A new species of the genus Deladenus isolated from the outer wood and bark layers of a dead red pine tree (Pinus densiflora f. erecta) was characterized using morphological and morphometric data, as well as DNA sequences. Deladenus coreanus n. sp. is characterized by the medium sized body of mycetophagous female abruptly narrowing behind vulva, lateral fields with four incisures, pharyngeal corpus without a distinct median bulb and lacking a chamber, pharyngo-intestinal junction immediately behind the nerve ring, hemizonid 13.0-37.0 μm posterior to nerve ring, excretory pore at level with hemizonid, vulva with prominently protuberant lips and with no lateral vulval flaps, post-uterine sac absent, vulva-anus distance approximately equal to tail length, tail conoid, gradually tapering to a broadly or narrowly rounded terminus, or subcylindrical and clubbed, males with slender spicules, 19.0-21.0 μm long and bursa reaching tail tip. The phylogenetic relationships were reconstructed using partial 18S rRNA, 28S rRNA, and COI gene sequences. The newly generated 18S rRNA and 28S rRNA sequences appeared as independent lineages in corresponding trees, and the new COI gene sequence formed a clade with the corresponding gene sequence of Deladenus brevis with moderate (87) Bayesian posterior probability.
a patient with spinal cord injury underwent spinal cord stimulation (SCS) and developed bladder and anal dysfunction, following inadvertent migration of the stimulation electrodes. we provide evidence that the reticulospinal tracts are significant for the control of the anus and bladder rhabdosphincters. we discuss the appropriate positioning of SCS electrodes.
The trends in cancers of Human papillomavirus (HPV)-related cancer sites in Japan are insufficiently reported. We evaluated the long-term trends of them as a baseline before the effects of HPV vaccine introduction became apparent in Japan. This retrospective, population-based study used data from the Osaka Cancer Registry to analyze 39,349 cases between 1977 and 2019. For women, the ASIRs were particularly high for cervical cancer. For squamous cell carcinoma, the ASIR changed from a decrease (from high to low) to an increase (from low to high) around 2000, although the trend for females aged 40-59 has recently showed no significant change. The trend in ASIR for adenocarcinoma also shifted from an increase to no significant change in the 40-59 age group, but increased consistently in the ≤ 39 age group. Vaginal cancer exhibited no significant change, while cancers of the oropharynx, anus, and vulva have increased. For men, cancers of the oropharynx and anus consistently increased. Squamous cell carcinoma of the anus decreased from 1997 to 2004, but then increased thereafter. Similarly, penile cancer decreased from 1977 to 1995, but then increased. Future studies will observe how this trend changes as groups with high HPV vaccination rates reach cancer-susceptible ages.
To our knowledge, this case represents one of the rarest and most severe forms of cloacal exstrophy (CE), distinguished by extensive multisystem involvement, including a large omphalocele, imperforate anus, bladder exstrophy, bilateral clubfeet, and the unusual concomitant presence of a lumbosacral myelomeningocele. This constellation of findings is exceptionally uncommon and poses significant surgical and multidisciplinary challenges from birth. Prenatal MRI demonstrated a large omphalocele containing liver, bowel, and gallbladder; a lumbar myelomeningocele (L5-S5); nonvisualization of the bladder and external genitalia; unilateral renal agenesis; and bilateral clubfeet. The infant was delivered at 37 weeks via cesarean section and required intubation at 10 minutes of life. Postnatal evaluation confirmed omphalocele, imperforate anus, meningocele, bladder exstrophy, and bilateral clubfeet. Echocardiography revealed a small mid-muscular ventricular septal defect and a moderate patent ductus arteriosus with bidirectional shunt, requiring no intervention. SNP microarray testing was negative for copy number abnormalities. At five days of life, the patient underwent excision of the omphalocele, colostomy creation, colon conduit cystoplasty, and first-stage closure of the bladder plate. At four months, neurosurgical repair of the lipomeningocele with resection of an extradural lipoma, bilateral muscle flaps, and complex soft-tissue reconstruction was performed. Orthopedic management included treatment of a right leg fracture, followed by bilateral pelvic osteotomies and application of a hip spica cast at eleven months. Definitive bladder exstrophy closure was achieved after orthopedic stabilization. The patient demonstrated stable cardiopulmonary status, preserved renal function, and appropriate recovery following each stage of repair. This case illustrates the extreme end of the CE spectrum and underscores the necessity of multidisciplinary coordination among pediatric surgery, urology, neurosurgery, orthopedics, and plastic surgery. Through careful sequencing and staged reconstruction, preservation of gastrointestinal, neurologic, orthopedic, and urologic function was achieved. Our experience highlights that, even in the most severe and rare presentations, particularly those with concurrent myelomeningocele, functional survival and meaningful quality of life are possible with meticulous planning and comprehensive care.
