The definition, prevalence, and risk factors for stress urinary incontinence

Stress urinary incontinence (SUI) has an observed prevalence of between 4% and 35%. Whereas the clinical definition of SUI has been established by the International Continence Society, the epidemiologic definition has not been established, leading to a broad disparity in reported prevalence rates. Numerous risk factors for SUI have been identified. Aging, obesity, and smoking appear to have consistent causal relationships with the condition, whereas the roles of pregnancy and childbirth remain controversial. The prevalence of many of these risk factors is increasing in the adult female population of the United States. These population changes, combined with increasing physician awareness and the availability of nonsurgical therapy, will likely increase the number of women receiving care for SUI over the next 3 decades.     

Burch colposuspension for stress urinary incontinence: a 14-year prospective follow-up

We aimed to evaluate the long-term effectiveness and safety of Burch colposuspension (BC) for stress urinary incontinence (SUI). In this prospective cohort study, 84 patients with SUI undergoing BC were enrolled from February 2004 to January 2010. Data on long-term subjective success and postoperative complications were collected at clinic visits and by telephone follow-up. During a mean follow-up period of 14.2 years, 68% (57/84) patients completed the follow-up. A total of 68.4% of patients (39/57) reported absence of SUI symptoms, 73.6% (42/57) were subjectively satisfied according to the Patient Global Impression of Improvement, and 68.4% (39/57) reported subjective success regarding urinary symptoms via the Urinary Distress Inventory Short Form. However, 28.1% (16/57) suffered at least one long-term postoperative complication and incident. Specifically, 1 in 25 (4.0%) sexually active patients reported dyspareunia, 3 patients (5.3%) had de novo overactive bladder, and 6 patients (10.5%) reported voiding dysfunction. Four patients (7.0%) reported new onset prolapse symptoms, and 3 patients (5.3%) underwent secondary urinary incontinence surgery. Our study indicated that Burch colposuspension is an effective procedure for SUI, and the cure effect was largely maintained for the 14-year follow-up period, with relatively low complication rates. BC should be considered a surgical option for SUI.

     

Duloxetine: a summary of published clinical experience

Effective oral therapy for genuine stress urinary incontinence (SUI) in women has, to date, been an unattainable goal. Although oral pharmacologic agents have been used for this condition, none has ultimately been successful, because of side effects, lack of efficacy, or problematic compliance with drug ingestion. The availability of an effective oral agent for SUI would increase the range of therapeutic options for symptom management and possibly make treatment accessible to more women who otherwise feel that surgical therapy is not an option because of social, personal, or medical reasons. Duloxetine is a selective serotonin (5-HT) and norepinephrine reuptake inhibitor that has been shown to increase rhabdosphincter activity. Rhabdosphincter contractility changes are thought to occur as the result of increased stimulation of alpha(1)-adrenergic and 5-HT(2) receptors in the sacral spinal cord, resulting in increased efferent pudendal nerve activity, producing increased pelvic floor tonus. Two large-scale studies have been completed employing subjective and objective outcomes to assess the therapeutic index of duloxetine as a therapy for SUI.     

Neurophysiology of stress urinary incontinence

Stress urinary incontinence (SUI) involves involuntary leakage of urine in response to abdominal pressure caused by activities such as sneezing and coughing. The condition affects millions of women worldwide, causing physical discomfort as well as social distress and even social isolation. Until recently, SUI was approached by clinicians as a purely anatomic problem requiring behavioral or surgical therapy. Over the past several years, extensive basic and clinical research in the field of neurourology has enhanced our understanding of the complex neural circuitry regulating normal function of the lower urinary tract. As a result, novel concepts have emerged regarding possible neurologic dysfunctions that might underlie the development of SUI, as well as potential novel strategies for pharmacologic therapy. This article reviews the normal neurophysiologic control of lower urinary tract function and considers potential pharmacologic approaches to correcting SUI.     

