bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of adenovirus‐mediated liver‐selective overexpression of protein tyrosine phosphatase‐1b on insulin sensitivity in vivo
Authors: Wang J. , Cheung A. T. , Kolls J. K. , Starks W. W. , Martinez‐Hernandez A. , Dietzen D. , Bryer‐Ash M.
Published: March 2003

Aim: Protein tyrosine phosphatase‐1B (PTP‐1B) is an intracellular PTP known to dephosphorylate and inactivate upstream tyrosine phosphoproteins in the insulin signalling cascade. We and others reported increased abundance of catalytically impaired PTP‐1B in tissue lysates from obese human subjects with and without type 2 diabetes, while genetic knockout of PTP‐1B improves insulin sensitivity and prevents nutritionally mediated insulin resistance and obesity. The aim of the present work was to further elucidate the role of PTP‐1B in glucose metabolism in vivo.

Methods: We used adenoviral constructs incorporating cDNAs for either wild‐type (W/T) or a catalytically inactive C215S (C/S) mutant PTP‐1B to achieve liver‐selective PTP‐1B overexpression in young Sprague–Dawley rats using tail vein injection, based on the high degree of hepatotropism of adenovirus 5 (Ad5). An Ad5‐lacZ construct encoding β‐galactosidase was used as a control for viral effects alone. A hyperinsulinaemic euglycaemic clamp was used to study whole body glucose disposal and endogenous glucose production rates.

Results: Control studies in HIRcB cells confirmed catalytic activity and inactivity of W/T and C/S respectively. Mean PTP‐1B abundance was 2.24 ± 0.02‐ and 2.33 ± 0.04‐fold of saline‐treated control in liver lysates of W/T and C/S rats respectively. Liver selective overexpression was confirmed by analysis of tissue lysates from liver, fat and muscle tissues. Ad5 treatment did not result in a statistically or clinically significant liver injury, as determined by serum alanine aminotransferase and histological examination. Seven days post injection, no significant difference in rate of weight gain, fasting blood glucose or insulin levels were seen in any group. Similarly, under steady‐state glucose clamp conditions, glucose disposal rate (Rd), endogenous glucose production rate (EGP) and serum insulin levels were similar in all groups.

Conclusion: We conclude that moderate medium‐term overabundance, to a degree resembling that seen in insulin‐resistant states, of PTP‐1B in liver tissue does not alter insulin action on glucose metabolism and that the major site of action of PTP‐1B is presumably at insulin‐responsive target tissue or tissues other than the liver.
Simultaneous glyburide/metformin therapy is superior to component monotherapy as an initial pharmacological treatment for type 2 diabetes
Authors: Garber A. J. , Larsen J. , Schneider S. H. , Piper B. A. , Henry D. ,   The Glyburide/Metformin Initial Therapy Study Group
Published: March 2003

Objective: To evaluate whether simultaneous initial treatment of both insulin resistance and impaired β‐cell insulin secretion with glyburide/metformin tablets is superior to monotherapy with each component agent.

Research Design and Methods: In this randomized, parallel‐group, placebo‐controlled, multicentre study, 806 patients with type 2 diabetes (mean duration, 3 years) who had failed diet and exercise were randomly assigned to 4 weeks of therapy with placebo, glyburide 2.5 mg, metformin 500 mg, glyburide/metformin 1.25/250 mg, or glyburide/metformin 2.5/500 mg once daily. Doses were then titrated over 8 weeks based on glycaemic response. The primary outcome measure was change from baseline in mean HbA1c after 20 weeks. Changes in fasting plasma glucose, lipids and body weight were also assessed along with 2‐h postprandial glucose and insulin values after a standardized meal.

Results: At week 20, patients taking glyburide/metformin 1.25/250 mg or 2.5/500 mg tablets had greater reductions in HbA1c levels (−1.48% and −1.53% respectively) compared with placebo (−0.21%; both p < 0.001), glyburide (−1.24%; p = 0.016 and p = 0.004 respectively) or metformin (−1.03%; both p < 0.001). Fasting plasma glucose concentrations were reduced more in both glyburide/metformin groups compared with placebo and metformin (p < 0.001); patients in both combination therapy groups also had significantly lower postprandial glucose concentrations compared with placebo, glyburide and metformin.

Conclusions: Initial combination treatment with glyburide/metformin tablets produces greater improvements in glycaemic control than either glyburide or metformin monotherapy. The superiority of initial therapy with glyburide/metformin tablets may arise from simultaneous treatment of both pathophysiological defects of type 2 diabetes.
Brain – Hatschek’s pit relationships in amphioxus species
Authors: Gorbman Aubrey
Published: March 2003

The vertebrate hypothalamo‐hypophyseal neurosecretory system is a complex anatomical device for central nervous control over secretion of pituitary hormones. Since it is present in the most primitive vertebrates, the cyclostomes, it is of interest to look for a possible invertebrate anatomical equivalent, or precursor, for clues as to its evolution. We have found in six species of amphioxus, members of an invertebrate group (cephalochordates), considered to be closest to the vertebrates, that there is a morphologically equivalent neuro‐epithelial complex, that in many ways resembles the hypothalamo‐hypophyseal system of vertebrates. In the six amphioxus species described here the nervous element is a ventral lobe of the brain, the infundibulum, that extends downward along the right side of the notochord, and ends near the dorsal surface of a Rathke’s pouch‐like structure known as Hatschek’s pit. This part of Hatschek’s pit has been found earlier to contain a vertebrate LH‐like gonadotropin. Therefore, the infundibulum‐Hatschek’s pit system of amphioxus may be involved in regulating the seasonal reproductive cycle, and it appears to be a direct homologue of the vertebrate hypothalamo‐hypophyseal neurosecretory system functionally as well as morphologically.
A reexamination of the epithelial sensory cells of amphioxus (Branchiostoma)
Authors: Lacalli Thurston C. , Hou Shufen
Published: March 2003

