bluuebunny/crossref_metadata_2025 huggingface dataset:
Pyrethroid resistance in Frankliniella occidentalis (Pergande) (Thysanoptera: Thripidae) and implications for its management in Australia
Authors: Thalavaisundaram Swaminathan , Herron Grant A , Clift Alan D , Rose Harley
Published: February 2008

Abstract  The study was conducted to characterise the underlying resistance mechanisms responsible for high levels of pyrethroid resistance in Frankliniella occidentalis (Pergande) in Australia. Seven commercially available pyrethroids (acrinathrin, alpha‐cypermethrin, bifenthrin, deltamethrin, esfenvalerate, permethrin and tau‐fluvalinate) were evaluated against seven F. occidentalis strains collected from ornamentals, fruit and vegetables in three states of Australia. A Potter spray tower was used to test for pyrethroid resistance and all field strains were found to be resistant, with resistance ratios ranging from 15‐fold deltamethrin to 1300‐fold tau‐fluvalinate. The two most resistant strains were further tested for detoxification enzymes that could be involved in resistance. Three synergists, piperonyl butoxide (PBO), diethyl maleate (DEM) and profenofos, which, respectively, inhibit the enzymes cytochrome P‐450 monooxygenases, glutathione S‐transferases and esterases, were used. The synergism data indicate that multiple mechanisms may be involved in pyrethroid resistance in Australian populations of F. occidentalis. Among the three synergists, PBO considerably reduced pyrethroid resistance in the selected strains compared with DEM and profenofos. The practical implication for PBO use to suppress pyrethroid resistance in F. occidentalis is elaborated.
Polymorphisms in the promoter region of the basic fibroblast growth factor gene and proliferative diabetic retinopathy in Caucasians with type 2 diabetes
Authors: Petrovič Mojca Globočnik , Krkovič Miha , Osredkar Joško , Hawlina Marko , Petrovič Daniel
Published: February 2008

Abstract

Background:  Basic fibroblast growth factor (bFGF) expression is implicated in proliferative diabetic retinopathy (PDR). The aim of this study was to investigate the association of genetic polymorphisms (−553T/A, −834T/A and −921C/G) in the promoter region of the bFGF gene with PDR in patients with type 2 diabetes. The second aim was to determine whether serum levels of bFGF are affected by genetic factors.

Methods:  In this cross‐sectional case–control study 313 unrelated Caucasians (Slovene population) with type 2 diabetes mellitus were enrolled: 206 patients with PDR and the control group of 107 subjects with type 2 diabetes of duration of more than 10 years who had no clinical signs of diabetic retinopathy. We analysed serum bFGF levels in 78 subjects with type 2 diabetes and 25 subjects without diabetes.

Results:  The AT genotype of the −553T/A polymorphism was present in 31 (15.0%) PDR patients and in seven (6.5%) controls (P = 0.03, odds ratio = 2.0, 95% confidence interval = 1.0–3.9). The AT genotype of the −834T/A polymorphism was present in 12 (5.8%) PDR patients and in 15 (14.0%) controls (P = 0.01, odds ratio = 0.4, 95% confidence interval = 0.2–0.8). Significantly higher bFGF serum levels were demonstrated in diabetics with the AT genotype of the −553 polymorphism compared with diabetics with the TT genotype, whereas the −834 and −921 polymorphisms failed to affect serum bFGF levels.

Conclusions:  We may conclude that the AT genotype of the 553 T/A polymorphism was associated with PDR in Caucasians with type 2 diabetes, therefore it might be used as a genetic marker of PDR in Caucasians, whereas carriage of the AT genotype of the −834 T/A polymorphism might decrease PDR risk.
Delirium among elderly general medical patients in a New Zealand hospital
Authors: Holden J. , Jayathissa S. , Young G.
Published: February 2008

Background:  Overseas studies suggest that delirium is a common and serious health problem of hospitalized elderly. There is very little information in New Zealand.

Aims:  To study prospectively the frequency and effect of delirium on a cohort of elderly general medical patients.

Methods:  Over 2 months, 317 patients were admitted to general medical wards; 70% were aged 65 years and above. These patients were screened for delirium. Comparisons were made between the delirious and non‐delirious patients.

Results:  Fifty‐six of the 216 patients screened had delirium. The prevalence and incidence of delirium were 23.4 and 5.7%, respectively. Thirty‐one per cent of delirious patients had a previous history of dementia; 48% of delirious patients had multiple precipitants, most commonly infections. Delirium was associated with higher complication rates – 94 versus 39% in the non‐delirious patients – and a doubling in the length of hospital stay. Over 50% of delirious patients required increased supports on discharge with a general trend towards higher frequency of institutionalization. The presence of delirium was associated with increased use of neuroleptic medications, special nursing care, cot sides and restraints. A non‐significant trend towards increased mortality was seen in the delirious group.

Conclusions:  Delirium is a common health problem in elderly patients, associated with multiple adverse outcomes. This study highlighted the prognostic importance of diagnosing delirium. Recommendations included improved health professional education, development of guidelines including rational use of neuroleptic medication and measures to improve follow up for these patients.
Prevalence, detection and drug treatment of hypertension in a rural Australian population: the Greater Green Triangle Risk Factor Study 2004–2006
Authors: Janus E. D. , Bunker S. J. , Kilkkinen A. , Namara K. Mc , Philpot B. , Tideman P. , Tirimacco R. , Laatikainen T. K. , Heistaro S. , Dunbar J. A.
Published: February 2008

Background:  Hypertension is an important risk factor for cardiovascular disease; however, limited findings are available on its detection and management in rural Australia.

