Be Kind to Your Behind: A Systematic Review of the Habitual Use of Bidets in Benign Perianal Disease.

Background: Benign perianal disease carries significant morbidity and financial burden on the healthcare system. Given that sitz baths are recommended as a treatment modality, we considered whether using a continuous stream of water, in the form of a bidet, offers a convenient and effective alternative. Bidet use is the predominant form of perianal hygiene in Asia, but its role in perianal disease is unknown. Purpose: To critically analyze and systematically review the current evidence regarding the effect of habitual bidet use on symptoms of benign perianal disease. Data Sources. A database search was conducted on MEDLINE and Epub Ahead of Print, Embase, ClinicalTrials.gov, the Cochrane Library, and ProQuest Dissertations. All studies on bidet use in pruritus ani, hemorrhoids, or anal fissures were included. Data Extraction. The studies were screened and critically analyzed by two independent reviewers in line with PRISMA guidelines. Results: Two prospective trials and 1 cross-sectional study found that habitual use of bidets had no impact on the odds of developing hemorrhoids or hemorrhoidal symptoms. One RCT concluded that using bidets was non-inferior to sitz bath for post-hemorrhoidectomy pain. Two prospective trials and 1 cross-sectional study determined that habitual bidet use may increase the odds of developing pruritus ani. Two case series found that habitual bidet use may cause perianal burns or anterior anal fissures. A meta-analysis was not performed because only a limited number of studies were available, and they were of variable quality. Conclusion: The current evidence does not identify using bidets as a treatment modality for perianal disease, and further research is warranted to study this increasingly utilized technology.

Prognosticating Outcome in Pancreatic Head Cancer With the use of a Machine Learning Algorithm.

Background: The purpose of this project is to identify prognostic features in resectable pancreatic head adenocarcinoma and use these features to develop a machine learning algorithm that prognosticates survival for patients pursuing pancreaticoduodenectomy. Methods: A retrospective cohort study of 93 patients who underwent a pancreaticoduodenectomy was performed. The patients were analyzed in 2 groups: Group 1 (n = 38) comprised of patients who survived < 2 years, and Group 2 (n = 55) comprised of patients who survived > 2 years. After comparing the two groups, 9 categorical features and 2 continuous features (11 total) were selected to be statistically significant (p < .05) in predicting outcome after surgery. These 11 features were used to train a machine learning algorithm that prognosticates survival. Results: The algorithm obtained 75% accuracy, 41.9% sensitivity, and 97.5% specificity in predicting whether survival is less than 2 years after surgery. Conclusion: A supervised machine learning algorithm that prognosticates survival can be a useful tool to personalize treatment plans for patients with pancreatic cancer.

A rare case of jejunogastric intussusception: A case report and review of the literature.

INTRODUCTION: Jejunogastric intussusception following gastrectomy or gastric bypass surgery is a rare complication that, if not identified early, can have catastrophic outcomes. PRESENTATION OF CASE: In this case, a 59-year-old male with a previous Billroth II gastrojejunostomy presented with intussusception of the efferent loop of jejunum through his previous repair. DISCUSSION: As there has only been approximately 300 reported cases of this complication, it often does not rank high as a differential diagnosis. Early detection of jejunogastric intussusception by maintaining a high level of suspicion is critical in reducing morbidity and mortality associated with this complication. This can be achieved by following the appropriate steps to diagnosis and choosing the appropriate treatment modality. CONCLUSION: Presentation of the case and a review of the literature is critical to make surgeons aware of this rare complication.

Neuronal Ryanodine Receptors in Development and Aging.

Ryanodine receptors (RyRs) are intracellular calcium-release channels found on the endoplasmic reticulum of all cells. All three RyR isoforms, RyR1-3, are expressed in the brain, with RyR2 predominating. RyRs are localized within the soma, axons, dendritic spines, and presynaptic terminals of neurons. RyRs are highly expressed in the cerebellum, hippocampus, olfactory region, basal ganglia, and cerebral cortex. During the physiological processes of development and aging, the intracellular calcium homeostasis is largely regulated by RyRs. In this review, we discussed the potential mechanisms underlying development- and age-related RyR regulation. Dysregulation of RyRs can cause imbalance of intracellular calcium levels, leading to cellular vulnerability, impairment of synaptic neuronal function, and eventually neuronal death. Regulation of RyRs may play an essential role in cellular senescence associated with aging, and thus may be pharmacological targets for slowing down aberrant processes and neurodegenerative diseases such as Alzheimer's disease.