Objectives:Postmenopausal women with stress urinary incontinence(SUI)exhibit low androgen expression.This study aimed to evaluate the efficacy and safety of vaginal androgen combined with pelvic floor muscle training(...Objectives:Postmenopausal women with stress urinary incontinence(SUI)exhibit low androgen expression.This study aimed to evaluate the efficacy and safety of vaginal androgen combined with pelvic floor muscle training(PFMT)in the treatment of SUI in postmenopausal women.Methods:Postmenopausal women with SUI were recruited from Hainan West Central Hospital between January 2024 and March 2025.Participants were randomly assigned in a double-blind manner to receive either vaginal androgen cream combined with PFMT(treatment group)or a visually identical placebo cream(without androgens)combined with PFMT(control group).The vaginal cream was applied to the vaginal wall at a dose of 0.5 g per application,twice weekly for a total of 10 applications,while PFMT was conducted for 8 weeks.The clinical efficacy and safety were compared between the two groups.Results:A total of 61 patients were finally enrolled,with 31 in the treatment group and 30 in the control group.At both 3-month and 6-month follow-ups,the treatment group demonstrated significantly lower values in daily pad usage(p<0.05),24-h pad test scores(p<0.05),and ICIQ-UI SF scores(p<0.05)compared to the control group.The improvement rate of urinary incontinence was significantly higher in the treatment group(p<0.05).Compared to baseline,the treatment group showed statistically significant reductions in all three outcome measures(all p<0.05).No severe adverse events were reported in either group during the treatment period.Conclusions:Androgen therapy combined with PFMT significantly improved the urinary incontinence remission rate in postmenopausal women with SUI,with no severe adverse effects observed.These findings suggest that androgen therapy may represent a novel therapeutic approach for SUI management in postmenopausal women.展开更多
Objectives: The Solyx System was developed to be easier and safer to use than other slings. It was the objective of this study to retrospectively assess the long-term safety and efficacy of the SolyxTM SIS Sling Syste...Objectives: The Solyx System was developed to be easier and safer to use than other slings. It was the objective of this study to retrospectively assess the long-term safety and efficacy of the SolyxTM SIS Sling System. Methods: After IRB approval and informed consent, chart reviews with follow up phone questionnaires of 69 subjects implanted with the Solyx Sling were collected at 2 sites. All of the patients had SUI and had urethral hypermobility with a q-tip test of >30 degrees. All subjects underwent surgery from 12/2008 to 01/2010 with a mean follow up of 43 months (range 39 -49). Subjects included in this data collection had a mean age of 67 years (range 30 -87). The dominant type of incontinence within the study patients was SUI while 17/69 (25%) of the subjects also had a component of urge incontinence. 38/69 (55%) of study patients had concomitant procedures. Results: Long-term Solyx results showed 64/69 (93%) of patients were subjectively dry by questionnaire and were satisfied with their outcome. 63/69 (91%) would have the procedure again. There were 4 cases of denovo urge incontinence and 2 reports of transient retention. There were no serious adverse events including no bladder, bowel, vessel or nerve perforations and no erosions or extrusions. No pain was reported that was attributed to the implant. Conclusions: Chart review with follow phone questionnaires indicated that the Solyx Sling was a safe, efficacious and less-invasive option for patients requiring SUI surgery and that these results were sustainable for an average of 43 months.展开更多
Fecal incontinence is a common condition that can significantly impact patients’quality of life.Obstetric anal sphincter injury and anorectal surgeries are common etiologies.Endoanal ultrasound and anorectal manometr...Fecal incontinence is a common condition that can significantly impact patients’quality of life.Obstetric anal sphincter injury and anorectal surgeries are common etiologies.Endoanal ultrasound and anorectal manometry are important diagnostic tools for evaluating patients.There are various treatment options,including diet,lifestyle modifications,drugs,biofeedback therapy,tibial and sacral nerve neuromodulation therapy,and surgery.In this editorial,we will discuss current controversies and novel approaches to fecal incontinence.Screening for asymptomatic anal sphincter defects after obstetric anal sphincter injury and in patients with inflammatory bowel disease is not generally recommended,but may be helpful in selected patients.The Garg incontinence score is a new score that includes the assessment of solid,liquid,flatus,mucous,stress and urge fecal incontinence.Novel tests such as translumbosacral anorectal magnetic stimulation and novel therapies such as translumbosacral neuromodulation therapy are promising diagnostic and treatment options,for both fecal incontinence and neuropathy.Home biofeedback therapy can overcome some limitations of the office-based therapy.Skeletal muscle-derived cell implantation of the external anal sphincter has been further studied as a possible treatment option.Sacral neuromodulation may be useful in scleroderma,congenital fecal incontinence and inflammatory bowel disease but merits further study.展开更多
Objective: To study risk factors for urinary incontinence (UI) in pregnant women in six health facilities in the city of Ouahigouya. Methodology: We conducted a cross-sectional, analytical observational study from May...Objective: To study risk factors for urinary incontinence (UI) in pregnant women in six health facilities in the city of Ouahigouya. Methodology: We conducted a cross-sectional, analytical observational study from May 1 to August 30, 2023 in six health facilities in the city of Ouahigouya. Binary logistic regression was used to identify risk factors associated with UTI. Results: The prevalence of UI was 39.3%. The mean age of incontinent women was 26.5 ± 6.2 years, with extremes of 18 and 44 years. Stress UI (55%) was the most frequent type. On univariate analysis, age over 25 (OR = 2.6), multiparity (OR = 2.8), number of gestures, body mass index greater than or equal to 25 kg/m2 (OR = 2.1), infantile enuresis (OR = 2.6), recurrent urinary tract infections (OR = 2.6), previous vaginal delivery (OR = 14.5) and third trimester of pregnancy (OR = 1.7) significantly increased the risk of UTI. Independent risk factors were previous vaginal delivery (OR = 17.6), previous caesarean section (OR = 5.2), third trimester of pregnancy (OR = 2.01), body mass index greater than or equal to 25 kg/m2 (OR = 2.09) and coffee consumption (OR = 4.5). Conclusion: UTI is highly prevalent in pregnant women. Obstetrical parameters are strongly associated with the risk of UTI during pregnancy.展开更多