Aim:  To assess the prevalence, awareness and treatment of hypertension in a rural South‐East Australian population.

Methods:  Three cross‐sectional surveys in Limestone Coast, Corangamite Shire and Wimmera regions during 2004–2006 using a random population sample (n = 3320, participation rate 49%) aged 25–74 years. Blood pressure was measured by trained nurses. Information on history of hypertension and medication was obtained by questionnaires. Hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg and/or on antihypertensive drug treatment.

Results:  Overall, one‐third of participants had hypertension; of these, two‐thirds, 54% (95% confidence interval (CI) 47–60) of men and 71% (95% CI 65–77) of women, were aware of their condition. Half of the participants with hypertension were treated and nearly half of these were controlled. Both treatment and control were more common in women (60%, 95% CI 54–67 and 55%, 95% CI 47–64) compared with men (42%, 95% CI 36–49 and 35%, 95% CI 26–44). Monotherapy was used by 55% (95% CI 48–61) of treated hypertensives. Angiotensin‐converting enzyme inhibitors were the most frequently used class of antihypertensive drugs in men, whereas angiotensin‐converting enzyme inhibitors, angiotensin receptor antagonists and diuretics were all widely used among women.

Conclusion:  This study emphasizes suboptimal detection and treatment of hypertension, especially in men, in rural Australia.
Using simulation models to teach junior doctors how to insert chest tubes: a brief and effective teaching module
Authors: Hutton I. A. , Kenealy H. , Wong C.
Published: February 2008

Background:  Pleural procedures may cause serious complications when incorrectly carried out. There is a need to find effective methods for teaching how to insert a chest drain safely.

Aim:  To assess the effectiveness of a programme for teaching chest tube insertion using a simulation model (SuperAnnie).

Methods:  Groups of four to six junior doctors were enrolled in a 2‐h teaching session, covering both theoretical knowledge and practical chest tube insertion techniques using a simulation model. Before the teaching module, participants completed a questionnaire about their confidence and skill levels and were videotaped inserting a standard chest tube in the model. The assessments were repeated 1 month after the teaching module. The video clips were scored by two independent assessors using an 18‐point scoring system that was blinded to whether the taping was pre‐ or post‐teaching.

Results:  Forty‐nine doctors completed the study. Baseline video assessment scores were low (median score 4 (maximum possible score 18), interquartile range (IQR) 2–7.5) and were not associated with past experience, the doctor’s self‐confidence level or their self‐assessed skill rating. After teaching, video assessment scores improved significantly (mean score 13, IQR 10.5–15). Doctors with the lowest baseline scores showed the most improvement. There were also improvements in doctors’ self‐confidence and self‐assessed skill levels, although there remained no association between these measures and video assessment scores.

Conclusions:  A brief teaching module using a simulation model is effective in improving confidence and skill in chest tube insertion.
Prolonged seated immobility at work is a common risk factor for venous thromboembolism leading to hospital admission
Authors: Aldington S. , Pritchard A. , Perrin K. , James K. , Wijesinghe M. , Beasley R.
Published: February 2008

The role of seated immobility at work in the pathogenesis of venous thromboembolism (VTE) is uncertain. In this case series, 61 patients aged <65 years with a recent admission for deep venous thrombosis and/or pulmonary embolism completed an interviewer‐administered questionnaire to obtain information regarding risk factors. Prolonged seated immobility at work in the 4 weeks before the VTE event was defined as being seated at least 8 h in a 24‐h period and at least 3 h at a time without getting up, at least 10 h in a 24‐h period and at least 2 h at a time without getting up or at least 12 h in a 24‐h period and at least 1 h at a time without getting up. The most commonly identified risk factors were family history of VTE (21 of 61, 34%), seated immobility at work (21 of 61, 34%) and a thrombophilic state (19 of 61, 31%). We conclude that prolonged seated immobility at work may represent a common and important risk factor for VTE.
Insights into Yersinia pestis biofilm development: topology and co‐interaction of Hms inner membrane proteins involved in exopolysaccharide production
Authors: Bobrov Alexander G. , Kirillina Olga , Forman Stanislav , Mack Dietrich , Perry Robert D.
Published: February 2008

Primarily, three operons, hmsHFRS, hmsT and hmsP, are responsible for the development of a Yersinia pestis biofilm, which is essential for blockage‐dependent transmission of plague from fleas to mammals. Here, using specific antibodies, a polymeric β‐1,6‐N‐acetyl‐d‐glucosamine‐like polysaccharide was detected in the extracellular matrix of hmsHFRS‐dependent Y. pestis biofilm. The production of this exopolysaccharide (EPS) was controlled by diguanylate cyclase HmsT and EAL domain phosphodiesterase HmsP, acting as positive and negative regulators respectively. Cellular compartmentalization of soluble segments of Hms inner membrane proteins, including the putative glycosyltransferase domain of HmsR, the diguanylate cyclase/GGDEF domain of HmsT and the phosphodiesterase/EAL domain of HmsP, was determined by a combination of topology prediction algorithms and construction of C‐terminal translational fusions with β‐galactosidase and alkaline phosphatase. Multiple interactions of Hms inner membrane proteins were detected using bacterial cAMP based two‐hybrid system. Biochemical analyses confirmed some of these protein–protein interactions. Our results indicate that synthesis and regulation of the Y. pestis biofilm EPS occurs in the cytoplasm by a proposed Hms enzymatic complex.
Role for the Ankyrin eukaryotic‐like genes of Legionella pneumophila in parasitism of protozoan hosts and human macrophages
Authors: Habyarimana Fabien , Al‐khodor Souhaila , Kalia Awdhesh , Graham James E. , Price Christopher T. , Garcia Maria Teresa , Kwaik Yousef Abu
Published: February 2008

