Is vitamin E the only lipid-soluble, chain-breaking antioxidant in human blood plasma and erythrocyte membranes?

The concentration of lipid-soluble, chain-breaking antioxidants in human plasma and in erythrocyte ghosts have been determined for the first time by an inhibited-autoxidation method. The results are very similar to the concentrations of vitamin E measured for the same blood components by the HPLC method. It is concluded that vitamin E, which is largely present as alpha-tocopherol, is the only significant lipid-soluble, chain-breaking type of antioxidant present in human blood. The concentration of vitamin E in the plasma lipids divided by the concentration of vitamin E in the ghost membrane lipids is approximately a constant despite the large differences in vitamin E-intake and in plasma lipid concentrations in different individuals. Vitamin E/lipid ratios for plasma and ghosts were larger for subjects taking a supplement of alpha-tocopherol acetate of 100 IU per week, compared to nonsupplemented subjects (based on data from a limited number of subjects). A larger supplement of 2800 IU per week did not significantly increase the vitamin E/lipid ratios.

The presence and severity of nonalcoholic steatohepatitis is associated with specific changes in circulating bile acids

The histologic spectrum of nonalcoholic fatty liver disease (NAFLD) includes fatty liver (NAFL) and steatohepatitis (NASH), which can progress to cirrhosis in up to 20% of NASH patients. Bile acids (BA) are linked to the pathogenesis and therapy of NASH. We (1) characterized the plasma BA profile in biopsy-proven NAFL and NASH and compared to controls and (2) related the plasma BA profile to liver histologic features, disease activity, and fibrosis. Liquid chromatography/mass spectrometry quantified BAs. Descriptive statistics, paired and multiple group comparisons, and regression analyses were performed. Of 86 patients (24 controls, 25 NAFL, and 37 NASH; mean age 51.8 years and body mass index 31.9 kg/m² ), 66% were women. Increased total primary BAs and decreased secondary BAs (both P < 0.05) characterized NASH. Total conjugated primary BAs were significantly higher in NASH versus NAFL (P = 0.047) and versus controls (P < 0.0001). NASH had higher conjugated to unconjugated chenodeoxycholate (P = 0.04), cholate (P = 0.0004), and total primary BAs (P < 0.0001). The total cholate to chenodeoxycholate ratio was significantly higher in NAFLD without (P = 0.005) and with (P = 0.02) diabetes. Increased key BAs were associated with higher grades of steatosis (taurocholate), lobular (glycocholate) and portal inflammation (taurolithocholate), and hepatocyte ballooning (taurocholate). Conjugated cholate and taurocholate directly and secondary to primary BA ratio inversely correlated to NAFLD activity score. A higher ratio of total secondary to primary BA decreased (odds ratio, 0.57; P = 0.004) and higher conjugated cholate increased the likelihood of significant fibrosis (F≥2) (P = 0.007). Conclusion: NAFLD is associated with significantly altered circulating BA composition, likely unaffected by type 2 diabetes, and correlated with histological features of NASH; these observations provide the foundation for future hypothesis-driven studies of specific effects of BAs on specific aspects of NASH. (Hepatology 2018;67:534-548).

Systems science and systems thinking for public health: a systematic review of the field

OBJECTIVES

This paper reports on findings from a systematic review designed to investigate the state of systems science research in public health. The objectives were to: (1) explore how systems methodologies are being applied within public health and (2) identify fruitful areas of activity.

DESIGN

A systematic review was conducted from existing literature that draws on or uses systems science (in its various forms) and relates to key public health areas of action and concern, including tobacco, alcohol, obesity and the social determinants of health.

DATA ANALYSIS

117 articles were included in the review. An inductive qualitative content analysis was used for data extraction. The following were systematically extracted from the articles: approach, methodology, transparency, strengths and weaknesses. These were then organised according to theme (ie, commonalities between studies within each category), in order to provide an overview of the state of the field as a whole. The assessment of data quality was intrinsic to the goals of the review itself, and therefore, was carried out as part of the analysis.

RESULTS

4 categories of research were identified from the review, ranging from editorial and commentary pieces to complex system dynamic modelling. Our analysis of each of these categories of research highlighted areas of potential for systems science to strengthen public health efforts, while also revealing a number of limitations in the dynamic systems modelling being carried out in public health.

