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.

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.

上调基因-11(URG11)生物信息学与功能分析

应用基因芯片技术获取以稳定转染HBx基因的肝癌细胞Hep G(Hep G22-X)Y,以及非转染的肝癌细胞Hep G 2的差异表达基因,利用生物信息学方法对其进行初步分析表明,该蛋白基因编码673个氨基酸,预测分子量为17.06 k D,理论等电点为4.83,定位于细胞核,具有转录调控、生长因子、信号传导的功能,同源性分析结果表明,其碱基序列与已经报道的其他12个物种的相似率为76%-97%,且符合种属之间的进化关系。

URG11在肝癌组织表达增强并促进肝癌细胞生长

目的探讨上调基因11(URG11)在肝细胞癌组织中的表达及对人肝癌细胞生长、增殖的影响。方法免疫组织化学检测肝细胞癌组织、对应癌旁组织及正常肝组织中URG11的表达水平;反转录PCR和Western blot法检测肝癌细胞系及对照细胞中URG11的表达,分别将URG11基因真核表达载体及URG11 siRNA载体转染人正常肝细胞QZG细胞及肝癌HHCC细胞,MTT法检测转染细胞的增殖情况,流式细胞术检测转染细胞周期变化。结果肝癌组织、癌旁组织及正常肝组织中URG11表达阳性率分别为62.35%、69.41%和18.5%;与正常肝组织相比,肝癌和癌旁组织中URG11水平显著升高。在HHCC肝癌细胞中URG11水平最高,QZG细胞中URG11为阴性。上调QZG细胞中URG11表达水平后,细胞生长加快;下调HHCC细胞中URG11表达后,细胞生长显著减慢。结论 URG11可促进肝癌细胞的生长与增殖,在肝癌的发生中起着重要作用。

URG4在肝癌组织中的表达及其与HBx的关系

目的:检测URG4在肝癌组织中的表达及意义。探讨URG4与HBx在肝癌组织表达之间的关系。方法:免疫组化方法检测URG4和HBx在正常组织、肝癌组织及癌旁组织中的表达分布,并分析其表达的意义及表达之间的相关性。结果:URG4在肝癌组织及肝癌细胞系中的阳性表达率分别为48%和54%,而在正常组织中仅22.2%弱表达,其与HBx表达的相关系数分别为0.38和0.45(P<0.05)。结论:URG4在肝癌组织及癌旁组织中的表达高于正常组织,且与HBx密切相关。

URG4基因促进肝癌细胞迁移和侵袭

目的探讨上调基因4(URG4)对人肝癌细胞系Hep3B细胞迁移、侵袭的作用。方法通过定量PCR检测转染干扰RNA(siRNA)后Hep3B细胞内URG4 mRNA变化,通过Western blotting检测转染siRNA后Hep3B细胞内URG4蛋白变化。分别对转染后的细胞采取划痕实验、Transwell实验检测URG4基因对Hep3B细胞迁移以及侵袭能力的影响。最后通过Western blotting方法检测URG4敲降对Hep3B细胞内TGF-β和E-cadherin表达的影响。结果siURG4不仅可显著降低Hep3B细胞内URG4 mRNA水平(P<0.05),同时还可以显著降低Hep3B细胞内URG4蛋白水平(P<0.05)。URG4敲降引起Hep3B细胞迁移和侵袭能力明显减弱(P<0.05)。除此之外,URG4敲降引起Hep3B细胞内TGF-β蛋白水平降低和E-cadherin蛋白水平上升。结论URG4通过调控TGF-β和E-cadherin基因的表达,从而降低Hep3B细胞的迁移、侵袭能力。这为继续展开对于肝癌的发生、发展过程的研究提供了新的思路。

URG4/URGCP与恶性肿瘤的研究进展

上调基因-4(upregulated gene-4/upregulator of cell proliferation,URG4/URGCP)是一种新发现的癌基因,定位于人类7号染色体上,全长3607 bp,相对分子质量为1.04×105。URG4/URGCP与信号通路密切相关,并参与肿瘤增殖、分化及预后等生物学过程,为新型抗癌药物的研发提供新思路。该文针对URG4/URGCP在恶性肿瘤中的研究进展做简要综述。

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.