Legionella pneumophila is a ubiquitous organism in the aquatic environment where it is capable of invasion and intracellular proliferation within various protozoan species and is also capable of causing pneumonia in humans. In silico analysis showed that the three sequenced L. pneumophila genomes each contained a common multigene family of 11 ankyrin (ank) genes encoding proteins with ∼30–35 amino acid tandem Ankyrin repeats that are involved in protein–protein interactions in eukaryotic cells. To examine whether the ank genes are involved in tropism of protozoan hosts, we have constructed isogenic mutants of L. pneumophila in ten of the ank genes. Among the mutants, the ΔankH and ΔankJ mutants exhibit significant defects in robust intracellular replication within A. polyphaga, Hartmanella vermiformis and Tetrahymena pyriformis. A similar defect is also exhibited in human macrophages. Most of the ank genes are upregulated by L. pneumophila upon growth transition into the post‐exponential phase in vitro and within Acanthamoeba polyphaga, and this upregulation is mediated, at least in part, by RpoS. Single‐cell analyses have shown that upon co‐infection of the wild‐type strain with the ankH or ankJ mutant, the replication defect of the mutant is rescued within communal phagosomes harbouring the wild‐type strain, similar to dot/icm mutants. Therefore, at least two of the L. pneumophila eukaryotic‐like Ank proteins play a role in intracellular replication of L. pneumophila within amoeba, ciliated protozoa and human macrophages. The Ank proteins may not be involved in host tropism in the aquatic environment. Many of the L. pneumophila eukaryotic‐like ank genes are triggered upon growth transition into post‐exponential phase in vitro as well as within A. polyphaga. Our data suggest a role for AnkH and AnkJ in modulation of phagosome biogenesis by L. pneumophila independent of evasion of lysosomal fusion and recruitment of the rough endoplasmic reticulum.
Relation of microvessel density with microvascular invasion, metastasis and prognosis in renal cell carcinoma
Authors: Yildiz Esin , Ayan Semih , Goze Fahrettin , Gokce Gokhan , Gultekin Emin Y.
Published: February 2008

OBJECTIVE

To clarify the significance of microvessel density (MVD) in a retrospective investigation the relationship between the pattern of MVD (reflecting angiogenesis), and tumour stage, grade, size, and occurrence of microvessel invasion (MVI), metastasis, and cancer‐specific survival (CSS) in patients who had surgery for renal cell carcinoma (RCC).

PATIENTS AND METHODS

Vessels were labelled in sections of formalin‐fixed, paraffin‐embedded tissues from 54 RCCs by CD34 immunohistochemistry. The mean MVD, expressed as the number of vessels per 10 high‐power fields (HPF, ×400) were measured for each case. In addition, all pathological slides were reviewed for the presence and absence of MVI. The prognostic value of MVD and MVI was then evaluated, and correlated with the usual prognostic variables, tumour metastasis and CSS.

RESULTS

In a univariate analysis of CSS, the MDV tended to be lower as stage increased from pT1 to pT3, and as grade increased from G1 to G4, although it was statistically significant only for stage (P < 0.001 and 0.050, respectively). The mean MVD was higher in 42 nonmetastatic than in 12 metastatic tumours, and in 33 tumours associated with MVI than in 21 with no MVI (P < 0.001). The mean MVD was also lower and significantly different for 28 large than 26 small tumours (P = 0.005). The survival rate of patients with tumours that were small, low‐stage, of higher MVD, with no MVI and metastasis was significantly higher than that of patients with large, high‐stage, low MVD, with MVI and metastatic tumours (all P < 0.001). MVI was significantly more common with a decreasing trend in MVD and the presence of metastasis (Spearman rank correlation rs = −0.68, P = 0.01, and rs = 0.39, P = 0.01, respectively). Independent prognostic factors in a multivariate analysis were: in all patients with RCC, tumour stage (P = 0.013) and metastasis (P = 0.028); in those with low MVD, MVI (P = 0.004) and metastases (P = 0.016); in those with no MVI, stage (P = 0.020); in those with MVI, MVD (P = 0.001); in those with no metastases, stage (P = 0.045); and in those with metastases, MVD (P < 0.001). No independent predictor was identified in patients with high MVD. In patients with no metastases there was a significantly shorter median CSS time in RCCs with low MVD and with MVI (P = 0.004 for both). Similarly, patients who had grade 3–4 tumours, vs those with lower MVD and with MVI, had a significantly shorter median CSS (P = 0.020 for MVD, and 0.01 for MVI).

CONCLUSIONS

This study suggested that MVD in RCC was inversely associated with MVI, tumour metastasis, patient survival and tumour diameter and stage, from the usual prognostic variables, but MVD was not an independent prognostic factor in multivariate analysis for all patients with RCC. Low MVD and the presence of MVI appears to be a marker for identifying patients with an adverse prognosis.
Introduction of an enhanced recovery protocol for radical cystectomy
Authors: Arumainayagam Nimalan , McGrath John , Jefferson Kieran P. , Gillatt David A.
Published: February 2008

OBJECTIVE

To describe and assess an enhanced recovery protocol (ERP) for the peri‐operative management of patients undergoing radical cystectomy (RC), which was started at our institution on 1 October 2005, as RC is associated with increased morbidity and longer inpatient stays than other major urological procedures.

