Search Results (130)

Background: Bloating, gas, and abdominal discomfort are common in healthy individuals but lack effective interventions. Probiotics can alleviate some gastrointestinal (GI) symptoms; however, evidence for their impact on bloating, gas and abdominal discomfort in otherwise healthy populations remains limited. Mechanistic studies suggest that synbiotics may influence the underlying mechanisms of bloating, including increased gas production, impaired gut motility, and visceral hypersensitivity, but there is a paucity of data from large trials evaluating clinical outcomes. Accordingly, we evaluated the effects of a multi-species synbiotic on GI symptoms. Methods: In a randomized, double-blind, placebo-controlled, decentralized trial, participants (n = 350) with self-reported bloating/indigestion received either a multi-species synbiotic (53.6 billion AFU multi-species probiotic and 400 mg pomegranate extract; DS-01) or placebo daily for 6 weeks. Outcomes included GI quality-of-life (DQLQ), bloating and gas (PROMIS-GI 13a), abdominal discomfort (PROMIS-GI 5a), constipation, regularity, mood-related symptoms, and safety. Results: The multi-species synbiotic improved GI quality-of-life compared to placebo (0.80 vs. 1.20; p < 0.05) at Week 6. Bloating and gas were reduced in the synbiotic arm compared to placebo (16.0 vs. 21.0; p < 0.01), with more participants reporting never/rarely bloating (72.3% vs. 55.9%; p < 0.001). Abdominal discomfort also decreased (8.0 vs. 10.0; p < 0.01). Additionally, there was a statistically significant improvement in constipation symptoms and regularity in the synbiotic arm relative to placebo. Conclusions: Daily supplementation with this multi-species synbiotic significantly improved GI quality-of-life, bloating, gas, abdominal discomfort, and bowel habits. This is the first synbiotic to demonstrate meaningful improvements in bloating and gas in a generally healthy, diverse, real-world population. Full article

Equine Gastric Ulcer Syndrome (EGUS) is a worldwide disease described in different categories of animals. A causal relationship between exercise and EGUS has been suggested, attributed to stress as well as physiological changes in the position of abdominal organs, especially during trot and gallop. EGUS can influence athletic fitness, as has been described in various papers on racehorses. The aim of this work was to determine if gastric ulcer healing is associated with changes in selected fitness parameters (i.e., speed, heart rate during exercise and recovery, stride length and frequency) in 21 trained showjumping horses affected by gastric ulcers. Four animals were excluded for incomplete healing or loss to follow-up. In the remaining seventeen subjects, all healed completely, and fitness parameters were evaluated before and after healing of EGUS during a ridden exercise. The animals were equipped with a fitness tracker validated for use in horses while they performed both flat work and a small obstacle course. Results show that speed and stride length increased after healing, with no concurrent modification in maximal heart rate recorded during exercise and the heart rate recorded during recovery. The increase in speed and stride length is probably related to the disappearance of abdominal discomfort, already described in racehorses after healing of gastric ulcers. Full article

Background: Takotsubo cardiomyopathy (TTC), also known as stress-induced cardiomyopathy, is an acute but reversible form of left ventricular dysfunction, most commonly triggered by physical or emotional stress. Although well documented in cardiology practice, its occurrence following hepatobiliary surgery is rarely reported. Case presentation: We describe the case of a 67-year-old woman with a history of arterial hypertension and prior cholecystectomy who was admitted for elective hepatobiliary surgery due to choledocholithiasis complicated by a liver abscess. She underwent laparotomy with choledocholithotomy, hepaticojejunostomy, and abdominal drainage. The postoperative course was complicated by intra-abdominal bleeding, requiring reoperation, and subsequent intestinal leakage, necessitating a second re-laparotomy. On the tenth postoperative day after the second surgery, she developed chest discomfort and dyspnea upon minimal exertion. Electrocardiography revealed T-wave inversions in leads V3–V6, while echocardiography demonstrated a reduced ejection fraction of 45% with apical akinesis. Plasma levels of N-terminal pro-B-type natriuretic peptide (NT–proBNP) were elevated, whereas troponin remained within normal limits. Coronary angiography excluded obstructive coronary artery disease, and ventriculography confirmed apical ballooning consistent with Takotsubo cardiomyopathy. Conclusions: This case highlights Takotsubo cardiomyopathy as a rare but important postoperative complication of major hepatobiliary surgery. Awareness of this condition in surgical patients presenting with acute chest symptoms is essential, as timely recognition and differentiation from acute coronary syndrome directly influence management and prognosis. Full article

