Sphincter Muscle Research Articles

Comparison of short-term outcomes and defecatory function following robotic and conventional laparoscopic surgery for stapled-ileal pouch-anal anastomosis-a retrospective cohort study.

This study assessed the potential advantages of robotic-assisted Stapled ileal pouch-anal anastomosis (Ro Stapled-IPAA) in ulcerative colitis (UC) compared to conventional laparoscopic surgery (Lap), with a focus on short-term outcomes and postoperative defecatory function, an aspect not previously explored. Out of a total of 132 patients who underwent proctocolectomy or residual rectal resection, consecutive patients undergoing minimally invasive Stapled-IPAA for UC at our hospital from May 2014 to May 2024 were included. The Ro approach was chosen for individuals with severe colitis extending into the anal canal, deeper rectal cancers (beyond T1), and cases requiring residual rectal resection, taking advantage of its benefits. Perioperative outcomes, including anastomosis height, operative time, intraoperative blood loss, complication rate, postoperative hospital stay, and defecatory function using Wexner scores and anorectal manometry before proctocolectomy and 6 months after stoma closure, were compared between the Ro and Lap groups. 33 patients (Lap, n=21; Ro, n=12) were included. The Ro group demonstrated a significantly lower anastomosis height (0.5 vs. 3.0 cm, P<0.001), reduced intraoperative blood loss (35 vs. 118mL, P=0.032), shorter postoperative hospital stay (8 vs. 10.5d), and no cases of anastomotic leakage (0% vs. 14.3%), as compared to the Lap group. Pouch failure occurred in 14% of Lap group; none were observed in the Ro group. Wexner scores favored the Ro group at 12 months after stoma closure (0 vs. 8 points), and there was better maximum voluntary squeeze pressure (302mmHg vs. 175mmHg, P=0.03), indicating preserved contraction of the external sphincter muscle despite the lower anastomosis. Ro Stapled-IPAA for patients with UC led to better short-term outcomes and preservation of defecatory function with lower anastomosis than Lap, suggesting the clinical advantages of the robotic approach in this field.

Transanal minimally invasive proctectomy for ulcerative colitis is beneficial in terms of short-term outcomes and defecation function.

Despite being reported safety, the advantages of transanal minimally invasive proctocolectomy (TAMIP) are controversial, and comparative studies on postoperative defecation function between ileal pouch-anal anastomosis (IPAA) using laparoscopic transanal manipulation (TAMIP-IPAA) and without this technique (traditional IPAA) are lacking. This study analyzed TAMIP's impact on short-term and postoperative defecation function in patients with ulcerative colitis (UC) to evaluate its safety and feasibility. Inclusion criteria comprised patients with UC undergoing minimally invasive proctocolectomy at our hospital from May 2014 to May 2023. The TAMIP-IPAA approach involved precise rectal mucosa removal while preserving the sphincter muscle during laparoscopic transanal manipulation. In the evaluation of short-term outcomes for 71 patients undergoing proctocolectomy, the TAMIP group (37 patients) outperformed the non-TAMIP group in operative time (395 vs. 289 min, p < 0.001) and postoperative hospital stay (12 vs. 8 days, p < 0.001). Additionally, TAMIP-IPAA demonstrated advantages over traditional IPAA (seven patients), in operative time (443 vs. 289 min, p = 0.006), intraoperative blood loss (392 vs. 130 mL, p = 0.001), postoperative hospital stay (18 vs. 8 days, p = 0.003), anastomotic leakage (42.9% vs. 8.1%, p = 0.041), and re-admission within 30 days (57.1% vs. 8.1%, p = 0.009). Wexner scores were significantly superior in the TAMIP-IPAA group at 6 months (14.5 vs. 8.0 points, p = 0.029) and 1 year post stoma closure (14.0 vs. 7.0 points, p = 0.020), indicating enhanced short-term outcomes and defecation function compared to traditional IPAA. TAMIP-IPAA for UC has the potential to offer promising benefits, including the enhancement of short-term outcomes and the improvement of defecation function.

