经会阴盆底二维超声联合脱垂定量分期用于顺产后POP患者SUI诊断的临床效能

目的:探讨经会阴盆底二维超声联合脱垂定量分期在顺产后盆腔器官脱垂(POP)患者压力性尿失禁(SUI)发生风险预测中的临床效能,为SUI发生高危人群早期识别及防治方案制定提供更多参考。方法:回顾性选择2021年1月—2023年1月于湖北医药学院附属十堰市太和医院就诊的160例顺产后POP患者,根据有无合并SUI分为SUI组(n=85)和非SUI组(n=75)。比较两组会阴盆底二维超声检查指标及脱垂定量分期法指标,描绘受试者工作特征(ROC)曲线分析经会阴盆底二维超声、脱垂定量分期指标单独及联合用于预测顺产后POP患者SUI发生的临床效能。结果:SUI组膀胱后壁最低点降低值、尿道旋转角、Aa和Ba均显著高于非SUI组,差异有统计学意义(P<0.05);ROC曲线结果显示,Aa、Ba、膀胱后壁最低点降低值及尿道旋转角联合预测顺产后POP患者SUI发生的曲线下面积(AUC)为0.89,高于四者单独预测的0.70、0.73、0.74、0.78。结论:经会阴盆底二维超声及脱垂定量分期均可用于顺产后POP患者SUI发生风险预测,同时两类指标联合检测具有更好的预测效能。

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.

Diagnostic tools for fecal incontinence: Scoring systems are the crucial first step

The main aim of this editorial is to comment on the recent article published by Garg et al in the World Journal of Gastroenterology 2023;29:4593-4603.This original research presents a new scoring system for fecal incontinence.Fecal incontinence is a chronic disease with a severe impact on the quality of life of the patients.Substantial social stigmatization often leads to significant underreporting of the condition even during visits to a specialist and could lead to further misman-agement or non-existent management of the disease.An important fact is that patients are often unable to describe their condition when not asked precisely defined questions.This problem is partially resolved by scoring questionnaires.Several scoring systems are commonly used;however,each of them has their shortcomings.For example,the absence of different kinds of leakage besides flatus and stool could further lead to underscoring the incontinence severity.Therefore,there has long been a call for a more precise scoring system.The correct identification of the presence and severity of fecal incontinence is paramount for further diagnostic approach and for choosing the appropriate therapy option.This editorial describes fecal incontinence,its effect on quality of life in general and further evaluates the diagnostic approach with a particular focus on symptom scoring systems and their implications for clinical practice.

Membrane vesicles derived from Streptococcus suis serotype 2 induce cell pyroptosis in endothelial cells via the NLRP3/Caspase-1/GSDMD pathway

Streptococcus suis serotype 2(S.suis 2)is a zoonotic pathogen that clinically causes severe swine and human infections(such as meningitis,endocarditis,and septicemia).In order to cause widespread diseases in different organs,S.suis 2 must colonize the host,break the blood barrier,and cause exaggerated inflammation.In the last few years,most studies have focused on a single virulence factor and its influences on the host.Membrane vesicles(MVs)can be actively secreted into the extracellular environment contributing to bacteria-host interactions.Gram-negative bacteria-derived outer membrane vesicles(OMVs)were recently shown to activate host Caspase-11-mediated non-canonical inflammasome pathway via deliverance of OMV-bound lipopolysaccharide(LPS),causing host cell pyroptosis.However,little is known about the effect of the MVs from S.suis 2(Gram-positive bacteria without LPS)on cell pyroptosis.Thus,we investigated the molecular mechanism by which S.suis 2 MVs participate in endothelial cell pyroptosis.In this study,we used proteomics,electron scanning microscopy,fluorescence microscope,Western blotting,and bioassays,to investigate the MVs secreted by S.suis 2.First,we demonstrated that S.suis 2 secreted MVs with an average diameter of 72.04 nm,and 200 proteins in MVs were identified.Then,we showed that MVs were transported to cells via mainly dynamin-dependent endocytosis.The S.suis 2 MVs activated NLRP3/Caspase-1/GSDMD canonical inflammasome signaling pathway,resulting in cell pyroptosis,but it did not activate the Caspase-4/-5 pathway.More importantly,endothelial cells produce large amounts of reactive oxygen species(ROS)and lost their mitochondrial membrane potential under induction by S.suis 2 MVs.The results in this study suggest for the first time that MVs from S.suis 2 were internalized by endothelial cells via mainly dynamin-dependent endocytosis and might promote NLRP3/Caspase-1/GSDMD pathway by mitochondrial damage,which produced mtDNA and ROS under induction,leading to the pyroptosis of endothelial cells.

