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To assess the short-term efficacy of electrical pudendal nerve stimulation (EPNS) versus pelvic floor muscle training (PFMT) plus transanal electrical stimulation (TES) for the early treatment of post-radical prostatectomy urinary incontinence (PRPUI) and explore its mechanism of action.A parallel designed randomized controlled trial was conducted at a research institute and a university hospital. Ninety-six PRPUI patients were allocated to EPNS group (64 cases) and PFMT+TES group (32 cases) and treated by EPNS and biofeedback-assisted PFMT plus TES, 3 times a week for 8 weeks, respectively. Outcome measurements were improvement rate, scores of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and the number of used diapers.After 24 treatments, the efficacy rate of 68.7% in EPNS group was significantly higher than that of 34.4% in PFMT+TES group (P=0.005). The ICIQ-UI SF score, and urine leakage amount score, diaper score, symptom and quality of life improved significantly in both groups and showed Therapy x Treatment interaction, and the above scores in EPNS group were significantly lower than these in PFMT+TES group. Perineal ultrasonographic recordings showed that PFM movement amplitude during EPNS (≥1-3 mm) was similar to that during PFMT, however, PFM movement EMG amplitude was significantly higher during EPNS than during PFMT (P0.001).EPNS is more effective than PFMT+TES in short-term (8 weeks) treatments of early urinary incontinence after radical prostatectomy. Its mechanism of action is that EPNS can excite the pudendal nerve and simulate PFMT.

IntroductionUrinary incontinence (UI) is one of the main complications of radical prostatectomy. Electrical pudendal nerve stimulation (EPNS) has been used to treat stress UI based on its mechanism of passive pelvic floor muscle contraction reported in the previous research. However, there are no studies comparing the effects of EPNS and active pelvic floor muscle training (PFMT) in the treatment of postradical prostatectomy UI (PPUI). Here, we describe the protocol for a randomised controlled trial to evaluate the efficacy of EPNS in treating PPUI compared with PFMT.Methods and analysisThis study is designed as an open-label randomised controlled trial with blinded assessment and analysis. A total of 90 eligible men will be randomly allocated to two groups. The treatment group (n=45) will receive EPNS while the control group will perform PFMT by doing the Kegel exercise. Forty EPNS treatment sessions will occur over a period of 8 weeks. The primary outcome measure will be improvement rate, and the secondary outcome measures, the number of pads used, 24-hour pad test, and International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form will be compared between baseline and the study endpoint. The International Consultation on Incontinence Questionnaire-Lower Urinary Tract Symptoms Quality of Life and care compared as the quality of life and satisfaction outcomes between groups.Ethics and disseminationThis protocol has been approved by the Ethics Committee of the First Affiliated Hospital of Zhejiang Chinese Medical University (approval no. 2021 KL-040-02). Written informed consent will be obtained from each participant. The results of the study will be published in peer-reviewed journals.Trial registration numberChiCTR2200055461.

The historic urban landscape (HUL) is the result of the continuous dynamic process of production, interaction, and accumulation. It is full of information from bygone years and remains to this day as a living witness of antiquity and a benefit to the contemporary public, both in mind and spirit. These intangible benefits, however, are easier to overlook than the tangible ones in conservation and management efforts that aim at sustainability. Therefore, we return to the prototype of the category “cultural services” in the ecosystem classification “information service” to evaluate these intangible benefits. The objectives of this study are: (1) to provide a methodological framework to assess the ability of the landscape to continuously provide information services in the historical process; (2) to analyze the drivers affecting HUL’s ability to continuously deliver information services, and then discuss the governance experience of HUL’s intangible dimensions for sustainability. First, we regard HUL as an object to learn from the experience of urban heritage governance: using the methods and tools of ecosystem service evaluation, this paper evaluates the intangible services that the public receives from the landscape over several consecutive historical periods, summarizes the dynamic changes in these services, and analyzes their drivers. Furthermore, we consider that the aforementioned intangible services are brought about in part by the spread of heritage information stored in HUL among specific people, and the continuous provision of information services is considered the sustainability of HUL in intangible dimensions. We use Yuexiu Hill in the center of Guangzhou, China, as a case study to verify the feasibility of our methodological framework by evaluating the information services provided by this ancient area with a construction history of 2000 years over five historical periods. The data needed for the evaluation of the information service was obtained through text mining by retrieving 1063 ancient Chinese poems related to Yuexiu Hill from the poetry database. The results obtained through this evaluation framework will provide a quantitative basis for planning, design, and decision making in small and medium-sized landscapes.