The Influence of Male Biostimulation on Cloacal Anatomy and Egg-Laying Behavior in Young Female Muscovy Ducks (Cairina moschata forma domestica).

The importance of Muscovy ducks in industrial poultry production is growing; however, little is known about the physiology of their reproductive cycles. This study investigated the influence of male biostimulation on female ducks before the commencement of the laying phase. A total of 30 muscovy ducks, hatched in the same year at 289-341 days of age, were divided into two groups of 15 birds each and kept with and without contact with a male duck until the day of first egg-laying-319 ± 14 and 335 ± 13, respectively. Before reaching egg-laying maturity, the cloacae of 29 adult ducks were subjected to daily clinical assessments. The evaluations yielded four unique categories of outcomes, determined by assessing factors such as the degree of redness and protrusion of the mucous membrane, the moisture level, and swelling of the cloacal sphincter muscle. The results of this study on biostimulation revealed that, on average, female ducks that had contact with males laid their first egg 16 days earlier, weighing 78.7 ± 3.0 g, compared to the isolated female ducks, weighing 79.1 ± 7.0 g. Furthermore, there was no significant difference observed in the mean initial egg weight between the groups (p = 0.841). The cloacal morphology indicated significant morphological changes 25-26 days before laying. Efforts to improve Muscovy production and develop biotechnological techniques to modify these ducks' reproductive cycle will benefit from these advancements.

Chinese expert consensus on radiofrequency therapy for gastroesophageal reflux disease 2024

ObjectiveRadiofrequency (RF) therapy is a minimally invasive procedure used to treat gastroesophageal reflux disease (GERD). During the procedure, electrodes are meticulously inserted into the lower esophageal sphincter and cardiac muscle through a gastroscope. By applying heat at various layers and sites around the gastroesophageal junction, the treatment intends to augment the junction's pressure and reduce tissue compliance. This process may also desensitize the esophagus, thereby preventing reflux and relieving symptoms. RF therapy boasts a high success rate and a low risk of adverse effects, making it an increasingly popular choice. However, there is a lack of consensus regarding its indications, contraindications, and the evaluation processes for pre- and postoperative care. To enhance the precision of patient selection and the technical execution of RF therapy, it is imperative to consolidate and standardize its clinical application in China. This will ensure the therapy's safety and efficacy are optimized. MethodsBetween December 2022 and April 2024, a group of 25 Chinese endoscopists, each with experience in over 50 radiotherapy procedures, engaged in six rounds of consensus discussions. The discussions focused on several key aspects of the procedure. During these discussions, each item was put to a vote among the experts. A consensus was reached when an item received agreement from at least 80 ​% of the participants. ResultsThe expert group, comprising 25 specialists from 22 different institutions, had an average experience of over 50 RF procedures. These experts engaged in comprehensive discussions on a total of eight critical items, covering the full spectrum of the procedure, including indications, contraindications, basic working conditions and preparation, preoperative preparation, surgical process and technical skills, postoperative management, therapeutic effects, complications and prevention. The group successfully reached a consensus on all these items, ensuring a standardized approach to RF procedures. ConclusionThis consensus summarized and standardized the clinical application of anti-reflux RF therapy in China. Adoption of this consensus will improve the precision of patient selection and technical implementation, thereby enhancing the safety and effectiveness of anti-reflux radiofrequency therapy.

Fecal incontinence patients categorized based on anal pressure and electromyography: Anal sphincter damage and clinical symptoms.