Ochetobibus elongatus (Kner) is a migratory fish found in the Yangtze River basin and areas south of it, and listed as a critically endangered (CR) fish on the China Red List of Vertebrates. To achieve group recovery and artificial breeding, this study investigated the dietary characteristics of O. elongatus based on high-throughput sequencing of its intestinal contents, and its digestive system morphology, and its histology. Results showed that the digestive system of O. elongatus lacked a stomach and mainly consisted of the oropharynx, pharyngeal teeth, esophagus, intestine, and anus. The gut index was 0.88, with clear segmentation of the foregut, midgut, and hindgut, and the visceral mass index was 7.35%. Histological analysis of the digestive system revealed the presence of keratinized dental plates or pharyngeal teeth in the pharynx, as well as a high density of taste bud cells in the soft palate of the oral cavity. The surface layer of the intestinal villi contained numerous mucous cells, with the average number of mucous cells per villus gradually increasing from the esophagus to the hindgut, and the foregut having the longest and most abundant mucosal folds. The esophagus exhibited well-developed circular and longitudinal muscle layers, while in the hindgut, both the circular and longitudinal muscle layers were slightly thicker than those in the midgut. High-throughput sequencing of the intestinal contents of O. elongatus revealed the following phyla based on 18S V4 meta-barcoding: Chlorophyta, Diatoms, Arthropoda, Basidiomycetes, and Ascomycetes, with the genus Hypophthalmichthys and algae being the main classifications. In contrast, based on COI meta-barcoding, the study newly identified the phyla Cnidaria and Mollusca, with the genera Chlorophyta, Scenedesmus, Pectinodesmus, and zooplankton such as Pseudodiaptomus. Metagenomic sequencing revealed that the gut microbiota at the phylum level was predominantly composed of Pseudomonadota, Ascomycota, Basidiomycota, Chytridiomycota, and Bacillota, with key genera including Cetobacter, Pseudomonas, Acinetobacter, Aeromonas, and Clostridium. This study indicates that O. elongatus is an omnivore with carnivorous tendencies. Basic biological research on O. elongatus is of great significance for the restoration of the population, artificial breeding, and the development of its artificially formulated feed. It also provides important data for the formulation of biodiversity conservation measures.