Background Sacral neuromodulation (SNM) has become an effective therapy for patients with lower urinary tract dysfunction (LUTD) who do not respond to conservative treatment. However, an effective treatment strategy for patients who fail SNM has not yet been identified. An option for LUTD is needed when the clinical response to the SNM diminishes. Case presentation A 51-year-old Chinese man presented to an outpatient clinic complaining of difficulty in urination for > 3 years. The patient also complained of urinary frequency and urgency, accompanied by perineal discomfort. He was diagnosed with LUTD based on his symptoms and previous examinations. The patient underwent sacral neuromodulation with a permanent implantable pulse generator (IPG) (provided free of charge by Chengnuo Medical Technology Co., Ltd.; General Stim, Hangzhou, China) in the left buttock, as he participated in the company’s clinical trial to test the long-term effects of IPG. He reported loss of efficacy of the device 3 months after the implantation. We performed bilateral electrical pudendal nerve stimulation (EPNS) therapy for him. After 2 weeks of treatment, he began to report smooth voiding within 2 h after EPNS, and a moderate improvement in urinary frequency, urgency, and perineal discomfort. After 4 weeks of EPNS, the patient reported > 50% improvement in his urination, evaluated with the short form of the International Consultation on Incontinence Questionnaire for Male Lower Urinary Tract Symptoms. He reported smooth voiding, moderate improvements in urinary frequency and urgency, and the disappearance of the perineal discomfort. He also reported improved sleep and erections. The patient was discharged after 8 weeks of EPNS treatment. Conclusion EPNS could be an option as an additional therapy for patients with LUTD who have failed SNM.

Throughout the long history of urban expansion and development, some of the natural mountains, lakes, and rivers that were once located on the outskirts of a city have gradually been encircled within it and have become nature in the urban, i.e., they are now in the heart of the city. These are not only green infrastructure for contemporary cities; they have also accumulated a rich cultural heritage and are closely related to the physical health and subjective well-being of city dwellers. The objectives of this study were: (1) to identify the no-material services that the public perceives from UGSs throughout history that contribute to subjective well-being; (2) to analyze which landscape elements are associated with the provision of such services and then to clarify the value of UGSs throughout history and provide a theoretical basis for urban managers. We returned to the original concept of cultural services (information services) to understand how UGSs throughout history, as information sources, have provided subjective well-being to specific groups of people. And we build a classification system for information services based on this understanding. Based on existing research methods on cultural services, we found that collecting information carriers such as texts, images, and interview transcripts is a more effective way to identifying the intangible services provided by a landscape than monetary methods. From understanding of the information communication process, we attempted to integrate the supply and demand indicators of information services. We validated the feasibility of the method of information service identification using Yuexiu Hill in Guangzhou, which has a construction history of 2000 years, as an example. Through the word frequency statistics of 1063 ancient poems (a type of information carrier), elements of the historical landscape of Yuexiu Hill and the information services provided in the past were identified. After that, semantic networks were constructed to analyze the association between elements and services. The results of this study show that information service identification is an effective method of analyzing the effect of the promotion of UGSs throughout history on the subjective well-being of the public. The provision of information services depends on the accumulation and dissemination of environmental information; both natural and cultural elements, especially symbolic elements, play an important role in this process.

