Mid-urethral slings for treatment of stress urinary incontinence : long- and mid-term follow-up

Urinary incontinence is a common problem, affecting one third of the women at least at some time during their lives. The prevalence of urinary incontinence increases with advancing age, and the everyday impact of incontinence on women and on health services is enormous. Urinary incontinence is usually divided into three different subtypes, of which stress urinary incontinence (SUI) is the most common. Surgical treatment is often needed to cure SUI, and modern mid-urethral sling procedures give the possibility to cure this condition with a low risk of adverse events, a problem often associated with the so-called traditional incontinence operations. Life expectancy among women in Western countries has grown beyond 80 years of age. Long-term efficacy of treatment options for urinary incontinence therefore becomes an important issue in a world with limited eco-nomic resources. The purpose of the present study was to prospectively evaluate the long-term efficacy and safety of the first minimally invasive mid-urethral tape procedure, the Tension-free Vaginal Tape (TVT) procedure. The long-term (5-year) follow-up results of the TVT procedure as a repeat operation af-ter an unsuccessful mid-urethral tape operation were studied and the reasons for failure of the first operation were analyzed. Another purpose was to compare the original TVT procedure with a newer modification, the Tension-free Vaginal Tape Obturator (TVT-O) procedure within a multi-centre, randomized context in order to find out possible differences between these procedures re-garding efficacy and complications and the effects on symptoms of urgency. The first study of the present thesis is a prospective, Nordic, three-centre follow-up study of 90 women suffering from SUI, who were treated by means of the TVT procedure. The mean follow-up time was more than eleven years, and the study is the first to be published in connection with more than ten years of follow-up. The second study is a retrospective analysis of 26 women who were treated with a repeat TVT procedure after an unsuccessful primary mid-urethral tape procedure. The third and fourth studies concern 273 women in seven centres in Finland who were ran-domly assigned to the TVT and TVT-O procedures, the 3-year follow-up results of which are pre-sented in this thesis. After eleven years of follow-up, 90% of the women had a negative cough stress test result and a negative 24-h pad test result. The subjective cure rate measured as the women s global impression of cure was 77%, the rate of improvement 20%, and only 3% thought that the treatment had failed. No late-onset adverse effects were found. The repeat TVT procedure was successful in 75% of the cases when women who were cured and women who were significantly improved were included. The reasons for failure of the first operation could be separated into four different groups: tape material-related, operation technique-related, concomitant illness-related and a group with no identifiable reason. There were no intra-operative complications during the repeat operation. In the randomized trial comparing the TVT with the TVT-O procedure a cough stress test results were negative in 94.6% and 89.5% of the women in the two groups, respectively, after a 3-year follow-up period. There were no statistical differences in the cure rate or the rate of complications be-tween the two procedures. Symptoms of urgency were analyzed more closely and the main finding was that the prevalence of urgency symptoms decreased significantly after both mid-urethral sling procedures. The TVT operation was found to be an effective and safe procedure even after eleven years of follow-up. Long-term follow-up after a repeat TVT procedure revealed that the TVT procedure can well be considered after an unsuccessful mid-urethra tape procedure, because 75% of the patients showed significantly improvement of their incontinence. The TVT and TVT-O procedures showed no statistically significant differences in efficacy and rate of complications after three years of follow-up. In most cases these procedures alleviate preoperative symptoms of urgency and the risk of developing de novo urgency is low.

Infrared spectroscopic study of the phase transitions in CsNO3, RbNO3 and NH4NO3

Phase transitions of CsNO3 (II-I), RbNO3 (IV-III-II) and NH4NO3 (V-IV-III-II-I) have been studied by i.r. spectroscopy. The study has provided useful information on the changes in the dispositions of the ions during the phase transitions.

Infrared and Nuclear Quadrupole Resonance Studies of the Phase Transitions of Para-dichlorobenzene

The α→γ→α→β transitions of para-dichlorobenzene have been studied by employing infrared and n.q.r. spectroscopy as well as differential scanning calorimetry. The γ phase is associated with considerably higher values of some of the intramolecular vibration frequencies. The α→γ transition shows athermal nucleation behaviour as in martensitic transitions. Intermolecular vibration bands around 46 and 85 cm–1 present in γ and α phases disappear in the β phase. The α→β transition seems to be associated with some orientational disorder.

