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BackgroundTo investigate the effect of moxibustion at the Tianshu acupoint in relieving abdominal pain and bloating after a painless colonoscopy.MethodsPatients who underwent painless colonoscopy from March 1, 2024, to September 30, 2024, and had abdominal pain and bloating scores of 2 or above (no pain or bloating scored 1, mild pain or bloating scored 2, moderate pain or bloating but tolerable scored 3 and severe unbearable abdominal pain or bloating scored 4) were selected. A total of 100 patients were randomly divided into two groups: the study group and the control group, with 50 patients in each group. The control group received routine nursing intervention (clockwise abdominal massage), while the study group received moxibustion at the Tianshu acupoint. The degree of bloating and the time of bloating disappearance were compared between the two groups before the intervention and at 30 minutes, 60 minutes, and 120 minutes after the intervention. A follow-up study was conducted via telephone.ResultsBefore the intervention, there was no significant difference in the degree of abdominal pain and bloating between the two groups (P > 0.05). After 30 minutes of intervention, the scores for abdominal pain and bloating were 1.78 ± 0.23 in the study group and 1.97 ± 0.20 in the control group (P = 0.015). After 60 minutes, the scores were 1.13 ± 0.18 in the study group and 1.59 ± 0.23 in the control group (P = 0.009). After 120 minutes, the scores were 0.60 ± 0.21 in the study group and 1.32 ± 0.26 in the control group (P = 0.006). The study group had significantly lower scores for abdominal pain and bloating than the control group (P < 0.05). The time for the disappearance of abdominal pain and bloating was significantly shorter in the study group (76.35 ± 18.13 minutes) than in the control group (158.36 ± 50.68 minutes, P = 0.002).ConclusionsMoxibustion at the Tianshu acupoint has a good therapeutic effect on patients with abdominal pain and bloating after painless colonoscopy. It can relieve these symptoms more quickly and improve the therapeutic effect, making it worthy of promotion.

ObjectiveA diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) is recommended for irritable bowel syndrome (IBS), if general lifestyle and dietary advice fails. However, although the impact of a low FODMAP diet on individual IBS symptoms has been examined in some randomised controlled trials (RCTs), there has been no recent systematic assessment, and individual trials have studied numerous alternative or control interventions, meaning the best comparator is unclear. We performed a network meta-analysis addressing these uncertainties.DesignWe searched the medical literature through to 2 April 2021 to identify RCTs of a low FODMAP diet in IBS. Efficacy was judged using dichotomous assessment of improvement in global IBS symptoms or improvement in individual IBS symptoms, including abdominal pain, abdominal bloating or distension, and bowel habit. Data were pooled using a random effects model, with efficacy reported as pooled relative risks (RRs) with 95% CIs, and interventions ranked according to their P-score.ResultsWe identified 13 eligible RCTs (944 patients). Based on failure to achieve an improvement in global IBS symptoms, a low FODMAP diet ranked first vs habitual diet (RR of symptoms not improving=0.67; 95% CI 0.48 to 0.91, P-score=0.99), and was superior to all other interventions. Low FODMAP diet ranked first for abdominal pain severity, abdominal bloating or distension severity and bowel habit, although for the latter it was not superior to any other intervention. A low FODMAP diet was superior to British Dietetic Association (BDA)/National Institute for Health and Care Excellence (NICE) dietary advice for abdominal bloating or distension (RR=0.72; 95% CI 0.55 to 0.94). BDA/NICE dietary advice was not superior to any other intervention in any analysis.ConclusionIn a network analysis, low FODMAP diet ranked first for all endpoints studied. However, most trials were based in secondary or tertiary care and did not study effects of FODMAP reintroduction and personalisation on symptoms.

