Efficacy of Kegel exercises in preventing incontinence after partial division of internal anal sphincter during anal fistula surgery

BACKGROUND The transanal opening of intersphincteric space(TROPIS)procedure,performed to treat complex anal fistulas,preserves the external anal sphincter(EAS)but involves partial incision of the internal anal sphincter(IAS).AIM To ascertain the incidence of incontinence after the division of the IAS as is done in TROPIS and to evaluate whether regular Kegel exercises(KE)in the postoperative period can prevent incontinence due to IAS division.METHODS Patients operated on for high complex fistulas and having no preoperative continence problem(score=0)were included in the study.All patients were operated on by the TROPIS procedure and were recommended KE(pelvic contraction exercises)50 times/day.KE were commenced on the 10^(th)postoperative day and continued for 1 year.Incontinence was evaluated objectively(by modified Vaizey’s scores)in the immediate postoperative period(Pre-KE group)and on long-term follow-up(Post-KE group).The incontinence scores in both groups were compared to evaluate the efficacy of KE.RESULTS Of 102 anal fistula patients operated on between July 2018 and July 2020 were included in this study.There were 90 males,the mean age was 42.3±12.8,and the median follow-up was 30 mo(18-42 mo).Three patients were lost to follow-up.There were 65 recurrent fistulas,92 had multiple tracts,42 had associated abscess,46 had horseshoe fistula and 34 were supralevator fistulas.All were magnetic resonance imaging-documented high fistulas(>1/3 EAS involved).Overall incontinence occurred in 31%patients(Pre-KE group)with urge and gas incontinence accounting for the majority of cases(28.3%).The mean incontinence scores in the Pre-KE group were 1.19±1.96(in 31 patients,solid=0,liquid=7,gas=8,urge=24)and in the Post-KE group were 0.26±0.77(in 13 patients,solid=0,liquid=2,gas=3,urge=10)(P=0.00001,t-test).CONCLUSION Division of the IAS led to incontinence,mainly urge incontinence,and also to a mild degree of gas and liquid incontinence.However,regular KE led to a significant reduction in incontinence(both in the number of affected patients and the severity of scores in these patients).

Premonitory urges located in the tongue for tic disorder: Two case reports and review of literature

BACKGROUND Premonitory urges (PUs) was defined as the uncomfortable physical sensations of inner tension that can be relieved by producing movement responses. Nearly 70%-90% patients with Tourette syndrome reported experiences of PUs. CASE SUMMARY In this paper, we present two cases of young patients with PUs located in their tongue, which is very rare and easily misdiagnosed in clinical work. Both two young patients complained of an itchy tongue and cannot help biting their tongue. These two cases were worth reporting because it was rare that PUs was the initial symptom and located in the tongue. The results indicated that PUs seem to play an important role in the generation of tics. CONCLUSION Thus, PUs may be the first process, and an essential part, of the formation of tics.

Can We Predict De Novo Urge Incontinence by Perineal Ultrasound?

Introduction: Urinary incontinence affects over 200 million people worldwide [1]. Tension free vaginal tape is the standard surgical treatment for stress urinary incontinence. De novo urge urinary incontinence is a long-term complication of this treatment with a significant impact in the quality of life of these patients. Objective: The major aim of this study is to assess the correlation between perineal ultrasonography findings and the incidence of de novo urge urinary incontinence. Material and Methods: A prospective observational study was designed. Patients with stress urinary incontinence diagnosed by clinical and urodynamic findings submitted to a tension-free vaginal tape surgery were included. International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and introital perineal ultrasound were performed before surgical intervention (I-STOP&copy). Clinical and ultrasound re-evaluation were executed six months after surgery. Stress urinary incontinence was defined according to the ICS-IUGA. Data were recorded using a Microsoft Access database and statistical analysis using SAS&copy. Results: Bladder thickness equal to or below 6 mm has a low positive predictive value (PPV, 0.55), but a negative predictive power (NPP) of 0.72. Following surgery, a slight increase in postvoid residue is observed. Considering demographic data, an increase of 5 points in body mass index (BMI) resulted in an odds ratio (OR) of 1.74 of presenting de novo urge urinary in continence. Conclusions: In patients submitted to a tension-free vaginal tape surgery, high BMI seems to be associated with a higher rate of de novo urge urinary incontinence. Preoperative bladder wall thickness below 6 mm seems predict absence of this complication.