The rostral epithelium of a newly metamorphosed juvenile of Branchiostoma floridae was examined at the EM level to confirm previous reports on its sensory cells. The majority of the sensory cells are of three types: two type I variants, with simple collars of unbranched microvilli surrounding their cilia, and one kind of type II cell, with an extended collar of repeatedly branched microvilli. The two type I variants differ in the structure and arrangement of the microvilli, basal body and rootlet, and the length of the cilium. Both variants are probably primary sensory cells (i.e. each has its own axon), but the data supporting this conclusion are much better for one variant than for the other. Type II cells are secondary sensory cells, with synaptic terminals borne on short extensions of the cell body. The presence of degenerating type II cells suggests that they may be subject to a regular process of loss and renewal. The results do not resolve the evolutionary issue of how amphioxus sensory cells relate to the epithelial sensory and receptor cells of vertebrates. Being primary, the type I cells resemble the supposed ancestral type more closely than do type II cells. Type II cells may be chemosensory, however, and should not be ruled out a priori as possible homologues of either primary or secondary chemosensory cells in vertebrates.
Structure and function of pilosebaceous units on the heads of small mammals (Insectivora, Chiroptera, Rodentia)
Authors: Haffner Marianne
Published: March 2003

Haffner, M. 2000. Structure and function of pilosebaceous units on the heads of small mammals (Insectivora, Chiroptera, Rodentia). —Acta Zoologica (Stockholm) 81: 195–203

The cranial integument of 32 species was examined for increased sebum production and structures serving sebum storage and expulsion by means of light and scanning electron microscopy. The head is rich in sebaceous glands in all species. Some have no further specializations other than regions with enlarged sebum production. These regions either need extra protection per se or they are situated where they can be used for fur grooming directly or be easily reached by the forepaws. The water shrew stores sebum that it can possibly apply as a water‐repellent lipid coating for the fur if required. All vespertilionid bats not only have huge glandular complexes with storage chambers, but also structures for the retaining and application of sebum. Stabilizing elements reflect the extent of external pressure on the specialized pilary canal during sebum discharge. Originally simple hair follicles evolved highly adapted pilosebaceous complexes that possibly produce scent themselves or at least a carrier substance for scent secreted by the many apocrine glands on the snout.
Ultrastructural study of the bacillary, granular and mucoid proboscidial gland cells of Riseriellus occultus (Nemertini, Heteronemertini)
Authors: Junoy Juan , Montalvo Sagrario , Roldán Carmen , García‐Corrales Pedro
Published: March 2003

Junoy, J., Montalvo, S., Roldán, C. and García‐Corrales, P. 2000. Ultrastructural study of the bacillary, granular and mucoid proboscidial gland cells of Riseriellus occultus (Nemertini, Heteronemertini). — Acta Zoologica (Stockholm) 81: 235–242.

The ultrastructure of six types (G5‐G10) of proboscidial gland cells whose cell necks emerge independently on the epithelium surface is analysed and compared with data from other nemerteans. These types differ in cytological features, as well as in the morphology of their respective secretory granules. Secretory granules of the types G5 and G6 have a bacillary shape, and differ from each other based on their contents and dimensions. Secretory granules of the types G7 and G8 are spherical to ovoid; type G8 gland cells are monociliated, and their secretory granules contain a paracrystalline material. Types G9 and G10 gland cells are typically goblet‐shaped; secretory granules in the type G9 have a spherical shape, contain a homogeneous electron dense material and maintain their individuality, whereas those of the G10 type are elongate and have fibrillar contents, showing a tendency to fuse before they are extruded. The mucus sheet of the proboscis is responsible for lubrication of its epithelial surface. Secretion products of type G10 gland cells form the background substance of this mucus, and those of the G5 type confer stickiness to it. Type G9 gland cells could provide the toxic component to the mucus, and type G7 and G8 gland cells could be concerned with the production of enzymatic secretions.
Fine structure of sheet‐webs of Linyphia triangularis (Clerck) and Microlinyphia pusilla (Sundevall), with remarks on the presence of viscid silk
Authors: Benjamin Suresh P , Düggelin Marcel , Zschokke Samuel
Published: March 2003

We examined the webs of Linyphia triangularis (Clerck) and Microlinyphia pusilla (Sundevall) using light and scanning electronic microscopic techniques and compared them with the better known orb‐webs. The linyphiid sheet‐web consists of an unordered meshwork of fibres of different thicknesses. The sheet is connected to the scaffolding by means of attachment discs. Thin threads with globules, which appear similar to the viscid silk droplets of orb‐webs, are present in most webs examined. Webs of M. pusilla had a higher density of these globules than did webs of L. triangularis. Webs of both species possess five types of thread connections and contain no aqueous glue for prey capture. Instead, unlike orb‐webs, the sticky substances produced by the linyphiid aggregate glands cement the different layers and threads of the sheet by drying up after being produced. Due to their function, sheet webs may not require viscid silk, thereby leading to a more economic web. The assumption made in most previous studies, that the globules in linyphiid webs have the same properties and function as viscid silk in orb‐webs, is unfounded.
Day‐case ureteroscopy: an observational study
Authors: Taylor A.L. , Oakley N. , Das S. , Parys B.T.
Published: March 2003

Objective To evaluate the outcome after day‐case ureteroscopy (used in diagnosing and managing ureteric disease, primarily urolithiasis), as awareness of reduced resources has resulted in increasing pressure to undertake procedures in a day‐surgery setting.

