Physiology of incontinence

IGF-1 gene-modified muscle-derived stem cells are resistant to oxidative stress via enhanced activation of IGF-1R/PI3K/AKT signaling and secretion of VEGF

Reactive oxygen species (ROS)-induced oxidative stress increases in skeletal muscle with aging and decreases the viability of implanted cells. Type 1 insulin-like growth factor (IGF-1) promotes the survival of skeletal muscle cells under oxidative stress. It is unknown whether IGF-1 protects muscle-derived stem cells (MDSCs) from oxidative stress. In this study, we genetically engineered rat MDSCs to overexpress IGF-1 and determined cell viability, apoptosis, and VEGF secretion under oxidative stress. Overexpression of IGF-1 prevented MDSCs from H2O2-induced caspase-dependent apoptotic cell death by upregulating the PI3K/AKT pathway, accompanied with an increase of NF-κB, p-NF-κB, Bcl-2, and VEGF, as well as a decrease of Bax. In contrast, pre-administration of picropodophyllinb, wortmannin, 1L-6-hydroxymethyl-chiro-inositol-2-((R)-2-O-methyl-3-O-octadecylcarbonate), or pyrrolidine-dithiocarbamate, specific inhibitors of IGF-1R, PI3K, AKT, and NF-κB, respectively, followed by treatment with H2O2, resulted in cell death of MDSCs. Our data indicated that IGF-1 suppresses apoptosis and enhances the paracrine function of MDSCs under oxidative stress via enhancing IGF-1R/PI3K/AKT signaling. Thus, IGF-1 gene-modified MDSCs present a potential application in the treatment of muscle wasting, such as urethra intrinsic sphincter deficiency.

Normal pressure hydrocephalus

Normal pressure hydrocephalus (NPH) is a reversible disorder characterized by gait impairment, subcortical dementia, and urinary urgency and incontinence associated with impaired cerebrospinal fluid circulation and ventriculomegaly. Treatment with shunt surgery is most likely to increase mobility, and may also improve dementia and urinary symptoms. An international, independent study group recently published guidelines for the diagnosis and management of idiopathic NPH. This article helps geriatricians identify patients who might have NPH, and care for these patients after shunt placement.

Pathophysiology of overactive bladder

Overactive bladder (OAB) is a complex of symptoms frequently encountered in the primary care setting. Impediments to optimal management of OAB include inaccurate perceptions on the part of patients and primary care providers, e.g., that the symptoms of OAB represent a natural progression of aging and are beyond the scope of treatment or that diagnosis and treatment are specialist concerns. Complicating the physician's task is the reluctance of many patients to initiate discussion of their OAB symptoms and the fact that patients often develop disruptive coping strategies rather than seek medical treatment, possibly because of a belief that OAB is a normal part of aging rather than an actual medical condition. In most cases, OAB may be managed quite well by the primary care physician who has an understanding of the pathophysiology of OAB. This article reviews normal bladder function and then explores pathophysiologic changes that likely cause the symptoms of OAB.