Solid organs transport fluids through distinct vascular networks that are biophysically and biochemically entangled, creating complex three-dimensional (3D) transport regimes that have remained difficult to produce and study. We establish intravascular and multivascular design freedoms with photopolymerizable hydrogels by using food dye additives as biocompatible yet potent photoabsorbers for projection stereolithography. We demonstrate monolithic transparent hydrogels, produced in minutes, comprising efficient intravascular 3D fluid mixers and functional bicuspid valves. We further elaborate entangled vascular networks from space-filling mathematical topologies and explore the oxygenation and flow of human red blood cells during tidal ventilation and distension of a proximate airway. In addition, we deploy structured biodegradable hydrogel carriers in a rodent model of chronic liver injury to highlight the potential translational utility of this materials innovation.

To understand the health impact of long-duration spaceflight, one identical twin astronaut was monitored before, during, and after a 1-year mission onboard the International Space Station; his twin served as a genetically matched ground control. Longitudinal assessments identified spaceflight-specific changes, including decreased body mass, telomere elongation, genome instability, carotid artery distension and increased intima-media thickness, altered ocular structure, transcriptional and metabolic changes, DNA methylation changes in immune and oxidative stress-related pathways, gastrointestinal microbiota alterations, and some cognitive decline postflight. Although average telomere length, global gene expression, and microbiome changes returned to near preflight levels within 6 months after return to Earth, increased numbers of short telomeres were observed and expression of some genes was still disrupted. These multiomic, molecular, physiological, and behavioral datasets provide a valuable roadmap of the putative health risks for future human spaceflight.

This paper presents an AI-powered solution for detecting and monitoring Autonomic Dysreflexia (AD) in individuals with spinal cord injuries. Current AD detection methods are limited, lacking non-invasive monitoring systems. We propose a model that combines skin nerve activity (SKNA) signals with a deep neural network (DNN) architecture to overcome this limitation. The DNN is trained on a meticulously curated dataset obtained through controlled colorectal distension, inducing AD events in rats with spinal cord surgery above the T6 level. The proposed system achieves an impressive average classification accuracy of 93.9% ± 2.5%, ensuring accurate AD identification with high precision (95.2% ± 2.1%). It demonstrates a balanced performance with an average F1 score of 94.4% ± 1.8%, indicating a harmonious balance between precision and recall. Additionally, the system exhibits a low average false-negative rate of 4.8% ± 1.6%, minimizing the misclassification of non-AD cases. The robustness and generalizability of the system are validated on unseen data, maintaining high accuracy, F1 score, and a low false-negative rate. This AI-powered solution represents a significant advancement in non-invasive, real-time AD monitoring, with the potential to improve patient outcomes and enhance AD management in individuals with spinal cord injuries. This research contributes a promising solution to the critical healthcare challenge of AD detection and monitoring.

Objectives Sigmoid volvulus (SV) is a common cause of bowel obstruction, especially in older patients. SV can be mesenteroaxial (M-SV) or organoaxial (O-SV). The purpose of this study was to assess if CT findings in SV are associated with clinical outcomes. including recurrence, choice of management, and mortality. Materials and methods This study includes patients with SV and a CT within 24 hours of presentation. CT features, including mesenteraoxial/organoaxial arrangement, direction of rotation, transition points, distension, whirl-sign, ischemia, and perforation were determined. Demographics, treatment, recurrence, and outcome data were recorded. Results One hundred and seventeen cases were diagnosed in 80 patients (54 male). The mean age was 70 years (± 17.1). M-SV and O-SV were equally prevalent ( n  = 39 vs . n  = 41, respectively). M-SV was significantly more common with anticlockwise rotation in the axial plane ( p  = 0.028) and clockwise rotation in the coronal plane ( p  = 0.015). All patients with imaging features of ischemia underwent surgery ( n  = 6). There was no significant difference in outcome variables (30-day mortality, 30-day readmission, recurrence) between the O-SV and M-SV groups. The degree of bowel distension on initial presentation was a significant predictor of recurrence, with ≥ 9 cm vs < 9 cm associated with an increased odds of any recurrence (OR: 3.23; 95%CI: 1.39–7.92). Conclusion In SV, sigmoid distension of more than 9 cm at baseline CT was associated with an increased risk of recurrence. Imaging features of ischemia predicted surgical over endoscopic intervention. Organoaxial and mesenteroaxial SV had similar prevalence, but the type of volvulus was not associated with clinical outcomes or choice of management. Clinical relevance statement There is a risk of recurrent sigmoid volvulus with colonic distension greater than 9 cm. This work, comparing volvulus subtypes, shows that this finding at the initial presentation could expedite consideration for surgical management. Key Points Reports of outcomes for different subtypes and rotational directions of volvuli have been contradictory. No difference in measured outcomes was found between subtypes; distension ≥   9   cm predicted recurrence. CT features can aide management of sigmoid volvulus and can prompt surgical intervention.

