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.

Valor nutritivo del pasto pangola (Digitaria decumbens stent.) vr. transvala a distintos niveles de fertilización y diversas edades de corte

Este estudio Se desarrolló en el periodo de julio a diciembre de 1990 en el Centro de Investigación Zootecnia “La Polvosa” de la UCA (Universidad Centroamericana), situada en el km 23 112 de la carretera nueva a León, depto. de Managua. El centro se ubica a una elevación de 40 msnrn a 1 2 grados 12 minutos, Latitud norte y 86 grados 22 minutos, longitud oeste registra temperaturas promedio anuales de 32 grados centígrados los y unos 8OO mm de precipitación media por año, por lo cual, es posible calificar su zona agroecológica como de trópico seco se evaluó la respuesta en términos de valor nutritivo del pasto Pangola (Digitaria decumbens Stent.) vr. Transvala, utilizándose un diseño experimental en bloques completos al azar (BCA) con arreglo factorial, se estudió el efecto de dos factores (Niveles de fertilizantes-edades de cortes) con cuatro repeticiones, formándose un total de 16 tratamientos El ensayo contó con un área experimental total de 357.75 mt2 para la toma de muestras, se empleó el método del metro cuadrado realizándose en las parcelas un muestreo sin reemplazo para cada frecuencia en estudio. Previo al momento experimental, se efectúo una poda de control procediéndose después a aplicar de una sola vez los respectivos niveles de fertizante. El estudio estadístico contempló el uso del análisis de varianza (ANDEVA), se hizo una separción de medias por Tukey, y se midió la influencia porcentual (Individual y asociada) de 4 niveles de fertilizante (0, 50,100 y150 kg urea (46%N2) / mz) y 4 edades de corte (15, 30.. 45y 60 días), sobre nueve variables o componentes bromatológicos (MS, PB,FC, ELN, EE, EB (Kcal/ 100g), Cz, Ca y P). Todos los componentes bromatológicos evaluados excepto el EE.. presentaron una variación significativa (P<0.05), bajo el efecto de los factores en estudio. Los niveles de fertilizante influyeron ios valores de mayor mérito con la dosis •150 kg urea / rnz, observando la PB.. 9.76% ;el ELN, 56.54 y la EB,190.97 Kcal ,' 100 g. En tanto que los 50 kg1mz mostraron !os mayores índices en FC (28.88), EE (2.75) y Cz. (11.:39) las parcelas no fertilizadas brindaron los porcentajes más altos de MS (23.78) y Ca (0.60),y el nivel 100 kg/ mz El mejor en P (0.39) y el más bajo en FC (26.61). A su vez con O kg / mz_. Observaron sus níveles minimos la PB (6.91), el ELN (53.58). el valor energético (175.45 Kcal/ 100 g) y el P (O.28), y con 100 kg/ mz los menores en MS y Cz (25.08 y 10.38 respectivamente), a. los 150kg/mz el EE (2.29) y el Ca (0.49), rindieron sus índices más bajos. En cuanto a la frecuencia de corte, la edad 15 días presentó los máximos contenidos en PH (11.95), ELN (56.45),EB (202.40 Kcal/ 100g), EE (2.65) y el mínimo en FC (27.09). Observando el corte a los 60 días, las mayores proporciones en MS (30.91) Cz (12.43) )'Ca (0.58),en tanto que con 30 y 45 días se dieron los más altos valores de P (0.34) FC (28.55) respectivamente los índices más bajos de PB (6.48),ELN (52.63), Ca (0.47)y P (0.30), se obtuvieron a los 45 días de madurez mientras que la MS (22.88) y la Cz (9.56),alcanzaron sus valores más pequeños con 15 días de corte a los 60 días, la EB (175. 42 Kcal ./ 100g) y el EE (2.20) respondieron con sus por cientos más bajos. Para los tratamientos resultantes de la combinación de un nivel de fertilizante y una edad de corte, la interacción 50 kg/mz-60 días reportó el mayor contenido en MS (32.72), sobresaliendo el tratamiento 150 kg / mz-15 días al presentar los valores más altos en EB (214.39 Kcal/100g), PB (14.30) y ELN (59.02), aunque la combinación 50 kg/mz-30 días brindó igual valor en ELN y el máximo en Cz (13.10) con aplicaciones de 100 kg/mz y frecuencia de 15 días se obtuvieron los menores índices en FC (24.82) y Cz (9.37). Consiguiéndose en O kg / mz-15 días el valor más alto en Ca (0.76) y el menor en P (0.22), observando la MS su índice más bajo (18.37) con el tratamiento 100 kg / mz-15 días. Finalmente, en las interacciones que incluyen la frecuencia 45 días, se encontró que las parcelas no fertilizadas presentaron los menores contenidos en PB (5.02), ELN (48.95) y EB (165.44 Kcal/ 1oo g). en cambio al aplicar 100 kg /rnz, se obtuvieron (para la misma interacción) los valores más bajos en EE (1.72), Ca (0.43) y el mayor en P (0.44),en tanto los niveles 50 y 150 kg / mz influyeron los índices más altos en EE (3.85) y FC (30.75) respectivamente.

Novel nanostructured biomaterials: implications for coronary stent thrombosis.