Outcomes and efficacy of magnetic resonance imaging-compatible sacral nerve stimulator for management of fecal incontinence: A multi-institutional study

BACKGROUND Fecal incontinence(FI)is an involuntary passage of fecal matter which can have a significant impact on a patient’s quality of life.Many modalities of treatment exist for FI.Sacral nerve stimulation is a well-established treatment for FI.Given the increased need of magnetic resonance imaging(MRI)for diagnostics,the In-terStim which was previously used in sacral nerve stimulation was limited by MRI incompatibility.Medtronic MRI-compatible InterStim was approved by the United States Food and Drug Administration in August 2020 and has been widely used.AIM To evaluate the efficacy,outcomes and complications of the MRI-compatible InterStim.METHODS Data of patients who underwent MRI-compatible Medtronic InterStim placement at UPMC Williamsport,University of Minnesota,Advocate Lutheran General Hospital,and University of Wisconsin-Madison was pooled and analyzed.Patient demographics,clinical features,surgical techniques,complications,and outcomes were analyzed.Strengthening the Reporting of Observational studies in Epidemiology(STROBE)cross-sectional reporting guidelines were used.RESULTS Seventy-three patients had the InterStim implanted.The mean age was 63.29±12.2 years.Fifty-seven(78.1%)patients were females and forty-two(57.5%)patients had diabetes.In addition to incontinence,overlapping symptoms included diarrhea(23.3%),fecal urgency(58.9%),and urinary incontinence(28.8%).Fifteen(20.5%)patients underwent Peripheral Nerve Evaluation before proceeding to definite implant placement.Thirty-two(43.8%)patients underwent rechargeable InterStim placement.Three(4.1%)patients needed removal of the implant.Migration of the external lead connection was observed in 7(9.6%)patients after the stage I procedure.The explanation for one patient was due to infection.Seven(9.6%)patients had other complications like nerve pain,hematoma,infection,lead fracture,and bleeding.The mean follow-up was 6.62±3.5 mo.Sixty-eight(93.2%)patients reported significant improvement of symptoms on follow-up evaluation.CONCLUSION This study shows promising results with significant symptom improvement,good efficacy and good patient outcomes with low complication rates while using MRI compatible InterStim for FI.Further long-term follow-up and future studies with a larger patient population is recommended.

基于盆底超声波的SUI肛提肌生物力学评估及其应用研究

关于SUI(压力性尿失禁)患者肛提肌生物力学特征的研究目标,旨在运用盆底超声波技术进行评估及实际应用,细究SUI之缘起,赋予了独到的观察与防范视点。该项探究运用了盆腹超声技术,针对压力性尿失禁(SUI)的女性,研究人员对其肛提肌生物力学进行了探讨。深入研究超声波图像,探寻肛提肌的构造与运动规律,对生物力学参数予以探究与剖析。有关SUI患者的现象,研究揭示出其特殊性,盆底肌肉力量失衡,运动能力衰退与肌肉组织层密度降低存在关联。此外,生物力学异变与病患病情深刻相连。调查成果表明,肛提肌的生物力学特性与压力性尿失禁(SUI)的发生及发展存在一定联系。运用盆底超声波之法,深入研究肛提肌之生物力学特性,SUI的诊断获得了实证,关于尿失禁(SUI)的全新应对策略已成功实施。

盆底超声对女性盆底功能障碍性疾病的评估效果及在SUI诊断中的应用分析

目的:探讨盆底超声在女性压力尿失禁(SUI)中的应用。方法:选取2018年1月—2022年10月在扬州市妇幼保健院治疗的SUI患者104例作为观察组,同时选取无SUI经产妇100例作为对照组,均经会阴部探查的方式行盆底超声检查,观察两组静息状态和Valsalva状态下的盆底超声检查参数。结果:静息状态下,观察组膀胱逼尿肌厚度、膀胱尿道后角(PVA)和尿道内口漏斗形成率分别为(5.70±1.02)mm、(124.46±12.46)°和18.27%,明显高于对照组(P<0.05),而膀胱颈与耻骨联合的垂直距离(BN-S)为(21.03±2.16)mm,明显低于对照组(P<0.05);Valsalva动作下,观察组RVA、尿道旋转角度(UR)、膀胱颈移动度(BND)和尿道内口漏斗形成率分别为(154.41±21.41)°、(85.12±21.41)°、(32.40±5.46)mm和61.54%,明显高于对照组(P<0.05),而BN-S为(-8.10±1.54)mm,明显低于对照组(P<0.05)。结论:经盆底超声可观察SUI患者盆底结构,其相关参数在评估SUI中有一定指导意义,膀胱颈“漏斗”形成是SUI的重要指征。

Long Term Follow up of the Solyx Single Incision Sling in the Treatment of Female Stress Urinary Incontinence (SUI)

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.

