for the management of neurogenic bladder dysfunction.

P224 Crohn’s disease experiences among a paediatric population: A qualitative study reviewing the agreement of symptoms discussed by children and adolescents

Abstract Background Crohn’s disease (CD) is a type of inflammatory bowel disease that can occur at any age. CD symptoms can have a significant impact on health-related quality of life (HRQL). Although key symptoms and impacts of CD in adults are well-known, they have not been well explored or documented in children and adolescents. The objective of this study was to explore the similarities and differences in CD symptoms and impacts across various age groups (children and adolescents) and develop a list of most common symptoms and impacts for these populations. Methods Children (ages 5–11 years) and adolescents (ages 12–17 years) with CD and parents/caregivers of children with CD (ages 2–11 years) were recruited from US medical practices. Qualitative semi-structured interview guides were developed, informed by published literature. Face-to-face and telephone concept elicitation interviews were conducted, audio-recorded, and transcribed. Transcripts were analysed using thematic methods facilitated by NVivo. Results A total of 49 individuals participated in this study (child n = 11, adolescents n = 20, parents/caregivers n = 18). Preliminary results showed that there was a high level of qualitative agreement between CD symptoms in children and adolescents. The ranking of the top 15 symptoms was nearly identical between the two cohorts. The most frequently discussed symptoms (discussed by ≥75% of the participants in each cohort) were feeling gassy, abdominal pain, diarrhoea, incomplete evacuation, tiredness, and urgency. The second most frequently discussed symptoms (discussed by ≥50% of the participants in each cohort) were cramping, constipation, blood in stool, and frequent bowel movement. While abdominal cramping and blood in stool were discussed by ≥75% of the adolescents, 63% and 50% of the children discussed them respectively. Similarly, while bloating and nausea were discussed by ≥50% of adolescents, 38% and 25% of children discussed them, respectively. Finally, while vomiting was discussed by 50% of the children, 33% of the adolescents discussed it. Impacts due to CD were also regularly discussed across both cohorts but less so by the children. School and low mood/sadness were discussed by ≥50% of the participants in each cohort. Exercise/sport, play/leisure activities, annoyance/frustration, and eating/drinking limitations were discussed by ≥50% of the adolescents but <50% of the children. Conclusion The results from the CE interviews show the clear burden of CD and that this is mostly similar across children and adolescents allowing for a future unified disease model to be developed.

Obstructed defecation syndrome: a diagnostic and therapeutic challenge.

Obstructed defecation syndrome produces constipation with anal blockage and a feeling of incomplete evacuation, due to either anatomic and functional causes. This is a complex and multifactorial entity due to diverse etiological factors that may coexist in many patients. Therefore, a diagnostic approach requires structural and functional assessment. The concordance between findings of diagnostic tests is suboptimal, thus an individualized analysis is mandatory in each patient. Therapeutic strategies require the best understanding of anatomic and functional aspects. Consequently, this entity is a diagnostic and therapeutic challenge.

Functional constipation in the general population of Cotonou (Benin): clinical features and factors influencing dietary behaviours

IntroductionLa constipation est considérée comme rare en Afrique subsaharienne, en raison de la forte teneur en fibre de l'alimentation locale. Le but de ce travail était de décrire les différents aspects cliniques de la constipation fonctionnelle en population générale à Cotonou et de déterminer l'influence de l'alimentation dans sa survenue.MéthodesCette étude était menée de juillet à août 2017. La constipation était fonctionnelle si les critères de Rome IV ou de l'échelle de Bristol étaient remplis.RésultatsAu total, 1058 participants étaient inclus: (574 hommes, sex-ratio de 1,2; âge moyen 29 ans). La fréquence de la constipation fonctionnelle était de 24.2% (Rome IV) et de 20.4% (Echelle de Bristol). Les manifestations cliniques étaient dominées par l'émission de selles dures ou fragmentées (90,6%), les efforts de poussée lors de la défécation (78,9%), et la sensation de vidange incomplète (76,2%). Les habitudes alimentaires chez les constipés étaient: au petit déjeuner, la bouillie de maïs + beignet/arachides (39,1%), au déjeuner, la pâte de maïs (38,7%), au diner, la pâte de maïs (57,4%), et en guise de collation: la banane (35,5%). Il n'y avait pas de lien statistiquement significatif entre la constipation et respectivement le type de repas pris au petit-déjeuner (p=0,09), au déjeuner (p=0,901), en collation (p=0,09) ou au dîner (p=0,75).ConclusionL'émission de selles dures ou fragmentées était la manifestation clinique la plus dominante chez les constipés à Cotonou. Les habitudes alimentaires n'influenceraient pas la survenue de la constipation fonctionnelle dans notre série.