Disruption of external anal sphincter muscle (EAS) is an important factor in the multifactorial etiology of fecal incontinence (FI). We categorize FI patients into four groups based on the location of lesion in neuromuscular circuitry of EAS to determine if there are differences with regards to fecal incontinence symptoms severity (FISI) score, age, BMI, obstetrical history, and anal sphincter muscle damage. Female patients (151) without any neurological symptoms, who had undergone high-resolution manometry, anal sphincter EMG, and 3D ultrasound imaging of the anal sphincter were assessed. Patients were categorized into four groups: Group 1 (normal)-normal cough EMG (>10 μV), normal squeeze EMG (>10 μV), and normal anal squeeze pressure (>124 mmHg); Group 2 (cortical apraxia, i.e., poor cortical activation)-normal cough EMG, low squeeze EMG, and low anal squeeze pressure; Group 3 (muscle damage)-normal cough EMG, normal squeeze EMG, and low anal squeeze pressure; and Group 4 (pudendal nerve damage)-low cough EMG, low squeeze EMG, and low anal squeeze pressure. The four patient groups were not different with regards to the patient's age, BMI, parity, and FISI scores. 3D ultrasound images of the anal sphincter complex revealed significant damage to the internal anal sphincter, external anal sphincter, and puborectalis muscles in all four groups. The FI patients are a heterogeneous group; majority of these patients have significant damage to the muscles of the anal sphincter complex. Whether biofeedback therapy response is different among different patient groups requires study.

En-bloc excision of sacral squamous cell carcinoma with immediate reconstruction.

Sacral squamous cell carcinoma is an uncommon condition that may arise in scars following burns or in chronic wounds, such as an untreated pilonidal cyst. The aim of the present technical note is to describe a surgical technique aimed at minimizing local recurrence rates by en-bloc resection as well as providing immediate plastic reconstruction: 1. right-sided extended vertical rectus abdominis myo-cutaneous (VRAM) flap; 2. abdomino-perineal excision of the rectum with end colostomy; 3. en-bloc excision of the mass inclusive of gluteus maximus muscles and distal sacrectomy; 4. sacrectomy defect covered with VRAM flap; 5. bilateral gluteal defects covered with single-layer dermal substitute of bovine collagen and elastin hydrolysate followed by immediate split-thicknessskin grafting from bilateral thigh donor sites, and negative pressure wound therapy dressings. This approach resulted in a favorable outcome at 2-year follow-up in a male patient presenting with a large locally advanced sacral squamous cell carcinoma involving the external anal sphincter muscle.

Docking Proteins Upregulate IL-1β Expression in Lower Esophageal Sphincter Muscle in Esophageal Achalasia.

Background/Objectives: Esophageal achalasia is an archetypal esophageal motility disorder characterized by abnormal peristalsis of the esophageal body and impaired lower esophageal sphincter (LES) relaxation. Methods: In this study, the mRNA expression of docking proteins 1 and 2 (DOK1 and DOK2, respectively) were analyzed and the mechanisms underlying achalasia onset were investigated. Results:DOK1 and DOK2 mRNA levels significantly increased in the LES of patients with achalasia. Moreover, significant correlations were observed between IL-1β and DOK1, IL-1β and DOK2, ATG16L1 and DOK1, and HSV1-miR-H1-3p and DOK2 expression levels. However, a correlation between ATG16L1 and DOK2 or between HSV-miR-H1-3p and DOK1 expression was not observed. In addition, a positive correlation was observed between patient age and DOK1 expression. Microarray analysis revealed a significant decrease in the expression of hsa-miR-377-3p and miR-376a-3p in the LES muscle of patients with achalasia. Conclusions: These miRNAs possessed sequences targeting DOK. The upregulation of DOK1 and DOK2 expression induces IL-1β expression in the LES of achalasia patients, which may contribute to the development of esophageal motility disorder.