Veronicastrum sibiricum (L.) Pennell, a species within the Plantaginaceae family, has a history of traditional application in addressing conditions such as abdominal pain, common cold, sore throat, parotitis, rheumatic discomfort, and snakebite. The plant produces diverse bioactive constituents, including phenylpropanoids, essential oils, flavonoids, and terpenoids. Terpenoids, generated via terpene synthases (TPSs), are of particular interest due to their pharmacological properties. Nevertheless, TPS enzymes in V. sibiricum have not been thoroughly investigated. In this research, a transcriptomic strategy was employed to isolate and profile TPS genes from V. sibiricum. Sequencing of the transcriptome produced 107,929 unigenes, among which 42,976 were functionally annotated using public databases. KEGG pathway examination revealed 264 genes associated with terpenoid metabolism, including 12 putative VsTPS genes harboring characteristic TPS domains. From these, VsTPS1 was successfully cloned. Functional characterization established that VsTPS1 operates as a bifunctional enzyme: in vitro, it catalyzes the conversion of FPP to (E)-nerolidol and, to a lesser extent, GPP to linalool. When expressed transiently in Nicotiana benthamiana, however, only (E)-nerolidol was detected, supporting its cytosolic localization and substrate specificity toward FPP. Accordingly, this sesquiterpene synthase was redesignated VsNES1. Co-expression of VsNES1 with HMGR in N. benthamiana markedly increased (E)-nerolidol yields, illustrating an effective strategy for heterologous production. These findings deepen our understanding of the TPS family in medicinal plant V. sibiricum and enable future biotechnological exploitation of terpenoid production in heterogenous plant cells. Full article

Background/Objectives: Vaginitis is a prevalent inflammatory disorder of the vaginal mucosa, frequently arising from its anatomical proximity to the anorectal region and a microenvironment conducive to pathogen colonization and dysbiosis. This prospective, multicenter, randomized, third-party-blinded study assessed the efficacy and safety of a plasma vaginal cleanser (WOMEN CARE^®) employing plasma-activated water (PAW) as a non-pharmacological alternative to conventional antimicrobials for restoring vaginal homeostasis. Methods: Women aged ≥19 years with clinically suspected vaginitis were assigned to either the experimental group (WOMEN CARE^®) or the control group (standard pharmacotherapy). The primary endpoint was the proportion of participants exhibiting decreased Nugent scores between baseline and Visit 4. Results: Of 144 participants in the experimental group, 125 completed the study. The experimental group showed comparable outcomes to standard pharmacotherapy group across Nugent scores, vaginal pH, and symptoms severity, with pathogen suppression confirmed as non-inferior. Additionally, PAW exerted anti-HPV activity through a potential effect against new genotypic HPV infection. While the control group experienced antibiotic-associated adverse effects (e.g., headache, abdominal discomfort, nausea), no treatment-related adverse events occurred in the WOMEN CARE^® group. Conclusions: These results indicate that PAW vaginal cleansing provides an effective, safe, non-antibiotic approach for managing vaginitis and maintaining vaginal ecological balance. Full article

Background: Cesarean section (CS) frequently results in abdominal scarring, affecting recovery, aesthetics, and quality of life. Platelet-rich plasma (PRP), an autologous concentrate rich in growth factors, may enhance wound healing. This pilot trial assessed the effect of intraoperative PRP on CS scar outcomes. Methods: In this single-center, single-blind randomized controlled trial (February 2023–December 2024), 100 women undergoing elective CS were randomized to PRP treatment (n = 50) or standard care (n = 50). PRP, prepared from 20 mL autologous blood, was infiltrated into uterine incision margins and subcutaneously before skin closure. Scar healing was evaluated at day 7 and day 40 postpartum using the Patient and Observer Scar Assessment Scale (POSAS; physician and patient), Vancouver Scar Scale, Manchester Scar Scale, REEDA (Redness, Edema, Ecchymosis, Discharge, Approximation) Scale, Visual Analog Scale (VAS), and Numeric Rating Scale (NRS). Mann–Whitney U tests and Cohen’s d effect sizes were calculated. Results: Follow-up was complete for all participants. On day 7, PRP-treated patients had lower mean scores across most scales (e.g., Vancouver: 1.74 ± 1.58 vs. 2.54 ± 2.30; p = 0.063). At day 40, improvements persisted, with POSAS Patient scores significantly lower in the PRP group (7.24 ± 1.81 vs. 8.00 ± 2.06; p = 0.029). Effect sizes were small-to-moderate (<0.5), suggesting underpowering. No adverse events occurred. Conclusions: PRP administration during CS showed favorable trends toward improved scar quality and reduced patient-reported discomfort, with statistical significance for POSAS Patient scores at 40 days. Larger, multicenter trials with extended follow-up are needed to confirm these findings. Full article

