Intestinal microecological transplantation for a patient with chronic radiation enteritis:A case report

BACKGROUND The gut microbiota is strongly associated with radiation-induced gut damage.This study aimed to assess the effectiveness and safety of intestinal microecological transplantation for treating patients with chronic radiation enteritis.CASE SUMMARY A 64-year-old female with cervical cancer developed abdominal pain,diarrhea,and blood in the stool 1 year after radiotherapy.An electronic colonoscopy was performed to diagnose chronic radiation enteritis.Two courses of intestinal microecological transplantation and full-length 16S rRNA microbiological analysis were performed.The patient experienced short-and long-term relief from symptoms without adverse effects.Whole 16S rRNA sequencing revealed significant differences in the intestinal flora’s composition between patient and healthy donors.Pathogenic bacteria,such as Escherichia fergusonii and Romboutsia timonensis,were more in the patient.Beneficial bacteria such as Faecalibacterium prausnitzii,Fusicatenibacter saccharivorans,Ruminococcus bromii,and Bifidobacterium longum were more in the healthy donors.Intestinal microbiota transplantation resulted in a significant change in the patient's intestinal flora composition.The composition converged with the donor's flora,with an increase in core beneficial intestinal bacteria,such as Eubacterium rectale,and a decrease in pathogenic bacteria.Changes in the intestinal flora corresponded with the patients'alleviating clinical symptoms.CONCLUSION Intestinal microecological transplantation is an effective treatment for relieving the clinical symptoms of chronic radiation enteritis by altering the composition of the intestinal flora.This study provides a new approach for treating patients with chronic radiation enteritis.

Relationship between dietary fiber intake and chronic diarrhea in adults

BACKGROUND Dietary fiber is essential for human health and can help reduce the symptoms of constipation.However,the relationship between dietary fiber and diarrhea is,poorly understood.AIM To evaluate the relationship between dietary fiber and chronic diarrhea.METHODS This retrospective study was conducted using data from the United States National Health and Nutrition Examination Survey,conducted between 2005 and 2010.Participants over the age of 20 were included.To measure dietary fiber consumption,two 24-hour meal recall interviews were conducted.The independent relationship between the total amount of dietary fiber and chronic diarrhea was evaluated with multiple logistic regression and interaction analysis.RESULTS Data from 12829 participants were analyzed.Participants without chronic diarrhea consumed more dietary fiber than participants with chronic diarrhea(29.7 vs 28.5,P=0.004).Additionally,in participants with chronic diarrhea,a correlation between sex and dietary fiber intake was present:Women who consume more than 25 g of dietary fiber daily can reduce the occurrence of chronic diarrhea.CONCLUSION Dietary fiber can reduce the occurrence of chronic diarrhea.

Gastrointestinal microbiome and cholelithiasis:Current status and perspectives

Cholelithiasis is a common digestive disease affecting 10%to 15%of adults.It imposes significant global health and financial burdens.However,the pathogenesis of cholelithiasis involves several factors and is incompletely elucidated.In addition to genetic predisposition and hepatic hypersecretion,the pathogenesis of cholelithiasis might involve the gastrointestinal(GI)microbiome,consisting of microorganisms and their metabolites.High-throughput sequencing studies have elucidated the role of bile,gallstones,and the fecal microbiome in cholelithiasis,associating microbiota dysbiosis with gallstone formation.The GI microbiome may drive cholelithogenesis by regulating bile acid metabolism and related signaling pathways.This review examines the literature implicating the GI microbiome in cholelithiasis,specifically gallbladder stones,choledocholithiasis,and asymptomatic gallstones.We also discuss alterations of the GI microbiome and its influence on cholelithogenesis.

Clinical characteristics and outcome of autoimmune pancreatitis based on serum immunoglobulin G4 level:A single-center,retrospective cohort study

