Virtual reality rehabilitation as a treatment approach for older women with mixed urinary incontinence : a feasibility study

Background Motivated patients are more likely to adhere to treatment resulting in better outcomes. Virtual reality rehabilitation (VRR) is a treatment approach that includes video gaming to enhance motivation and functional training. Aims The study objectives were (1) to evaluate the feasibility of using a combination of pelvic floor muscles (PFM) exercises and VRR (PFM/VRR) to treat mixed urinary incontinence (MUI) in older women, (2) to evaluate the effectiveness of the PFM/VRR program on MUI symptoms, quality of life (QoL), and (3) gather quantitative information regarding patient satisfaction with this new combined training program. Methods Women 65 years and older with at least 2 weekly episodes of MUI were recruited. Participants were evaluated two times before and one time after a 12-week PFM/VRR training program. Feasibility was defined as the participants' rate of participation in and completion of both the PFM/VRR training program and the home exercise. Effectiveness was evaluated through a bladder diary, pad test, symptom and QoL questionnaire, and participant's satisfaction through a questionnaire. Results Twenty-four women (70.5 ± 3.6 years) participated. The participants complied with the study demands in terms of attendance at the weekly treatment sessions (91%), adherence to home exercise (92%) and completion of the three evaluations (96%). Post-intervention, the frequency and quantity of urine leakage decreased and patientreported symptoms and QoL improved significantly. Most participants were very satisfied with treatment (91%). Conclusion A combined PFM/VRR program is an acceptable, efficient, and satisfying functional treatment for older women with MUI and should be explore through further RCTs.

TRPV4 is necessary for trigeminal irritant pain and functions as a cellular formalin receptor.

Detection of external irritants by head nociceptor neurons has deep evolutionary roots. Irritant-induced aversive behavior is a popular pain model in laboratory animals. It is used widely in the formalin model, where formaldehyde is injected into the rodent paw, eliciting quantifiable nocifensive behavior that has a direct, tissue-injury-evoked phase, and a subsequent tonic phase caused by neural maladaptation. The formalin model has elucidated many antipain compounds and pain-modulating signaling pathways. We have adopted this model to trigeminally innervated territories in mice. In addition, we examined the involvement of TRPV4 channels in formalin-evoked trigeminal pain behavior because TRPV4 is abundantly expressed in trigeminal ganglion (TG) sensory neurons, and because we have recently defined TRPV4's role in response to airborne irritants and in a model for temporomandibular joint pain. We found TRPV4 to be important for trigeminal nocifensive behavior evoked by formalin whisker pad injections. This conclusion is supported by studies with Trpv4(-/-) mice and TRPV4-specific antagonists. Our results imply TRPV4 in MEK-ERK activation in TG sensory neurons. Furthermore, cellular studies in primary TG neurons and in heterologous TRPV4-expressing cells suggest that TRPV4 can be activated directly by formalin to gate Ca(2+). Using TRPA1-blocker and Trpa1(-/-) mice, we found that both TRP channels co-contribute to the formalin trigeminal pain response. These results imply TRPV4 as an important signaling molecule in irritation-evoked trigeminal pain. TRPV4-antagonistic therapies can therefore be envisioned as novel analgesics, possibly for specific targeting of trigeminal pain disorders, such as migraine, headaches, temporomandibular joint, facial, and dental pain, and irritation of trigeminally innervated surface epithelia.

Nanowires for 3d silicon interconnection – low temperature compliant nanowire-polymer film for z-axis interconnect

Semiconductor chip packaging has evolved from single chip packaging to 3D heterogeneous system integration using multichip stacking in a single module. One of the key challenges in 3D integration is the high density interconnects that need to be formed between the chips with through-silicon-vias (TSVs) and inter-chip interconnects. Anisotropic Conductive Film (ACF) technology is one of the low-temperature, fine-pitch interconnect method, which has been considered as a potential replacement for solder interconnects in line with continuous scaling of the interconnects in the IC industry. However, the conventional ACF materials are facing challenges to accommodate the reduced pad and pitch size due to the micro-size particles and the particle agglomeration issue. A new interconnect material - Nanowire Anisotropic Conductive Film (NW-ACF), composed of high density copper nanowires of ~ 200 nm diameter and 10-30 µm length that are vertically distributed in a polymeric template, is developed in this work to tackle the constrains of the conventional ACFs and serves as an inter-chip interconnect solution for potential three-dimensional (3D) applications.