Objective:Stress urinary incontinence(SUI)is a common condition among women that severely impairs quality of life.Pelvic floor proprioceptive training(PFPT)has attracted increasing attention for its potential to enhan...Objective:Stress urinary incontinence(SUI)is a common condition among women that severely impairs quality of life.Pelvic floor proprioceptive training(PFPT)has attracted increasing attention for its potential to enhance pelvic floor muscle function and alleviate SUI symptoms.This study aims to observe and compare the clinical efficacy of PFPT combined with electroacupuncture,electrical stimulation,and biofeedback therapy versus conventional therapy consisting of electroacupuncture,electrical stimulation,and biofeedback alone in women with SUI,and to explore the role of PFPT in improving symptom and functional outcomes.Methods:In this randomized controlled trial,72 women with mild to moderate SUI were recruited from the Department of Rehabilitation Medicine at Third Xiangya Hospital,Central South University,between December 2021 and October 2023.Participants were randomly assigned to an experimental group(n=36)or a control group(n=36).Both groups received health education.The control group underwent electroacupuncture combined with electrical stimulation and biofeedback therapy,while the experimental group additionally received PFPT 3 times per week for 4 weeks.The primary outcome was assessed using the International Consultation on Incontinence Questionnaire-Short Form(ICIQ-SF).Secondary outcomes included pelvic floor muscle strength,bladder neck mobility,and balance ability.The ICIQ-SF was reassessed at 1,3,6,and 12 months post-treatment.Results:Both groups showed statistically significant improvements in all parameters after treatment(all P<0.05).However,there were no statistically significant differences between groups in most measures(all P>0.05).The experimental group demonstrated longer singleleg stance duration with eyes closed than the control group(left leg:P=0.026;right leg:P=0.006),with a significant increase from baseline(P<0.001).At 6 months post-treatment,the cure rate in the experimental group was significantly higher than that in the control group(P=0.037).Conclusion:Conventional therapy effectively improves SUI symptoms,but adding PFPT provides notable additional benefits,including enhanced balance ability and sustained midterm cure rates.These findings suggest that PFPT is a valuable adjunct to standard SUI management strategies.展开更多
Fecal incontinence(FI),which can arise from various pathogenic mechanisms,has attracted considerable attention worldwide.Despite its importance,the reproduction of the defecatory system to study the mechanisms of FI r...Fecal incontinence(FI),which can arise from various pathogenic mechanisms,has attracted considerable attention worldwide.Despite its importance,the reproduction of the defecatory system to study the mechanisms of FI remains limited,largely because of social stigma and being considered inappropriate.Inspired by the rectum’s functionalities,we developed a soft robotic system that includes a power supply,pressure sensors,data acquisition systems,a flushing mechanism,stages,and a rectal module.Specifically,the innovative soft rectal module includes actuators inspired by sphincter muscles,both soft and rigid covers,and a soft rectum mold.The rectal mold,which was fabricated from materials that mimic human rectal tissue,was produced using a mold replication fabrication method.Both the soft and rigid components of the mold were created using three-dimensional(3D)printing technology.In addition,the sphincter muscle-inspired actuators featured double-layer pouch structures that were modeled and optimized based on multilayer perceptron methods to obtain a high contraction ratio(100%),generate high pressure(9.8 kPa),and have a short recovery time(3 s).Upon assembly,this defecation robot could smoothly expel liquid feces,perform controlled solid fecal cutting,and defecate extremely solid long feces,thus closely replicating the functions of the human rectum and anal canal.This defecation robot has the potential to facilitate human understanding of the complex defecation system and contribute to the development of improved quality-of-life devices related to defecation.展开更多
Streptococcus suis serotype 2(SS2)is a zoonotic pathogen that can cause acute infection,such as septicemia in pigs and streptococcal toxic shock-like syndrome(STSLS)in humans,indicating that SS2 can evade innate immun...Streptococcus suis serotype 2(SS2)is a zoonotic pathogen that can cause acute infection,such as septicemia in pigs and streptococcal toxic shock-like syndrome(STSLS)in humans,indicating that SS2 can evade innate immunity.Macrophages perform essential antimicrobial functions in the innate immune system by engulfing and killing pathogens.Previously,a dna K mutant strain that showed impaired phagocytosis resistance ability was screened from the transposon mutant library of SS2,but the specific mechanism is unclear.In this study,we further demonstrated that DnaK was required for SS2 to be antiphagocytosed by macrophages and survive in adverse environments.A mouse challenge experiment indicated that DnaK promoted bacteremia and systemic dissemination of SS2,enhancing bacterial pathogenicity.Western blot and immunofluorescence results indicated that DnaK could be secreted by SS2 and was able to enter RAW264.7 macrophages.Then,the endocytic receptor LRP1 regulated by DnaK was identified through RNA sequencing(RNA-Seq).We found that DnaK decreased both the mRNA and protein levels of LRP1.Knockdown of the LRP1β-chain(LRP1β)significantly decreased the phagocytosis rate of the SS2 strain ZY05719,suggesting that LRP1 is a phagocytic receptor of SS2.Furthermore,inhibitor treatment assays revealed that DnaK decreased LRP1 protein levels through the transcription factor PPARγand the ubiquitin-proteasome system.In summary,DnaK contributes to the phagocytosis resistance of SS2 by decreasing LRP1 protein levels in macrophages,providing new insights into the antiphagocytosis mechanisms of SS2 and helping to understand its pathogenesis.展开更多