包穗突变体sui1-5鉴定及OsPSS1互作蛋白筛选

包穗是水稻生产上的不利性状,表现为倒一节间伸长异常,穗部不能正常从叶鞘伸出。目前,已经鉴定报道了多个包穗性状突变体,但对该性状产生的分子机制认识仍然有限。OsPSS1/SUI1是一个磷脂酰丝氨酸合酶的编码基因,该基因突变会引起突变体sui1-4的倒一节间严重缩短。我们鉴定到了一个新的OsPSS1/SUI1等位突变体sui1-5,该突变体倒一节间缩短程度明显减轻。测序发现突变体中基因SUI1的第7个外显子存在1个单碱基G→T替换,导致甘氨酸突变为缬氨酸。为了研究OsPSS1的功能,我们通过酵母筛库发现了一个与OsPSS1互作的蛋白GH9A3,并通过酵母双杂交、荧光素酶互补(LCI)和双分子荧光互补(BIFC)实验加以验证。GH9A3是GH9基因家族成员,编码内切-1,4-β葡聚糖酶,推测是细胞壁成分纤维素合成的一个关键酶。在苗期,SUI1和互作蛋白编码基因GH9A3的表达量并不同步,GH9A3在sui1-5的表达量上调。但是在拔节抽穗期,SUI1和GH9A3在sui1-5中的表达量都相应降低,其他纤维素合酶CESAs家族基因的表达量在sui1-5中也明显降低。这些结果为进一步研究OsPSS1的功能奠定了一定的理论基础。

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.

经直肠双平面超声检查对绝经后不同分度SUI女性尿道括约肌的评估

目的利用经直肠双平面高频超声及声触诊弹性成像(sound touch elastography,STE)技术,评估绝经后不同程度压力性尿失禁(stress urinary incontinence,SUI)女性尿道括约肌形态及弹性的变化。方法选取90例绝经后压力性尿失禁患者,根据Ingelman-Sundberg分度法进行分组,其中轻度组29例,中度组31例,重度组30例。选取同期正常的绝经后女性32例作为对照组。通过双平面探头观察尿道括约肌矢状切面和横切面的声像图特征,测量入组观察对象的尿道括约肌厚度、长度及采集各组尿道括约肌的平均弹性模量值(mean elastic modulus,Emean)。结果1)轻、中、重度组的尿道括约肌厚度、长度与对照组相比减小,Emean值增大,差异有统计学意义(P<0.05);2)重度组与轻度组、中度组相比,尿道括约肌长度、厚度均减小,Emean值增大,差异有统计学意义(P<0.05);3)轻度组尿道括约肌厚度、长度、Emean值与中度组相比,差异无统计学意义(P>0.05)。结论经直肠双平面高频超声及STE技术能定量评价尿道括约肌形态和弹性的变化,评估绝经后压力性尿失禁患者尿道括约肌受损的严重程度,为临床治疗及康复提供决策性依据。

Small Extracellular Vesicles Secreted by Peri-urethral Tissues Regulate Fibroblast Function and Contribute to the Pathogenesis of Female Stress Urinary Incontinence

Objective:This study aimed to explore the existence of small extracellular vesicles(sEVs)in peri-urethral tissues and the role of abnormal expression of sEVs in the pathogenesis of female stress urinary incontinence(SUI).Methods:sEVs were extracted from peri-urethral vaginal wall tissues using differential centrifugation and were observed by transmission electron microscopy(TEM).The number of sEVs and their protein contents were compared between SUI and control groups using nanoparticle tracking analysis(NTA)and bicinchoninic acid(BCA)protein assay.Fibroblasts were cultured separately with SUI(SsEVs group)and normal tissue sEVs(NsEVs group).Proliferation and migration of fibroblasts were compared between groups using CCK-8 and wound healing assays,respectively.Expression levels of collagenⅠandⅢwere compared among blank control(BC),NsEVs,and SsEVs groups using real-time PCR.Protein mass spectrometry was used to test the differentially expressed proteins contained in sEVs between groups.Results:sEVs were extracted and found under the electron microscope.There were significantly more sEVs extracted from the SUI group compared to the normal group.Fibroblasts showed increased proliferative and decreased migratory abilities,and expressed more collagen in the SsEVs group compared to the NsEVs and BC groups.Protein spectrum analysis demonstrated several differentially expressed targets,including components of microfibrils,elastin polymer,and anti-inflammatory factors.Conclusion:sEVs were detected in the peri-urethral tissues.SUI tissues expressed more sEVs than control.The abnormal expression of sEVs and their protein contents may contribute to the pathogenesis and progression of SUI.