Association of life habits and fermented milk intake with stool frequency, defecatory symptoms and intestinal microbiota in healthy Japanese adults.

Few studies have examined the effects of smoking habit, the frequency of alcohol drinking, exercise, and fermented milk consumption on defecatory symptoms and gut microbiota composition, and particularly their interactive effects. We examined the effect of these lifestyle factors on bowel movements and gut microbiota composition in 366 healthy Japanese adults by analysis of covariance. Smoking did not affect defecatory symptoms but was negatively correlated with total bacteria and Enterococcus counts. Drinking frequency was significantly positively correlated with a feeling of incomplete evacuation and counts of the Bacteroides fragilis group and Acidaminococcus groups. Exercise frequency tended to be negatively correlated with the Bristol Stool Form Scale score and was significantly negatively correlated with the counts of Enterobacteriaceae and positively correlated with the Prevotella counts in the faeces. The frequency of fermented milk consumption was not significant but tended to be positively correlated with stool frequency. The frequency of fermented milk consumption was significantly positively correlated with the counts of the Atopobium cluster, Eubacterium cylindroides group, Acidaminococcus group, Clostridium ramosum subgroup, and Lactobacillus in the faeces. The frequency of consumption of probiotic Lactobacillus casei-containing fermented milk was significantly positively correlated with stool frequency. The counts of probiotic Lactobacillus casei in the stool was positively correlated with the counts of Bifidobacterium and total Lactobacillus. These results suggest that smoking, alcohol drinking, exercise, and consumption of fermented milk, particularly containing probiotic L. casei, differently affect bowel movements and gut microbiota composition in healthy Japanese adults.

Chronic constipation among community-dwelling older people in the East Coast region of Peninsular Malaysia

Background: This study aimed to investigate the prevalence, symptoms and factors associated with chronic constipation among community dwelling older people in the East Coast region of Peninsular Malaysia. Methods: A cross-sectional study was conducted in four selected health clinics using stratified cluster sampling. A face-to-face interview was carried out among the elderly outpatients, in order to complete a structured questionnaire. Results: A total of 400 participants were included in the study. The mean age was 68.7 ± 6.4, and 55% of the cohort were women. The prevalence of chronic constipation was 32.3% among the sample population. The most common symptom was ‘sensation of incomplete evacuation’ (63.6%), and none of the participants reported having ‘less than three defecations per week’, ‘straining’, or ‘lumpy or hard stool’. Educational level (p = 0.005), number of defecations per week, stool form, time spent for defecation and abdominal bloating were significantly associated with chronic constipation (p < 0.001). Conclusions: Chronic constipation was common in older people and associated with a low educational level. Recognition of symptoms was predominantly based on clinical features of constipation and will require the healthcare providers to consider these factors in their routine assessment of older people.

Mifepristone and misoprostol versus misoprostol alone for uterine evacuation after early pregnancy failure: study protocol for a randomized double blinded placebo-controlled comparison (Triple M Trial)

