Radiation proctopathy (RP) is a common complication of radiotherapy for pelvic malignancies with high incidence. RP accompanies by microbial dysbiosis. However, how the gut microbiota affects the disease remains unclear. Here, metabolomics reveals that the fecal and serous concentrations of microbiota‐derived 3‐hydroxybutyrate (3HB) are significantly reduced in RP mice and radiotherapeutic patients. Moreover, the concentration of 3HB is negatively associated with the expression of proinflammatory IL6 that is increased along with the severity of radiation damage. 3HB treatment significantly downregulates IL6 expression and alleviates IL6‐mediated radiation damage. Irradiated cell‐fecal microbiota co‐culture experiments and in vivo assays show that such a radioprotection of 3HB is mediated by GPR43. Microbiome analysis reveals that radiation leads to a distinct bacterial community compared to untreated controls, in which Akkermansia muciniphila is significantly reduced in RP mice and radiotherapeutic patients and is associated with lower 3HB concentration. Gavage of A. muciniphila significantly increases 3HB concentration, downregulates GPR43 and IL6 expression, and ameliorates radiation damage. Collectively, these results demonstrate that the gut microbiota, including A. muciniphila, induce higher concentrations of 3HB to block GPR43‐mediated IL6 signaling, thereby conferring radioprotection. The findings reveal a novel implication of the gut‐immune axis in radiation pathophysiology, with potential therapeutic applications.

Rectal gastrointestinal stromal tumor (GIST) is a rare digestive disease that originates in mesenchymal tissues and has malignant tendencies. At present, no standard treatment has been developed, and surgical approaches and the resection scope for rectal GISTs are controversial. The clinical, surgical, pathological and prognosis data of patients with primary rectal GIST in our center from January 2008 to January 2019 were retrospectively collected. The patients were divided into the radical excision (RE) and local resection (LR) groups. A total of 537 GIST cases were collected, and 64 patients with primary rectal GIST were included in this study, including 25 cases in the RE group and 39 cases in the LR group. Tumor size (p = 0.013), distance from the anus (p = 0.038), National Institutes of Health (NIH) criteria (p = 0.001), preoperative adjuvant therapy (p = 0.016), postoperative adjuvant therapy (p = 0.028), blood loss (p = 0.048), operative time (p = 0.020) and the duration of hospitalization (p = 0.021) were statistically different between these 2 groups. The mean overall follow-up time was 46 months (range, 1-122 months). Disease recurrence was observed in 12 patients. No statistical differences were observed in 5-year disease-free survival (DFS) (93.3% vs 92.6%, p = 0.952) or overall survival (OS) (90.0% vs 91.6%, p = 0.832) between the RE group and the LR group. Our study showed that LR has a similar prognosis to that of RE with respect to DFS and OS. For appropriate cases, LR has the advantages of a short operative time, less bleeding, and a quick recovery. Especially when combined with neoadjuvant therapy, LR can also achieve better perioperative efficacy. Therefore, LR is an effective method for resection of rectal GISTs and warrants clinical endorsement.

Pelvic organ prolapse (POP) is one of the most common pelvic floor dysfunction disorders worldwide. The weakening of pelvic connective tissues initiated by excessive collagen degradation is a leading cause of POP. However, the patches currently used in the clinic trigger an unfavorable inflammatory response, which often leads to implantation failure and the inability to simultaneously reverse progressive collagen degradation. Therefore, to overcome the present challenges, a new strategy is applied by introducing puerarin (Pue) into poly(l‐lactic acid) (PLLA) using electrospinning technology. PLLA improves the mechanical properties of the patch, while Pue offers intrinsic anti‐inflammatory and pro‐collagen synthesis effects. The results show that Pue is released from PLLA@Pue in a sustained manner for more than 20 days, with a total release rate exceeding 80%. The PLLA@Pue electrospun patches also show good biocompatibility and low cytotoxicity. The excellent anti‐inflammatory and pro‐collagen synthesis properties of the PLLA@Pue patch are demonstrated both in vitro in H₂O₂‐stimulated mouse fibroblasts and in vivo in rat abdominal wall muscle defects. Therefore, it is believed that this multifunctional electrospun patch integrating anti‐inflammatory and pro‐collagen synthesis properties can overcome the limitations of traditional patches and has great prospects for efficient pelvic floor reconstruction.

Background: Ileostomy was widely used during colorectal cancer (CRC) surgery and peristomal dermatitis was one of the most common stoma-relative complications. Stoma education class may reduce the rate of peristomal dermatitis. Methods: We enrolled patients who were diagnosed with rectal cancer and underwent surgery with ileostomy between January 2018 to December 2018 at a single tertiary hospital. The general demographic information of patients along with the participation in stoma education class and the occurrence of peristomal dermatitis were analyzed. Results: A total of 491 patients were included in the study, and 162 patients (32.99%) participated in the stoma education class. Eighty-five patients (17.31%) suffered peristomal dermatitis within one month after ileostomy. The rate of peristomal dermatitis in the stoma education group was significantly lower than that in the control group (11.11% vs. 20.36%, P=0.011). Regardless of the education level, the risk of peristomal dermatitis in the education group was reduced (P<0.05). Lower peristomal dermatitis rates were found in patients who were younger than 60 years (P=0.012), whose stoma were taken care of by other people (P=0.014), or without diabetes (P=0.026). Univariate and Multivariate analysis showed that stoma education was the only factor associated with the decrease in rates of peristomal dermatitis (OR =0.458, P=0.008), while diabetes was an independent risk factor (OR =3.732, P<0.001). Conclusions: Postoperative stoma education class significantly decreased the rate of peristomal dermatitis in the early postoperative period in CRC patients with ileostomy, especially for those who were younger than 60 years, received stoma care from others or without diabetes.

Background: Rectal gastrointestinal stromal tumor (GIST) is a rare digestive disease that has a distinct malignant tendency compared to that of gastric-derived GIST. At present, there is still no standard, and the surgical approach to rectal GIST is controversial. Methods: The clinicopathological data and prognosis of rectal GIST patients admitted to the Sixth Affiliated Hospital of Sun Yat-sen University from 1998.01.01 to 2018.12.31 were collected retrospectively. All cases were divided into either the transanal (TA) group or the nontransanal (NTA) group. Results: A total of 537 GIST cases were treated in 10 years, including 82 rectal GIST cases (64 cases underwent surgical resection, including 29 cases in the TA group and 35 cases in the NTA group). Preoperative neoadjuvant therapy (P=0.003), postoperative adjuvant therapy (P=0.017), operative time (P=0.013), blood loss (P=0.038), anus-preserver (P=0.048), 30-day complication rate (P=0.000), time to flatus (P=0.036), hospital stays (P=0.011), distance from the anus (P=0.047), tumor size (P=0.002), mitotic count (P=0.035) and National Institutes of Health (NIH) criteria (P=0.000) were significantly different between these two groups (all P<0.05). The median follow-up time was 41 (range, 1–122) months. Twelve patients had recurrence and metastasis, and 4 patients died. The 5-year disease-free survival (DFS) and overall survival (OS) were 74.4% and 91.2%, respectively, in the whole group. There were no statistically significant differences between the TA group and the NTA group at 5-year DFS (81.3% vs. 79.0%, P=0.243) and OS (88.7% vs. 93.3%, P=0.308). Conclusions: In the treatment of rectal GIST, TA resection has a minimally invasive effect, less postoperative complications, high anal sphincter preservation rate, and R0 resection rate and a better prognosis. How to improve the proportion of neoadjuvant therapy and choose the appropriate cases for TA surgery is still a challenge.