Impact on quality of life and sexual satisfaction of continent cystostomy with enterocystoplasty in an adult neurologic population

AIMS

To evaluate long-term general and urinary quality of life (QOL) and sexual satisfaction in adult neurologic patients undergoing continent cystostomy surgery associated with a bladder enlargement to treat neurogenic lower urinary tract dysfunction.

METHODS

Monocentre, retrospective series of adult neurologic patients who underwent continent cystostomy with bladder enlargement and followed-up in the long-term. We assessed during follow-up, urinary and renal function and patients filled QOL questionnaires on general QOL, sexuality and urinary (short form Qualiveen) disability.

RESULTS

Fifty-three patients were included and followed-up 77 months on average. Rates of patients' satisfaction, stomal and urethral continences were respectively of 98.7% (n = 51), 94.1% (n = 48), and 80.4% (n = 41). Impact of surgery on general QOL and autonomy were strong and positive (respective mean scores of 4.8 and 4.7 on a scale ranging from 1 to 5). Mean overall urinary Qualiveen QOL score was 0.8 (0.09-2.67) indicating a low negative impact of urinary disability on QOL. In patients <45 years, 52.6% (n = 10) reported a moderate to important improvement of their sexuality after surgery. Renal function remained stable during follow-up.

CONCLUSION

In the long-term, continent cystostomy with bladder enlargement provides great satisfaction to almost most patients. It has a strong positive impact on general and specific urinary QOL, patients' autonomy and urinary continence. In young patients a positive impact on sexuality was also noticed. These encouraging data, that need to be confirmed, constitute interesting information to provide to neurologic patients to help them deciding whether they are willing to undergo continent cystostomy surgery.

Signaltransduktionswege der Mechanotransduktion in Knochenzellen

Die Erhaltung der Knochenmasse wird durch die Interaktion von verschiedenen Faktoren, einschließlich systemischen Hormonen, lokalen Wachstumsfaktoren und mechanischer Belastung reguliert. Verantwortlich für die adaptive Antwort von Knochenzellen auf mechanische Belastung sind zelluläre Prozesse der Aufnahme, der Umwandlung des physikalischen Stimulus in strukturelle und biochemische Reaktionen, die als Mechanotransduktion bezeichnet werden. Osteoblasten und vor allem Osteozyten sind die mechanosensorischen Zellen des Knochens. Sie benötigen den mechanischen Stimulus für ihre Vitalität und Funktion. Die in der Mechanotransduktion aktivierten Signalwege wirken anabol auf die Knochenmasse. Hierzu gehören der WNT (wingless integration)/β-Catenin und der Östrogenrezeptor (ER)-Signalweg, die beide eine entscheidende Rolle in der Regulation von Knochenbildung und Knochenresorption spielen. Eine Aufklärung der Interaktion der Signalwege in der Mechanotransduktion durch geeignete In-vitro-und In-vivo-Experimente ist sinnvoll, um in Zukunft effektiv mechanische Signale in der Prävention und Intervention von/bei osteodegenerativen Krankheiten, wie z. B. Osteoporose, nutzen zu können.

Improved parental dietary quality is associated with children's dietary intake through the home environment

BACKGROUND

Improving access to supermarkets has been shown to improve some dietary outcomes, yet there is little evidence for such effects on children. Relatedly, there is a dearth of research assessing the impact of a structural change (i.e. supermarket in a former food desert) on the home environment and its relationship with children's diet.

OBJECTIVE

Assess the relative impact of the home environment on children's diet after the introduction of a new supermarket in a food desert.

METHODS

Among a randomly selected cohort of households living in a food desert, parental diet was assessed before and after the opening of a full-service supermarket. The home environment and children's intake of fruits and vegetables was measured at one point - after the store's opening. Structural equation models were used to estimate the pathways between changes in parental dietary quality at follow-up and children's dietary intake through the home environment.

RESULTS

Parental dietary improvement after the supermarket opened was associated with having a better home environment (β = 0.45, p = 0.001) and with healthier children's dietary intake (β = 0.46, p < 0.001) through higher family nutrition and physical activity scores (β = 0.25, p = 0.02).

CONCLUSIONS

Policy solutions designed to improve diet among low-resource communities should take into account the importance of the home environment.