A Strategic Vision Urged for Sino-US Economic Relations

As an important ingredient in bilateral ties, China-US economic and trade rela-tions have now evolved into a bond of strategic interests that glue the world’stwo great powers. Since a trans-Pacific strategic partnership is taking shape in the political arena,the author believes that, the call of the hour is to go a step further and put

Sichuan Urges Legal Reform For NGOs Against HIV

he government of an HIV/AIDS ravaged province in southwestern China has recently completed an innovative new research report entitied ＂To get NGOs involved in national lawmaking for HIV control work.＂

Who Gets up or Gets out?——A joint circular to urge textile industry to be restructured and upgraded

Ten governmental organizations recently issued a joint circular (No.762-2006, State Development & Reform Commission) to guide Chinese textile growth in the next five years (2006-2010). The circular, seriously taken as guideline policy, is given out amid aggravating factors for resources, environment, trade disputes, structural problems and other challenging issues that Chinese textile industry is supposed to address in

SOEs urged not to profit by crowding out private economy

Hu Deping,68,is the oldest son of Hu Yaobang,a late Party secretary general. His name has recently appeared in the press not because of his father’s reputation but for his own

Garg incontinence scores: New scoring system on the horizon to evaluate fecal incontinence. Will it make a difference?

The main aim of this opinion review is to comment on the recent article published by Garg et al in the World Journal of Gastroenterology 2023;29:4593–4603.The authors in the published article developed a new scoring system,Garg incon-tinence scores(GIS),for fecal incontinence(FI).FI is a chronic debilitating disease that has a severe negative impact on the quality of life of the patients.Rome IV criteria define FI as multiple episodes of solid or liquid stool passed into the clothes at least twice a month.The associated social stigmatization often leads to significant under-reporting of the condition,which further impairs management.An important point is that the complexity and vagueness of the disease make it difficult for the patients to properly define and report the magnitude of the problem to their physicians.Due to this,the management becomes even more difficult.This issue is resolved up to a considerable extent by a scoring ques-tionnaire.There were several scoring systems in use for the last three decades.The prominent of them were the Cleveland Clinic scoring system or the Wexner scoring system,St.Marks Hospital or Vaizey’s scores,and the FI severity index.However,there were several shortcomings in these scoring systems.In the opinion review,we tried to analyze the strength of GIS and compare it to the existing scoring systems.The main pitfalls in the existing scoring systems were that most of them gave equal weightage to different types of FI(solid,liquid,flatus,etc.),were not comprehensive,and took only the surgeon’s perception of FI into view.In GIS,almost all shortcomings of previous scoring systems had been addressed:different weights were assigned to different types of FI by a robust statistical methodology;the scoring system was made comprehensive by including all types of FI that were previously omitted(urge,stress and mucus FI)and gave priority to patients’rather than the physicians’perceptions while developing the scoring system.Due to this,GIS indeed looked like a paradigm shift in the evaluation of FI.However,it is too early to conclude this,as GIS needs to be validated for accuracy and simplicity in future studies.

Correlation between premonitory urges and tic symptoms in a Chinese population with tic disorders

Importance Tics usually start around 4–6 years old and affect about 1%of school‐age children.Premonitory urges(PUs)are sensory phenomena that precede tics and are often described as unpleasant feelings.Recent evidence supports a relationship between PUs and tic severity,but reports are conflicting.In addition,there is no report of PUs in the Chinese population.Objective To investigate the correlation between PUs and tic symptoms in the Chinese population with tic disorders.Methods We recruited 252 Chinese individuals with chronic tic disorders(age 5–16 years).The Yale Global Tic Severity Scale(YGTSS)was used to assess tic symptoms,and the Premonitory Urge for Tics Scale(PUTS)was used to assess PUs.We calculated Spearman correlations between PUTS and YGTSS scores,and constructed a linear regression model to predict the tic symptom severity by PUs.Results There was a significant positive correlation between PU severity(PUTS scores)and motor tic severity,total tic severity,tic‐caused impairment(YGTSS scores)(P<0.05).PU severity was a significant positive predictor of tic symptom severity(standardized beta coefficient=0.174,t=2.786,P=0.006).Interpretation We provide evidence for a correlation between PUs and tic symptoms.PU severity predicts tic symptom severity.Further research on PUs is needed to clarify the shared brain mechanism with tics,and their role in tic expression.A suitable tool to assess PUs in younger children is also needed.