Perineoplasty for anal incontinence after obstetric anal sphincter injury repair: a case report

BackgroundThe rectal and vaginal walls are typically sutured if severe perineal lacerations with rectal mucosal damage occur during vaginal delivery. In case of anal incontinence after the repair, re-suturing of the anal sphincter muscle is standard procedure. However, this procedure may not result in sufficient improvement of function.Case presentationA 41-year-old woman underwent suture repair of the vaginal and rectal walls for fourth-degree perineal laceration at delivery. She was referred to our department after complaining of flatus and fecal incontinence. Her Wexner score was 15 points. Examination revealed decreased anal tonus and weak contractions on the ventral side. We diagnosed anal incontinence due to sphincter dysfunction after repair of a perineal laceration at delivery. We subsequently performed sphincter re-suturing with perineoplasty to restructure the perineal body by suturing the fascia located lateral to the perineal body and running in a ventral–dorsal direction, which filled the space between the anus and vagina and increased anal tonus. One month after surgery, the symptoms of anal incontinence disappeared (the Wexner score lowered to 0 points), and the anorectal manometry values increased compared to the preoperative values. According to recent reports on the anatomy of the female perineal region, bulbospongiosus muscle in women does not move toward the midline to attach to the perineal body, as has been previously believed. Instead, it attaches to the ipsilateral surface of the external anal sphincter. We consider the fascia lateral to the perineal body to be the fascia of the bulbospongiosus muscle.ConclusionsIn a case of postpartum anal incontinence due to sphincter dysfunction after repair of severe perineal laceration, perineoplasty with re-suturing an anal sphincter muscle resulted in improvement in anal sphincter function. Compared to conventional simple suture repair of the rectal wall only, this surgical technique may improve sphincter function to a greater degree.

Treatment of fecal incontinence-is there alight in the end of the tunnel?

Fecal incontinence (FI) is acommon disease with higher incidence rates in the elderly population. Treatment of affected patients remains challenging and ranges from conservative management to surgical techniques. Despite all efforts patients often undergo several therapeutic measurements to achieve reasonable functional improvements.Although sacral neuromodulation still remains akey therapy with success rates up to 80%, asignificant number of patients do not respond sufficiently and require further treatment.Several artificial bowel sphincter devices exist, which can lead to better functional control in selected patients. Notably, complications after these surgeries do occur frequently and the need for implant replacement is still considerable high.Anovel anal band, developed by Agency for Medical Innovations (A.M.I., Austria) is currently under evaluation. This device, composed of silicone and polyester, is placed around the anus outside the external sphincter muscle complex aiming to improve stool continence via mechanical pressure. Early results of this new operation are eagerly awaited.

Functional mapping of the lower urinary tract by epidural electrical stimulation of the spinal cord in decerebrated cat model

Several neurologic diseases including spinal cord injury, Parkinson’s disease or multiple sclerosis are accompanied by disturbances of the lower urinary tract functions. Clinical data indicates that chronic spinal cord stimulation can improve not only motor function but also ability to store urine and control micturition. Decoding the spinal mechanisms that regulate the functioning of detrusor (Detr) and external urethral sphincter (EUS) muscles is essential for effective neuromodulation therapy in patients with disturbances of micturition. In the present work we performed a mapping of Detr and EUS activity by applying epidural electrical stimulation (EES) at different levels of the spinal cord in decerebrated cat model. The study was performed in 5 adult male cats, evoked potentials were generated by EES aiming to recruit various spinal pathways responsible for LUT and hindlimbs control. Recruitment of Detr occurred mainly with stimulation of the lower thoracic and upper lumbar spinal cord (T13-L1 spinal segments). Responses in the EUS, in general, occurred with stimulation of all the studied sites of the spinal cord, however, a pronounced specificity was noted for the lower lumbar/upper sacral sections (L7-S1 spinal segments). These features were confirmed by comparing the normalized values of the slope angles used to approximate the recruitment curve data by the linear regression method. Thus, these findings are in accordance with our previous data obtained in rats and could be used for development of novel site-specific neuromodulation therapeutic approaches.

Fecal incontinence risk factors and pregnancy.

