Stool Volume Research Articles

Hubungan Perilaku Mencuci Tangan Dengan Kejadian Diare Pada Anak Di Wilayah Kerja Puskesmas Cirimekar Tahun 2023

Diarrhea is a condition where there is increased defecation due to an infection. Children can be said to have diarrhea if the volume of stool is measured at 10ml/kg per day. According to the World Health Organization (WHO) 2020, the benefit of washing hands is to keep hands clean, not only as an effective defense against the spread of infections and serious diseases. The aim of the research was to determine the relationship between hand washing and the incidence of diarrhea in children in Cibinong District. This type of research is quantitative research. The research design used is correlational research with a controlling approach. The sampling technique uses total sampling. The number of samples in this research is 30 medical records of children suffering from diarrhea at the Cirimekar Community Health Center. In this research, the Chi-Square statistical test is used. . The results show that the relationship between hand washing behavior and the incidence of diarrhea shows that the P-Value is 0.001 <0.05, so it can be concluded that there is a significant relationship between hand washing behavior and the incidence of diarrhea in children in the Cirimekar Health Center Working Area. The conclusion of this research is that there is a relationship between hand washing behavior and the incidence of diarrhea in children in the Cirimekar Health Center Working Area in 2023.

Effects of Prebiotic Yeast Mannan on Gut Health and Sleep Quality in Healthy Adults: A Randomized, Double-Blind, Placebo-Controlled Study.

Human gut health is closely related to sleep. We aimed to evaluate the efficacy of yeast mannan (YM) in improving bowel habits and sleep quality, along with metabolomics in fecal samples. A total of 40 healthy adults (age range, 22-64 years) with discomfort in defecation were enrolled and randomly allocated to receive either YM (n = 20; 1.1 g/day) or placebo (n = 20) for four weeks. Participants recorded their defecation habits throughout the test periods. Sleep electroencephalogram (EEG) recording using an EEG device and fecal sampling were performed pre- and post-treatment. The YM group significantly increased defecation frequency and stool volumes compared to the placebo group. After 4 weeks of treatment, the non-REM sleep stage 3 (N3) duration in the YM group was significantly higher than that in the placebo group. YM ingestion significantly lengthened total time in bed (TIB) and significantly shortened N3 latency compared to placebo intake during the trial. The metabolomics analysis found a total of 20 metabolite differences between the YM and placebo groups. As a result of stepwise linear regression, changes in fecal propionate and gamma-aminobutyric acid (GABA) levels were identified as the primary factors explaining changes in TIB and N3 latency, respectively. Our findings suggest that the prebiotic YM could be beneficial to gut health and sleep quality.

Acute gastroenteritis-changes to the recommended original oral rehydrating salts: a review.

The World Health Organization recommended a formulation of oral rehydration salts as the intervention of choice for the treatment of acute gastroenteritis. While of value for the replacement of fluids and electrolytes, the formulation does not reduce stool volume, frequency, or symptom duration. This may prevent wide acceptance. To increase tolerability, shorten the duration of diarrhea and improve parental quality of life, several modifications to the original formula have been proposed. These include; low osmolarity, rice-based, glucose polymers as an alternative to glucose, the addition of probiotics, prebiotics and/or zinc, and various other ingredients. Here we summarize evidence regarding such changes and additions.

Pharmacological Management of Cholera: A Century of Expert Opinions in Cecil Textbook of Medicine.

Cholera is a potentially lethal diarrheal disease produced by Vibrio cholerae serotypes O1 El Tor and O139. Known since antiquity, the condition causes epidemics in many areas, particularly in Asia, Africa, and South America. Left untreated, the mortality may reach 50%. The crucial therapeutic intervention is intravenous or oral rehydration and correction of acidosis, dyselectrolytemia, and renal impairment. Antibiotic use represents the main pharmacological intervention. What are the milestones of the antibiotics use recommended by experts for the pharmacological management of cholera in the past century? To determine the changes in the experts' approach to the management of cholera and particularly the use of antibiotics as presented in a widely used textbook in the United States. The chapters describing the management of cholera in the 26 editions of Cecil Textbook of Medicine published from 1927 through 2020. Sulfonamides were recommended in 1947, followed by the introduction of tetracyclines, chloramphenicol, and furazolidone in 1955. The options were restricted in 2000 to doxycycline. In the past decade, patients infected with strains known to have a degree a resistance to tetracyclines were treated with azithromycin or ciprofloxacin. Antibiotic use decreases the volume of stool and the duration of diarrhea but has not been considered lifesaving. Drugs with antimotility, antiemetic, or antisecretory properties are not useful. The utility of antibiotic use in cholera has been endorsed by experts, but only as an adjunct to rapid and complete fluid and electrolyte replacement.