Streptococcus suis serotype 2(SS2)is an emerging zoonotic pathogen that causes meningitis in humans and pigs.This pathogen generates substantial economic losses in the swine industry while posing a significant threat ...Streptococcus suis serotype 2(SS2)is an emerging zoonotic pathogen that causes meningitis in humans and pigs.This pathogen generates substantial economic losses in the swine industry while posing a significant threat to public health security.The mechanisms through which SS2 penetrates the brain and induces meningitis remain incompletely understood.This study examines the role and mechanism of SS2 collagenase-like protease(Clp)in facilitating bacterial passage across the blood-brain barrier(BBB).The research demonstrates that SS2 Clp enhanced virulence and tissue colonization while promoting BBB degradation in mice.The Δclp mutant exhibited reduced ability to traverse human brain microvascular endothelial(hCMEC/D3)cell monolayers compared to wild-type SS2,while the addition of recombinant protein rClp increased permeability.Furthermore,rClp significantly enhanced SS2 adhesion to hCMEC/D3,suppressed the expression of intercellular tight junction proteins ZO-1,Occludin,and Claudin-5 independent of its enzyme activity,and triggered hCMEC/D3 apoptosis through cell receptor ligand apoptosis and mitochondrial apoptosis pathways,partially dependent on its enzyme activity,leading to BBB disruption and enhanced permeability.Additionally,Clp enhanced the infiltration of macrophages(F4/80+),monocytes(F4/80-Ly6C+),and neutrophils(Ly6G+)into the brain following SS2 infection.These findings establish that SS2 Clp is essential for bacterial passage across the BBB,offering a theoretical foundation for improved prevention and treatment strategies for SS2-induced meningitis.展开更多
Fecal incontinence,a debilitating condition that significantly impairs quality of life,affects 2%-21%of adults worldwide.For patients whose structural defects are unresponsive to conservative therapies,sphincter recon...Fecal incontinence,a debilitating condition that significantly impairs quality of life,affects 2%-21%of adults worldwide.For patients whose structural defects are unresponsive to conservative therapies,sphincter reconstruction remains the primary treatment approach.Although traditional surgical techniques effectively restore anatomy in the short term,their long-term efficacy is constrained by progressive muscle atrophy and fibrotic scarring.In complex cases,alternative interventions,including dynamic gracilis or gluteus maximus transposition and artificial sphincter implantation,offer therapeutic options yet are associated with increased surgical risks and high complication rates.Emerging therapies such as regenerative medicine and neuromodulatory approaches have potential,although further rigorous clinical validation is needed to establish standardized protocols.Optimizing fecal incontinence management necessitates precise patient stratification,multidisciplinary collaboration,and the development of individualized treatment algorithms.Advancements in this field depend on large-scale clinical trials and comprehensive long-term outcome assessments to improve therapeutic efficacy and patient-centered care.展开更多
We report a case involving an 85-year-old man who underwent laparoscopic radical prostatectomy for prostate cancer in 2011.During follow-up,he required long-term use of a penile clamp to manage urination due to perman...We report a case involving an 85-year-old man who underwent laparoscopic radical prostatectomy for prostate cancer in 2011.During follow-up,he required long-term use of a penile clamp to manage urination due to permanent severe stress incontinence.In February 2023,he presented with a painless cystic mass in the scrotum.Upon pressing the mass with hand,fluid drained from the external urethral orifice,causing the mass to shrink in size,although it returned to its original size a few hours later.Urography and cystoscopy showed a globular urethral diverticulum located anteriorly.The patient underwent surgical excision of the diverticulum along with urethroplasty.Postoperatively,the urinary stress incontinence persisted,but he declined any further surgical intervention.An artificial urinary sphincter is currently the first-line treatment for male urinary incontinence.However,devices such as penile clamps can serve as an alternative when considering surgical suitability or cost.It is important to note that these devices can lead to serious complications such as urethral erosion,stricture,or diverticulum.Therefore,caution is advised when using such devices,and they should be removed periodically at short intervals.展开更多
Toxin–antitoxin(TA)systems,which are prevalent in bacteria and archaea,play diverse roles in bacterial physiology and have been proposed to be significant in stress adaptation.Despite the extensive characterization o...Toxin–antitoxin(TA)systems,which are prevalent in bacteria and archaea,play diverse roles in bacterial physiology and have been proposed to be significant in stress adaptation.Despite the extensive characterization of numerous TA systems in various bacteria,the investigation of these systems within Streptococcus suis is still limited.Here,we systematically analyzed the type Ⅱ TA systems of 95 S.suis genomes available in the GenBank database using TAfinder.A total of 612 putative type Ⅱ TA systems were retrieved and classified into 10 categories by phylogenetic analysis.Notably,an elevated occurrence of these TA systems was observed among the important prevalent serotypes 2,4,5,9,14,Chz,NCL1,and NCL3 strains.The following study identified the activities of TA systems using 2 strategies and confirmed the regulatory effect of HigBA on the type Ⅶ secretion system in S.suis by measuringβ-galactosidase activity and transcriptional changes.Moreover,we unveiled a hitherto uncharacterized,highly prevalent novel TA system,with the composition of antitoxin–toxin–antitoxin(SS-ATA),which regulates the downstream two-component signaling system.Altogether,this study systematically analyzed the type Ⅱ TA systems within S.suis,highlighting the widespread distribution of Hig BA and SS-ATA as important regulatory elements in S.suis.展开更多