IntroductionSpontaneous bacterial peritonitis (SBP) is a serious complication of liver cirrhosis. Delays in diagnosis are associated with increased mortality and national guidance recommends a diagnostic ascitic tap should be sent within 6 hours of hospitalisation. We studied the experience of doctors working within general medicine in this procedure.MethodsA questionnaire was circulated to doctors working in general medicine, with questions about their training level, experience in the procedure and a clinical case. 105 doctors from foundation year 1 (F1) to consultants responded across four hospital sites [1 liver transplant centre, 1 tertiary liver centre, 2 district general hospitals]. Statistical analysis was performed using SPSS v30.ResultsResponses were collected from 105 doctors. 5% were consultants, 28.6% were registrars (SpR), 53.3% were senior house officers (SHO) and 13.3% were foundation year 1 (F1). 27.6% of responders had never performed an ascitic tap, with another 33.3% having performed the procedure less than 5 times. 61% would not be confident to do an ascitic tap independently, with confidence significantly increased in those who had done a higher number of procedures [p<0.001]. 59% would not do an ascitic tap without ultrasound. In a case of a patient presenting with alcohol related liver disease, abdominal pain and distension, 51.4% of doctors would do an ascitic tap with 25.7% not doing the procedure due to abnormal clotting and 21.9% due to lack of confidence. The likelihood of doing an ascitic tap was significantly increased with increased seniority, having had a gastroenterology job, and in those who self reported confidence in doing the procedure [p<0.001]. Of 14 F1s who responded, 85% had never done an ascitic tap and none would do one in the described clinical case. Of the 56 SHOs, 30.4% had never performed an ascitic tap and 78.6% would not be confident to do this independently. Of the 30 SpR doctors, 20% were not confident to do the procedure independently.ConclusionsNearly half of doctors surveyed would not perform an ascitic tap in a patient presenting with symptoms of SBP, due to lack of experience and knowledge regarding clotting derangement in cirrhosis. Most foundation and core trainees surveyed as well as 20% of specialist trainees did not feel confident to do the procedure without supervision. This could lead to delays in the diagnosis of SBP, which is associated with worsened prognosis. We suggest that additional training on this procedure during medical school or early in clinical training may improve confidence and procedural skill.

The mammalian lung´s structural design is optimized to serve its main function: gas exchange. It takes place in the alveolar region (parenchyma) where air and blood are brought in close proximity over a large surface. Air reaches the alveolar lumen via a conducting airway tree. Blood flows in a capillary network embedded in inter-alveolar septa. The barrier between air and blood consists of a continuous alveolar epithelium (a mosaic of type I and type II alveolar epithelial cells), a continuous capillary endothelium and the connective tissue layer in-between. By virtue of its respiratory movements, the lung has to withstand mechanical challenges throughout life. Alveoli must be protected from over-distension as well as from collapse by inherent stabilizing factors. The mechanical stability of the parenchyma is ensured by two components: a connective tissue fiber network and the surfactant system. The connective tissue fibers form a continuous tensegrity (tension + integrity) backbone consisting of axial, peripheral and septal fibers. Surfactant (surface active agent) is the secretory product of type II alveolar epithelial cells and covers the alveolar epithelium as a biophysically active thin and continuous film. Here, we briefly review the structural components relevant for gas exchange. Then we describe our current understanding of how these components function under normal conditions and how lung injury results in dysfunction of alveolar micromechanics finally leading to lung fibrosis.