Sam50, a key component of the sorting and assembly machinery (SAM) complex, is also involved in bridging mitochondrial outer-membrane and inner-membrane contacts. However, the physiological and pathological functions of Sam50 remain largely unknown.Here we show that Sam50 interacts with MICOS (mitochondrial contact site and cristae organizing system) and ATAD3 (ATPase family AAA domain-containing protein 3) to form the Sam50-MICOS-ATAD3-mtDNA axis, which maintains mtDNA stability. Loss of Sam50 causes mitochondrial DNA (mtDNA) aggregation. Furthermore, Sam50 cooperates with Mic60 to bind to cardiolipin, maintaining the integrity of mitochondrial membranes. Sam50 depletion leads to cardiolipin externalization, which causes mitochondrial outer-membrane and inner-membrane (including crista membrane) remodeling, triggering Bax mitochondrial recruitment, mtDNA aggregation, and release. Physiologically, acetaminophen (an effective antipyretic and analgesic)-caused Sam50 reduction or Sam50 liver-specific knockout induces mtDNA release, leading to activation of the cGAS-STING pathway and liver inflammation in mice. Moreover, exogenous expression of Sam50 remarkably attenuates APAP-induced liver hepatoxicity.Our findings uncover the critical role of Sam50 in maintaining mitochondrial membrane integrity and mtDNA stability in hepatocytes and reveal that Sam50 depletion-induced cardiolipin externalization is a signal of mtDNA release and controls mtDNA-dependent innate immunity.

Small molecules emitting in the NIR for tracking mitochondrial pH alteration with super-resolution are expected to play an essential role in biomedical applications. Herein, two small molecules based on pyridinium salt (P1 and P2) have been synthesized and systematically investigated. It was found that pyridinium salts P1 and P2 emitted in the NIR (about 610 nm), which could detect pH changes from 2.0 to 11.0 with good linearity and high sensitivity. Importantly, P2 could precisely target cellular mitochondria in a real-time manner under stimulated emission depletion (STED). These results implied a chemical strategy with a potential application in super-resolution imaging and mitochondrial pH determination.

Additional file 1: Supplymentary Table 1. Lower urinary tract symptoms changes and bothersomeness index at each point of EPNS therapy investgated by Short form of International Consultation on Incontinence Questionnaire - Male Lower Urinary Tract Symptoms (ICIQ-MLUTS).

Objective: To examine the impact of electroacupuncture (EA) at the ‘four sacral points’ on urge urinary incontinence (UUI). Methods: Twenty-five patients diagnosed with UUI or urgency-predominant mixed urinary incontinence (MUI) were treated by EA at the ‘four sacral points’. EA was performed in the sacrococcygeal region using disposable sterile 0.40-mm-diameter acupuncture needles that were either 100 or 125 mm in length. Treatments were delivered once every other day. Before and after treatment, a questionnaire measuring symptom severity and quality of life associated with UUI was administered. Results: The median total score (interquartile range) from the severity of symptoms and the quality of life questionnaire (Q-score) of the participants was significantly reduced from 12 (7.5, 15) before treatment to 3 (0, 6) after 6 (6, 12) EA treatments. The Q-score of urgency-predominant MUI and UUI was 8 (5, 14.5) and 12.5 (11, 15), respectively, before treatment; after treatment these were reduced to 2 (0, 7.5) and 4.5 (2, 6), respectively. There was no statistically significant difference in the Q-score between urgency-predominant MUI and UUI before and after treatment. Upon treatment completion, seven patients (28%) were ‘cured’ (improvement rate 100%). Treatments were considered ‘markedly effective’ (improvement rate 75% to Conclusion: EA at the ‘four sacral points’ was associated with statistically significant improvements in UUI.

