The pathophysiology of contractile activity in the chronic decentralized feline bladder

Autonomous wave activity occurs in the decentralized bladder and may contribute to upper tract damage and incontinence. In order to clarify the poorly understood pathophysiology and neuropharmacology of autonomous waves, cats were prepared with L7-S3 ventrodorsal rhizotomy alone or with L7-S3 ventral rhizotomy with and without total sympathectomy. The incidence of autonomous waves was < 15% 12 weeks after ventral or ventrodorsal rhizotomy, but acute sympathectomy at 13 weeks increased the incidence to 58% in these groups. With chronic sympathectomy the incidence was 100%. This suggests that the waves arise locally via a mechanism which is independent of L7-S3 dorsal roots, due to lack of a suppressive sympathetic pathway. Autonomous waves were inhibited by atropine after acute sympathectomy and by prazosin after chronic sympathectomy, but increased inhibition occurred after both drugs in either case. Adrenergic neuron depletion with 6-hydroxydopamine enhanced wave activity, which was incompletely inhibited by subsequent atropine. This implies that the peripheral reflex pathway has facilitatory alpha 1-adrenergic, muscarinic and also noncholinergic nonadrenergic elements. Clinically, sensory or sympathetic damage caused incontinence, but sympathectomy also caused high pressure waves, which may cause upper tract damage and treatment resistant incontinence in patients.

Urethral pressure profile during the spinal shock stage in man: a preliminary report

The functional state of the proximal urethra in the spinal shock stage in man is not fully understood. We studied patients with spinal cord injuries during spinal shock and found that the urethral pressure profile had a normal configuration, the peak profile pressure increased with bladder filling and phentolamine (10 mg. intravenously) reduced the peak pressure, with empty and full bladders.

Urethral function after chronic cauda equina lesion in cats. II. The role of autonomically-innervated smooth and striated muscle in distal sphincter dysfunction

We investigated the possibility that distal sphincter dysfunction after chronic sacral rhizotomy in the cat might be due to altered sympathetic influences on smooth and striated muscle. Three months after rhizotomy, sympathetic influences on basal perfusion pressure in the distal sphincteric urethra were significantly decreased. A prazosin-sensitive component of basal perfusion pressure remained after section of all extrinsic urethral innervation in both control and chronic cats. Local intra-arterial 6-hydroxydopamine also abolished this component. After rhizotomy, noradrenaline content in the distal sphincteric urethra was significantly increased but there was no evidence of a change in sensitivity to sympathetic stimulation. A novel prazosin- and atropine-resistant component of the response to hypogastric nerve stimulation was seen in the rhabdosphincteric urethra of chronic cats. This component was abolished by atracurium or hexamethonium. It was significantly greater in cats with S1-3 as compared to S2-3 lesions and was never seen in control cats. It is concluded that autonomic activation of the rhabdosphincter could be a factor in distal sphincter obstruction.

Urethral response during bladder contraction induced by subcutaneous bethanechol chloride: elicitation of a sympathetic reflex urethral constriction

The responses of the urethra to bladder filling and to subcutaneous bethanechol were studied in a surgically separated bladder-urethra preparation in chloralose anesthetized cats. With the pudendal nerves cut or the neuromuscular junction blocked with gallamine, urethral closure pressure increased during bladder filling and the initial phase of the micturition contraction. It then fell spontaneously or in response to bladder emptying through a vent. With the bladder volume held constant subcutaneous bethanechol induced an increase in basal bladder pressure which culminated in a sustained (reflex) contraction. The urethral constrictor response resembled that seen during the cystometrogram; an increase during the rise in detrusor pressure and a fall during the latter part of the sustained (reflex) contraction. In both cases the urethral response was substantially depressed by hypogastric nerve transection or by intravenous prazosin, implying that the urethral responses were reflexly mediated through the sympathetic system. Intra-arterial bethanechol also produced a urethral constriction, but this response was abolished by atropine and not affected by hypogastric nerve section or prazosin. It is therefore concluded that although bethanechol can produce urethral constriction through a direct muscarinic action on the urethra, it does not do so after subcutaneous administration in a neurally intact cat. The urethral response seen after subcutaneous bethanechol administration is part of the micturition reflex complex and is sympathetically mediated.