The pathophysiology of stress urinary incontinence: a historical perspective

This article provides a historical perspective on the evolution of theories regarding the pathophysiology of stress urinary incontinence (SUI). The progression of these theories has followed the development of the diagnostic technologies that have provided insight into different aspects of urethral dysfunction. The earliest theories tied SUI to anatomic failure of urethral support. Recognition that anatomic failure impacted the interplay of intra-abdominal pressure and the bladder and urethra led to theories focused on the dynamic interaction between the bladder and urethral pressures. Investigators then began to recognize the importance of urethral sphincteric dysfunction. More recently, investigators have attempted to combine the anatomic and functional etiologies into a consolidated theory. These efforts point to a multi-factorial etiology of SUI. Continuing research has provided new insight into the neurophysiology of urethral function, opening new avenues for tailoring therapy for SUI.     

Expectations of Stress Urinary Incontinence Surgery in Patients With Mixed Urinary Incontinence

Mixed urinary incontinence is estimated to affect 30% of all women who have urinary incontinence, and it has been shown to be more bothersome to women than pure stress incontinence. Given the degree of bother, many women will undergo surgical correction for incontinence. Patients have high expectations about the success of these interventions. Understanding mixed incontinence and the effects of our interventions can help guide therapeutic choices and manage patients’ expectations.Key words: Urodynamics, Mixed urinary incontinence, Sling, Anti-incontinence surgery, Urgency incontinenceIt has been estimated that approximately 30% of women with urinary incontinence have mixed urinary incontinence (MUI). Degree of bother is higher among women with MUI compared with those who have pure stress urinary incontinence (SUI).¹ MUI can be a very challenging and costly condition to treat.^2,3 Patients with MUI are often offered conservative therapy such as physical therapy, weight-loss strategies, and behavioral modification. Some patients also benefit from treatments aimed directly at urgency, frequency, and urgency incontinence (overactive bladder), which currently include pharmacologic therapy (antimuscarinic or β-3 agonists), chemodenervation (botulinum toxin), or neuromodulation (sacral or posterior tibial nerves).⁴ However, many patients with MUI progress to surgical therapies for treatment of SUI. This article reviews the literature available that can help clinicians manage expectations of SUI surgeries on patients with MUI.     

Casein kinase II mediates multiple phosphorylation of Saccharomyces cerevisiae eIF-2 alpha (encoded by SUI2), which is required for optimal eIF-2 function in S. cerevisiae.

Previous studies have demonstrated that the alpha subunit of eukaryotic initiation factor 2 (eIF-2 alpha), encoded by the SUI2 gene in the yeast Saccharomyces cerevisiae, is phosphorylated at Ser-51 by the GCN2 kinase in response to general amino acid control. Here we describe that yeast eIF-2 alpha is a constitutively phosphorylated protein species that is multiply phosphorylated by a GCN2-independent mechanism. 32Pi labeling and isoelectric focusing analysis of a SUI2+ delta gcn2 strain identifies eIF-2 alpha as radiolabeled and a single isoelectric protein species. Treatment of SUI2+ delta gcn2 strain extracts with phosphatase results in the identification of three additional isoelectric forms of eIF-2 alpha that correspond to the stepwise removal of three phosphates from the protein. Mutational analysis of SUI2 coupled with biochemical analysis of eIF-2 alpha maps the sites to the carboxyl region of SUI2 that correspond to Ser residues at amino acid positions 292, 294, and 301 that compose consensus casein kinase II sequences. 32Pi labeling or isoelectric focusing analysis of eIF-2 alpha from conditional casein kinase II mutants indicated that phosphorylation of eIF-2 alpha is abolished or dephosphorylated forms of eIF-2 alpha are detected when these strains are grown at the restrictive growth conditions. Furthermore, yeast casein kinase II phosphorylates recombinant wild-type eIF-2 alpha protein in vitro but does not phosphorylate recombinant eIF-2 alpha that contains Ser-to-Ala mutations at all three consensus casein kinase II sequences. These data strongly support the conclusion that casein kinase II directly phosphorylates eIF-2 alpha at one or all of these Ser amino acids in vivo. Although substitution of SUI2 genes mutated at these sites for the wild-type gene have no obvious effect on cell growth, one test that we have used appears to demonstrate that the inability to phosphorylate these sites has a physiological consequence on eIF-2 function in S. cerevisiae. Haploid strains constructed to contain Ser-to-Ala mutations at the consensus casein kinase II sequences in SUI2 in combination with a mutated allele of either the GCN2, GCN3, or GCD7 gene have synthetic growth defects. These genetic data appear to indicate that the modifications that we describe at the carboxyl end of the eIF-2 alpha protein are required for optimal eIF-2 function in S. cerevisiae.     