Randomized controlled trial of physiotherapy for postpartum stress incontinence : 7-year follow-up

Objective To estimate the long-term effect of intensive, 6-week physiotherapy programs, with and without deep abdominal muscle (TrA) training, on persistent postpartum stress urinary incontinence (SUI). Methods The study was a single-blind randomized controlled trial. Fifty-seven postnatal women with clinically demonstrated persistent SUI 3 months after delivery participated in 8 weeks of either pelvic floor muscle training (PFMT) (28) or PFMT with deep abdominal muscle training (PFMT + TrA) (29). Seven years post-treatment, 35 (61.4%) participants agreed to the follow-up; they were asked to complete a 20-min pad test and three incontinence-specific questionnaires with an assessor blinded to each participant's group assignment. Results: Of the 35 (61.4%) who agreed to the follow-up: 26 (45.6%) took the 20-min pad test (12 PFMT and 14 PFMT + TrA) and 35 (61.4%) completed the questionnaires (18 PFMT and 17 PFMT + TrA). The baseline clinical characteristics of the follow-up and non-follow-up participants were not significantly different; nor did they differ between PFMT and PFMT + TrA participants enrolled in the follow-up study. At 7 years, the pad test scores for the PFMT group did not differ statistically from those of the PFMT + TrA group. When combining both treatment groups, a total of 14/26 (53%) follow-up participants were still continent according to the pad test. Conclusion The addition of deep abdominal training does not appear to further improve the outcome of PFM training in the long term. However, benefits of physiotherapy for postpartum SUI, although not as pronounced as immediately after the initial intervention, is still present 7 years post-treatment.

Physiotherapy for persistent postnatal stress urinary incontinence : a randomized controlled trial

OBJECTIVE: The aim of this study was to compare the effectiveness of multimodal supervised physiotherapy programs with the absence of treatment among women with persistent postnatal stress urinary incontinence. METHODS: This was a single-blind randomized controlled trial. Sixty-four women with stress urinary incontinence were randomly assigned to 8 weeks of either multimodal pelvic floor rehabilitation (n = 21), multimodal pelvic floor rehabilitation with abdominal muscle training (n = 23), or control non–pelvic floor rehabilitation (n = 20). The primary outcome measure consisted of a modified 20-minute pad test. The secondary outcome measures included a Visual Analog Scale describing the perceived burden of incontinence, the Urogenital Distress Inventory, the Incontinence Impact Questionnaire, and pelvic floor muscle function measurements. RESULTS: Two patients dropped out, leaving 62 for analysis. At follow-up, more than 70% of the women in the treatment groups (14/20 in the pelvic floor and 17/23 in the pelvic floor plus abdominal group) were continent on pad testing compared with 0% of women in the control group. Scores on the pad test, Visual Analog Scale, Urogenital Distress Inventory, and Incontinence Impact Questionnaire improved significantly in both treatment groups (all P < .002), whereas no changes were observed in the control group. Pelvic floor muscle function, however, did not improve significantly in either active group. CONCLUSION: Multimodal supervised pelvic floor physiotherapy is an effective treatment for persistent postnatal stress urinary incontinence.

Virtual reality rehabilitation as a treatment approach for older women with mixed urinary incontinence : a feasibility study

Background Motivated patients are more likely to adhere to treatment resulting in better outcomes. Virtual reality rehabilitation (VRR) is a treatment approach that includes video gaming to enhance motivation and functional training. Aims The study objectives were (1) to evaluate the feasibility of using a combination of pelvic floor muscles (PFM) exercises and VRR (PFM/VRR) to treat mixed urinary incontinence (MUI) in older women, (2) to evaluate the effectiveness of the PFM/VRR program on MUI symptoms, quality of life (QoL), and (3) gather quantitative information regarding patient satisfaction with this new combined training program. Methods Women 65 years and older with at least 2 weekly episodes of MUI were recruited. Participants were evaluated two times before and one time after a 12-week PFM/VRR training program. Feasibility was defined as the participants' rate of participation in and completion of both the PFM/VRR training program and the home exercise. Effectiveness was evaluated through a bladder diary, pad test, symptom and QoL questionnaire, and participant's satisfaction through a questionnaire. Results Twenty-four women (70.5 ± 3.6 years) participated. The participants complied with the study demands in terms of attendance at the weekly treatment sessions (91%), adherence to home exercise (92%) and completion of the three evaluations (96%). Post-intervention, the frequency and quantity of urine leakage decreased and patientreported symptoms and QoL improved significantly. Most participants were very satisfied with treatment (91%). Conclusion A combined PFM/VRR program is an acceptable, efficient, and satisfying functional treatment for older women with MUI and should be explore through further RCTs.