Anthraquinones from the polar fractions of Galium sinaicum

The new anthraquinones, 6,7-dimethoxy xanthopurpurin, 6-hydroxy-7-methoxy rubiadin, 5-hydroxy-6-hydroxymethyl anthragallol 1, 3-dimethyl ether, 7-carboxy anthragallol 1,3-dimethyl ether, anthragallol 1-methyl ether 3-O-beta-D-glucopyranoside, anthragallol 1-methyl ether 3-O-rutinoside, anthragallol 3-O-rutinoside and alizarin 1-methyl ether 2-O-primeveroside were isolated from the CH2Cl2 and n-BuOH extracts of Galium sinaicum roots and their structures were established by various spectroscopic techniques. In addition, two known anthraquinones were also isolated and fully characterized.

Control of detrusor stiffness in the chronic decentralized feline bladder

The neuropharmacology of increased bladder stiffness, which may contribute to upper tract damage and incontinence, was investigated in 76 cats. beta-blockade increased but combined alpha 1-adrenergic with muscarinic blockade decreased filling phase stiffness in normal cats. Bladder wall stiffness during the early filling phase was unaffected by chronic S2 ventrodorsal rhizotomy or L7-S3 ventral rhizotomy, but was decreased when L7-S3 dorsal rhizotomy or total sympathectomy was combined with the ventral root lesion, implying that sacral dorsal roots and sympathetic efferents maintain normal detrusor stiffness. Acute sympathectomy increased stiffness in all the former 3 chronic groups, implying that a tonic or reflex sympathetic inhibition operates independently of the L7-S3 dorsal roots. Stiffness during early filling phase decreased with acute ventral rhizotomy. This change persisted with chronic sympathectomy but returned to normal if sympathetic nerves were left intact. These results suggest that bladder stiffness is modulated by tonic or reflexic sympathetic activity, which is influenced by L7-S3 afferents. Detrusor stiffness during the later stages of filling, which was decreased by acute sympathectomy in chronic groups but increased by chronic sympathectomy, was reduced by interference with adrenergic or muscarinic mechanisms after either lesion. Therefore, a peripheral pathway with facilitatory alpha 1-adrenergic and muscarinic receptors is involved in the production of increased late stage stiffness after chronic sympathetic damage. We propose that the increased bladder stiffness seen in congenital sacral lesions may be analogous to the stiffness during late stages of filling reported here. Our results also imply that the presence of this increased stiffness is closely associated with chronic sympathetic damage. Whether the increased stiffness in congenital and traumatic neural lesions in humans arises from sympathetic damage remains to be determined.

The adrenergic component in the proximal urethra

Two experimental systems are described in which simultaneous radiological and perfusion pressure monitoring of proximal urethral function can be carried out. In one series of experiments, hypogastric nerve stimulation and noradrenaline administration caused urethral constriction while isoprenaline caused dilatation. Using a model similar to a stress cystogram, hypogastric nerve section resulted in opening of the urethra earlier under the same stress, and wider when a steady flow was established. This effect was greater than the influence of parasympathetic or somatic nerve supplies to the urethra. It was concluded that sympathetically innervated smooth muscle has a significant influence on urinary continence and urethral wall tension.

Final diagnosis and therapeutic implications of mixed symptoms of urinary incontinence in women

The final diagnosis of 244 females who presented with mixed symptoms of stress incontinence (SI) and urge incontinence (UI) was made based on clinical, urodynamic, and cystoscopic findings. The UD studies consisted of cystometrogram, uroflow and urethral pressure profiles in the supine and standing positions. Diagnosis of genuine stress urinary incontinence (GSI) in 72 patients (30%) was based on the presence of positive Marshall test result or maximum urethral closure pressure 40 cm of water or less, in addition to the symptoms of stress incontinence. Diagnosis of reduced bladder storage (RBS) in 36 patients (15%) was based on MCC 300 mL or less, or the findings of bladder instability on cystometrogram in addition to the symptoms of urge incontinence. Ninety-five patients (39%) with the criteria of both GSI and RBS were classified as the mixed group. The diagnosis of interstitial cystitis in 19 patients (8%) was made according to the criteria outlined by Messing. Urethral stenosis was diagnosed in 6 patients (2%) based on a reduced maximal flow rate by at least 2 S.D. and a tight urethra to F16 calibration at cystoscopy. Sixteen patients (7%) with inconclusive diagnosis had symptoms only of SI and UI but no objective findings. The clinical and urodynamic findings in each group and the results of the surgical and medical treatment are compared.