Patients and methods All patients presenting to the unit and requiring ureteroscopy between May 1995 and May 2000 were considered for a day‐surgery procedure. The assessment of suitability comprised anaesthetic and social factors; no urological criteria precluded a day‐surgery procedure. Outcomes after day‐case ureteroscopy, including immediate or delayed admissions and subsequent inpatient management, were reviewed retrospectively.

Results Sixty‐three day‐case ureteroscopies were performed on 56 patients (mean age 47 years, range 19–78); eight procedures were diagnostic. Therapeutic ureteroscopies included one balloon dilatation of a ureteric stricture and 54 procedures for urolithiasis, with 98% stone clearance. Most patients were discharged with a JJ stent in situ. Of nine patients requiring immediate admission, seven were for pain control; eight were discharged on the following day. Seven patients required delayed admission 1–13 days after the procedure, three for stent‐related symptoms and three for infection. No significant predictors of immediate or delayed admission were identified, although antibiotic prophylaxis was associated with a reduced admission rate.

Conclusion Ureteroscopy can be used successfully as a planned day‐case procedure in a dedicated day‐surgery unit, with few patients requiring hospitalization. Implementation of analgesia protocols and routine antibiotic prophylaxis may reduce admission after day‐case ureteroscopy.
Urgency, urge incontinence and voiding symptoms in men and women aged 70 years and over
Authors: Nuotio M. , Jylhä M. , Luukkaala T. , Tammela T.L.J.
Published: March 2003

Objective To evaluate the prevalence of urgency, urge incontinence and voiding symptoms, and their associations in older men and women.

Subjects and methods A population‐based cross‐sectional survey was conducted involving 171 men and 227 women aged 70 years. The data were collected by interview, with a response rate of 92.8%. Voiding symptoms were defined as weakened and/or intermittent stream. The prevalence of urgency, urge incontinence and voiding symptoms were calculated for men and women aged 70–79 and 80 years. Logistic regression models were used to examine the association of voiding symptoms with urgency, with or without incontinence, adjusted in the separate models for age and in the combined model also for gender.

Results The prevalence of urge incontinence was higher than urgency alone in both men and women (23.9% vs 9.8% and 36.4% vs 8.6%, respectively); 71.9% of the men and 48.3% of the women reported voiding symptoms (P < 0.001). Men and women with voiding symptoms were both significantly more likely to report urgency with or without incontinence than those with no voiding symptoms (odds ratio 3.49, 95% confidence interval 1.42–8.57, and 2.34, 1.31–4.17, respectively). Age had no independent effect in men, and in women the effect was marginal. In the combined model female gender (1.98, 1.25–3.16) increased the risk of urgency with or without incontinence.

Conclusion Urgency, urge incontinence and voiding symptoms are common and associated with each other in older men and women; the association is stronger in men. Women are at greater risk of having urgency with or without incontinence. Because the study was cross‐sectional a causal relationship cannot be confirmed.
Knowledge and attitudes of Korean parents towards their son's circumcision: a nationwide questionnaire study
Authors: Oh S.‐J. , Kim K.D. , Kim K.M. , Kim K.S. , Kim K.K. , Kim J.S. , Kim H.G. , Woo Y.N. , Yoon Y.L. , Lee S.D. , Han S.W. , Lee S.I. , Choi H.
Published: March 2003

Objective To evaluate knowledge about the foreskin and circumcision, and to understand the attitudes of parents to circumcision in Korea, where circumcision in childhood is widely practised with no particular religious or medical background.

Subjects and methods A nationwide study involving questionnaires was conducted on 5500 parents with at least one son attending elementary school. Responses were obtained from one of the parents.

Results The response rate was 76.1% (4183); circumcision was most common in boys when aged 11 years, followed by neonatal circumcision. Of the parents, 91.3% believed that circumcision is necessary, while 2.1% believed it to be unnecessary. The principal reasons given for circumcision were ‘to improve penile hygiene’ (82.4%), followed by ‘to improve future sexual potency’ (7.5%). Among those who did not believe circumcision to be necessary, the most common reason was the expectation of spontaneous retraction of the prepuce with age (55.1%). Most (88.4%) of the parents believed that smegma is not a clean material, and is infected by microorganisms. Most parents (80.6%) thought that circumcision would prevent genital tract infection of the future spouse. Peer pressure was one of the most influential factors in deciding upon circumcision; 41.9% of the parents were anxious that their child might be ridiculed by his peer group unless he was circumcised, while 27.4% of the parents believed that their child might be ridiculed if he was circumcised. Mothers were more positive about circumcision than fathers (P < 0.05). Parents with a higher education and higher socio‐economic status were also more positive about circumcision (P < 0.05). Mothers were prone to emphasize improved sexual potency (P < 0.05). There was no significant difference in response between urban and rural areas.