Quantity-effect Relationship of Electroacupuncture for Urge Incontinence:A Multicenter Randomized Controlled Trial

Objective：To investigate the quantity-effect relationship of electroacupuncture in treating urge incontinence （UI）.Methods：A clinical multicenter randomized controlled trial was carried out.One hundred and ninety-nine UI patients meeting the inclusion criteria were randomly allocated,at a ratio of 2：1,to acupuncture and medication groups.The acupuncture group of 199 patients was treated with electroacupuncture plus manual acupuncture,and the medication group of 68 patients was treated with oral administration of Tolterodine Tartrate tablets.Results：The total scores of international consultation on incontinence questionnaire-short form （ICIQ-SF） score plus the international prostatic symptom score （I-PSS） were significantly lower in both groups at each follow-up visit （after 3,6 and 9 treatments） than before treatment.The effect was accumulated with an increase in the number of treatments.The improving effect was significantly better at each follow-up visit in the acupuncture group than that in the medication group （P0.05）.Conclusion：The improvement degree of urinary symptoms and the number of treatments are positively correlated in the treatment of UI by electroacupuncture plus manual acupuncture and by oral administration of Tolterodine Tartrate tablets.Acupuncture has a more marked effect.

Repatriation Urged for Suspected Terrorists

Beijing has vigorously con- demned the United States’ recent transfer of suspected Uygur terrorists to Palau and called for their repatriation to China, according to the Chi- nese Foreign Ministry.

Groups Urge Americans to Eat up Fruits, Vegetables

美国20余家健康组织联合发出呼吁,号召国民从维护健康出发,改变传统的以米、面、肉、蛋、奶为主的饮食结构,改以蔬菜和水果为主。美国目前的饮食指南中也包括蔬菜和水果,但推荐的力度不够。科学家们希望在明年向国民颁布的健康指南中能够大力宣传多吃蔬菜水果,蔬菜水果不应再是身体营养的补 充食品,而应该是美国人饮食结构中的主食。 在美国造成死亡率最高的6种病症中,有5种与饮食不合理有关。其中包括心脏病、癌症、中风和糖尿病。(Five of the top six causes of death in the United States are diet-related. These include heart disease, cancer, stroke and diabetes.)多数人只知道有三分之一的癌症患者与吸烟有关,却不知道另有三分之一的癌症患者之所以得癌与饮食结构不合理有很大关系。(While one-third of all cancers is related to tobacco use, another full third are related to diet.) 饮食以蔬菜和水果为主,是否会造成营养不良?否。专家认为: People can get all the nutrients they need from fruits and vegetables. 所谓“饮食以蔬菜和水果为主”,就不能将蔬菜和水果当作“点缀”或是“旁衬”:The evidence is very strong that those who eat five or more servings of fruits

Researcher Urges Less Use of Anti-Bacteria Products

现在消毒柜,消毒水倍受许多有"洁癖"的人的青睐。同时,我们也经常听到悉心的父母对自己的孩子说:不要碰那个东西,上面有细菌。久而久之,人们一谈起细菌,就似乎是流行病、传染病如流感、疟疾、肝炎、肺结核等的代名词。现在研究表明,其实,细菌并没那么可怕。相反,有时候没有细菌的"真空"世界对你和你孩子的抗病能力的培养反而不利。物极必反,抗菌和抗生素的随意使用很可能招致"超级细菌"的滋生。

No Sex for Two Years, President Urges

肯尼亚的人口总数是3000万,但每日有700人死于艾滋病,14人中间就有1人感染了人体免疫缺损病毒(HIV),最近该国进口了的安全套达300million个!总统为之感到羞愧。他公开恳求国人在两年时间内禁绝性生活!