[Adjustable retropubic suburethral sling Remeex® in the treatment of male stress urinary incontinence: One-year results]

OBJECTIVE

To evaluate the efficacy and safety of the adjustable suburethral sling Remeex^® in the treatment of male stress urinary incontinence (SUI).

PATIENTS AND METHODS

Single-center prospective study of patients treated for SUI after radical prostatectomy or transurethral resection of prostate. The severity of incontinence was evaluated by the number of pads used per day. Success rate, complications and number of adjustments were studied.

RESULTS

From February 2011 to May 2015, Remeex^® was implanted in 25 patients. The average preoperative number of pads used per day was 3,8 (±1,8). Sling tension has been adjusted the day after surgery in all patients. Mean follow-up was 31 months (±15). During follow-up, 6 patients did not need any readjustment (24%) and 15 patients (60%) had to be readjusted. One Remeex system had to be completely removed because of a sub-occlusive syndrome. Three patients had early infection requiring partial system removal (Varitensor). At the end of follow-up, 9 patients were cured (36%), 9 patients (36%) were significantly improved and 7 patients (28%) were not improved. Five patients are waiting for a new readjustment.

CONCLUSION

In this short series of patients who had prostatic surgery, at mid-term follow-up, the placement of a BSUA-R was associated with an improvement or cure of urinary incontinence symptoms in two-thirds of cases.

LEVEL OF EVIDENCE

4.

Long-term efficacy and safety of tension free vaginal tape in a historic cohort of 463 women with stress urinary incontinence

INTRODUCTION AND HYPOTHESIS

We report retrospective data on the long-term safety and efficacy of the retropubic midurethral sling (MUS) in a large series of women with stress urinary incontinence.

METHODS

In all, 517 patients were treated during the period January 2005 to June 2012 at a single centre in France. The Urinary Symptoms Profile score was used to identify women who were subjectively cured or improved or in whom treatment had failed. The rates of peroperative, and early (<30 days) and late postoperative complications were recorded.

RESULTS

A total of 463 patients were evaluable at a mean (±SD) follow-up of 71 ± 23 months. At the last follow-up, 344 patients (74.3 %) demonstrated subjective cure, 55 (11.9 %) were improved and 64 (13.8 %) had treatment failure. Bladder perforations occurred in 33 patients (7.1 %); however, this had no effect on cure rate. In the early postoperative period, temporary intermittent self-catheterization was required in 10 patients (2.2 %) due to voiding difficulties. The most frequent long-term postoperative complication was de novo urge incontinence that was reported by 59 patients (12.7 %); seven patients (1.5 %) needed tape excision due to voiding difficulties and six (1.3 %) needed tape removal due to erosion or chronic pain.

CONCLUSIONS

The retropubic MUS was shown to be durable at a mean follow-up of 71 ± 23 months, with a high success/improvement rate and no serious long-term tape-induced adverse effects.

NMR-based metabolomics reveals compartmental metabolic heterogeneity in liver of Arctic char (Salvelinus alpinus)

Metabolomics involves systematic study of low-molecular-mass metabolites in cells, tissues, or biofluids and is nowadays widely applied to characterize the physiological status of aquatic organisms under a set of conditions, such as disease and toxin exposure. Liver, an important metabolic center in the fish body, is often used for metabolomics analysis. Compared with the whole fish liver, the proportion of liver sample needed for metabolomics analysis is relatively small. The homogeneity of metabolites in liver is thus an important issue, especially for comparative studies and biomarker discovery. This study examined the homogeneity of the metabolic profile in liver of Arctic char (Salvelinus alpinus (L., 1758)) using a NMR-based metabolomics approach. For the analysis, whole liver samples were cut into four parts along the direction of gall bladder and at right angles to this, and metabolites in each part of the liver were extracted and analyzed by multivariate and univariate data analyses. Although the multivariate model was not significant due to variation within the data, the metabolic differences in polar portion of liver extract between the parts were seen, indicating non-homogeneity of Arctic char liver. Therefore, when sampling fish liver for further metabolomics studies, this heterogeneity should be taken into consideration.

[Rigid cystoscopy versus retrovision for adjustable peri-urethral balloons guidance: Comparison of precision thanks to a surgical navigation system]

OBJECTIVES

The main goal of our phantom study was to compare the precision of adjustable periurethral balloons positioning depending whether the guidance was obtained by retrovision or rigid cystoscopy.