Conclusion This study indicates that common beliefs held by parents about the prepuce or circumcision differ significantly from current medical knowledge, and these beliefs have a major influence on the practice of circumcision in Korea. More clinical research on the natural history of the foreskin is needed, and it is critical that both children and parents are informed about the potential benefits and disadvantages of circumcision.
Decreased nocturnal urinary antidiuretic hormone excretion in enuresis is increased by imipramine
Authors: Tomasi P.A. , Siracusano S. , Monni A.M. , Mela G. , Delitala G.
Published: March 2003

Objective To assess the role of integrated nocturnal antidiuretic hormone (ADH) secretion in children with enuresis, and possible modifications induced by treatment with imipramine.

Patients and methods The morning plasma ADH and nocturnal urinary ADH integrated concentrations were measured in 18 consecutive enuretic children (patients) and 21 age‐ and sex‐matched controls admitted for minor treatment. Diurnal and nocturnal urine production, and plasma and urinary osmolality were also determined; lumbosacral radiography and uroflowmetry were undertaken in the patients. The assessments were repeated after 14 days of treatment with imipramine hydrochloride (orally, 20 mg/night).

Results Half the patients had occult spinal malformations but the uroflowmetry results were all within the normal range. The median (95% confidence interval, CI) urinary ADH integrated concentrations were markedly lower in patients, at 29.7 (22.1–37.3) vs 63.0 (35.1–90.8) pg/mL/h (P = 0.03) than in controls. Plasma ADH levels were significantly increased by imipramine (0.64 to 1.47 pg/mL, 95% CI, 0.40–0.89 vs −0.26–3.2; P < 0.001), as were nocturnal urinary ADH integrated concentrations, at 29.7 (22.1–37.3) vs 59.0 (37.3–80.6) pg/mL/h (P < 0.001), and morning plasma osmolality decreased, from 298.5 (294.5–302.5) to 294.9 (292.4–297.3) mosmol/kg (P = 0.003), as was the 24‐h fluid intake, from 983 (721–1245) to 666 (435–897) mL (P = 0.004).

Conclusions We conclude that enuretic children have a lower nocturnal ADH excretion; imipramine restores nocturnal ADH excretion, increases morning plasma ADH levels, and causes consistent changes in other biochemical variables.
Developmental changes in the biochemical and functional properties of endothelin receptors in rabbit renal pelvis
Authors: Wada Y. , Latifpour J. , Saito M. , Afiatpour P. , Weiss R.M.
Published: March 2003

Objective To examine the effect of age on the biochemical and functional properties, and regional distribution of endothelin (ET) receptors in the rabbit renal pelvis.

Materials and methods The properties of ET receptors in 6‐week‐old and 6‐month‐old male rabbit renal pelves were examined using isolated muscle‐bath and radioligand receptor‐binding techniques.

Results ET‐1 caused a significant increase in the contractile force in muscle strips from all regions of the renal pelvis from both age groups, with the following rank order: upper = middle > lower. The magnitude of the ET‐1‐induced contractile responses were similar in the lower pelvic regions in both ages, but the responses in the upper and middle regions were significantly greater in younger rabbits. ET‐1 increased the frequency of spontaneous activity in a concentration‐dependent manner in the upper and middle pelvic regions in both age groups, with significantly smaller ED50 values in the younger than in the older rabbits. In both age groups the lower pelvic region lacked spontaneous activity. The density of total ET receptors was higher in the upper and middle regions of the renal pelvis than in the lower renal pelvis of both ages, with the density in the upper and middle regions being greater in older than in younger rabbits. In all regions, ET subtype selective compounds inhibited [125I]ET‐1, binding consistent with the predominance of the ETA receptor subtype, except in the lower region of the older rabbits, in which the densities of ETA and ETB subtypes were similar. In all regions, the younger renal pelvis contained a higher proportion of ETA receptors than in older tissues. Light microscopic autoradiographic data indicated the presence of ETA and ETB receptors in smooth muscle and epithelial cells, respectively.

Conclusion These data indicate the presence of regional differences in the density of ET receptors and in the contractile responses to ET‐1 in rabbit renal pelvis, and that although older rabbit renal pelvis contains more total ET receptors than younger renal pelvis, the latter had a higher portion of the ETA receptor subtype and the younger tissues were more responsive to ET‐1.
Detrusor hypocontractility in children with posterior urethral valves arises before puberty
Authors: De Gennaro M. , Capitanucci M.L. , Capozza N. , Caione P. , Mosiello G. , Silveri M.
Published: March 2003

Objectives

To assess prepubertal boys with posterior urethral valves (PUV) using an analysis of pressure‐flow studies to evaluate the voiding phase and thus determine if myogenic failure (hypocontractility) arises before puberty and if it can be detected early.

Patients and methods

Eleven boys (8–13 years old) with PUV underwent urodynamics and the results were analysed using pressure‐flow mathematical analysis (PFA) of the following variables of detrusor activity: contraction velocity (Vdet ), detrusor contractile power expressed as power factor (WF) and Schafer’s diagram, which differentiates a ‘strong’, ‘normal’ and ‘weak’ detrusor. Vdet and WF were compared with normal values previously determined in boys of similar age and considered ‘low’ if more than 2 SDs below the mean. The results of PFA were compared with standard pressure‐flow studies and the three classical urodynamic patterns in boys with PUV, as determined by voiding symptoms. The subsequent PFA of seven of the 11 boys were also assessed as they had undergone previous urodynamics when <8 years old.

