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Neuromodulation for fecal incontinence: An effective surgical intervention

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World Journal of Gastroenterology 2013年第41期19卷 7048-7054页

作者： Giuseppe Chiarioni Olafur S Palsson Corrado R Asteria william e whitehead Division of Gastroenterology of the University of Verona Valeggio s/M HospitalAzienda Ospedaliera Universitaria Integrata di Verona37067 Valeggio sul MincioVeronaItaly Division of Gastroenterology and Hepatology and Center for Functional Gastrointestinal and Motility Disorders University of North Carolina at Chapel HillChapel HillNC 27516United States Department of Surgery and Orthopedics General Surgery UnitAzienda Ospedaliera Carlo Poma di MantovaAsola General Hospital46041 AsolaMantovaItaly

Fecal incontinence is a disabling symptom with medical and social implications,including fear,embarrassment,isolation and even *** patients live in seclusion and have to plan their life around the symptom,with secondary impairment of their quality of *** management and biofeedback therapy are reported to benefit a good percentage of those ***,surgery must be considered in the nonresponder ***,sacral nerve electrostimulation,lately named neuromodulation,has been reported to benefit patients with fecal incontinence in randomized controlled trials more than placebo stimulation and conservative management,by some unknown *** is a minimally invasive procedure with a low rate of adverse events and apparently favorable cost-efficacy *** review is intended to expand knowledge about this effective intervention among the non-surgically skilled community who deals with this disabled group of patients.

关键词： Fecal incontinence Neuromodulation Sacral nerve stimulation Biofeedback Anal sphincter

Chronic proctalgia and chronic pelvic pain syndromes:New etiologic insights and treatment options

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World Journal of Gastroenterology 2011年第40期17卷 4447-4455页

作者： Giuseppe Chiarioni Corrado Asteria william e whitehead Division of Gastroenterology of the University of Verona Azienda Ospedaliera Universitaria Integrata di Verona Valeggio sul Mincio Hospital 37067 Valeggio sul Mincio Verona Italy Department of Surgery and Orthopedics General Surgery Unit Azienda Ospedaliera Carlo Poma di Mantova Asola General Hospital 46041 Asola Mantova Italy Division of Gastroenterology and Hepatology Division of Urogynecology and Center for Functional Gastrointestinal and Motility Disorders University of North Carolina at Chapel Hill Chapel Hill NC 27599-7080 United States

This systematic review addresses the pathophysiology, diagnostic evaluation, and treatment of several chronic pain syndromes affecting the pelvic organs:chronic proctalgia, coccygodynia, pudendal neuralgia, and chronic pelvic pain. Chronic or recurrent pain in the anal canal, rectum, or other pelvic organs occurs in 7% to 24% of the population and is associated with impaired quality of life and high health care costs. However, these pain syndromes are poorly understood, with little research evidence available to guide their diagnosis and treatment. This situation appears to be changing:A recently published large randomized,controlled trial by our group comparing biofeedback, electrogalvanic stimulation, and massage for the treatment of chronic proctalgia has shown success rates of 85% for biofeedback when patients are selected based on physical examination evidence of tenderness in response to traction on the levator ani muscle-a physical sign suggestive of striated muscle tension. excessive tension (spasm) in the striated muscles of the pelvic floor appears to be common to most of the pelvic pain syndromes. This suggests the possibility that similar approaches to diagnostic assessment and treatment may improve outcomes in other pelvic pain disorders.

关键词： Biofeedback Chronic pelvic pain Chronicproctalgia Coccygodynia Levator ani syndrome Pudendal neuralgia

Biofeedback therapy for dyssynergic defecation

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World Journal of Gastroenterology 2006年第44期12卷 7069-7074页

作者： Giuseppe Chiarioni Steve Heymen william e whitehead Gastrointestinal Rehabilitation Division Valeggio sul Mincio Hospital Azienda Ospedaliera and University of Verona Valeggio sul Mincio Italy UNC Center for Functional Gastrointestinal and Motility Disorders University of North Carolina at Chapel Hill Chapel Hill NC United states