CONCLUSIONS

There is a great deal of interest in how the application of systems concepts and approach might aid public health. Our analysis suggests that soft systems modelling techniques are likely to be the most useful addition to public health, and align well with current debate around knowledge transfer and policy. However, the full range of systems methodologies is yet to be engaged with by public health researchers.

Risk factors for serious prescription opioid-related toxicity or overdose among Veterans Health Administration patients

OBJECTIVE

Prescription opioid use and deaths related to serious toxicity, including overdose, have increased dramatically in the United States since 1999. However, factors associated with serious opioid-related respiratory or central nervous system (CNS) depression or overdose in medical users are not well characterized. The objective of this study was to examine the factors associated with serious toxicity in medical users of prescription opioids.

DESIGN

Retrospective, nested, case-control analysis of Veterans Health Administration (VHA) medical, pharmacy, and health care resource utilization administrative data.

SUBJECTS

Patients dispensed an opioid by VHA between October 1, 2010 and September 30, 2012 (N=8,987).

METHODS

Cases (N=817) experienced life-threatening opioid-related respiratory/CNS depression or overdose. Ten controls were randomly assigned to each case (N=8,170). Logistic regression was used to examine associations with the outcome.

RESULTS

The strongest associations were maximum prescribed daily morphine equivalent dose (MED)≥ 100 mg (odds ratio [OR]=4.1, 95% confidence interval [CI], 2.6-6.5), history of opioid dependence (OR=3.9, 95% CI, 2.6-5.8), and hospitalization during the 6 months before the serious toxicity or overdose event (OR=2.9, 95% CI, 2.3-3.6). Liver disease, extended-release or long-acting opioids, and daily MED of 20 mg or more were also significantly associated.

CONCLUSIONS

Substantial risk for serious opioid-related toxicity and overdose exists at even relatively low maximum prescribed daily MED, especially in patients already vulnerable due to underlying demographic factors, comorbid conditions, and concomitant use of CNS depressant medications or substances. Screening patients for risk, providing education, and coprescribing naloxone for those at elevated risk may be effective at reducing serious opioid-related respiratory/CNS depression and overdose in medical users of prescription opioids.

Development of a Risk Index for Serious Prescription Opioid-Induced Respiratory Depression or Overdose in Veterans' Health Administration Patients

OBJECTIVE

Develop a risk index to estimate the likelihood of life-threatening respiratory depression or overdose among medical users of prescription opioids.

SUBJECTS, DESIGN, AND METHODS

A case-control analysis of administrative health care data from the Veterans' Health Administration identified 1,877,841 patients with a pharmacy record for an opioid prescription between October 1, 2010 and September 30, 2012. Overdose or serious opioid-induced respiratory depression (OSORD) occurred in 817. Ten controls were selected per case (n = 8,170). Items for an OSORD risk index (RIOSORD) were selected through logistic regression modeling, with point values assigned to each predictor. Modeling of risk index scores produced predicted probabilities of OSORD; risk classes were defined by the predicted probability distribution.

RESULTS

Fifteen variables most highly associated with OSORD were retained as items, including mental health disorders and pharmacotherapy; impaired drug metabolism or excretion; pulmonary disorders; specific opioid characteristics; and recent hospital visits. The average predicted probability of experiencing OSORD ranged from 3% in the lowest risk decile to 94% in the highest, with excellent agreement between predicted and observed incidence across risk classes. The model's C-statistic was 0.88 and Hosmer-Lemeshow goodness-of-fit statistic 10.8 (P > 0.05).

CONCLUSION

RIOSORD performed well in identifying medical users of prescription opioids within the Veterans' Health Administration at elevated risk of overdose or life-threatening respiratory depression, those most likely to benefit from preventive interventions. This novel, clinically practical, risk index is intended to provide clinical decision support for safer pain management. It should be assessed, and refined as necessary, in a more generalizable population, and prospectively evaluated.

Enhanced pharmacy services, barriers and facilitators in Australia's community pharmacies: Australia's National Pharmacy Database Project

Objective

To report the frequency of 27 enhanced pharmacy services (EPS) provided in Australia's community pharmacies and to analyse barriers and facilitators for providing priority services. Setting A large representative sample of community pharmacies in Australia in 2002.