BackgroundEarly pregnancy failure (EPF) is a common complication of pregnancy. If women do not abort spontaneously, they will undergo medical or surgical treatment in order to remove the products of conception from the uterus. Curettage, although highly effective, is associated with a risk of complications; medical treatment with misoprostol is a safe and less expensive alternative. Unfortunately, after 1 week of expectant management in case of EPF, medical treatment with misoprostol has a complete evacuation rate of approximately 50%. Misoprostol treatment results may be improved by pre-treatment with mifepristone; its effectiveness has already been proven for other indications of pregnancy termination.This study will test the hypothesis that, in EPF, the sequential combination of mifepristone with misoprostol is superior to the use of misoprostol alone in terms of complete evacuation (primary outcome), patient satisfaction, complications, side effects and costs (secondary outcomes).MethodsThe trial will be performed multi-centred, prospectively, two-armed, randomised, double-blinded and placebo-controlled. Women with confirmed EPF by ultrasonography (6–14 weeks), managed expectantly for at least 1 week, can be included and randomised to pre-treatment with oral mifepristone (600 mg) or oral placebo (identical in appearance). Randomisation will take place after receiving written consent to participate. In both arms pre-treatment will be followed by oral misoprostol, which will start 36–48 h later consisting of two doses 400 μg (4 hrs apart), repeated after 24 h if no tissue is lost. Four hundred sixty-four women will be randomised in a 1:1 ratio, stratified by centre.Ultrasonography 2 weeks after treatment will determine short term treatment effect. When the gestational sac is expulsed, expectant management is advised until 6 weeks after treatment when the definitive primary endpoint, complete or incomplete evacuation, will be determined. A sonographic endometrial thickness < 15 mm using only the allocated therapy by randomisation is considered as successful treatment. Secondary outcome measures (patient satisfaction, complications, side effects and costs) will be registered using a case report form, patient diary and validated questionnaires (Short Form 36, EuroQol-VAS, Client Satisfaction Questionnaire, iMTA Productivity Cost Questionnaire).DiscussionThis trial will answer the question if, in case of EPF, after at least 1 week of expectant management, sequential treatment with mifepristone and misoprostol is more effective than misoprostol alone to achieve complete evacuation of the products of conception.Trial registrationClinicaltrials.gov (d.d. 02-07-2017): NCT03212352.Trialregister.nl (d.d. 03-07-2017): NTR6550.EudraCT number (d.d. 07-08-2017): 2017–002694-19.File number Commisie Mensgebonden Onderzoek (d.d. 07-08-2017): NL 62449.091.17.

Urinary Tract Infection among Pregnant Women and its Associated Risk Factors: A Cross-Sectional Study

Urinary tract infection is widespread among pregnant women and is accompanying adverse maternal, fetal, and neonatal outcomes. Even so, no data exist regarding this problem in Wadi Addawser to guide specific management and thus to avert the adverse consequences. The study aimed to assess the urinary tract infection among pregnant women and its associated risk factors and to investigate the most common antibacterial agent used by infected pregnant women. A total of 303 pregnant women who attend the obstetrics and gynecology clinic with the inclusion criteria were included. The sample was collected using a structured interview. The study results showed, 53.5 % of the studied women had positive pathogens in the urine culture. E. coli (37%) followed by Klebsiella pneumonia (27%) had the highest percentage of the isolated pathogens. Amoxicillin and cefoxitin (40.1% &amp;21.6%, respectively) are the most antibiotics used by infected women, while the lowest used antibiotics are fusidic acid (5.6%). The clinical symptoms such as frequency of micturition, dysuria, lower abdominal pain, urine color change, painful burning sensation, incomplete bladder evacuation were e most common among infected women. Since the symptoms are a good predictor for urinary tract infection during pregnancy, so early screening for pathogens and proper treatment for infected cases should be applied.

