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.

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.

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.

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.

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.

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.

Magnetic resonance imaging in assessment of stress urinary incontinence in women: Parameters differentiating urethral hypermobility and intrinsic sphincter deficiency

AIM: To define the magnetic resonance imaging(MRI) parameters differentiating urethral hypermobility(UH) and intrinsic sphincter deficiency(ISD) in women with stress urinary incontinence(SUI).METHODS: The static and dynamic MR images of 21 patients with SUI were correlated to urodynamic(UD) findings and compared to those of 10 continent controls. For the assessment of the urethra and integrity of the urethral support structures, we applied the highresolution endocavitary MRI, such as intraurethral MRI, endovaginal or endorectal MRI. For the functional imaging of the urethral support, we performed dynamic MRI with the pelvic phased array coil. We assessed the following MRI parameters in both the patient and thevolunteer groups:(1) urethral angle;(2) bladder neck descent;(3) status of the periurethral ligaments,(4) vaginal shape;(5) urethral sphincter integrity, length and muscle thickness at mid urethra;(6) bladder neck funneling;(7) status of the puborectalis muscle;(8) pubo-vaginal distance. UDs parameters were assessed in the patient study group as follows:(1) urethral mobility angle on Q-tip test;(2) Valsalva leak point pressure(VLPP) measured at 250 cc bladder volume; and(3) maximum urethral closure pressure(MUCP). The UH type of SUI was defined with the Q-tip test angle over 30 degrees, and VLPP pressure over 60 cm H2 O. The ISD incontinence was defined with MUCP pressure below 20 cm H2 O, and VLPP pressure less or equal to 60 cm H2 O. We considered the associations between the MRI and clinical data and UDs using a variety of statistical tools to include linear regression, multivariate logistic regression and receiver operating characteristic(ROC) analysis. All statistical analyses were performed using STATA version 9.0(Stata Corp LP, College Station, TX).RESULTS: In the incontinent group, 52% have history of vaginal delivery trauma as compared to none in control group(P < 0.001). There was no difference between the continent volunteers and incontinent patients in body habitus as assessed by the body mass index. Pubovaginal distance and periurethral ligament disruption are significantly associated with incontinence; periurethral ligament symmetricity reduces the odds of incontinence by 87%. Bladder neck funneling and length of the suprapubic urethral sphincter are significantly associated with the type of incontinence on UDs; funneling reduced the odds of pure UH by almost 95%; increasing suprapubic urethral sphincter length at rest is highly associated with UH. Both MRI variables result in a predictive model for UDs diagnosis(area under the ROC = 0.944). CONCLUSION: MRI may play an important role in assessing the contribution of hypermobility and sphincteric dysfunction to the SUI in women when considering treatment options.

Prevalence and Risk Factors of Stress Urinary Incontinence Among Perimenopausal Women and Its Influence on Daily Life in Women with Sexual Desire Problem

The prevalence of,and related factors to,stress urinary incontinence (SUI) among perimenopausal Chinese women and its impact on daily life among those women with sexual desire problem in Hubei province were investigated.In this study,1519 perimenopausal women aged 40 to 65 years were selected from three urban communities in the Wuhan area,and two impoverished,mountainous communities in Hubei province,and followed from April to October 2014.Detailed information about demographic characteristics,menstruation,pregnancy,sexual life and chronic diseases was collected.A cross-sectional survey was carried out following information collection by Chi-square test and multiple logistic regression analysis.Univariate and multivariate logistic regression analysis demonstrated that the potential factors associated with developing SUI were old age (OR=3.4,95% CI:1.92-6.04),vaginal delivery (OR=0.623,95% CI:0.45-0.87),low income (OR=0.063,95% CI:0.40-0.92),atrophic vaginitis (OR=1.4,95% CI:1.03-1.80),pelvic organ prolapse (OR=2.81,95% CI:1.36-5.80),chronic pelvic pain (OR=2.17,95% CI:1.90-4.03),constipation (OR=1.44,95% CI:1.07-1.93) and incontinence of feces (OR=3.32,95% CI:2.03-5.43).Moreover,the ratio of SUI (33.2%) was higher than the ratio of urgency urinary incontinence (24.1 %) or the ratio of mixed urinary incontinence (17.4%),and SUI had a greater impact on daily life among women with decreased sexual desire.In conclusion,SUI is a common disorder affecting over one third of the women surveyed,and has a severe impact on the daily life of perimenopausal women with declined sexual desire.Age,mode of delivery,and monthly income are major risk factors involved in the development of SUI.