PATIENTS AND METHODS

An ERP was introduced in our institution that focused on reduced bowel preparation, and standardized feeding and analgesic regimens. In all, 112 consecutive patients were compared, i.e. 56 before implementing the ERP and 56 since introducing the ERP. The primary outcome measures were duration of total inpatient stay and interval from surgery to discharge, and the morbidity and mortality. Data were analysed retrospectively from cancer network and hospital records.

RESULTS

The demographics of the two groups showed no significant difference in age, gender distribution, American Society of Anesthesiologists grade, or type of urinary diversion. Re‐admission, mortality and morbidity rates showed no statistically significant difference between the groups. The median (interquartile range) duration of hospital stay was 17 (15–23) days in the no‐ERP group, and 13 (11–17) days in the ERP group (significantly different, P < 0.001, Wilcoxon rank‐sum test). The median duration of recovery after RC was 15 (13–21) days in the no‐ERP group and 12 (10–15) days in the ERP group (significantly different, P = 0.001, Wilcoxon rank‐sum test).

CONCLUSION

The introduction of an ERP was associated with significantly reduced hospital stay, with no deleterious effect on morbidity or mortality.
Methylation of the TPEF‐ and PAX6‐promoters is increased in early bladder cancer and in normal mucosa adjacent to pTa tumours
Authors: Hellwinkel Olaf J.C. , Kedia Merab , Isbarn Hendrik , Budäus Lars , Friedrich Martin G.
Published: February 2008

OBJECTIVE

To evaluate CpG island methylation patterns of cancer‐associated genes for their applicability as molecular biomarkers for the detection of superficial bladder cancer and for the discrimination of invasive from noninvasive tumours.

PATIENTS AND METHODS

We analysed the methylation status of CpG islands in the promoter region of the cancer‐associated genes GSTP1, DAPK, MDR1, TPEF, PAX6, and TSLC1 in primary papillary bladder cancer specimens from 39 patients (pT1 10, pTis one, pTa 20, pT2 five). Tumour‐adjacent normal mucosa served as the control. The DNAs were bisulphite‐treated and submitted to methylation‐specific real‐time polymerase chain reactions.

RESULTS

Only TPEF and PAX6 had substantial CpG island methylation percentages. The TPEF‐ and PAX6‐promoters also had significantly higher methylation rates in tumour tissue compared with the normal tumour‐adjacent tissue. Interestingly, the methylation rates of the TPEF‐ and the PAX6‐promoter were higher in adjacent normal tissues from bladders with pTa then in those with pT1 tumours.

CONCLUSION

Our results shed a critical light on the hypothesis that CpG island hypermethylation of the GSTP1‐, DAPK‐, MDR1‐ and TSLC1‐promoter could represent molecular biomarkers for bladder cancer diagnosis and detection. However, methylated PAX6‐ or TPEF‐promoters could represent biomarkers for this disease. Additional studies are needed to evaluate whether methylation rates of these genes in normal bladder tissues are applicable as accessory markers for the tumour state or its invasive behaviour.
Real‐time virtual ultrasonographic radiofrequency ablation of renal cell carcinoma
Authors: Ukimura Osamu , Mitterberger Michael , Okihara Koji , Miki Tsuneharu , Pinggera Germar M. , Neururer Richard , Peschel Reinhard , Aigner Friedrich , Gradl Johann , Bartsch Georg , Colleselli Daniela , Strasser Hannes , Pallwein Leo , Frauscher Ferdinand
Published: February 2008

OBJECTIVE

To evaluate the usefulness of real‐time virtual ultrasonography (RVS) as a new navigational tool for percutaneous radiofrequency ablation (RFA) of solid renal cell carcinoma (RCC).

PATIENTS AND METHODS

Ten patients with 13 RCCs were treated with percutaneous RFA using RVS, which displays ultrasonograms and corresponding multiplanar reconstruction images of computed tomography in parallel.

RESULTS

RVS allowed excellent anatomical visualization and precise navigation of RFA for RCC. All patients were treated successfully in one session with percutaneous RVS RFA. There were no significant complications, and none of the patients had a local tumour recurrence during the follow‐up.

CONCLUSION

RVS for RFA of solid RCC is a new and promising alternative imaging method.
Pharmacological characterization of a novel investigational antimuscarinic drug, fesoterodine, in vitro and in vivo
Authors: Ney Peter , Pandita Raj Kumar , Newgreen Donald T. , Breidenbach Alexander , Stöhr Thomas , Andersson Karl‐Erik
Published: February 2008

OBJECTIVE

To investigate the primary pharmacology of fesoterodine (a novel antimuscarinic drug developed for treating overactive bladder) and SPM 7605 (its active metabolite, considered to be the main pharmacologically active principle of fesoterodine in man) against human muscarinic receptor subtypes, and to investigate in vitro and in vivo functional activity of these agents on the rat bladder compared with existing standard agents.

MATERIALS AND METHODS

The displacement of radioligand binding by fesoterodine, SPM 7605 and standard agents in membrane preparations of Chinese hamster ovary (CHO) cells expressing the different human muscarinic receptors (M1–M5) was characterized. Agonistic and antagonistic activities were studied using different CHO cell lines stably expressing the human recombinant muscarinic receptor subtypes. The effects of fesoterodine and SPM 7605 on isolated bladder strips contracted by carbachol or electrical field stimulation (EFS) were investigated. In vivo the effects of fesoterodine and SPM 7605 on micturition variables were assessed using continuous cystometry in conscious female Sprague‐Dawley rats, and compared to those of oxybutynin and atropine.