Cancer incidence is increasing globally, with the largest burden in low-income and middle-income countries. Workforce shortages and health system barriers contribute to substantial diagnostic delays and underdiagnosis, but estimates of undiagnosed cancer burden are lacking. The aim of this study was to estimate incidence (total and diagnosed) and stage at diagnosis in each country for 17 cancers from 1990 to 2050. We developed the Global Cancer Workforce microsimulation model to simulate 17 cancer types (oral, nasopharynx, oesophagus, stomach, colon, rectum, anus, liver, pancreas, lung, skin melanoma, breast, cervix uteri, ovary, prostate, bladder, and brain and CNS) in 200 countries and territories from 1990 to 2050, accounting for demographic trends and health system factors, including ten specific workforce personnel types relevant to cancer diagnosis. We calibrated the incidence module to empirical data on diagnosed cancer incidence and stage distribution at diagnosis. Using the calibrated model, we estimated both total (underlying) and diagnosed crude and age-standardised incidence rates (per 100 000 population) and numbers of cancer cases for each country and region from 1990 to 2050. We also estimated the proportion of cancers diagnosed at each stage (I-IV). Globally, among the 17 cancers included in the model, diagnosed cancer incidence was projected to increase from 13·58 million (95% uncertainty interval [UI] 12·17-14·51) cases in 2025 to 19·32 million (17·65-21·33) in 2050. Lung, breast, and prostate cancers were projected to remain the most commonly diagnosed cancers globally. The proportions of incident cancers that die undiagnosed showed large disparities by region, ranging from 0·9% (95% UI 0·6-1·3) in western Europe to 67·4% (60·1-74·2) in western Africa, with a global average of 31·5% (28·1-36·7). Globally, the proportion of cancers diagnosed at advanced stages (III-IV) was projected to decline slightly, from 45·7% (44·7-46·7) in 2025 to 44·7% (43·7-45·7) in 2050, with worse stage distributions in Africa and Asia compared with other regions. These findings highlight the substantial and growing burden of cancers, especially in low-income and middle-income countries, where many people who develop cancer die undiagnosed. Accounting for demographic and epidemiological trends as well as health system factors, our modelling framework enables evaluation of targeted interventions to strengthen the cancer workforce and improve diagnostic pathways across diverse geographical and socioeconomic settings. American Cancer Society and Breast Cancer Research Foundation.
Idiopathic mesenteric phlebosclerosis (IMP) is a rare disease with unclear etiology and pathogenesis. Although most IMP patients have a long-term history of traditional Chinese herbal medicine use, this article reports a case without such a special medical history, which may provide new insights into the disease's etiology. A 59-year-old middle-aged man was admitted to the gastroenterology department due to recurrent upper abdominal pain for 1 month. The fecal occult blood test was weakly positive. No significant abnormalities were found in tumor markers, Epstein-Barr virus, cytomegalovirus, T-SPOT, tuberculosis antibodies, or coagulation function. Computed tomography revealed edema and thickening of the intestinal wall in the ascending colon and part of the transverse colon, accompanied by narrowing of the lumen. Multiple calcifications were observed in the right mesenteric vessels, associated with the affected areas. Colonoscopy findings: a circumferential ulcer was noted in the ascending colon at a distance of 75 to 60 cm from the anus, with partial cyanosis of the mucosa and nodular changes. During hospitalization, a series of tests was conducted, and the final diagnosis was IMP. The patient received conservative treatment during hospitalization. After conservative treatment, the patient's abdominal pain and hematochezia improved, and the findings of computed tomography and colonoscopy also showed improvement in the condition. To date, the patient has not experienced any significant discomfort during follow-up. Diagnosing IMP requires familiarity with its characteristic features and the ability to interpret relevant imaging findings. It is important to note that long-term use of traditional Chinese herbal medicine is not always the cause. Further research, including the analysis of more clinical cases and the performance of animal experiments, is needed to fully understand the etiology and pathogenesis of IMP.
