Uncovering the Challenges of Faecal Sludge Management in Benin’s Urban Hubs: The Cases of Abomey-Calavi and Natitingou

The issue of faecal sludge management in developing countries remains a significant challenge due to the indiscriminate discharge of sludge into the environment. This practice generates more environmental problems than it solves. This study aims to assess the management of household faecal sludge in the communes of Abomey-Calavi and Natitingou, Benin, in order to optimise the best storage conditions for subsequent more effective treatment. To this end, a sociological survey was conducted among households in Abomey-Calavi and Natitingou, as well as among manual emptiers. The results of our studies revealed that two types of latrines are used in households. 20.55% of households use traditional latrines, while 59.83% use ordinary latrines. 7.97% of households use both types of latrine. Moreover, the depth of the latrines varies from 2.5 m to 7 m in Abomey-Calavi and from 2.5 m to 8 m in Natitingou. Among households with a latrine, 28.26% empty their pit at least once, while 71.74% have never emptied it. The emptying cost varies between 35,000 FCFA and 90,000 FCFA. The mixing of faecal sludge with solid waste, including plastic materials, makes emptying difficult due to the obstruction of the vacuum pump. The results obtained will serve as a reliable database to facilitate decision-making in the context of faecal sludge management.

Effect of Different Rates and Mixtures of Solid Household Waste and Faecal Sludge-Based Composts on Soil Fertility and Productivity of Sunflower (Helianthus annuus L.) in Dschang, West Cameroon

The unbalanced and inadequate use of fertilizers is one of the causes of soil degradation. Combined with the ever-increasing population, it is necessary to find sustainable agricultural production alternatives. The present work aims to determine the effect of different rates and mixtutes of organic amendments on soil fertility and the performance of Sunflower (Helianthus annuus L.). In the field, treatments consisted of solid household waste and faecal sludge in the ratios of 3/5 (V1), and a mixture of faecal sludge and household waste in the ratio of 3/5 with 900 worms (V2). At the end of the composting process, V1, V2 composts and the poultry manure (PM) were applied at rates of 4, 5 and 6 t∙ha−1 in a randomized complete block design with three replications. Soil samples were collected before and after the experiment and analyzed. The main results revealed that at the end of the composting process, there was a progressive improvement in the physico-chemical properties of V1 and V2 composts. In particular, the C/N ratio, phosphorus (P) and total nitrogen (TN) initially at 16.49 ± 0.42 (V1, V2), 21.06 ± 0.07 mg∙kg−1 (V1, V2), 0.76% ± 0.08% (V1, V2) respectively, increased after 60 days to 12.40 ± 0.41 (V1), 9.74 ± 0.28 (V2) for C/N, 21.94 ± 0.63 mg∙kg−1 (V1) and 22.04 ± 0.04 mg∙kg−1 (V2) for P, 0.96% ± 0.0% (V1) and 1.22 ± 0.04 (V2) for TN. The application of 6 t∙ha−1of PM had the greatest influence on the diameter and weight of the flower heads (27.16 ± 4.01 t∙ha−1 and 230.83 ± 2.64 t∙ha−1), while 4 t∙ha−1 of V2 gave the tallest sunflower plants (110.07 ± 73.28 cm) as well as the diameter at the crown (19.30 ± 9.07 cm). However, CEC was most influenced by 4 t∙ha−1 of V1, while 4 t∙ha−1 of PM had the greatest effect on organic carbon and phosphorus. However, 5 t∙ha−1 of PM showed the highest sunflower production and yield (1.67 ± 0.21 t∙ha−1). The combination with 900 earthworms is recommended for composting and 5 t∙ha−1 of PM is recommended to obtain a better sunflower production.

