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Zou J, Li J, Wang X, Tang D, Chen R. Neuroimmune modulation in liver pathophysiology. J Neuroinflammation 2024; 21:188. [PMID: 39090741 PMCID: PMC11295927 DOI: 10.1186/s12974-024-03181-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 07/19/2024] [Indexed: 08/04/2024] Open
Abstract
The liver, the largest organ in the human body, plays a multifaceted role in digestion, coagulation, synthesis, metabolism, detoxification, and immune defense. Changes in liver function often coincide with disruptions in both the central and peripheral nervous systems. The intricate interplay between the nervous and immune systems is vital for maintaining tissue balance and combating diseases. Signaling molecules and pathways, including cytokines, inflammatory mediators, neuropeptides, neurotransmitters, chemoreceptors, and neural pathways, facilitate this complex communication. They establish feedback loops among diverse immune cell populations and the central, peripheral, sympathetic, parasympathetic, and enteric nervous systems within the liver. In this concise review, we provide an overview of the structural and compositional aspects of the hepatic neural and immune systems. We further explore the molecular mechanisms and pathways that govern neuroimmune communication, highlighting their significance in liver pathology. Finally, we summarize the current clinical implications of therapeutic approaches targeting neuroimmune interactions and present prospects for future research in this area.
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Affiliation(s)
- Ju Zou
- Hunan Key Laboratory of Viral Hepatitis, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Jie Li
- Hunan Key Laboratory of Viral Hepatitis, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Xiaoxu Wang
- Hunan Key Laboratory of Viral Hepatitis, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Daolin Tang
- Department of Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ruochan Chen
- Hunan Key Laboratory of Viral Hepatitis, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
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Young C, Cooper D, Mostafa A, Abdel-Fattah M. The "Aberdeen Home Continence Stress Test": a novel objective assessment tool for female stress urinary incontinence. Int Urogynecol J 2023; 34:1961-1969. [PMID: 37052645 PMCID: PMC10415466 DOI: 10.1007/s00192-023-05530-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 03/06/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Clinical trials for stress urinary incontinence (SUI) require a robust, reliable, and responsive tool for objective assessment of SUI post-intervention. The Aberdeen Home Continence Stress Test (HCST) is a novel patient-reported objective assessment tool, aimed to be patient-friendly and reduce attrition rates by avoiding hospital appointments and prolonged pad-wearing. We aim to describe the HCST for the first time and evaluate its reliability, diagnostic accuracy, and response to change. METHODS A secondary analysis of the Single-Incision Mini-Slings (SIMS) study (a prospective multicentre randomised control trial (RCT) comparing two surgical treatments of SUI was performed. In SIMS (n = 600 women), the objective outcome was assessed by the 24-h pad test, while the patient-reported success rates were assessed using the Patient Global Impression of Improvement (PGI-I) at 15 months, 2 years and 3 years post-randomisation. Participants were instructed to perform the HCST before and after the 24-h pad test. The HCST was analysed in relation to reliability, validity, and the relationship between the 24-h pad test and HCST results and finally with regard to its responsiveness to change in PGI-I. (Trial registration-number ISRCTN93264234, registration date 14/01/2014). RESULTS Compared to the 24-h pad test, the sensitivity of the HCST ranged from 0.81-0.95, specificity was 0.76-0.79, negative predictive value was 0.96-0.99 and positive predictive value was 0.32-0.43. Reliability was indicated by high-performing Cronbach's alpha value (> 0.7). An improvement of ≥ 2 leakage groups on the HCST (for example from Large at baseline to Small leakage at follow-up) was strongly associated with patient-reported success on PGI-I (OR 4.38, 95% CI 2.31, 8.31). CONCLUSIONS The HCST is a valid and reliable patient-reported objective assessment tool that can be used for assessing SUI in surgical trials with good specificity, sensitivity, and consistency.
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Affiliation(s)
- Catriona Young
- The Aberdeen Centre for Women's Health Research, University of Aberdeen, Foresterhill, AB25 2ZD, Aberdeen, UK.
| | - David Cooper
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Alyaa Mostafa
- The Aberdeen Centre for Women's Health Research, University of Aberdeen, Foresterhill, AB25 2ZD, Aberdeen, UK
| | - Mohamed Abdel-Fattah
- The Aberdeen Centre for Women's Health Research, University of Aberdeen, Foresterhill, AB25 2ZD, Aberdeen, UK
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Roberts K, Alfahmy A, Mitchell D, Kamumbu S, Sebikali-Potts A, Sheyn D. Dipstick urinalysis does not predict post-urodynamic study morbidity. Int Urogynecol J 2023; 34:897-904. [PMID: 35763048 DOI: 10.1007/s00192-022-05276-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/02/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Pre-procedure urinalysis may add unnecessary cost and inconvenience for patients undergoing urodynamics. The hypothesis of this study was that urinalysis would perform poorly when predicting complications following urodynamics. METHODS Case-control study of women aged 18-89 undergoing urodynamics from 01 January2008 to 31 December 2017 at two tertiary medical centers. Data collected included patient demographics, past medical history, lower urinary tract symptoms, urodynamics indication, urodynamics results, urinalysis result, antibiotic administration, and adverse events within 30 days. Wilcoxon rank-sum test was used to compare those with and without an adverse event. Logistic regression was performed using statistically significant variables on pairwise analysis. RESULTS A total of 601 patients met the criteria; 11 of these experienced an adverse event, of which all were a urinary tract infection. There were no differences in the frequency of adverse events based on any urinalysis result, regardless of whether the patient received antibiotics. On pairwise analysis, variables associated with a higher frequency of adverse events were higher parity (3.5 (2-5) vs 2 (2, 3), p=0.038) and complaint of suprapubic pain (1 (9.1%) vs 4 (0.7%), p=0.002). On logistic regression, significant variables included increasing age (adjusted odds ratio [aOR] 1.03 per year (95% CI 1.03-4.06); p=0.002), any prolapse (aOR 6.45 (95% CI 3.60-11.54); p<0.001), pelvic organ prolapse as the indication for urodynamics (aOR 7.27 (95% CI 2.60-20.36); p<0.001), and a diagnosis of stress urinary incontinence (4.98 (95% CI 1.95-12.67); p<0.001). CONCLUSION The frequency of adverse events after urodynamics is low, and urinalysis in asymptomatic patients does not seem to be useful in predicting morbidity.
