Effects of combined behavioral intervention and tolterodine on patient-reported outcomes

OBJECTIVE

To assess the effects of tolterodine extended release (ER) plus behavioral intervention on urgency and other patient-reported outcomes in subjects with overactive bladder (OAB) who were previously dissatisfied with antimuscarinic treatment.

METHODS

In this 16-week, multicenter, open-label study, eligible adults (aged > or = 18 y) reported dissatisfaction with their most recent antimuscarinic OAB medication; > or = 8 micturitions and > or = 2 urgency episodes per 24 hours and > or = 1 UUI episode in 5 day bladder diaries; and OAB symptoms for > or = 3 months. Subjects received tolterodine ER plus a behavioral educational handout with verbal reinforcement of behavioral intervention content for 8 weeks. Those satisfied with treatment at week 8 continued with this therapy; those dissatisfied received tolterodine ER plus individualized behavioral intervention (pelvic floor muscle training, tailored behavioral techniques) for 8 weeks. Endpoints were changes from baseline in daytime and nocturnal micturition-related urgency episodes and frequency-urgency sum (a measure of urgency severity and frequency) reported in 5 day bladder diaries at weeks 4, 8, 12, and 16; Patient Perception of Bladder Condition (PPBC), Overactive Bladder Questionnaire (OAB-q), and Urgency Perception Scale (UPS) scores at weeks 8 and 16.

RESULTS

Daytime and nocturnal urgency episodes and frequency-urgency sum were significantly reduced at all time points (all p < 0.0001). Significant improvements were also observed in PPBC, OAB-q Symptom Bother and Health-Related Quality of Life, and UPS scores at weeks 8 and 16 (all p < 0.0001).

CONCLUSIONS

Patients with OAB who are dissatisfied with antimuscarinic therapy may experience improved treatment outcomes by adding a self-administered behavioral intervention to their drug regimen.

Structure validation of an integrated waterworks model for trihalomethanes simulation by applying regional sensitivity analysis

A previously developed integrated waterworks model for trihalomethanes simulation was validated by applying a new framework for comprehensive model structure validation. The proposed framework followed the procedure of regional sensitivity analysis and also involved correlation analysis and frequency distribution analysis. Through such an analysis framework, a deep insight into model structure and parameters could be gained besides the traditional focuses on model validation, i.e. model performance and rationality of model parameters. The integrated waterworks model, to which the framework was applied, was proved to give good predictions of the simulated variables, and the identified values of model parameters coincided well with the reported values in the literature. The model was also found to have a large proportion of sensitive parameters, no distinct correlations among parameters, and thus a balanced structure. Moreover, most of the sensitive parameters could be well identified and the associated uncertainties significantly reduced. A detailed investigation into the sensitivity, identifiability, and uncertainty of model parameters showed that the model conceptualization was in good agreement with accepted scientific principles and anticipated system behaviors. All these results, therefore, supported the validity and trustworthiness of the model. In addition, further opportunities for refining the model were also proposed.

Environmental neurotoxic pesticide increases histone acetylation to promote apoptosis in dopaminergic neuronal cells: relevance to epigenetic mechanisms of neurodegeneration

Pesticide exposure has been implicated in the etiopathogenesis of Parkinson's disease (PD); in particular, the organochlorine insecticide dieldrin is believed to be associated with PD. Emerging evidence indicates that histone modifications play a critical role in cell death. In this study, we examined the effects of dieldrin treatment on histone acetylation and its role in dieldrin-induced apoptotic cell death in dopaminergic neuronal cells. In mesencephalic dopaminergic neuronal cells, dieldrin induced a time-dependent increase in the acetylation of core histones H3 and H4. Histone acetylation occurred within 10 min of dieldrin exposure indicating that acetylation is an early event in dieldrin neurotoxicity. The hyperacetylation was attributed to dieldrin-induced proteasomal dysfunction, resulting in accumulation of a key histone acetyltransferase (HAT), cAMP response element-binding protein. The novel HAT inhibitor anacardic acid significantly attenuated dieldrin-induced histone acetylation, Protein kinase C delta proteolytic activation and DNA fragmentation in dopaminergic cells protected against dopaminergic neuronal degeneration in primary mesencephalic neuronal cultures. Furthermore, 30-day exposure of dieldrin in mouse models induced histone hyperacetylation in the striatum and substantia nigra. For the first time, our results collectively demonstrate that exposure to the neurotoxic pesticide dieldrin induces acetylation of core histones because of proteasomal dysfunction and that hyperacetylation plays a key role in dopaminergic neuronal degeneration after exposure of dieldrin.