Aquaculture economy plays an important role in guaranteeing the food supply and quality protein output of our residents. By cleaning, aggregating and analyzing the big data of China, Japan and the United States from 2010 to 2017, published by the fisheries and aquaculture department of FAO, we study the development trend of aquaculture production and value in the three countries and make a prediction in 5 years by linear regression fitting. Finally, suggestions were put forward for the aquaculture development. This paper found that China’s aquaculture production and value have been developing steadily, and would continue to stay progression in five years, but the growth rate would decline. The variety of aquaculture species is diversified, the production and value of aquaculture farming species are relatively balanced. China should strengthen aquaculture resources and environmental conservation and vigorously develop high technology in aquaculture. As for Japan, development prospects are not bright in the near future. Due to the combined effects of tsunami and aging fishery communities, the aquaculture is generally showing a declining trend. Japan should take measures to restore and strengthen fishery resources and revitalize fishing communities. In the United States, aquaculture production declined gradually after 2004 due mainly to the shrinking scale of channel catfish farming. Since then, it has remained quite stable. Besides, the aquaculture species are relatively poor, the production and value of the farming species are extremely uneven. At present, the United States should expand aquaculture species, substantially increase aquaculture production and maintain a growing trend.

Supplemental material, sj-pdf-1-aim-10.1177_0964528420968846 for Sacral electroacupuncture as a treatment for urge urinary incontinence: a prospective case series by Shan Chen, Siyou Wang, Lihua Xuan, Fu Xu, Hanti Lu and Jing Lu in Acupuncture in Medicine

The drug abuse crisis has become a national emergency in the USA. Based on drug abuse data for Ohio, Kentucky, West Virginia, Virginia, and Pennsylvania in 2014–2017, this study used WinBUGS14 to create a Bayesian model. We added time and space effects and socioeconomic factors to correct the model. With the minimum DIC value as standard, we find out the optimal model to dynamically analyze the spatial–temporal trend of the relative risk of drug abuse and its relationship with socioeconomic factors. Besides, We used ArcGIS 10.6 to map drug abuse rates and relative risk in five states and found that the Bayesian space–time model with socioeconomic factors is the best (DIC = 336.282). This paper found that the relative risk of space–time interaction trends has experienced a process from convergence to divergence within four years. Ohio and Pennsylvania are high-risk states, while Virginia is a low-risk state. Although the rate of drug abuse is high, the relative risk is not necessarily high. Then, combined with socioeconomic factors, we found that the lower the GDP, the worse the educational background, the higher the unemployment rate and the greater the relative risk it is. The Bayesian spatial–temporal model is an effective method for analyzing the drug abuse data.

We compared the efficacy of electrical pudendal nerve stimulation vs transvaginal electrical stimulation to treat female idiopathic urgency urinary incontinence.A total of 120 female patients with idiopathic urgency urinary incontinence refractory to medication were randomized at a ratio of 2:1 to group 1 of 80 patients and group 2 of 40. Groups 1 and 2 were treated with electrical pudendal nerve stimulation and transvaginal electrical stimulation, respectively. To perform electrical pudendal nerve stimulation long acupuncture needles were deeply inserted into 4 sacrococcygeal points and electrified to stimulate pudendal nerves. Outcome measures were the 24-hour pad test and a questionnaire to measure the severity of symptoms and quality of life in women with urgency urinary incontinence.The median severity of symptoms and quality of life score on the urgency urinary incontinence questionnaire (urgency urinary incontinence total score) was 13 (range 7 to 18.75) in group 1 and 11 (range 8 to 16) in group 2 before treatment, which decreased to 2 (range 0 to 6.75) in group 1 and 6.5 (range 3.25 to 10.75) in group 2 (both p0.01) after the completion of treatment. At the end of treatment in group 1 complete symptom resolution was noted in 34 patients (42.5%), with a 50% or greater symptom improvement rate in 70.1%. In group 2 complete symptom resolution was noted in 1 patient (2.5%) with a 50% or greater symptom improvement rate in 45.0%. The posttreatment urgency urinary incontinence total score was lower and the therapeutic effect was better in group 1 than in group 2 (both p0.01).Electrical pudendal nerve stimulation is more effective than transvaginal electrical stimulation in treating drug refractory, female idiopathic urgency urinary incontinence.