Clinical characteristics of pediatric patients with treatment-refractory Tourette syndrome:An evidence-based survey in a Chinese population

BACKGROUND Tourette syndrome(TS)is a complex neurodevelopmental condition marked by tics,as well as a variety of psychiatric comorbidities,such as obsessivecompulsive disorders(OCDs),attention deficit hyperactivity disorder(ADHD),anxiety,and self-injurious behavior.TS might progress to treatment-refractory Tourette syndrome(TRTS)in some patients.However,there is no confirmed evidence in pediatric patients with TRTS.AIM To investigate the clinical characteristics of TRTS in a Chinese pediatric sample.METHODS A total of 126 pediatric patients aged 6-12 years with TS were identified,including 64 TRTS and 62 non-TRTS patients.The Yale Global Tic Severity Scale(YGTSS),Premonitory Urge for Tics Scale(PUTS),and Child Behavior Checklist(CBCL)were used to assess these two groups and compared the difference between the TRTS and non-TRTS patients.RESULTS When compared with the non-TRTS group,we found that the age of onset for TRTS was younger(P<0.001),and the duration of illness was longer(P<0.001).TRTS was more often caused by psychosocial(P<0.001)than physiological factors,and coprolalia and inappropriate parenting style were more often present in the TRTS group(P<0.001).The TRTS group showed a higher level of premonitory urge(P<0.001),a lower intelligence quotient(IQ)(P<0.001),and a higher percentage of family history of TS.The TRTS patients demonstrated more problems(P<0.01)in the“Uncommunicative”,“Obsessive-Compulsive”,“Social-Withdrawal”,“Hyperactive”,“Aggressive”,and“Delinquent”subscales in the boys group,and“Social-Withdrawal”(P=0.02)subscale in the girls group.CONCLUSION Pediatric TRTS might show an earlier age of onset age,longer duration of illness,lower IQ,higher premonitory urge,and higher comorbidities with ADHD-related symptoms and OCD-related symptoms.We need to pay more attention to the social communication deficits of TRTS.

Treating Urinary Incontinence with Electrical Stimulus: A Review

Urinary incontinence markedly affects women’s quality of life. There are several methods to mitigate or reduce this problem such as medication, surgery, or exercises. Of various types of urinary incontinence, overactive bladder consists of one category, which is often resistant to various treatments. Electrical stimulation methods have been considered a treatment option of overactive bladder. We here briefly summarize various treatment options for urinary incontinence, with special reference to the role of electrical stimulation methods for this disease. Electrical stimulation methods include vaginal electrical stimulation (VES), posterior tibial nerve stimulation (PTNS) and sacral nerve stimulation (SNS). The three methods have shown good results, and these findings will contribute to achieving a better quality of life for patients.

URG11基因介导Wnt/β-catenin信号通路调控EMT参与非小细胞肺癌转移的分子机制研究

目的探讨URG11基因介导的Wnt/β-Catenin信号通路调控EMT参与非小细胞肺癌转移的分子机制。方法非小细胞肺癌细胞系A549经shRNA质粒转染48h,敲除URG11后收集细胞行后续实验。实验共分两组,分别为敲除URG11的A549细胞组(实验组)和未敲除URG11的A549细胞组(空白对照组)。采用Western blott测定β-Catenin及其下游基因cyclinD1、c-myc的蛋白表达,同时用RT-qPCR检测β-Catenin、cyclinD1和c-myc的mRNA表达。并用裸鼠成瘤模型评估URG11基因对NSCLC侵袭性生长的影响。结果①敲除URG11显著抑制Wnt/β-Catenin信号通路在NSCLC细胞中激活。Western blot蛋白质印迹分析显示β-Catenin、cyclin D1和c-myc的蛋白水平在敲除实验组中的表达显著低于对照组(DPI值分别为0.22±0.06 VS 0.77±0.21,0.61±0.09 VS 1.52±0.23,0.42±0.07 VS 0.84±0.14,P<0.05)。RT-qPCR结果显示β-Catenin、cyclinD1和c-myc的mRNA在对照组中的表达显著高于实验组(分别为3.52倍,2.58倍和2.19倍,P<0.05)。②敲除URG11显著减少异种移植肿瘤体在裸鼠体内侵袭性生长。通过裸鼠异种移植肿瘤模型动态观察了URG11对肿瘤的体内生长作用。与对照组相比,敲除URG11能显著抑制Balb/C裸鼠体内新生肿瘤的重量,第35天实验组VS对照组(0.21±0.04)g VS(0.58±0.08)g,P<0.05,平均抑瘤率为63.79%;同时敲除URG11能显著减少异种移植肿瘤的体积:第21、28、35天的新生瘤体体积,实验组VS对照组(258.33±0.24)mm^(3)VS(512.86±0.18)mm^(3),(414.59±0.17)mm^(3)VS(685.78±0.23)mm^(3),(423.21±0.36)mm^(3)VS(986.73±0.14)mm^(3),P<0.05。结论URG11导致的EMT与NSCLC的发生和进展密切相关。

