Yuwei Li

Purpose Magnetoelectric biofeedback therapy (MEBFT) is an emerging intervention for moderate rectocele-associated obstructed defecation syndrome (ODS); however, its efficacy and mechanisms remain unclear. This study compared MEBFT with conventional biofeedback therapy (BFT) and developed a 3D high-resolution anorectal manometry (HR-ARM)-based predictive model for clinical decision-making. Methods In this prospective, single-blind, randomized controlled trial, 68 female patients with defecography-confirmed moderate rectocele-associated ODS were treated in the outpatient department of Tianjin Union Medical Center from January 2019 to June 2024). Patients were randomly assigned in a 1:1 ratio to either the MEBFT or BFT group. Primary outcomes included 3D HR-ARM parameters, Glazer surface electromyography, and patient-reported outcomes (Cleveland Clinic Constipation and Patient Assessment of Constipation Quality of Life scores) at baseline and 3 months. The secondary outcomes included predictive indicators derived from the Hosmer–Rothman model and treatment response stratification. Results MEBFT significantly improved fast-twitch fiber recruitment, anorectal function, and quality of life compared to BFT (all P < 0.01). The Hosmer–Rothman model identified a negative MRP-MTV interaction (synergy index = 0.20), with the R₁₁ phenotype (MRP < 80 mmHg–MTV < 135 cc) predicting an 82.35% response to MEBFT after 3 months of treatment (area under the curve [AUC] = 0.72). Phenotypic stratification-guided management: R₁₁ for MEBFT, R₀₀ (elevated MRP–MTV) for surgical evaluation, and R₁₀/R₀₁ for extended MEBFT with surgical backup. Conclusions MEBFT demonstrated superior clinical effectiveness, anorectal functional recovery, and quality of life compared with BFT after 3 months of treatment. The exploratory Hosmer–Rothman model may provided a moderate-accuracy phenotype-based approach using 3D HR-ARM parameters to stratify treatment response and optimize the individualized management of moderate rectocele-associated ODS. Trial registration 1. Date of registration (needs to be before the Date of the First Patient): December 26, 2023. 2. Date of initial participant enrollment: January 9, 2019. 3. Clinical trial identification number: ChiCTR2300079173. 4. URL of the registration site: http://www.chictr.org.cn/

“Shufa Tan1#, Chengtao Peng2#, XinLin5# ”should be regarded as co-authors and have made equal contributions to this research.

Purpose This study aimed to assess the diagnostic accuracy of combining anal relaxation rate (ARR) and maximum anal resting pressure (MARP), measured by three-dimensional (3D) high-resolution anorectal manometry (HR-ARM), in identifying high-risk phenotypes of severe rectocele in women (SRW) aged ≥ 50 years compared with healthy female volunteers (HFVs). Methods This retrospective comparative study was conducted at the Tianjin Union Medical Center (2018–2024) and included 50 SRW scheduled for surgery and 40 age-matched HFVs aged ≥ 50 years. Log-linear regression was used to assess interaction effects, and the Hosmer–Rothman additive model evaluated qualitative and quantitative interactions. Diagnostic accuracy was assessed using receiver operating characteristic curve analysis. Results The concurrent elevation of ARR and MARP (R₁₁ phenotype) was an independent risk factor (P < 0.01), surpassing the diagnostic value of individual parameters. Interaction analysis showed improved diagnostic accuracy, achieving a sensitivity of 82.0%, specificity of 100.0%, area under the curve of 0.82, Youden index of 0.82, odds ratio of 6.14, and 95% confidence interval of 2.19–17.17. Defecography-based classification with SRW-concomitant diseases may be identified using 3D HR-ARM phenotypes, whereas the reverse diagnostic pathway is not feasible. The integration of these modalities holds promise for guiding evidence-based personalized treatment strategies. Conclusions Age-stratified 3D HR-ARM analysis of ARR and MARP interactions may help identify high-risk R₁₁ phenotypes in SRW, providing enhanced diagnostic specificity. The R₁₁ phenotype identified in the preoperative X-ray defecography classification for SRW holds the potential for informing tailored therapeutic strategies.