PGI53 A QUALITATIVE STUDY EXPLORING THE BURDEN OF ULCERATIVE COLITIS AMONG CHILD, ADOLESCENT, AND ADULT PATIENTS

To explore the similarities and differences in UC symptoms and impacts across various age groups (children, adolescents, and adults) and develop a disease model. Participants with UC were recruited from US clinical sites to participate in-depth, open-ended face-to-face concept elicitation (CE) interviews. Two studies were conducted, one interviewing parents of children aged 2–4 years, children aged 5-11 years, and their parents. The other interviewed adolescents (aged 12–18 years) and adults (aged 18+ years). Interviews were audio-recorded and transcribed. Interview transcripts were analyzed using thematic analysis. Sample recruited: 8 parents of 2–4-year olds, three 5–7-year olds and their parents, nine 8–11-year olds and their parents, 14 adolescents (12–17 years), and 21 adults (20–70 years). There was a high level of qualitative agreement between cohorts with nearly all symptoms being discussed by children, adolescents, and adults and also observed by the child’s parents. The most frequently discussed symptoms (discussed by ≥75% of the participants in each cohort) were similar across all cohorts. These were: blood in stool, urgent bowel movement, frequent bowel movements, diarrhea, and incomplete evacuation. The only symptom reported by all participants [children (their parents), adolescents, and adults] was stomach/abdominal pain. Feeling dehydrated was discussed only by adult participants (4/21) and was the only symptom not discussed by children, their parents or adolescents. Impacts due to UC were also regularly discussed across all cohorts with only a few impacts being age specific (i.e., work for adults and school for children). However, impact on activities of daily living was only discussed by adults. The results from the CE interviews show the clear burden of UC and that this is similar across all age groups allowing for a unified disease model to be developed.

Postoperative Bowel Symptoms Improve over Time after Rectosigmoidectomy for Endometriosis

To evaluate bowel function (changes in stool caliber, sensation of incomplete evacuation, stooling frequency, and rectal bleeding) and urinary function (dysuria and retention) after segmental resection in patients with bowel endometriosis. Retrospective study. Tertiary hospital. A total of 413 (mean age = 33.6 ± 5.1 years) of reproductive aged women, with bowel endometriosis that underwent segmental bowel resection of the rectosigmoid from 2005 to 2018, without history of prior bowel surgery, without existing or history of malignancy. Laparoscopic segmental bowel resection performed by the same team and with the same technique. Data collected from the patients' records included length of resected segment, distance of the lesion from the anal verge, and complications. Information on intestinal and urinary function was obtained from a questionnaire applied before the surgery and at 2, 6, and 12 months after the surgery. There was a significant increase in the incidence of stool thinning and rectal bleeding 2 months after surgical procedure; these symptoms decreased significantly over time. The incidence of urinary symptoms decreased significantly over time after surgery. The length of the bowel segment resected was not associated with the postoperative symptoms, but the rectosigmoid lesion was significantly closer to the anal verge in patients with rectal bleeding and urinary symptoms. There was no association between the length of intestinal segment resected and the frequency of stooling. At 6 months, patients who had a decreased frequency of stooling underwent a resection closer to the anal verge (9.7 cm) in comparison with the ones with unchanged or increase frequency of stooling (10.1 cm and 10.7 cm, respectively; p <.05). Patient complaints on bowel and urinary alterations after segmental resection were transient with significant improvement over time up to 12 months. Bowel and urinary symptoms were not associated with the size of the bowel segment resected, whereas rectal bleeding at 2 months after surgery was significantly associated with the distance from anal verge. Segmental resection was also associated with a great improvement in constipation at 12 months postoperative.

PREVALENCIA Y PERFIL EPIDEMIOLÓGICO DE LA CONSTIPACIÓN FUNCIONAL EN ADULTOS CON LOS NUEVOS CRITERIOS ROMA IV

Introducción: Los reportes extranjeros dan cuenta de la presencia de esta patología en cifras que varían entre 10 y 70 %, con sólo un reporte nacional centrado en ancianos institucionalizados. Existen diferentes formas de evaluar la presencia de constipación, en nuestra experiencia utilizamos los nuevos criterios de ROMA IV que define como constipación funcional cuando se cumplen dos o más criterios. Objetivos: Determinar la prevalencia y el perfil epidemiológico de pacientes adultos sanos con constipación Material y Método: Estudio de corte transversal realizado entre enero y marzo de 2018. Se incluyen mayores de 18 años que acceden a completar la encuesta. Se excluye aquellas personas con antecedentes quirúrgicos o mórbidos gastrointestinales. Se realiza encuesta aplicando los criterios de ROMA IV considerando aspectos demográficos. Se utiliza estadística descriptiva. Resultados: De 1500 encuestas realizadas se seleccionan 1223. Un 68,4 % cumplían con dos o más criterios de constipación funcional, con diferencias estadísticamente significativas en el grupo de sexo femenino y en pacientes de mayor edad. El análisis específico de cada criterio de ROMA IV muestra que los síntomas más frecuentes fueron deposiciones duras, esfuerzo defecatorio excesivo y sensación de evacuación incompleta. Hubo diferencias estadísticamente significativas en mujeres en los ítems: menor frecuencia, deposiciones duras y esfuerzo defecatorio mientras que la mayor edad se asocia a evacuación incompleta. Las maniobras digitales fueron poco frecuentes.Conclusiones: La constipación es frecuente en la población adulta sana afectando principalmente a mujeres de mayor edad. Los síntomas más frecuentes fueron deposiciones duras, esfuerzo defecatorio y sensación de evacuación incompleta.