The global burden of cancer continues to rise, disproportionately affecting low-income and middle-income countries, where cancer workforce shortages are especially acute and contribute to poor outcomes. In this analysis, we estimate the effect on cancer mortality of scaling up specific workforce personnel types in order to provide global, regional, and country-specific guidance to inform cancer workforce policy. Using the Global Cancer Workforce microsimulation model, which accounts for demographic, epidemiological, and health system factors related to cancer incidence and survival, we modelled the projected effect of scaling up 18 specific workforce personnel types on total cancer mortality (diagnosed and undiagnosed) from 17 cancers (oral, nasopharynx, oesophagus, stomach, colon, rectum, anus, liver, pancreas, lung, skin melanoma, breast, cervix uteri, ovary, prostate, bladder, and brain and CNS) in 200 countries and territories from 2030 to 2050. Workforce density (per 100 000 population) of each workforce personnel type was modelled based on estimates from various sources (including WHO Global Health Workforce Statistics, the IMAGINE database, and previous Lancet Commissions). Expert opinion surveys, with responses from 86 experts in 16 countries, informed the involvement of workforce personnel in specific model events. We also modelled scale-up of workforce by cadre (ie, teams of personnel that work together in a particular specialty) and level of training (ie, years of education). Substantial disparities in cancer workforce were projected to persist in 2050, with especially large workforce shortages in Africa. Among single personnel types, scaling up surgeons was projected to yield the largest reduction in global cancer mortality (3·64% [95% uncertainty interval 2·68-4·66]), especially in Africa, Asia, and Oceania, but with considerable heterogeneity by country. Among workforce cadres, scaling up diagnostic and imaging personnel was projected to yield the greatest benefit (global cancer mortality reduction of 7·61% [5·23-9·88]), with some heterogeneity by country. Comprehensive scale-up of all workforce levels was projected to reduce cancer mortality by over 50% in 55 countries, most notably in Africa, central America, and southern Asia. Investments to strengthen the cancer workforce will be essential to reduce global cancer mortality and improve timely diagnosis and survival. Strategic scale-up of personnel, particularly in diagnostics, alongside innovative strategies such as digital health solutions and role delegation, could result in substantial improvements in cancer outcomes. Policy makers should prioritise data-driven workforce planning as a crucial component of comprehensive cancer control strategies. American Cancer Society and Breast Cancer Research Foundation.
Anorectal malformations (ARMs) are congenital anomalies affecting the anus and rectum, with a global incidence of 1 in 5,000 live births. Despite clinical advancements, the genetic basis of ARMs remains largely unknown. Our study utilized whole-exome sequencing (WES) on ARM-diagnosed individuals to identify rare and potentially pathogenic variants. We prioritized 20 variants by using consensus variant pipeline for exome analyses (CONVEX) and the AION pipeline, followed by validation. Cross-referencing with existing genome-wide association study (GWAS) datasets identified two common variants, ISL1 and EFNA1, both of which are reported in European ancestry, suggesting a genetic architecture. Network analysis using Cytoscape and Cytohubba highlighted PKD1, PKD2, and PKHD1 as important hub genes and the pathways for ARM, including several developmental pathways. Furthermore, our structural variant analysis identified a prioritized variant within a copy number variant. Our findings provide novel insights into syndromic ARMs (SARMs), which may lead to improved genetic diagnosis and personalized interventions.
Accurate placement of the neo-anus within the sphincter complex is critical for continence in anorectal malformation (ARM) surgery. Intraoperative localization may be difficult, and dedicated stimulators are not always available. We describe the modification and clinical use of a low-cost pen-type neuromuscular electrical stimulator for intraoperative muscle complex localization, with successful localization achieved in all patients, enabling precise neo-anal placement without device-related complications or significant increase in operative time.
Pagetoid spread (PS) of anorectal cancer is relatively rare and is associated with poor prognosis compared with Extramammary Paget disease. It is therefore essential to accurately differentiate between the two entities. In PS cases, the primary tumor lesion is usually obvious; however, this is not the case in nonmass-forming type anorectal cancer, making it difficult to distinguish between the two. We hereby report the case of a 79-year-old woman who presented with a six-month history of perianal skin eruption. Physical examination revealed maceration and erosion around the anus. On endoscopy, no obvious tumor formation was observed; however, an ulcer with a whitish coating extending from the anal region into the anal canal was noted. Biopsy was positive for CK7, CK20, and CDX2, and negative for GCDFP-15. The patient was diagnosed with nonmass-forming type anorectal cancer with PS. Laparoscopic abdominoperineal resection was performed with lymph node dissection and mapping biopsy. Postoperative immunohistochemical staining confirmed the diagnosis. Since primary Paget disease differs from perianal pagetoid spread with respect to treatment strategy as well as prognosis, accurate differentiation between the two is necessary. Diagnosis based on several immunohistochemical stains is highly effective for distinguishing between these entities.