Dyssynergic defecation is one of the most common forms of functional constipation both in children and adults; it is defined by incomplete evacuation of fecal material from the rectum due to paradoxical contraction or failure to relax pelvic floor muscles when straining to defecate. This is believed to be a behavioral disorder because *** no associated morphological or neurological abnormalities, and consequently biofeedback training has been recommended for treatment. Biofeedback involves the use of pressure measurements or averaged electromyographic activity within the anal canal to teach patients how to relax pelvic floor muscles when straining to defecate. This is often combined with teaching the patient more appropriate techniques for straining （increasing intra-abdominal pressure） and having the patient practice defecating a water filled balloon. Tn adults, randomized controlled trials show that this form of biofeedback is more effective than laxatives, general muscle relaxation exercises （described as sham biofeedback）, and drugs to relax skeletal muscles. Moreover, its effectiveness is specific to patients who have dyssynergic defecation and not slow transit constipation. However, in children, no clear superiority for biofeedback compared to laxatives has been demonstrated. Based on three randomized controlled studies in the last two years, biofeedback appears to be the preferred treatment for dyssynergic defecation in adults.

关键词： Biofeedback Constipation Pelvic floor dyssynergia Dyssynergic defecation Functional defecation disorders Randomized controlled trials

Social learning contributions to the etiology and treatment of functional abdominal pain and inflammatory bowel disease in children and adults

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World Journal of Gastroenterology 2007年第17期13卷 2397-2403页

作者： Rona L Levy Shelby L Langer william e whitehead School of Social Work University of WashingtonUnited States Center for Functional GI and Motility Disorders University-of-North-Carolina-at-Chapel-Hill-United-State

This paper reviews empirical work on cognitive and social learning contributions to the etiology and treatment of illness behavior associated with functional abdominal pain and inflammatory bowel disease. A particular emphasis is placed on randomized controlled trials, the majority of which are multi-modal in orientation, incorporating elements of cognitive behavioral therapy, social learning, and relaxation. Based on this review, we offer methodological and clinical suggestions: (1) Research investigations should include adequate sample sizes, long-term follow-up assessments, and a credible, active control group. (2) Standard gastrointestinal practice should include, when appropriate, learning opportunities for patients and family members, for example, instruction regarding the encouragement of wellness behavior.

关键词： Functional abdominal pain Cognitivebehavioral therapy Social learning Irritable bowelsyndrome Inflammatory bowel disease Illness behavior

Psychosocial mechanisms for the transmission of somatic symptoms from parents to children

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World Journal of Gastroenterology 2015年第18期21卷 5532-5541页

作者： Miranda AL van Tilburg Rona L Levy Lynn S Walker Michael Von Korff Lauren D Feld Michelle Garner Andrew D Feld william e whitehead Center for Functional GI and Motility Disorders University of North Carolina School of Social Work University of Washington Department of Pediatrics Vanderbilt University School of Medicine Nashville TN 37201 United States Group Health Research Institute Mount Sinai School of Medicine Department of Social Work University of Washington Tacoma Group Health Cooperative

AIM: To examine familial aggregation of irritable bowel syndrome(IBS) via parental reinforcement/modeling of symptoms, coping, psychological distress, and exposure to ***:Mothers of children between the ages of8 and 15 years with and without IBS were identified through the Group Health Cooperative of Puget *** completed questionnaires,including the Child Behavior Checklist(child psychological distress),the Family Inventory of Life events(family exposure to stress),SCL-90R(mother psychological distress),and the Pain Response Inventory(beliefs about pain).Children were interviewed separately from their parents and completed the Pain Beliefs Questionnaire(beliefs about pain),Pain Response Inventory(coping)and Child Symptom Checklist[gastrointestinal(GI)symptoms].In addition,health care utilization data was obtained from the automated database of Group Health *** with IBS(n=207)and their 296 children were compared to 240 control mothers and their 335 children,while controlling for age and ***:Hypothesis 1:reinforcement of expression of GI problems is only related to GI symptoms,but not others(cold symptoms)in *** was no significant correlation between parental reinforcement of symptoms and child expression of GI or other *** 2:modeling of GI symptomsis related to GI but not non-GI symptom reporting in *** of parents with IBS reported more non-GI(8.97 vs 6.70,Pell as more GI(3.24 vs 2.27,Pealth care visits made by the mother correlated with visits made by the child(rho=0.35,Pes,rho=0.26,Pesis 3:children learn to share the methods of coping with illness that their mothers *** used by children to cope with stomachaches differed from methods used by their *** 2/16 scales showed weak but significant correlations(stoicism rho=0.13,Peptance rho=0.13,Pesis 4:mothers and chi