We conducted an analysis on 231 pregnant women. A proctologist examined the patients three times: in the 1st trimester (within the first 15 weeks), in the 3rd trimester (29-40 weeks), and 12 months after childbirth. The total number of fecal incontinence observations among women included in the study was 66 cases (28.6%), detected at the final visit. Risk factors for fecal incontinence with a high probability were age over 36 years (P = 0.001), low physical activity (P = 0.034), three or more pregnancies resulting in childbirth (P = 0.022), history of hemorrhoids (P = 0.027), perianal discomfort on the first visit (P = 0.045), and constipation on the first visit (P = 0.006). Factors such as being overweight, marital status, education, living conditions, living area, and infant size did not have significance for fecal incontinence. Pregnancy- and obstetric-related risk factors contributing to fecal incontinence are multifactorial, including factors such as multiple childbirths with trauma to the pelvic muscles or anal sphincter muscles, chronic constipation, age, and vaginal deliveries. However, currently, there is no clear concept for the prevention of fecal incontinence in pregnant women. The prevalence of fecal incontinence among pregnant women is 12.9%, which increases to 28.6% one year after childbirth. The most common complaint was involuntary passage of intestinal gas. Risk factors for fecal incontinence with a high probability included being over 36-years old, low physical activity, three or more pregnancies resulting in childbirth, a history of hemorrhoids, perianal discomfort, and constipation in the 1st trimester of pregnancy.

A taxonomic revision of the sponge-associated genus Thoracactis Gravier, 1918 (Anthozoa: Zoantharia) based on an integrated approach

Abstract The integrated approach of molecular phylogenetic and morphological analyses has revolutionized the systematics and our understanding of the evolutionary relationships of marine taxa. One such group is the hexacorallian order Zoantharia Rafinesque, 1815. The monotypic genus Thoracactis Gravier, 1918 has been little investigated since its placement within the order Zoantharia more than 100 years ago. Here, we examined museum specimens collected from the Cape Verde Islands (eastern Atlantic) and newly collected specimens from Brazil (southwestern Atlantic), using a combined molecular and morphological approach. Our results conclusively show Thoracactis to be referable to the family Parazoanthidae. Morphological data show that Thoracactis topsenti Gravier, 1918, the type species of this monotypic genus, has a cyclically transitional arrangement of its sphincter muscle, and this arrangement has previously been reported from the Parazoanthidae. Thoracactis can be distinguished from other hexasterophoran glass-sponge-associated genera (Churabana Kise, Montenegro &amp; Reimer, 2022, Parachurabana Kise, 2023, and Vitrumanthus Kise, Montenegro &amp; Reimer, 2022) by a combination of morphological, ecological and molecular phylogenetic data. In addition, molecular phylogenetic analyses clearly indicate that Thoracactis topsenti is placed within Parazoanthidae. These results are yet another demonstration of the utility of comprehensive combined approaches. From now, research attention should focus on the revision of remaining taxonomic questions within the family Epizoanthidae, with the goal of a comprehensively revised suborder Macrocnemina within reach.

Anatomy and Physiology of Water Buffalo Mammary Glands: An Anatomofunctional Comparison with Dairy Cattle.

The present review aims to analyze the anatomical and physiological characteristics of the mammary gland and udders of water buffalo by making an anatomofunctional comparison with dairy cattle. It will also discuss the knowledge generated around the physiological regulation of milk ejection in the water buffalo. It was found that buffalo's average udder depth and width is approximately 20 cm smaller than Bos cattle. One of the main differences with dairy cattle is a longer teat canal length (around 8.25-11.56 cm), which highly influences buffalo milking. In this sense, a narrower teat canal (2.71 ± 0.10 cm) and thicker sphincter muscle are associated with needing higher vacuum levels when using machine milking in buffalo. Moreover, the predominant alveolar fraction of water buffalo storing 90-95% of the entire milk production is another element that can be related to the lower milk yields in buffalo (when compared to Bos cattle) and the requirements for prolonged prestimulation in this species. Considering the anatomical characteristics of water buffalo's udder could help improve bubaline dairy systems.