Modern diets are high in fructans, which may lead to abdominal discomfort, particularly in sensitive individuals. Microbial inulinase, an enzyme that hydrolyzes inulin into fructose and fructo-oligosaccharides (FOS), has significant prebiotic potential and may contribute to the prevention of metabolic disorders by enhancing fructan digestion. This study investigates inulinase production by the Aspergillus niger ICCF 92 strain under various growth conditions. Three carbon sources (inulin, molasses, and carob pod decoction), the time required for biosynthesis processes, and stirring speed were evaluated for their influence on inulinase activity. Nitrogen sources included yeast extract, ammonium nitrate, and ammonium phosphate. Process monitoring included pH measurement, protein quantification via the Bradford assay, and inulinase activity assessment using the 3,5-dinitrosalicylic acid method. The highest inulinase production (38.29 U/mL) and protein concentration (0.7548 mg/mL) were achieved after 14 days of static fermentation with carob pod decoction as the carbon source. Full article

A 66-year-old female underwent a colonoscopy for persistent left lower abdominal discomfort and mucous stool passage. Endoscopic examination revealed a 3 mm sessile polyp in the ascending colon. Histopathological examination of the polyp showed preserved crypt architecture with a monomorphic spindle-cell proliferation within the lamina propria. Scattered ganglion cells were present and demonstrated immunoreactivity for Calretinin and S100. The lesion was diagnosed as a colonic ganglioneuroma. Ganglioneuromas are rarely localised to the gastrointestinal tract and often detected incidentally during colonoscopic screening. While solitary lesions are typically sporadic; diffuse or multiple ganglioneuromas may be associated with hereditary syndromes such as neurofibromatosis type 1, multiple endocrine neoplasia type 2B, and juvenile polyposis, the latter belonging to the PTEN-hamartoma tumour syndrome spectrum. Clinically, most colonic ganglioneuromas are asymptomatic, although some may present with nonspecific gastrointestinal symptoms. Despite their benign nature, rare cases of malignant transformation and association with adenocarcinoma have been reported. Full article

Background/Objectives: Acute appendicitis is the most common non-obstetric surgical emergency during pregnancy. Diagnosing appendicitis in the third trimester remains especially challenging due to physiological changes that obscure clinical presentation and limit the utility of imaging modalities. These challenges can lead to diagnostic delays, increasing the risk of severe complications for both mother and fetus. Case presentation: We present a complex case of a 36-year-old pregnant woman at 29 + 4 weeks of gestation who developed acute appendicitis with an atypical clinical course. Her initial symptoms were nonspecific and misattributed to gastrointestinal discomfort related to pregnancy. Her condition progressively worsened, leading to an emergency laparoscopic appendectomy. Intraoperative findings confirmed a perforated, necrotic appendix. Postoperatively, she experienced multiple complications, including ileus, wound dehiscence, and complete eventration of the abdominal wall. These required two additional laparotomies and the application of vacuum-assisted closure (VAC) therapy for effective wound management. Despite the severity of maternal complications and the risk of preterm delivery, a multidisciplinary team provided coordinated care. The patient was delivered vaginally at 34 + 4 weeks using vacuum assistance. The neonate, who developed sepsis, was treated in the neonatal intensive care unit and discharged after 24 days. Both mother and child ultimately recovered. Conclusions: This case highlights the diagnostic complexity of appendicitis in late pregnancy and the potential for severe postoperative complications. Prompt surgical intervention, high clinical suspicion, and a multidisciplinary approach are crucial. Moreover, this report adds to the limited literature on the use of VAC therapy for abdominal eventration in pregnancy, demonstrating its feasibility and safety in selected cases. Full article

Background and Clinical Significance: Lymphatic-venous malformations (LVMs) are uncommon congenital vascular anomalies with low blood flow, consisting of atypical connections between lymphatic and venous vessels. They may develop in different body regions, with a predilection for lymphatic-rich areas. Fewer than 5% of LVMs are located intra-abdominally, typically arising from the mesentery, retroperitoneum, or greater omentum. Patients with intra-abdominal LVMs may be asymptomatic, but they can also present with symptoms such as acute abdominal pain, chronic discomfort, palpable masses, or progressive abdominal distension. Case Presentation: This case describes a 24-year-old female who presented to our emergency department with progressive abdominal distension, nausea, and vomiting. Conclusions: The diagnosis of LVMs can be challenging and requires a combination of imaging techniques, including ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI), along with histological confirmation. Full article