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Affiliation(s)
- Kasey Roberts
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
| | - Anood Alfahmy
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Diana Mitchell
- Division of Female Pelvic Medicine and Reconstructive Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Stacy Kamumbu
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - David Sheyn
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Thorkildsen MS, Mohus RM, Åsvold BO, Skei NV, Nilsen TIL, Solligård E, Damås JK, Gustad LT. Thyroid function and risk of bloodstream infections: Results from the Norwegian prospective population-based HUNT Study. Clin Endocrinol (Oxf) 2022; 96:896-906. [PMID: 34951039 DOI: 10.1111/cen.14658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/14/2021] [Accepted: 12/05/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Previous studies on thyroid function and risk of infection is conflicting and often stem from intensive care cohorts were nonthyroidal illness syndrome (NTIS) may be present. The objective of this study was to identify the risk of bloodstream infections (BSI) and BSI-related mortality with thyroid-stimulating hormone (TSH) levels within the reference range in a general population. DESIGN Prospective follow-up. PARTICIPANTS The HUNT2 (1995-97) included 34,619 participants with information on TSH levels. MEASUREMENTS Hazard ratios (HRs) with 95% confidence interval (CI) confirmed BSIs and BSI-related mortality until 2011. RESULTS During a median follow-up of 14.5 years, 1179 experienced at least one episode of BSI and 208 died within 30 days after a BSI. TSH levels within the reference range of 0.5-4.5 mU/L were not associated with the risk of first-time BSI, with an HR of 0.97 (95% CI: 0.90-1.04) per mU/L. Stratified by baseline age < or ≥65 years, TSH was inversely associated with the risk of BSI (HR: 0.88; 95% CI: 0.78-1.00 per mU/L) in the youngest age group only. Persons with any baseline thyroid disease had a 30% risk and the hyperthyroid subgroup a 57%, and hypothyroidism a 20% increased risk of BSI. TSH levels were not clearly associated with BSI mortality, but the HRs were imprecise due to few BSI-related deaths. CONCLUSION There was some evidence of a weak inverse association between TSH levels and the risk of BSI in persons below 65 years of age. The increased risk seen in persons with thyroid illness is probably explained by confounding by concurrent ill health.
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Affiliation(s)
- Marianne S Thorkildsen
- Gemini Center for Sepsis Research at Institute of Circulation and Medical Imaging, NTNU, Trondheim, Norway
| | - Randi M Mohus
- Gemini Center for Sepsis Research at Institute of Circulation and Medical Imaging, NTNU, Trondheim, Norway
- Clinic of Anesthesia and Intensive Care, St. Olavs Hospital, Trondheim, Norway
| | - Bjørn O Åsvold
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology, NTNU, Trondheim, Norway
- Department of Endocrinology, Clinic of Medicine, St. Olavs Hospital, Trondheim, Norway
- Department of Public Health and Nursing, HUNT Research Centre , NTNU, Levanger, Norway
| | - Nina V Skei
- Gemini Center for Sepsis Research at Institute of Circulation and Medical Imaging, NTNU, Trondheim, Norway
- Department of Anesthesia and Intensive Care, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Tom I L Nilsen
- Clinic of Anesthesia and Intensive Care, St. Olavs Hospital, Trondheim, Norway
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Erik Solligård
- Gemini Center for Sepsis Research at Institute of Circulation and Medical Imaging, NTNU, Trondheim, Norway
- Clinic of Anesthesia and Intensive Care, St. Olavs Hospital, Trondheim, Norway
| | - Jan K Damås
- Gemini Center for Sepsis Research at Institute of Circulation and Medical Imaging, NTNU, Trondheim, Norway
- Centre of Molecular Inflammation Research, NTNU, Trondheim, Norway
- Department of Clinical and Molecular Medicine, NTNU, Trondheim, Norway
- Department of Infectious Diseases, St. Olavs Hospital, Trondheim, Norway
| | - Lise T Gustad
- Gemini Center for Sepsis Research at Institute of Circulation and Medical Imaging, NTNU, Trondheim, Norway
- Clinic of Medicine and Rehabilitation, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
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A Retrospective Cohort Study to Identify the Risk Factors for Urinary Tract Infection After Office Procedures. Female Pelvic Med Reconstr Surg 2022; 28:165-172. [PMID: 35272324 DOI: 10.1097/spv.0000000000001151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The objective of this study is to identify the incidence of and risk factors for urinary tract infection (UTI) after office cystoscopy and urodynamic studies (UDS) in a female population. METHODS This was a retrospective cohort study investigating incidence of and risk factors for UTI after office testing. Inclusion criteria included women presenting for either cystoscopy or UDS from September 2019 to February 2020. Modified Poisson regression with robust error variance was used to identify risk factors for UTI after cystoscopy and UDS in a female population. RESULTS A total of 274 patients met inclusion criteria. One hundred eighty-five patients underwent office cystoscopy. Nine (4.8%) had a postcystoscopy UTI. Significant risk factors for postcystoscopy UTI included recurrent UTI (relative risk, 7.51; 95% confidence interval, 1.66-34.05) and a history of interstitial cystitis (relative risk, 4.56; 95% confidence interval, 1.52-13.73). Of those with recurrent UTI, 13.7% had a postcystoscopy UTI. Among patients with interstitial cystitis, 25% had a postcystoscopy UTI. One hundred ninety-two patients underwent UDS. Ten (5.2%) developed a post-UDS UTI. No risk factors were identified. CONCLUSIONS Patients with recurrent UTI were 7.51 times more likely to develop a UTI after cystoscopy, whereas those with interstitial cystitis were 4.56 times more likely to develop a UTI after cystoscopy. The incidence of UTI after UDS was low overall. Understanding who is at higher risk of postprocedural UTIs may help identify subpopulations that may benefit from prophylactic strategies.