Non-Ablative Transvaginal Radiofrequency in the Treatment of Stress Urinary Incontinence: Review of the Literature

Background: Urinary incontinence is defined as the involuntary loss of urine, which can affect up to 45% of women after menopause. Radiofrequency is a non-invasive procedure that involves the application of an electromagnetic wave that through heat generation promotes neocollagenesis and neoeslatinogenesis in the vaginal epithelium. This energy-based technology has been studied as a potential alternative for the treatment of genitourinary syndrome of menopause and urinary incontinence. Objective: To review the recent literature (from 2020 to June 2022) on the use of transvaginal radiofrequency in the treatment of stress urinary incontinence, by searching articles at databases of Capes, PubMed Cochrane and Scielo. Methods: The descriptor terms “Urinary Incontinence/therapy” [Majr] AND “Urinary Incontinence, Stress/therapy” [Majr] AND RADIOFREQUENCY-Search Results-PubMed, [“woman” OR “women”] AND [“urinary incontinence” OR “stress urinary incontinence”] AND Radiofrequency were used, with a filter for the period 2020 to 2022. Conclusion: The studies evaluated in this review demonstrated significant results of radiofrequency in the resolution or reduction of complaints of women with urinary incontinence, especially stress urinary incontinence, but most of these studies presented a low methodological quality. There is, therefore, a lack of studies with longer follow-ups, evaluation of cost-effectiveness, randomized clinical trials with objective outcomes and the use of validated questionnaires with international acceptance.

Dihydroartemisinin ameliorates innate inflammatory response induced by Streptococcus suis-derived muramidase-released protein via inactivation of TLR4-dependent NF-kB signaling

Muramidase-released protein(MRP)is now being recognized as a critical indicator of the virulence and pathogenicity of Streptococcus suis(S.suis).However,the identification of viable therapeutics for S.suis infection was hindered by the absence of an explicit mechanism for MRP-actuated inflammation.Dihydroartemisinin(DhA)is an artemisinin derivative with potential anti-inflammatory activity.The modulatory effect of DhA on the inflammatory response mediated by the virulence factor MRP remains obscure.This research aimed to identify the signaling mechanism by which MRP triggers the innate immune response in mouse spleen and cultured macrophages.With the candidate mechanism in mind,we investigated DhA for its ability to dampen the pro-inflammatory response induced by MRP.The innate immune response in mice was drastically triggered by MRP,manifesting as splenic and systemic inflammation with splenomegaly,immune cell infiltration,and an elevation in pro-inflammatory cytokines.A crucial role for Toll-like receptor 4(TLR4)in coordinating the MRP-mediated inflammatory response via nuclear factor-kappa B(NF-kB)activation was revealed by TLR4 blockade.In addition,NFkB-dependent transducer and activator of transcription 3(STAT3)and mitogen-activated protein kinases(MAPKs)activation was required for the inflammatory signal transduction engendered by MRP.Intriguingly,we observed an alleviation effect of DhA on the MRP-induced immune response,which referred to the suppression of TLR4-mediated actuation of NF-kB-STAT3/MAPK cascades.The inflammatory response elicited by MRP is relevant to TLR4-dependent NF-kB activation,followed by an increase in the activity of STAT3 or MAPKs.DhA mitigates the inflammation process induced by MRP via blocking the TLR4 cascade,highlighting the therapeutic potential of DhA in targeting S.suis infection diseases.