Background: A subset of patients with chronic dyspepsia exhibits palpable upper abdominal hardness and systemic symptoms like headache, chest discomfort, neck/shoulder stiffness, fatigue, and depression. In traditional Korean medicine (TKM), this symptom complex is referred to as Damjeok syndrome (痰积症候群, DJS). Although DJS is frequently observed in TKM practice, it lacks a clear case definition and biological mechanism, limiting its integration in gastroenterology research and evidence-based practice. Clarifying its clinical and biological features is essential to understand its pathophysiology and clinical significance. Methods: This case–control study aimed to characterize DJS by comparing 16 female patients diagnosed with DJS and 15 age-matched healthy females as controls. A female-only cohort was selected to reflect the higher prevalence of chronic dyspepsia in women and reduce biological variability. Clinical characteristics and potential DJS-specific biomarkers were evaluated through complete blood count (CBC), serum biochemical tests, heart rate variability (HRV) for autonomic function, and plasma 5-hydroxyindoleacetic acid (5-HIAA), a serotonin metabolite linked to gastrointestinal motility and autonomic regulation. Results: The DJS group had a mean disease duration of 58.0 ± 46.2 months, with epigastric fullness and underlying abdominal hardness as primary complaints. Postprandial distress syndrome (PDS) was the most common (43.8%) dyspepsia subtype, often combined with epigastric pain syndrome (EPS). Extra-gastrointestinal symptoms such as headache/fatigue (87.5%) and anxiety/depression (81.3%) were highly prevalent. Neutrophil counts were significantly lower in the DJS group (p = 0.01), while other hematological or biochemical markers showed no differences (p > 0.1). HRV analysis revealed decreased parasympathetic activity (RMSSD and HF, p < 0.1), and plasma 5-HIAA levels were significantly elevated compared to healthy controls (p = 0.01). Conclusions: DJS aligns with functional gastrointestinal disorders (FGIDs), sharing psychosomatic symptoms and reduced parasympathetic activity, suggesting gut–brain axis dysregulation. However, distinct features like palpable upper abdominal hardness and elevated plasma 5-HIAA levels indicate that DJS may represent a unique subtype within the category of FGIDs. These findings highlight the need for larger, well-designed studies to further elucidate the pathophysiology of DJS. Full article

Background: Symptomatic uncomplicated diverticular disease (SUDD) is a common condition in older adults, primarily managed through symptom control. Emerging evidence highlights the role of gut microbiota in symptom modulation and disease progression. Butyrate supplementation offers anti-inflammatory benefits and supports gut barrier integrity; when combined with specific probiotic strains, it may further promote microbiota balance. Objectives: To evaluate the clinical and microbiological effects of an oral formulation combining microencapsulated sodium butyrate with probiotic strains from four probiotic strains (Lacticaseibacillus rhamnosus, Lactiplantibacillus plantarum, Limosilactobacillus reuteri, and Bifidobacterium longum subsp. infantis) in patients with SUDD. Methods: This prospective, preliminary observation enrolled 23 patients. To control for high interindividual variability in microbiota composition, each participant served as their own control. The intervention lasted 12 weeks and included five scheduled visits, incorporating a 3-week washout period. Symptom severity and quality of life were assessed using validated questionnaires. Faecal microbiota composition was evaluated using 16S rRNA sequencing and strain-specific colonisation was monitored with qPCR. Results: Significant improvements were observed in seven out of nine reported symptoms, including reductions in abdominal pain, bloating, and discomfort. Overall symptom burden decreased, especially symptoms related to gas and stool consistency. Quality of life scores improved notably. qPCR confirmed colonisation by the administered probiotic strains. Microbiome analysis demonstrated individualized but meaningful improvements in microbial profiles. Conclusions: The combined use of microencapsulated sodium butyrate and selected probiotic strains led to measurable clinical improvements and the positive modulation of gut microbiota in patients with SUDD. This formulation was well tolerated and may represent a promising adjunct or standalone approach in the dietary management of SUDD. Full article