BACKGROUND Autoimmune pancreatitis(AIP)has been linked with elevated immunoglobulin(Ig)G4 levels.The characteristics and outcomes of AIP based on serum markers have not been fully evaluated.AIM To compare clinical features,treatment efficacy,and outcome of AIP based on serum IgG4 levels and analyze predictors of relapse.METHODS A total of 213 patients with AIP were consecutively reviewed in our hospital from 2006 to 2021.According to the serum IgG4 level,all patients were divided into two groups,the abnormal group(n=148)with a high level of IgG4[>2×upper limit of normal(ULN)]and the normal group(n=65).The t-test or Mann-Whitney U test was used to compare continuous variables.Categorical parameters were compared by theχ^(2) test or Fisher’s exact test.Kaplan-Meier curves Zhou GZ et al.Clinical characteristics and outcome of AIP WJG https://www.wjgnet.com 5126 September 21,2023 Volume 29 Issue 35 and log-rank tests were established to assess the cumulative relapse rates.Univariate and multivariate analyses were used to investigate potential risk factors of AIP relapse.RESULTS Compared with the normal group,the abnormal group had a higher average male age(60.3±10.4 vs 56.5±12.9 years,P=0.047);higher level of serum total protein(72.5±7.9 g/L vs 67.2±7.5 g/L,P<0.001),IgG4(1420.5±1110.9 mg/dL vs 252.7±106.6 mg/dL,P<0.001),and IgE(635.6±958.1 IU/mL vs 231.7±352.5 IU/mL,P=0.002);and a lower level of serum complement C3(100.6±36.2 mg/dL vs 119.0±45.7 mg/dL,P=0.050).In addition,a lower number of cases with abnormal pancreatic duct and pancreatic atrophy(23.6%vs 37.9%,P=0.045;1.6%vs 8.6%,P=0.020,respectively)and a higher rate of relapse(17.6%vs 6.2%,P=0.030)were seen in the abnormal group.Multivariate analyses revealed that serum IgG4[(>2×ULN),hazard ratio(HR):3.583;95%confidence interval(CI):1.218–10.545;P=0.020]and IgA(>1×ULN;HR:5.908;95%CI:1.199–29.120;P=0.029)and age>55 years(HR:2.383;95%CI:1.056–5.378;P=0.036)were independent risk factors of relapse.CONCLUSION AIP patients with high IgG4 levels have clinical features including a more active immune system and higher relapse rate.Several factors,such as IgG4 and IgA,are associated with relapse.

Update and latest advances in mechanisms and management of colitis-associated colorectal cancer

Colitis-associated colorectal cancer(CAC)is defined as a specific cluster of colorectal cancers that develop as a result of prolonged colitis in patients with inflammatory bowel disease(IBD).Patients with IBD,including ulcerative colitis and Crohn’s disease,are known to have an increased risk of developing CAC.Although the incidence of CAC has significantly decreased over the past few decades,individuals with CAC have increased mortality compared to individuals with sporadic colorectal cancer,and the incidence of CAC increases with duration.Chronic inflammation is generally recognized as a major contributor to the pathogenesis of CAC.CAC has been shown to progress from colitis to dysplasia and finally to carcinoma.Accumulating evidence suggests that multiple immune-mediated pathways,DNA damage pathways,and pathogens are involved in the pathogenesis of CAC.Over the past decade,there has been an increasing effort to develop clinical approaches that could help improve outcomes for CAC patients.Colonoscopic surveillance plays an important role in reducing the risk of advanced and interval cancers.It is generally recommended that CAC patients undergo endoscopic removal or colectomy.This review summarizes the current understanding of CAC,particularly its epidemiology,mechanisms,and management.It focuses on the mechanisms that contribute to the development of CAC,covering advances in genomics,immunology,and the microbiome;presents evidence for management strategies,including endoscopy and colectomy;and discusses new strategies to interfere with the process and development of CAC.These scientific findings will pave the way for the management of CAC in the near future.

Intestinal microbiota pathogenesis and fecal microbiota transplantation for inflammatory bowel disease

The intestinal microbiota plays an important role in inflammatory bowel disease(IBD).The pathogenesis of IBD involves inappropriate ongoing activation of the mucosal immune system driven by abnormal intestinal microbiota in genetically predisposed individuals.However,there are still no definitive microbial pathogens linked to the onset of IBD.The composition and function of the intestinal microbiota and their metabolites are indeed disturbed in IBD patients.The special alterations of gut microbiota associated with IBD remain to be evaluated.The microbial interactions and hostmicrobe immune interactions are still not clarified.Limitations of present probiotic products in IBD are mainly due to modest clinical efficacy,few available strains and no standardized administration.Fecal microbiota transplantation(FMT)may restore intestinal microbial ho-meostasis,and preliminary data have shown the clinical efficacy of FMT on refractory IBD or IBD combined with Clostridium difficile infection.Additionally,synthetic microbiota transplantation with the defined composition of fecal microbiota is also a promising therapeutic approach for IBD.However,FMT-related barriers,including the mechanism of restoring gut microbiota,standardized donor screening,fecal material preparation and administration,and long-term safety should be resolved.The role of intestinal microbiota and FMT in IBD should be further investigated by metagenomic and metatranscriptomic analyses combined with germfree/human flora-associated animals and chemostat gut models.