Results

As assessed by the three patterns of dysfunction, two boys had bladder instability, two had low compliance and three had hypocontractility, with four boys being normal. From the PFA, the Vdet and WF were lower than normal, respectively, in seven and nine of the 11 boys; Schafer’s nomogram showed a ‘weak’ detrusor in seven boys. The PFA suggested a pathology in four of five boys with symptoms and in three of six with no symptoms (two of the six showing a ‘low’ WF). Moreover, in older (11–13 years) boys, all five had a ‘weak’ detrusor, a ‘low’ WF and four a ‘low’ Vdet . Of the seven patients who underwent repeat PFA, three had a stable WF 3 years later, one (normal) worsened slightly and two were clearly worse, while one, who underwent late (at 3 years old) valve ablation, had an increased WF.

Conclusions

The PFA showed hypocontractility in two‐thirds of prepubertal boys with PUV, including asymptomatic patients. These findings confirm the hypothesis that bladder dysfunction in boys with PUV eventually causes detrusor myogenic failure and finally a postpubertal overdistended bladder.
Comparison of different bladder autoaugmentation techniques in a rabbit model
Authors: EliÇevik  , Celayir  , Dervisoglu  , Büyükünal
Published: March 2003

Objective

 To compare the urodynamic, radiological and histopathological findings of a bladder autoaugmentation method combined with different seromuscular enterocystoplasty (mucosectomized) techniques and the rectus abdominis muscle‐flap (RAMF) technique, and thus devise a method that may eliminate the potential risks of bladder autoaugmentation.

Materials and methods

 The study comprised 20 male New Zealand White rabbits in four groups. In group 1 (control), an autoaugmentation model was created by incising the detrusor muscle of the bladder, forming a large wide‐mouthed bladder diverticulum. In group 2, a full‐thickness RAMF with an intact vascular supply was used to cover the augmented bladder wall. In groups 3 and 4, besides the autoaugmentation procedure, a 5 cm ileal segment with an intact vascular supply was prepared and the mucosal layer of the segment removed. In group 3, the mucosectomized surface of the ileal graft was used to cover the autoaugmented bladder (seromuscular ileocystoplasty, SMEC) and in group 4, the serosal surface of the pedunculated ileal graft was used in reverse to cover the autoaugmented bladder wall (reversed SMEC, RSMEC). All groups were followed using intravenous pyelography (IVP), voiding cysto‐urethrography (VCUG), urodynamic investigations and histopathological analysis for 2 months post‐operatively.

Results

 In all groups except 2 (RAMF), a diffuse bulging of the bladder wall was detected on IVP and VCUG. In groups 1, 3 and 4, there was a significant increase in mean bladder capacity and the compliance also increased. However, in group 2 there was a significant reduction in bladder capacity and compliance, and the histopathological analysis showed severe fibrosis. The fibrotic changes were moderate in groups 1 and 4 and mild in group 3.

Conclusions

 The urodynamic studies, IVP, VCUG and histopathology suggested that the SMEC technique decreased the potential risks of bladder autoaugmentation, had minimal side‐effects and was the most appropriate coat over the uroepithelium after bladder autoaugmentation.
The structure and autonomic innervation of the vesico‐ureteric junction in cases of primary ureteric reflux
Authors: Dixon  , Jen  , Yeung  , Chow  , Mathews  , Gearhart  , Gosling
Published: March 2003

Objective

 To determine the histological structure and autonomic innervation of the vesico‐ureteric junction (VUJ) in cases of primary ureteric reflux, to compare the results with those reported previously for non‐refluxing VUJs and thus determine possible structural anomalies which could be responsible for vesico‐ureteric reflux (VUR).

Materials and methods

 Nineteen specimens of VUJs with reflux were obtained from four males and 10 females undergoing ureteric reimplantation. Serial frozen sections were cut and stained either with Masson’s trichrome or immunostained for protein gene product (PGP 9.5), a general nerve marker, dopamine beta hydroxylase (DβH), a marker for noradrenergic nerves, or neuropeptide Y (NPY).

Results

 Longitudinally orientated muscle bundles of narrow diameter accompanied the ureter to its termination at the ureteric orifice, where they merged with those of the superficial trigone. In some specimens, an additional muscle component was identified, situated on the outer aspect of the ureteric muscle coat, consisting of an incomplete layer of distinctive muscle whose constituent cells formed an interlacing meshwork. Occasionally, specimens included detrusor muscle which consisted of relatively large diameter compact bundles separated from the ureter by a connective tissue sheath. DβH‐ and NPY‐immunoreactive (‐IR) nerves were numerous among the ureteric muscle bundles. Many NPY‐IR nerves occurred within the detrusor muscle while DβH‐IR nerves were mainly perivascular. When present, the outer muscle component was richly innervated by both DβH‐ and NPY‐IR nerves. PGP immunoreactivity varied among regions in the same section, PGP‐IR nerves frequently being less numerous than those containing DβH or NPY.

Conclusion

 These results indicate that the morphology of the VUJ in cases of VUR is indistinguishable from the normal VUJ described previously. Furthermore, the density and distribution of DβH‐ and NPY‐IR nerves is identical to that in controls. However, the antigenicity of PGP in the reflux specimens appears to be masked in some regions by an unknown factor.
Vasoactive intestinal polypeptide and phentolamine mesylate administered by autoinjector in the treatment of patients with erectile dysfunction resistant to other intracavernosal agents
Authors: Dinsmore  , Alderdice
Published: March 2003

Objective To study the effect of vasoactive intestinal polypeptide (VIP) and phentolamine mesylate (PM) on patients in whom previous intracavernosal therapy had failed.