Poor States Urged to Research Biotech, Fight Hunger

夜读此文,既兴奋,又悲凉。兴奋,是因为千百年来,人们靠天吃饭,地里的活,种瓜得瓜,种豆得豆。得多少,并非“大跃进”可以吹出来的,而是有一个常规,种地能手,能超出常规亩产20％,已有登天之难。而如今,植物的遗传工程(genetic engineering of plants)令世人一惊:It can improve crop yields and develop resis-tance to drought(干旱),salinity(盐份)and pests(害虫)。Biotechnology is also used todevelop drugs to treat diseases such as diabetes and hepatitis(肝炎);悲凉的是,这些专利正紧锁于富国的保险柜中待价而沽:The big biotech companies are locking uppatents at an incredible(难以置信的)rate！其另一个借口是:The full impact of thesenew life sciences on health and the environment is not known。 本文末尾的一句话又让我们另有想法: Biotechnology is by no means the only answer to the problem of hunger as the words already producing more food than it needs。】

Labs Urged to Pre-empt Bioterrorism Threat

恐怖分子可以利用的手段是层出不穷的。为了将风险降到最低,两个非盈利组织于2月20日在华盛顿宣布要采取措施,并且敦促生化技术公司防范它们的员工或实验室成为恐怖活动的源头。然而,各个方面对此的反应却不尽相同。

Study Urges Caution on Childhood Sports

本文对儿童体育运动提出了警告,很有现实意义。儿童不宜过早地投入某专项体育运动。为什么?本文有一句话,说得委婉,却值得深思: Those who participate in a variety of sports and specialize only after reachingthe age of pubergy(青春期)tend to be more consistent performers,have fewerinjuries and adhere to sports play longer than those who specialize early. 为什么会强迫儿童从事某项专门的体育训练?文章透露的原因令人悲从中来: Children and their parents are motivated to commit to such training by thelure(诱惑)of college scholarships and professional careers,the report said. 本文的另一精彩处是对为何儿童不宜过早投入专项体育训练作了生理原因的分析,令人信服。读者不妨细读。 Children need to be children.此话说得何等好啊！

New objective scoring system to clinically assess fecal incontinence

BACKGROUND Several scoring systems are used to assess fecal incontinence(FI),among which,the most commonly used are Wexner and Vaizey’s scoring systems.However,there are significant lacunae in these scoring systems,due to which they are neither accurate nor comprehensive.AIM To develop a new scoring system for FI that is accurate,comprehensive,and easy to use.METHODS A pro forma was made in which six types of FI were included:solid,liquid,flatus,mucous,stress,and urge.The weight for each FI was determined by asking a group of patients and laypersons to give a disability score to each type of FI from 0 to 100(0-least,100-maximum disability).The disability was assessed on a modified EQ-5D+(EuroQol)description system,4D3L(4 dimensions and 3 levels)for each FI.The average score of each FI was calculated,divided by 10,and rounded off to determine the weight of each FI type.The scores for the three levels of frequency of each FI were assigned as never=0(No episode of FI ever),occasional=1(≤1 episode of FI/wk),and common=2(>1 episode of FI/wk),and was termed as frequency score.The score for each FI would be derived by multiplying the frequency score and the weight for that FI type.In the second phase of the study,a group of colorectal surgeons was asked to rank the six FI types in order of severity,and their ranking was compared with the patient and laypersons’rankings.RESULTS Fifty patients and 50 laypersons participated in the study.The weight was assigned to each FI(solid-8,liquid-8,urge-7,flatus-6,mucus-6,and stress-5),and an new scoring system was formulated.The maximum possible score was 80(total incontinence),and the least 0(no incontinence).The surgeons’ranking of FI severity did not correlate well with patients’and laypersons’rankings of FI,highlighting that surgeons and patients may perceive the severity of FI differently.CONCLUSION A new scoring system for FI was formulated,which was simple,logical,comprehensive,and easy to use,and eliminated previous shortcomings.Patients’and surgeons’perceptions of FI severity of FI did not correlate well.