Chinese physicians' perceptions of fecal microbiota transplantation

AIM: To explore Chinese physicians' perceptions towards fecal microbiota transplantation(FMT) and to provide information and an assessment of FMT development in China.METHODS: A self-administered questionnaire was developed according to the FMT practice guidelines and was distributed to physicians in hospitals via Internet Research Electronic Data Capture(REDcap) software and electronic mails to assess their attitudes toward and knowledge of FMT. The questionnaire included a brief introduction of FMT that was followed by 20 questions. The participants were required to respond voluntarily, under the condition of anonymity and without compensation. Except for the fill-in-the-blank questions, all of the other questions were required in the REDcap data collection systems, and the emailed questionnaires were completed based on eligibility.RESULTS: Up to December 9, 2014, 844 eligible questionnaires were received out of the 980 distributed questionnaires, with a response rate of 86.1%. Among the participants, 87.3% were from tertiary hospitals, and there were 647(76.7%) gastroenterologists and 197(23.3%) physicians in other departments(nongastroenterologists). Gastroenterologists' awareness of FMT prior to the survey was much higher than non-gastroenterologists'(54.3 vs 16.5%, P < 0.001); however, acceptance of FMT was not statistically different(92.4 vs 87.1%, P = 0.1603). Major concerns of FMT included the following: acceptability to patients(79.2%), absence of guidelines(56.9%), and administration and ethics(46.5%). On the basis of understanding, the FMT indications preferred byphysicians were recurrent Clostridium difficile infection(86.7%), inflammatory bowel disease combined with Clostridium difficile infection(78.6%), refractory ulcerative colitis(70.9%), ulcerative colitis(65.4%), Crohn's disease(59.4%), chronic constipation(43.7%), irritable bowel syndrome(39.1%), obesity(28.1%) and type 2 diabetes(23.9%). For donor selection, the majority of physicians preferred individuals with a similar gut flora environment to the recipients. 76.6% of physicians chose lower gastrointestinal tract as the administration approach. 69.2% of physicians considered FMT a safe treatment. CONCLUSION: Chinese physicians have awareness and a high acceptance of FMT, especially gastroenterologists, which provides the grounds and conditions for the development of this novel treatment in China. Physicians' greatest concerns were patient acceptability and absence of guidelines.

Diagnosis of gastric intraepithelial neoplasia by narrow-band imaging and confocal laser endomicroscopy

AIM:To evaluate the diagnosis of different differentiated gastric intraepithelial neoplasia (IN) by magnifica-tion endoscopy combined with narrow-band imaging (ME-NBI) and confocal laser endomicroscopy (CLE). METHODS:Eligible patients with suspected gastric IN lesions previously diagnosed by endoscopy in secondary hospitals and scheduled for further diagnosis and tratment were recruited for this study. Excluded from the study were patients who had liver cirrhosis, impaired renal function, acute gastrointestinal (GI) bleeding, coagulopathy, esophageal varices, jaundice, and GI post-surgery. Also excluded were those who were pregnant, breastfeeding, were younger than 18 years old, or were unable to provide informed consent. All patients had all mucus and bile cleared from their stom-achs. They then received upper GI endoscopy. When a mucosal lesion is found during observation with whitelight imaging, the lesion is visualized using maximal magnification, employing gradual movement of the tip of the endoscope to bring the image into focus. Saved images are analyzed. Confocal images were evaluated by two endoscopists (Huang J and Li MY), who were familiar with CLE, blinded to the related information about the lesions, and asked to classify each lesion as either a low grade dysplasia (LGD) or high grade dysplasia (HGD) according to given criteria. The results were compared with the final histopathologic diagnosis. ME-NBI images were evaluated by two endoscopists (Lu ZS and Ling-Hu EQ) who were familiar with NBI, blinded to the related information about the lesions and CLE images, and were asked to classify each lesion as a LGD or HGD according to the "microvascular pattern and surface pattern" classification system. The results were compared with the final histopathologic diagnosis. RESULTS: The study included 32 pathology-proven low grade gastric IN and 26 pathology-proven high grade gastric IN that were detected with any of the modalities. CLE and ME-NBI enabled clear visualization of the vascular microsurface patterns and microvascular structures of the gastric mucosa. The accuracy of the CLE and the ME-NBI diagnosis was 88% (95% CI:78%-98%) and 81% (95% CI: 69%-93%), respectively. The kappa coefficient of agreement between the histopathology and the in vivo CLE imaging was 0.755; between the histopathology and the in vivo CLE imaging was 0.615. McNemar's test (binomial distribution used) indicated that the agreement was significant (P < 0.05). When patients were diagnosed by MENBI with CLE, the overall accuracy of the diagnosis was 86.21% (95% CI:73%-96%), and the kappa coefficient of agreement was 0.713, according to McNemar's test (P < 0.05). CONCLUSION:Higher diagnostic accuracy, sensitivityand specificity of CLE over ME-NBI indicate the feasibility of these two techniques for the efficacious diagnostic classification of gastric IN.