825 Ulcerative Colitis Experiences Among a Pediatric Population: A Qualitative Study Reviewing the Agreement of Symptoms Discussed by Children and Their Parents

INTRODUCTION: Although key symptoms of UC are well-known, exploration of these in children and the level of agreement between child reported and those observed by parents/caregiver have not been well documented and is important to understand if patient reported or observer reported outcome measures should be used. METHODS: Children with UC aged 5–11 years and their parents were recruited from US clinical sites for face-to-face concept elicitation interviews. Collages and play-doh models were used during child interviews. Interview transcripts were subjected to thematic analysis using NVivo. RESULTS: In total 24 participants were interviewed, three children aged 5–7 years, nine children aged 8–11 years, and their parents/caregivers. All children and parents/caregivers reported that they/their child experienced abdominal pain. Among the younger children, all children and parents/caregivers also discussed blood in stool and there was general agreement (&gt;66%) for stool urgency and incontinence. However, parents/caregivers in this age group were more likely to mention a symptom that was not reported by their child, e.g., stool frequency, constipation, and mucus in stool. The agreement in the description of the experience of symptoms was much higher in 8–11-year olds. There was a high level of agreement (&gt;75%) for blood in stool frequency, diarrhea, incomplete evacuation, and feeling gassy or passing gas. Constipation, bloating, and cramping all had a moderate level of agreement (&gt;50%). CONCLUSION: The findings showed a high level of agreement between children and their parents/caregivers in reporting the child’s symptoms. Children aged 8–11 years demonstrate higher agreement with their parents/caregivers than younger children. To obtain an accurate picture of symptoms experienced, an observer-reported measure should be used for the 5–7-year olds, but 8–11-year olds could self-report own symptoms. Limitations: only three 5-7-year olds were interviewed.

510 Ginger, Paullinia Cupana, Muira Puama, and L-citrulline (COMP-4) as a Novel Natural Treatment for Severe Constipation

INTRODUCTION: Epidemiologic studies report that about 15% of adults and 30% of people older than 60 years suffer from constipation in the United States. The actual prevalence is likely greater as many people believe their bowel habits are normal and underreport symptoms of constipation. Moreover, most recent surveys assessing current medical management of constipation show that patients are dissatisfied and believe that conventional treatments, like laxatives and colonic stimulants, are suboptimal since they can cause explosive bowel movements which are difficult to control. COMP-4, a combination of ginger, Paullinia cupana, muira puama, and L-citrulline is a novel nutraceutical that has been shown to stimulate the production of nitric oxide and cGMP in smooth muscle cells resulting in smooth muscle relaxation and possibly increases intestinal secretion. In this study, we aim to demonstrate that treatment with COMP-4 is an effective treatment for severe constipation. METHODS: Seventeen patients with constipation were treated COMP-4 (2-4 capsules per day) for 2-4 weeks. Constipation was defined as two or more of the following: the sensation of incomplete evacuation, Bristol stool score 1-2 (hard, lumpy nut or sausage-shaped bowel movements), and straining during the majority of defecations. Patients were surveyed before and after the treatment regarding their approximate number of bowel movements per week, their typical Bristol stool score, the presence of abdominal pain, and the feeling of incomplete evacuation. Statistical analysis was performed using the Wilcoxon rank test with a P &lt; 0.05 considered significant. RESULTS: Following treatment with COMP-4, the average weekly number of stools significantly (P &lt; 0.0001) increased from 2.7+/-0.68 to 7.3+/- 1.11 (Figure 1). Prior to COMP-4, 16/17 patients reported incomplete bowel evacuation during bowel movements. After COMP-4, 10/17 patients reported complete bowel evacuation. The mean Bristol Stool Score significantly (P &lt; 0.0001) increased from 1.5+/- 0.15 to 3.4+/-0.29 with softer and more formed stools (Figure 2). Patients also experienced a significant (P &lt; 0.0001) decrease in abdominal pain (Figure 3). CONCLUSION: The combination of ginger, Paulinia cupana, muira puama, and L-citrulline improves the frequency and consistency of stools and helps relieve symptoms of constipation. The nutraceutical may be a novel agent used to treat severe constipation not responding well to other conventional treatments.