基于生/醋大黄的大承气汤对实热壅滞证胎粪性腹膜炎小鼠血清ET、NO和TNF-α的影响

目的:研究基于生/醋大黄的大承气汤对胎粪性腹膜炎(faecal peritonitis with excessive heat stagnation,ABP)小鼠血清内毒素(endotoxin,ET)、一氧化氮(nitric oxide,NO)和肿瘤坏死因子α(tumor necrosis factor α,TNF-α)的影响。方法:将105只昆明种小鼠按随机数字表法分为生/醋大黄炮制品的大承气汤组(6、10 g/kg)、阳性对照组、空白对照组及模型组,按容积20 mL/kg剂量给药后测定各组小鼠血清ET、NO和TNF-α含量。结果:生/醋大黄炮制品的大承气汤组均能增加实热壅滞证ABP小鼠血清NO含量,降低小鼠血清ET和TNF-α含量。结论:生/醋大黄炮制品的大承气汤对ABP小鼠血清ET、NO和TNF-α含量的影响可能与生/醋大黄炮制方法以及其配伍的厚朴、枳实和芒硝有关。

穴位贴敷联合乌梅丸加减治疗寒热错杂型溃疡性结肠炎的临床效果

目的探索穴位贴敷联合乌梅丸加减对寒热错杂型溃疡性结肠炎患者的临床疗效、免疫功能、粪钙卫蛋白(FC)及血常规的影响。方法选取2019年1月至2021年1月徐州市中医院收治的60例寒热错杂型溃疡性结肠炎患者作为研究对象,按照就诊先后顺序分为对照组和观察组,各30例。对照组服用乌梅丸加减,观察组在对照组基础上联合穴位贴敷。比较两组临床疗效、溃疡性结肠炎活动度指数评分、外周血T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))水平、FC、全血细胞计数。结果两组治疗后临床有效率、CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05),两组治疗后Sutherland疾病活动指数评分、CD8^(+)水平、FC低于治疗前,且治疗后观察组低于对照组,差异有统计学意义(PP<0.05)。两组治疗前后白细胞(WBC)、红细胞(RBC)、血红蛋白(Hb)计数比较,差异无统计学意义(P>0.05)。结论穴位贴敷联合乌梅丸加减安全有效,对于寒热错杂型溃疡性结肠炎不能耐受水杨酸制剂患者可以改善患者临床症状,减轻炎症反应,增强免疫功能。

稀土对林麝采食量、血液指标和粪便微生物的影响

为探究稀土作为饲料添加剂对林麝(Moschus berezovskii)采食量、血液指标和粪便微生物的影响,选取12只年龄相同、体况良好的育成期林麝,随机分为2组,每组6只(3♀,3),对照组饲喂常规日粮,试验组饲喂常规日粮和稀土添加剂(150 mg/kg精补料),预饲期15 d,正试期25 d。结果表明:(1)添加稀土对林麝基础饲粮的采食量没有显著影响(p>0.05),但试验组树叶采食量和总采食量显著高于对照组(p<0.05)。(2)添加稀土对林麝的体质量和体增质量没有显著影响(p>0.05)。(3)添加稀土后林麝血清尿素(UREA)和总胆固醇(TCH)含量较对照组低(p<0.05),其他血液指标差异不显著(p>0.05)。(4)试验组和对照组粪便微生物的Chao1指数、Simpson指数、Shannon指数和基于ANOSIM分析的Beta多样性没有显著差异(p>0.05)。由此可见,本试验条件下添加稀土提高了林麝采食量,降低了血清UREA和TCH含量,对林麝体质量和粪便微生物多样性没有显著影响。

肠道菌群及代谢物对代谢功能障碍相关脂肪性肝病的影响

2020年国际专家小组建议将非酒精性脂肪性肝病更名为代谢功能障碍相关脂肪性肝病(metabolic dysfunction associated fatty liver disease,MAFLD),并提出一套新的诊断标准。MAFLD的病理生理机制涉及环境、遗传、代谢以及肠道微生物等多种因素。肠道微生物来源的代谢物可能在MAFLD的发生发展中发挥重要作用。本文对胆汁酸、短链脂肪酸、色氨酸、胆碱、内毒素和乙醇作为肠道菌群代谢物导致MAFLD发展的机制以及相关治疗进展进行综述。

Effects of Effluent from a Dumpsite on the Physicochemical Properties of River Achichum in Bamendakwe, Northwest Cameroon