Understanding the Experiences of Heavy Smokers after Exercise

There is now strong evidence that exercise has an acute effect on the urge to smoke and the accompanying withdrawal symptoms. However, the perceptions by heavy smokers of exercise and its relationship to the urge to smoke have not been well documented. The aim of the present study is to understand the experiences of heavy smokers with regard to exercise and its effect on their urge to smoke. Five physically inactive, heavy smokers are asked to abstain from smoking the night before exercising on a cycle ergometer under two conditions (one at medium and one at vigorous intensity done a week apart). Semi-structured, in-depth interviews are conducted after the second exercise session. Thematic analysis reveals six themes describing the participants’ experience of exercise, urge to smoke, exercise preferences, exercise and smoking relationship, exercise as an aid to quit smoking, and the effects of the experimental procedure. Overall, the participants’ experiences support the existing literature, which has posited affective, biological, and cognitive mechanisms contributing to a delay in the urge to smoke after exercise. The main findings pertain to: (1) the “feel-good” effect after exercise as a relief from the “feel-bad” effect during exercise;(2) the decreased urge to smoke after exercise, stated by all participants regardless of reported positive and negative feelings;and (3) exercise as a “clearing the mind” mechanism rather than an attention-distracting mechanism.

URG4在乳腺癌中的表达及其临床意义

探讨上调基因4(URG4)在乳腺癌中表达及其临床应用价值。采用实时定量PCR和Western blot方法检测乳腺癌细胞和组织中URG4mRNA和蛋白表达;通过免疫组织化学染色检测95对乳腺癌组织及癌旁组织中URG4蛋白表达。与人正常乳腺细胞相比,乳腺癌细胞中URG4mRNA和蛋白表达水平均显著升高(P<0.05);与癌旁组织相比,乳腺癌组织中URG4mRNA和蛋白表达显著上调(P<0.05)。免疫组化染色显示URG4表达与乳腺癌患者肿瘤直径(P=0.037)、肿瘤侵袭(P=0.007)、临床分期(P=0.016)、及淋巴转移(P=0.005)密切相关。Kaplan-Meier生存分析表明URG4高表达乳腺癌患者总生存期显著低于URG4低表达患者(P=0.008)。多重变量Cox回归分析结果显示,URG4是提示乳腺癌患者预后的独立标志物(HR:3.457,95%CI:1.647-6.557,P=0.008)。URG4在乳腺癌发生和发展中发挥重要作用,其过表达提示乳腺癌患者预后不良。

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.

Types of Urinary Incontinence Prevalent among Kuwaiti Women with Type Two Diabetes Mellitus