The prevalence,associated factors,and impact of urinary incontinence in pregnant and postpartum women in Nanjing,China:A cross-sectional study

Objective:Urinary incontinence(UI)is highly prevalent in antenatal and postnatal women while the prevalence of UI varied largely from 3.84%to 38.65%.This study was to assess the prevalence of UI,the associated factors,and the impact of UI on daily life in pregnant and postpartum women in Nanjing,China.Methods:The prevalence of UI and the impact of UI on life were assessed by the validated Chinese version of International Consultation on Incontinence Questionnaire-urinary incontinence-short form and the validated Chinese version of urinary incontinence quality of life.The associated factors were estimated by using logistic regression analysis.Results:UI affected 37.80%of pregnant women and 16.41%of postpartum women of the study population.Among the pregnant participants,the prevalence rates of stress UI,urge UI,and mixed UI were 25.77%,4.47%,and 7.10%,respectively.Among the postpartum women,the prevalence rates of stress UI,urge UI,and mixed UI were 11.15%,1.92%,and 2.69%,respectively.In both pregnant women and postpartum women,vaginal delivery had significantly increased the odds of reporting UI(p=0.007,p=0.003,respectively).The impact of UI on daily life was significantly greater in postpartum women compared to pregnant women especially in social embarrassment(p=0.000).Conclusion:The prevalence rates of UI were high in pregnant women in Nanjing,China.Vaginal delivery significantly increased odds of reporting UI.UI has a great impact on pregnant and postpartum women’s life,especially in social embarrassment.

A Study on the“Social Behavior”of Zen Poetry Culture:A Case Study of the Sui and Tang Dynasties

During the Sui and Tang dynasties,Buddhism and Zen poetry underwent great development.Zen poetry is diverse in form,strong in personality,and high in achievement.Among the types of Zen poetry are poems,lyrics,and prose,some of which have social attributes closely related to the development of Chinese Buddhism.An analysis reveals that the viewpoints and information conveyed in these poems,lyrics,and prose are positively correlated with the attitudes of the emperors towards Buddhism.When the attitude of the emperor towards Buddhism reached its peak of positivity during the Tang dynasty,there was a change towards a negative correlation with the viewpoints expressed in poetry.

Effect of Comprehensive Nursing Intervention in Patients with Urinary Incontinence After Radical Prostatectomy

Objective:To explore and analyze the clinical effect of comprehensive nursing intervention in patients with urinary incontinence after radical prostatectomy.Methods:84 patients with urinary incontinence after radical prostatectomy admitted to the Urology Department between May 2021 and May 2023 were included in this study.The patients were divided into a comprehensive group and a control group,with 42 cases in each group through a double-blind mechanism.The comprehensive group received comprehensive nursing care,and the control group received primary nursing care.The duration of indwelling urinary catheters and urinary incontinence;psychological performance and living conditions were compared between the two groups.Results:The duration of the indwelling urinary catheter and urinary incontinence of the patients in the comprehensive group were significantly shorter than that in the control group(P<0.05).Before nursing,there was no statistically significant difference in the anxiety,depression,and other psychological manifestations between the two groups(P>0.05);after nursing,the comprehensive group’s anxiety,depression,and other psychological manifestations of the comprehensive group were significantly lower than those of the control group(P<0.05).Before nursing,there was no statistically significant difference in the physical function,mental state,emotional state,and physical recovery of the patients between both groups(P>0.05);after nursing,the physical function,mental state,emotional state,physical recovery of the patients in the comprehensive group were significantly better than those of the control group.Besides,the living conditions of the patients in the comprehensive group were also significantly better than the control group’s(P<0.05).Conclusion:Comprehensive nursing intervention can effectively improve symptoms of urinary incontinence after radical prostatectomy,reduce inner pressure,and improve living standards.

经会阴盆底超声Trace描记法测量尿道漏斗深度用于评估女性压力性尿失禁

目的 观察经会阴盆底超声Trace描记法测量尿道漏斗深度评估女性压力性尿失禁(SI)的价值。方法 回顾性分析接受经会阴盆底超声检查的160例女性SI患者(SI组)及100例子宫良性病变患者(非SI组),均于最大瓦尔萨尔瓦动作下以Trace描记法测量尿道漏斗深度,根据尿道漏斗深度与尿道长度比值区分大、小尿道漏斗;比较组间一般资料及超声参数。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),观察以尿道漏斗深度及大、小尿道漏斗评估SI的效能。结果 组间顺产次数、最大瓦尔萨尔瓦动作下膀胱后角、尿道漏斗类型及尿道漏斗深度差异均有统计学意义(P均<0.05);年龄、体质量指数、首次妊娠新生儿体质量、静息态尿道长度、尿道旋转角及最大瓦尔萨尔瓦动作下膀胱颈移动度差异均无统计学意义(P均>0.05)。以6.35 mm为尿道漏斗深度的最佳截断值,采用Trace描记法评估SI的敏感度、特异度及AUC分别为66.00%、83.00%及0.862。以Trace描记法根据小尿道漏斗评估SI的敏感度、特异度及AUC分别为84.60%、42.50%及0.660,根据大尿道漏斗分别为70.50%、86.30%及0.884。结论 经会阴盆底超声Trace描记法可定量分析尿道漏斗、有效评估女性SI;根据大尿道漏斗评估SI的效能优于小尿道漏斗。