关键词： Abdominal pain Coping Illness behaviors Psychological distress Social learning Stress

Rome Ⅲ survey of irritable bowel syndrome among ethnic Malays

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World Journal of Gastroenterology 2012年第44期18卷 6475-6480页

作者： Yeong Yeh Lee Anuar Waid Huck Joo Tan Andrew Seng Boon Chua william e whitehead Department of Medicine School of Medical SciencesUniversity Sains MalaysiaKubang Kerian 16150Malaysia Department of Gastroenterology Sunway Medical CenterPetaling Jaya 46150Malaysia 31 Lebuh Raya Raman Ipoh Ipoh Garden SouthIpoh 31400Malaysia Center for Functional Gastrointestinal and Motility Disorders University of North Carolina at Chapel HillChapel HillCA 27599-7080United States

AIM:To survey irritable bowel syndrome(IBS) using Rome Ⅲ criteria among Malays from the north-eastern region of Peninsular ***:A previously validated Malay language Rome Ⅲ IBS diagnostic questionnaire was used in the current study.A prospective sample of 232 Malay subjects(80% power) was initially *** a stratified random sampling strategy,a total of 221 Malay subjects(112 subjects in a "full time job" and 109 subjects in "no full time job") were *** were visitors(friends and relatives) within the hospital compound and were representative of the local *** flags and psychosocial alarm symptoms were also assessed in the current study using previously translated and validated *** with IBS were sub-typed into constipation-predominant,diarrhea-predominant,mixed type and *** and multivariable analyses were used to test for association between socioeconomic factors and presence of red flags and psychosocial alarm features among the Malays with ***:IBS was present in 10.9%(24/221),red flags in 22.2%(49/221) and psychosocial alarm features in 9.0%(20/221).Red flags were more commonly reported in subjects with IBS(83.3%) than psychosocial alarm features(20.8%,P ects with IBS were older(mean age 41.4 years vs 36.9 years,P = 0.08),but no difference in gender was noted(P = 0.4).Using univariable analysis,IBS was significantly associated with a tertiary education,high individual income above RM1000,married status,exsmoker and the presence of red flags(all P e logistic regression analysis,only the presence of red flags was significantly associated with IBS(odds ratio:0.02,95%CI:0.004-0.1,P e commonest IBS sub-type was mixed type(58.3%),followed by constipation-predominant(20.8%),diarrheapredominant(16.7%) and un-subtyped(4.2%).Four of 13 Malay females(30.8%) with IBS also had menstrual *** subjects with IBS had at least one red flag(70.8%)

关键词： Irritable bowel syndrome Malays Preva-lence Rome Ⅲcriteria Malaysia

Predictive value of the systemic immune inflammation index in recurrence of atrial fibrillation after radiofrequency catheter ablation

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World Journal of Cardiology 2025年第1期17卷 22-27页

作者： Alexander e Berezin Department of Internal Medicine-II Paracelsus Medical University SalzburgSalzburg 5020Austria

The recurrence of atrial fibrillation(AF)in patients after successful radiofrequency catheter ablation(RFCA)appears to be an unresolved clinical issue and needs to be clearly *** are many factors associated with AF recurrence,such as duration of AF,male sex,concomitant heart failure,hemodynamic parameters,chronic obstructive pulmonary disease,hypertension,obstructive sleep apnea,hyperthyroidism,smoking and ***,the inflammatory changes are strongly associated with electrical and structural cardiac remodeling,cardiac damage,myocardial fibrotic changes,microvascular dysfunction and altered reparative *** this context,biomarkers reflecting the different stages of AF pathogenesis deserve thorough *** authors of the retrospective study revealed that one-year recurrence rate of non-valvular AF in the high systemic immune inflammation(SII)index group was significantly increased compared to that of the low SII index group and provided additional predictive value to the ***,the authors suggest that this biomarker may help physicians to optimize the selection of AF patients and to develop a personalized treatment *** conclusion,the SII index may serve as a valuable indicator of recurrent AF in patients after RFCA and may be a biomarker with plausible predictive value for poor clinical outcomes.