Long-term results of combined interstitial gold seed implantation plus external beam irradiation in localised carcinoma of the prostate

Carcinoma of the prostate is one of the leading causes of death in men. Patients with localised disease can be treated with radiotherapy, but controversy still exists regarding the most effective therapeutic technique. We report 180 patients with surgical stage A2-C prostate cancer treated between 1976 and 1986 by pelvic lymphadenectomy and radioactive gold seed implantation followed by external irradiation. Annual post-treatment biopsies were performed up to 5 years in most patients. Regular follow-up included a digital rectal examination, prostatic acid phosphatase and bone scan. One hundred and sixty-four patients had complete follow-up data at the end-point of data collection (December 1991). The actuarial 10-year cancer-free survival rates were 83.0% and 91.3% for stages A2 and B1 respectively. The incidence of positive biopsy at 2 and 5 years was 13% and 17.1% respectively for the whole series. A firm correlation was defined between biopsy result and subsequent development of local progression, distant metastases and overall survival. Combined interstitial gold seed implantation plus external beam irradiation represent a valid option for the treatment of patients with localised prostatic cancer.

Cystitis associated with tiaprofenic acid

Ten patients with cystitis associated with tiaprofenic acid were reviewed. All patients displayed similar cystoscopic and histological features, and all failed a variety of initial therapies but achieved a dramatic improvement or resolution of symptoms with discontinuation of the tiaprofenic acid. Drug-induced cystitis may be more common than previously recognized.

Effect of acute selective sacral rhizotomy in cats on bladder and urethral function and the response to bethanechol chloride

Bladder and urethral responses to filling and to subcutaneous bethanechol are dependent upon intact sacral innervation. Acute selective sectioning of nerve roots in chloralose anesthetized cats was used to compare the sacral innervation requirements for the support of these responses. The detrusor was found to require primarily intact S2 roots although an S2 root on one side could, alone, subserve a weak, unsustained detrusor reflex. The urethral reaction to bladder filling required an afferent sacral pathway through either S1 or S2 roots. The sustained bladder response to subcutaneous bethanechol required greater sacral innervation than the detrusor reflex inasmuch as the S2 segment could subserve this response in only half the cases, and unilateral rhizotomy L7-S3 eliminated the response in half the cases. Both treatments, however, were compatible with a preserved detrusor reflex. The urethral constriction response to subcutaneous bethanechol required an intact sacral afferent pathway through either the S1 or S2 segments. In conclusion, the detrusor and urethral reflex responses to bladder filling and subcutaneous bethanechol require a certain amount of intact sacral innervation through S1 and S2 which is least for the detrusor reflex and greatest for the bladder response to subcutaneous bethanechol.

Urethral function after chronic cauda equina lesions in cats. I. The contribution of mechanical factors and sympathetic innervation to proximal sphincter dysfunction

We investigated the contribution of mechanical and sympathetic neural factors to proximal urethral sphincter dysfunction in the cat after chronic sacral rhizotomy. Concomitant vesicostomy prevented a decrease in the urethral pressure profile measured three months post-rhizotomy. Sympathetic influences on basal urethral perfusion pressure were the same in neurally-intact and chronic rhizotomised cats. A significant prazosin-sensitive component of basal urethral perfusion pressure remained after section of all extrinsic urethral innervation in both neurally-intact and chronic cats. Local intra-arterial 6-hydroxydopamine also abolished this component. After rhizotomy, noradrenaline content in the proximal urethra was significantly increased but there was no change in sensitivity to sympathetic stimulation. A small (5% of control) atropine-sensitive and prazosin-resistant constriction was seen only after chronic sacral rhizotomy. We conclude that a mechanical factor associated with bladder expression and not an alteration in sympathetic control is the major factor leading to diminished proximal urethral closure after vesicourethral lower motor neuron lesion. Furthermore, short adrenergic neurons have an important role in the maintenance of urethral pressure in the normal state and after lower motor neuron lesion.

Immunophenotypic Characterization of Cytogenetic Subgroups in Egyptian Pediatric Patients With B-Cell Acute Lymphoblastic Leukemia

BACKGROUND

Identification of prognostic factors in acute lymphoblastic leukemia (ALL) patients is important for stratifying patients into risk groups and tailoring treatment accordingly. Molecular and cytogenetic abnormalities are the most important prognostic factors. Minimal residual disease (MRD) is also an important predictor of relapse in ALL. However, the correlation of both prognostic variables has not been thoroughly studied.