This study was aimed to assess the effects of effluent from a dumpsite on the physicochemical properties of river Achichum in Bamendakwe in the Bamenda I municipality, Northwest Region of Cameroon. The quality of water used for domestic purposes by the population of this area is mostly appreciated through its organoleptic assessment while no attention is paid to the physicochemical and microbiological properties. Samples (upstream, effluent, and downstream) were collected in the months of September 2022 and February 2023 and examined for organoleptic, physicochemical and bacteriological characteristics using standard methods. The river was contaminated to different extents by nitrates (28.56 - 149.91 mg/L), sulphates (246.89 - 725.42 mg/L) and heavy metals (0.01 - 0.04 mg/L for lead and 0.98 - 2.15 mg/L for aluminum). This contamination could be due to an inflow of the untreated effluent into the river. The river contained a high pollution level of lead and aluminum. Bacteriological investigations revealed that all the analyzed samples from the river contained indicators of faecal pollution such as Enterobacteria spp., E. coli, Streptococcus spp., Salmonella spp., Shigella spp., Staphylococcus spp. and Vibrio spp. Consequently, its utilization exposes consumers to health risks. Thus, water from the river should be treated prior to consumption.

县域医共体模式下无症状人群结直肠癌筛查结果分析

目的探讨县域医共体模式下无症状人群结直肠癌的筛查效果。方法在县域医共体模式下,选取2022年1月至2023年12月本县域内居民10,204例,分成两组进行结直肠癌筛查。仅愿意接受高危因素问卷评估(HRFQ)者6214例作为对照组,愿意接受HRFQ联合粪便隐血试验(FIT)者3990例作为观察组,两组按照各自方案进行初筛,初筛阳性者转至县级医院进行进一步内镜检查。结果对照组初筛阳性率为16.90%;观察组初筛阳性率为19.95%。对照组和观察组的初筛阳性者中分别有510例和520例接受结肠镜检查;对照组镜检阳性56例,观察组镜检阳性132例,两组镜检阳性率比较,差异有统计学意义(P<0.05)。结论在县域医共体模式下,对无症状人群进行大范围结直肠癌筛查和有效转诊、随访,在一定程度上可准确反映本地区结直肠癌患病情况,实现结直肠癌的早发现、早诊断和早治疗,可应用至其他肿瘤疾病的筛查中。

High-risk symptoms and quantitative faecal immunochemical test accuracy: Systematic review and meta-analysis

BACKGROUND The quantitative faecal immunochemical test for haemoglobin(FIT) has been revealed to be highly accurate for colorectal cancer(CRC) detection not only in a screening setting, but also in the assessment of patients presenting lower bowel symptoms. Therefore, the National Institute for Health and Care Excellence has recommended the adoption of FIT in primary care to guide referral for suspected CRC in low-risk symptomatic patients using a 10 μg Hb/g faeces threshold.Nevertheless, it is unknown whether FIT′s accuracy remains stable throughout the broad spectrum of possible symptoms.AIM To perform a systematic review and meta-analysis to assess FIT accuracy for CRC detection in different clinical settings.METHODS A systematic literature search was performed using MEDLINE and EMBASE databases from inception to May 2018 to conduct a meta-analysis of prospective studies including symptomatic patients that evaluated the diagnostic accuracy of quantitative FIT for CRC detection. Studies were classified on the basis of brand,threshold of faecal haemoglobin concentration for a positive test result,percentage of reported symptoms(solely symptomatic, mixed cohorts) and CRC prevalence(< 2.5%, ≥ 2.5%) to limit heterogeneity and perform subgroup analysis to assess the influence of clinical spectrum on FIT′s accuracy to detect CRC.RESULTS Fifteen cohorts including 13073 patients(CRC prevalence 0.4% to 16.8%) were identified. Pooled estimates of sensitivity for studies using OC-Sensor at 10 μg Hb/g faeces threshold(n = 10400) was 89.6% [95% confidence interval(CI): 82.7%to 94.0%). However, pooled estimates of sensitivity for studies formed solely by symptomatic patients(n = 4035) and mixed cohorts(n = 6365) were 94.1%(95%CI: 90.0% to 96.6%) and 85.5%(95%CI: 76.5% to 91.4%) respectively(P <0.01), while there were no statistically significant differences between pooled sensitivity of studies with CRC prevalence < 2.5%(84.9%, 95%CI: 73.4% to 92.0%)and ≥ 2.5%(91.7%, 95%CI: 83.3% to 96.1%)(P = 0.25). At the same threshold, OCSensor? sensitivity to rule out any significant colonic lesion was 78.6%(95%CI:75.6% to 81.4%). We found substantial heterogeneity especially when assessing specificity.CONCLUSION The results of this meta-analysis confirm that, regardless of CRC prevalence,quantitative FIT is highly sensitive for CRC detection. However, FIT ability to rule out CRC is higher in studies solely including symptomatic patients.