BACKGROUND: Nanomedicine has the potential to revolutionize medicine and help clinicians to treat cardiovascular disease through the improvement of stents. Advanced nanomaterials and tools for monitoring cell-material interactions will aid in inhibiting stent thrombosis. Although titanium boron nitride (TiBN), titanium diboride, and carbon nanotube (CNT) thin films are emerging materials in the biomaterial field, the effect of their surface properties on platelet adhesion is relatively unexplored. OBJECTIVE AND METHODS: In this study, novel nanomaterials made of amorphous carbon, CNTs, titanium diboride, and TiBN were grown by vacuum deposition techniques to assess their role as potential stent coatings. Platelet response towards the nanostructured surfaces of the samples was analyzed in line with their physicochemical properties. As the stent skeleton is formed mainly of stainless steel, this material was used as reference material. Platelet adhesion studies were carried out by atomic force microscopy and scanning electron microscopy observations. A cell viability study was performed to assess the cytocompatibility of all thin film groups for 24 hours with a standard immortalized cell line. RESULTS: The nanotopographic features of material surface, stoichiometry, and wetting properties were found to be significant factors in dictating platelet behavior and cell viability. The TiBN films with higher nitrogen contents were less thrombogenic compared with the biased carbon films and control. The carbon hybridization in carbon films and hydrophilicity, which were strongly dependent on the deposition process and its parameters, affected the thrombogenicity potential. The hydrophobic CNT materials with high nanoroughness exhibited less hemocompatibility in comparison with the other classes of materials. All the thin film groups exhibited good cytocompatibility, with the surface roughness and surface free energy influencing the viability of cells.

Polymeric photosensitizer-embedded self-expanding metal stent for repeatable endoscopic photodynamic therapy of cholangiocarcinoma

Photodynamic therapy (PDT) is a new therapeutic approach for the palliative treatment of malignant bile duct obstruction. In this study, we designed photosensitizer-embedded self-expanding nonvascular metal stent (PDT-stent) which allows repeatable photodynamic treatment of cholangiocarcinoma without systemic injection of photosensitizer. Polymeric photosensitizer (pullulan acetate-conjugated pheophorbide A; PPA) was incorporated in self-expanding nonvascular metal stent. Residence of PPA in the stent was estimated in buffer solution and subcutaneous implantation on mouse. Photodynamic activity of PDT-stent was evaluated through laserexposure on stent-layered tumor cell lines, HCT-116 tumor-xenograft mouse models and endoscopic intervention of PDT-stent on bile duct of mini pigs. Photo-fluorescence imaging of the PDT-stent demonstrated homogeneous embedding of polymeric Pheo-A (PPA) on stent membrane. PDT-stent sustained its photodynamic activities at least for 2 month. And which implies repeatable endoscopic PDT is possible after stent emplacement. The PDT-stent after light exposure successfully generated cytotoxic singlet oxygen in the surrounding tissues, inducing apoptotic degradation of tumor cells and regression of xenograft tumors on mouse models. Endoscopic biliary in-stent photodynamic treatments on minipigs also suggested the potential efficacy of PDT-stent on cholangiocarcinoma. In vivo and in vitro studies revealed our PDT-stent, allows repeatable endoscopic biliary PDT, has the potential for the combination therapy (stent plus PDT) of cholangiocarcinoma. © 2014 Elsevier Ltd.

Factors affecting in vitro adherence of ureteral stent biofilm isolates to polyurethane

Adherence of bacteria to biomaterials is the first stage in the development of a device-related infection. The adherence of bacterial cells to biomaterials may be influenced by surface characteristics of the cell, its growth conditions and the biomaterial surface chemistry. Following growth in human urine, the cell surface,hydrophobicity and zeta potential of two ureteral stent biofilm isolates, Enterococcus faecalis and Escherichia coli, were significantly altered. In addition, the adherence of human urine-grown Enterococcus faecalis and Escherichia coli to polyurethane was significantly increased by up to 52.1% and 58.6%, respectively. Treatment of the polyurethane with human urine rendered the polymer surface more hydrophilic (mean advancing water contact angle reduced from 97.59 degrees to 26.37 degrees). However, organisms grown in human urine showed less adherence (up to 90.4%) to the treated polymer than those grown in Mueller-Hinton broth. The results presented in this study indicate that in vivo conditions should be simulated as far as possible when carrying out in vitro bacterial adherence assays, especially if assessing novel methods for reduction of adherence. (C) 1997 Elsevier Science B.V.

Activation of the cGMP/PKG pathway inhibits electrical activity in rabbit urethral interstitial cells of Cajal by reducing the spatial spread of Ca2+ waves.

In the present study we used a combination of patch clamping and fast confocal Ca2+ imaging to examine the effects of activators of the nitric oxide (NO)/cGMP pathway on pacemaker activity in freshly dispersed ICC from the rabbit urethra, using the amphotericin B perforated patch configuration of the patch-clamp technique. The nitric oxide donor, DEA-NO, the soluble guanylyl cyclase activator YC-1 and the membrane-permeant analogue of cGMP, 8-Br-cGMP inhibited spontaneous transient depolarizations (STDs) and spontaneous transient inward currents (STICs) recorded under current-clamp and voltage-clamp conditions, respectively. Caffeine-evoked Cl- currents were unaltered in the presence of SP-8-Br-PET-cGMPs, suggesting that activation of the cGMP/PKG pathway does not block Cl- channels directly or interfere with Ca2+ release via ryanodine receptors (RyR). However, noradrenaline-evoked Cl- currents were attenuated by SP-8-Br-PET-cGMPs, suggesting that activation of cGMP-dependent protein kinase (PKG) may modulate release of Ca2+ via IP3 receptors (IP3R). When urethral interstitial cells (ICC) were loaded with Fluo4-AM (2 microm), and viewed with a confocal microscope, they fired regular propagating Ca2+ waves, which originated in one or more regions of the cell. Application of DEA-NO or other activators of the cGMP/PKG pathway did not significantly affect the oscillation frequency of these cells, but did significantly reduce their spatial spread. These effects were mimicked by the IP3R blocker, 2-APB (100 microm). These data suggest that NO donors and activators of the cGMP pathway inhibit electrical activity of urethral ICC by reducing the spatial spread of Ca2+ waves, rather than decreasing wave frequency.