Rectal atresia (RA) and stenosis are rare anorectal malformations presenting with distal obstruction despite a normally positioned anus. We report a neonate with type II RA managed by posterior sagittal web excision using the Heineke-Mikulicz technique. Anal canal preservation yielded favorable short-term outcomes, supporting this reproducible surgical approach.
Taxonomic studies of freshwater fish reveal that intraspecific morphological variation highlights cryptic species complexes. Here, we describe Laubuka sittaungensis, a new species of the family Danionidae, based on 23 specimens collected from a tributary of the Sittaung River drainage in Myanmar. The new species can be distinguished from the congeners by a combination of the following characters: (1) an unbranched pelvic-fin ray reaching the anus, (2) the presence of vertical bars along the side of the body in preserved specimens, (3) predorsal scales 18-20, (4) branched anal-fin rays 17½-20½, (5) precaudal+caudal vertebrae 15-16 + 18-20, and (6) smooth lower jaw. The molecular phylogenetic analyses based on mitochondrial cytochrome c oxidase I (COI) and cytochrome b (Cytb) gene sequences confirm that it is a distinct species, closely related to Laubuka tenella.
Anal cancer incidence is rising in the United States, now exceeding 10 000 cases annually. Chemoradiation (CRT) is the standard curative-intent treatment for non-metastatic squamous cell carcinoma of the anus (SCCA), with surgery generally reserved for non-responders with persistent or progressive disease. Recent trials have refined management, supporting the assessment of response at 26 weeks before considering surgery. However, contemporary population-level patterns of upfront primary surgery and associated survival trends remain incompletely described. Using the Surveillance, Epidemiology, and End Results (SEER) registry (2004-2020), we identified adults with newly diagnosed non-metastatic anal squamous cell neoplasms (ICD-O-3 8050-8089). Outcomes were receipt of primary surgery as initial treatment and overall survival. We evaluated temporal trends (Cochran-Armitage), factors associated with primary surgery (multivariable logistic regression), and survival over time (Kaplan-Meier; multivariable Cox proportional hazards modeling). Among 16 718 patients with non-metastatic anal cancer, 33.1% (n = 5529) underwent primary surgery and 83.7% (n = 13 997) received radiation as part of initial management. Primary surgery declined from 46.0% in 2004 to 28.7% in 2020 (trend P < 0.001), while radiation utilization was relatively stable over time (trend P = 0.106). In adjusted analyses, younger age (<50 vs 60-69 years; OR 1.614), male sex (OR 1.508), and Non-Hispanic Black race (vs Non-Hispanic White; OR 1.178) were associated with higher odds of primary surgery. Tumor factors were strongly associated with surgical use (eg, T1 vs T2: OR 3.072; higher N stage associated with lower odds). Overall survival improved across diagnosis periods (log-rank P = 0.0002); in adjusted Cox models, diagnosis in 2016-2020 (vs 2004-2007) was associated with lower mortality risk (HR 0.77). From 2004 to 2020, primary surgery as initial management for non-metastatic anal cancer declined substantially, consistent with increasing adoption of CRT, while overall survival improved over time. Persistent use of upfront surgery in select subgroups warrants further study to clarify indications and ensure guideline-concordant care.
Rectal prolapse occurs when layers of the rectum protrude through the anus, which is classified as partial or complete based on the extent of the tissue involvement. The condition has a yearly rate of 2.5% per 100,000 individuals, with a higher incidence in those over 50 due to muscle weakness. Surgical intervention is often necessary to repair the prolapse, manage incontinence, and address underlying factors. In this case report, a para-surgical method known as Agni Karma was used, which applies localized heat to promote healing and reduce tissue prolapse. The condition was assessed using the Oxford Radiological Rectal Prolapse Rating System. The patient was initially rated as grade five, indicating an external prolapse. Following the Agni Karma treatment, the follow-up showed significant improvement, reducing the grade to three.