Immunological Significance of Meconium-Stained Amniotic Fluid with Complement Factors C3 and CD4 Levels for Pregnancy Health

Background: Meconium stained liquor (MSL) occurs when the fetal anal sphincter muscles relax in utero, tinting the amniotic fluid green, yellow, or brown. It is less common in premature fetuses. Method: Complement factors (C3 and CD4) were assessed in maternal serum and amniotic fluid from 30 women with MSL undergoing diagnostic fetoscopy at gestational week. Serum levels were consistently higher than control levels, which were higher than levels in amniotic fluid. Results: In the MSL group versus the control group, mean C3 levels in serum and amniotic fluid were (200.3913±37.6689 vs. 155.1321.8257) and (100.912±22.1869 vs. 98.0027±30.0989 pg/ml), respectively, showing statistically significant differences (p&lt;0.01). Significant differences (p&lt;0.01) were also observed between amniotic fluid and serum samples (155.1321 vs. 200.3913 pg/ml) in the MSL group, but not in the control group (100.912 vs. 98.0027 pg/ml). Mean CD4 levels in serum and amniotic fluid in the MSL group versus the control group were (13.1072 ± 4.2871 vs. 7.8651±2.5954) and (4.0372 ± 1.766 vs. 4.2328 ± 1.3943 pg/ml), respectively, with statistically significant differences (p&lt;0.01). Significant differences (p&lt;0.01) were noted between amniotic fluid and serum samples (7.8651 vs. 13.1072 pg/ml) in the MSL group, but not in the control group (4.2328 vs. 4.0372 pg/ml). Conclusion: Elevated levels of C3 and CD4 in serum and meconium-stained amniotic fluid indicate potential issues in pregnancy, suggesting their utility for early detection of this pathological condition to safeguard fetal health.

Differences in activation of pelvic floor muscles in response to electrical stimulation in men using different electrode montages

Objective:To measure contraction of the striated urethral sphincter, bulbocavernosus and puborectalis muscles with transperineal ultrasound imaging in response to electrical stimulation with three electrode montages. Materials and methods:Electrical stimulation was applied via anal, perineal and perineal-to-suprapubic electrode montages in ten healthy men. Induced pelvic landmark displacement was recorded with transperineal ultrasound imaging. Threshold current to evoke contraction of each muscle and maximum displacement was identified from displacement of relevant landmarks. outcomes were compared between landmarks and montages. Results:Contraction of all muscles (identified from landmark displacement) could be evoked with each electrode montage. Contraction of puborectalis was evoked in less men than the sphincter for the perineal montage. Threshold current was lower for the anal montage than either perineal montage and lower for contraction of the sphincter than puborectalis. Conclusion:Although electrical stimulation can evokes contraction of all pelvic floor muscles tested, differences in frequency of contraction and threshold imply different electrode montages may have different clinical applications. A perineal montage biases contraction to the sphincter and bulbocavernosus.

Neurotoxic pesticides change respiratory parameters in early gill-breathing, but not in skin-breathing life-stages of zebrafish (Danio rerio)