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Haavik H, Niazi IK, Kumari N, Amjad I, Duehr J, Holt K. The Potential Mechanisms of High-Velocity, Low-Amplitude, Controlled Vertebral Thrusts on Neuroimmune Function: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:536. [PMID: 34071880 PMCID: PMC8226758 DOI: 10.3390/medicina57060536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/25/2021] [Indexed: 12/12/2022]
Abstract
The current COVID-19 pandemic has necessitated the need to find healthcare solutions that boost or support immunity. There is some evidence that high-velocity, low-amplitude (HVLA) controlled vertebral thrusts have the potential to modulate immune mediators. However, the mechanisms of the link between HVLA controlled vertebral thrusts and neuroimmune function and the associated potential clinical implications are less clear. This review aims to elucidate the underlying mechanisms that can explain the HVLA controlled vertebral thrust--neuroimmune link and discuss what this link implies for clinical practice and future research needs. A search for relevant articles published up until April 2021 was undertaken. Twenty-three published papers were found that explored the impact of HVLA controlled vertebral thrusts on neuroimmune markers, of which eighteen found a significant effect. These basic science studies show that HVLA controlled vertebral thrust influence the levels of immune mediators in the body, including neuropeptides, inflammatory markers, and endocrine markers. This narravtive review discusses the most likely mechanisms for how HVLA controlled vertebral thrusts could impact these immune markers. The mechanisms are most likely due to the known changes in proprioceptive processing that occur within the central nervous system (CNS), in particular within the prefrontal cortex, following HVLA spinal thrusts. The prefrontal cortex is involved in the regulation of the autonomic nervous system, the hypothalamic-pituitary-adrenal axis and the immune system. Bi-directional neuro-immune interactions are affected by emotional or pain-related stress. Stress-induced sympathetic nervous system activity also alters vertebral motor control. Therefore, there are biologically plausible direct and indirect mechanisms that link HVLA controlled vertebral thrusts to the immune system, suggesting HVLA controlled vertebral thrusts have the potential to modulate immune function. However, it is not yet known whether HVLA controlled vertebral thrusts have a clinically relevant impact on immunity. Further research is needed to explore the clinical impact of HVLA controlled vertebral thrusts on immune function.
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Affiliation(s)
- Heidi Haavik
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand; (H.H.); (N.K.); (I.A.); (J.D.)
| | - Imran Khan Niazi
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand; (H.H.); (N.K.); (I.A.); (J.D.)
- Faculty of Health & Environmental Sciences, Health & Rehabilitation Research Institute, AUT University, Auckland 0627, New Zealand
- Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark
| | - Nitika Kumari
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand; (H.H.); (N.K.); (I.A.); (J.D.)
- Faculty of Health & Environmental Sciences, Health & Rehabilitation Research Institute, AUT University, Auckland 0627, New Zealand
| | - Imran Amjad
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand; (H.H.); (N.K.); (I.A.); (J.D.)
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University, Islamabad 46000, Pakistan
| | - Jenna Duehr
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand; (H.H.); (N.K.); (I.A.); (J.D.)
| | - Kelly Holt
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand; (H.H.); (N.K.); (I.A.); (J.D.)
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Zhang X, Husmann DA, Mynderse LA, Alizad A, Fatemi M. Non-invasive assessment of urinary bladder compliance using ultrasound: first validation study based on clinical urodynamic study. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:547. [PMID: 33987245 DOI: 10.21037/atm-20-6900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This study aims to validate a recently introduced non-invasive method, ultrasound bladder vibrometry (UBV), for the assessment of detrusor compliance in patients with neurogenic bladders. Methods The study was carried out on 79 adult patients with neurogenic bladders (60 male and 19 female). The UBV test was performed on each patient to measure the Lamb wave group velocity (cg ) in the anterior bladder wall at every 50mL volume increment throughout the filling phase. Bladder compliance was assessed based on the trend of Lamb wave group velocity squared (cg 2 ) versus volume. A compliance index was defined to differentiate between the compliant and non-compliant bladders. Results of the UBV compliance assessment were validated using the readings of the corresponding urodynamic studies as the clinical gold standard. Results The Patients' bladders were divided into non-compliant and compliant groups by an experienced urologist using the information in the urodynamic study (UDS) recordings. The compliance index defined on the basis of cg 2 showed a significant difference (P<0.008) between the compliant and non-compliant groups. The areas under the receiver operating characteristic curve were 0.813, with 95% CI ranging from 0.709 to 0.892. Under the optimal criterion, the bladder was considered as non-compliant if the compliance index was less than 100 mL∙s2/m2, resulting in a sensitivity and specificity of 86.4% and 71.9%, respectively. Conclusions The results of this study demonstrate that UBV can be used as a non-invasive method for the determination of bladder compliance; thus, it can potentially serve as an alternative method to UDS for the appropriate patient groups.