Contemporary diagnostics and treatment options for female stress urinary incontinence

Stress urinary incontinence is not a deadly disease,but for the large population of women suffering from it,it is a very important issue.Especially in the continuously aging population all over the world,there is more and more need for treatment of this serious medical condition.Treatment of female stress urinary incontinence exists already for ages.In the 20th century invasive treatments like Burch colposuspension and pubovaginal slings were the mainstay of surgical treatments.The introduction of the midurethral sling made the procedure less invasive and accessible for more caregivers.Luckily there are many options available and the field is developing quickly.In recent years many new medical devices have been developed,that increase the number of treatment options available and make it possible to find a suitable solution for the individual patient based on subjective and objective results and the chances of complications.This manuscript provides an introduction to the therapeutical options that are available nowadays for female stress urinary incontinence.

Regenerative medicine based applications to combat stress urinary incontinence

Stress urinary incontinence(SUI), as an isolated symptom, is not a life threatening condition. However, the fear of unexpected urine leakage contributes to a significant decline in quality of life parameters for afflicted patients. Compared to other forms of incontinence, SUI cannot be easily treated with pharmacotherapy since it is inherently an anatomic problem. Treatment options include the use of bio-injectable materials to enhance closing pressures, and the placement of slings to bolster fascial support to the urethra. However, histologic findings of degeneration in the incontinent urethral sphincter invite the use of tissues engineering strategies to regenerate structures that aid in promoting continence. In this review, we will assess the role of stem cells in restoring multiple anatomic and physiological aspects of the sphincter. In particular, mesenchymal stem cells and CD34+cells have shown great promise to differentiate into muscular and vascular components,respectively. Evidence supporting the use of cytokines and growth factors such as hypoxia-inducible factor1-alpha, vascular endothelial growth factor, basic fi-broblast growth factor, hepatocyte growth factor and insulin-like growth factor further enhance the viability and direction of differentiation. Bridging the benefits of stem cells and growth factors involves the use of synthetic scaffolds like poly(1,8-octanediol-co-citrate)(POC) thin films. POC scaffolds are synthetic, elastomeric polymers that serve as substrates for cell growth,and upon degradation, release growth factors to the microenvironment in a controlled, predictable fashion.The combination of cellular, cytokine and scaffold elements aims to address the pathologic deficits to urinary incontinence, with a goal to improve patient symptoms and overall quality of life.

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.

Effect of Conjugated Estrogen in Stress Urinary Incontinence in Women with Menopause

Menopause is one of the natural stages of life of women that is associated with instability of vasomotor, flushing, sweating, anxiety and depression, urogenital atrophy and urinary problems. The age range of physiological event is between 48 - 55 years old. With regard to the role of genetics, nutrition and geographical conditions of the age of menopause in Iranian women is lower than and among 46 - 53 years. With the increase in life expectancy in recent decades, duration of menopause is increased and almost involved a third of the life of women so special issues of this era have had more attention. Since menopause is not the end of the life of a woman and keep her physical and mental health and problems resulting from the process of menopause such as urinary problems and incontinence will lead to improve the quality of life in this period. Many studies have tried to find a therapy for postmenopausal women with stress urinary incontinence using hormone. So this article seeks to examine the effect of conjugated estrogen in stress urinary incontinence of menopausal women with using the library method. The survey showed that by starting menopause, decreasing estrogen causes atrophy of mucosa of urogenital and the lining of the urethra and bladder, estrogen causes to maintain muscle tonicity. Also sacral nerves are also rich in estrogen receptors and by estrogen deficiency, elasticity of the urinary system decreases. Estrogen deficiency causes excitability of nerves and frequency of urine. So estrogen can increase the resistance of the urethra, bladder sensory threshold and sensitivity in Adorno in smooth muscles of the urethra and the rest of detrusor.