An infrared spectroscopic study of the low-spin-high-spin transition in FexMn1-x(Phen)2(NCS)2: A composition-induced change in the order of the spin-state transition

Infrared spectroscopy provides a valuable tool to investigate the spin-state transition in Fe(II) complexes of the type Fe(Phen)2(NCS)2. With progressive substitution of Fe by Mn, the first-order transition changes over to a second-order transition, with a high residual population of the high-spin state even at very low temperatures

Synthesis, infrared spectra and thermoanalytical properties of transition metal sulfite hydrazine hydrates

Transition metal sulfite hydrazine hydrates, MSO3·xN2H4·yH2O whereM=Mn, Fe, Co, Ni and Zn have been prepared and characterized by chemical analysis, infrared spectra, thermoanalytical and combustion studies. The colours,x andy parameters of the complexes varied depending upon the preparation conditions. Thermal decomposition characteristics differ from metal to metal yielding metal oxides at relatively low temperatures.Mittels chemischer Analyse, IR-Spektren, thermoanalytischen und Verbrennungsstudien wurden die Hydrazinhydrate der hergestellten Übergangsmetallsulfite MSO3·xN2H4·yH2O mitM=Mn, Fe, Co, Ni und Zn beschrieben. Farbe sowie die Parameterx undy der Komplexe hängen von den Herstellungsbedingungen ab. Die thermische Zersetzung, bei der bei relativ niedrigen Temperaturen Metalloxide entstehen, ist von Metall zu Metall verschieden.

Infrared divergences and confinement in massive (2+1)-dimensional QED

In (2+1)-dimensional quantum electrodynamics with massless photons and massive matter fields, it is shown that the mass renormalization of the latter is infrared divergent at one loop. This result remains unchanged at two loops. A simple argument based on a similar divergence of the Coulomb potential leads us to conjecture that charged states are not observable in this model. This argument holds in 1+1 dimensions also.

An infrared spectroscopic study of the orientational phase transitions of C70

Infrared spectroscopic studies of C70 films show variation in absorbance and linewidth of the bands across the orientational phase transitions around 280 and 340 K. There is some evidence for the coexistence of phases in the 210–270 K region and for the occurrence of another transition below 200 K.

Model Based Target Tracking in a Wireless Network of Passive Infrared Sensor Nodes

We consider the problem of tracking an intruder in a plane region by using a wireless sensor network comprising motes equipped with passive infrared (PIR) sensors deployed over the region. An input-output model for the PIR sensor and a method to estimate the angular speed of the target from the sensor output are proposed. With the measurement model so obtained, we study the centralized and decentralized tracking performance using the extended Kalman filter.

Dynamic structure of charge carrier in polyaniline by near-infrared excited resonance Raman spectroscopy

New vibrational Raman features characteristic to the conductive form of polyaniline have been observed with the near-infrared excitation at 1047 nm. Based on an analogy with the resonance Raman spectrum of Michler's ketone in the lowest excited triplet (T-1) state, we consider these features as due to a dynamic structure of a diimino-1,4-phenylene unit in the polyaniline chain exchanging a positive charge very rapidly. This consideration directly leads to a conducting mechanism in which a positive charge migrates from one nitrogen to the other through the conjugated chain of polyaniline.

Ultrafast laser spectroscopy-A tool chemists and biologists

Application of ultrafast lasers to chemistry and biology has been an active area of research in the international scene for over a decade for physical and biophysical chemists. Perhaps, ultrafast laser spectroscopy is one of the most versatile tools available today to experimentally study structure and dynamics in the time domain of nanoseconds (10(-9) sec) to femtoseconds (10(-15) sec). In this article we attempt to highlight some of the recent developments in ultrafast laser spectroscopy with particular reference to vibrational spectroscopy, viz. infrared and Raman spectroscopy, in the above time domain.

Recombinant mid gut antigen (Bm95) as a vaccine against Indian Rhiphicephalus haemaphysaloides in Bos indicus cattle

In the present study, we report for the first time the efficacy of recombinant Bm95 mid gut antigen isolated from an Argentinean strain of Rhipicephalus microplus strain A in controlling the tick infestations in India. The synthetic gene for Bm95 optimized for expression in yeast was obtained and used to generate yeast transformants expressing Bm95 which was purified to apparent homogeneity. Liquid chromatography-mass spectrometry analysis of the purified protein confirmed its identity as Bm95. Vaccine was prepared by blending various concentrations of purified Bm95 with aluminium hydroxide as an adjuvant. lmmunogenicity studies of the vaccine in rabbits and cattle indicated that the vaccine was highly immunogenic. The efficacy studies of the vaccine was done in cattle. Naive Bos indicus cattle were vaccinated with the recombinant vaccine and were challenged with the larval, nymphal and adult forms of Rhiphicephalus haemaphysaloides. The vaccine protected the animals from larval, nymph and adult tick challenges with an efficacy of 98.7%, 84.6% and 78.9% respectively. The results obtained from the above studies clearly demonstrated the advantage and possibilities of the use of Bm95 in controlling R. haemaphysaloides infestations in the field. (C) 2010 Elsevier Ltd. All rights reserved.

An investigation of the first-order spin-state transition in Fe(Phen)(2)(NCS)(2) EXAFS and infrared spectroscopy

The structure of Fe(Phen)(2)(NCS)(2) has been examined across the first-order spin-state transition by EXAFS with full multiple scattering analysis. The EXAFS data at 298 K can be satisfactorily assigned to the high-spin state, but the analysis of the low-temperature data at 90 K is not entirely unequivocal, although consistent with the predominant presence of the low-spin state. That some proportion of the high-spin state remains at low temperatures, well below the first-order transition, is clearly evidenced in the infrared spectra, suggesting possible sublattice ordering.