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Affiliation(s)
- Xinyu Zhang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China.,Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine & Science, Rochester, MN, USA
| | - Douglas A Husmann
- Department of Urology, Mayo Clinic College of Medicine & Science, Rochester, MN, USA
| | - Lance A Mynderse
- Department of Urology, Mayo Clinic College of Medicine & Science, Rochester, MN, USA
| | - Azra Alizad
- Department of Radiology, Mayo Clinic College of Medicine & Science, Rochester, MN, USA
| | - Mostafa Fatemi
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine & Science, Rochester, MN, USA
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Prophylactic Antibiotics for Urinary Tract Infections after Urodynamic Studies: A Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6661588. [PMID: 33728337 PMCID: PMC7937458 DOI: 10.1155/2021/6661588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 01/31/2021] [Accepted: 02/23/2021] [Indexed: 12/20/2022]
Abstract
Aim We aimed to perform a meta-analysis to determine whether antibiotic prophylaxis reduces the incidence of urinary tract infections (UTIs) after urodynamic studies (UDS). Methods We conducted a systematic search of PubMed, Web of Science, Ovid, Elsevier, ClinicalKey, Embase, Cochrane Library, Medline, and Wiley Online Library. Randomized controlled trials (RCTs) comparing the effectiveness of prophylactic antibiotics with placebo or no treatment in preventing UTI after UDS were included. Two reviewers extracted data independently, and RevMan 5.3 software was used to analyze relative risk (RR) with 95% confidence intervals (CI). Heterogeneity was assessed by the Q test and I2 test. Results The final meta-analysis included 1829 patients in 13 RCTs. Compared with the placebo or no treatment group, prophylactic antibiotics could significantly reduce the risk of bacteriuria (RR = 0.42, 95% CI: 0.30-0.60) and the risk of symptomatic UTI (RR = 0.65, 95% CI: 0.48-0.88). In addition, there was no statistically significant difference in the risk of adverse events (RR = 4.93, 95% CI: 0.61-40.05). No significant heterogeneity or publication bias was found in this study. Conclusions Current evidence showed that prophylactic antibiotics could reduce the risk of asymptomatic bacteriuria and symptomatic UTI after UDS without increasing the incidence of adverse events.
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Schiller M, Ben-Shaanan TL, Rolls A. Neuronal regulation of immunity: why, how and where? Nat Rev Immunol 2021; 21:20-36. [PMID: 32811994 DOI: 10.1038/s41577-020-0387-1] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2020] [Indexed: 02/07/2023]
Abstract
Neuroimmunology is one of the fastest-growing fields in the life sciences, and for good reason; it fills the gap between two principal systems of the organism, the nervous system and the immune system. Although both systems affect each other through bidirectional interactions, we focus here on one direction - the effects of the nervous system on immunity. First, we ask why is it beneficial to allow the nervous system any control over immunity? We evaluate the potential benefits to the immune system that arise by taking advantage of some of the brain's unique features, such as its capacity to integrate and synchronize physiological functions, its predictive capacity and its speed of response. Second, we explore how the brain communicates with the peripheral immune system, with a focus on the endocrine, sympathetic, parasympathetic, sensory and meningeal lymphatic systems. Finally, we examine where in the brain this immune information is processed and regulated. We chart a partial map of brain regions that may be relevant for brain-immune system communication, our goal being to introduce a conceptual framework for formulating new hypotheses to study these interactions.
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Affiliation(s)
- Maya Schiller
- Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Tamar L Ben-Shaanan
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
- Howard Hughes Medical Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Asya Rolls
- Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
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Benseler A, Anglim B, Zhao ZY, Walsh C, McDermott CD. Antibiotic prophylaxis for urodynamic testing in women: a systematic review. Int Urogynecol J 2020; 32:27-38. [PMID: 32845398 PMCID: PMC7447964 DOI: 10.1007/s00192-020-04501-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/13/2020] [Indexed: 11/27/2022]
Abstract
Introduction and hypothesis Urinary tract infection is the most common complication after urodynamic studies (UDS). Practice guidelines recommend against antibiotic prophylaxis based on an outdated review of the literature, which advised on the premise of “a lack of good quality studies” and based on an assumed low incidence not consistently supported by the literature. Objectives This systematic review aims to update the assessment of the efficacy of antibiotic prophylaxis compared with placebo or no treatment for prevention of urinary tract infection in females over the age of 18 years undergoing UDS. Methods MEDLINE, EMBASE, COCHRANE, DISSERTATIONS, conference proceedings and clinical trial registries were searched for relevant randomized controlled trials. Two authors independently screened and selected articles, assessed these for quality according to Cochrane guidelines and extracted their data. Results A total of 2633 records were screened, identifying three relevant randomized controlled trials. The one study that was critically appraised as being the least likely biased showed a statistically significant effect of antibiotic prophylaxis in reducing bacteriuria post UDS in female patients. The other two studies included in the review did not. None of the studies included were powered to show a significant change in the incidence of urinary tract infection following UDS in female patients receiving antibiotic prophylaxis versus no prophylaxis. Conclusions Similar to the 2012 Cochrane review on this subject, this systematic review demonstrated that antibiotic prophylaxis may decrease bacteriuria in women post UDS; however, further research is required to assess its effect on urinary tract infections in this context.
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Affiliation(s)
- Anouk Benseler
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
| | - Breffini Anglim
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, 8-815, 700 University Ave., Toronto, Ontario, Canada
| | - Zi Ying Zhao
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Chris Walsh
- Sidney Liswood Library, Sinai Health System, Toronto, Canada
| | - Colleen D McDermott
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, 8-815, 700 University Ave., Toronto, Ontario, Canada.