469 Efficacy of Biofeedback Therapy for Dyssynergic Constipation Among Elderly Patients

INTRODUCTION: The prevalence of constipation among older adults is estimated to be as high as 40% (Melton et al, 1996). Dyssynergic defecation (DD) is an important cause of constipation for a large proportion of these patients. While biofeedback (BFB) therapy has been shown to be highly effective in correcting DD, it involves operant conditioning which requires learning new techniques and few studies have looked at how older adults respond to BFB. METHODS: This is a retrospective analysis of age 65+ patients enrolled in BFB for DD between 2015 to 2018 at a tertiary referral motility program. For patients that had greater than two sessions, survey and high resolution anorectal manometry (HR-ARM) data were collected at baseline and during each BFB visit. 58 patients met criteria. ARM is utilized with sensors in the rectum and anal canal. Stool retention simulation is performed involving inflation of a rectal balloon during the BFB sessions. RESULTS: Patients described improvement in several meaningful clinical outcomes. The overall median education level was completed high school and some college. Mean global bowel satisfaction on a scale of 1 (very dissatisfied) to 10 (very satisfied) showed a statistically significant increase, 2.77 to 5.01 with BFB (P ≤ 0.0001). In addition, the important symptom of a feeling of incomplete evacuation after stooling decreased from 95% down to 24% (P = 0.0025). Most significantly, 79% of the age 65+ patients showed resolution of their dysyynergia on HR-ARM at their final session (P = 0.0006). The defecation index (DI), intrarectal pressure divided by intra-anal pressure during simulated defecation, also trended towards improvement (0.564 to 0.681, P = 0.12). In terms of types of dyssynergia (1 through 4), subjects with defects in both propulsion and paradoxical contraction of sphincter muscles during defecation, i.e. type 2 dyssynergia, showed the most substantial objective gains in defecation index, with an average increase of 0.486, P-value 0.01 (2 vs 1) and 0.02 (2 vs 3). CONCLUSION: Biofeedback for DD shows meaningful improvement in both patient reported outcomes and objective manometric parameters in older adults. This is an important finding because our data supports the efficacy of BFB among older adults, across all levels of education. Given the profound burden of constipation with DD in older adults, we propose biofeedback therapy continue to be given strong consideration as first line therapy for this population.

1529 An Interesting Presentation of Solitary Rectal Ulcer Syndrome Mimicking a Rectal Mass

INTRODUCTION: Solitary Rectal Ulcer Syndrome (SRUS) is an uncommon benign disease. The diagnosis is based on clinical features, proctosigmoidoscopy findings, and histopathology. Men and women are equally affected. The term SRUS is a misnomer as ulcers are only found in 40% of patients and a solitary ulcer is only identified in 20% of patients. Clinical features include rectal bleeding, mucus discharge, excess straining, perineal or abdominal pain, sensation of incomplete evacuation, constipation or rectal prolapse. Characteristic histologic features include obliteration of the lamina propria by fibrosis and smooth muscle fibers extending from a thickened muscularis mucosa to the lumen. We present a case of SRUS presenting as a rectal mass. CASE DESCRIPTION/METHODS: A 70 year old female with a history of hepatitis C and colon polyps presented after a hospital admission for infectious colitis. Colonoscopy revealed a 3 cm multi-lobulated rectal polyp with superficial ulceration approximately 10 cm from the anal verge. Endoscopic mucosal resection was performed with complete piecemeal resection. Histopathology revealed solitary polypoid growth (Figure 2), fibromuscular hyperplasia and obliteration of the lamina propria (Figure 3) suggestive of solitary rectal ulcer syndrome. The patient was managed with a strict high fiber diet. DISCUSSION: The etiology of SRUS may include ischemia due to impacted stools and local trauma from self-disimpaction. 25% of SRUS cases may present as a polypoid lesion, 18% as patchy mucosal erythema and 30% as multiple lesions. Given the wide variety of presentations, rectal biopsies are critical for diagnosis. Anorectal physiology studies indicate 24-82% of patients with this condition may have dyssynergia with paradoxical anal contraction. Treatment options include diet and bulking agents, biofeedback therapy, and surgery. The differential diagnosis includes inflammatory bowel disease, ischemic colitis and malignancy. Our case highlights the variable presentations of SRUS and its ability to mimic advanced adenoma and rectal malignancy. Gastroenterologists must carry a high index of suspicion for SRUS when approaching rectal lesions in the proper clinical context.