Introduction: The purpose of this study is to compare the relative effectiveness and safety of non-pharmacological interventions for the treatment of functional constipation (FC).Methods: We searched Pubmed, Embase, Cochrane, and Web of Science databases for randomized controlled trials published from 2010 to November 2024. The quality of the included studies was evaluated using the Cochrane bias risk tool and Review Manager 5.4, and the evidence was graded using GRADEPro. A network meta-analysis (NMA) was conducted using R Studio, and the surface under the cumulative ranking curve (SUCRA) was used to rank the included drugs for each outcome measure to compare the clinical efficacy of different treatment methods for chronic functional constipation.Results: A total of 29 RCT studies were included, with a total of 4389 patients with functional constipation who were randomly assigned to receive placebo or one of the nine different non-pharmacological treatment methods. The assessment of bias risk showed that the bias risk of most included studies was low. The results showed that the first-ranked treatment method for clinical efficacy was acupuncture; the first-ranked treatment method for changes in spontaneous bowel movement (SBM) and complete spontaneous bowel movement (CSBM) was fecal microbiota transplantation (FMT); the first-ranked treatment method for changes in the Bristol Stool Form Scale (BSFS) score was FMT; the first-ranked treatment method for changes in the Patient Assessment of Constipation Quality of Life (PAC-QOL) score after treatment was the Vibration capsule; the first-ranked treatment method for changes in the Patient Assessment of Constipation Symptoms (PAC-SYM) score after treatment was percutaneous electrical stimulation; and the treatment method with the lowest incidence of adverse reactions was probiotics.Conclusion: Based on the SUCRA values and NMA results, we found that FMT showed better effects and higher safety on BSFS scores, SBM, and CSBM. In addition, acupuncture showed a good clinical efficacy. We hypothesize that the combination of FMT and acupuncture may be an effective and safe treatment option for functional constipation, but further high-quality clinical studies are needed to confirm this.Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42024625747.

Background: Few studies have investigated healthy female individuals (HFI) and those with obstructed defecation syndrome associated with moderate rectocele in women (MRW), identified using three-dimensional high-resolution anorectal manometry (3D HRAM) parameters that correlate with age stratification. Objective: We aimed to explore the clinical diagnostic values of the MRW and HFI groups using 3D HRAM parameters related to age stratification. Methods: A prospective non-randomized controlled trial involving 128 cases from the MRW (treatment group, 68 cases) and HFI (control group, 60 cases) groups was conducted using 3D HRAM parameters at Tianjin Union Medical Center between January 2017 and June 2022, and patients were divided into two subgroups based on their ages: the ≥50 and < 50 years subgroups. Results: Multivariate binary logistic regression analysis showed that age (P = 0.024) and rectoanal inhibitory reflex (P = 0.001) were independent factors affecting the disease in the MRW group. Compared to the HFI group, the receiver operating characteristic (ROC) curve demonstrated that the 3D HRAM parameters exhibited a higher diagnostic value for age (Youden index = 0.31), urge to defecate (Youden index = 0.24), and rectoanal pressure differential (Youden index = 0.21) in the MRW group. Conclusions: Compared to the HFI group, the ROC curve of the 3D HRAM parameters suggests that age, urge to defecate, and rectoanal pressure differential in the MRW group have a significant diagnostic value. Because the Youden index is lower, 3D HRAM cannot be considered the gold standard method for diagnosing MRW.

