[Electroacupuncture stimulation of the pudendal nerve for urinary incontinence after radical prostatectomy].

OBJECTIVE: To evaluate the clinical effect of pudendal nerve electroacupuncture (EAP) on urinary incontinence after radical prostatectomy. METHODS: According to the time of hospital visit, we randomly divided 81 patients, aged (68.56 ± 10.47) years, with urinary incontinence after radical prostatectomy into a control (n = 40) and an observation group (n = 41), the former treated by transrectal pelvic floor biofeedback combined with electrical stimulation (qd alt, 50 min/time) and the latter by EAP stimulation of the pudendal nerve at the four sacral points (qd alt, 50 min/time), both for 12 weeks. Before, at 4, 8 and 12 weeks of and 6 months after treatment, we obtained their scores on Urinary Incontinence Questionnaire Short Form (ICI-Q-SF ), urinary incontinence quality of life (I-QOL), Visual Analogue Scale (VAS) and pelvic floor muscle strength (Glazer), and evaluated the effect of 12 weeks of treatment. RESULTS: Compared with the baseline, the ICI-Q-SF, I-QOL, VAS and Glazer scores were significantly improved in the observation group at 4 , 8 and 12 weeks and during the 6-month follow-up (P < 0.05), even more significantly at 12 weeks and 6 months than at 4 and 8 weeks (P < 0.05), and also in the control group (P < 0.05), even more significantly at 6 months than at 12 weeks (P < 0.05). And all the indicators above were even better improved in the observation than in the control group at any point (P < 0.05). The patients in the observation group showed a markedly higher rate of total effectiveness than the controls at 12 weeks (73.17% ï¼»30/41ï¼½ vs 37.50% ï¼»15/40ï¼½, P < 0.05). CONCLUSIONS: EAP stimulation of the pudendal nerve is safe and has a good long-term effect in the treatment of urinary incontinence after radical prostatectomy, and therefore can be used as a first-choice conservative therapeutic strategy for this condition.

Characterization of the Polymyxin D Synthetase Biosynthetic Cluster and Product Profile of Paenibacillus polymyxa ATCC 10401.

The increasing prevalence of polymyxin-resistant bacteria has stimulated the search for improved polymyxin lipopeptides. Here we describe the sequence and product profile for polymyxin D nonribosomal peptide synthetase from Paenibacillus polymyxa ATCC 10401. The polymyxin D synthase gene cluster comprised five genes that encoded ABC transporters (pmxC and pmxD) and enzymes responsible for the biosynthesis of polymyxin D (pmxA, pmxB, and pmxE). Unlike polymyxins B and E, polymyxin D contains d-Ser at position 3 as opposed to l-α,γ-diaminobutyric acid and has an l-Thr at position 7 rather than l-Leu. Module 3 of pmxE harbored an auxiliary epimerization domain that catalyzes the conversion of l-Ser to the d-form. Structural modeling suggested that the adenylation domains of module 3 in PmxE and modules 6 and 7 in PmxA could bind amino acids with larger side chains than their preferred substrate. Feeding individual amino acids into the culture media not only affected production of polymyxins D1 and D2 but also led to the incorporation of different amino acids at positions 3, 6, and 7 of polymyxin D. Interestingly, the unnatural polymyxin analogues did not show antibiotic activity against a panel of Gram-negative clinical isolates, while the natural polymyxins D1 and D2 exhibited excellent in vitro antibacterial activity and were efficacious against Klebsiella pneumoniae and Acinetobacter baumannii in a mouse blood infection model. The results demonstrate the excellent antibacterial activity of these unusual d-Ser3 polymxyins and underscore the possibility of incorporating alternate amino acids at positions 3, 6, and 7 of polymyxin D via manipulation of the polymyxin nonribosomal biosynthetic machinery.

Obesity and lipid profiles in middle aged men and women in Tanzania.

OBJECTIVE: To examine the relationship between obesity and lipid profiles and to compare the effects of total obesity and central adiposity on lipids in three locations in Tanzania. DESIGN: Cross-sectional epidemiological study. SETTING: Three areas in Tanzania: Dar es Salaam (urban), Handeni (rural) and Monduli (pastoralists), in August 1998. SUBJECTS: Five hundred and forty five men and women from a random sample of 600 people aged 46-58 years. MAIN OUTCOME MEASURES: Mean BMI, waist circumference, WHR, TC, HDL-C, LDL-C, TG and LDL/HDL ratio. Prevalence rates of overweight,obesity, central obesity and dyslipidaemia. RESULTS: As compared to men, women had higher BMI (24.7 versus 22.5 kg/m2, p<0.0001), waist circumference (92.4 versus 89.1 cm, p<0.05), TC (4.9 versus 4.2 mmol/L, p<0.0001) and LDL-C (3.3 versus 2.6 mmol/L, p<0.0001). The urban population demonstrated higher levels of lipid factors than the rural population (TC, men 4.8 mmol/L; women 5.3 mmol/L, p<0.0001; TG, men 3.6 mmol/L; women 3.7 mmol/L, p<0.0001, LDL-C, men 2.8 mmol/L, p<0.0001). BMI and waist circumference correlated positively with serum TC, TG, and LDL-C in both genders. Stepwise regression analysis showed that BMI predicted triglyceride concentration in men (p<0.05) and women (p<0.0001). Waist circumference predicted levels of TC in women only (p<0.0001) and of LDL-C in both genders (men p<0.05, women p<0.0001). The prevalence of overweight, obesity and central obesity were significantly higher in urban than in rural areas in both men and women. Compared to lean subjects, obese men and women had significantly higher mean serum TC, TG, LDL-C and a higher prevalence of dyslipidaemia. The mean levels of TC, TG and LDL cholesterol increased across successive increases in BMI and waist circumference quintiles in both genders. CONCLUSION: Subjects from the urban area had greater lipid abnormalities related to obesity than those from the rural area and that, central adiposity had a greater effect on total cholesterol and LDL cholesterol among women than was BMI.