The aim of this study was to determine the types of urinary incontinence prevalent among Kuwaiti women with Type two Diabetes Mellitus attending the outpatient clinic at the Urology center and suggest appropriate nursing interventions. Urinary incontinence is not a life threatening condition but it can be emotionally devastating and therefore affects the sufferer’s quality of life. This cross-sectional descriptive survey consisted of 250 Kuwaiti women with type two diabetes mellitus receiving treatment at the outpatient department at Sabah Al-Ahmad Urology Center, Kuwait. The questionnaire comprised of a total of 33 questions, twelve of which explored participants’ socio demographic characteristics, risk factors and symptoms of their urinary incontinence. The remaining 21 items were adapted from King’s Health Questionnaire (KHQ) formulated in 1997 at King’s college, London, for the assessment of quality of life in women with urinary incontinence. Data collection was from February to May 2014. The result revealed that mixed urinary incontinence was the most prevalent type of urinary incontinence affecting Kuwaiti women with type two diabetes mellitus. Symptoms of both stress incontinence and urge incontinence (Over active bladder) were not mutually exclusive as they were present in 247 (98.8%) and 240 (96%) of the participants respectively. Key risk factors for developing incontinence were over three years duration of diabetes mellitus in 115 (56%) and delivery of one or more children reported by 206 (82%) of the participants. Analysis and result of King Health Questionnaire on quality of life will be reported in separate paper on the psychosocial impact of urinary incontinence on diabetic Kuwaiti women. In conclusion, urinary incontinence had a devastating effect on the lives of sufferers and therefore should be prevented at all cost by nurses providing anticipatory guidance to all pregnant and diabetic women and routinely teaching pelvic floor exercises to all postnatal women. However, in the event that there are symptoms of urinary incontinence then thorough investigation and early treatment is advocated.

Urodynamic Findings in Young Women of Less Than Forty Years Old with Lower Urinary Tract Symptoms

Purpose: The aim of the study was to determine urodynamic findings in young women (<40 years old) with bothersome lower urinary tract symptoms. Materials and Methods: The records of 315 women were reviewed during 2002 to 2010. Those with neurological disease, history of urogenital malignancies, urethral stricture or trauma, acute UTI, unsterile urine analysis, congenital urological disease, pelvic organ prolapse, diabetes mellitus or a primary complaint of stress incontinence were excluded. All completed the American Urological Association Symptom Index (AUASI) and underwent urodynamic studies. Results: Bladder dysfunction was diagnosed in 78.4% of the patients with urge incontinence. Bladder and voiding phase dysfunction were found in 134 (42.5%) and 110 (34.9%) of patients, respectively. Occult neurological disease was later diagnosed in 10 women (3.17%) with urge incontinence and bladder dysfunction. Discussion: Urge incontinence and voiding symptoms are frequently associated with urodynamical abnormalities. Urge incontinence and bladder dysfunction may be a sign of occult neurological disease in this population. The presenting symptoms are useful in determining the advantage of urodynamic study in this population.

The Psycho-Social Impact of Urinary Incontinence on the Quality of Life among Kuwaiti Women with Type 2 Diabetes Mellitus

This study was conducted to determine the psycho-social impact of urinary incontinence (UI) on the quality of life of 250 Kuwaiti women with type 2 diabetic mellitus (DM). A survey method, using a 33-item 5-point Likert scale Arabic questionnaire adapted from the King’s Health Questionnaire (KHQ), was employed for data collection from February to May, 2014 while all the participants were receiving treatment for UI at a specialized urology center in Kuwait. Participants with UI and a co-morbidity of type 2 DM and obesity were 20 to 65 years old. Results showed the following variables were statistically significant for frequency of urine leak: Age was (χ2 = 36.877, df = 3, P ≤ 0.000). Parity showed nulliparous women reported less urine leak compared to parous women: Chi-square was (χ2 = 24.83, df = 12, P ≤ 0.016). Type 2 DM for more than 3 years duration had the highest incidence of several leaks per day. BMI of above 25 kg/m2 caused daily urine leak: Chi-square (χ2 = 17.912, df = 9, P ≤ 0.036). Participants’ self reports of good general health were those who leaked urine either 2 - 3 times weekly or occasionally. Finally, the impact of incontinence on their lifestyle was reported as extreme by 128 (51.2%), and 6 (2.4%) reported little or no impact on their quality of life: Chi-square was (χ2 = 52.392, df = 18, P ≤ 0.000). In conclusion, this study showed a clear correlation between UI and reduced quality of life. Midwives are well positioned to correct the myth that UI is an inevitable byproduct of childbearing. Midwives should explain to all pregnant women how childbirth can be a risk factor and provide anticipatory guidance by teaching preventive measures like pelvic floor exercises before and after delivery. Family members should assist sufferers in coping with their challenges by dispelling any form of stigmatization, joining them in practicing pelvic floor exercises, and encouraging, empathizing and supporting them emotionally.

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