Mitochondrial ATP 6 and 8 polymorphisms in irritable bowel syndrome with diarrhea

AIM: To investigate mitochondrial ATP 6 and 8 poly-morphisms in the colon and ileum of patients with ir-ritable bowel syndrome with diarrhea (IBS-D). METHODS: Twenty-eight patients fulfilling the Rome Ⅲ criteria for IBS-D and 28 healthy subjects were in-vestigated. All study participants underwent screening colonoscopy and mucosal biopsies were obtained from the colon and/or terminal ileum. Genomic DNA was ex-tracted from specimens based on standard protocols. Mitochondrial ATP (MT-ATP) 6 and 8 genes in speci-mens were polymerase chain reaction amplified and sequenced. Sequencing data were analyzed via Variant Reporter Software and compared with the reference sequence from Genbank (accession No. NC_012920) to indicate possible polymorphisms. The protocol was registered at www.clinicaltrials.gov as NCT01028898. RESULTS: Twenty-five polymorphic sites of MT-ATP 6 and 8 genes were detected and 12 of them were missense mutations. A median of two polymorphic sites in MT-ATP genes was found in colon specimens of controls while a median of three polymorphic sites was noted in patients with IBS-D (Mann-Whitney test, P=0.012). The variants of the colon and ileum speci-mens from the same subjects were identical in all but one case. Symptom duration in IBS was not found to be a significant factor associated with the mtDNA polymorphism (Spearman correlation, P=0.592). The mitochondrial DNA change at 8860 was present in all cases of both groups. The frequency of the 8701 poly-morphism was found to be the second most frequent; however, no statistical difference was noted between the groups (χ2 test, P=0.584). CONCLUSION: Patients with IBS-D have a higher inci-dence of MT-ATP 6 and 8 polymorphisms than healthy subjects, implying that the mtDNA polymorphism may play a role in IBS-D.

Influence of endoscopic submucosal dissection on esophageal motility

AIM: To assess esophageal motility after esophageal endoscopic submucosal dissection (ESD). METHODS: Twelve patients (6 men and 6 women) aged 53-64 years (mean age, 58 years) who underwent regular examination 3-12 mo after esophageal ESD for neoplasms of the esophageal body were included in this study. The ESD procedure was performed under deep sedation using a combination of propofol and fentanyl, and involved a submucosal injection to lift the lesion and use of a dual-knife and an insulated-tip knife to create a circumferential incision around the lesion extending into the submucosa. Esophageal motility was examined using a high-resolution manometry system. Dysphagia was graded using a five-point scale according to the Mellow and Pinkas scoring system. Patient symptoms and the results of esophageal manometry were then analyzed. RESULTS: Of the 12 patients enrolled, 1 patient hadgrade 2 dysphagia, 1 patient had grade 1 dysphagia, and 3 patients complained of sporadic dysphagia. Ineffective esophageal motility was observed in 5 of 6 patients with above semi-circumference of resection extension. Of these 5 patients, 1 patient complained of grade 2 dysphagia (with esophageal stricture), one patient complained of grade 1 dysphagia, and 3 patients complained of sporadic dysphagia. Normal esophageal body manometry was observed in all 6 patients with below semi-circumference of resection extension. The 6 patients with normal esophageal motility did not complain of dysphagia. CONCLUSION: Extensive esophageal ESD may cause esophageal dysmotility in some patients, and might also have an influence on dysphagia although without esophageal stricture.

