Fissure in Ano

便秘，一种难以言说的痛，困扰着不少朋友。虽然说人类的悲喜并不相通，但在便秘这件事情上，大概是相通的，使出“洪荒之力”，却依然“颗粒无收”，那种在厕所经经历地老天荒的感觉并不好受。偶尔一次的排便费劲儿，并不属于便秘。便秘是指每周排便少于3次、粪便干硬、排便困难。偶尔发生便秘是常见现象，但当便秘持续＞12周则为慢性便秘。众所周知，长期便秘对身体危害很大，比如腹痛腹胀影响生活质量，诱发混合痔、肛裂和直肠脱垂等。那么问题来了，排便次数可能还会影响认知功能，您知道吗？近日，美国马萨诸塞大学、哈佛大学等单位联合在知名期刊Neurology发表了一篇研究论文，题目为“Association Between Bowel-Movement Pattern and Cognitive Function: Prospective Cohort Study and a Metagenomic Analysis of the Gut Microbiome”，结果发现，与每日排便一次者相比，每3日或更长时间才排便的受试者认知功能明显更差，相当于认知功能衰老三年，其可能与肠道微生物菌群和特定微生物种类显著相关。doi: 10.1212/WNL.0000000000207849在这项前瞻性研究中，研究人员调查了护士健康研究II（NHSII）中12696名女性受试者排便频率与客观测量认知功能的关系；以及来自护士健康研究（NHS）、NHSII和卫生专业人员随访研究（HPFS）三个队列研究的113145名女性和男性受试者排便频率与主观认知功能的关系。并在探索性分析中，深入研究了来自NHSII和HPFS的515名受试者的排便频率、肠道微生物群和主观认知功能之间的相互关系。研究者将研究人群按照排便频率分为四类：每三天或更久，每隔一天，每天，每天两次或更多次。在排便频率评估时，NHS研究人群的平均年龄为75.7岁，NHSII为58.6岁，HPFS为74.5岁。报告显示，排便频率较高的参与者膳食纤维摄入量较高，使用泻药的频率较低。与那些每天排便一次的人相比，排便频率或多或少的参与者身体活动较少，更有可能出现抑郁症状并使用抗抑郁药。研究者使用CogState计算机神经心理评价软件来评估客观认知功能，研究显示，在对潜在混杂因素进行调整后，排便频率与客观认知功能呈现反J形剂量反应方式相关。并且学习和工作记忆以及精神运动速度和注意力也存在类似的剂量-反应关联。图：排便频率和客观认知功能的关联（来源：[1]）客观认知功能方面，与每日排便的受试者相比，排便频率为每3天或更长时间一次的受试者的认知恶化程度相当于衰老3.0岁。特别是在学习和工作记忆方面，排便频率为每3天或更长时间一次的受试者，其认知能力恶化相当于衰老7.1岁。主观认知能力下降是用一组是/否问题来评估的，包括NHSII和NHS的7个问题和HPFS的6个问题，涉及自我感知的近期记忆和认知变化。结果显示，在三个独立队列中，排便频率与主观认知能力下降剂量反应均呈反J型关系。图：排便频率和主观认知能力下降的关联（来源：[1]）主观认知功能方面，与每日排便者相比，排便次数最少（每3天或更长时间一次）和最多（每天两次或更多次）的受试人群，主观认知能力下降的几率分别高出73%和37%，并且，随着时间的推移，出现主观认知下降抱怨的可能性分别高出19%和10%。与此同时，排便频率与一般记忆、执行功能、注意力和视觉空间技能的长期恶化可能性之间也存在非线性剂量-反应关系。紧接着，研究人员还在515名受试者中探索了肠道微生物在排便频率和认知功能之间关系中的作用。研究者指出，虽然排便频率不是肠道微生物组成的主要驱动因素，但PERMANOVA显示，排便频率与肠道微生物组的整体变化之间存在显著关联，排便频率与PCo1呈显著非线性相关。此外，主观认知能力下降与肠道微生物组总体变异显著相关，与PCo1呈正相关。最终，研究者确定了19种与排便频率显著相关的微生物，15种与认知功能显著相关的微生物；3种微生物与排便频率和认知功能均显著相关，包括瘤状球菌、柠檬酸梭菌和厌氧杆菌（An250）。与生态失调相关的细络菌属，如细小弧菌、异速弧菌和非典型弧菌，是常见于口腔、肠道和泌尿生殖系统的革兰氏阴性和严格厌氧细菌，与更频繁的排便有关。图：排便频率、认知功能与肠道微生物群整体变化的关系（来源：[1]）在排便频率较低的受试者中，观察到Roseburia spp.丰度减少，包括R. inulinivorans和R. faecis等主要的丁酸盐产生细菌物种在内。在认知功能方面，条件致病菌丹毒弧菌Erysipelatoclostridium ramosum和厌氧细菌Blautia sp. CAG 257的富集与认知功能恶化有关。膳食纤维加工者和丁酸盐生产者Eubacterium eligens菌在认知功能较好的受试者体内含量更为丰富。总的来说，便秘人群要多注意，排便频率越低，客观测量的认知功能越差，主观认知能力下降的风险越高。与肠道微生物失调相关的促炎微生物物种的富集和产生丁酸盐的微生物的消耗可能部分解释了异常排便模式和认知功能之间的机制联系。无独有偶，我国的一项横断面研究[2]发现，中国老年人便秘的患病率较高，与认知健康的个体相比，痴呆和na-MCI（na-MCI）患者的便秘患病率更高。而香港中文大学医学院也曾发表一篇文章[3]，认为微生物群-肠-脑轴被认为在帕金森病（PD）中起重要作用，PD样肠道生态失调发生在PD的前驱阶段，与本研究有着异曲同工之意。由上所知，长期便秘病不是小事，与身体健康有着千丝万缕的联系，要引起足够重视，须改善生活方式并积极治疗。作者指出，本研究仍存在一定的局限性，需要更多的前瞻性研究来证实排便频率与认知功能之间的关联，并进一步阐明肠道微生物群在认知障碍和痴呆中的机制作用。参考文献：[1] Ma C, Li Y, Mei Z, Yuan C, et al. Association Between Bowel-Movement Pattern and Cognitive Function: Prospective Cohort Study and a Metagenomic Analysis of the Gut Microbiome. Neurology. 2023 Sep 29:10.[2] Wang F, Fei M, Hu WZ, et al. Prevalence of Constipation in Elderly and Its Association With Dementia and Mild Cognitive Impairment: A Cross-Sectional Study. Front Neurosci. 2022 Jan 24;15:821654.[3] Huang B, Chau SWH, Liu Y, et al. Gut microbiome dysbiosis across early Parkinson's disease, REM sleep behavior disorder and their first-degree relatives. Nat Commun. 2023 May 2;14(1):2501.撰文 | 青叶编辑 | 小白精彩推荐：1、别吃得太精细！BMJ：超13万人数据研究揭示摄入高质量碳水化合物有助减肥、延长寿命！2、恋爱选择相似or互补的人？Nature子刊研究近8万对情侣发现，相似度80%以上的人更容易成为伴侣3、久坐伤身不用怕！《英国运动医学杂志》发现每天只需这样运动22分钟即可抵消久坐带来的死亡风险4、爱吃鸡蛋的人注意了！我国学者最新研究：冠心病高遗传风险者或应少吃鸡蛋，每周增加3个鸡蛋冠心病风险增加10%！5、痴呆能“转移”？最新报道：首次证实阿尔茨海默病症状可通过肠道微生物群转移到健康生物体！本文仅用于学术分享，转载请注明出处。若有侵权，请联系微信：bioonSir 删除或修改！