Musicoterapia y Arteterapia. Puntos de encuentro en el camino terapéutico

En este artículo pretendemos buscar los aspectos que confluyen en el ámbito de la musicoterapia y el arteterapia, comenzando por su definición y orígenes y siguiendo con los modelos teóricos más importantes. Al analizar los trabajos de investigación elaborados a partir de proyectos en los que se combina la práctica de las dos disciplinas, observamos la necesidad de una mayor interdisciplinareidad. Esto daría lugar a un mayor enriquecimiento de las sesiones y por tanto, del trabajo terapéutico, lo que revertiría en una mejora de la calidad de la intervención.

Peripheral Artery Disease Patients May Benefit More from Aggressive Secondary Prevention than Aneurysm Patients to Improve Survival

BACKGROUND AND AIMS: Although it has become clear that aneurysmal and occlusive arterial disease represent two distinct etiologic entities, it is still unknown whether the two vascular pathologies are prognostically different. We aim to assess the long-term vital prognosis of patients with abdominal aortic aneurysmal disease (AAA) or peripheral artery disease (PAD), focusing on possible differences in survival, prognostic risk profiles and causes of death. METHODS: Patients undergoing elective surgery for isolated AAA or PAD between 2003 and 2011 were retrospectively included. Differences in postoperative survival were determined using Kaplan-Meier and Cox regression analysis. Prognostic risk profiles were also established with Cox regression analysis. RESULTS: 429 and 338 patients were included in the AAA and PAD groups, respectively. AAA patients were older (71.7 vs. 63.3 years, p < 0.001), yet overall survival following surgery did not differ (HR: 1.16, 95% CI: 0.87-1.54). Neither was type of vascular disease associated with postoperative cardiovascular nor cancer-related death. However, in comparison with age- and gender-matched general populations, cardiovascular mortality was higher in PAD than AAA patients (48.3% vs. 17.3%). Survival of AAA and PAD patients was negatively affected by age, history of cancer and renal insufficiency. Additional determinants in the PAD group were diabetes and ischemic heart disease. CONCLUSIONS: Long-term survival after surgery for PAD and AAA is similar. However, overall life expectancy is significantly worse among PAD patients. The contribution of cardiovascular disease towards mortality in PAD patients warrants more aggressive secondary prevention to reduce cardiovascular mortality and improve longevity.

Exercise Training in Rats Impairs the Replenishment of White Adipose Tissue after Partial Lipectomy

The aim of this study was to evaluate the effect of exercise training on the metabolism of rats following the partial removal of fat pads. Three-month-old male Wistar rats were subjected to the partial removal (L) of retroperitoneal white adipose tissue (RET) and epididymal white adipose tissue (EPI), or a sham operation (Sh). Seven days after surgery, both sets of rats were subdivided into exercised (LE or ShE) (swimming 90 min/day, 5 days/week, 6 weeks) and sedentary (LS or ShS) groups. Partial removal of the fat pads increased the lipogenesis rates in both the RET and EPI and decreased the weight and lypolysis rate of the EPI, while the RET weight was not significantly affected by lipectomy. In both lipectomized and sham-operated groups, exercise training caused a reduction in carcass lipid content, food intake, RET and EPI weights, and RET lipogenesis rate. On the other hand, the exercise training increased the percentage of diet-derived lipid accumulation in both tissues, either in sham and lipectomized rats. These results confirmed that regrowth is not uniform and depends on the particular fat pad that is excised. They also demonstrated that exercise training following the partial removal of fat pads modified adipose tissue metabolism, impaired the replenishment of adipose tissue, and decrease body adiposity.