Neurotoxic compounds can interfere with active gill ventilation in fish, which might lead to premature death in adult fish, but not in skin-breathing embryos of zebrafish, since these exclusively rely on passive diffusion across the skin. Regarding lethality, this respiratory failure syndrome (RFS) has been discussed as one of the main reasons for the higher sensitivity of adult fish in the acute fish toxicity test (AFT), if compared to embryos in the fish embryo toxicity test (FET). To further elucidate the relationship between the onset of gill respiration and death by a neurotoxic mode of action, a comparative study into oxygen consumption (MO2), breathing frequency (fv) and amplitude (fampl) was performed with 4 d old skin-breathing and 12 d old early gill-breathing zebrafish. Neurotoxic model substances with an LC50 FET/AFT ratio of > 10 were used: chlorpyrifos, permethrin, aldicarb, ziram, and fluoxetine. Exposure to hypoxia served as a positive control, whereas aniline was tested as an example of a narcotic substance interfering non-specifically with gill membranes. In 12 d old larvae, all substances caused an increase in MO2, fv and partly fampl, whereas effects were minor in 4 d old embryos. An increase of fv in 4 d old embryos following exposure to chlorpyrifos, aldicarb and hypoxia could not be correlated with an increased MO2 and might be attributed either to (1) to the successfully postponed decrease of arterial partial pressure of oxygen (PO2) through support of skin respiration by increased fv, (2) to an unspecific stimulation of the sphincter muscles at the base of the gill filaments, or (3) to the establishment of oxygen sensing for later stages. In gill-breathing 12 d old zebrafish, a concentration-dependent increase of fv was detected for aniline and chlorpyrifos, whereas for aldicarb, fluoxetine and permethrin, a decline of fv at higher substance concentrations was measured, most likely due to the onset of paralysis and/or fatigue of the gill filament sphincter muscles. Since alterations of fv serve to postpone the decrease in arterial PO2 and MO2 increased with decreasing fv, the respiratory failure syndrome could clearly be demonstrated in 12 d old zebrafish larvae. Passive respiration across the skin in zebrafish embryos could thus be confirmed as a probable reason for the lower sensitivity of early life-stages to neurotoxicants. Integration of respiratory markers into existing testing protocols with non-protected developmental stages such as embryos might help to not underestimate the toxicity of early life-stages of fish.

The rectum, anal sphincter and puborectalis muscle show different contraction wave forms during prolonged measurement with a simulated feces

Contractile patterns in rectum, puborectalis muscle and anal sphincter must be studied to understand defecation. Six subjects had contractile waveforms studied with Fecobionics. Symptom questionnaires, balloon expulsion test and anorectal manometry were done for reference. The Fecobionics bag was filled in rectum to urge-to-defecate volume and measurements were done for 4 h before the subjects attempted to evacuate the device. Pressures and bend angle (BA) variations were analyzed with Fast Fourier Transformation. Four normal subjects exhibited low frequency waves (< 0.06 Hz) for pressures and BA. The waves were uncoordinated between recordings, except for rear and bag pressures. Peak wave amplitudes occurred at 0.02–0.04 Hz. Pressures and the BA differed for peak 1 (p < 0.001) and peak 2 amplitudes (p < 0.005). The front pressure amplitude was bigger than the others (rear and BA, p < 0.05; bag, p < 0.005) for peak 1, and bigger than bag pressure (p < 0.005) and BA (p < 0.05) for peak 2. One subject was considered constipated with lower front pressure amplitudes compared to normal subjects and increased amplitudes for other parameters. The sixth subject was hyperreactive and differed from the other subjects. In conclusion, the rectum, anal sphincter and puborectalis muscle showed different contraction waves during prolonged measurements. The data call for larger studies to better understand normal defecation, feces-withholding patterns, and the implications on anorectal disorders.

Pelvic floor muscle training in men with post-prostatectomy urinary incontinence: a scoping review.

(1) The pelvic floor muscle training is an effective first choice intervention. (2) Scarcity of studies describing the protocols of pelvic floor muscle training detail. (3) There is no consensus between the instructions contained in the different protocols. to map pelvic floor muscle training protocols available in the literature for the management of post-prostatectomy urinary incontinence. this is a scoping review conducted in six databases. Information retrieval was performed using a specific instrument, including: title, authorship, year of publication, journal, objective, study design and description of the protocols' content. a total of 24 studies were included, which resulted in different protocols. The most frequent recommendations were the following: three sessions per day; with a frequency of six to 15 contractions per session; performing the exercises in the lying, sitting, and standing positions. The most cited guidelines in the protocols were anal sphincter and bulbocavernosus muscle contractions. All protocols followed the principle of regular pelvic floor muscle contraction, but there was no consensus regarding the start of the protocol, treatment duration, contraction/relaxation time, and intensity of the contraction force. different orientations were found in the pelvic floor muscle training protocols post-prostatectomy urinary incontinence, with emphasis on contraction time, relaxation time, number of contractions per session, training position, and protocol duration time. Different concepts were adopted to define urinary continence in the protocols. It is necessary to develop consensus guidelines that clearly define the parameters of training protocols.