Ayurvedic case study of Balatisara

In contemporary science, watery diarrhoea and Atisara are closely related. Ayurveda defines Atisara as excessive frequency and volume of watery stools passing, where Atisara is ATI (excessive) and Saranam (flow). According to folklore, Atisara first appeared as a result of eating flesh from cows and bulls. Agnidushti is brought on by the Guru and Ushna Guna of cow and bull flesh. Bhaya, Shoka and other Mansika Doshas, among others, develop Atisara. Atisara has Krimi as a significant cause. According to Ayurvedic science, Agnidushti is the main cause of Atisara. Agni's primary location is Grahani. Between Amashaya and Pakwashaya, it is located. Food particle digestion is incomplete when Mandagni is present. Ama is created as a result of this. Ama is considered like toxins or pathogens which is responsible for etiology of all disease. This Ama leads to vitiation of Vata like Saman Vata and Apana Vata Dushti. In Samyawashtha of Apana Vata is responsible for defecation, micturition, and Nishkramana of Shukra and Artava, A 9 year male patient diagnosed with Atisara and treated with Ayurvedic management.

Effects of Teduglutide on Diarrhea in Pediatric Patients with Short Bowel Syndrome-Associated Intestinal Failure.

This post-hoc analysis evaluated the effect of teduglutide treatment on diarrhea in patients with short bowel syndrome-associated intestinal failure (SBS-IF). Data from 2 open-label, multicenter, phase 3 pediatric SBS-IF clinical trials of teduglutide (NCT01952080 and NCT02682381) were pooled where possible. The primary objective was to evaluate the change in stool consistency, frequency, and volume from baseline to weeks 12 and 24 of treatment in patients who received any teduglutide dose from both studies ("total teduglutide"). Safety assessments included gastrointestinal adverse event reporting. Overall, 101 patients were analyzed. Among the total teduglutide group (n = 87), there were significant changes from baseline to weeks 12 and 24 in mean (standard error) Bristol Stool Form Scale (BSFS) score [-1.8 (0.26; P < 0.0001) and -2.2 (0.27; P < 0.0001), respectively], parenteral nutrition and/or intravenous fluid (PN/IV) volume [-16.9 (1.7; P < 0.0001) and -20.1 (2.3; P < 0.0001) mL/kg/day, respectively], and enteral nutrition volume [9.2 (1.7; P < 0.0001) and 9.6 (2.3; P = 0.0002) mL/kg/day, respectively]. Among patients in the standard of care group (n = 14) there were numerical changes in BSFS score, and enteral nutrition volume at weeks 12 and 24; significant changes in PN/IV volume [-6.9 (1.5) mL/kg/day; P = 0.0041] were observed at 24 weeks, but not at 12 weeks. In this post-hoc analysis, short-term treatment with teduglutide was associated with improved stool consistency, as well as trends towards reductions in PN/IV requirements and advancements in enteral nutrition volume in children with SBS-IF. Further research assessing the impact of patient-level factors on stool characteristics when using teduglutide is warranted.