Analysis of coping styles of elderly women patients with stress urinary incontinence

Objective:The aim of this study was to survey the coping style and related factors of elderly women with stress urinary incontinence(SUI)and provide a strong theoretical basis for promoting a positive coping style to improve quality of life in these patients.Methods:Cross-sectional surveys addressing SUI cognition and coping techniques of 520 elderly women patients with SUI were administered between July 2013 and February 2014.Results:Elderly women with SUI had significantly higher avoidance and acceptanceresignation scores than the normal population(p<0.05).Age,marital status,education level and stress urinary incontinence cognitive level all influenced the medical coping style of these patients.Conclusions:Elderly female patients with SUI differ in the factors that influence their coping styles;therefore,clinical and community medical staff should include a comprehensive analysis that takes these factors into consideration when working with patients with SUI to guide them in adopting a positive coping style.

Grain Yield,Biomass Accumulation,and Leaf Photosynthetic Characteristics of Rice under Combined Salinity-Drought Stress

Simultaneous stresses of salinity and drought often coincide during rice-growing seasons in saline lands,primarily due to insufficient water resources and inadequate irrigation facilities.Consequently,combined salinity-drought stress poses a major threat to rice production.In this study,two salinity levels(NS,non-salinity;HS,high salinity)along with three drought treatments(CC,control condition;DJ,drought stress imposed at jointing;DH,drought stress imposed at heading)were performed to investigate their combined influences on leaf photosynthetic characteristics,biomass accumulation,and rice yield formation.Salinity,drought,and their combination led to a shortened growth period from heading to maturity,resulting in a reduced overall growth duration.Grain yield was reduced under both salinity and drought stress,with a more substantial reduction under the combined salinity-drought stress.The combined stress imposed at heading caused greater yield losses in rice compared with the stress imposed at jointing.Additionally,the combined salinity-drought stress induced greater decreases in shoot biomass accumulation from heading to maturity,as well as in shoot biomass and nonstructural carbohydrate(NSC)content in the stem at heading and maturity.However,it increased the harvest index and NSC remobilization reserve.Salinity and drought reduced the leaf area index and SPAD value of flag leaves and weakened the leaf photosynthetic characteristics as indicated by lower photosynthetic rates,transpiration rates,and stomatal conductance.These reductions were more pronounced under the combined stress.Salinity,drought,and especially their combination,decreased the activities of ascorbate peroxidase,catalase,and superoxide dismutase,while increasing the contents of malondialdehyde,hydrogen peroxide,and superoxide radical.Our results indicated a more significant yield loss in rice when subjected to combined salinity-drought stress.The individual and combined stresses of salinity and drought diminished antioxidant enzyme activities,inhibited leaf photosynthetic functions,accelerated leaf senescence,and subsequently lowered assimilate accumulation and grain yield.

Ferroptosis and endoplasmic reticulum stress in ischemic stroke

Ferroptosis is a form of non-apoptotic programmed cell death,and its mechanisms mainly involve the accumulation of lipid peroxides,imbalance in the amino acid antioxidant system,and disordered iron metabolism.The primary organelle responsible for coordinating external challenges and internal cell demands is the endoplasmic reticulum,and the progression of inflammatory diseases can trigger endoplasmic reticulum stress.Evidence has suggested that ferroptosis may share pathways or interact with endoplasmic reticulum stress in many diseases and plays a role in cell survival.Ferroptosis and endoplasmic reticulum stress may occur after ischemic stroke.However,there are few reports on the interactions of ferroptosis and endoplasmic reticulum stress with ischemic stroke.This review summarized the recent research on the relationships between ferroptosis and endoplasmic reticulum stress and ischemic stroke,aiming to provide a reference for developing treatments for ischemic stroke.

Treatment success of transobturator tape compared with tension free vaginal tape for stress urinary incontinence at 24 months: A randomized controlled trial

Objective: To compare the long term efficacy of transobturator Tape (TOT) with tension free vaginal tape (TVT) at 24 months postoperatively. Patients & Methods: 160 women with stress urinary incontinence (SUI) were randomly allocated to either TVT or TOT procedures and reviewed at 24 months after surgery. The primary outcomes were objective cure (a negative cough stress test, and a negative 1-hour pad test), and subjective cure (defined as “very much better” or “much better” improvement in the Patient Global Impression of Improvement scale). The secondary outcomes included incontinence related quality of life (using Urogenital Distress Inventory Questionnaire, and Incontinence Impact Questionnaire), and complications. Results: No statistical difference was reported in objective and subjective cure rates between both groups. Objective cure rate was 85.6% and 81.6% in the TOT and TVT groups respectively (P = 0.55). Subjective cure rate in the TOT and TVT groups were 87% and 83% respectively (P = 0.68). There were no significant differences in postoperative complications and incontinence related quality of life. However, the operating time was significantly shorter in the TOT group compared with the TVT group (22.6 ± 3.9, 27.1 ± 3;respectively, P < 0.001). Conclusion: TOT and TVT procedures were equally efficient and safe for treatment of SUI, with maintenance of high objective and subjective cure rates for 24 months. Longer follow-up is needed to confirm these results.