Autofluorescence imaging endoscopy can distinguish non-erosive reflux disease from functional heartburn: A pilot study

AIM: To investigate whether autofluorescence imaging (AFI) endoscopy can distinguish non-erosive reflux disease (NERD) from functional heartburn (FH).METHODS: In this prospective observational trial, 127 patients presenting with typical reflux symptoms for &#x0003e; 6 mo were screened. All the participants underwent endoscopy, during which white light imaging (WLI) was followed by AFI. Finally 84 patients with normal esophageal appearance on WLI were enrolled. It was defined as being suggestive of NERD if one or more longitudinal purple lines longer than one centimeter were visualized in the distal part of the esophagus during AFI endoscopy. Ambulatory 24-h multichannel intraluminal impedance and pH monitoring was also performed. After standard proton-pump inhibitor (PPI) tests, subjects were divided into an NERD group and an FH group and the diagnostic performance of AFI endoscopy to differentiate NERD from FH was evaluated.RESULTS: Of 84 endoscopy-negative patients, 36 (42.9%) had a normal pH/impedance test. Of these, 26 patients with favorable responses to PPI tests were classified as having NERD. Finally 10 patients were diagnosed with FH and the others with NERD. Altogether, 68 (81.0%) of the 84 patients were positive on AFI endoscopy. In the NERD group, there were 67 (90.5%) patients with abnormal esophageal findings on AFI endoscopy while only 1 (10%) patient was positive on AFI endoscopy in the FH group. The sensitivity and specificity of AFI in differentiating NERD from FH were 90.5% (95%CI: 81.5%-96.1%) and 90.0% (95%CI: 55.5%-99.7%), respectively. Meanwhile, the accuracy, positive predictive value and negative predictive value of AFI in differentiating between NERD and FH were 90.5% (95%CI: 84.2%-96.8%), 98.5% (95%CI: 92.1%-99.9%) and 56.3% (95%CI: 30.0%-80.2%), respectively.CONCLUSION: Autofluorescence imaging may serve as a complementary method in evaluating patients with NERD and FH.

Coronaviruses and gastrointestinal diseases

The effects of coronaviruses on the respiratory system are of great concern,but their effects on the digestive system receive much less attention.Coronaviruses that infect mammals have shown gastrointestinal pathogenicity and caused symptoms such as diarrhea and vomiting.Available data have shown that human coronaviruses,including the newly emerged SARS-CoV-2,mainly infect the respiratory system and cause symptoms such as cough and fever,while they may generate gastrointestinal symptoms.However,there is little about the relation between coronavirus and digestive system.This review specifically addresses the effects of mammalian and human coronaviruses,including SARS-CoV-2,on the digestive tract,helping to cope with the new virus infection-induced disease,COVID-19.

Shiqi herbal tea reduces the susceptibility to H1N1 influenza virus in stressed mice

Objective:It is well known that stress plays a critical role in immune response and susceptibility to diseases.Among many stressors,restraint stress has been shown to suppress immune function and increase susceptibility to infections.In this study,we employed a restraint-mouse model to investigate the effect and preliminary mechanism of ShiQi herbal tea(SQHT),a traditional Chinese medicine,on H1N1 virus infection.Methods:Mice were exposed to restraint stress and infected with H1N1 influenza virus by intranasal inoculation.SQHT(936 and 1872 mg/kg/d)was orally administrated to mice for 7 days from the first day of restraint stress.The survival rate of mice in each group was monitored daily for 21 days.Histopathological changes,inflammatory cells infiltration,and virus titer in lungs were examined.For the study of mechanisms,we investigated whether SQHT could promote interferon-β(IFN-β)generation and interferon stimulated genes(ISG)expression.Results:Our results suggested that SQHT(936 mg/kg/d)significantly reduced H1N1-induced mortality,the level of complement C5a and lung tissue inflammation,and viral replication in restraint-stressed mice.Further results revealed that in restraint-stressed mice model,SQHT(936 mg/kg/d)administration markedly improved IFN-βgeneration,and increased MX1 and IFITM3 gene expression.Conclusion:Our study demonstrates that SQHT reduces restraint stress-induced susceptibility to H1N1 infection via improving IFN-βantiviral pathway,which provides a certain basis for the clinical use of SQHT to treat H1N1 infection.

