Comparing Impacts of Different Bowel Cleansing Agents and Oral Probiotics After Cleansing On Symptom and Microbiota: a Randomized Placebo-Controlled Trial

Background: Sodium sulfate-based purge has shown better quality of bowel preparation than polyethylene glycol (PEG) in a large retrospective study. However, its side effects and impact to gut microbiota have not been assessed. Besides, evidence from intestinal microecology that probiotics were beneficial to individuals who received bowel preparation is still lacking. The aims are to evaluate the side effects and microecological impact of two bowel cleansing agents (PEG and mirabilite), as well as the regulating effect of probiotics on microecosystem perturbed by bowel preparation.Results: Mirabilite preparation appeared superior to PEG preparation in terms of side effects, consumed time and volume of solutions. Quantitative PCR results showed that the recovery rate of total microbial load in mirabilite group was faster than that in PEG group. 16S rRNA sequencing showed that there were no significant differences in effects of two bowel cleansing agents on multiple microbiota diversity metrics. And both laxatives may affect the relative abundance of core microbiota until 28 days after bowel preparation. Probiotics supplementation was beneficial to recovery of perturbed microecosystem and the maintenance of homeostasis in the gut according to our results. Moreover, probiotics supplementation relieved abdominal symptoms and few individual events induced by bowel preparation during long-term follow-up.Conclusions: Mirabilite could be an optimal bowel cleansing agent for healthy people and can be applied broadly. Besides, probiotics are suggested to administrate after bowel cleansing as it brings multiple benefits in our study.

Cooled Radiofrequency Ablation of the Articular Sensory Branches of the Obturator and Femoral Nerves using Fluoroscopy and Ultrasound Guidance: A Large Retrospective Study

BACKGROUND: We previously reported on a combined technique and initial data of hip denervation using an anterior approach and cooled radiofrequency. OBJECTIVES: A large retrospective study to evaluate the long-term effectiveness of cooled radiofrequency ablation (CRFA) in the general chronic hip pain population. STUDY DESIGN: Retrospective electronic chart review. SETTING: A single specialty private practice. METHODS: Retrospective chart review of 235 consecutive (CRFA) in 136 patients with chronic hip pain. RESULTS: Out of 235 CRFA, 178 (96 initial procedures and 82 repeats) were performed in 84 patients with 12 or more months follow-up. The average decrease in visual analog scale (VAS) pain scores was 7.3 ± 1.3 to 2.3 ± 1.5 and 2.48 ± 1.5 for the first and second diagnostic block, respectively, and was statistically significant (P < 0.001). Similarly, the average decrease in VAS pain scores at 6 and 12 months after CRFA denervation was 3.44 ± 2.5 and 4.23 ± 2.5, respectively; P < 0.001. Out of the 96 initial procedures in 84 patients, 66 procedures (69%) provided more than 50% relief at 6 months, and 50 (52%) at 12 months. There were 82 repeat denervations in 36 patients. Repeated procedures in the same patients provided a similar degree of pain relief with no statistically significant difference in the median pain scores (2.8 ± 2.1 cm vs 3.1 ± 1.7 cm ; P = 0.197) or time interval of pain relief (12.7 ± 10.9 vs 10.3 ± 4.7; P = 0.508). There were 3 minor complications. LIMITATIONS: Retrospective nature of the study. CONCLUSION: Improvements in pain scores and longevity of pain relief from chronic hip pain using a simple, anterior approach to radiofrequency denervation of the lateral obturator and lateral femoral nerves justifies further randomized prospective trials. Repeated CRFAs demonstrated consistency in pain relief and absolute safety of repeated denervation. KEY WORDS: Hip denervation, degenerative joint disease, chronic hip pain, radiofrequency denervation, lateral obturator nerve, lateral femoral nerve

Jain point: an alternate laparoscopic non-umbilical first blind entry port to avoid vessel, viscera, adhesions and bowel (VVAB)

The Jain point entry is based on the concept of non-umbilical entry to avoid sudden catastrophic injury to major retroperitoneal vessels, viscera, adhesions and bowel which could happen before the start of procedure by blind umbilical entry. To study the safety and efficacy of a novel first non-umbilical blind entry port. Tertiary referral centre for advanced laparoscopic surgeries with active training and fellowship programs. A large retrospective study of 7802 cases done at Vardhman Infertility & Laparoscopy Centre from January 2011 to December 2020. In all cases, first blind entry was by veress needle and 5 mm trocar and telescope through a non-umbilical port, The Jain point, irrespective of BMI, large masses, lax abdomen, previous surgery and complex situations. Patients’ demographic profile, types of surgeries performed and entry-related complications were recorded and analysed. Mean age of patients was 33 years with BMI ranging from 12.66 to 54.41 kg/m2. Thus, Jain point can be applicable for all ranges of BMI, all types of surgeries from simple to complex and large masses. Entry related minor complications were in 3.4% cases while major complication involving bowel occurred in one case. No case of injury to major retro-peritoneal vessel was seen. Jain point entry is a novel, first blind 5 mm non-umbilical, entry technique in a variety of surgeries and previous scars and patients with wide range of BMI. It has a short learning curve and continues as main ergonomic working port.