不同治疗方式对产后压力性尿失禁的疗效评估

目的:探究不同方法治疗产后压力性尿失禁(stress urinary incontinence,SUI)的临床疗效,并分析其相关的产科影响因素,为该病的预防和治疗提供相关的依据。方法:选取2015年1月至2016年1月在汉川市人民医院于产后42天返院行盆底功能筛查时诊断为产后SUI同时符合纳入标准的初产妇103例,并将其按患者的意愿分为3个治疗组,随访观察组(I组)有30例患者,盆底肌锻炼组(II组)有35例患者,生物反馈联合电刺激治疗组(III组)有38例患者。分别治疗8周后,通过国际尿失禁咨询委员会尿失禁问卷表(ICI-Q-SF)问卷调查、尿垫试验及盆底肌力测定进行疗效评价,并分析生物反馈联合电刺激疗效的影响因素。结果:治疗前,三组间盆底肌力无显著性差异(P0.05);治疗后,三组间两两比较均有显著性差异(P0.05)。治愈率而言,III组与II组和I组比较,差异有统计学意义(P0.05)。单因素分析显示:孕期体重增加量与产后SUI严重程度和抑郁评分对生物反馈联合电刺激治疗疗效显著相关(P0.05),而年龄、产前BMI、新生儿出生体重等对治疗疗效无显著相关性(P0.05)。多因素非条件Logistic回归分析显示:孕期体重增加量与产后SUI严重程度是影响生物反馈联合电刺激治疗疗效的独立因素。结论:电刺激联合生物反馈治疗对产后SUI的疗效与单纯盆底肌锻炼治疗和单纯随访观察相比具有明显的优势,可作为临床治疗产后SUI的首选方案。影响其疗效的主要因素为孕期体重增加量与产后SUI严重程度,故控制孕期体重可能会促进电刺激对产后SUI的疗效。     

Stress urinary incontinence in women: diagnosis and medical management

Stress urinary incontinence (SUI) is the most common form of urinary incontinence in women and is associated with high financial, social, and emotional costs. The history and physical examination can identify most patients with a significant stress incontinence component without the need for urodynamic testing. A variety of pharmacologic agents have been used off-label, but an evidence-based pharmacologic treatment has not been readily available. The development of a selective serotonin and norepinephrine reuptake inhibitor will add a potentially useful drug to the primary care physician's practice for treating female patients with SUI. In August 2004, a selective serotonin and norepinephrine reuptake inhibitor, duloxetine, became the first medication approved for the treatment of women with moderate to severe SUI throughout the European Union. As of November 2005, however, duloxetine has not been approved for the treatment of SUI in the United States.     