Objective:To analyze the preventive and management effects of the 4R crisis management theory on incontinence-associated dermatitis(IAD)in ICU patients with fecal incontinence.Methods:A hundred patients with fecal inc...Objective:To analyze the preventive and management effects of the 4R crisis management theory on incontinence-associated dermatitis(IAD)in ICU patients with fecal incontinence.Methods:A hundred patients with fecal incontinence who were admitted to the ICU for treatment between January 2024 and December 2024 were selected and randomly divided into two groups using a random number table.The observation group received 4R crisis management theory,while the control group received routine management.The IAD risk score,incidence of IAD,severity of IAD,and formation and healing time of IAD were compared between the two groups.Results:After management,the IAD risk score of the observation group was lower than that of the control group(P<0.05).The incidence of IAD in the observation group was lower than that in the control group,the proportion of mild IAD was higher than that in the control group,the formation time of IAD was later than that in the control group,and the healing time was shorter than that in the control group(P<0.05).Conclusion:Adopting the 4R crisis management theory for ICU patients with fecal incontinence can reduce the risk of IAD occurrence,effectively prevent IAD,reduce its severity,delay its formation time,and promote good healing.展开更多
BACKGROUND Postpartum stress urinary incontinence(SUI)symptoms affect a patient’s daily activities and quality of life and increase the negative emotions that they experience.At present,there is no research on the ef...BACKGROUND Postpartum stress urinary incontinence(SUI)symptoms affect a patient’s daily activities and quality of life and increase the negative emotions that they experience.At present,there is no research on the effect of fractional CO_(2)laser treatment combined with Kegel exercise on postpartum SUI and postpartum depression and anxiety.AIM To investigate the effect of lattice CO_(2)laser treatment combined with Kegel exercise on mild to moderate postpartum SUI and its influence on postpartum depression and anxiety.METHODS Using a retrospective study,data from 82 cases of mild to moderate postpartum SUI in Huzhou Maternal&Child Health Care Hospital from January to April 2024 were retrospectively collected.The cases were divided into groups according to the different treatment methods,namely Group S(41 cases,only receiving lattice CO_(2)laser treatment)and Group L(41 cases,receiving lattice CO_(2)laser combined with Kegel exercise treatment).The baseline data of the two groups were compared.In addition,we analyzed and compared the scores of the international commission on urinary incontinence questionnaire short form(ICI-Q-SF),incontinence quality of life questionnaire(I-QOL),Edinburgh postnatal depression scale(EPDS),and postpartum specific anxiety scale(PSAS)before treatment,at the end of treatment,and 3 months after the end of treatment between the two groups.Furthermore,the clinical efficacy and adverse reactions of the two groups were analyzed and compared at the end of treatment and 3 months after the end of treatment.RESULTS There was no significant difference in the baseline data and the ICI-Q-SF,I-QOL,EPDS,and PSAS scores between the two groups before treatment.However,at the end of treatment,the ICI-Q-SF,I-QOL,EPDS,and PSAS scores between Groups L and S were significantly different.The overall effective rate of treatment in Group L was significantly higher than that in Group S.During the 3-month follow-up after treatment,it was found that the ICIQ-SF,EPDS,and PSAS scores of Group L were still lower than those of Group S.In comparison,the I-QOL score and total effective rate of treatment were still higher in Group L than those in Group S,and this difference was significant.There was no significant difference in the adverse reactions between Group L and Group S.CONCLUSION The combination of dot lattice CO_(2)laser and Kegel exercise has a significant therapeutic effect on mild to moderate postpartum SUI.It can prolong the duration of therapeutic effects,improve a patient’s quality of life,and alleviate postpartum depression and anxiety.展开更多
Streptococcus suis(S.suis)is a major disease impacting pig farming globally.It can also be transferred to humans by eating raw pork.A comprehensive study was recently carried out to determine the indices throughmultip...Streptococcus suis(S.suis)is a major disease impacting pig farming globally.It can also be transferred to humans by eating raw pork.A comprehensive study was recently carried out to determine the indices throughmultiple geographic regions in China.Methods:The well-posed theorems were employed to conduct a thorough analysis of the model’s feasible features,including positivity,boundedness equilibria,reproduction number,and parameter sensitivity.Stochastic Euler,Runge Kutta,and EulerMaruyama are some of the numerical techniques used to replicate the behavior of the streptococcus suis infection in the pig population.However,the dynamic qualities of the suggested model cannot be restored using these techniques.Results:For the stochastic delay differential equations of the model,the non-standard finite difference approach in the sense of stochasticity is developed to avoid several problems such as negativity,unboundedness,inconsistency,and instability of the findings.Results from traditional stochastic methods either converge conditionally or diverge over time.The stochastic non-negative step size convergence nonstandard finite difference(NSFD)method unconditionally converges to the model’s true states.Conclusions:This study improves our understanding of the dynamics of streptococcus suis infection using versions of stochastic with delay approaches and opens up new avenues for the study of cognitive processes and neuronal analysis.Theplotted interaction behaviour and new solution comparison profiles.展开更多
基金supported by Joint Program on Health Science&Technology Innovation of Hainan Province(WSJK2024QN093)Discipline Leader Development Program for Outstanding Talents of Hainan West Central Hospital.