Effects of tolterodine ER on patient-reported outcomes in sexually active women with overactive bladder and urgency urinary incontinence

OBJECTIVE

To assess the effects of tolterodine extended release (ER) on patient-reported outcomes (PROs) in sexually active women with overactive bladder (OAB) and urgency urinary incontinence (UUI).

RESEARCH DESIGN AND METHODS

This multicenter, double-blind, placebo controlled trial included 411 women aged > or =18 years reporting OAB symptoms for > or =3 months; > or =8 micturitions per 24 hours (including > or =0.6 UUI episodes and > or =3 OAB micturitions) in 5-day bladder diaries at baseline, and being in a sexually active relationship for > or =6 months. Subjects randomized to placebo or tolterodine ER completed validated OAB- or incontinence-specific questionnaires, including the Patient Perception of Bladder Condition (PPBC), Overactive Bladder Questionnaire (OAB-q), Urgency Perception Scale (UPS), and the Incontinence Impact Questionnaire (IIQ) at baseline and week 12, as well as the Perception of Treatment Benefit and Treatment Satisfaction questions at week 12. This study is registered with ClinicalTrials.Gov (identifier: NCT00143481).

RESULTS

The mean age of enrolled women was approximately 48 years. Compared with placebo, the tolterodine ER group reported significant baseline to week 12 improvements in PPBC responses (p = 0.0048); OAB-q Symptom Bother, total Health-Related Quality of Life (HRQL), and HRQL domain scores (all p < 0.05); IIQ Emotional Health domain scores (p < 0.05); proportions of subjects reporting treatment benefit (79 vs. 54%; p < 0.0001) and satisfaction (78 vs. 59%; p < 0.0001). Improvements on the UPS were not significantly different.

CONCLUSIONS

Tolterodine ER treatment was associated with improvements in multiple OAB- and incontinence-specific PROs in a sexually active, relatively young, and racially diverse population of women. The findings provide clinicians with new insights into the impact of OAB and its treatment on HRQL in this population, which has been underrepresented in previous OAB studies. Study limitations include a potential underestimation of the impact of OAB symptoms resulting from the exclusion of women who may not be sexually active because of their urinary symptoms.

Combined effects of behavioral intervention and tolterodine in patients dissatisfied with overactive bladder medication

PURPOSE

We assessed the effect of tolterodine extended release plus behavioral intervention on treatment satisfaction and bladder diary variables in patients with overactive bladder who had been previously treated and were dissatisfied with tolterodine or other antimuscarinics.

MATERIALS AND METHODS

This 16-week, multicenter, open label study included eligible patients 18 years old or older who reported overactive bladder symptoms 3 months or greater in duration, 8 or greater micturitions and 2 or greater urgency related micturitions per 24 hours, and 1 or greater urgency urinary incontinence episodes in a 5-day bladder diary at baseline as well as dissatisfaction with prior antimuscarinic medication. Patients received tolterodine extended release plus self-administered behavioral intervention, consisting of an educational pamphlet with verbal reinforcement, for 8 weeks. Satisfied patients continued with this therapy and dissatisfied patients received tolterodine extended release plus individualized behavioral intervention, consisting of in-depth interaction with a clinician to refine behavioral techniques, for 8 weeks thereafter. Patients rated treatment satisfaction at weeks 8 and 16, and completed a 5-day bladder diary at weeks 4, 8, 12 and 16, respectively.

RESULTS

At weeks 8 and 16, 346 and 357 patients or 91% of the total cohort reported being at least a little satisfied with tolterodine extended release plus behavioral intervention, including 201 (53%) and 252 (64%), respectively, who were very satisfied. Of the 33 patients who were dissatisfied at week 8, 25 (76%) reported treatment satisfaction at week 16 after individualized behavioral intervention. Compared with baseline all bladder diary variables were significantly improved by week 4 (p <0.0001). Patients who were dissatisfied with prior tolterodine or other antimuscarinic treatment reported similar results.

CONCLUSIONS

Tolterodine extended release plus behavioral intervention resulted in high treatment satisfaction and improved bladder diary variables in patients who had previously been treated and were dissatisfied with tolterodine or other antimuscarinics.