SCOTTSDALE, Ariz., Sept. 5, 2023 /PRNewswire/ -- Prominently featured in The Inner Circle, Aisha Akhtar, MD, FCPS, is acknowledged as a Top Pinnacle Healthcare Professional for her contributions to the field of Colorectal Surgery. Continue Reading Aisha Akhtar Dr. Akhtar pursued higher education at the Army Medical College, National University of Science and Technology in Islamabad, Pakistan where she earned an MBBS. She then completed a surgical residency at Shiffa International Hospital in Pakistan and relocated to the United States at the age of 29 where she finished a surgical oncology fellowship at the MD Anderson Cancer Center in Texas; a surgical residency at Texas Tech University in Lubbock; Penn State Medical Cente; and St. Agnes Hospital. The doctor is FCPS certified in Pakistan and board certified by the American Board of Surgery (ABS) in the United States. Dr. Akhtar explained that the ABS is an independent, non-profit organization located in Philadelphia, Pennsylvania founded for the purpose of certifying surgeons who have met a defined standard of education, training, and knowledge. According to the doctor, colorectal surgery is a field in medicine dealing with disorders of the rectum, anus, and colon. It involves caring for patients with cancers of the colon, rectum, and anus, along with other benign disorders, like inflammatory bowel disease (Ulcerative Colitis and Crohn's Disease); diverticulitis; and a myriad of anorectal pathologies, like hemorrhoids, fistulas, abscesses, and fissures. Specializing in the treatment of benign and malignant conditions, Dr. Akhtar practices at Arizona Advanced Surgery in Glendale Phoenix and Scottsdale Arizona. She is an expert in treating many different ailments including cancers of the colon and rectum; inflammatory bowel disease; hemorrhoids; anal fissures; anal fistulas; pelvic floor problems; and fecal incontinence. The doctor is a general surgeon and also performs colonoscopies using the latest surgical techniques to treat the full range of colorectal disorders from simple to complex and notes that she is committed to providing quality care to patients with compassion and dignity. A testament to her professional and acumen in the field, Dr. Akhtar is licensed to practice in New York; Maryland; and Arizona; and is affiliated with HonorHealth John C. Lincoln Medical Center; HonorHealth Scottsdale Shea Medical Center; HonorHealth Scottsdale Thompson Peak Medical Center; HonorHealth Deer Valley Medical Center; and HonorHealth Sonoran Crossing Medical Center. The doctor is trained in the most advanced laparoscopic and robotic surgical techniques for the diagnosis and treatment of conditions that affect the colon rectum and anus and maintains affiliation with many professional organizations including the American College of Surgery; the American Medical Association; the Society of American Gastrointestinal and Endoscopic Surgeons; and the American Society of Colon and Rectal Surgeons. She is also a distinguished Fellow of the College of Physicians and Surgeons Pakistan. The doctor has published in various medical journals, including International Surgery Journal and Cureus, and has presented many posters at the American Society of Colon and Rectal Surgery. Dr. Akhtar asserts that she is ardent about being a female colorectal surgeon to provide personal care to female patients who want female providers for medical care and feel ashamed to discuss anorectal problems with male surgeons. Expanding her reach into underserved populations, she also specializes in screening for anal cancer in the LGBT-Q population and performs anal PAP smears and High-Resolution Anoscope's for high-risk patients. Dr. Akhtar lives in Scottsdale and enjoys cooking, hiking, and spending time with her two sons in her spare time. She has been married to Mr. Muhammad Khawaja for 9 years. The doctor speaks multiple languages including English, Hindi, and Urdu, and volunteers her time with the Islamic Society of the Northeast Valley Free Clinic, providing educational seminars and seeing patients who are underinsured. Dr. Akhtar would like to dedicate this honor to her mother, Mrs. Kosar Praveen. Contact: Katherine Green, 516-825-5634, [email protected] SOURCE The Inner Circle