Patients and method The study comprised 70 consecutive patients attending a clinic for erectile dysfunction, in whom previous therapy with intracavernosal prostaglandin‐E1 (20 μg and papaverine (30 mg) combined with 1 mg PM had failed. They were given intracavernosal injections, initially with 25 μg VIP/1 mg PM (VIP1) and if unsuccessful, 25 μg VIP/2 mg PM (VIP2). Both VIP1 and VIP2 were administered using a pre‐filled ready‐to‐use autoinjector fitted with a 29 G needle. The patients were diagnosed as having spinal cord lesion (eight), diabetes (21), ischaemic heart disease (12), hypertension (six), other diagnoses (nine), or idiopathic causes (14).

Result Forty‐seven (67%) of patients achieved erections sufficient for sexual intercourse (33 on VIP1 and 14 on VIP2), initially under clinical supervision and subsequently during home use. Minor side‐effects were transient facial flushing in 37 (53%), truncal flushing in six (9%), bruising in 14 (20%) and pain from the injection needle in eight (11%). No patients reported priapism or other serious adverse events.

Conclusion The combination of VIP and PM at the dose used was a safe and effective treatment in patients in whom other therapies had failed.
Comparing neural networks in the discrimination of benign from malignant lower urinary tract lesions
Authors: Pantazopoulos  , Karakitsos  , Iokim‐Liossi  , Pouliakis  , Dimopoulos
Published: March 2003

Objective

 To compare the performance of two different neural networks (NNs) in the discrimination of benign and malignant lower urinary tract lesions.

Materials and methods

 A group of patients was evaluated, comprising 50 cases of lithiasis, 61 of inflammation, 99 of benign prostatic hyperplasia (BPH), five of insitu carcinoma, 71 of grade I transitional cell carcinoma of the bladder (TCCB), and 184 of grade II and grade III TCCB. Images of routinely processed voided urine smears were stained using the Giemsa technique and analysed using an image‐analysis system, providing a dataset of 45 452 cells. Two NN models of the back propagation (BP) and learning vector quantizer (LVQ) type were used to discriminate benign from malignant cells and lesions, based on morphometric and textural features. The data from 13 636 randomly selected cells (30% of the total data) were used as a training set and data from the remaining 31 816 cells comprised the test set. Similarly, in an attempt to discriminate patients, 30% of the cases, selected randomly, were used to train a BP and an LVQ NN, with the remaining 329 cases used for the test set. The data used for training and testing were the same for the two kinds of classifiers.

Results

 The two NNs gave similar results, with an overall accuracy of discrimination of ≈90.5% at the cellular level and of ≈97% for individual patients. There were no statistically significant differences between the two NNs at the cellular or patient level.

Conclusions

 The use of NNs and image morphometry could increase the diagnostic accuracy of voided urine cytology; despite the different nature of the two classifiers, the results obtained were very similar.
Inhibitory effects of propiverine, atropine and oxybutynin on bladder instability in rats with infravesical outlet obstruction
Authors: Kwak  , Lee
Published: March 2003

Objective

 To compare the inhibitory effects of propiverine HCl (BUP‐4) with those of atropine and oxybutynin on the detrusor instability induced by partial obstruction of the bladder neck of female rats.

Materials and methods

 Partial obstruction was created using partial ligation of the proximal urethra in 20 female Sprague‐Dawley rats. Both the obstructed rats and a control group of 15 rats were evaluated cystometrically about 6 weeks later and the values compared both at baseline and after injection with BUP‐4, atropine or oxybutynin. During cystometry, the bladder capacity (BC), residual volume (RV), compliance and frequency of spontaneous activity (SA) were determined.

Results

 The BC, RV and frequency of SA were significantly increased, and compliance markedly decreased, in obstructed compared with normal rats. The micturition pressure was significantly decreased only after injection with BUP‐4 in both normal and obstructed rats. For both, the BC was increased significantly after injection with atropine or BUP‐4 (P<0.05), with the increase greater after BUP‐4 than after atropine in both groups (P<0.01). After injecting BUP‐4, the RV was significantly increased in both groups (P<0.05); atropine increased the RV only in normal rats (P<0.01) and oxybutynin had no significant effect on RV. Increases in compliance after the administration of each drug were significant only in obstructed rats (P<0.01) and were markedly higher after oxybutynin (780%) than after the other drugs (180–250%). The frequencies and amplitude of SA after injection with each drug were significantly lower only in obstructed rats, but in these rats, there were no significant differences in this reduction after injecting oxybutynin or BUP‐4, whereas they were significantly greater after injecting oxybutynin than after atropine.