Lipid Metabolism of Monosodium Glutamate Obese Rats after Partial Removal of Adipose Tissue

We analyzed the effects of partial fat pad removal on retroperitoneal and epididymal fat depots and carcass metabolism of control (C) and MSG-obese (M) rats. Three-month-old C and M male Wistar rats were submitted to either partial surgical excision of epididymal and retroperitoneal fat tissue (lipectomy, L) or sham surgery (S) and studied after 7 or 30 days. Retroperitoneal and epididymal tissue re-growth after lipectomy was not observed, as indicated by the low pads weight of the L groups. The lipolysis rate was stimulated in LC7 and LM7, probably due to surgical stress and low insulin levels. In LM7, but not in LC7, in vivo lipogenesis rate increased in retroperitoneal and epididymal fat tissue, as did the diet-derived lipid accumulation in epididymal fat tissue. Although these local increases were no longer present in LM30, this group showed a large increase in the percentage of small area adipocytes in both pads as well as increased carcass lipogenesis rate. The present data showed that the partial removal of fat depots affected the metabolism of control and MSG-obese rats differently. In the obese animals only, it stimulated both local and carcass lipogenesis rate as well as adipocyte differentiation, i.e. responses likely to favor excised tissue re-growth and/or compensatory growth of non-excised depots.

Long Chain Saturated Fatty Acids Increase Haptoglobin Gene Expression in C57BL/6J Mice Adipose Tissue and 3T3-L1 Cells

Background Dietary lipids are directly related to the composition of adipose tissue, aetiology of obesity and arousal of obesity-related pathologies, like chronic inflammation states. Haptoglobin is an acute phase protein secreted by the liver and white adipose tissue, and its blood levels vary according to the volume of fat in the body. Aim of the study To investigate the effect of diets enriched with large amounts of dietary fats, which differ in their fatty acid composition, on the haptoglobin gene expression by visceral and subcutaneous adipose tissue of mice fed for 2 days or 8 weeks. 3T3-L1 cells were treated with fatty acids that are found in those types of dietary fats. Methods Mice were treated acutely (for 2 days) or chronically (for 8 weeks) with diets enriched with soybean oil, fish oil, coconut oil or lard. 3T3-L1 cells were treated with six different fatty acids. Haptoglobin gene expression was quantified by northern blotting. Results Both chronic and acute treatment with lard, which is rich in long chain saturated fatty acids, increased the haptoglobin mRNA expression in the retroperitoneal and epidydimal white adipose tissues. Chronic treatment with coconut oil, which is rich in medium chain saturated fatty acids, increased the haptoglobin expression in the epidydimal and subcutaneous depots. In 3T3-L1, palmitic acid increased the haptoglobin gene expression. Conclusion The type of lipids in the diet can differently modulate the white adipose tissue gene expression of haptoglobin, and saturated fatty acids play a major role in promoting a pro-inflammatory environment. This response is fat pad specific and dependant on the duration of treatment.

Dynamic self-regulating prosthesis in inguinal hernia repair

Inguinal hernia repair is one of the most common surgical procedure performed in Western countries and it consumes a lot of healthcare resources. Several types of different mesh are now disposable and tension-free techniques represent the “golden standard”. In our study, fifty male patients were operated on for inguinal hernia and a PAD (i.e., dynamic self-regulating prosthesis) used for the repair of the inguinal defect: this technique demonstrated to be safe, effective and easy to perform.

Resultado de la intervención Enseñanza: dieta prescrita en la consulta de enfermedad renal crónica avanzada