RESULTS

In vitro SPM 7605 potently inhibited radioligand binding at all five human muscarinic receptor subtypes with equal affinity across all five. Fesoterodine had a similar balanced selectivity profile but was less potent than SPM 7605. Both substances were competitive antagonists of cholinergic agonist‐stimulated responses in human M1‐M5 cell lines and had a similar potency and selectivity profile to the radioligand‐binding studies. In rat bladder strips, fesoterodine and SPM 7605 caused a rightward shift of the concentration‐response curve for carbachol with no depression of the maximum, and concentration‐dependently reduced contractions induced by EFS. The potency of both drugs was similar to that of atropine and oxybutynin. In the presence of the esterase inhibitor neostigmine, the concentration‐response curve of fesoterodine was shifted to the right, suggesting that part of the activity was caused by metabolism to SPM 7605 by tissue enzymes. In vivo, low doses (0.01 mg/kg) of fesoterodine and SPM 7605 reduced micturition pressure and increased intercontraction intervals and bladder capacity, but did not affect residual volume.

CONCLUSIONS

Fesoterodine and its active metabolite, SPM 7605, are nonsubtype selective, competitive antagonists of human muscarinic receptors, but SPM 7605 has greater potency than the parent compound. Pharmacodynamic studies in the rat bladder in vitro confirm the competitive muscarinic antagonist profile of these agents in a native tissue preparation, and in vivo studies in the rat showed effects on bladder function consistent with a muscarinic antagonist profile.
Laser‐capture microdissection in prostate cancer research: establishment and validation of a powerful tool for the assessment of tumour–stroma interactions
Authors: Shukla Chitranjan J. , Pennington Caroline J. , Riddick Antony C.P. , Sethia Krishna K. , Ball Richard Y. , Edwards Dylan R.W.
Published: February 2008

OBJECTIVES

To describe our experience with the optimization and validation of laser‐capture microdissection (LCM) for biomarker analysis in prostate tissues. As LCM allows the separation of benign and malignant epithelial structures and stromal elements, it not only allows identification of the source of the biomarker, but might also accentuate gene or protein expression changes by reducing contamination by other cellular elements.

MATERIALS AND METHODS

In all, 19 fresh‐frozen prostate tissue samples were subjected to LCM, with the cDNA being analysed using quantitative polymerase chain reaction for several genes, to identify the optimum number of cells for capture, as well as gene markers assessing for the purity of the captured cells. The localization was further confirmed by in situ hybridization.

RESULTS

Prostate‐specific antigen (PSA) and cytokeratin 8, were expressed solely by epithelial cells, whereas hepatocyte growth factor (HGF) and tissue inhibitor of metalloproteinases‐3 (TIMP3) were expressed only by stromal cells, and the levels of transcripts of these genes were unaltered between benign and malignant tissues.

CONCLUSIONS

These data suggest that PSA, cytokeratin 8, HGF and TIMP3 are reliable gene markers of purity of epithelial and stromal compartments for LCM of prostate tumours. Although this technique is not new and is increasingly used in laboratories, it needs optimization and stringent validation criteria before data analysis. This applies to all tissue types subjected to LCM.
Female sexual dysfunction: a new urogynaecological research field
Authors: Dalpiaz Orietta , Kerschbaumer Andrea , Mitterberger Michael , Pinggera Germar M. , Colleselli Daniela , Bartsch Georg , Strasser Hannes
Published: February 2008

Associate Editor

Michael G. Wyllie

Editorial Board

Ian Eardley, UK

Jean Fourcroy, USA

Sidney Glina, Brazil

Julia Heiman, USA

Chris McMahon, Australia

Bob Millar, UK

Alvaro Morales, Canada

Michael Perelman, USA

Marcel Waldinger, Netherlands

OBJECTIVE

To critically review published data on the urogynaecological aspects of female sexual dysfunction (FSD), as FSD is a developing multidisciplinary issue associated with several biological, medical and psychological factors.

METHODS

The reported prevalence of FSD is 19–50% and women with lower urinary tract symptoms or urinary incontinence (UI) not only complain of a deteriorating of quality of life but also of sexual life with an incidence as high as 26–47%. Furthermore, urogynaecological surgery represents an important but underestimated cause of FSD. Different databases (Pub Medical, Medline, serial titles, the Cochrane library and the NLM gateway database) were searched for the keywords ‘sexuality; sexual function; urinary incontinence; pelvic organ prolapse; questionnaire; symptom severity; epidemiology; quality of life; instruments; sexual health; vagina; vaginal surgery; pelvic surgery’.

RESULTS

There is a lack of a standardized instrument for assessing FSD. Recent studies investigate the impact of UI on sexual function, but the pathophysiology has not been elucidated. Vaginal or pelvic surgery does not affect overall sexual satisfaction.

CONCLUSIONS

Our investigation highlights the need for studies to assess the anatomical, physiological and sensory mechanisms related to FSD. Specific questionnaire are needed to quantify the problem. In the definition, symptoms assessment and preoperative counselling is important, to make a distinction between overall sexual function and individual parameters, such as psychosocial context. Only in this way, will it be possible to identify new therapeutic targets. A definition of success in urogyneacological terms should include aspects of quality of life and quality of sexual life. Immediate research in this field is needed.
A four‐step technique of robotic right adrenalectomy: initial experience
Authors: Krane L. Spencer , Shrivastava Alok , Eun Dan , Narra Vinod , Bhandari Mahendra , Menon Mani
Published: February 2008

OBJECTIVE

To report a safe, quick and reproducible technique of robotically assisted right adrenalectomy (RRA), developed by assessing the surgical anatomy of the right adrenal gland, its vascularity, and the surrounding structures, through a high definition, magnified three‐dimensional view of the operating field provided by the da Vinci® surgical system (Intuitive Surgical, Sunnyville CA, USA).