文摘Objectives:Postmenopausal women with stress urinary incontinence(SUI)exhibit low androgen expression.This study aimed to evaluate the efficacy and safety of vaginal androgen combined with pelvic floor muscle training(PFMT)in the treatment of SUI in postmenopausal women.Methods:Postmenopausal women with SUI were recruited from Hainan West Central Hospital between January 2024 and March 2025.Participants were randomly assigned in a double-blind manner to receive either vaginal androgen cream combined with PFMT(treatment group)or a visually identical placebo cream(without androgens)combined with PFMT(control group).The vaginal cream was applied to the vaginal wall at a dose of 0.5 g per application,twice weekly for a total of 10 applications,while PFMT was conducted for 8 weeks.The clinical efficacy and safety were compared between the two groups.Results:A total of 61 patients were finally enrolled,with 31 in the treatment group and 30 in the control group.At both 3-month and 6-month follow-ups,the treatment group demonstrated significantly lower values in daily pad usage(p<0.05),24-h pad test scores(p<0.05),and ICIQ-UI SF scores(p<0.05)compared to the control group.The improvement rate of urinary incontinence was significantly higher in the treatment group(p<0.05).Compared to baseline,the treatment group showed statistically significant reductions in all three outcome measures(all p<0.05).No severe adverse events were reported in either group during the treatment period.Conclusions:Androgen therapy combined with PFMT significantly improved the urinary incontinence remission rate in postmenopausal women with SUI,with no severe adverse effects observed.These findings suggest that androgen therapy may represent a novel therapeutic approach for SUI management in postmenopausal women.
文摘Objectives: The Solyx System was developed to be easier and safer to use than other slings. It was the objective of this study to retrospectively assess the long-term safety and efficacy of the SolyxTM SIS Sling System. Methods: After IRB approval and informed consent, chart reviews with follow up phone questionnaires of 69 subjects implanted with the Solyx Sling were collected at 2 sites. All of the patients had SUI and had urethral hypermobility with a q-tip test of >30 degrees. All subjects underwent surgery from 12/2008 to 01/2010 with a mean follow up of 43 months (range 39 -49). Subjects included in this data collection had a mean age of 67 years (range 30 -87). The dominant type of incontinence within the study patients was SUI while 17/69 (25%) of the subjects also had a component of urge incontinence. 38/69 (55%) of study patients had concomitant procedures. Results: Long-term Solyx results showed 64/69 (93%) of patients were subjectively dry by questionnaire and were satisfied with their outcome. 63/69 (91%) would have the procedure again. There were 4 cases of denovo urge incontinence and 2 reports of transient retention. There were no serious adverse events including no bladder, bowel, vessel or nerve perforations and no erosions or extrusions. No pain was reported that was attributed to the implant. Conclusions: Chart review with follow phone questionnaires indicated that the Solyx Sling was a safe, efficacious and less-invasive option for patients requiring SUI surgery and that these results were sustainable for an average of 43 months.
文摘Fecal incontinence is a common condition that can significantly impact patients’quality of life.Obstetric anal sphincter injury and anorectal surgeries are common etiologies.Endoanal ultrasound and anorectal manometry are important diagnostic tools for evaluating patients.There are various treatment options,including diet,lifestyle modifications,drugs,biofeedback therapy,tibial and sacral nerve neuromodulation therapy,and surgery.In this editorial,we will discuss current controversies and novel approaches to fecal incontinence.Screening for asymptomatic anal sphincter defects after obstetric anal sphincter injury and in patients with inflammatory bowel disease is not generally recommended,but may be helpful in selected patients.The Garg incontinence score is a new score that includes the assessment of solid,liquid,flatus,mucous,stress and urge fecal incontinence.Novel tests such as translumbosacral anorectal magnetic stimulation and novel therapies such as translumbosacral neuromodulation therapy are promising diagnostic and treatment options,for both fecal incontinence and neuropathy.Home biofeedback therapy can overcome some limitations of the office-based therapy.Skeletal muscle-derived cell implantation of the external anal sphincter has been further studied as a possible treatment option.Sacral neuromodulation may be useful in scleroderma,congenital fecal incontinence and inflammatory bowel disease but merits further study.
文摘Objective: To study risk factors for urinary incontinence (UI) in pregnant women in six health facilities in the city of Ouahigouya. Methodology: We conducted a cross-sectional, analytical observational study from May 1 to August 30, 2023 in six health facilities in the city of Ouahigouya. Binary logistic regression was used to identify risk factors associated with UTI. Results: The prevalence of UI was 39.3%. The mean age of incontinent women was 26.5 ± 6.2 years, with extremes of 18 and 44 years. Stress UI (55%) was the most frequent type. On univariate analysis, age over 25 (OR = 2.6), multiparity (OR = 2.8), number of gestures, body mass index greater than or equal to 25 kg/m2 (OR = 2.1), infantile enuresis (OR = 2.6), recurrent urinary tract infections (OR = 2.6), previous vaginal delivery (OR = 14.5) and third trimester of pregnancy (OR = 1.7) significantly increased the risk of UTI. Independent risk factors were previous vaginal delivery (OR = 17.6), previous caesarean section (OR = 5.2), third trimester of pregnancy (OR = 2.01), body mass index greater than or equal to 25 kg/m2 (OR = 2.09) and coffee consumption (OR = 4.5). Conclusion: UTI is highly prevalent in pregnant women. Obstetrical parameters are strongly associated with the risk of UTI during pregnancy.