Fecal Calprotectin as a Marker of the Gut Immune System Activation Is Elevated in Parkinson's Disease.

IntroductionAlpha-synucleinopathy constituting a characteristic feature of Parkinson’s disease (PD) occurs at all levels of the brain-gut axis including the enteric nervous system (ENS). Lesions in the ENS may be connected with gut inflammation, increased intestinal permeability and dysmotility contributing to the pathogenesis of PD and its gastrointestinal manifestations.AimsTo evaluate fecal calprotectin and zonulin as biomarkers of gut inflammation and intestinal barrier dysfunction in PD patients.MethodsQuantitative evaluation of fecal biomarkers was performed by ELISA tests in 35 PD patients and 20 healthy controls. Additionally, patients filled out a short questionnaire concerning gastrointestinal symptoms.ResultsMedian fecal calprotectin level (μg/g) was significantly higher in PD patients compared to the controls: 54.5 (29.0–137.9) vs. 9.7 (5.2–23.3), p < 0.0001. Applying age-related reference ranges, the increased fecal calprotectin level was found in 43% of PD patients and in none of the control subjects (p < 0.001). No correlation between fecal calprotectin level and PD duration was observed. No statistically significant difference between the groups regarding zonulin level was found. The most frequent bowel symptoms reported by PD patients included constipation (69% of subjects), feeling of incomplete evacuation (51%), bloating (51%), abdominal pain (20%), and alternating bowel movement pattern (17%).ConclusionThe evaluation of fecal calprotectin level may be a useful tool to detect the signs of gut immune system activation present in a remarkable number of PD patients, also in the early stage of the disease. Calprotectin may constitute a critical link between amyloid formation and neuroinflammatory cascades serving as a prospective diagnostic and therapeutic target.

Effects of oxytocin administration on milk yield and milk composition of West African Dwarf does

Abstract Incomplete evacuation of milk from the alveoli during milking leads to reduced milk yield and milk quality. This makes it imperative to search for means of enhancing complete removal of milk from the udder. The study was carried out to determine the effects of oxytocin (OT) administration on milk yield and milk composition of twenty one lactating West African Dwarf (WAD) does. The 21 does were grouped into three treatment groups of seven animals each, homogeneous by weight and parity, and fed 0.3–0.5 kg and 1 kg/head/day concentrate and Panicum maximum respectively and they have free access to water until the end of the experiment. Does were administered oxytocin intramuscularly for 12 weeks according to the dose assigned to each group: 0, 2, and 4 IU respectively. The experiment commenced five days post-partum. Does were injected with 1 IU synthetic oxytocin in the evening (7:00 pm) of weekly separation from their kids and hand milked to empty their udders. After 12 h of separation, the does were injected with the appropriate dose of oxytocin and hand milked. Weekly data were collected on milk yield, fat, protein, lactose, total solids, moisture, ash, solids-not-fat, milk pH and titratable acidity. Data were subjected to Analysis of Variance using the General Linear Model for repeated measures in Analytical Computer Package, Version 5.02 (SYSTAT, 1992). Milk yield was significantly (P

Preparation and Characterization of Mill Scale Industrial Waste Reduced by Biomass-Based Carbon