METHODS

We investigated the correlation between defined cytogenetic abnormalities and selected new MRD markers (CD79b, CD123, and CD200) in 56 newly diagnosed Egyptian pediatric B-cell ALL patients.

RESULTS

CD123 found to be expressed in 45% of patients, CD200 in 80.3%, and CD79b in 67.9%. MRD analysis during treatment showed stable expression patterns of CD200. There was significant association of CD123 expression with the hyperdiploid ALL group (P = .017). Another association (P = .029) was found between CD79b negativity and the t(12;21) group. CD200 was widely expressed in all groups.

CONCLUSION

There is a significant correlation between some markers, and certain ALL recurrent cytogenetic subgroups (CD123 and hyperdiploidy, CD79b negativity, and ETV-RUNX1 group) have good prognostic value. CD200 can be used as MRD markers in ALL patients and can also can serve as therapy targets.

Skin flap technique in formation of urinary conduit stoma

Stomal stenosis following ileal loop diversion is a significant complication to warrant attention. One of the predisposing factors remains the circular nature of the stoma itself, often in conjunction with chronic skin irritation. Surgical revisions predispose one not only to the usual hazards of operation, but also tend to be multiple or involve extensive surgical reconstruction. A skin flap technique in the initial formation of the stoma avoids the incidence of stenosis related to the circular nature of the stoma. The procedure is simple and does not increase the surgical time. No significant stomal complications developed in 28 patients who had urinary diversions, followed for a mean of 30.6 months.

High-throughput drug screening identifies SMAC mimetics as enhancers of NK cell cytotoxicity in chronic myeloid leukemia

Natural killer (NK) cells have proven to be safe and effective immunotherapies, associated with favorable treatment responses in chronic myeloid leukemia (CML). Augmenting NK cell function with oncological drugs could improve NK cell-based immunotherapies. Here, we used a high-throughput drug screen consisting of over 500 small-molecule compounds to systematically evaluate the effects of oncological drugs on primary NK cells against CML cells. We identified SMAC mimetics as potent enhancers of NK cell cytotoxicity in both cell lines and primary patient samples. In contrast, several drug classes, including glucocorticoids and tyrosine kinase inhibitors such as dasatinib, inhibited NK cell cytotoxicity. Single-cell RNA sequencing revealed drug-induced transcriptomic changes in both NK and target CML cells. SMAC mimetics upregulated NF-κB target genes in NK cells, potentially contributing to their enhanced cytotoxicity. Inhibitory drugs dexamethasone, dasatinib, and sotrastaurin prevented NK cell transition to an activated state and suppressed the expression of IFN-γ by NK cells, thus preventing IFN-γ mediated target cell transcriptomic response. In conclusion, we discovered that SMAC mimetics sensitize cancer cells to NK cell mediated killing, with potential clinical applications especially in patients with advanced phase CML.

The state of urethral musculature during the detrusor areflexia after spinal cord transection

The state of the urethral musculature was studied using the urethral pressure profile and electromyographic recording in periurethral striated muscle. In dogs under chloralose anesthesia a micturition reflex could be elicited by bladder distension and somatic reflexes could be elicited by various stimuli. Both the urethral profile and electromyographic activity could be recorded immediately after surgical transection of the spinal cord between T2 and T8 but the bladder remained areflexic for more than 12 hr. Pharmacologic analysis of the urethral pressure profile revealed a substantial contribution from both sympathetic and somatic components. The periurethral striated musculature usually responded to bladder filling in a similar manner both before and after transection, although there was no bladder contraction in the latter circumstance. It is concluded that the urethra does not experience the same depression of reflex activity as does the bladder in the acute stage after spinal cord transection.

The effect of adrenergic drugs and hypogastric nerve stimulation on the canine urethra. A radiologic and urethral pressure study

A combination of fluoroscopy and measurement of changes in urethral resistance was used to identify the nature and location of the urethral response to adrenergic stimulation. Intraaortic norepinephrine or bilateral hypogastric nerve stimulation produced a constriction of the prostatic urethra in males and of the distal urethra in females. Intraaortic isoproterenol produced a dilation in the same regions. The adrenergically sensitive areas determined in this study appear more discrete than those determined by measurements of urethral pressure profile.