Validation of a new scoring system: Rapid assessment faecal incontinence score

AIM: To implement a quick and simple test- rapid assessment faecal incontinence score(RAFIS) and show its reliability and validity.METHODS: From March 2008 through March 2010, we evaluated a total of 261 consecutive patients, including 53 patients with faecal incontinence. Demographic and comorbidity information was collected. In a single visit, patients were administered the RAFIS. The results obtained with the new score were compared with those of both Wexner score and faecal incontinence quality of life scale(FIQL) questionnaire. The patient withoutinfluence of the surgeon completed the test. The role of surgeon was explaining the meaning of each section and how he had to fill. Reliability of the RAFIS score was measured using intra-observer agreement and Cronbach's alpha(internal consistency) coefficient. Multivariate analysis of the main components within the different scores was performed in order to determine whether all the scores measured the same factor and to conclude whether the information could be encompassed in a single factor. A sample size of 50 patients with faecal incontinence was estimated to be enough to detect a correlation of 0.55 or better at 5% level of significance with 80% power.RESULTS: We analysed the results obtained by 53 consecutive patients with faecal incontinence(median age 61.55 ± 12.49 years) in the three scoring systems. A total of 208 healthy volunteers(median age 58.41 ± 18.41 years) without faecal incontinence were included in the study as negative controls. Pearson's correlation coefficient between "state" and "leaks" was excellent(r = 0.92, P < 0.005). Internal consistency in the comparison of "state" and "leaks" yielded also excellent correlation(Cronbach's α = 0.93). Results in each score were compared using regression analysis and a correlation value of r = 0.98 was obtained with Wexner score. As regards FIQL questionnaire, the values of "r " for the different subscales of the questionnaire were: "lifestyle" r =-0.87, "coping/behaviour" r =-0.91, "depression" r =-0.36 and "embarrassment" r =-0.90,(P < 0.01). A multivariate analysis showed that all the scoring systems measured the same factor. A single factor may explain 80.84% of the variability of FI, so all the scoring systems measure the same factor. Patient's continence improves when RAFIS and Jorge-Wexner scores show low values and when the values obtained in the FIQL questionnaire are high.CONCLUSION: RAFIS is a valid and reliable tool to assess Faecal Incontinence.

Consuming fermented distillers＇ dried grains with solubles (DDGS) feed reveals a shift in the faecal microbiota of growing and fattening pigs using 454 pyrosequencing

The objective of this study was to investigate pig fed by Bacillus coagulans-fermented distillers＇ dried grains with solubles （DDGS） on the faecal microbial composition and diversity using 454 pyrosequencing. Healthy crossbred （Durocx Yorkshirex Landrace） growing and fattening pigs （n=48）, with an average initial body weight of 65 kg, were divided into two groups （24 replicates per group; four pens per group; six pigs per pen）, and given either DDGS feed as the control, or B. coagulans-fermented DDGS feed as the treatment. Faecal samples were collected on day 0, 7, 14, 21, and 28. DNA was extracted, and the V3-V6 region of the 16S rRNA gene was amplified. The fermented DDGS feed affected the relative abundance of bacteria populations at the phylum, genus, and species levels. At the genus level, the consumption of fermented DDGS feed led to higher relative abundances of faecal Prevotella, Lactobacillus, Clostridium, Bifidobacterium, Roseburia, and Bacillus, and lower relative abundances of faecal Escherichia, Ruminococcus, Dialister, unclassified Lachnospiraceae, unclassified Ruminococcaceae, and unclassified Enterobacteriaceae than in the control. At the species level, the consumption of fermented DDGS feed led to higher relative abundances of faecal Prevotella sp., Lactobacillus johnsonii, Lactobacillus fermentum, Lactobacillus mucosae, Lactobacillus reuteri, Clostridium butyricum, Bifidobacterium sp., and Roseburia sp., and lower relative abundances of faecal Prevotella copri, Escherichia coil, Ruminococcus gnavus, Ruminococcus flavefaciens, and Dialister sp. than in the control. Principal coordinates analysis indicated a distinct separation in the faecal microbial communities of pigs that were fed the fermented and unfermented DDGS feed. Fermented DDGS feed significantly increased the average daily gain （ADG） of pigs, and significantly decreased the average daily feed intake （ADFI） of feed and feed/gain （F/G）. Thus, our results demonstrate a beneficial shift in the faecal microbiota of pigs consuming fermented DDGS feed, with potential applications in livestock production.

