Urethral atrophy after artificial urinary sphincter placement:Is cuff downsizing effective?

Purpose: We reviewed the outcome of cuff downsizing with an artificial urinary sphincter for treating recurrent incontinence due to urethral atrophy.

Materials and Methods: We analyzed the records of 17 patients in a 7-year period in whom clinical, radiological and urodynamic evidence of urethral atrophy was treated with cuff downsizing. Cuff downsizing was accomplished by removing the existing cuff and replacing it with a 4 cm. cuff within the established false capsule. Incontinence and satisfaction parameters before and after the procedure were assessed by a validated questionnaire.

Results: Mean patient age was 70 years (range 62 to 79). Average time to urethral atrophy was 31 months (range 5 to 96) after primary sphincter implantation. Mean followup after downsizing was 22 months (range 1 to 64). Cuff downsizing caused a mean decrease of 3.9 to 0.5 pads daily. The number of severe leakage episodes decreased from a mean of 5.4 to 2.1 The mean SEAPI (stress leakage, emptying, anatomy, protection, inhibition) score decreased from 8.2 to 2.4. Patient satisfaction increased from 15% to 80% after cuff downsizing. In 1 patient an infected cuff required complete removal of the device.

Conclusions: Patient satisfaction and continence parameters improved after cuff downsizing. We believe that this technique is a simple and effective method of restoring continence after urethral atrophy.

Renouveau religieux et politique au Mozambique: entre permanence, rupture et historicité

La recherche sur le religieux en Afrique s’est beaucoup intéressée, ces vingt dernières années, au phénomène du « renouveau religieux », et elle s’est plutôt penchée sur la question des ruptures et des innovations qui en résultent. Le présent article interroge la réalité ce renouveau et explore, sur la base d’une étude de cas, la question des continuités et des ruptures dans les changements survenus  [1]. Tout d’abord, il s’intéresse à la nature du renouveau religieux au Mozambique ; il examine ensuite les continuités historiques et dénominationnelles existantes au sein du renouveau pour discuter, dans une troisième section, l’impact des transformations religieuses sur la relation entre religion et politique. La conclusion tente, elle, de faire la part entre ruptures et permanences, et d’appréhender la question du renouveau au-delà de cette dichotomie.

Current-induced embrittlement of atomic wires

Recent experiments suggest that gold single-atom contacts and atomic chains break at applied voltages of 1 to 2 V. In order to understand why current flow affects these defect-free conductors, we have calculated the current-induced forces on atoms in a Au chain between two Au electrodes. These forces are not by themselves sufficient to rupture the chain. However, the current reduces the work to break the chain, which results in a dramatic increase in the probability of thermally activated spontaneous fracture of the chain. This current-induced embrittlement poses a fundamental limit to the current-carrying capacity of atomic wires.

Playing with the ‘Erbe’: The Legacy of the Songs of the 1848 Revolution in the GDR

After the twelve-year rupture caused by the Nazis, in the Soviet zone after 1945 attempts were made to reconnect with the traditions of workers’ songs and critical folk songs that were viewed as the cultural heritage of the communist movement. One of these ‘repertoires’ of song was that of the 1848 Revolution. In the 1950s GDR researchers such as the Germanist Bruno Kaiser, the musicologist Inge Lammel and in particular the folklorist Wolfgang Steinitz made substantial contributions to the collecting and publication of the 1848 songs. Their work provided an important reference point for the singers of the German folk song revival in the GDR from the late 1970s onwards. As the cases of groups such as Folkländer and Wacholder showed, theirs was a particularly creative appropriation of the revolutionary Erbe that involved performing protest songs of the past as if they were criticising the present.

Systematic review of reviews of risk factors for intracranial aneurysms

Systematic reviews of systematic reviews identify good quality reviews of earlier studies of medical conditions. This article describes a systematic review of systematic reviews performed to investigate factors that might influence the risk of rupture of an intracranial aneurysm. It exemplifies the technique of this type of research and reports the finding of a specific study. The annual incidence of subarachnoid haemorrhage resulting from the rupture of intracranial aneurysms is estimated to be nine per 100,000. A large proportion of people who have this bleed, will die or remain dependent on the care of others for some time. Reliable knowledge about the risks of subarachnoid haemorrhage in different populations will help in planning, screening and prevention strategies and in predicting the prognosis of individual patients. If the necessary data were available in the identified reviews, an estimate for the numerical relationship between a particular characteristic and the risk of subarachnoid haemorrhage was included in this report. The identification of eligible systematic reviews relied mainly on the two major bibliographic databases of the biomedical literature: PubMed and EMBASE. These were searched in 2006, using specially designed search strategies. Approximately 2,000 records were retrieved and each of these was checked carefully against the eligibility criteria for this systematic review. These criteria required that the report be a systematic review of studies assessing the risk of subarachnoid haemorrhage in patients known to have an unruptured intracranial aneurysm or of studies that had investigated the characteristics of people who experienced a subarachnoid haemorrhage without previously being known to have an unruptured aneurysm. Reports which included more than one systematic review were eligible and each of these reviews was potentially eligible. The quality of each systematic review was assessed. In this review, 16 separate reports were identified, including a total of 46 eligible systematic reviews. These brought together research studies for 24 different risk factors. This has shown that the following factors appear to be associated with a higher risk of subarachnoid haemorrhage: being a woman, older age, posterior circulation aneurysms, larger aneurysms, previous symptoms,

Microstructure evolution of a 10Cr heat-resistant steel during high temperature creep

The microstructure evolution of a 10Cr ferritic/martensitic heat-resistant steel during creep at 600°C was investigated in this work. Creep tests demonstrated that the 10Cr steel had higher creep strength than conventional ASME-P92 steel at 600°C. The microstructure after creep was studied by transmission electron microscopy, scanning electron microscopy and electron probe microanalysis. It was revealed that the martensitic laths were coarsened with time and eventually developed into subgrains after 8354 h. Laves phase was observed to grow and cluster along the prior austenite grain boundaries during creep and caused the fluctuation of solution and precipitation strengthening effects, which was responsible for the two slope changes on the creep rupture strength vs rupture time curve. It was also revealed that the microstructure evolution could be accelerated by stress, which resulted in the lower hardness in the deformed part of the creep specimen, compared with the aging part.