PATIENTS AND METHODS

Four patients had RRA between January and July 2007 at the Vattikuti Urology Institute, for varied indications. We extensively reviewed published anatomical and surgical reports of the anatomy of the region to plan the surgical steps for RRA, careful reconfirming recognized anatomical facts and their probable significance. The surgical steps involved: (i) complete division of the hepatocolic ligament; (ii) definition of the right adreno‐caval junction (ACJ); (iii) division of the right adrenal vein; (iv) dissection and removal of the adrenal gland circumferentially. The surgery was digitally recorded and reviewed.

RESULTS

All the adrenalectomies were done transperitoneally through five ports, replicating predetermined surgical steps. There were no anaesthesia or surgery related events and no patient required conversion to open surgery. All the patients had an uneventful recovery and were discharged home 0–3 days after RRA. With increasing experience it was possible to reach the ACJ with minimal peripheral dissection. From a lateral approach, we visualized the adrenal vein travelling along the anterior portion of the gland before terminating at the inferior vena cava and the retrocaval location of the medial edge of the adrenal gland. The right adrenal vein (singular or duplicate) was the only surgically significant vessel, as the other vessels encountered were controlled with bipolar diathermy.

CONCLUSIONS

Robotic assistance facilitated microdissection of fine anatomical planes around the right adrenal gland and provided direct access to the crucial ACJ. This technique permits ligation of the adrenal vein as an initial step, with no need to handle the adrenal gland. In the initial experience with four patients this technique was reproducible, regardless of indication or anatomical variance.
Is continent diversion using the Mitrofanoff principle a viable long‐term option for adults requiring bladder replacement?
Authors: Sahadevan Kanagasabai , Pickard Robert S. , Neal David E. , Hasan Tahseen S.
Published: February 2008

OBJECTIVE

To audit the long‐term outcome of patients with Mitrofanoff continent urinary diversion (MUD) to inform counselling of future patients concerning the procedure.

PATIENTS AND METHODS

All patients who underwent MUD between 1990 and 2003 were identified. Continence, urinary tract infection (UTI), calculus formation and renal function were assessed by chart review and interviews.

RESULTS

Of the 29 patients identified 12 were women and 17 men with a mean (range) age of 48 (18–79) years at operation. The median (range) follow‐up was 126 (5–190) months. On questioning, 25 of 28 (89%) patients stated that they were continent. There was more than one confirmed UTI per year in two patients. Half of the patients had at least two UTIs within the follow‐up period but with no deterioration in renal function. Calculi developed in eight (29%) patients; four with bladder, three with renal and one with both renal and bladder calculi. Stomal stenosis developed in 15 (54%) patients requiring intervention at a mean (range) rate of 0.4 (0.1–2.4) episodes per year and nine ultimately required stomal reconstruction. Five (18%) patients required conversion to ileal conduit, two of these for persistent incontinence and three for recurrent stomal complications, at a mean (range) of 82  (9–140) months.

CONCLUSIONS

MUD is effective in offering continence with no major deterioration of renal function; however, this needs to be balanced against the need for subsequent additional interventions for stomal stenosis, stone formation and UTI on an individual basis.
Modified technique for neurovascular bundle preservation during radical prostatectomy: association between technique and recovery of erectile function
Authors: Masterson Timothy A. , Serio Angel M. , Mulhall John P. , Vickers Andrew J. , Eastham James A.
Published: February 2008

OBJECTIVES

To prospectively evaluate whether a modified surgical technique for neurovascular bundle (NVB) preservation during radical prostatectomy (RP) is associated with an improvement in erectile function (EF) recovery after RP.

PATIENTS AND METHODS

Data from patients treated before technique modification was used to create a predictive model for EF at 6 months after RP using age, date of surgery, and nerve sparing (none vs unilateral vs bilateral) as predictors for patients who received the modified technique (MT) to estimate the expected outcomes had they received the standard technique (ST), and compared these with actual outcomes. In the MT, the neurovascular bundle (NVB) is completely mobilized off the prostate from the apex to above the seminal vesicles including incision of Denonvilliers’ fascia before urethral division and mobilization of the prostate off the rectum.

RESULTS

Of 372 patients with evaluable data, 275 (74%) underwent the ST from 1 January 2001 to 31 December 2004 and 97 (26%) underwent the MT from 1 January 2005 to 30 May 2006. Sixty‐five of 97 patients (67%) receiving the MT had EF recovery at 6 months, whereas the expected probability of 6‐month recovery of EF, had they received the ST, was 45%. The absolute improvement in EF recovery attributable to the MT was 22% (95% confidence interval 5–40%; P = 0.013).

CONCLUSIONS

Technical modifications to NVB preservation during RP were associated with improved rates of EF recovery.
Comparison of four systems of classification of diabetic foot ulcers in Tanzania
Authors: Abbas Z. G. , Lutale J. K. , Game F. L. , Jeffcoate W. J.
Published: February 2008

Aims  The aim was to compare the use of four different systems of foot ulcer classification in a consecutive population with diabetes presenting to a specialist clinic in Dar es Salaam, Tanzania.

