Rectal Prolapse: Review According to the Personal Experience

The aim of treatment of rectal prolapse is to control the prolapse, restore continence, and prevent constipation or impaired evacuation. Faced with a multitude of options, the choice of an optimal treatment is difficult. It is best tailored to patient and surgeon. Numerous procedures have been described and are generally categorized into perineal or abdominal approaches. In general, an abdominal procedure has associated with lower recurrence and better functional outcome than perineal procedures. The widespread success of laparoscopic surgery has led to the development of laparoscopic procedures in the treatment of complete rectal prolapse. In Korea, there has been a trend toward offering perineal procedures because of the high incidence of rectal prolapse in young males and its being a lesser procedure. Delorme-Thiersch procedure has appeal as a lesser procedure for patients of any age or risk category, especially for elderly low-risk patients, patients with constipation or evacuation difficulties, young males, and patients with symptomatic hemorrhoids or mucosal prolapse. Laparoscopic suture rectopexy is recommended for either low-risk female patients or patients who are concerned with postoperative aggravation of their incontinence

Adipose-derived stem cell exosomes for treatment of dupilumab-related facial redness in patients with atopic dermatitis

Background Dupilumab facial redness (DFR) is a side effect of dupilumab treatment that has only been recently reported. We previously reported on two patients with DFR who were successfully treated with a topical formulation containing human adipose tissue-derived mesenchymal stem cell-derived exosomes (ASCEs). Objectives The study aimed to evaluate the efficacy and safety of ASCEs in DFR. Participants and methods We performed 12-week prospective study at single center. Twenty adult atopic dermatitis patients diagnosed with DFR were enrolled. They were treated with a topical application of the exosome formulation every week for five consecutive weeks. Results After exosome treatment, both the average investigator global assessment score and clinical erythema assessment scale scores decreased. 19 patients (95%) were satisfied with the treatment. Compared to baseline, erythema index at week 4 were decreased by 31, 27, 13, and 25 units on the forehead, chin, right and left cheek respectively. The analysis of stratum corneum samples revealed the expression of IL-1α and human thymic stromal lymphopoietin was suppressed after exosome treatment, whereas filaggrin and vascular endothelial growth factor expression increased. Conclusions This study suggests topical formulation containing ASCEs can alleviate DFR by downregulating local inflammation and restoring skin barrier function

Clinical outcomes of surgical management for recurrent rectal prolapse: a multicenter retrospective study

Purpose: There are few reports on outcomes following surgical repair of recurrent rectal prolapse. The purpose of this study was to examine surgical outcomes for recurrent rectal prolapse. Methods: We conducted a multicenter retrospective study of patients who underwent surgery for recurrent rectal prolapse. This study used data collected by the Korean Anorectal Physiology and Pelvic Floor Disorder Study Group. Results: A total of 166 patients who underwent surgery for recurrent rectal prolapse were registered retrospectively between 2011 and 2016 in 8 referral hospitals. Among them, 153 patients were finally enrolled, excluding 13 patients who were not followed up postoperatively. Median follow-up duration was 40 months (range, 0.2-129.3 months). Methods of surgical repair for recurrent rectal prolapse included perineal approach (n = 96) and abdominal approach (n = 57). Postoperative complications occurred in 16 patients (10.5%). There was no significant difference in complication rate between perineal and abdominal approach groups. While patients who underwent the perineal approach were older and more fragile, patients who underwent the abdominal approach had longer operation time and admission days (P < 0.05). Overall, 29 patients (19.0%) showed re-recurrence after surgery. Among variables, none affected the re-recurrence. Conclusion: For the recurrent rectal prolapse, the perineal approach is used for the old and fragile patients. The postoperative complications and re-recurrence rate between perineal and abdominal approach were not different significantly. No factor including surgical method affected re-recurrence for recurrent rectal prolapse. [Ann Surg Treat Res 2022;102(4):234-240]N

Measurement of Cosmic-Ray Nuclei with the Third Flight of the CREAM Balloon-Borne Experiment

International audienceThe balloon-borne Cosmic Ray Energetics And Mass experiment had its third flight (CREAM-III) over Antarctica for 29 days from December 17, 2007 to January 19, 2008. CREAM-III was designed to directly measure the elemental spectra of cosmic-ray nuclei from Hydrogen to Iron in the energy range from 10^12 to 10^15 eV. Energy of incident cosmic rays was measured with a calorimeter that consisted of a densified carbon target directly above a stack of 20 alternating layers of tungsten and scintillating fiber ribbons. Multiple charge measurements were independently made with the silicon charge detector (SCD), Cherenkov Camera (CherCam), and a Timing Charge Detector (TCD) in order to identify particles and minimize backscattering effects from the calorimeter. Compared to previous CREAM flights, the electronic noise of CREAM-III was reduced, significantly lowering the energy threshold. Results from on-going analysis of the energy spectra will be presented

Boron And Carbon Cosmic rays in the Upper Stratosphere (BACCUS)

International audienceThe balloon-borne BACCUS experiment measures directly the elemental spectra of cosmic-ray nuclei from protons to Fe over the energy range ~10^12 to 10^15 eV. It focuses on the energy dependence of secondary to primary ratios (e.g. B/C) to investigate cosmic-ray propagation history. BACCUS consists of redundant and complementary particle detectors including the Timing Charge Detector (TCD), Transition Radiation Detector (TRD), Cherenkov Detector (CD), Silicon Charge Detector (SCD), and Calorimeter (CAL). The TCD measures the light yield produced by the particle in plastic scintillator. The TRD provides energy measurements of incident 3 ≤ Z ≤ 26 nuclei in the 102 – 105 Lorentz factor range. The CD responds only to particles with velocity exceeding the velocity of light in the plastic. It allows BACCUS to reject the abundant low energy cosmic rays present in the polar region. The CAL is used to determine the particle’s energy for all nuclei for 1 ≤ Z ≤ 26. With the SCD based on pixellation, in addition to the TCD based on timing, and the CD, the BACCUS instrument implements virtually all possible techniques to minimize the effect of backscatter on charge measurements in the presence of a large particle shower in the CAL. The 30 day flight was carried out successfully over Antarctica in 2016 from Nov. 28 to Dec. 28. The integration test, and performance of instruments will be presented