Utilizing locally based and renewable biomass resources are challenging. This work aims to understand the role of the utilization of solid byproduct of Indonesian mill scale, formed during the cold rolling process, and abundant local resources of coconut coir wastes. Mill scale has a fairly high total iron content with the dominant phase being hematite, while pure Fe content is insignificant. In this study, we utilized coconut coir-based carbon (CCC) for direct reduction of mill scale via a carbothermic process to enhance its metallic Fe content. The reduction was carried out by mixing mill scale/CCC at 6:1 wt% ratio in high energy milling for 2 min. The mixture was pressed (100 MPa for 1 min) into pellets and sintered at 900 °C for 1 h and 1000 °C for 1 and 2 h under inert gas atmosphere. After cooling, the sintered pellets were crushed into powder and separated from impurities by magnetic separation. The results show that the reduction process is dominated by carbon gasification–diffusion from CCC. The improved metallization and better reducing process was more pronounced at 1000 °C for 2 h than that for 1 h with over 80 wt% being separated into metallic Fe and lesser CO2 trapped within the sample. X-ray diffractometry revealed that the intimate contact of mill scale/CCC was more increased in solid than that in powder state and indicated that the obtained phases are Fe, Fe3O4, and CO2. The presence of CO2 can be expected due to incomplete evacuation within the sample. These results suggest that mill scale/CCC has some promising potential on certain technical-industrial-scale applications, which might enhance their economic value after further research investigation and evaluation.

Emergency evacuation with incomplete information in the presence of obstacles

Pedestrians can be modeled as self-driven particles influenced by “social forces” in emergency evacuation scenarios. It has been suggested by recent studies that placing an obstacle near the exit can boost evacuation efficiency. Here we consider the situation that pedestrians are not acquainted with the evacuation environment, that is, pedestrians cannot specify the location of the exit. By dividing the evacuation space into different areas, the improved “social force model” was adopted to compare the path selection and evacuation tactic of pedestrians under the condition of complete and incomplete evacuation information. The simulations reveal that the total evacuation time depends on complex elements, such as the desired velocity, parameters of obstacle. There are some optimal values of these factors resulting in the minimum value of total evacuation time. Moreover, we also consider that when pedestrians are not fully aware of the evacuation information, the pedestrians flow rate is not necessarily altered by the presence of an obstacle. As the value of the pedestrian perception range increases, evacuation efficiency will be enhanced. When the value of perception range exceeds a certain threshold, the evacuation efficiency is contingent on the distance between pedestrians and the door. More importantly, we explore how to improve evacuation efficiency under these settings. We hope to offer some insights into effective emergency evacuations.

Clinical features and treatment options among Chinese adults with self-reported constipation: An internet-based survey.

We aimed to investigate the clinical features, precipitating factors, bowel habits, bothersome symptoms and treatment strategies of individuals in China with self-reported constipation. An internet-based survey was conducted in China. The participants had self-reported chronic constipation (≥1 symptoms including straining, hard stools, time-consuming defecation, sensations of incomplete evacuation and anorectal blockage, using manual assistance, and fewer than three defecations per week, for over 6 months). Data on their sex, age and occupation, precipitating factors, bowel habit, main symptoms and treatment options were collected. Overall, 6318 participants fulfilled the inclusion criteria for chronic constipation. More women (54.6%, n = 3450) than men reported constipation. The most common age group for constipation was 31 to 40 years (40.0%, n = 2520) and the most common occupation was office workers (43.6%, n = 2754). Disordered eating routines, consuming spicy food, and failure to defecate in time were the most common factors associated with constipation. Overall, 76.0% (n = 4804) participants did not defecate in the morning; 56.2% (n = 3548) spent 6 to 15 minutes in defecating. The most prevalent symptom was straining (39.4%, n = 2489). For preferred treatment options, 81.7% (n = 5160) selected changes in their lifestyle and diet, 51.1% (n = 3229) selected using traditional Chinese medicine, and 25.2% (n = 1590) selected using laxatives. Constipation rates were higher in women, people aged 31 to 40 years old, and those working in offices. Having eating disorders, eating spicy food and withholding stools were the most common precipitating factors. Straining was the most prevalent symptom. Lifestyle changes were the most common action taken for managing constipation.