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Risk of infection in patients undergoing urologic surgery based on the presence of asymptomatic bacteriuria: A prospective study. Am J Infect Control 2019; 47:1474-1478. [PMID: 31375294 DOI: 10.1016/j.ajic.2019.06.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Treatment of asymptomatic bacteriuria (ASB) is recommended in pregnant women and prior to urologic procedures with anticipated mucosal disruption. However, there is still insufficient evidence of the usefulness of treating ASB prior to urologic procedures. Therefore, the aim of this study was to ascertain the risk of infections in patients undergoing urologic surgery based on the presence of ASB. METHODS We conducted a cohort study among patients undergoing urologic surgery at a single center located in Medellín, Colombia. All patients were screened for ASB prior to their procedures. Patients were evaluated for the development of any postoperative infectious complications for up to 30 days after the procedure. RESULTS A total of 149 patients were included in this cohort. Incidence of ASB was 14.8%. Thirteen patients (8.72%) developed infectious complications: 3 (13.64%) with ASB and 10 (7.87%) without ABS. Factors associated with postoperative infectious complications included urologic cancers (hazard ratio [HR], 5.26; 95% confidence intervals [CI], 1.24-22.37), urologic interventions in the preceding 3 months (HR, 3.72; 95% CI, 1.02-13.51), and use of antibiotics 3 months prior to surgery (HR, 3.83; 95% CI, 1.01-15.49). Presence of ASB was not associated with postsurgical infectious complications (HR, 1.02; 95% CI, 0.26-3.96). CONCLUSIONS There was no association between ASB and postoperative infectious complications. There were other factors associated with infectious complications, such as urologic cancer, previous history of urologic manipulation, and antibiotic use.
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Egrot C, Dinh A, Amarenco G, Bernard L, Birgand G, Bruyère F, Chartier-Kastler E, Cosson M, Deffieux X, Denys P, Etienne M, Fatton B, Fritel X, Gamé X, Lawrence C, Lenormand L, Lepelletier D, Lucet JC, Marit Ducamp E, Pulcini C, Robain G, Senneville E, de Sèze M, Sotto A, Zahar JR, Caron F, Hermieu JF. [Antibiotic prophylaxis in urodynamics: Clinical practice guidelines using a formal consensus method]. Prog Urol 2018; 28:943-952. [PMID: 30501940 DOI: 10.1016/j.purol.2018.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/08/2018] [Accepted: 10/11/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aim of this work was to issue clinical practice guidelines on antibiotic prophylaxis in urodynamics (urodynamic studies, UDS). MATERIALS AND METHODS Clinical practice guidelines were provided using a formal consensus method. Guidelines proposals were drew up by a multidisciplinary experts group (pilot group = steering group), then rated by a panel of 12 experts (rating group) using a formal consensus method, and then peer reviewed by a reviewing/reading group of experts (different from the rating group). RESULTS Urine (bacterial) culture with antimicrobial susceptibility testing is recommended for all patients before UDS (strong agreement). In patients with no neurologic disease, the risk factors for tract urinary infection (UTI) after UDS are age > 70 years, recurrent UTI, and post-void residual volume > 100ml. In patients with neurologic disease, the risk factors for UTI after UDS are recurrent UTI, vesicoureteral reflux, and intermicturition pressure > 40cmH2O. If the urine culture is negative before UDS and there is no risk factor for UTI, antibiotic prophylaxis is not recommended (Strong agreement). If the urine culture is negative before UDS, but there are one or more risk factors for UTI, antibiotic prophylaxis is optional. If antibiotic prophylaxis is initiated, a single oral dose (3g) of fosfomycin-tromethamine two hours before UDS is recommended (Strong agreement). If there is bacterial colonization on UCB before UDS, antibiotic therapy is optional (Undecided). If prescribed, it should be adapted to the antimicrobial susceptibility of the identified bacterium or bacteria, started the day before and stopped after UDS (except for fosfomycin-tromethamine: a single dose the day before UDS is necessary and sufficient) (Strong agreement). In the event of UTI before UDS, the UTI should be treated and UDS postponed (Strong agreement). The proposed recommendations should not be changed for patients with a hip or knee replacement (Strong agreement). No antibiotic prophylaxis of bacterial endocarditis is necessary, including in high-risk patients with valvular heart disease (Strong agreement). CONCLUSION These new guidelines should help to harmonize clinical practice and limit exposure to antibiotics. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- C Egrot
- Service d'urologie, université Paris-7, hôpital Bichat Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France.