Development and identification of an integrated waterworks model for trihalomethanes simulation

To evaluate the impact that new trihalomethanes (THMs) regulations will have on the performance of conventional waterworks in China, we developed an integrated waterworks model to simulate the dynamic behavior of THMs and other associated components, e.g. organic matter, ammonia, and residual chlorine, throughout the conventional water treatment process, which included pre-chlorination, coagulation-flocculation, sedimentation, filtration and post-chlorination. A comprehensive kinetic scheme that takes into account both the physical and biological mechanisms involved in the water treatment processes and the chemical reactions that result from chlorination was proposed for model conceptualization. In addition, the Petersen matrix was designed to present the model and formulate the mass balance equations for the model variables. The model was then identified using the Hornberger-Spear-Young (HSY) algorithm and tested against field data from the Qingzhou Waterworks in Macao, China. Despite gross uncertainty associated with the field data, the model could generally provide good predictions of the simulated variables and meet the management purposes. Furthermore, the identified model parameters agreed well with values that were reported in the literature and could be reasonably interpreted.

Inhibitory effect of osthole on alcohol-induced fatty liver in mice

BACKGROUND

Alcohol is a major cause of fatty liver, the disease is a spectrum that is initiated with steatosis, and without therapy it is apt to develop inflammation, necrosis, fibrosis and finally cirrhosis. There are currently no ideal pharmacological reagents that can prevent or reverse this disease. Osthole is an active constituent isolated from the fruit of Cnidium monnieri (L.) Cusson, a Chinese herbal medicine, which has been used in clinics for many years. It has many functions such as anti-inflammation, anti-osteoporosis and anti-tumor and so on, but there is no report about treatment of alcoholic fatty liver in mice.

AIM

To examine the inhibitory effect of osthole on alcohol-induced fatty liver in mice and to investigate the potential mechanisms.

METHODS

A mouse model with alcoholic fatty liver was induced by orally feeding 52% erguotou wine by gavage when they were simultaneously treated with osthole 10, 20, 40 mg/kg for 4 weeks. Whereafter, the lipids in serum and hepatic tissue, the levels of malondialdehyde (MDA), superoxide dismutase (SOD), reduced glutathione hormone (GSH), tumor necrosis factor-alpha (TNF-alpha) in hepatic tissue, hepatic weight coefficient and its histological evaluation were measured.

RESULTS

After treatment with osthole, the levels of serum total cholesterol (TC), triglyceride (TG), coefficient of hepatic weight, and the hepatic tissue contents of TC and TG were significantly decreased, the levels of MDA and TNF-alpha in liver were also decreased, while the GSH in liver was increased. Importantly, the histological evaluation of liver specimens demonstrated that osthole dramatically decreased lipid accumulation.

CONCLUSION

Osthole could inhibit alcohol-induced fatty liver in mice, and the mechanism might be associated with its anti-oxidation and suppression of TNF-alpha production.

Agricultural phosphorus flow and its environmental impacts in China

The transfer of nutrients from agricultural land to waters attracts the attention of policy makers as well as scientists as it plays an increasingly significant role in affecting the water environment. It is therefore essential to first understand the nutrient flow in agricultural systems and then correspondingly formulate a series of cost-effective policies and best management practices (BMPs). On the basis of an emission inventory analysis (EIA) and a nutrient full balance (NFB) calculation, this paper presents a partial substance flow analysis (SFA) method, as well as an Agricultural Phosphorus Flow Analysis (AgiPhosFA) model, to describe the phosphorus (P) flow in the agricultural systems in China and assess the impact of human activities on waters driven by agriculture and rural life. It is estimated that average P input and output were 28.9 kg ha(-1) a(-1) and 14.2 kg ha(-1) a(-1) respectively in China in 2004, while the total P utilization efficiency (Plant uptake P/P input) in agriculture was 45.7% leading to an average P surplus of 14.7 kg ha(-1) a(-1). Excessive P application through mineral fertilizer in the arable farming system has led to the accumulation of soil P and constituted a risk to the recipient water quality, whereas the grassland grazing system is confronted with a severe P deficit problem which has resulted in widespread grass degradation. Therefore it may be an efficient way to mitigate the problems simultaneously by regulating and balancing the P flows between the two systems. Uncertainties of the method and model are also discussed in terms of model conceptualization, data and parameters, and spatial and temporal variability.