WEDNESDAY, May 31, 2023 -- You're due for a prostate exam, but you don't know what to expect. So, what is this exam like? Regular check-ups are essential for maintaining your health, and a prostate exam is crucial to preventive care for men. Not only is it a screening test for early signs of prostate cancer, but it also helps detect other potential health issues. Here, experts walk you through what a prostate exam entails, when to consider scheduling one, how to prepare, and what the results might mean for you. So, dive in and learn more about this medical examination that every man should get at some point in his life. What is a prostate exam? Per the Cleveland Clinic, a prostate exam is a screening method to detect early signs of prostate cancer . Typically, the exam involves two main components: a prostate-specific antigen (PSA) blood test, and a digital rectal exam. The PSA blood test measures the levels of PSA in the bloodstream. According to the U.S. Centers for Disease Control and Prevention , PSA is a substance produced by the prostate gland, and higher levels can indicate the presence of prostate cancer. However, it's important to note that elevated PSA levels can also be caused by other prostate-related conditions and factors such as age and race. Medical procedures, medications, an enlarged prostate or a prostate infection can all influence PSA levels. Therefore, it is crucial to consult with your doctor to accurately interpret PSA test results. If the PSA test shows abnormal results, your doctor may recommend a biopsy to determine if prostate cancer is present. The other test that is often conducted during a prostate exam is the digital rectal exam, or DRE. The prostate gland is located just in front of the rectum. The Prostate Cancer Foundation says that during this part of your prostate exam, your doctor will gently insert a lubricated, gloved finger into the rectum to assess the size, shape and texture of the prostate for any irregularities. Although the test is brief, it may cause some discomfort, but it should not be painful. By combining the PSA blood test results and the digital rectal exam, health care providers can gather vital information to evaluate the health of your prostate. When should men get a prostate exam? The ideal prostate exam age can vary, depending on individual risk factors. According to the American Cancer Society (ACS) recommendations, men should have an informed discussion with their health care provider about the potential benefits and risks of prostate cancer screening starting at age 50 for average-risk individuals . For men at higher risk, such as those with a family history of prostate cancer or Black men, the discussion should take place at age 45. Men at even higher risk, such as those with multiple close relatives diagnosed with prostate cancer before age 65, may consider starting the discussion as early as age 40. Further, the Prostate Cancer Foundation suggests that Black men are 1.6 times more likely to get prostate cancer . For this reason, if you are Black or if you have a family history of prostate cancer, you should talk with your doctor about starting a prostate exam at age 40. The frequency of prostate exams also depends on the individual's risk profile and the results of previous screenings. Based on the ACS guidelines, if the