| | - A Dinh
- Unité de maladies infectieuses, UVSQ, hôpital Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - G Amarenco
- GRC 01, groupe de recherche clinique en neuro-urologie (GREEN), Sorbonne université, hôpital Tenon, AP-HP, 75020 Paris, France
| | - L Bernard
- Service de médecine interne et maladies infectieuses, centre hospitalier régional Bretonneau, 37000 Tours, France
| | - G Birgand
- Centre de prévention des infections associées aux soins, CHU de Nantes, 5, rue du Pr-Boquien, 44000 Nantes, France
| | - F Bruyère
- Service d'urologie, centre hospitalier régional universitaire de Tours, 37000 Tours, France
| | - E Chartier-Kastler
- Médecine Sorbonne Université, hôpital universitaire de la Pitié-Salpêtrière, 75013 Paris, France
| | - M Cosson
- Laboratoire BioTIM, école centrale de Lille, université de Lille, CHU de Lille, 59000 Lille, France
| | - X Deffieux
- Service de gynécologie obstétrique, université Paris-Sud, hôpital Antoine-Béclère, groupe hospitalier Sud, AP-HP, 92140 Clamart, France
| | - P Denys
- Service de neuro-urologie, hôpital Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - M Etienne
- Service de maladies infectieuses et tropicales, hôpital Charles-Nicolle, CHU de Rouen, 76000 Rouen, France
| | - B Fatton
- Unité d'urogynécologie, groupe hospitalier Carémeau, CHU de Nîmes, 30029 Nîmes, France
| | - X Fritel
- Service de gynécologie-obstétrique, CHU de Poitiers, 86000 Poitiers, France
| | - X Gamé
- Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, TSA 50032, 31059 Toulouse, France
| | - C Lawrence
- Service microbiologie et hygiène, hôpital Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - L Lenormand
- Service d'urologie, centre fédératif de pelvipérinéologie, CHU de Nantes, place A.-Ricordeau, 44093 Nantes cedex 01, France
| | - D Lepelletier
- Service bactériologie et hygiène hospitalière, CHU de Nantes, 44093 Nantes cedex 01, France
| | - J-C Lucet
- Service de bactériologie, hygiène, virologie, parasitologie, hôpital Bichat-Claude-Bernard, AP-HP, Paris, France
| | - E Marit Ducamp
- Service de médecine physique et réadaptation, urodynamique, clinique Saint-Augustin, 33200 Bordeaux, France
| | - C Pulcini
- Infectious Diseases Department, université de Lorraine, APEMAC, CHRU de Nancy, 54000 Nancy, France
| | - G Robain
- Service de rééducation neurologique, hôpital Rothschild, AP-HP, 75012 Paris, France
| | - E Senneville
- Service universitaire des maladies infectieuses et du voyageur, centre hospitalier Gustave-Dron, CHRU de Lille, 59200 Tourcoing, France
| | - M de Sèze
- Service de médecine physique et réadaptation, urodynamique, clinique Saint-Augustin, 33200 Bordeaux, France
| | - A Sotto
- Service des maladies infectieuses et tropicales, CHU de Nîmes, place du Professeur-Robert-Debré, 30029 Nîmes cedex, France
| | - J-R Zahar
- Département de microbiologie, hôpital Avicenne, AP-HP, groupe hospitalier Paris-Seine-Saint-Denis, 93000 Bobigny, France; Unité de recherche Inserm 1137, IAME, université Paris-13, 93000 Bobigny, France
| | - F Caron
- Service des maladies infectieuses, groupe de recherche sur l'adaptation microbienne (EA2656), université de Rouen, CHU de Rouen, 76000 Rouen, France
| | - J-F Hermieu
- Service d'urologie, université Paris-7, hôpital Bichat Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
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Should We Always Use Antibiotics after Urodynamic Studies in High-Risk Patients? BIOMED RESEARCH INTERNATIONAL 2018; 2018:1607425. [PMID: 30519569 PMCID: PMC6241335 DOI: 10.1155/2018/1607425] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 10/22/2018] [Indexed: 11/17/2022]
Abstract
Aim The aim of this observational study was to evaluate the effectiveness of a phytotherapic drug (Canephron N) in preventing urinary tract infection (UTI) in high-risk women undergoing urodynamic studies (UDS). Methods The study protocol was approved by the local institutional ethical committee. Adult women with at least one risk factor for acquiring UTI (defined as: age over 70, elevated postvoid residual urine>100 ml, recurrent UTI, pelvic organ prolapse (POP) ≥II in POP-Q scale, and neurogenic bladder) had received after UDS either a single oral dose of fosfomycin trometamol (FT) (3 grams) or a phytodrug containing centaury herb, lovage root, and rosemary leaves (5 ml taken orally three times daily for one week). All patients included in the study had no pyuria according to urine dipstick (nitrite and/or blood and/or leukocyte esterase) and negative urine culture (CFU < 103/ml) before UDS. Urine samples were also tested 7 days after UDS. Results Seventy-two high-risk participants completed the study. Seven days after urodynamic studies UTI symptoms, pyuria (nitrite and/or blood and/or leukocyte esterase) and bacteriuria with E. coli occurred in two patients (one (2.8%) in the FT and one (2.7%) in the phytodrug group, respectively). No statistical differences in UTI incidence were found between both treatment groups. We did not observe any additional adverse events in both groups. The major disadvantage of prophylaxis with the phytodrug as compared to FT was the necessity of continuing therapy for 7 days. Conclusion Prophylaxis of UTI with a phytodrug (Canephron N) may be considered a good alternative to antibiotic prophylaxis use after UDS in high-risk female patients.
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Milandri R, Maltagliati M, Bocchialini T, Del Prete C, Bianchi G, Rocco BM, Micali S. Effectiveness of D-mannose, Hibiscus sabdariffa and Lactobacillus plantarum therapy in prevention of infectious events following urodynamic study. Urologia 2018; 86:122-125. [DOI: 10.1177/0391560318798291] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction and aim: The urodynamic study is an invasive examination that allows a thorough evaluation of the functional activity of the lower urinary tract (bladder, urethra). The execution of urodynamic study exposes the patient to the risk of contracting infections of the lower urinary tract. Prevention of urinary tract infections consists in the avoidance of risk factors and prophylaxis with antimicrobial and non-antimicrobial measures. In this article, we aimed to evaluate the effectiveness of a phytotherapeutic product composed of D-mannose, Hibiscus sabdariffa, and Lactobacillus plantarum in the prevention of infectious events following invasive urodynamic examination. Materials and methods: We selected 100 female consecutive patients (age 19–87 years) that underwent urodynamic invasive procedure. We prescribed 14-day therapy with D-mannose, H. sabdariffa, and L. plantarum to these 100 patients after urodynamic invasive test. After that, we have examined urine cultures and urinary symptoms through telephone interviews and hospital outpatient visits to evaluate the possible presence of urinary tract infections. Results: Urinary tract infections were observed through urine culture in 13% of the selected patients; of the 13 urinary tract infections, 9 were observed in patients with urinary tract recurrent infections in the last year and the other 4 cases were associated with patients with no urinary infection in the last year. Three women reported some urinary symptoms and underwent antibiotic therapy. The other 10 cases were classified as asymptomatic bacteriuria. Three cases were related to patients presenting with pelvic organ prolapse. Eight cases were instead related to significant post-voiding residue (>100). Six patients with urinary tract infection reported constipation in the last year. All patients completed the prescribed therapy due to the affordable price of the product and no side effects have been reported. Conclusion: Our study about the administration of D-mannose, H. sabdariffa, and L. plantarum after invasive urodynamic examination underlined how this phytotherapeutic product can reduce the risk of bacteriuria and urinary tract infection in women.
