Role of interleukin-17 in the pathogenesis of perianal abscess and anal fistula: a clinical study on 50 patients with perianal abscess

A Mendelian Randomization Study of the Connection Between Exogenous Hormones and Perianal Abscess in Pediatric Patients

Background: Recent years have witnessed the hypothesis that bioavailable testosterone (BT) might be closely related to the development of inflammatory diseases, especially anal abscess (AA), a common inflammatory ailment with unclear pathogenesis. Given that AA is more prevalent among males, this study investigates the causal relationship between BT and AA. Objective: To explore the causal link between BT and AA, a Mendelian randomization (MR) study was conducted using large-scale genomic data. Materials and Methods: Utilizing genomic data from the UK Biobank and IEU OpenGWAS databases, a two-sample MR analysis was executed. Twenty-six genetic variants strongly associated with BT were selected as instrumental variables (IVs) to assess their link with AA risk. Various MR methods were employed for consistency checks, including sensitivity analyses for heterogeneity and horizontal pleiotropy. Results: Using a combination of MR methods, we identified a significant causal relationship between BT and the risk of AA. Specifically, the MR analysis revealed that higher levels of BT were associated with an increased risk of AA. Sensitivity analyses, including heterogeneity tests and assessments for horizontal pleiotropy, confirmed the robustness of these findings. The IVs used in the analysis demonstrated a strong association with BT and showed no evidence of significant heterogeneity or horizontal pleiotropy, indicating the validity of the causal inference. Conclusion: This study, employing two-sample MR for the first time, confirms a causal relationship between BT levels and the risk of AA. These findings provide preliminary evidence of the causal relationship between BT and AA and may offer new insights into the pathophysiological mechanism of AA and future therapeutic strategies.

Differences in Gut Microbiota between Healthy Individuals and Patients with Perianal Abscess before and after Surgery

Surgery is the most important treatment for perianal abscesses. However, the gut microbiota of patients with perianal abscess and the effects of perianal abscess on the gut microbiota after surgery are unknown. In this study, significant changes in interleukin 6 and tumor necrosis factor-α in the blood of healthy subjects, patients with perianal abscesses, and patients after perianal abscess surgery were identified. 16S rRNA gene sequencing technology was used to detect the changes in the gut microbiota among 30 healthy individuals and 30 patients with perianal abscess before and after surgery. Venn diagrams and alpha diversity analyses indicated differences in the abundance and uniformity of gut microbiota between the healthy individuals and patients with perianal abscesses before and after surgery. Beta diversity analysis indicated that the grouping effects among the control, abscess, and surgery groups were good. The classification and compositional analysis showed significant differences in the gut microbiota between healthy individuals and patients with perianal abscesses before and after surgery. LEfSe analysis, random forest analysis, and ROC curve analysis showed that Klebsiella (AUC = 0.7467) and Bilophila (AUC = 0.72) could be potential biomarkers for the diagnosis of perianal abscess. The functional prediction results showed that the differential microbiota is significantly enriched in the pathways related to nutrition and drug metabolism. This study may have important implications for the clinical management and prognostic assessment of patients with perianal abscesses.

Clinical features and independent predictors of postoperative refractory trauma to anal fistula combined with T2DM: A propensity score-matched analysis-retrospective cohort study

Background

Refractory wound is a common postoperative complication in anal fistula surgery, when combined with type 2 diabetes mellitus (T2DM) it presents a slower recovery time and more complex wound physiology. The study aims to investigate factors associated with wound healing in patients with T2DM.

Materials and methods

365 T2DM patients who underwent anal fistula surgery at our institution were recruited from June 2017 to May 2022. Through propensity score-matched (PSM) analysis, multivariate logistic regression analysis was applied to determine independent risk factors affecting wound healing.

Results

122 pairs of patients with no significant differences were successfully established in matched variables. Multivariate logistic regression analysis revealed that uric acid (OR: 1.008, 95% CI: 1.002-1.015, p = 0.012), maximal fasting blood glucose (FBG) (OR: 1.489, 95% CI: 1.028-2.157, p = 0.035) and random intravenous blood glucose (OR: 1.130, 95% CI: 1.008-1.267, p = 0.037) elevation and the incision at 5 o'clock under the lithotomy position (OR: 3.510, 95% CI: 1.214-10.146, p = 0.020) were independent risk factors for impeding wound healing. However, neutrophil percentage fluctuating within the normal range can be considered as an independent protective factor (OR: 0.906, 95% CI: 0.856-0.958, p = 0.001). After executing the receiver operating characteristic (ROC) curve analysis, it was found that the maximum FBG expressed the largest under curve area (AUC), glycosylated hemoglobin (HbA1c) showed the strongest sensitivity at the critical value and maximum postprandial blood glucose (PBG) had the highest specificity at the critical value. To promote high-quality healing of anal wounds in diabetic patients, clinicians should not only pay attention to surgical procedures but also take above-mentioned indicators into consideration.