基金supported by the Natural Science Foundation of Hunan Province(2024JJ8121,2024JJ6626)the Hunan Provincial Key Research and Development Program(2023SK2038),China.
文摘Objective:Stress urinary incontinence(SUI)is a common condition among women that severely impairs quality of life.Pelvic floor proprioceptive training(PFPT)has attracted increasing attention for its potential to enhance pelvic floor muscle function and alleviate SUI symptoms.This study aims to observe and compare the clinical efficacy of PFPT combined with electroacupuncture,electrical stimulation,and biofeedback therapy versus conventional therapy consisting of electroacupuncture,electrical stimulation,and biofeedback alone in women with SUI,and to explore the role of PFPT in improving symptom and functional outcomes.Methods:In this randomized controlled trial,72 women with mild to moderate SUI were recruited from the Department of Rehabilitation Medicine at Third Xiangya Hospital,Central South University,between December 2021 and October 2023.Participants were randomly assigned to an experimental group(n=36)or a control group(n=36).Both groups received health education.The control group underwent electroacupuncture combined with electrical stimulation and biofeedback therapy,while the experimental group additionally received PFPT 3 times per week for 4 weeks.The primary outcome was assessed using the International Consultation on Incontinence Questionnaire-Short Form(ICIQ-SF).Secondary outcomes included pelvic floor muscle strength,bladder neck mobility,and balance ability.The ICIQ-SF was reassessed at 1,3,6,and 12 months post-treatment.Results:Both groups showed statistically significant improvements in all parameters after treatment(all P<0.05).However,there were no statistically significant differences between groups in most measures(all P>0.05).The experimental group demonstrated longer singleleg stance duration with eyes closed than the control group(left leg:P=0.026;right leg:P=0.006),with a significant increase from baseline(P<0.001).At 6 months post-treatment,the cure rate in the experimental group was significantly higher than that in the control group(P=0.037).Conclusion:Conventional therapy effectively improves SUI symptoms,but adding PFPT provides notable additional benefits,including enhanced balance ability and sustained midterm cure rates.These findings suggest that PFPT is a valuable adjunct to standard SUI management strategies.
基金supported by Grant-in-Aid for Scientific Research on Innovative Areas from the Japan Society for the Promotion of Science(Nos.18H05473 and 23K13290).
文摘Fecal incontinence(FI),which can arise from various pathogenic mechanisms,has attracted considerable attention worldwide.Despite its importance,the reproduction of the defecatory system to study the mechanisms of FI remains limited,largely because of social stigma and being considered inappropriate.Inspired by the rectum’s functionalities,we developed a soft robotic system that includes a power supply,pressure sensors,data acquisition systems,a flushing mechanism,stages,and a rectal module.Specifically,the innovative soft rectal module includes actuators inspired by sphincter muscles,both soft and rigid covers,and a soft rectum mold.The rectal mold,which was fabricated from materials that mimic human rectal tissue,was produced using a mold replication fabrication method.Both the soft and rigid components of the mold were created using three-dimensional(3D)printing technology.In addition,the sphincter muscle-inspired actuators featured double-layer pouch structures that were modeled and optimized based on multilayer perceptron methods to obtain a high contraction ratio(100%),generate high pressure(9.8 kPa),and have a short recovery time(3 s).Upon assembly,this defecation robot could smoothly expel liquid feces,perform controlled solid fecal cutting,and defecate extremely solid long feces,thus closely replicating the functions of the human rectum and anal canal.This defecation robot has the potential to facilitate human understanding of the complex defecation system and contribute to the development of improved quality-of-life devices related to defecation.
基金funded by the National Key Research and Development Program of China(2021YFD1800400)the National Natural Science Foundation of China(32373018)+2 种基金Jiangsu Agriculture Science and Technology Innovation Fund,China(CX(23)1029)the Excellent Research Innovation Team in Universities in Anhui Province,China(2022AH010088)the Shennong Scholar Project of Anhui Agricultural University,China(rc392101)。
文摘Streptococcus suis serotype 2(SS2)is a zoonotic pathogen that can cause acute infection,such as septicemia in pigs and streptococcal toxic shock-like syndrome(STSLS)in humans,indicating that SS2 can evade innate immunity.Macrophages perform essential antimicrobial functions in the innate immune system by engulfing and killing pathogens.Previously,a dna K mutant strain that showed impaired phagocytosis resistance ability was screened from the transposon mutant library of SS2,but the specific mechanism is unclear.In this study,we further demonstrated that DnaK was required for SS2 to be antiphagocytosed by macrophages and survive in adverse environments.A mouse challenge experiment indicated that DnaK promoted bacteremia and systemic dissemination of SS2,enhancing bacterial pathogenicity.Western blot and immunofluorescence results indicated that DnaK could be secreted by SS2 and was able to enter RAW264.7 macrophages.Then,the endocytic receptor LRP1 regulated by DnaK was identified through RNA sequencing(RNA-Seq).We found that DnaK decreased both the mRNA and protein levels of LRP1.Knockdown of the LRP1β-chain(LRP1β)significantly decreased the phagocytosis rate of the SS2 strain ZY05719,suggesting that LRP1 is a phagocytic receptor of SS2.Furthermore,inhibitor treatment assays revealed that DnaK decreased LRP1 protein levels through the transcription factor PPARγand the ubiquitin-proteasome system.In summary,DnaK contributes to the phagocytosis resistance of SS2 by decreasing LRP1 protein levels in macrophages,providing new insights into the antiphagocytosis mechanisms of SS2 and helping to understand its pathogenesis.