Method

Questionnaires were mailed to owners or managers of a stratified, representative sample of Australia's community pharmacies; 1131of 1391 consenting pharmacies responded (81.3%). Specifically trained staff, fees charged, structural and other components and plan to introduce EPS were analysed. The barriers and facilitators for all EPS were rated by a Likert scale. Logistic regression models tested for predictors for providing one or more EPS and those related to Australia's National Health Priorities.

Key findings

Eighty-eight per cent of Australia's community pharmacies offered ≥1 EPS. More than 40% offered EPS for asthma, diabetes, methadone, herbal medicines, hypertension and wound care. Pharmacies with higher turnover (odds ratio (OR), 1.90; 99% confidence interval (CI) = 1.05–3.42) and younger owners (OR for age, 0.69; 99% CI = 0.48–0.99) were predictors for providing ≥1 EPS. Higher turnover was a predictor for diabetes care. Enclosed counselling area was a predictor for hypertension care. Owners and managers committed to continuing education was a predictor for diabetes and hyperlipidaemia services. Significant barriers perceived were lack of confidence for diabetes care and not being regarded as ‘part of the job’ for asthma, diabetes, hypertension and weight-management services.

Conclusion

The percentages of pharmacies in Australia that provided equivalent EPS were similar or higher than the UK, New Zealand and USA. The frequency of existing and planned EPS appeared disproportionately low to satisfy national health priorities. Significant barriers and facilitators and pharmacy characteristics for providing EPS were identified. The results assist national bodies to increase the uptake of EPS by pharmacies.

A qualitative exploration of the emotional wellbeing and support needs of new mothers from Afghanistan living in Melbourne, Australia

Background

The Afghan community is a priority population for many health and social services within the southeast region of Melbourne, which is home to the largest population of Afghanistan-born people within the state of Victoria. The majority of Afghan women arriving in Australia are of childbearing age, and evidence suggests that they are at increased risk of emotional challenges following birth as a result of the refugee and migration experience. This research aimed to explored the experiences of Afghan women living in Melbourne throughout pregnancy, birth, and early motherhood, and gain insight into the aspects of their experiences that they perceive as positively and negatively impacting their emotional wellbeing.

Methods

This qualitative study collected data through two focus group discussions (conducted in Dari) and 10 in-depth interviews (conducted in Dari or English). Thirty-eight Afghanistan-born women aged 18 years and older, who recently migrated to Australia and have at least one Australian-born child, were purposively selected to participate. A trained bicultural worker assisted in recruitment, data collection and translation. Thematic analysis was performed, and findings were confirmed with a subgroup of participants prior to being included within reporting.

Results

Participants consistently discussed experiencing emotional challenges following birth, identifying symptoms commonly associated with postnatal depression. Women largely attributed this emotional state to separation from family and culture, leading to loneliness, isolation, and disconnection. Participants expressed resistance towards professional support due to cultural stigma associated with mental illness. Partner support was seen to be positive but difficult to negotiate. Religion, strong relationship with child, forming friendships, education, and utilising childcare were identified as positive influences on the emotional wellbeing of women.

Conclusions

This study highlighted social and cultural factors contributing towards the emotional wellbeing of Afghan mothers. Findings confirm the need for innovative community-based models to support the mental health of Afghan women. This is particularly pertinent given the identified resistance towards discussing emotional wellbeing with healthcare professionals. Further research and investment is required in this area.

Relationships Among Rheological, Sensory Texture, and Swallowing Pressure Measurements of Hydrocolloid-Thickened Fluids