Stem cell therapy for faecal incontinence: Current state and future perspectives

Faecal continence is a complex function involving different organs and systems. Faecal incontinence is a common disorder with different pathogeneses, disabling consequences and high repercussions for quality of life. Current management modalities are not ideal, and the development of new treatments is needed. Since 2008, stem cell therapies have been validated, 36 publications have appeared(29 in preclinical models and seven in clinical settings), and six registered clinical trials are currently ongoing. Some publications have combined stem cells with bioengineering technologies. The aim of this review is to identify and summarise the existing published knowledge of stem cell utilization as a treatment for faecal incontinence. A narrative or descriptive review is presented. Preclinical studies have demonstrated that cellular therapy, mainly in the form of local injections of muscle-derived(muscle derived stem cells or myoblasts derived from them) or mesenchymal(bone-marrow-or adipose-derived) stem cells, is safe. Cellular therapy has also been shown to stimulate the repair of both acute and subacute anal sphincter injuries, and some encouraging functional results have been obtained. Stem cells combined with normal cells on bioengineered scaffolds have achieved the successful creation and implantation of intrinsically-innervated anal sphincter constructs. The clinical evidence, based on adipose-derived stem cells and myoblasts, is extremely limited yet has yielded some promising results, and appears to be safe. Further investigation in both animal models and clinical settings is necessary to drawing conclusions. Nevertheless, if the preliminary results are confirmed, stem cell therapy for faecal incontinence may well become a clinical reality in the near future.

Persistence and growth of faecal culturable bacterial indicators in water column and sediments of Vidy Bay,Lake Geneva,Switzerland

The aims of this study was to investigate the persistence and the growth of culturable bacterial indicators （CBI） including total coliforms （TC） and faecal coliforms represented by Escherichia coli, enterococcus （ENT）, and aerobic mesophilic bacteria （AMB） in the surface sediments and the water column of Vidy Bay fLake Geneva, City of Lausanne, Switzerland）. The study was carded out for 60 d using microcosms containing Sewage Treatment Plant （STP） effluent and nonsterile water without CBI, as well as contaminated and non-contaminated sediments. The effects of water temperature and of organic matter associated with sediments on the survival of CBI in the sediments and the water column were observed. The number of CBI colonies in the contaminated sediments of Vidy Bay and in the STP effluent was almost identical in the order of 10^5-10^7, 10^4-10^6, 10^5-10^5, and 10^4-10^7 CFU/100 g sediment or/100 mL water for TC, E. coli, ENT, and AMB respectively. A degradation of CBI was observed in the sediments where organic mater content was low and in the water column at a temperature of 10℃ after 5 d of experimentation. In addition, a growth of CBI was observed in the sediment which is rich in organic matter at 20℃. The results of this study indicate： （1） the higher concentrations of the CBI observed in different points in the water column of Vidy Bay may not be explained only by the recent contribution of the three potential sources of the Bay contamination including STP and the Chamberonne and Flon Rivers, but also by the persistence, removal from sediment and multiplication of CBI in the sediment and water column; （2） the sediment of Vidy Bay constitute a reservoir of CBI and can even support their growth; and （3） the CBI not only survive in sediments, but also can be remobilized and increased in the water column, therefore, it become a permanent microbiological pollution in Vidy Bay.