Background: This study investigated the biomechanical and physiological demands of the hiking position in Laser sailing, a posture requiring sailors to extend their upper bodies outside the boat to counter wind-induced heeling. This study utilized a mixed-methods approach. Methods: Twenty-two experienced Laser sailors participated in both on-land and offshore assessments. The study combined subjective discomfort ratings, biomechanical measurements, digital human modeling, and muscle activation analysis to evaluate the effects of hiking during and after exertion. Results: A two-way ANOVA showed significant effects by body region and time. The quadriceps, abdominals, and lower back reported the highest discomfort. Key postural angles were identified, including knee and hip flexion, trunk inclination, and ankle dorsiflexion. Muscle activation analysis revealed the highest engagement in the rectus abdominis (46.1% MVC), brachialis (~45%), and psoas major (~41%), with notable bilateral asymmetries. The trunk region had the highest overall activation (28.7% MVC), followed by the upper limbs (~18.7%), while the lower limbs were minimally engaged during static hiking. Conclusions: On-water conditions resulted in greater variability in joint angles, likely reflecting wind fluctuations and wave-induced boat motion. Findings highlight the quadriceps, abdominals, and lower back as primary contributors to sustained hiking, while also emphasizing the importance of targeted endurance training and ergonomic equipment design. These insights can guide training, recovery, and ergonomic strategies to optimize performance and reduce injury risk in Laser sailors. Full article

Background/Objectives: Probiotic interventions can alleviate gastrointestinal (GI) discomfort, but evidence comparing multi-strain combinations at different doses remains limited. We evaluated whether formulation potency influences clinical and microbiome outcomes. Methods: In a 4-week, randomized, double-blind trial, 100 eligible adults received one of two higher-dose multi-strain probiotic formulations at different dosages (Wec120B vs Wec300B). Weekly Gastrointestinal Symptom Rating Scale (GSRS) scores tracked symptom trajectories. Gut microbiota composition and diversity were profiled by 16S rRNA gene sequencing. Biomarkers included lipopolysaccharide (LPS), fecal calprotectin (FC), and immunoglobulin A (IgA). Results: Results indicated that the Wec120B group showed more significant improvement in abdominal pain during the early phase of intervention, while the Wec300B group was more effective in relieving reflux symptoms. In terms of biomarkers, Wec120B was more effective in reducing lipopolysaccharide (LPS) levels, whereas Wec300B showed a greater increase in immunoglobulin A (IgA) and a more pronounced reduction in fecal calprotectin (FC) levels. Both formulations significantly increased the abundance of beneficial genera such as Bifidobacterium, Blautia, [Eubacterium]_hallii_group, and Anaerostipes, while suppressing the growth of potential pathogens including Prevotella and Escherichia-Shigella. Conclusions: These findings suggest that both compound probiotic products can significantly improve GI symptoms and modulate gut microbiota structure, with Wec300B showing a superior performance in microbial regulation, likely due to its higher dosage of probiotics. This study provides reference evidence for the rational application of probiotic products in gut health management. Full article

Background/Objectives: Laparoscopic gynecologic surgery is widely utilized due to its minimally invasive nature. Postoperative discomfort, including intra-abdominal and referred shoulder pain, remains a challenge. This study evaluates the impact of deep neuromuscular blockade (NMB) reversed with sugammadex compared to moderate NMB reversed with neostigmine on postoperative pain, recovery, and surgical conditions in patients undergoing laparoscopic hysterectomy. Methods: This double-blind, randomized controlled trial included 228 patients undergoing laparoscopic hysterectomy under standardized pneumoperitoneum pressure (12 mmHg). Participants were randomized into two groups: deep NMB with sugammadex (SUG) and moderate NMB with neostigmine (NEO). Primary outcomes included postoperative pain (NRS) and neuromuscular recovery time (TOF ratio ≥ 0.9). Secondary outcomes were surgical conditions, surgeon satisfaction, extubation and recovery times, incidence of postoperative nausea and vomiting (PONV), and analgesic consumption. Results: The SUG group exhibited lower pain scores up to 24 h compared to the NEO group (p < 0.05). Pain reductions remained statistically significant up to 6 h postoperatively after Bonferroni correction, while differences beyond this time were not significant after adjustment. Neuromuscular recovery was markedly faster in the SUG group (147.58 ± 82.26 s vs. 488.02 ± 223.07 s, p < 0.05). Patients in the SUG group had shorter extubation (ΔT1), awakening (ΔT2), and recovery room transfer times (ΔT3). PONV was significantly lower in the SUG group. Deep NMB did not contribute to the improvement of surgical workspace conditions. Conclusions: Deep NMB with sugammadex enhances postoperative pain control and accelerates neuromuscular recovery in laparoscopic hysterectomy. These findings support the adoption of deep NMB with sugammadex as a valid anesthetic approach in laparoscopic hysterectomy procedures. Full article