Effectiveness of bulking procedures in measuring population-pairwise similarity with dominant and co-dominant genetic markers

Two bulking procedures (bulking individuals before and after genotyping) are commonly applied in similarity based studies of genetic distance at the population or higher level, but their effectiveness is largely unknown. In this study, expected population-pairwise similarity for both bulking procedures is derived with dominant and co-dominant diallelic markers. Numerical examples for the derived formulae are given with up to ten individuals randomly selected from each population. The procedure of bulking individuals after genotyping with either marker system is generally more informative than the procedure of bulking individuals before genotyping, because the former incorporates the information from marker alleles of intermediate frequency. Both procedures are effective with 5–10 individuals selected randomly from either population, but the procedure of bulking before genotyping requires a genotyping effort several-fold less than the procedure of bulking after genotyping. For either bulking procedure, a co-dominant marker system is generally more informative than a dominant marker system. Received: 20 October 1999 / Accepted: 11 November 1999     

The future of bladder control-intravesical drug delivery, a pinch of pepper, and gene therapy

The incidence of urinary incontinence and overactive bladder problems will continue to grow as the population ages. Future treatments are likely to include an implantable drug delivery system, gene therapy, and the intravesical use of the vallinoids capsaicin and resiniferatoxin (RTX). An understanding of the urothelium is essential for effective design of these therapies. Intravesical anticholinergic drug treatment is currently not widely used, but intravesical pumps are under development to provide less cumbersome treatment methods and will provide nonsurgical options for patients who cannot tolerate oral anticholinergic agents. Research on the use of capsaicin as an intravesicular drug has had limited success, but trials have confirmed the efficacy of intravesical capsaicin for detrusor hyperreflexia. RTX is as effective as capsaicin but without side effects, such as pain and inflammatory neuropeptide release. RTX treatment may eliminate the need for surgical and other drug treatments of lower urinary tract dysfunction in patients with spinal cord injuries. Gene therapy will change the practice of urology by addressing the deficiencies that cause symptoms rather than attacking the symptoms themselves.     

An assessment of pathogen removal during composting of the separated solid fraction of pig manure

The aim was to investigate pathogen survival during composting of pig manure solids with and without bulking agents in two trials of 56 days duration, each with four treatments. Salmonella was detected in the sawdust and straw bulking agents but was undetectable in the compost, except in one treatment at day 0. Enteric indicator organisms were reduced by day 7 (P<0.001) and were undetectable in the final compost, except for coliform which were present at 3.66-4.43 log?? CFU/g. Yeasts and moulds were reduced and aerobic spore-formers remained stable in one trial but both increased in the other (P<0.001). Bacillus licheniformis and Clostridium sporogenes were the predominant culturable spore-forming bacteria recovered. Microbial counts were influenced by the bulking agent but only at particular time points (P<0.05). Overall, the pig manure-derived compost complied with EU regulations for processed manure products, as E. coli and Enterococcus were below limits and it was Salmonella-free.     

Management of vesicoureteral reflux

Four cases of vesicoureteral reflux are discussed by prominent pediatric urologists. The condition can range from minimal reflux into the distal ureter to massive reflux causing tortuosity of the ureter and hydronephrosis. Treatment options range from medical management to tapering of the ureter with reimplantation. The cross-trigonal technique is popular among pediatric urologists, and the Politano-Leadbetter technique is a very successful technique that has stood the test of time. The extravesical approach to ureteral reimplantation reduces morbidity, shortens hospital stays, reduces medical costs, and maintains the high success rates of the intravesical techniques. Subureteric injection of bulking agents to correct the reflux holds promise as an alternative to open surgery, but presents the challenge of identifying the ideal bulking agent.     

Effectiveness of fractional CO<Subscript>2</Subscript> laser in women with stress urinary incontinence

Background

Stress urinary incontinence (SUI) is a relatively common disorder that significantly affects the quality of life. Many conservative and surgical treatment methods have been recommended for SUI, but they have major limitations.

Aims

To assess the use of the CO₂ fractional laser in the treatment of SUI.

Methods

This clinical trial included 55 patients with confirmed SUI. Patients underwent fractional CO₂ laser treatment 3 times at 30-day intervals. Data on age, smoking history, sexual activity, menopause, and history of hormone replacement therapy (HRT) were collected. Response to treatment was assessed by SUI severity and the level of sexual satisfaction was assessed using the visual analog scale (VAS). Patients were evaluated at 3 different time points: before treatment, and 45 days and 6 months after the last laser treatment.