Effects of intake of Lactococcus cremoris subsp. cremoris FC on constipation symptoms and immune system in healthy participants with mild constipation: a double-blind, placebo-controlled study

This study evaluated the effect of Lactococcus cremoris subsp. cremoris FC (FC) on constipation symptoms and the immune system in healthy participants with mild constipation. Eighty-three participants were randomised into four groups with different doses: 50, 75, and 100 mg of freeze-dried FC (test) or corn starch (placebo). Defaecation frequency significantly increased in all test groups compared to the placebo group. Stool appearance and volume were improved considerably within the groups administered 50 mg and 75 mg of FC. The abundances of total bacteria, Bifidobacterium spp., and Lactobacillus group in the faeces showed increasing trends in the test groups. Regarding immunological parameters, the naive T cell counts in the blood were significantly higher at a dose of 75 mg of FC in the test group than in the placebo group. These results suggest that FC intake improves defaecation and some immunological parameters, especially naive T cell counts, in healthy adults.

Diagnosis and Management of Constipation: A Narrative Literature Review

Constipation can occur as a primary or secondary condition. This literature review aimed to describe the diagnosis and management of constipation. Primary constipation is generally classified into three categories. Normal transit (functional) constipation involves a normal rate of passage of stool, but there is difficulty with the evacuation of the stool. Functional constipation is most common and is associated with a sedentary lifestyle, a low-residue diet (consumption of very refined foods), or low fluid intake, which decreases stool volume and bulk and can lead to constipation. Lack of access to toilet facilities, consistent suppression of the urge to empty the bowels, and dehydration are other causes. Slow transit constipation involves impaired motor activity of the colon with infrequent bowel movements, straining to have a bowel movement, mild abdominal distention, and palpable stool in the sigmoid colon. Pelvic floor dysfunction (pelvic floor dyssynergia-anismus), or outlet dysfunction, is difficulty passing stool due to failure of the pelvic floor muscles or anal sphincter to relax with a bowel movement.

Effects of &lt;i&gt;Bifidobacterium longum&lt;/i&gt; CLA8013 on bowel movement improvement: a placebo-controlled, randomized, double-blind study

A placebo-controlled, randomized, double-blind study was conducted to evaluate the effect of taking 25 billion colony-forming units of heat-killed Bifidobacterium longum CLA8013 over 2 weeks on bowel movements in constipation-prone healthy individuals. The primary endpoint was the change in defecation frequency between the baseline and 2 weeks after the intake of B. longum CLA8013. The secondary endpoints were the number of days of defecation, stool volume, stool consistency, straining during defecation, pain during defecation, feeling of incomplete evacuation after defecation, abdominal bloating, fecal water content, and the Japanese version of the Patient Assessment of Constipation Quality of Life. A total of 120 individuals were assigned to two groups, 104 (control group, n=51; treatment group, n=53) of whom were included in the analysis. After 2 weeks of consuming the heat-killed B. longum CLA8013, defecation frequency increased significantly in the treatment group compared with that in the control group. Furthermore, compared with the control group, the treatment group showed a significant increase in stool volume and significant improvement in stool consistency, straining during defecation, and pain during defecation. No adverse events attributable to the heat-killed B. longum CLA8013 were observed during the study period. This study revealed that heat-killed B. longum CLA8013 improved the bowel movements of constipation-prone healthy individuals and confirmed that there were no relevant safety issues.

Correlation between Constipation Symptoms and Abdominal CT Imaging: A Cross-Sectional Pilot Study.

Evaluation of chronic constipation is important, although it is often difficult to satisfactorily treat due to the complex interplay of factors. This study aimed to determine whether the volume of intraluminal contents and lateral diameter of the colon measured from computed tomography (CT) images were correlated with the symptoms of chronic constipation and stool consistency. Consecutive patients who underwent the Constipation Scoring System (CSS), Bristol Stool Form Scale (BSFS) questionnaires and simple abdominal CT were selected retrospectively. The intestinal tract diameter at each site was measured, and the amounts of stool and gas in the intestinal tract were evaluated at five levels. Of the 149 study participants, 54 were males and 95 were females and their mean age was 72.1 years. In the right hemi-colon, CSS5 (Time) correlated significantly with gas volume (p < 0.01). In the left hemi-colon, stool volume correlated significantly with CSS2 (Difficulty), CSS3 (Completeness), CSS5 (Time) and CSS total (p < 0.05). The BSFS negatively correlated with gas volume and diameter in the right hemi-colon and with gas volume in the rectum (p < 0.05). CT findings including stool volume, gas volume and diameter correlated with some constipation symptoms and stool consistency. These findings may be useful in evaluating and treating constipation.