Effect of three lactobacilli with strainspecific activities on the growth performance, faecal microbiota and ileum mucosa proteomics of piglets

Background: The beneficial effects of Lactobacillus probiotics in animal production are often strain-related.Different strains from the same species may exert different weight-gain effect on hosts in vivo. Most lactobacilli are selected based on their in vitro activities, and their metabolism and regulation on the intestine based on strainrelated characters are largely unexplored. The objective of the present study was to study the in vivo effects of the three lactobacilli on growth performance and to compare the differential effects of the strains on the faecal microbiota and ileum mucosa proteomics of piglets.Methods: Three hundred and sixty piglets were assigned to one of four treatments, which included an antibioticstreated control and three experimental groups supplemented with the three lactobacilli, L. salivarius G1-1, L. reuteri G8-5 and L. reuteri G22-2, respectively. Piglets were weighed and the feed intake was recorded to compare the growth performance. The faecal lactobacilli and coliform was quantified using quantitative PCR and the faecal microbiota was profiled by denaturing gradient gel electrophoresis(DGGE). The proteomic approach was applied to compare the differential expression of proteins in the ileum mucosa.Results: No statistical difference was found among the three Lactobacillus-treated groups in animal growth performance compared with the antibiotics-treated group(P > 0.05). Supplementation of lactobacilli in diets significantly increased the relative 16 S rRNA gene copies of Lactobacillus genus on both d 14 and d 28(P < 0.05).,and the bacterial community profiles based on DGGE from the lactobacilli-treated groups were distinctly different from the antibiotics-treated group(P < 0.05). The ileum mucosa of piglets responded to all Lactobacillus supplementation by producing more newly expressed proteins and the identified proteins were all associated with the functions beneficial for stabilization of cell structure. Besides, some other up-regulated and down-regulated proteins in different Lactobacillus-treated groups showed the expression of proteins were partly strain-related.Conclusions: All the three lactobacilli in this study show comparable effects to antibiotics on piglets growth performance. The three lactobacilli were found able to modify intestinal microbiota and mucosa proteomics. The regulation of protein expression in the intestinal mucosa are partly associated with the strains administrated in feed.

Faecal incontinence and health related quality of life in inflammatory bowel disease patients: Findings from a tertiary care center in South Asia

AIM: To analyze the frequency and severity of faecal incontinence (FI) and its effect on the quality of life (QOL) in inflammatory bowel disease (IBD) patients. METHODS: All patients who attended surgical and medical gastroenterology outpatient clinics in a tertiary care center with an established diagnosis of either ulcerative colitis (UC) or Crohn&rsquo;s disease (CD) over a period of 10 mo were included in this study. Before enrollment into the study, the patients were explained about the study and informed consent was obtained. The patients with unidentified colitis were excluded. The data on demographics, disease characteristics, FI (Vaizey score), and quality of life (IBD-Q) were collected. Data were analyzed using SPSS version 21. RESULTS: There were 184 patients (women = 101, 54.9%; UC = 153, 83.2%) with a female preponderance for UC (male/female ratio = 1:1.5) and a male preponderance for CD (male/female = 2:1). Forty-eight (26%) patients reported symptoms of FI. Among the patients with FI, 70.8% were women (n = 34) and 29.2% were men (n = 14) with an average age of 52.7 years (range, 20-78 years). Average age of onset of FI was 48.6 (range, 22-74) years. Ten percent (n = 5) reported regular FI. Incontinence to flatus was seen in 33.3% (n = 16), to liquid faeces in 56.2% (n = 27), to solid faeces in 6.2% (n = 3) and to all three in 4.1% (n = 2). Twenty-one percent (n = 10) complained of disruption of their physical and social activity. There was no association between FI and type of IBD. Significant associations were found between FI and age (P = 0.005) and gender (P CONCLUSION: In our study, nearly a quarter of patients reported FI. There was a significant correlation between FI and QOL. Therefore, enquiring about FI in IBD patients can lead to identification of this debilitating condition. This will enable early referral for continence care in this group of patients.