Lipid droplets (LDs) ultrastructure progression under proteohormone stimulation provide valuable clues for understanding conditions associated with obesity and diabetes. Current available LDs probes either alter intra-LDs environments or lack photo-resistance; thus, this research domain is poorly understood. In this work, a N-B-O type BODIPY- hexylcarbazole derivative named BoCz-Lip was rationally designed while achieving specific LDs live-cell targeting. BoCz-Lip showed minimal impact on cell viability as well as internal LDs' protein, triglyceride and cholesterol level. Along with its good photostability, it can be used to monitor LDs evolution under super-resolution nanoscopy. More importantly, we concluded how proteohormone could influence LDs ultrastructure, offering a better understanding for correlating diseases at the nanoscale.

To compare the efficacies of electrical pudendal nerve stimulation (EPNS) vs electromyogram biofeedback (BF)-assisted pelvic floor muscle training (PFMT) plus transvaginal electrical stimulation (TES) in treating female stress urinary incontinence (SUI) and to evaluate the posttreatment and long-term efficacies of EPNS for female SUI.Forty-two female SUI patients were randomized into groups I and II, 21 in each group. The two groups were treated by EPNS and BF-assisted PFMT plus TES, respectively, for comparison of their effects. Group III (196 patients) were treated by EPNS for evaluation of its effects. To perform EPNS, long acupuncture needles were deeply inserted into four sacrococcygeal points and electrified to stimulate pudendal nerves. Outcome measures were stress test, 24-hour pad test, and a questionnaire to measure the severity of symptoms and quality of life in women with SUI.After 4 weeks of treatment, the questionnaire score was lower and the therapeutic effect was better in group I (questionnaire score 0 [0, 6] and a ≥ 50% symptom improvement rate of 85.7%, respectively) than in group II (questionnaire score 9 [5.5, 15.5] and a ≥ 50% symptom improvement rate of 28.6%) (both P .01). In group III, complete resolution occurred in 94 cases (48.0%), with a ≥ 50% symptom improvement rate of 85.7%, after 20.3 ± 16.8 sessions of treatment. At the mean follow-up of 52.9 months, complete resolution occurred in 32 (47.1%) of the 68 patients in group III who attained ≥50% posttreatment improvement.EPNS is more effective than BF-assisted PFMT plus TES in treating female SUI. It has good posttreatment and long-term effects on female SUI.

Since December 2019, Wuhan has became an outbreak epicentre of the novel coronavirus pneumonia. This study inferred the epidemic spread in Wuhan, which is of great importance for government immediately deployed mitigation interventions. In view of the fact that the virus is infectious during the incubation period, we added new variables to the SEIR model. We used the data published by Wuhan government from Dec 8, 2019, to Feb 4, 2020 to forecast the spreading trend and the number of infected people, then simulated the results of different government control efforts by changing the control variables. Furthermore, we used mathematical formulas to infer the basic reproduction number, and then calculated the probability of the neighbor being infected at each time step, simulated the epidemic course of epidemic by using the cellular automata model. Our finding suggested that the epidemic outbreak earlier under the government’s powerful control measures and the outbreak period begin on mid-January, then reach a peak on the mid-February. The cumulative number of infections in Wuhan would be controlled at 58310. More importantly, The basic reproduction number is 3.13, which indicated that the virus is high risk. Simultaneously, the cellular automata model is very suitable for simulating the spread course after the public health interventions.

Amounts of strategies implemented to obtain improved two-photon absorption responses but remains challenging. Herein, a serials zwitterionic chromophores, TSEO1–3, with D-π-A configuration were rational designed and synthesized. Notably, by minor modification of the side chain, the obtained TSEO3 exhibited enhanced two-photon activity and considerable two-photon imaging in vitro and in vivo. It manifested that appropriate modifications of side chains that are linked to conjugated frameworks can improve the intermolecular packing order and boost charge transfer favoring two-photon activity.