Methods  Clinical data were collected prospectively in all patients presenting with foot ulcers between 3 January 2003 and 30 September 2005, and were used retrospectively to classify their ulcers using the Meggitt/Wagner, University of Texas (UT), Size (Area and Depth), Sepsis, Arteriopathy, and Denervation [S(AD)SAD] and Perfusion, Extent/size, Depth/tissue loss, Infection and Sensation (PEDIS) systems. Comparison was made between the strength of the associations between baseline characteristics of each system and outcome determined at 5 December 2005, using linear by linear association.

Results  The strongest statistical associations (P < 0.001) were observed between percent healing and Wagner score (χ2= 85.923), depth [S(AD)SAD, PEDIS and UT grade, 70.558], infection [S(AD)SAD, 61.774; PEDIS, 37.924] and UT stage (32.929). Weaker but significant (P < 0.001) associations were observed between percent healing and neuropathy [S(AD)SAD, PEDIS 12.475] and peripheral arterial disease [S(AD)SAD, PEDIS 10.799], as well as cross‐sectional area [S(AD)SAD 4.387, P = 0.036].

Conclusion  The strength of the statistical association between outcome and both neuropathy and infection contrasts with findings in series previously reported from the USA and UK, and highlights the differences which may be found in different populations. These differences have implications for any system of classification chosen to compare the effectiveness of management in different centres in different countries.
Diabetes care in hospital—the impact of a dedicated inpatient care team
Authors: Flanagan D. , Moore E. , Baker S. , Wright D. , Lynch P.
Published: February 2008

Aims  At any given time, people with diabetes occupy approximately 5–10% of acute hospital beds. In addition, diabetes is associated with a greater length of stay (LOS). This is partially because of increased complexity of the cases but also because of unfamiliarity of dealing with the condition by other specialist teams.

Methods  In 2002, with increasing pressure on acute hospital beds, a team was established to improve the care of inpatients with diabetes admitted to Derriford Hospital. The team consisted of five diabetes specialist nurses dedicated to inpatient care, supported by a consultant and specialist registrar diabetologist. A link nurse responsible for diabetes was appointed on every ward and each individual with a diagnosis of diabetes was identified on admission. We have compared LOS of all patients with diabetes admitted between January 2002 and December 2006.

Results  LOS fell from a mean ± se of 8.3 ± 0.18 days in 2002 to 7.7 ± 0.10 days in 2006 (P = 0.002). Significant falls were seen for emergency admissions (9.7 ± 0.23 vs. 9.2 ± 0.20, P < 0.001) but not elective admissions. The data show significant reductions in LOS for medical admissions (9.2 ± 0.24 vs. 8.4 ± 0.20, P < 0.001) but not surgical admissions. Over the same period, LOS for the total hospital population fell by 0.3 days (P < 0.001).

Conclusion  In conclusion, a team specifically employed to focus on inpatient diabetes care has a significant impact on LOS of this patient group.
Compliance with physical activity recommendations in US adults with diabetes
Authors: Zhao G. , Ford E. S. , Li C. , Mokdad A. H.
Published: February 2008

Aims  To investigate whether US adults with diabetes meet both the national and American Diabetes Association (ADA) recommendations for physical activity compared with people without diabetes, and to examine the trends of this behaviour over time.

Methods  We analysed data from large nationally representative cohorts from the 1996–2005 Behavioral Risk Factor Surveillance System. The number of participants ranged from 98 127 in 1996 to 204 977 in 2005, and the number of people with diabetes ranged from 4379 in 1996 to 13 608 in 2005. Participants were classified by their exercise status and physical activity levels. The age‐standardized prevalence of physical activity participation or meeting physical activity recommendations was calculated in people with and without diabetes.

Results  People with diabetes participated less in physical activity (63.1–68.9 vs. 71.7–78.3%) and met physical activity recommendations less than people without diabetes (40.2–42.9 vs. 48.0–51.5% for meeting national recommendations and 38.5–41.7 vs. 46.6–49.8% for meeting ADA recommendations). The percentage of people with diabetes who participated in physical activity in the past 10 years or met physical activity recommendations in the past 5 years did not vary, whereas significantly increasing trends were observed in people without diabetes. The odds for adults with diabetes meeting physical activity recommendations were significantly lower than in adults without diabetes even after multivariate adjustment.

Conclusion  People with diabetes were less likely to meet either national or ADA recommendations for physical activity than people without diabetes. Our results demonstrate the need for more efforts from health‐care professionals to promote physical activity in people with diabetes.
Liraglutide, a once‐daily human GLP‐1 analogue, improves pancreatic B‐cell function and arginine‐stimulated insulin secretion during hyperglycaemia in patients with Type 2 diabetes mellitus
Authors: Vilsbøll T. , Brock B. , Perrild H. , Levin K. , Lervang H.‐H. , Kølendorf K. , Krarup T. , Schmitz O. , Zdravkovic M. , Le‐Thi T. , Madsbad S.
Published: February 2008

Aims  To assess the effect of liraglutide, a once‐daily human glucagon‐like peptide‐1 analogue on pancreatic B‐cell function.

Methods  Patients with Type 2 diabetes (n = 39) were randomized to treatment with 0.65, 1.25 or 1.9 mg/day liraglutide or placebo for 14 weeks. First‐ and second‐phase insulin release were measured by means of the insulin‐modified frequently sampled intravenous glucose tolerance test. Arginine‐stimulated insulin secretion was measured during a hyperglycaemic clamp (20 mmol/l). Glucose effectiveness and insulin sensitivity were estimated by means of the insulin‐modified frequently sampled intravenous glucose tolerance test.