The pathogenesis of cryptoglandular anal fistula: New insight into the immunological profile

AIM

The aetiology of cryptoglandular anal fistula (AF) is poorly understood. Evidence suggests that persistence and/or recurrence of the disease is more related to inflammatory than infectious factors. The aim of this study was to investigate the immune profile of cryptoglandular AF and to perform a histopathological characterization.

METHOD

Fistulectomy was performed in all patients; healthy ischioanal fat from the same patients was used as a control. Samples were evaluated by the Luminex xMAP system for the detection of 27 analytes. AF tissues were analysed using immunofluorescence. Staining was performed using primary antibodies to identify M1 inflammatory and M2 anti-inflammatory macrophages. Selective staining of total T lymphocytes and different T lymphocyte subsets was performed.

RESULTS

Twenty patients with AF underwent a fistulectomy. Specific cytokine pathways differentiated AF from healthy tissue: pro-inflammatory cytokines interleukin (IL)-1β, IL-4, IL-8 and IL-17 and the anti-inflammatory cytokine IL-10 were overexpressed in AF compared with controls. Chemokines involved in macrophage recruitment (CCL2, CCL3, CCL4) were higher in AF than in healthy fatty tissue. Moreover, we showed that Tc17 cells characterize AF patients, thus confirming the enzyme-linked immunosorbent assay data. Furthermore, elevated infiltration of CD68+ myeloid cells and a reduction of the M1/M2 ratio characterize AF patients.

CONCLUSION

A combination of inflammatory cytokines, chemokines and growth factors reside in the wound microenvironment of AF patients. For the first time an important prevalence of Tc17 cells and a reduction in the M1/M2 ratio was observed, thus suggesting new insights into the immunological characterization of AF patients.

Intervention Effect of Evidence-Based Nursing on Postoperative Recovery of Vacuum Sealing Drainage in Patients with High Perianal Abscess with Magnetic Resonance Imaging Sequence Images

The purpose of this study was to evaluate the intervention effect of evidence-based nursing (EBN) on vacuum sealing drainage (VSD) recovery of patients with high perianal abscess after vacuum sealing drainage based on magnetic resonance imaging (MRI) sequence images. 60 patients with high perianal abscess were selected, and 30 patients before VSD were selected as the control group. Routine nursing was implemented in the control group, 30 patients after VSD were observed, and EBN was implemented in the observation group. The detection rates of various types of perianal abscess with different sequence combinations were studied, and the effects of EBN on pain and anal function scores of perianal abscess patients were analyzed. Anal function and defecation were assessed, and postoperative complications were calculated. Different combinations of MRI sequences can reach higher detection rates of intersphincter abscess and ischial anal abscess. The observation group had better pain relief and anal function recovery. The complication rate of the observation group was 16.67%, which was significantly lower than that of the control group (P < 0.05). It was confirmed that different MRI sequence combinations had higher detection rates for intersphincter abscess and ischial fossa abscess. EBN can promote the recovery of anal function and reduce complications in patients with perianal abscess.

Deep Learning-Based Computed Tomography Image Features in the Detection and Diagnosis of Perianal Abscess Tissue

The performance characteristics of deep learning fully convolutional neural network (DLFCNN) algorithm-based computed tomography (CT) images were investigated in the detection and diagnosis of perianal abscess tissue. 60 patients who were medically diagnosed as perianal abscesses in the hospital were selected as the experimental group, and 60 healthy volunteers were selected as the control group. In this study, the DLFCNN algorithm based on deep learning was compared with the CNN algorithm and applied to the segmentation training of CT images of patients with perianal abscesses. Then, the segmentation metrics Jaccard, Dice coefficient, precision rate, and recall rate were compared by extracting the region of interest. The results showed that Jaccard (0.7326) calculated by the CNN algorithm was sharply lower than that of the DLFCNN algorithm (0.8525), and the Dice coefficient (0.7264) was also steeply lower than that of the DLFCNN algorithm (0.8434) (P < 0.05). The thickness range of the epidermis and dermis in patients from the experimental group was 4.1–4.9 mm, which was markedly greater than the range of the control group (1.8–3.6 mm) (P < 0.05). Besides, the CT value of the subcutaneous fascia in the experimental group (−95.45 ± 8.26) hugely reduced compared with the control group (−76.34 ± 7.69) (P < 0.05). The accuracy rate of the patients with perianal abscesses was 96.67% by multislice spiral CT (MSCT). Therefore, the DLFCNN algorithm in this study had good stability and good segmentation effect. The skin at the focal site of anal abscess was obviously thickened, and it was simple and accurate to use CT images in the diagnosis of patients with perianal abscesses, which could effectively locate the lesion and clarify the relationship between the lesion and the surrounding structure.