Conclusion

 Partial bladder outlet obstruction successfully created a hyperactive (unstable) bladder, typified by increased BC, RV, frequency of SA and a marked decrease in compliance. The greater BC, lower MP and frequency and amplitude of SA were prominent after the administration of BUP‐4. Thus it is suggested that BUP‐4 effectively inhibited bladder instability in rats induced by infravesical outlet obstruction and was more effective than oxybutynin in increasing BC.
Congenital reflux nephropathy: a follow‐up of 108 cases diagnosed perinatally
Authors: Assael  , Guez  , Marra  , Secco  , Manzoni  , Bosio  , Pelegatta  , Acerbi  , Alberto Delli’agnola  , Selvaggio  , Vegni  , Cecchetti  , Cucchi
Published: March 2003

Objectives

 To determine: (i) the proportion of vesico‐ureteric reflux (VUR) associated with congenital renal damage and whether it can be severe enough to cause renal impairment from birth; (ii) to evaluate the distribution of males and females affected; and (iii) to describe the course of congenital damage in the first years of life.

Patients and methods

 A total of 108 children (76 male and 32 female, M:F 2.3:1), whose VUR was diagnosed before any infection, were followed from birth for a mean (range) of 4.3 (1–10) years. Renal damage was defined by serum creatinine concentration, creatinine clearance and renal imaging (ultrasonography and renal scintigraphy) performed within the first month of life and periodically thereafter.

Results

 Of the 108 children, 58 had bilateral and 50 unilateral reflux (total number of refluxing units, 166). High‐grade VUR (grade ≥4) was found in 96 (58%) refluxing renal units (RRUs). Males had a prevalence of bilateral severe (≥grade 4) reflux (M:F 5.2:1), while in those with unilateral VUR, the M:F ratio was 1.5:1. At birth, mild to moderate damage was present in 56 (36%) RRUs and only associated with VUR of grade ≥3. Bilateral reflux of grade ≥4 was associated with congenital moderate/severe renal failure in nine neonates (seven males). In infants with grade ≥4 VUR who underwent surgical correction, VUR resolved in 92% of cases. In infants with VUR of grade ≥4 followed medically, the reflux spontaneously resolved in 42% and ameliorated in 16% after 18 months. Serial renal scans during the follow‐up showed no progression of renal damage.

Conclusions

 VUR diagnosed at birth on prenatal ultrasonography is associated with congenital damage, with males affected more often than females. The damage involves both kidneys in a consistent proportion and is an important cause of chronic renal impairment from birth. It does not progress in the first years of life if infections are prevented. It is suggested that males with this condition may constitute a major group at risk of developing chronic renal failure in later life.
‘Nerve‐sparing’ cystectomy and substitution cystoplasty in patients of either sex: limitations and techniques
Authors: Venn  , Popert  , Mundy
Published: March 2003

Objectives

 To determine the limitations of cystectomy and orthotopic substitution cystoplasty in men and women with bladder cancer.

Patients and methods

 Cystectomy and orthotopic substitution cystoplasty were carried out in 79 patients (mean age 60 years, range 31–74, including eight women) who were followed for a mean of 7 years (range 1–13) to evaluate continence, potency and survival.

Results

 Overall, 80% of the patients were continent without further treatment and 55% of the men who were potent before surgery remained so afterward. The best results were obtained with retrograde cystectomy in both sexes and are only achievable in women in this way. Continence was achieved more easily in women than in men, although pathological delineation of the tumour preoperatively and technical considerations per‐operatively make both the selection and the procedure more demanding in women than in men.

Conclusions

 Cystectomy and orthotopic substitution cystoplasty is possible in patients of either sex and should be offered to all patients as an alternative to ileal conduit urinary diversion, unless preoperative assessment suggests that the urethra must be removed with the bladder, which is rare in men and uncommon in women. In such patients, a continent diversion may be the preferred option.
Differential alterations of prostacyclin, cyclic AMP and
Authors: Sullivan  , Thompson  , Mikhailidis  , Morgan  , Angelini  , Jeremy
Published: March 2003

Objective

 To investigate the effect of alloxan‐induced diabetes mellitus (DM, a major risk factor for erectile dysfunction and associated with impaired endothelial function) on the formation of nitric oxide (NO), prostacyclin (PGI2), cGMP and cAMP in the corpus cavernosum of rabbits.

Materials and methods

 Rabbits were rendered diabetic (hyperglycaemic, nonketotic) with alloxan; after 3 and 6 months, the penises were excised and the corpus cavernosum processed for the study of PGI2, NO, cAMP and cGMP formation, using a range of stimulators and radioimmunoassays.

Results

 PGI2 formation in response to acetylcholine and phorbol ester, but not arachidonate, and cGMP formation in response to A23187 (NO‐release dependent), was significantly diminished in diabetic rabbit corpus cavernosum compared with controls at both 3 and 6 months after the induction of DM. cAMP formation in response to forskolin and prostaglandin E1 was reduced after 6 but not 3 months, although nitroprusside‐stimulated cGMP (activates guanylyl cyclase directly) was unaffected in cavernosal tissue from diabetic rabbits.

Conclusions

 These results show that the formation of NO and PGI2, and adenylyl cyclase activity but not guanylyl cyclase, are impaired in the corpus cavernosum of diabetic rabbits. As NO and PGI2 are produced by the endothelium, these studies consolidate the view that endothelial dysfunction is a major contributor to erectile dysfunction in diabetes mellitus.
The long‐term effects of prostatic infarction in the rat
Authors: Park  , Lee  , Lee
Published: March 2003

Objective

 To evaluate the long‐term effects of infarction, which usually induces organ atrophy, on the prostate by examining the changes occurring in rat ventral prostate after infarction.

Materials and methods

 The unilateral arteriolar branches to the ventral prostate were electrocauterized under an operative microscope in 10 adult rats. The gross and histological changes of the treated lobes of the ventral prostate were compared with those of untreated control lobes in the same rats 12 weeks later.