486: CHOLERA IN THE TIME OF COVID

Introduction: Cholera is endemic to 50 countries with most US cases acquired during international travel. However, several cases have occurred from the ingestion of local oysters, crabs, and shrimp with resident Vibrio cholerae strains on the Gulf Coast. Description: A 52-year-old man with insulin dependent diabetes mellitus and well controlled HIV presented with hypovolemic shock. He reported 4 days of non-bloody diarrhea, poor oral intake, and oliguria. Before symptom onset, he ate crabs and tasted the water they were boiled in. He was prescribed azithromycin outpatient which mildly improved his diarrhea but presented to the hospital due to dizziness. He was initially hypotensive but this improved with 2 liters of normal saline without needing vasopressors. He had a blood glucose of 417 mg/dL, sodium bicarbonate of 13 mmol/L, anion gap of 29, creatinine of 10.5 mg/dL, calcium 8.3 mg/dL and corrected sodium of 124 mmol/L. Lactate and beta-hydroxybutyric acid levels were normal. Prior to admission, he took his insulin despite little oral intake. Given his glucose level and anion gap acidosis, he was placed on an insulin drip for concern of diabetic ketoacidosis (DKA). Stool PCR was positive for Vibrio cholerae and Salmonella enterica. Blood cultures were also positive for S. enterica. He received doxycycline for cholera and 14 days of ciprofloxacin for salmonella bacteremia. During his hospitalization, he got 14 liters of fluids with resolution of electrolyte abnormalities by discharge. Discussion: In this patient, the anion gap acidosis was concerning for DKA but normal ketones made this diagnosis less likely. Cholera infection leads to “rice water” stool outputs up to 200cc/kg/hour in the first 2 days then ending after 4-6 days with profound electrolyte abnormalities. Due to rapid volume loss, patients present in hypovolemic shock with hyponatremia, hypocalcemia and hypoglycemia. Anion gap metabolic acidosis occurs due to acute tubular necrosis as in this patient. Stool culture is the gold standard for diagnosis. Treatment with doxycycline, ciprofloxacin or azithromycin decreases the duration of illness and reduces stool volume by 50%. Despite its rarity in the US, cholera should be considered and promptly treated in patients presenting with copious diarrhea, hypovolemia, and renal failure.

The Potential Health Benefits of Resistant Starch on Human Metabolism- A Narrative Review

Resistant starch, also known as water-soluble dietary fiber, has the advantages of both water-soluble and insoluble fibers. The characteristic of resistant starch is that resistant starch is difficult to be absorbed by the small intestine, so it will not increase blood sugar and has the effect of controlling blood sugar. Like dietary fiber, it is decomposed after entering the large bowel and becomes food for beneficial bacteria in the intestine, which contributes to intestinal health. Its functions include: delaying gastric emptying, preventing a sharp rise in blood sugar, lowering blood cholesterol, and the functions of insoluble dietary fiber include: increasing stool volume, promoting intestinal peristalsis, preventing constipation and hemorrhoids, preventing colorectal diverticulitis and colorectal cancer. The term resistant starch appeared in 1982, also known as difficult-to-digest starch or the third type of dietary fiber. Resistant starch cannot be decomposed by human digestive enzymes until the colon end. The heat generated by the fermentation and utilization of intestinal bacteria is much lower than that of ordinary starch, and the maximum heat generated per gram is no more than 2.8 kcal (ordinary starch is 4 kcal).