Results  The two highest doses of liraglutide (1.25 and 1.9 mg/day) significantly increased first‐phase insulin secretion by 118 and 103%, respectively (P < 0.05). Second‐phase insulin secretion was significantly increased only in the 1.25 mg/day group vs. placebo. Arginine‐stimulated insulin secretion increased significantly at the two highest dose levels vs. placebo by 114 and 94%, respectively (P < 0.05). There was no significant treatment effect on glucose effectiveness or insulin sensitivity.

Conclusions  Fourteen weeks of treatment with liraglutide showed improvements in first‐ and second‐phase insulin secretion, together with improvements in arginine‐stimulated insulin secretion during hyperglycaemia.
Quality of life and treatment satisfaction in adults with Type 1 diabetes: a comparison between continuous subcutaneous insulin infusion and multiple daily injections
Authors:   The EQuality1 Study Group—evaluation of QUALITY of life and costs in diabetes Type 1. Writing committee:, Nicolucci A. , Maione A. , Franciosi M. , Amoretti R. , Busetto E. , Capani F. , Bruttomesso D. , Di Bartolo P. , Girelli A. , Leonetti F. , Morviducci L. , Ponzi P. , Vitacolonna E.
Published: February 2008

Aims  The aim of this case–control study was to compare quality of life (QoL) and treatment satisfaction in adults with Type 1 diabetes (T1DM) treated with either continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI).

Methods  Consecutive patients aged between 18 and 55 years, and attending diabetes clinics for a routine visit, completed the Diabetes‐Specific Quality‐of‐Life Scale (DSQOLS), the Diabetes Treatment Satisfaction Questionnaire (DTSQ) and the SF‐36 Health Survey (SF‐36). Case (CSII) and control subjects (MDI) were recruited in a 1 : 2 ratio.

Results  Overall, 1341 individuals were enrolled by 62 diabetes clinics; 481 were cases and 860 control subjects. Cases had a longer diabetes duration and were more likely to have eye and renal complications. Age, school education, occupation and HbA1c were similar. Of control subjects, 90% followed glargine‐based MDI regimens and 10% used NPH‐based MDI regimens. On multivariate analysis, after adjusting for socioeconomic and clinical characteristics, scores in the following areas of the DSQOLS were higher in cases than control subjects: diet restrictions (β = 5.96; P < 0.0001), daily hassles (β = 3.57; P = 0.01) and fears about hypoglycaemia (β = 3.88; P = 0.006). Treatment with CSII was also associated with a markedly higher DTSQ score (β = 4.13; P < 0.0001) compared with MDI. Results were similar when CSII was compared separately with glargine‐ or NPH‐based MDI regimens.

Conclusions  This large, non‐randomized, case–control study suggests quality of life gains deriving from greater lifestyle flexibility, less fear of hypoglycaemia, and higher treatment satisfaction, when CSII is compared with either glargine‐based or NPH‐based MDI regimens.
Effect of acute hyperglycaemia and/or hyperinsulinaemia on proinflammatory gene expression, cytokine production and neutrophil function in humans
Authors: Stegenga M. E. , Crabben S. N. van der , Dessing M. C. , Pater J. M. , Van Den Pangaart P. S. , De Vos A. F. , Tanck M. W. , Roos D. , Sauerwein H. P. , Van Der Poll T.
Published: February 2008

Aims  Type 2 diabetes is frequently associated with infectious complications. Swift activation of leucocytes is important for an adequate immune response. We determined the selective effects of hyperglycaemia and hyperinsulinaemia on lipopolysaccharide (LPS)‐induced proinflammatory gene expression and cytokine production in leucocytes and on neutrophil functions.

Methods  Six healthy humans were studied on four occasions for 6 h during: (i) lower insulinaemic euglycaemic clamp, (ii) lower insulinaemic hyperglycaemic clamp, (iii) hyperinsulinaemic euglycaemic clamp, and (iv) hyperinsulinaemic hyperglycaemic clamp. Target levels of plasma glucose were 12.0 mmol/l (hyperglycaemic clamps) or 5.0 mmol/l (euglycaemic clamps). Target plasma insulin levels were 400 pmol/l (hyperinsulinaemic clamps) or 100 pmol/l (lower insulinaemic clamps).

Results  Hyperglycaemia reduced LPS‐induced mRNA expression of nuclear factor of κ light polypeptide gene enhancer in B cells inhibitor alpha (NFKBIA), interleukin‐1 alpha (IL1A) and chemokine (C‐C motif) ligand 3 (CCL3), whereas during hyperinsulinaemia enhanced mRNA levels occurred in six out of eight measured inflammation‐related genes, irrespective of plasma glucose levels. Combined hyperglycaemia and hyperinsulinaemia led to enhanced IL1A, interleukin‐1 beta (IL1B) and CCL3 mRNA levels upon LPS stimulation. Neither hyperglycaemia nor hyperinsulinaemia altered cytokine protein production, neutrophil migration, phagocytic capacity or oxidative burst activity.

Conclusions  These results suggest that short‐term hyperglycaemia and hyperinsulinaemia influence the expression of several inflammatory genes in an opposite direction, that the acute effects of hyperinsulinaemia on inflammatory mRNA levels may be stronger than those of hyperglycaemia, and that the effects of insulin, in particular, may be relevant in the concurrent presence of hyperglycaemia.