initial PSA blood test and digital rectal exam results are normal, further testing is typically recommended every two years. However, if the results indicate a higher risk, more frequent screenings may be necessary. How to prepare for a prostate exam Preparing for a prostate exam typically requires minimal effort. As per the Cleveland Clinic, there is little specific preparation needed. However, it is important to inform your health care provider if you have existing conditions such as hemorrhoids, anal fissures or anal tears, as they may cause discomfort during the exam. Additionally, your health care provider may advise abstaining from sexual activity for 48 hours prior to the exam. Ejaculation can temporarily raise PSA levels, which might affect the accuracy of your test results. Regarding the common question on whether you should poop before a prostate exam, urologist Dr. Wagner Baptiste suggested in a recent article that it is acceptable to do so if you feel the need. “But don’t force it if you don’t need to move your bowels," Baptiste added. “There’s no specific bowel prep necessary. It’s common for poop to appear during the exam, but your doctor is used to it and knows what they’re doing and knows where your rectal wall lies to move feces out of the way.” What is a prostate exam like? “A prostate exam is a digital or finger exam in the rectum to feel the prostate through the rectal wall,” Dr. Matthew Sand , a urologist at Piedmont Physicians Urology in Atlanta, said in a recent article. “We estimate the size of the prostate and then we feel around for nodules, which are concerning for prostate cancer.” Sand explained that the purpose of the exam is to assess the size of the prostate and check for any nodules that could indicate prostate cancer. The procedure is fairly straightforward and typically lasts only a few seconds. "The whole procedure probably takes three to five seconds," Sand noted. Despite its brevity, the prostate exam serves as a crucial step in monitoring prostate health. What do the results mean? “ Screening can lead to earlier prostate cancer detection, and with earlier detection, you’re eligible for multiple different treatments or active surveillance ,” said Dr. Sia Daneshmand , director of urologic oncology at Keck Medicine of USC and a professor of clinical urology at USC's Keck School of Medicine. “So we encourage patients who are candidates for screening to discuss it with their urologist and/or primary care physician so that we can determine what’s the best course of treatment for them.” According to the CDC , the goal of screening for prostate cancer is to detect cancers that may be at a high risk of spreading if left untreated and to identify them before they have a chance to spread. However, the U.S. National Cancer Institute states there is no specific normal or abnormal level of PSA in the blood . While PSA levels below 4.0 ng/mL were previously considered normal, it is important to note that some individuals with levels below this threshold can still have prostate cancer, while many with levels between 4 and 10 ng/mL do not have prostate cancer. PSA levels can fluctuate due to age, prostate gland size, inflammation or infection, recent prostate biopsy, ejaculation and intense exercise. Certain medications used to treat an enlarged prostate can lower PSA levels. Generally, a higher PSA level increases the likelihood of prostate cancer, but it is crucial to interpret PSA results in consultation with a health care provider who can assess the individual's overall risk profile and consider additional factors for a more accurate diagnosis. Posted May 2023