Objective To compare the short-term efficacy of electrical pudendal nerve stimulation (EPNS) vs anogenital electrical stimulation (AES) for neurogenic lower urinary tract disease. Patients and Methods Sixty eligible participants were randomized at a ratio of 2:1 to the test group of 40 patients and the control group of 20. The test group was treated with EPNS and the control group was treated with AES. After 12 sessions of treatment, therapeutic effects were evaluated based on self-assessed questionnaire scores. All patients with a residual urine volume >50 mL were also assessed by the post-treatment residual urine volume. Results At the end of treatment, the median symptom score and the quality of life score were 11 (range 3-23) and 4.26 (range 1.00-5.81) in the test group, and the median post-treatment residual urine volume was 46 (range 0-223) mL. By contrast, the median severity of symptoms and quality of life scores were 15 (range 8-33) and 3.84 (range 0.89-5.84) in the control group, and the median post-treatment residual urine volume was 105 (range 28-340) mL. Significant differences between the test group and the control group could be observed in the post-treatment symptom score, the quality of life score, and the residual urine volume (with P = .005, P Conclusion Compared with AES, EPNS is more effective in treating neurogenic lower urinary tract disease in the short term.

Study Type – Diagnostic (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Pelvic floor muscle training (PFMT) and transvaginal electrical stimulation (TES) are two commonly used forms of conservative treatment for stress urinary incontinence (SUI). PFMT may build up the structural support of the pelvis, but many SUI patients are unable to perform PFMT effectively and its primary disadvantage is lack of long-term patient compliance. TES is a passive treatment that produces PFM contraction and patient compliance with it is good; however, its effect is not as good as that of PFMT when performed correctly. Electrical pudendal nerve stimulation (EPNS) combines the advantages of PFMT and TES and incorporates the technique of deep insertion of long needles. In this study, simultaneous perineal ultrasound and vaginal pressure measurement prove that EPNS can contract the PFM and simulate PFMT. It is shown that EPNS is an alternative therapy for female SUI patients who fail PFMT and TES and the therapy can also be used for severe SUI. OBJECTIVES • To prove that electrical pudendal nerve stimulation (EPNS) can contract the pelvic floor muscles (PFM) and simulate pelvic floor muscle training (PFMT). • To show that EPNS is an alternative therapy for female stress urinary incontinence (SUI) that does not respond effectively to PFMT and transvaginal electrical stimulation (TES). PATIENTS AND METHODS • Thirty-five female patients with SUI who did not respond effectively to PFMT and TES (group I) were enrolled and 60 other female patients with SUI were allocated to group II (30 patients) and group III (30 patients). • Long needles were deeply inserted into four sacral points and electrified to stimulate the pudendal nerves. Group I and group II were treated by a doctor skilled in performing EPNS and group III, by a doctor unskilled in performing EPNS. • When EPNS was performed in group I, perineal ultrasonographic PFM movements, vaginal pressure (VP) and PFM electromyography were recorded simultaneously. • The therapeutic effects were evaluated according to objective and subjective criteria RESULTS • When EPNS was performed correctly, the patient felt strong PFM contractions. Simultaneous recordings in group I showed: B-mode cranio-caudal PFM movements; M-mode PFM movement curves (amplitude: about 1 mm, n= 31); a sawtooth curve of VP changes (2.61 ± 1.29 cmH2O, n= 34); and PFM myoelectric waves (amplitude: 23.9 ± 25.3 µV). • If during the EPNS process the electric current was stopped or its intensity was reduced to about 7–12 mA or the two lower needles were drawn back, then the above ultrasonographic PFM movements and VP changes disappeared. • In group I, the incontinence severity and quality of life score was 16.5 ± 4.0 before treatment and decreased to 4.2 ± 4.0 after 27.5 ± 11.9 sessions of treatment (P < 0.01). At the end of treatment, 100% improvement occurred in 16 cases (45.7%). A 2-year follow-up showed that 100% improvement occurred in 14 of cases (40.0%). • In group II, the incontinence severity and quality of life score was 17.1 ± 6.3 before treatment and decreased to 3.5 ± 3.7 after 10 sessions of treatment (P < 0.01) and 100% improvement occurred in 12 cases (40.0%). In group III, the incontinence severity and quality of life score was 17.6 ± 6.3 before treatment and decreased to 10.8 ± 8.2 after 10 sessions of treatment (P < 0.01) and 100% improvement occurred in one case (3.3%). • The post-treatment score was lower and the therapeutic effect was better in group II than in group III (both P < 0.01). CONCLUSIONS • EPNS can contract the PFM and simulate PFMT. • EPNS is an alternative therapy for female SUI patients who fail PFMT and TES.