Results

 The size and mean (sd) weight of the treated lobes decreased markedly, to 148 (34) mg, compared with those of the controls, at 698 (62) mg (P<0.01). The treated lobes were composed of both normal and atrophic glandular tissue.

Conclusion

 Prostatic atrophy can be induced by infarction in the rat; prostatic infarction might have potential as a new therapeutic strategy in the treatment of benign prostatic hyperplasia.
Fertility and histological studies of the contralateral testes in two different intra‐ and extra‐abdominal rat models of unilateral cryptorchidism
Authors: Zakaria  , Shono  , Imajima  , Suita
Published: March 2003

Objective

 To investigate the effect of location of the testis on both testicular development and fertility in unilateral cryptorchidism.

Material and methods

 Forty‐nine Wistar King A newborn male rats were divided into three groups. In group 1 (15 rats) intra‐abdominal unilateral cryptorchidism were created by the intra‐abdominal fixation of the testis in the neonatal period. In group 2 (16 rats) extra‐abdominal unilateral cryptorchidism was created by extra‐abdominal fixation of the gubernaculum in the neonatal period. In group 3, 18 rats underwent a sham operation as controls. At 90 days of age, fertility was then assessed in each rat by housing it with two mature virgin females for 2 weeks. Thereafter, at 115–120 days of age, the rats were killed and their testes removed for histological examination.

Results

 There was no significant difference in the pregnancy rate between females coupled with rats from any group, but the mean number of offspring was significantly lower in females coupled with rats in group 1 than in group 2. Furthermore, histological examination of both the cryptorchid and contralateral scrotal testes showed more severe changes in the intra‐abdominal than the extra‐abdominal testes.

Conclusion

 These results suggest that intra‐abdominal cryptorchid testes are significantly more impaired than extra‐abdominal cryptorchid testes, and that such impairment might be caused by exposure of the testis to a higher temperature. The more severely impaired undescended testes may thus induce the degeneration of the contralateral scrotal testis and thereby cause subfertility in the intra‐abdominal unilateral cryptorchid rat model.
Metallic ureteric stents: early experience
Authors: Pandian  , Hussey  , Mcclinton
Published: March 2003

Objective

 To report our experience with metallic self‐expanding stents in the palliative care of patients with ureteric obstruction caused by advanced pelvic malignancy.

Patients and methods

 Seven patients (five men and two women, mean age 72.8 years, range 58–88) with ureteric obstruction caused by advanced pelvic malignancy were evaluated. Self‐expanding metallic Memotherm™ stents (Angiomed, Karlsruhe, Germany) were deployed using an antegrade approach in all patients. Patients were followed for a mean (range) of 9 (4–13) months to assess renal function and survival.

Results

 All seven patients had good palliation; their quality of life was improved and symptoms such as loin pain were ameliorated. Renal function was preserved; the mean serum creatinine level before and after stenting was 636 and 263 μmol/L, respectively). The mean duration of stent patency was 9 months. Of the five patients who subsequently died, only two had recurrent renal failure, presumably caused by stent occlusion.

Conclusions

 The use of metallic stents in the palliative care of ureteric obstruction caused by advanced pelvic malignancy is a safe and effective treatment.
Lithogenic risk factors in the urine of black and white subjects
Authors: Whalley  , Moraes  , Shar  , Pretorius  , Meyers
Published: March 2003

Objective

 To identify biochemical and dietary factors which may play a role in the low incidence of stone formation in the black South African population.

Subjects and methods

 The study included 31 semi‐urbanized black and 29 urbanized white subjects. The protocol and modern laboratory techniques used to assess recurrent stone formers were followed. Urinary sodium, potassium, creatinine, calcium, phosphate and urate levels were measured, and urinary citrate, oxalate and cystine assessed.

Results

 Black subjects ate a diet significantly higher in sodium (P<0.04); there was no difference in serum levels but urinary sodium was significantly higher (P<0.001) in black than in white subjects. Urinary potassium, calcium, citrate, phosphate and cystine were all significantly lower in black than in white subjects (P<0.001 for the first four and P<0.03 for cystine).

Conclusion

 Certain intrinsic factors in South African black subjects may account for their lower frequency of stone formation than in white subjects. Of these, the very low urinary calcium, decreased urinary cystine and different interactions between sodium and calcium/cystine are probably important.
Pelvic fracture injuries of the female urethra
Authors: Venn  , Greenwell  , Mundy
Published: March 2003

Objective

To review pelvic fracture urethral injuries in women, generally regarded as rare and thus discussed infrequently.

Patients and methods

Twelve patients (age range 7–51 years) with such injuries were reviewed; most had associated injuries, generally more severe than seen in males with urethral injuries.

Results

Patients with milder injuries, perhaps damaging just the innervation of the urethra, presented with incontinence; more severe injuries seemed to cause a longitudinal tear in the urethra but again patients presented mainly with incontinence problems. The most severe injuries were associated with complete rupture of the urethra and a distraction defect suggesting an avulsion injury. These problems were difficult to treat both reconstructively and in providing continence.

Conclusions

Pelvic fracture urethral injuries occur in females, but less often than in males. The female urethra seems relatively resistant to injury; differing degrees of severity of pelvic trauma cause different types of urethral injury but in general, a more severe injury is needed to damage it than is necessary in males.