关键词： Systemic immune inflammation index Recurrent atrial fibrillation Radiofrequency catheter ablation Biomarkers APPLe score Prediction

Protective activity of adipose-derived stem cell extracellular vesicles in ischemia and/or reperfusion

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World Journal of Stem Cells 2025年第1期17卷 1-5页

作者： Alexander e Berezin Internal Medicine-II Paracelsus Medical University SalzburgSalzburg 5020Austria

Increasing evidence of the significant clinical value of protection against ischemia/reperfusion injury has contributed to the realization of the independent importance of this approach in improving prognosis and reducing cardiovascular *** vesicles(eVs)derived by adipose mesenchymal stem cells may mediate the paracrine effects of stem cells and provide regenerative and anti-inflammatory properties,which are enhanced byγ-aminobutyric *** protective effects on cardiac myocytes may result from the eV embarked by miR-21-5p,which is a target for thioredoxin-interacting protein,regulating the formation of thioredoxin-interacting protein-thioredoxin complexes and subsequently enhancing the antioxidant activity of *** has been found thatγ-aminobutyric acid governs myocardial bioenergetics through suppressing inflammation and supporting mitochondrial ***,stem cell-based cell-free therapy based on adipose-derived stem cell eVs is considered a promising approach to individualized management of ischemia-induced cardiomyopathy.

关键词： extracellular vesicles Adipose mesenchymal stem cells MicroRNA-21-5p Cardiac protection Ischemia Reperfusion

Altered microRNA composition in the uterine lumen fluid in cattle(Bos taurus)pregnancies initiated by artificial insemination or transfer of an in vitro produced embryo

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Journal of Animal Science and Biotechnology 2025年第1期16卷 76-91页

作者： Fernando H.Biase Sarah e.Moorey Julie G.Schnuelle Soren Rodning Martha Sofia Ortega Thomas e.Spencer School of Animal Sciences Virginia Polytechnic Institute and State University175 W Campus DrBlacksburgVA 24061USA Department of Animal Science University of TennesseeKnoxvilleTN 37996USA Department of Clinical Sciences Auburn UniversityAuburnAL 36849USA Department of Animal Science Auburn UniversityAuburnAL 36849USA Department of Animal and Dairy Sciences University of Wisconsin MadisonMadisonWI 53706USA Division of Animal Sciences University of MissouriColumbiaMO 65211USA

Background MicroRNAs(miRNAs)are presented in the uterine lumen of many mammals,and in vitro experiments have determined that several miRNAs are important for the regulation of endometrial and trophoblast *** aim was to identify and contrast the miRNAs present in extracellular vesicles(eVs)in the uterine lumen fluid(ULF)at the onset of attachment in cattle pregnancies(gestation d 18)initiated by artificial insemination(AI)or by the trans-fer of an in vitro-produced blastocyst(IVP-eT).A third group had no conceptus after the transfer of an IVP *** The abundance of 263 annotated miRNAs was quantified in the eVs collected from *** was an increase in the transcript abundance of 20 miRNAs in the ULF eVs from the AI pregnant group,while 4 miRNAs had a lower abundance relative to the group not containing a ***,4 miRNAs were more abun-dant in ULF eVs in the AI pregnant group relative to IVP-eT group(bta-mir-17,bta-mir-7-3,MIR7-1,MIR18A).Specific miRNAs in the ULF eVs were co-expressed with messenger RNAs expressed in extra-embryonic tissues and endome-trium,including genes that are known to be their *** The results provide biological insights into the participation of miRNAs in the regulation of trophoblast proliferation and differentiation,as well as in endometrium *** knowledge that in vitro cultured embryos can contribute to the altered abundance of specific miRNAs in the uterine lumen can lead to the development of cor-rective approaches to reduce conceptus losses during the first month of pregnancy in cattle.

关键词： Artificial reproductive technology Cattle Conceptus embryos endometrium Small RNA