Simulation of the Fate of Faecal Bacteria in Estuarine and Coastal Waters Based on A Fractionated Sediment Transport Model

A two-dimensional depth-integrated numerical model is refined in this paper to simulate the hydrodynamics, graded sediment transport process and the fate of faecal bacteria in estuarine and coastal waters. The sediment mixture is divided into several fractions according to the grain size. A bed evolution model is adopted to simulate the processes of the bed elevation change and sediment grain size sorting. The faecal bacteria transport equation includes enhanced source and sink terms to represent bacterial kinetic transformation and disappearance or reappearance due to sediment deposition or re-suspension. A novel partition ratio and dynamic decay rates of faecal bacteria are adopted in the numerical model. The model has been applied to the turbid water environment in the Bristol Channel and Severn estuary, UK. The predictions by the present model are compared with field data and those by non-fractionated model.

Faecal calprotectin: Management in inflammatory bowel disease

Inflammatory bowel disease(IBD) is a chronic and relapsing disorder which leads to an inflammation of the gastrointestinal tract. A tailored therapy to achieve mucosal healing with the less adverse events has become a key issue in the management of IBD. In the past, the clinical remission was the most important factor to consider for adapting diagnostic procedures and therapeutic strategies. However, there is no a good correlation between symptoms and intestinal lesions, so currently the goals of treatment are to achieve not only the control of symptoms, but deep remission, which is related with a favourable prognosis. Thus, the determination of biological markers or biomarkers of intestinal inflammation play a crucial role. Many biomarkers have been extensively evaluated in IBD showing significant correlation with endoscopic lesions, risk of recurrence and response to treatment. One of the most important markers is faecal calprotectin(FC). Despite calprotectin limitations, this biomarker represents a reliable and noninvasive alternative to reduce the need for endoscopic procedures. FC has demonstrated its performance for regular monitoring of IBD patients, not only to the diagnosis for discriminating IBD from non-IBD diagnosis, but for assessing disease activity, relapse prediction and response to therapy. Although, FC provides better results than other biomarkers such as C-reactive protein and erythrocyte sedimentation rate, these surrogate markers of intestinal inflammation should not be used isolation but in combination with other clinical, endoscopic, radiological or/and histological parameters enabling a comprehensive assessment of IBD patients.

Faecal calprotectin and magnetic resonance imaging in detecting Crohn's disease endoscopic postoperative recurrence

AIM To assess magnetic resonance imaging(MRI) and faecal calprotectin to detect endoscopic postoperative recurrence in patients with Crohn's disease(CD).METHODS From two tertiary centers, all patients with CD who underwent ileocolonic resection were consecutively and prospectively included. All the patients underwent MRI and endoscopy within the first year after surgery or after the restoration of intestinal continuity [median = 6 mo(5.0-9.3)]. The stools were collected the day before the colonoscopy to evaluate faecal calprotectin level. Endoscopic postoperative recurrence(POR) was defined as Rutgeerts' index ≥ i2b. The MRI was analyzed independently by two radiologists blinded from clinical data.RESULTS Apparent diffusion coefficient(ADC) was lower in patients with endoscopic POR compared to those with no recurrence(2.03 ± 0.32 vs 2.27 ± 0.38 × 10^(-3) mm^2/s, P = 0.032). Clermont score(10.4 ± 5.8 vs 7.4 ± 4.5, P = 0.038) and relative contrast enhancement(RCE)(129.4% ± 62.8% vs 76.4% ± 32.6%, P = 0.007) were significantly associated with endoscopic POR contrary to the magnetic resonance index of activity(Ma RIA)(7.3 ± 4.5 vs 4.8 ± 3.7; P = 0.15) and MR scoring system(P = 0.056). ADC < 2.35 × 10^(-3) mm^2/s [sensitivity = 0.85, specificity = 0.65, positive predictive value(PPV) = 0.85, negative predictive value(NPV) = 0.65] and RCE > 100%(sensitivity = 0.75, specificity = 0.81, PPV = 0.75, NPV = 0.81) were the best cutoff values to identify endoscopic POR. Clermont score > 6.4(sensitivity = 0.61, specificity = 0.82, PPV = 0.73, NPV = 0.74), Ma RIA > 3.76(sensitivity = 0.61, specificity = 0.82, PPV = 0.73, NPV = 0.74) and a MR scoring system ≥ MR1(sensitivity = 0.54, specificity = 0.82, PPV = 0.70, and NPV = 0.70) demonstrated interesting performances to detect endoscopic POR. Faecal calprotectin values were significantly higher in patients with endoscopic POR(114 ± 54.5 μg/g vs 354.8 ± 432.5 μg/g; P = 0.0075). Faecal calprotectin > 100 μg/g demonstrated high performances to detect endoscopic POR(sensitivity = 0.67, specificity = 0.93, PPV = 0.89 and NPV = 0.77).CONCLUSION Faecal calprotectin and MRI are two reliable tools to detect endoscopic POR in patients with CD.