IntroductionElectroacupuncture at ‘four sacral points’, also known as electrical pudendal nerve stimulation therapy, combines the advantages of pudendal nerve neuromodulation and the technique of deep insertion of long acupuncture needles. It has been used to treat stress urinary incontinence, female urgency-frequency syndrome, idiopathic urgency urinary incontinence and neurological bladders in previous studies. Here, we describe the protocol for a randomised controlled trial for evaluation of the efficacy and safety of electroacupuncture at ‘four sacral points’ for the management of urinary incontinence after stroke.Methods and analysisThis is an open-label randomised controlled trial with blinded assessments and analyses. A total of 140 eligible patients will be randomly allocated to two groups. The treatment group (n=70) will receive electroacupuncture at ‘four sacral points’ along with routine medical care, while the control group will receive conventional electroacupuncture along with routine medical care. Twenty treatment sessions will occur over a period of 4 weeks. The primary outcome measures will be the self-recorded findings in an incontinent episode diary at baseline and at 4 weeks after baseline. The secondary outcome measures will be the International Consultation on Incontinence Questionnaire Urinary Incontinence—Short Form (ICIQ-UI SF) score and the Barthel Activities of Daily Living Index (Barthel ADL Index) score at baseline and at 4 and 28 weeks after baseline.Ethics and disseminationThis protocol has been approved by the Ethics Committee of the First Affiliated Hospital of Zhejiang Chinese Medical University (approval No. 2018-K-059–01). Written informed consent will be obtained from each participant. The results of the study will be published in peer-reviewed journals.Trial registration numberChiCTR-IOR-17012847; Pre-result.

Electrical pudendal nerve stimulation (EPNS) was developed by combining the advantages of pudendal neuromodulation (PNM) and percutaneous tibial nerve stimulation (PTNS) and incorporating the technique of deep insertion of long acupuncture needles. The purpose of this study is to show the long-term efficacy of EPNS in treating urgency-frequency syndrome (UFS) in women.One hundred and six consecutive female UFS patients were enrolled and treated with EPNS. Long acupuncture needles were deeply inserted into four sacral points and electrified to stimulate the pudendal nerves. Evaluation of therapeutic effects was based on a questionnaire (including questions on storage, voiding, and postmicturition symptoms). Patients with ≥50 % posttreatment symptom improvement were followed up for at least 60 months.Complete resolution and ≥50 % improvement rate were 42.5 % and 85.8 %, respectively, in the 106 patients after a mean of 21.2 sessions of EPNS treatment. Of the 91 patients with ≥50 % posttreatment improvement, 62 (29 with complete resolution, 15 with marked improvement, and 18 with moderate improvement) were available for follow-up at 60-126 (mean 99.5; median 98) months after the end of EPNS treatment. Of these 62 patients, 35 maintained the posttreatment effect, 18 changed from better to complete resolution, and seven changed back to50 % improvement; only four of whom changed to25 % improvement.EPNS combines the advantages of PNM (better effect) and PTNS (minimally invasive, easily applicable, and well tolerated) in treating UFS. It has a good long-term therapeutic effect on UFS in women.