S2079 Not Just Another Case of Diarrhea: A Case of Vibrio Cholera During COVID-19 Era

Introduction: Vibrio cholerae is a gram negative, comma-shaped, toxin producing bacteria, which causes large volumes of watery stool leading to dehydration, hypovolemic shock, and metabolic acidosis. Stool culture with PCR is the gold standard for diagnosis. It is pertinent that if cholera is a differential, treatment with isotonic oral rehydration and antibiotics are not delayed. When traveling to endemic or epidemic areas vaccination should be considered. Here we discuss a case of Vibrio cholera infection diagnosed in Farmington, Connecticut in a patient with recent travel back from Pakistan in mid-April 2022. Case Description/Methods: 61-year-old female with no relevant past medical history presented to the hospital complaining of fatigue and 3 days of profuse, watery, dark diarrhea occurring 8 times daily, starting the day she returned home to Connecticut after traveling in Pakistan. She drank primarily store-bought bottled water but reported some cooking with tap water. She was lethargic and hypovolemic with a diffusely tender abdomen and hyperactive bowel sounds. Lab work was pertinent for leukocytosis, AKI, hypokalemia, and mild metabolic acidosis. Hemoccult stool, Clostridium difficile toxins A&B, Salmonella, Shigella, and fecal leukocyte count were negative. Her course was complicated by altered mental status, worsening AKI, hypokalemia, and metabolic acidosis requiring a bicarbonate drip. Eight days into her admission stool study resulted positive for cholera (Figure 1). Her metabolic derangements were aggressively treated, and her symptoms improved. Discussion: During the COVID-19 pandemic and ongoing travel restrictions, cholera is not typically the first infection thought of for patients with diarrhea and fatigue. Still, we are seeing cases rise in locations where cholera case-fatality rates were previously dropping in a pre-pandemic COVID-era, thought to be from reduced health promotion activities.1 In 2019, the Center for Disease Control and Prevention reported a total of 14 cases of Vibrio cholera within the United States,2 most from overseas travel. Thus, it is important to keep a broad differential diagnosis regardless of location even during a time of travel restrictions.Figure 1.: Vibrio culture on thiosulfate-citrate-bile salts-sucrose (TCBS) agar (left) and on blood agar (right).

122 Human-Grade dog Diets Dramatically Shift the Fecal Microbiome of Healthy Adult Dogs

Abstract Human-grade pet foods have been shown to be highly palatable and digestible, resulting in reduced stool volume, but their impact on the gut microbiome has not been well studied. Therefore, our objective was to compare the fecal characteristics and microbiome of dogs consuming a human-grade or extruded kibble diet. Female beagles (n = 20; BW = 10.25±0.82 kg; age = 3.85±1.84 yr) were used in a completely randomized design. The diets tested were: 1) Chicken and Brown Rice Recipe [extruded; Blue Buffalo (BB)] and 2) Chicken and White Rice [human-grade; Just Food for Dogs (JFFD)]. The study consisted of a 4-week baseline when all dogs were fed BB, and a 12-week treatment phase when dogs were randomized to eat each diet (n=10/group). After the baseline and treatment phases, fresh fecal samples were collected for fecal pH, dry matter (DM), score, and microbiota analysis. Fecal bacterial DNA was extracted and shotgun sequencing was conducted using an Illumina NovaSeq, generating over 1.8 billion reads. Taxonomic and pathway abundances were calculated using MetaPhlan and HUMAnN, respectively. Fecal pH and DM were less (p&amp;lt; 0.05) in dogs fed JFFD than those fed BB, but fecal scores were not affected by diet. PCoA plots based on Bray-Curtis distances of bacterial genera and species showed some shifts over time in dogs fed BB, but much greater shifts in those fed JFFD. JFFD increased (adj p&amp;lt; 0.05) the relative abundances of 4 bacterial genera, 11 bacterial species, 129 KEGG pathways, and 167 Maaslin pathways and decreased (adj p&amp;lt; 0.05) the relative abundances of 16 bacterial genera, 25 bacterial species, 37 KEGG pathways, and 87 Maaslin pathways. In conclusion, the human-grade food tested vastly shifted the fecal microbiome. More research is needed to link taxonomic and gene content shifts to ingredient inclusion, nutrient concentrations, and health outcomes.