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Affiliation(s)
- Riccardo Milandri
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Matteo Maltagliati
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Tommaso Bocchialini
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Chiara Del Prete
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Giampaolo Bianchi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Bernardo M Rocco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
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Finazzi-Agro E, Gammie A, Kessler TM, van Koeveringe G, Serati M, Solomon E, de Wachter S, Kirschner-Hermanns R. Urodynamics Useless in Female Stress Urinary Incontinence? Time for Some Sense-A European Expert Consensus. Eur Urol Focus 2018; 6:137-145. [PMID: 30061075 DOI: 10.1016/j.euf.2018.07.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/15/2018] [Accepted: 07/20/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Routine use of urodynamics (UDS) for the assessment of female stress urinary incontinence (SUI) appears to be in decline across Europe. The reasons for this trend appear multifactorial, but the implications are of significant concern. OBJECTIVES To achieve an expert consensus viewpoint on the value of UDS in female SUI and current barriers to its use. METHODOLOGY A multidisciplinary group of UDS experts from six European countries was convened, and a modified version of the Delphi method was utilised to reach a consensus viewpoint structured around five key questions. RESULTS Consensus was achieved on all five questions. The group was unanimous that the decline in routine use of UDS is unjustified and misguided, driven by restrictions in funding and accelerated by the publication-and subsequent influence-of two trials that had major limitations. LIMITATIONS The authors comprised a selected group of UDS experts and the analysis is not a formal systematic review. CONCLUSIONS Extensive experience and observational studies have demonstrated the value of UDS for the assessment of female SUI and the dangers of empiric management. This evidence base should not be eclipsed by the findings of two randomised controlled trials that had numerous shortcomings. PATIENT SUMMARY A group of experts were worried that, even though the cause of incontinence varies, doctors seem to be skipping a diagnostic test called urodynamics (UDS) in some patients and just providing treatment-even surgery-without knowing exactly what is wrong. These experts analysed the situation in detail and reached agreement that UDS testing should not be skipped.
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Affiliation(s)
- Enrico Finazzi-Agro
- Department of Experimental Medicine and Surgery, Unit for Functional Urology, Tor Vergata University Hospital, Rome, Italy
| | - Andrew Gammie
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Thomas M Kessler
- Neuro-urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Gommert van Koeveringe
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Maurizio Serati
- Department of Obstetrics and Gynaecology, Urogynaecology Unit, University of Insubria, Varese, Italy.
| | | | - Stefan de Wachter
- Department of Urology, University Hospital Antwerpen, University of Antwerp, Belgium
| | - Ruth Kirschner-Hermanns
- Neuro-urology/Urology, University Clinic, Friedrich Wilhelms University Bonn and Neurological Rehabilitation Centre, Bonn, Germany
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Nadeem M, Sheikh MI, Sait M, Emmanuel N, Sheriff M, Masood S. Is urinary tract infection after urodynamic study predictable? UROLOGICAL SCIENCE 2017. [DOI: 10.1016/j.urols.2016.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Cuevas-Romero E, Sánchez-Cardiel A, Zamora-Gallegos AM, Cruz-Lumbreras R, Corona-Quintanilla DL, Castelán F, Martínez-Gómez M. Moderate-to-high normal levels of thyrotropin is a risk factor for urinary incontinence and an unsuitable quality of life in women over 65 years. Clin Exp Pharmacol Physiol 2017; 44 Suppl 1:86-92. [DOI: 10.1111/1440-1681.12788] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 04/17/2017] [Accepted: 05/12/2017] [Indexed: 01/03/2023]
Affiliation(s)
- Estela Cuevas-Romero
- Centro Tlaxcala de Biología de la Conducta; Universidad Autónoma de Tlaxcala; Tlaxcala Mexico
| | | | | | - Rosalía Cruz-Lumbreras
- Doctorado en Ciencias Biológicas; Universidad Autónoma de Tlaxcala; Tlaxcala Mexico
- Facultad de Ciencias de la Salud; Universidad Autónoma de Tlaxcala; Tlaxcala Mexico
| | | | - Francisco Castelán
- Centro Tlaxcala de Biología de la Conducta; Universidad Autónoma de Tlaxcala; Tlaxcala Mexico
- Instituto de Investigaciones Biomédicas; Universidad Autónoma de México; Tlaxcala Mexico
| | - Margarita Martínez-Gómez
- Centro Tlaxcala de Biología de la Conducta; Universidad Autónoma de Tlaxcala; Tlaxcala Mexico
- Instituto de Investigaciones Biomédicas; Universidad Autónoma de México; Tlaxcala Mexico
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Analysis of the incidence and risk factors of male urinary tract infection following urodynamic study. Eur J Clin Microbiol Infect Dis 2017; 36:1873-1878. [PMID: 28577157 DOI: 10.1007/s10096-017-3007-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 05/03/2017] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to investigate the incidence and risk factors of male urinary tract infection (UTI) after urodynamic study (UDS). A total of 854 consecutive male patients, who underwent UDS at Peking Union Medical College Hospital from January 2010 to March 2016, were recruited in this study. Two to four weeks before the examination, urinalysis with bacterial culture was performed. Patients with negative results were selected for UDS. Immediately before the examination, urinalysis was repeated to rule out any preoperative UTI. Between 48 and 72 h after the exam, urine culture was performed again to determine the incidence of UTI. The incidence of UTI and patients' baseline characteristics, including age, medical history, urodynamic parameters, current diagnosis and pathogen type, were analyzed. Among the 854 patients undergoing UDS, urinary infection was found in 84 cases after the examination, the incidence was 9.83%. Comorbidity with diabetes, post void residual (PVR), volume of prostate (Vp), and two urodynamic parameters, maximal flow rate (Qmax) and average flow rate (Qav) were found to be the independent risk factors for UTI after UDS. The most common pathogens were Escherichia coli (54.76%) and Enterococcus faecalis (19.05%). The incidence of UTI after UDS in male patients was 9.83%. Patients who suffered from comorbidity of diabetes, high PVR, high Vp, low Qmax or Qav may need to be treated with prophylactic antibiotics to prevent postoperative UTI.