En la consulta de enfermedad renal crónica avanzada (ERCA), se proporcionan cuidados a los pacientes con enfermedad renal crónica con un filtrado glomerular (FG) < 30 ml/min. Estos incluyen diferentes intervenciones de enfermería. Una de ellas es la intervención 5614 Enseñanza: dieta prescrita. Objetivo: Analizar la eficacia de la intervención 5614 Enseñanza: dieta prescrita, en pacientes ERCA realizada en la consulta de enfermería, en la primera visita. Material y métodos: Estudio cuasiexperimental. Se incluyeron 92 pacientes incidentes en la consulta ERCA en 2014. Se realizó la intervención 5614 Enseñanza: dieta prescrita y se evaluaron indicadores de resultado 1004 Estado nutricional a los 2 meses de la intervención. Se llevó a cabo una estadística descriptiva de las variables pre y post intervención. Resultados: Edad media 69,5±15 años, 64,1% (n=59) hombres, 35,9% (n=33) mujeres, 41,3% diabéticos. Después de la intervención el 62% de los pacientes disminuyeron el valor del K, el 54,3% el del P, el 55,4% el del colesterol total, el 59,8% el del colesterol-LDL, y el 44,6% el del ácido úrico. El 67,4% de los pacientes presentó pérdida ponderal. En estos pacientes la variación media de la albúmina fue -0,005±0,0028 mg/dL. El FG permaneció estable en el 63% de los pacientes. La PAS media disminuye en el 42,4% de los pacientes y la PAD media en el 38%. Conclusiones: Tras la intervención 5614 Enseñanza: dieta prescrita realizada a los pacientes ERCA en la primera visita, se observa disminución del peso y valores plasmáticos de P, K, colesterol- LDL, colesterol total y ácido úrico. La Función renal permanece estable. La concentración de albúmina en los pacientes que perdieron peso se mantiene estable. La diferencia de la media para los valores de K y colesterol total fue estadísticamente significativa.

Facteurs influençant la prescription de la médication cardioprotectrice recommandée chez les patients avec une maladie artérielle périphérique

Introduction : Les guides de pratique recommandent que les patients avec une maladie artérielle périphérique (MAP) soient traités médicalement afin de réduire la survenue d’évènements cardiovasculaires majeurs. Objectif : Identifier les facteurs associés à la prescription des thérapies préventives recommandées. Méthode : Les patients avec une MAP (n=362) traités consécutivement par angiodilatation fémoropoplitée entre 2008 et 2010 dans un centre tertiaire (CHU de Québec, Canada) ont été inclus dans l’étude. L’issue clinique primaire était la prescription de trois thérapies combinées. Résultats : Au total, 52% des patients recevaient la thérapie combinée. La présence d’au moins trois facteurs de risque cardiovasculaire (Rapport de cotes (RC)=4,51; IC 95% : 2,76-7,37) était le facteur le plus fortement associé à la prise des thérapies combinées. Conclusion : La prise en charge du risque cardiovasculaire des patients avec une MAP est encore sous-optimale. Une meilleure compréhension des barrières et des facilitateurs à l’application des recommandations est toujours nécessaire.

Geologie und Hydrogeologie im Raum Bad Pyrmont unter besonderer Berücksichtigung des Quellensystems

The hydrodynamics and hydrochemistry of salt and fresh water from solid rock aquifer systems in the Pyrmont area are described and interpreted on the basis of recent investigations including geoelectrics, isotope hydrology, soil air analysis. Theories on the source of the springs in this area are developed, which explain the different compositions of the springs and make it possible to protect them. Data from new and re-interpretated drill holes, borehole logs and outcrops suggest a revision of the geological structure of the Pyrmont dome. Bad Pyrmont is situated on a wide dome of Triassic rocks in the southern part of the Lower Saxony uplands. Inversion of the relief has caused the development of an erosional basin surrounded by prominent ridges. Deep faults developed at the crest of the dome as this part of the structure was subjected to the strongest tectonic stress. Subrosion of the Zechstein salts in the western part of the dome has caused the main salt bed to wedge out below the western part of the dome along a N-S striking structure; this structure is refered to as the „Salzhang“ (salt slope). West of the „Salzhang“, where subrosion has removed the salt bed that prevents gas rising from below, carbon dioxide of deep volcanic origin can now rise to the surface. Hydraulic cross sections illustrate the presence of extensive and deep-seated groundwater flow within the entire Pyrmont dome. While groundwater flow is directed vertically downwards in the ridges surrounding the dome, centripetal horizontal flow predominates the intermediate area. In the central part of the dome, groundwater rises to join the River Emmer, which is the main receiving water course in the central part of the eroded basin. The depth of the saltwater/freshwater interface is determinated by the weight of the superimposed freshwater body. Hydrochemical cross sections show the shape and position of the interface and document a certain degree of hydrochemical zonation of the gently mineralized fresh water. Genetic relationships between the two main water types and the hydrochemical zones of the freshwater body are discussed. The knowledge of the hydrogeological relationship in the Bad Pyrmont aquifer systems permits a spatially narrow coexistence of wells withdrawing groundwater for different purposes (medicinal, mineral, drinking and industrial water).