Prevalence of diarrhea in adult patients in intensive care and its relationship with ready-to-use enteral formulas

Diarrhea is a frequent complication in critically ill patients. Its origin is multifactorial. The objective of this work is to analyze the relationship between 5 ready-to-use formulas and the development of diarrhea in critically ill patients. Retrospective study where the volume of the stools of 315 patients and the presence of diarrhea defined with a cut-off point of a volume of 250 ml/day were evaluated. 35.34% of the patients presented diarrhea with said cut-off point. The mean volume of stools was 269.20 ml (95% CI: 255.05-283.06). It was observed that all the formulas analyzed had a slight correlation with the Spearman test between the volume provided and the volume of stools, being: Nutricia Nutrison ® (R: 0.159; P: 0.053), Nutricia Multifibra ® (R: 0.296; <0.001), Nutricia Peptisorb ® (R: 0.323; P<0.001), Nutricia Protison ® (R: 0.108; P<0.001), Fresenius Supportan ® (R: 0.152; P<0.001). Multivariate analysis was performed and it was observed that there were no differences in the incidence of diarrhea between the different enteral formulas during the first 10 days. The change of formulas during hospitalization would be a predisposing factor for diarrhea. Therefore, the formula and the volume provided are factors that could influence whether patients have diarrhoea. Understanding these possible influences in a deeper way will allow the safest choice of enteral formulas for a patient with diarrhea.

Antidiarrheal and Antibacterial Activities of Calpurnia aurea: Benth Seed Different Extracts.

Background Calpurnia aurea is believed to have antidiarrheal potential but with limited scientific evidence. This study aimed investigating antidiarrheal and antibacterial activity of aqueous and 80% methanol seed extracts of the plant in mice and selected diarrhea-causing bacterial strains, respectively. Methods Castor oil-induced diarrhea, prostaglandin-induced enteropooling, and castor oil-induced charcoal meal test models in mice of either sex using three dose levels (60, 120, and 240 mg/kg) were applied to evaluate antidiarrheal activity. Parameters, including onset, number, wet stool weight, weight and volume of secretion, and intestinal motility, were taken into consideration. The antibacterial activity was assessed on Shigella soni, Salmonella typhimurium, Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa using disk diffusion and microdilution techniques. Results Compared to controls, pretreatment of mice at the graded dose (60, 120, and 240 mg/kg) resulted in a significant (p < 0.05) drop in frequency of wet stools and watery content of diarrhea as well as in delaying onset of diarrhea. Both extracts exhibited inhibition of diarrhea in a dose-dependent manner in all models used. The extracts also showed significant (p < 0.05) reduction in intestinal motility in castor oil-induced models. Both extracts showed a marginal activity against the selected bacterial strains; a better effect was seen with 80% methanol seed extract. Conclusion Both extracts of the plant have beneficial effect in controlling diarrhea. This finding supports the use of the plant as a traditional antidiarrheal remedy.

Effectiveness of nitazoxanide in the treatment of COVID-19 related diarrhoea

Background: Diarrhoea is becoming one of the most prominent and troublesome manifestations in COVID-19 infection but no definitive treatment is available. So Nitazoxanide was used to see whether it can shorten the duration and sufferings form COVID-19 related diarrhoea.&#x0D; Objective: To see the efficacy of Nitazoxanide in decreasing frequency and improving the consistency of stool in COVID-19 related diarrhoea.&#x0D; Methods: This randomized comparative study was done in private chambers of medicine specialists in Khulna and patients admitted in corona dedicated hospital, Khulna from July 2020 to June 2021. 100 patients were enrolled in the study using Nitazoxanide &amp; ORS (oral rehydration solution) in 50 patients and only ORS in another 50 patients. Decreased frequency and volume of stool at 24, 48 and 72 hours of both groups were compared.&#x0D; Results: After giving Nitazoxanide in diarrhoea of COVID-19 patients, improvement was in 90% patients at 24 hours: in 96% patients in 48 hours and in 98% cases at 72 hours. On the other hand, without Nitazoxanide improvement was found in 30%, 40% and 50% cases at 24, 48 and 72 hours respectively. So Nitazoxanide was effective (p &lt;0.05) at reducing frequency of diarrhoea and improving the consistency of stool.&#x0D; Conclusion: Nitazoxanide significantly improves diarrhoea in COVID-19 patients by reducing duration of diarrhoea and improving consistency of stool.&#x0D; Bang Med J Khulna 2021; 54 : 13-16