Comparative analysis of chemical profiles of Radix Astragali between ultrafine granular powder and sliced traditional material

Radix Astragali,one of the most popular herbs in traditional Chinese medicine(TCM),is used to strengthen the immune system,protect liver function,fight bacteria and viruses,and treat diabetes,heart failure and seasonal allergies.In recent years,a new form of Radix Astragali material processed by cell wall disrupting technology,namely ultrafine granular powder(UGP)has been introduced into the market.In order to determine chemical consistency and homogeneity of the UGP material prepared from sliced traditional materials(TM)of Radix Astragali,multiple batches of the UGP and TM samples derived from Astragalus membranaceus var.mongholicus were analyzed by UHPLC/DAD-MS using isoflavones and triterpenoid glycosides as marker compounds.The results demonstrated that the chemical profiles of UGP was identical or similar to that of TM,but UGP was highly homogeneous in terms of marker compound contents as assessed,e.g.,by the relative standard deviation values of the nine marker compounds in the range of 8.55%−43.80%for TM2 compared against 1.70%−8.38%for UGP2.Macromolecular component preparation and 1H NMR analyses indicated that TM4 and its corresponding UGP4 produced similar polysaccharides,but the later had approximately two-fold dissolution rate of the polysaccharides when compared to the former(yield 7.22±0.35%vs 3.39±0.20%).This study confirms that UGP of Radix Astragali is chemically consistent and homogenous,supporting its use as a promising material in TCM prescriptions.

Effects of Proton Pump Inhibitors on the Gastrointestinal Microbiota in Gastroesophageal Reflux Disease

Proton pump inhibitors(PPIs) are commonly used to lessen symptoms in patients with gastroesophageal reflux disease(GERD). However, the effects of PPI therapy on the gastrointestinal microbiota in GERD patients remain unclear. We examined the association between the PPI usage and the microbiota present in gastric mucosal and fecal samples from GERD patients and healthy controls(HCs) using 16 S rRNA gene sequencing. GERD patients taking PPIs were further divided into short-term and long-term PPI user groups. We showed that PPI administration lowered the relative bacterial diversity of the gastric microbiota in GERD patients. Compared to the non-PPIuser and HC groups, higher abundances of Planococcaceae, Oxalobacteraceae, and Sphingomonadaceae were found in the gastric microbiota from the PPI-user group. In addition, the Methylophilus genus was more highly abundant in the long-term PPI user group than in the short-term PPI-user group. Despite the absence of differences in alpha diversity, there were significant differences in the fecal bacterial composition of between GERD patients taking PPIs and those not taking PPIs. There was a higher abundance of Streptococcaceae, Veillonellaceae, Acidaminococcaceae,Micrococcaceae, and Flavobacteriaceae present in the fecal microbiota from the PPI-user group than those from the non-PPI-user and HC groups. Additionally, a significantly higher abundance of Ruminococcus was found in GERD patients on long-term PPI medication than that on shortterm PPI medication. Our study indicates that PPI administration in patients with GERD has a significant effect on the abundance and structure of the gastric mucosal microbiota but only on the composition of the fecal microbiota.

A Multi-centered Cross-sectional Study of Disease Burden of Pain of Inpatients in Southwest China

Background：Pain is a common burden of disease globally;yet,it is not systematically investigated in China,especially in hospitalized patients.This study was aimed at clarifying the epidemiological characteristics of pain and related factors in hospitalized patients in Southwest China.Methods：A cross-sectional study was conducted to investigate the prevalence,severity,and influencing factors of pain and modes of postoperative analgesia in hospitalized patients from 17 hospitals in Southwest China.A prevalidated questionnaire was employed to calibrate all of these items within 3 days from March 18,2015 to March 20,2015.Results：A total of 2293 patients were surveyed,the incidence of pain was 57.4% in all hospitalized patients at rest,of which 62.1% were with acute pain and 37.9% had persistent to chronic pain.Among surgical patients,90.8% of them complained of acute postoperative pain at rest and 97.1% in motion.The incidence of acute postoperative moderate-to-severe pain was 28.8% at rest and 45.1% in motion.Surgical patients reported higher incidences of pain,especially acute and persistent pain compared with nonsurgical patients （P 〈 0.05）.Postoperative pain occurred predominately at surgical sites （95.2%） as compared with nonsurgical sites （4.8%）.Agedness,lower education level,surgery,and history of smoking were factors associated with increased duration and severity of postoperative pain and nonsurgical pain （P 〈 0.05）.Conclusions：Pain is a common burden of disease in China,of which surgical pain constituted an important component.Surgical patients complained more severe pain than those who did not undergo surgery.Postoperative analgesia still needs to be improved to control pain after surgery.Patients＆#39; perception might influence the efficacy of pain management,which should be implemented with a multidisciplinary approach.