基金supported by the National Key Research and Development Program of China(2021FYD1800405)the National Natural Science Foundation of China(32072823).
文摘Streptococcus suis serotype 2(SS2)is an emerging zoonotic pathogen that causes meningitis in humans and pigs.This pathogen generates substantial economic losses in the swine industry while posing a significant threat to public health security.The mechanisms through which SS2 penetrates the brain and induces meningitis remain incompletely understood.This study examines the role and mechanism of SS2 collagenase-like protease(Clp)in facilitating bacterial passage across the blood-brain barrier(BBB).The research demonstrates that SS2 Clp enhanced virulence and tissue colonization while promoting BBB degradation in mice.The Δclp mutant exhibited reduced ability to traverse human brain microvascular endothelial(hCMEC/D3)cell monolayers compared to wild-type SS2,while the addition of recombinant protein rClp increased permeability.Furthermore,rClp significantly enhanced SS2 adhesion to hCMEC/D3,suppressed the expression of intercellular tight junction proteins ZO-1,Occludin,and Claudin-5 independent of its enzyme activity,and triggered hCMEC/D3 apoptosis through cell receptor ligand apoptosis and mitochondrial apoptosis pathways,partially dependent on its enzyme activity,leading to BBB disruption and enhanced permeability.Additionally,Clp enhanced the infiltration of macrophages(F4/80+),monocytes(F4/80-Ly6C+),and neutrophils(Ly6G+)into the brain following SS2 infection.These findings establish that SS2 Clp is essential for bacterial passage across the BBB,offering a theoretical foundation for improved prevention and treatment strategies for SS2-induced meningitis.
基金Supported by Science and Technology Projects in Guangzhou,No.SL2022A03J00756.
文摘Fecal incontinence,a debilitating condition that significantly impairs quality of life,affects 2%-21%of adults worldwide.For patients whose structural defects are unresponsive to conservative therapies,sphincter reconstruction remains the primary treatment approach.Although traditional surgical techniques effectively restore anatomy in the short term,their long-term efficacy is constrained by progressive muscle atrophy and fibrotic scarring.In complex cases,alternative interventions,including dynamic gracilis or gluteus maximus transposition and artificial sphincter implantation,offer therapeutic options yet are associated with increased surgical risks and high complication rates.Emerging therapies such as regenerative medicine and neuromodulatory approaches have potential,although further rigorous clinical validation is needed to establish standardized protocols.Optimizing fecal incontinence management necessitates precise patient stratification,multidisciplinary collaboration,and the development of individualized treatment algorithms.Advancements in this field depend on large-scale clinical trials and comprehensive long-term outcome assessments to improve therapeutic efficacy and patient-centered care.
文摘We report a case involving an 85-year-old man who underwent laparoscopic radical prostatectomy for prostate cancer in 2011.During follow-up,he required long-term use of a penile clamp to manage urination due to permanent severe stress incontinence.In February 2023,he presented with a painless cystic mass in the scrotum.Upon pressing the mass with hand,fluid drained from the external urethral orifice,causing the mass to shrink in size,although it returned to its original size a few hours later.Urography and cystoscopy showed a globular urethral diverticulum located anteriorly.The patient underwent surgical excision of the diverticulum along with urethroplasty.Postoperatively,the urinary stress incontinence persisted,but he declined any further surgical intervention.An artificial urinary sphincter is currently the first-line treatment for male urinary incontinence.However,devices such as penile clamps can serve as an alternative when considering surgical suitability or cost.It is important to note that these devices can lead to serious complications such as urethral erosion,stricture,or diverticulum.Therefore,caution is advised when using such devices,and they should be removed periodically at short intervals.
基金supported by the National Key Research and Development Program of China(2022YFD1800904)the National Natural Science Foundation of China(31972650 and 32102673)+1 种基金the Postgraduate Research&Practice Innovation Program of Jiangsu Province,China(KYCX22_0780)the China Postdoctoral Science Foundation(2020M682297)。
文摘Toxin–antitoxin(TA)systems,which are prevalent in bacteria and archaea,play diverse roles in bacterial physiology and have been proposed to be significant in stress adaptation.Despite the extensive characterization of numerous TA systems in various bacteria,the investigation of these systems within Streptococcus suis is still limited.Here,we systematically analyzed the type Ⅱ TA systems of 95 S.suis genomes available in the GenBank database using TAfinder.A total of 612 putative type Ⅱ TA systems were retrieved and classified into 10 categories by phylogenetic analysis.Notably,an elevated occurrence of these TA systems was observed among the important prevalent serotypes 2,4,5,9,14,Chz,NCL1,and NCL3 strains.The following study identified the activities of TA systems using 2 strategies and confirmed the regulatory effect of HigBA on the type Ⅶ secretion system in S.suis by measuringβ-galactosidase activity and transcriptional changes.Moreover,we unveiled a hitherto uncharacterized,highly prevalent novel TA system,with the composition of antitoxin–toxin–antitoxin(SS-ATA),which regulates the downstream two-component signaling system.Altogether,this study systematically analyzed the type Ⅱ TA systems within S.suis,highlighting the widespread distribution of Hig BA and SS-ATA as important regulatory elements in S.suis.