Randomized controlled trial: neostigmine for intra-abdominal hypertension in acute pancreatitis

BackgroundIntra-abdominal hypertension (IAH) in acute pancreatitis (AP) is associated with deterioration in organ function. This trial aimed to assess the efficacy of neostigmine for IAH in patients with AP.MethodsIn this single-center, randomized trial, consenting patients with IAH within 2 weeks of AP onset received conventional treatment for 24 h. Patients with sustained intra-abdominal pressure (IAP) ≥ 12 mmHg were randomized to receive intramuscular neostigmine (1 mg every 12 h increased to every 8 h or every 6 h, depending on response) or continue conventional treatment for 7 days. The primary outcome was the percent change of IAP at 24 h after randomization.ResultsA total of 80 patients were recruited to neostigmine (n = 40) or conventional treatment (n = 40). There was no significant difference in baseline parameters. The rate of decrease in IAP was significantly faster in the neostigmine group compared to the conventional group by 24 h (median with 25th–75th percentile: −18.7% [− 28.4 to − 4.7%] vs. − 5.4% [− 18.0% to 0], P = 0.017). This effect was more pronounced in patients with baseline IAP ≥ 15 mmHg (P = 0.018). Per-protocol analysis confirmed these results (P = 0.03). Stool volume was consistently higher in the neostigmine group during the 7-day observational period (all P < 0.05). Other secondary outcomes were not significantly different between neostigmine and conventional treatment groups.ConclusionNeostigmine reduced IAP and promoted defecation in patients with AP and IAH. These results warrant a larger, placebo-controlled, double-blind phase III trial.Trial registration Clinical Trial No: NCT02543658 (registered August /27, 2015).

Diet and Gut Microbiome and the "Chicken or Egg" Problem.

Quantity and quality of the intestinal and fecal microbiome vary considerably between individuals and are dependent on a very large number of intrinsic and environmental factors. Currently, only around 15% of the variance in microbiome diversity can be explained by these factors. Although diet and individual food items have effects, other individual parameters such as gender, age, body mass index (BMI), but also plasma lipids and blood pressure reveal stronger associations with microbiome diversity. In addition, gastrointestinal functions that translate into changes in stool frequency, stool volume, and stool appearance rank very high as effectors of microbiome signatures. In particular, the intestinal/colonic transit time is a critical factor that alters the substrate load for bacterial growth and metabolism as it alters simultaneously stool volume, water content, bacterial mass, and diversity. Moreover, metabolic and neurological diseases are frequently associated with marked changes in intestinal transit time that may translate into the reported changes in gut microbiota. This review provides scientific arguments for a more comprehensive assessment of the individual's intestinal phenotype in microbiome studies to resolve the “chicken or egg” problem in these observational studies.

Steroid-resistant intestinal aGVHD and refractory CMV and EBV infections complicated by haplo-HSCT were successfully rescued by FMT and CTL infusion

Haploidentical hematopoietic stem cell transplantation (haplo-HSCT) produces similar survival outcomes as HLA-matched sibling donor allogeneic HCST in younger patients with acquired severe aplastic anemia (SAA). This study reported a 29-years-old man with SAA and intracranial hemorrhage who underwent haplo-HSCT with a modified BU/CY + ATG conditioning regimen. Neutrophil and platelet engraftment were both achieved on day 14 after HSCT. The patient developed grade IV acute graft-versus-host disease (aGVHD) on day 20 and acquired cytomegalovirus (CMV) and Epstein–Barr virus (EBV) infections on day 47. After the failure of methylprednisolone, basiliximab, ruxolitinib, and antiviral treatment, the patient was diagnosed with steroid-resistant grade IV aGVHD and refractory CMV and EBV infections. We performed fecal microbiota transplantation and infused CMV- and EBV-specific cytotoxic T lymphocytes. After that the stool volume and frequency gradually decreased, and viral DNA was undetectable on day 80. This report provides helpful clinical experience for treating steroid-resistant aGVHD and refractory viral infections.