Stratified pain management counseling and implementation improving patient satisfaction:a prospective,pilot study

Background:Post-operative pain is unpleasant for patients and may worsen surgical recovery.Peri-operative multimodal analgesia has been used for many years;however,its efficacy still needs improvement.In the present study,a thorough peri-operative pain counseling and stratified management program based on risk assessment was implemented,with the goal of improving postoperative analgesia and patient satisfaction.Methods:This prospective,controlled,pilot study included 361 patients who underwent elective surgery.Of these 361 patients,187 received peri-operative pain risk assessment and stratified analgesia and counseling(stratified analgesia group),while 174 received conventional multimodal analgesia(conventional group).The two groups were compared regarding the post-operative pain intensity,rescue analgesia administration,post-operative quality of recovery as assessed via the quality of recovery 40 questionnaire,total dosage of peri-operative opioids,analgesic satisfaction,and analgesic costs.Results:Compared with the conventional group,the stratified analgesia group reported decreased pain intensity during motion at 24 h post-operatively and required lower dosages of rescue analgesia(P=0.03).The total quality of recovery 40 questionnaire score and the scores for physical wellbeing and pain were significantly better in the stratified analgesia group than the conventional group(P=0.04);the stratified analgesia group also reported better scores for analgesic satisfaction(P=0.03)and received lower dosages of opioids(P=0.03).Analgesic costs were lower in the stratified analgesia group than the conventional group;the cost-effective ratio was 109 in the conventional group and 62 in the stratified analgesia group.Conclusions:The analgesic efficacy was improved by the implementation of stratified analgesia based on surgical pain risk assessment and counseling.This stratified analgesia protocol increased the patients5 analgesic satisfaction and improved the quality of recovery without increasing healthcare costs.The present findings may help improve the efficacy of peri-operative multimodal analgesia in clinical practice.

Implementation of the pre-operative rehabilitation recovery protocol and its effect on the quality of recovery after colorectal surgeries

Background:Patients’recovery after surgery is the major concern for all perioperative clinicians.This study aims to minimize the side effects of peri-operative surgical stress and accelerate patients’recovery of gastrointestinal(GI)function and quality of life after colorectal surgeries,an enhanced recovery protocol based on pre-operative rehabilitation was implemented and its effect was explored.Methods:A prospective randomized controlled clinical trial was conducted,patients were recruited from January 2018 to September 2019 in this study.Patients scheduled for elective colorectal surgeries were randomly allocated to receive either standardized enhanced recovery after surgery(S-ERAS)group or enhanced recovery after surgery based on pre-operative rehabilitation(group PR-ERAS).In the group PR-ERAS,on top of recommended peri-operative strategies for enhanced recovery,formatted rehabilitation exercises pre-operatively were carried out.The primary outcome was the quality of GI recovery measured with I-FEED scoring.Secondary outcomes were quality of life scores and strength of handgrip;the incidence of adverse events till 30 days post-operatively was also analyzed.Results:A total of 240 patients were scrutinized and 213 eligible patients were enrolled,who were randomly allocated to the group S-ERAS(n=104)and group PR-ERAS(n=109).The percentage of normal recovery graded by I-FEED scoring was higher in group PR-ERAS(79.0%vs.64.3%,P<0.050).The subscores of life ability and physical well-being at post-operative 72 h were significantly improved in the group PR-ERAS using quality of recovery score(QOR-40)questionnaire(P<0.050).The strength of hand grip post-operatively was also improved in the group PR-ERAS(P<0.050).The incidence of bowel-related and other adverse events was similar in both groups till 30 days post-operatively(P>0.050).Conclusions:Peri-operative rehabilitation exercise might be another benevolent factor for early recovery of GI function and life of quality after colorectal surgery.Newer,more surgery-specific rehabilitation recovery protocol merits further exploration for these patients.