Cancer survival has improved in many countries in recent decades, but large disparities remain globally. Understanding the effects of workforce shortages, stage at diagnosis, and broader health system barriers on poor survival is important for the design and evaluation of policy interventions to improve cancer survival in diverse settings. We aimed to develop a model to estimate trends in cancer survival (overall and by stage), accounting for these factors. We developed the Global Cancer Workforce microsimulation model to simulate 17 cancer types (oral, nasopharynx, oesophagus, stomach, colon, rectum, anus, liver, pancreas, lung, skin melanoma, breast, cervix uteri, ovary, prostate, bladder, and brain and CNS) in 200 countries and territories from 1990 to 2050, accounting for trends in stage-specific survival and health system factors, including 14 specific workforce personnel types relevant to cancer survival. We calibrated the survival module to empirical data on population-based 5-year net survival, and estimated survival in each country by cancer and overall (pooled and standardised for country-specific incidence of different cancer types). We also estimated stage-specific cancer survival, and cancer mortality rates based on both observed (diagnosed) and total (undiagnosed and diagnosed) cancer cases. Between 2025 and 2050, global pooled 5-year net survival was projected to remain stable (47·6% [95% uncertainty interval (UI) 45·9-49·1] to 47·7% [46·0-49·4]), with persistent disparities by income group and geographical area. In 2050, pooled survival was projected to be lowest in Africa (34·4% [32·6-36·3]) and Asia (38·7% [36·0-40·6]), and highest in North America (63·9% [58·1-66·6]) and Oceania (70·4% [67·2-73·7]). Standardising survival for country-specific incidence of different cancer types resulted in decreased estimates for all world regions except eastern Asia, which has a higher proportion of cancer types with poor survival. Large disparities in survival by geographical region also existed within each cancer type. For example, in 2025, estimated 5-year net survival for melanoma ranged from 39·0% (22·2-57·2) in Africa to 91·7% (85·1-95·7) in North America. Global cancer mortality in 2025 was estimated to be 90·0 per 100 000 population (95% UI 79·6-97·2) based on diagnosed cases, which increased to 188·9 per 100 000 population (183·4-195·5) when total cancer cases were considered, with substantially higher estimates compared with those based on observed cases in settings such as Africa and south Asia. Disparities in global cancer survival are large and are expected to persist on current trends without transformative policy action. Our modelling framework provides comprehensive, country-level projections of survival and mortality for multiple cancers, accounting for demographic and epidemiological trends, as well as health system barriers and workforce constraints. American Cancer Society and Breast Cancer Research Foundation.
Papillary immature metaplasia, originally described in the uterine cervix, is increasingly recognized as a distinctive squamous intraepithelial lesion rather than a true metaplastic process. Accordingly, the term papillary squamous intraepithelial lesion (PSIL) has been proposed. PSIL occurring outside the uterine cervix is exceedingly rare. In this study, we characterize the clinicopathologic, immunophenotypic, and virologic features of 25 cases of PSIL involving non-cervical sites (vagina, vulva, anus, and endometrium). All lesions demonstrated exophytic papillary architecture lined by uniform immature squamous cells with limited surface maturation. Mitotic figures were frequently identified in the lower half of the epithelium. Low-risk HPV E6/E7 mRNA was detected in 76% of cases, whereas none harbored high-risk HPV. HPV transcripts exhibited a distinctive punctate distribution throughout the epithelium, contrasting with the superficial clustered pattern seen in condyloma/LSIL. Non-block p16 immunostaining pattern was seen in all PSILs, while Ki-67 labeling indices were increased (median 50%), predominantly involving the lower half to two-thirds of the epithelium. Clinical follow-up (median 32 months) demonstrated recurrence in 43% of cases, most commonly with incomplete excision. Our study shows that non-cervical PSIL shares morphologic, immunophenotypic, and virologic features with cervical PSIL. Despite the absence of block-type p16 expression, PSIL demonstrates high proliferative activity, frequently leading to diagnostic confusion with HSIL. Given its distinctive papillary architecture, unusual HPV distribution pattern, and tendency for recurrence, PSIL represents a unique low-risk HPV-associated intraepithelial lesion distinct from conventional LSIL and HSIL. Adoption of the term papillary squamous intraepithelial lesion is recommended in accordance with LAST terminology.