Results

The mean patient age was 44.4±11.4 years (range: 28 to 68 years). Smoking history was positive in 6 patients (9.1%); 19 (54.3%) were menopausal on HRT. The SUI severity score at baseline (before treatment) was 8.56±0.62 and decreased to 2.28 6 months after treatment (p<0.0001). The sexual satisfaction score was 3±0.94 at baseline and increased to 7.87±0.93 6 months after treatment (day 180) (p<0.0001, slope = + 2.2)

Conclusion

Our findings are in line with a previous study that showed the value of transvaginal CO₂ fractional laser treatment for alleviation of SUI symptoms and its potential as an alternative treatment. We also observed improved sexual satisfaction in SUI patients.

     

Organic Bulking Agents for Enhancing Oil Bioremediation in Soil

Soil contaminated with oil is bioremediated by optimizing conditions for microbial activity. Often the question arises about the benefits of bulking with organic materials to improve soil conditions to enhance degradation of the less biodegradable or less bioavailable components. An investigation was undertaken in the laboratory with the objective of measuring the influence of bulking with dried plant material, bermudagrass, and alfalfa on the degradation of oily sludge added to soil. The oily sludge was diluted 50:50 on a weight basis with soil to achieve a final concentration of 100 g oil and grease kg^-1 of final soil mixture. Bulking agents were added 40 d after dilution of the sludge and optimization of environmental conditions to allow time for the readily decomposable fraction to be degraded before amendment with bulking agents. Populations of heterotrophic microorganisms increased approximately ten times by 40 and 80 d after addition of bulking agents, but the numbers of hydrocarbon-degrading microorganisms did not significantly increase above the number in the nonbulked control. Bulking agents increased the quantity of total petroleum hydrocarbons degraded by approximately 20% during the first 40 d after being added. Disappearance of hydrocarbons for bulked treatments was much slower during the next 40 d, such that the total petroleum hydrocarbon content for both bulked and nonbulked treatments generally was not significantly different at the end. It appears that adding bulking agents may enhance the rate of decomposition of total petroleum hydrocarbons by stimulating the general heterotrophic population of microorganisms, but the influence may not be sustained to influence the extent of decomposition.     

SUI1/p16 is required for the activity of eukaryotic translation initiation factor 3 in Saccharomyces cerevisiae.

A genetic reversion analysis at the HIS4 locus in Saccharomyces cerevisiae has identified SUI1 as a component of the translation initiation complex which plays an important role in ribosomal recognition of the initiator codon. SUI1 is an essential protein of 12.3 kDa that is required in vivo for the initiation of protein synthesis. Here we present evidence that SUI1 is identical to the smallest subunit, p16, of eukaryotic translation initiation factor 3 (eIF-3) in S. cerevisiae. SUI1 and eIF3-p16 comigrate upon sodium dodecyl sulfate-polyacrylamide gel electrophoresis and cross-react with anti-SUI1 and anti-eIF3 antisera. Anti-SUI1 antisera immunoprecipitate all of the subunits of eIF3, whereas antisera against the eIF3 complex and the individual PRT1 and GCD10 subunits of eIF3 immunoprecipitate SUI1. Finally, the N-terminal amino acid sequence of a truncated form of eIF3-p16 matches the sequence of SUI1. eIF3 isolated from a sui1(ts) strain at 37 degrees C lacks SUI1 and fails to exhibit eIF3 activity in the in vitro assay for methionyl-puromycin synthesis. A free form of SUI1 separate from the eIF3 complex is found in S. cerevisiae but lacks activity in the in vitro assay. The results, together with prior genetic experiments, indicate that SUI1 is essential for eIF3 activity and functions as part of eIF3 and in concert with eIF2 to promote eIF2-GTP-Met-tRNAi ternary complex recognition of the initiator codon.     