2型猪链球菌天津分离株的鉴定及其遗传特征分析

为了解天津市某猪场引起育肥猪神经症状的病原及其特性和遗传特征,本研究采集8份患病猪脑组织样品经细菌分离、形态学观察、gdh基因和cps2J基因的PCR扩增及序列分析,确定8份样品中的分离株均为同一2型猪链球菌(SS2),命名为TJS75。测定其生长曲线、并按照文献方法进行溶血性试验、黏附/侵入试验和对小鼠的致病性试验,分析该SS2分离株特性。结果显示,TJS75菌株经TSB培养6 h~15 h可达对数生长期,对绵羊血红细胞(RBC)具有崩解效果,可黏附并侵入PK-15细胞(黏附率和侵袭率分别为5.16%和7.90%),且感染TJS75株的BALB/c小鼠出现不同程度的行动迟缓、呼吸急促、精神萎靡和神经症状等,经测定其LD50为2.15×107cfu/mL。进一步采用高通量测序,并预测其毒力基因,分析该菌株的遗传特征,结果显示,TJS75菌株基因组全长2368195 bp,GC含量40.88%,含有2299个编码基因,其中有1822、1830和1077个基因分别注释于GO、COG和KEGG数据库,携带的16S r RNA基因序列与国内分离的SS强毒株98HAH33和05ZYH33的亲缘性较近,毒力基因的预测结果显示该菌株携带499种毒力相关基因(编码173种毒力相关因子),依据功能分类,这些毒力基因参与SS2的黏附和侵袭、溶血、促进铁转运、自溶酶的合成、降解胶原酶、唾液酸的合成等。本研究首次分离到携带MRP毒力因子的ST25型SS2,为深入开展SS2 TJS75株的致病机制研究提供了科学依据。

术前盆底肌电生理参数对前列腺癌根治性切除术后早期尿失禁的预测价值

目的:探索术前盆底肌电生理参数对前列腺癌术后尿失禁风险的预测价值。方法:选择2020年1月至2022年10月在北京大学第一医院泌尿外科行根治性前列腺切除术患者的病例资料进行回顾性分析,记录患者的年龄、体重指数(body mass index,BMI)、国际前列腺症状评分(international prostate symptom score,IPSS)、前列腺特异性抗原(prostate-specific antigen,PSA)水平、Gleason评分、手术方式、是否尿道功能重建、是否淋巴结清扫、性神经是否保留、留置导尿时间、D’Amico风险分级、美国麻醉医师协会(American Society of Anesthesiologists,ASA)评分、查尔森(Charlson)合并症指数、术后随访时间、前列腺体积,以及盆底肌电生理参数(前静息均值、快肌均值和慢肌均值)。通过多因素Logistic回归分析,筛选出影响术后早期尿失禁发生的独立危险因素,并通过计算受试者工作特征曲线(receiver operating characteristic,ROC)下面积,评估盆底肌电参数的预测效能,再利用约登指数(Youden index)并结合临床意义,共同确定术后早期尿失禁发生的最佳临界值。结果:纳入患者271例,术后自主控尿率为81.9%。患者快肌评分为23.5(18.2,31.6)分,慢肌评分为12.5(9.6,17.3)分,179例(66.1%)患者未保留性神经,110例(40.6%)患者进行了尿道功能重建。高龄和盆底快肌评分低被确认为尿失禁发生的独立危险因素。≤60岁患者是≥70岁患者自主控尿率的5.482倍(95%CI:1.532~19.617,P<0.05);患者的盆底快肌评分与尿失禁恢复的关系密切(OR=1.209,95%CI:1.132~1.291,P<0.05)。当术前盆底快肌评分的最佳临界值设定为18.5分时,ROC的敏感度和特异度分别为80.6%和61.2%。结论:术前盆底肌电生理参数对于前列腺癌术后尿失禁风险表现出较好的预测准确性和临床应用性,能够用于前列腺癌术后尿失禁风险的早期识别,其中年龄和盆底快肌评分是重要的预测因子。