nsedated colonoscopy is often associated with patient discomfort and may increase procedural difficulty for endoscopists. This study aimed to investigate the influence of perianal lidocaine application on the comfort level of patients and endoscopic operations during unsedated colonoscopy. 122 patients aged 18-40 years were enrolled and randomly allocated to colonoscopy with 2% lidocaine (experiment group, n = 61) or normal saline (control, n = 61) smeared around the anus. The primary outcomes were anal pain score and abdominal pain score during and after colonoscopy, assessed using a visual analogue scale (VAS). Secondary outcomes included cecal intubation time, polyp detection rate, adenoma detection rate, and adverse events. There was no statistical difference between groups in terms of abdominal pain scores during unsedated colonoscopy. Abdominal pain scores after colonoscopy were significantly lower in the lidocaine group than in the saline group. (P < 0.001). However, the lidocaine group had significantly lower anal pain scores during and after colonoscopy (P < 0.001) and a shorter cecal intubation time (P < 0.001). Polyp and adenoma detection rates were higher in the lidocaine group (P < 0.05). Junior endoscopists achieved greater improvements in these outcomes compared to senior endoscopists. Perianal application of lidocaine may reduce anal pain and may improve procedural efficiency during unsedated colonoscopy, particularly among junior endoscopists.
Vestibular fistula (VF) is a common anorectal malformation in females. However, the timing and methods of surgical treatment vary considerably between institutions, mainly because of concerns regarding postoperative complications at the surgical site. This concern primarily relates to the sagittal skin incision extending from the vestibule to the anal region; therefore, we sought ways to minimize its extent. The procedure involved making a skin incision only at the anus, incising the anal sphincter muscle according to the ASARP, and separating the internal fistula tract according to the PSARP. The remaining fistula tract was inverted from the intestinal side and pulled out through the vestibular opening for excision. We report a surgical technique that potentially reduces the concerns and risks of wound complications by avoiding sutured wounds in the perineal skin.
Perianal Crohn's disease (pCD) is a debilitating condition with a prevalence of approximately 20% in patients within 10 years of diagnosis of CD. The condition significantly impacts patient quality of life, and there remain a number of unmet needs relating to its optimal management. A global Priority Setting Partnership (PSP) was established to identify the top 10 research priorities for pCD. The PSP followed standard James Lind Alliance (JLA) methodology. An initial survey was circulated to gather unanswered research questions from key stakeholders. From these responses, a longlist of summary questions was formed. These questions were ranked by stakeholders in a second prioritization survey. The highest ranking 19 questions were taken into the final workshop, where a panel of people with lived or professional experience of pCD identified the top 10 research priorities. Over 1200 individual research questions were submitted by over 400 respondents, from over 30 countries. From the 51 summary questions that were developed from these responses, the top 10 were identified in the final workshop. These included identifying the optimal combined treatment strategy across the full spectrum of pCD, reducing the impact on quality of life, improving timely diagnosis of pCD, identifying a biological classification of pCD, and understanding and managing the impacts on sexual function, intimacy, and relationships. This global PSP represents a major step towards stakeholder-driven and focused research in pCD. The research priorities provide a roadmap for researchers, funders and policy-makers to align future research with patient and clinician needs to improve outcomes.