Influence of Bulking Agents,Fertilizers and Bacteria on the Removal of Diesel from a Newfoundland Soil

Laboratory experiments in culture flasks, containing diesel-contaminated Newfoundland soil samples, were undertaken to compare the influence of fertilizers, microorganisms and bulking agents on bioremediation. In Phase I experiments only one fertilizer (cow manure or poultry manure), one bulking agent (sand or hay), or one inoculum (cold-tolerant indigenous bacteria or exogenous commercial bacteria) was added to a soil sample. In Phase II experiments, Design-Expert® Version 6 design of experiment software determined the combinations of fertilizers, bulking agents and inocula to be mixed with the soil samples to study the interactions among the amendments. The maximum diesel removal at 90 days occurred in the sample with sand (Phase I) and in the sample with cow manure, an inoculum of cold-tolerant indigenous bacteria, and sand (Phase II). Diesel removal at 45 days for the same two samples was 85.4% (Phase I) and 91.9% (Phase II), suggesting the cow manure and/or cold-tolerant bacteria inoclum accelerated the process. The poultry manure, commercial bacteria and hay were less effective than their counterparts. The commercial bacteria were more sensitive to diesel concentration than the indigenous cold-tolerant bacteria. The addition of sand, cow manure, and poultry manure improved diesel removal.     

利用分子标记分析遗传多样性时的玉米群体取样策略研究

利用分子标记技术对玉米种质资源进行遗传多样性分析对种质资源的保存和利用具有重要的指导意义。但是,在对地方品种和育种群体这些开放授粉群体进行大规模遗传多样性分析时,取样方法将会严重影响到研究结果和工作效率。本研究用2个育种群体和3个地方品种为试材,利用微卫星(SSR)标记对每个群体100个个体及其组成的不同随机混合样品进行了分子检测。结果表明,不同群体的群体内遗传变异大小存在差异;相同数目的个体随机混合的不同样品间的检测结果基本相同;不同数目的个体混合的样品间存在一定程度的差异,并且与材料本身的遗传变异大小有一定关系。考虑到结果的科学性和工作的可行性,建议在利用分子标记(如SSR)进行地方品种和育种群体的遗传多样性评估时,随机选取30个个体组成混合样(或用15个个体组成2个混合样)来代表1个地方品种或育种群体进行分子鉴定。     

Identification and characterization of SHORTENED UPPERMOST INTERNODE 1, a gene negatively regulating uppermost internode elongation in rice

In rice, the elongated internodes are derived from the vegetative shoot apical meristem (SAM), and the transition of the SAM from the vegetative to the reproductive stage induces internode elongation. In this study, we characterize two shortened uppermost internode mutants (sui1-1 and sui1-2). During the seedling and tillering stages, sui1 plants are morphologically similar to wild-type plants. However, at the heading stage, the sui1-1 mutant exhibits a shortened uppermost internode and a partly sheathed panicle, and the sui1-2 mutant shows an extremely shortened uppermost internode and a fully sheathed panicle. Gibberellin treatment results in elongation of every internode, but the shortened uppermost internode phenotype remains unaltered. Microscopic analysis indicates that cell length of sui1-1 uppermost internode exhibits decreased. Map-based cloning revealed that SUI1 is located on Chromosome 1, and encodes a putative phosphatidyl serine synthase (PSS) family protein. Searches for matches in protein databases showed that OsSUI1 contains the InterPro domain IPR004277, which is conserved in both animal and plant kingdoms. Introduction of a wild-type SUI1 gene fully rescued the mutant phenotype of sui1-1 and sui1-2, confirming the identity of the cloned gene. Consistent with these results, the SUI1-RNAi transgenic plants displayed decreased elongation of the uppermost internode. Our results suggest that SUI1 plays an important role in regulating uppermost internode length by decreasing longitudinal cell length in rice.