Background Although end-to-end ileorectal anastomosis (EEIRA) followed total colectomy is the most effective surgical treatment for slow transit constipation (STC), but frequent diarrhea and urgent defecation have not been solved for more than 6 months after surgery. This study aimed to compare the defecating frequency, surgical complications, and quality of life after ileorectal intussusception anastomosis (IRIA) or EEIRA following laparoscopic total colectomy in STC. Methods This is a prospectively collected and retrospectively analyzed the data of 100 consecutive STC patients treated by 1 medical team in Tianjin Union Medical Center from August 2016 to July 2021. There were 70 cases underwent IRIA and 30 cases underwent EEIRA. The incidence and mortality of postoperative complications, gastrointestinal quality of life score（GIQLI）and fecal incontinence quality of life score（FIQL）were followed up after operation at median 3 years. The frequency of defecation, use of antidiarrheal drugs, Wexner constipation score follow-up at 1 year. Results A total of 100 patients(83 females and 17 males) were enrolled, and no death. Follow-up a year, there was more than 10 defecating frequency for 19 patients (19/30, 63,33%) in EEIRA group after operation. At 7 days, 1 month, 2 months, 3 months, 6 months after operation, and there were statistically significant difference in IRIA group for the reduction of defecation times compared with EEIRA (all P < 0.05); After 12 months of follow-up, there was no significant difference in the frequency of defecation between the two groups (P= 0.25); ANVOA analysis of variance showed that the number of defecation significantly decreased in IRIA group compared with EEIRA group F（5，490）= 193.09，(P = 0.00). Follow-up at median 3 years, there were prevalencesignificant difference in short-term and long-term complications between IRIA and EEIRA group, respectively (9/70, 12.86%) vs. (11/30, 36.67%)（P =0.03）, and (6/70, 8.57%) vs. (8/30, 26.67%)（P =0.01）. IRIA group were better than those of EEIRA group for FIQL and GIQLIscores follow-up at median 3 years, respectively (112.56 ± 8.25) vs. 105.14 ± 20.74)(P = 0.03), and (170.58 ± 8.24) vs. (164.00 ± 15.15)，(P = 0.01) . Conclusion Follow-up at median 3 years, IRIA has a lower prevalence of surgical complications than EEIRA in the treatment of STC and significantly improve the quality of life, which can reduce the frequency of defecation within 1 year of follow-up.

The coronavirus SARS-CoV-2 has mutated quickly and caused significant global damage. This study characterizes two mRNA vaccines ZSVG-02 (Delta) and ZSVG-02-O (Omicron BA.1), and associating heterologous prime-boost strategy following the prime of a most widely administrated inactivated whole-virus vaccine (BBIBP-CorV). The ZSVG-02-O induces neutralizing antibodies that effectively cross-react with Omicron subvariants following an order of BA.1>BA.2>BA.4/5. In naïve animals, ZSVG-02 or ZSVG-02-O induce humoral responses skewed to the vaccine’s targeting strains, but cellular immune responses cross-react to all variants of concern (VOCs) tested. Following heterologous prime-boost regimes, animals present comparable neutralizing antibody levels and superior protection across all VOCs. Single-boost only generated ancestral and omicron dual-responsive antibodies, probably by “recall” and “reshape” the prime immunity. New Omicron-specific antibody populations, however, appeared only following the second boost with ZSVG-02-O. Overall, our results support a heterologous boost with ZSVG-02-O, providing the best protection against current VOCs in inactivated virus vaccine– primed populations.

Background: This study was to observe the diagnostic efficacy of high resolution total colonic intracavitary manometry (HRCM) vs colonic transit test (CTT) in the assessment of functional constipation (FC) in Chinese patients.Methods: Seventy-nine cases of patients with severe FC who were admitted and received colon resection between July 2016 and July 2019 at the Tianjin Union Medical Center were retrospectively reviewed. Before operation, all patients received CTT at outpatient service, followed by HRCM at ward. The resected tissues were subject to histological observation, which was used to determine the diagnostic efficacy of HRCM vs CTT.Results: The accuracy of CTT for the FC diagnosis was 69.6% (55/79), and the false negative ratio was 30.4%. The accuracy of HRCM for the FC diagnosis was 81.0% (64/79), and the false negative ratio was 19.0% (15/79). Twelve patients showed normal characteristics after CTT but abnormal after HRCM. In contrast, only 4 showed normal after HRCM but abnormal after CTT. In addition, among the 79 patients 12 were detected normal by both CTT and HRCM.Conclusion: HRCM can be more suitable to assess FC compared with CTT, while CTT is still indispensable for HRCM to diagnose FC.