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.

Stress urinary incontinence in women and cell therapy: What can we expect from the future?

Stress urinary incontinence(SUI)is a common disorder that affects a large number of women and their quality of life.The aim of SUI therapy is to restore the existing urethral function via physical therapy,biofeedback,pelvic floor rehabilitation,pharmacological therapy,bulking agents and surgical approaches.Currently,the gold standard for the management of SUI is the tensionfree vaginal sling,which provides structural support to the female urethra.However,even minimally invasive surgical procedure such as"slings"carries risks for the patients,lost efficacy over the time and has long-term complications.For this reason,new therapeutic modalities are needed.Cell therapy has been emerged as an alternative to be used on the treatment of different diseases.The use of stem cells as a therapeutic option for SUI is an attractive alternative because,theoretically,injected cells could restore functional muscle cells and aid in sphincter closure in women with sphincterassociated incontinence.This study aims to review the current literature regarding evidences for using stem cell therapy on stress urinary incontinence in women.

Synergistic effects of carbon cycle metabolism and photosynthesis in Chinese cabbage under salt stress

Chinese cabbage(Brassica rapa ssp. pekinensis) has a long cultivation history and is one of the vegetable crops with the largest cultivation area in China. However, salt stress severely damages photosynthesis and hormone metabolism, nutritional balances, and results in ion toxicity in plants. To better understand the mechanisms of salt-induced growth inhibition in Chinese cabbage, RNA-seq and physiological index determination were conducted to explore the impacts of salt stress on carbon cycle metabolism and photosynthesis in Chinese cabbage. Here, we found that the number of thylakoids and grana lamellae and the content of starch granules and chlorophyll in the leaves of Chinese cabbage under salt stress showed a time-dependent response, first increasing and then decreasing. Chinese cabbage increased the transcript levels of genes related to the photosynthetic apparatus and carbon metabolism under salt stress, probably in an attempt to alleviate damage to the photosynthetic system and enhance CO_(2) fixation and energy metabolism. The transcription of genes related to starch and sucrose synthesis and degradation were also enhanced;this might have been an attempt to maintain intracellular osmotic pressure by increasing soluble sugar concentrations. Soluble sugars could also be used as potential reactive oxygen species(ROS) scavengers, in concert with peroxidase(POD)enzymes, to eliminate ROS that accumulate during metabolic processes. Our study characterizes the synergistic response network of carbon metabolism and photosynthesis under salt stress.

A semi-analytical model for coupled flow in stress-sensitive multi-scale shale reservoirs with fractal characteristics

A large number of nanopores and complex fracture structures in shale reservoirs results in multi-scale flow of oil. With the development of shale oil reservoirs, the permeability of multi-scale media undergoes changes due to stress sensitivity, which plays a crucial role in controlling pressure propagation and oil flow. This paper proposes a multi-scale coupled flow mathematical model of matrix nanopores, induced fractures, and hydraulic fractures. In this model, the micro-scale effects of shale oil flow in fractal nanopores, fractal induced fracture network, and stress sensitivity of multi-scale media are considered. We solved the model iteratively using Pedrosa transform, semi-analytic Segmented Bessel function, Laplace transform. The results of this model exhibit good agreement with the numerical solution and field production data, confirming the high accuracy of the model. As well, the influence of stress sensitivity on permeability, pressure and production is analyzed. It is shown that the permeability and production decrease significantly when induced fractures are weakly supported. Closed induced fractures can inhibit interporosity flow in the stimulated reservoir volume (SRV). It has been shown in sensitivity analysis that hydraulic fractures are beneficial to early production, and induced fractures in SRV are beneficial to middle production. The model can characterize multi-scale flow characteristics of shale oil, providing theoretical guidance for rapid productivity evaluation.