MATERIAL AND METHODS

A navigation guidance system was used to localize the introduction mandrel which was equipped with tracking targets. Two ideal sites of implantation were predefined and recorded into the navigation system. The two points were placed symmetrically to the phantom reproducing the urethra. Four different users were asked to position the tip of the introduction mandrel as close as possible to the ideal site of implantation with the help of each method of guidance. For each attempt, the distance (mm) between the tip of the introduction mandrel and the ideal position was recorded by the navigation system.

RESULTS

For each method of guidance, a total of 20 attempts on each side were made by direct puncture on one side and a symmetrical contralateral puncture. For direct puncture, the median distances were 5.20 (±3.96) and 4.38 (±1.55) mm with rigid cystoscopy and retrovision respectively (P=0.29). For symmetrical contralateral puncture, the median distance were 7,19 (±3,78) and 6,86 (±2,76) mm with rigid cystoscopy and retrovision respectively (P=0,32) CONCLUSION: This study could not demonstrate any significant difference between the two guidance systems. Nevertheless, it showed that navigation guidance system could be used to compare the precision of surgical interventions.

LEVEL OF EVIDENCE

4.

Cut to the chase: a review of CD26/dipeptidyl peptidase-4's (DPP4) entanglement in the immune system

CD26/DPP4 (dipeptidyl peptidase 4/DP4/DPPIV) is a surface T cell activation antigen and has been shown to have DPP4 enzymatic activity, cleaving-off amino-terminal dipeptides with either L-proline or L-alanine at the penultimate position. It plays a major role in glucose metabolism by N-terminal truncation and inactivation of the incretins glucagon-like peptide-1 (GLP) and gastric inhibitory protein (GIP). In 2006, DPP4 inhibitors have been introduced to clinics and have been demonstrated to efficiently enhance the endogenous insulin secretion via prolongation of the half-life of GLP-1 and GIP in patients. However, a large number of studies demonstrate clearly that CD26/DPP4 also plays an integral role in the immune system, particularly in T cell activation. Therefore, inhibition of DPP4 might represent a double-edged sword. Apart from the metabolic benefit, the associated immunological effects of long term DPP4 inhibition on regulatory processes such as T cell homeostasis, maturation and activation are not understood fully at this stage. The current data point to an important role for CD26/DPP4 in maintaining lymphocyte composition and function, T cell activation and co-stimulation, memory T cell generation and thymic emigration patterns during immune-senescence. In rodents, critical immune changes occur at baseline levels as well as after in-vitro and in-vivo challenge. In patients receiving DPP4 inhibitors, evidence of immunological side effects also became apparent. The scope of this review is to recapitulate the role of CD26/DPP4 in the immune system regarding its pharmacological inhibition and T cell-dependent immune regulation.

[Cost comparison of open and robot-assisted partial nephrectomy in treatment of renal tumor]

INTRODUCTION

Robot-assisted partial nephrectomy rapidly took on among urologists, even though studies showing its superiority over other techniques are still scarce and its costs hard to evaluate, especially in the French medical system.

OBJECTIVE

To evaluate the cost overrun of robot-assisted partial nephrectomy compared to that of open partial nephrectomy.

EQUIPMENT AND METHODS

From January 2010 to December 2013, 77 patients underwent a partial nephrectomy, 46 of which by robot-assisted laparoscopy and the remaining 31 by lombotomy. The two groups were similar in composition. Economic data regarding the staff, the consumables and the premises involved have been analyzed.

RESULTS

Costs are significantly higher in the NPR group (9253.21 euros vs. 7448.42 euros) due to higher consumable expenses as well as the costs pertaining to the amortization and maintenance of the robot. Yet, that difference tends to diminish as the duration of the experiment increases. No significant difference was found in warm ischemia times, operation duration and renal function a month after the operation. On the other hand, patients from the NPR group spent a significantly smaller amount of time in recovery room (159 minutes vs. 205 minutes, P=0.004), presented fewer complications and were discharged faster (6.1 days vs. 8.1 days, P=0.04).

CONCLUSIONS

To be profitable for the hospital in the French GHS system, robot-assisted partial nephrectomy must take place in a complex where at least 300 robot-assisted interventions are performed annually, in the framework of a hospitalization lasting four days or less, the use of a single needle holder and no systematic use of a haemostatic agent.

LEVEL OF EVIDENCE

4.