基金Exploration of the Preventive Effect of Skin Management Program Based on 4R Crisis Management Theory on Incontinence-Associated Dermatitis in ICU Patients with Fecal Incontinence(Project No.:YK202335)。
文摘Objective:To analyze the preventive and management effects of the 4R crisis management theory on incontinence-associated dermatitis(IAD)in ICU patients with fecal incontinence.Methods:A hundred patients with fecal incontinence who were admitted to the ICU for treatment between January 2024 and December 2024 were selected and randomly divided into two groups using a random number table.The observation group received 4R crisis management theory,while the control group received routine management.The IAD risk score,incidence of IAD,severity of IAD,and formation and healing time of IAD were compared between the two groups.Results:After management,the IAD risk score of the observation group was lower than that of the control group(P<0.05).The incidence of IAD in the observation group was lower than that in the control group,the proportion of mild IAD was higher than that in the control group,the formation time of IAD was later than that in the control group,and the healing time was shorter than that in the control group(P<0.05).Conclusion:Adopting the 4R crisis management theory for ICU patients with fecal incontinence can reduce the risk of IAD occurrence,effectively prevent IAD,reduce its severity,delay its formation time,and promote good healing.
基金Supported by Huzhou Science and Technology Bureau,No.2023GYB16.
文摘BACKGROUND Postpartum stress urinary incontinence(SUI)symptoms affect a patient’s daily activities and quality of life and increase the negative emotions that they experience.At present,there is no research on the effect of fractional CO_(2)laser treatment combined with Kegel exercise on postpartum SUI and postpartum depression and anxiety.AIM To investigate the effect of lattice CO_(2)laser treatment combined with Kegel exercise on mild to moderate postpartum SUI and its influence on postpartum depression and anxiety.METHODS Using a retrospective study,data from 82 cases of mild to moderate postpartum SUI in Huzhou Maternal&Child Health Care Hospital from January to April 2024 were retrospectively collected.The cases were divided into groups according to the different treatment methods,namely Group S(41 cases,only receiving lattice CO_(2)laser treatment)and Group L(41 cases,receiving lattice CO_(2)laser combined with Kegel exercise treatment).The baseline data of the two groups were compared.In addition,we analyzed and compared the scores of the international commission on urinary incontinence questionnaire short form(ICI-Q-SF),incontinence quality of life questionnaire(I-QOL),Edinburgh postnatal depression scale(EPDS),and postpartum specific anxiety scale(PSAS)before treatment,at the end of treatment,and 3 months after the end of treatment between the two groups.Furthermore,the clinical efficacy and adverse reactions of the two groups were analyzed and compared at the end of treatment and 3 months after the end of treatment.RESULTS There was no significant difference in the baseline data and the ICI-Q-SF,I-QOL,EPDS,and PSAS scores between the two groups before treatment.However,at the end of treatment,the ICI-Q-SF,I-QOL,EPDS,and PSAS scores between Groups L and S were significantly different.The overall effective rate of treatment in Group L was significantly higher than that in Group S.During the 3-month follow-up after treatment,it was found that the ICIQ-SF,EPDS,and PSAS scores of Group L were still lower than those of Group S.In comparison,the I-QOL score and total effective rate of treatment were still higher in Group L than those in Group S,and this difference was significant.There was no significant difference in the adverse reactions between Group L and Group S.CONCLUSION The combination of dot lattice CO_(2)laser and Kegel exercise has a significant therapeutic effect on mild to moderate postpartum SUI.It can prolong the duration of therapeutic effects,improve a patient’s quality of life,and alleviate postpartum depression and anxiety.
基金supported by the Deanship of Scientific Research,Vice Presidency for Graduate Studies and Scientific Research,King Faisal University,Saudi Arabia[KFU250259].
文摘Streptococcus suis(S.suis)is a major disease impacting pig farming globally.It can also be transferred to humans by eating raw pork.A comprehensive study was recently carried out to determine the indices throughmultiple geographic regions in China.Methods:The well-posed theorems were employed to conduct a thorough analysis of the model’s feasible features,including positivity,boundedness equilibria,reproduction number,and parameter sensitivity.Stochastic Euler,Runge Kutta,and EulerMaruyama are some of the numerical techniques used to replicate the behavior of the streptococcus suis infection in the pig population.However,the dynamic qualities of the suggested model cannot be restored using these techniques.Results:For the stochastic delay differential equations of the model,the non-standard finite difference approach in the sense of stochasticity is developed to avoid several problems such as negativity,unboundedness,inconsistency,and instability of the findings.Results from traditional stochastic methods either converge conditionally or diverge over time.The stochastic non-negative step size convergence nonstandard finite difference(NSFD)method unconditionally converges to the model’s true states.Conclusions:This study improves our understanding of the dynamics of streptococcus suis infection using versions of stochastic with delay approaches and opens up new avenues for the study of cognitive processes and neuronal analysis.Theplotted interaction behaviour and new solution comparison profiles.