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Cameron AP, Campeau L, Brucker BM, Clemens JQ, Bales GT, Albo ME, Kennelly MJ. Best practice policy statement on urodynamic antibiotic prophylaxis in the non-index patient. Neurourol Urodyn 2017; 36:915-926. [PMID: 28345769 DOI: 10.1002/nau.23253] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 02/09/2017] [Indexed: 11/12/2022]
Abstract
AIMS Antibiotic prophylaxis before urodynamic testing (UDS) is widely utilized to prevent urinary tract infection (UTI) with only limited guidance. The Society of Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction (SUFU) convened a Best Practice Policy Panel to formulate recommendations on the urodynamic antibiotic prophylaxis in the non-index patient. METHODS Recommendations are based on a literature review and the Panel's expert opinion, with all recommendations graded using the Oxford grading system. RESULTS All patients should be screened for symptoms of UTI and undergo dipstick urinalysis. If the clinician suspects a UTI, the UDS should be postponed until it has been treated. The first choice for prophylaxis is a single oral dose of trimethoprim-sulfamethoxazole before UDS, with alternative antibiotics chosen in case of allergy or intolerance. Individuals who do NOT require routine antibiotic prophylaxis include those without known relevant genitourinary anomalies, diabetics, those with prior genitourinary surgery, a history of recurrent UTI, post-menopausal women, recently hospitalized patients, patients with cardiac valvular disease, nutritional deficiencies or obesity. Identified risk factors that increase the potential for UTI following UDS and for which the panel recommends peri-procedure antibiotics include: known relevant neurogenic lower urinary tract dysfunction, elevated PVR, asymptomatic bacteriuria, immunosuppression, age over 70, and patients with any indwelling catheter, external urinary collection device, or performing intermittent catheterization. Patients with orthopedic implants have a separate risk stratification. CONCLUSIONS These recommendations can assist urodynamic providers in the appropriate use of antibiotics for UDS testing. Clinical judgment of the provider must always be considered.
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Affiliation(s)
- Anne P Cameron
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | | | - Benjamin M Brucker
- New York Langone Medical Center, NYU Urology Associates, New York, New York
| | | | - Gregory T Bales
- Section of Urology, The University of Chicago, Chicago, Illinois
| | - Michael E Albo
- Division of Urology, UCSD Medical Center, San Diego, California
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Jara EL, Muñoz-Durango N, Llanos C, Fardella C, González PA, Bueno SM, Kalergis AM, Riedel CA. Modulating the function of the immune system by thyroid hormones and thyrotropin. Immunol Lett 2017; 184:76-83. [PMID: 28216261 DOI: 10.1016/j.imlet.2017.02.010] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 02/14/2017] [Accepted: 02/15/2017] [Indexed: 12/18/2022]
Abstract
Accumulating evidence suggests a close bidirectional communication and regulation between the neuroendocrine and immune systems. Thyroid hormones (THs) can exert responses in various immune cells, e.g., monocytes, macrophages, natural killer cells, and lymphocytes, affecting several inflammation-related processes (such as, chemotaxis, phagocytosis, reactive oxygen species generation, and cytokines production). The interactions between the endocrine and immune systems have been shown to contribute to pathophysiological conditions, including sepsis, inflammation, autoimmune diseases and viral infections. Under these conditions, TH therapy could contribute to restoring normal physiological functions. Here we discuss the effects of THs and thyroid stimulating hormone (TSH) on the immune system and the contribution to inflammation and pathogen clearance, as well as the consequences of thyroid pathologies over the function of the immune system.
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Affiliation(s)
- Evelyn L Jara
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Portugal 49, Santiago, Chile
| | - Natalia Muñoz-Durango
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Portugal 49, Santiago, Chile
| | - Carolina Llanos
- Departamento de Inmunología Clínica y Reumatología, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 350, Santiago, Chile
| | - Carlos Fardella
- Millennium Institute on Immunology and Immunotherapy, Departamento de Endocrinología, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 350, Santiago, Chile
| | - Pablo A González
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Portugal 49, Santiago, Chile
| | - Susan M Bueno
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Portugal 49, Santiago, Chile
| | - Alexis M Kalergis
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Portugal 49, Santiago, Chile; Millennium Institute on Immunology and Immunotherapy, Departamento de Endocrinología, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 350, Santiago, Chile; INSERM U1064, Nantes, France.
| | - Claudia A Riedel
- Millenium Institute on Immunology and Immunotherapy, Departamento de Ciencias Biológicas, Facultad de Ciencias Biológicas y Facultad de Medicina, Universidad Andrés Bello, Chile.
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