Faecal incontinence： Current knowledges and perspectives

Faecal incontinence(FI) is a disabling and frequent symptom since its prevalence can vary between 5% and 15% of the general population. It has a particular negative impact on quality of life. Many tools are currently available for the treatment of FI, from conservative measures to invasive surgical treatments. The conservative treatment may be dietetic measures, various pharmacological agents, anorectal rehabilitation, posterior tibial nerve stimulation, and transanal irrigation. If needed, patients may have miniinvasive approaches such as sacral nerve modulation or antegrade irrigation. In some cases, a surgical treatment is proposed, mainly external anal sphincter repair. Although these different therapeutic options are available, new techniques are arriving allowing new hopes for the patients. Moreover, most of them are non-invasive such as local application of an α1-adrenoceptor agonist, stem cell injections, rectal injection of botulinum toxin, acupuncture. New more invasive techniques with promising results are also coming such as anal magnetic sphincter and antropylorus transposition. This review reports the main current available treatments of FI and the developing therapeutics tools.

Risk of gastrointestinal cancer in a symptomatic cohort after a complete colonoscopy:Role of faecal immunochemical test

BACKGROUND Faecal immunochemical test(FIT)has been recommended to assess symptomatic patients for colorectal cancer(CRC)detection.Nevertheless,some conditions could theoretically favour blood originating in proximal areas of the gastrointestinal tract passing through the colon unmetabolized.A positive FIT result could be related to other gastrointestinal cancers(GIC).AIM To assess the risk of GIC detection and related death in FIT-positive symptomatic patients(threshold 10μg Hb/g faeces)without CRC.METHODS Post hoc cohort analysis performed within two prospective diagnostic test studies evaluating the diagnostic accuracy of different FIT analytical systems for CRC and significant colonic lesion detection.Ambulatory patients with gastrointestinal symptoms referred consecutively for colonoscopy from primary and secondary healthcare,underwent a quantitative FIT before undergoing a complete colonoscopy.Patients without CRC were divided into two groups(positive and negative FIT)using the threshold of 10μg Hb/g of faeces and data from follow-up were retrieved from electronic medical records of the public hospitals involved in the research.We determined the cumulative risk of GIC,CRC and upper GIC.Hazard rate(HR)was calculated adjusted by age,sex and presence of significant colonic lesion.RESULTS We included 2709 patients without CRC and a complete baseline colonoscopy,730(26.9%)with FIT≥10μgr Hb/gr.During a mean time of 45.5±20.0 mo,a GIC was detected in 57(2.1%)patients:An upper GIC in 35(1.3%)and a CRC in 14(0.5%).Thirty-six patients(1.3%)died due to GIC:22(0.8%)due to an upper GIC and 9(0.3%)due to CRC.FIT-positive subjects showed a higher CRC risk(HR 3.8,95%CI:1.2-11.9)with no differences in GIC(HR 1.5,95%CI:0.8-2.7)or upper GIC risk(HR 1.0,95%CI:0.5-2.2).Patients with a positive FIT had only an increased risk of CRC-related death(HR 10.8,95%CI:2.1-57.1)and GIC-related death(HR 2.2,95%CI:1.1-4.3),with no differences in upper GIC-related death(HR 1.4,95%CI:0.6-3.3).An upper GIC was detected in 22(0.8%)patients during the first year.Two variables were independently associated:anaemia(OR 5.6,95%CI:2.2-13.9)and age≥70 years(OR 2.7,95%CI:1.1-7.0).CONCLUSION Symptomatic patients without CRC have a moderate risk increase in upper GIC,regardless of the FIT result.Patients with a positive FIT have an increased risk of post-colonoscopy CRC.