The association of anal sphincter morphology and somatotype characteristics with the pathogenesis of hemorrhoidal disease

Objective: This study aims to evaluate the changes that may occur in the morphology of the anal sphincter muscles in hemorrhoidal disease. The relationship between the somatotype features of individuals and the disease were also evaluated. Materials and Methods: The study was conducted with 76 stage IV hemorrhoidal disease patients and 75 controls. Internal (IAS) and external (EAS) anal sphincter muscle thicknesses were measured at the middle anal canal level and in four quadrants (anterior, posterior, right, left), puborectalis muscle thicknesses were measured at the upper anal canal level and in two quadrants (right, left) by using 3D-endoanal ultrasonography (3D-EAUSG). Anal triangle dimensions were measured with a digital caliper and the area was calculated with the relevant formula. Somatotype features of individuals were determined according to the Heath-Carter formula. Results: It was observed that the external anal sphincter muscle thicknesses were higher in the right and posterior quadrants of the patients compared to the control group. The internal anal sphincter muscle thicknesses were thicker in the right and anterior quadrants in the patient group. Somatotype features of individuals in the patient and control groups were similar. Conclusions: The thickenings in some quadrants of the anal sphincter muscles in the patient group can be considered as a result of hemorrhoidal disease. However, the fact that there is no difference in terms of the mean value cannot confirm its relationship with the disease. Therefore, it can be concluded that individual somatotype differences do not have any effect on the pathogenesis of hemorrhoidal disease.

Patterns of connexin36 and eGFP reporter expression among motoneurons in spinal sexually dimorphic motor nuclei in mouse.

Sexually dimorphic spinal motoneurons (MNs) in the dorsomedial nucleus (DMN) and dorsolateral nucleus (DLN) as well as those in the cremaster nucleus are involved in reproductive behaviours, and the cremaster nucleus additionally contributes to testicular thermoregulation. It has been reported that MNs in DMN and DLN are extensively linked by gap junctions forming electrical synapses composed of connexin36 (Cx36) and there is evidence that subpopulation of MNs in the cremaster nucleus are also electrically coupled by these synapses. We used immunofluorescence methods to detect enhanced green fluorescent protein (eGFP) reporter for Cx36 expression in these motor nuclei. We document in male mice that about half the MNs in each of DMN and DLN express eGFP, while the remaining half do not. Further, we found that the eGFP+ vs. eGFP- subsets of MNs in each of these motor nuclei innervate different target muscles; eGFP+ MNs in DMN and DLN project to sexually dimorphic bulbocavernosus and ischiocavernosus muscles, while the eGFP- subsets project to sexually non-dimorphic anal and external urethral sphincter muscles. Similarly, eGFP+ vs. eGFP- cremaster MNs were found to project to anatomically distinct portions of the cremaster muscle. By immunofluorescence, nearly all motoneurons in both DMN and DLN displayed punctate labelling for Cx36, including at eGFP+/eGFP+, eGFP+/eGFP- and eGFP-/eGFP- cell appositions. Most if not all motoneurons in DMN and DLN are electrically coupled, including sexually dimorphic and non-dimorphic motoneurons with each other, despite absence of eGFP reporter in the non-dimorphic populations in these nuclei that have selective projections to sexually non-dimorphic target muscles.