IntroductionMACE is a new, non-invasive technology which approaches the diagnostic sensitivity of OGD in gastric focal lesion detection in patients with dyspepsia. [Li et al., CGH 2016] This study compared the two in the detection of focal and diffuse lesions in patients referred for the investigation of anaemia.MethodsMACE was performed within one week before OGD using the AnX Robotica magnet system and Navicam capsule (single camera capsule, frame rate 6/sec: Wuhan, China). Following a fast, simethicone and gastric distension using 0.5–1L water, patients swallowed the capsule semi-recumbent on the left lateral side before lying supine to allow approximation of the magnet to the chest. The examination protocol included a sequence of magnet movements and patient position changes. Inspection of an anatomical location was considered complete if sufficient to exclude any significant pathology. Endoscopists performing OGD were blinded to the MACE outcome and all findings were recorded from a pre-identified diagnostic list. Data was analysed using SPSS.Results45 of 81 (55.5%; median age 63 (IQR 45.5- 72), 60% male) patients had pathology identified by MACE, OGD or both. Complete views were obtained by MACE in the oesophagus (72.4%), proximal stomach (93.8%), distal stomach (93.8%) and duodenum(79.6%, p<0.001) and mean examination time was 22 minutes.Findings were concordant in 17 (37.8%: gastric erosions (n=6), ulcers (n=5), oesophagitis (n=2), eroded polyps (n=2) and gastric antral vascular ectasia (n=2)). MACE alone identified pathology in 24 (53.3%: gastric erosions (n=17), angioectasia (n=4), ulcers (n=2, oesophageal and duodenal), eroded polyp (n=1) and both angioectasia and erosions (n=1). OGD identified a distal body ulcer (n=1), small (n=1) and large (n=1) oesophageal varices and oesophageal ulcers (n=1) missed by MACE and in one patient MACE identified only an oesophageal ulcer and OGD only a duodenal ulcer, each missing the pathology detected by the other. Diagnostic yield was higher for MACE than OGD (P<0.001).ConclusionsThe improved diagnostic yield of MACE compared to OGD is accounted for mainly by minor mucosal abnormalities which could, nonetheless, contribute to occult bleeding and anaemia. Although speculative this could be because of better tolerance of MACE and a longer examination time. An increased frame capture rate, with or without a second camera, is needed to improve oesophageal visualisation.

BackgroundTo explore the effects of pushing notifications about recommended diet and correct medication in colonoscopy intestinal preparation by the WeChat platform.MethodsA total of 100 patients who underwent colonoscopy from Aug 3rd, 2022 to Aug 8th, 2022 were selected as the research objects. The patients were divided into a control group and an observation group according to the random number table method, with 50 cases in each group. The control group was given routine intestinal preparation nursing, and the observation group was given pushing notifications about recommended diet and correct medication in colonoscopy intestinal preparation by WeChat platform every day since three days before the colonoscopy ago, on the basis of the control group. The adequacy rate of bowel preparation, the detection rate of adenoma, the compliance of bowel preparation and the occurrence of adverse reactions of the 2 groups were compared.ResultsThe bowel preparation adequacy rate, colon adenoma detection rate, and bowel preparation compliance ratio of the observation group were all higher than those of the control group(P<0.05). The number of cases of nausea, abdominal distension and hypoglycemia in bowel preparation in the observation group was less than in the control group (P <0.05).ConclusionsThe application of pushing notifications about recommended diet and correct medication in colonoscopy intestinal preparation by the WeChat platform can effectively improve the bowel preparation adequacy rate, the detection rate of polyps, and the compliance of intestinal preparation; reduce the occurrence of adverse reactions during the intestinal preparation process, and alleviate the intestinal preparation of patients.