The objective of this study was to examine the relationships among three categories of measurements (rheological, sensory texture, and swallowing pressure) from fluids thickened to two different viscosities with 15 different hydrocolloids. Fluids at viscosities of 300 and 1500 cP (at 30 s(-1)) were targeted because these are the viscosities corresponding to the barium standards used in radiographic dysphagia diagnosis. Within the low viscosity (nectar) fluids (300 cP), the sensory properties thickness, stickiness, adhesiveness, mouth coating, and number of swallows were highly positively correlated with each other and highly positively correlated with the flow behavior index, n value (an indicator of shear-thinning behavior). Within the higher viscosity (thin honey) fluids (1500 cP), the sensory textures of adhesiveness, stickiness, mouth coating, and number of swallows correlated positively with rheological measures of n value. Swallowing pressures measured in the anterior oral cavity correlated negatively with the consistency coefficient k [shear stress/(shear rate) (n) ]. Samples that were more shear thinning (lower n values, higher k values) were generally perceived as less thick, with less adhesive properties (stickiness, adhesiveness, mouthcoating, and number of swallows). This information can be useful for selecting thickeners for people with dysphagia. A desirable thickener for many dysphagic patients would be one that allowed for a safe swallow by being viscous enough to reduce airway penetration, yet pleasant to drink, having the minimal perceived thickness and mouthcoating associated with greater shear thinning.

Screening of human bladder tumors and urine sediments for the presence of H-ras mutations

A series of 111 human bladder tumors were screened using oligonucleotide mutant specific probes, restriction enzyme analysis and single-stranded confirmation polymorphism (SSCP) for the presence of H-ras activation events. Thirty-three tumors were found to harbor H-ras mutations where a glycine to valine (G-->T) change in codon 12 was the most common point mutation recorded (26 tumors). Additional mutations involved glycine to cysteine at codon 13 (2 tumors) and glutamine to arginine/lysine/leucine at codon 61 (3/1/1 tumors, respectively). Ambiguous signals recorded with oligonucleotide probes were further analyzed using SSCP analysis revealing the presence of H-ras mutations in restricted regions of some tumors. The apparent sensitivity of SSCP enabled us to extend this study to DNA isolated from urine sediments where 4 of the 9 patients studied showed representation of mutant H-ras. Our study demonstrates a sensitive, non-invasive assay for the screening of urine-borne cells, with no requirement for prior knowledge of the mutational change at the H-ras locus.

Unenhanced multidetector CT (CT KUB) in the initial imaging of suspected acute renal colic: evaluating a new service

AIM

To evaluate a new imaging pathway for the investigation of patients presenting with suspected acute renal colic.

MATERIALS AND METHODS

A retrospective review of 500 consecutive cases of suspected acute renal colic was undertaken to evaluate the initial results of a new imaging pathway introduced at our institution, which completely replaced the intravenous urogram (IVU) with unenhanced multidetector CT (CT KUB).

RESULTS

The positive rate for urolithiasis was 44% (221/500), the negative rate 46% (229/500) and the rate of other significant findings was 12% (59/500). Female patients had a low positive rate compared with male patients (27.5 versus 57.5%; p<0.001). Urological intervention was required in 28% (61/221) and these patients had a larger average stone size (6.6 versus 3.7 mm; p<0.001) and the stone was located more proximally. Out-of-hours imaging was performed in 37% (186/500), and these patients had a higher positive rate (52 versus 40%; p<0.001). Other findings included a wide range of acute non-urological conditions.

CONCLUSION

The feasibility of replacing the acute IVU with CT KUB in the initial assessment of suspected acute renal colic was demonstrated in the present study. The technique enables rapid diagnosis of urolithiasis, stratification of patients likely to proceed to urological intervention, and prompt diagnosis of a variety of other acute pathological conditions.

Genes in drug abuse

Because of the genome projects it will be possible to identify the changes in gene expression that are associated with drug abuse. The ultimate goal will be to determine the role and significance of the gene products. To date about 100 genes have been found with altered expression after administration of drugs. The development of new technologies such as microarrays will greatly facilitate finding such changes in expression. The rate at which levels of some gene products change is compatible with the time course of development of dependence in animals, but we must be able to establish a cause-effect relationship between genes and drug abuse, which this will be difficult. The product of the novel cocaine and amphetamine regulated transcript (CART) gene is a useful example where a gene product has been associated with drug abuse. CART was identified as an mRNA that changed in response to psychostimulant drug administration and injection of CART peptides into the ventral tegmental area produces psychostimulant-like effects. Definitive evidence, if obtainable, that specific genes are responsible for vulnerability to drug abuse could have dramatic effects on public health policy.

Present Practice and Treatment Strategies in Endourological Stone Management

OBJECTIVES

The European Society of Urological Technology (ESUT) conducted a survey in order to assess and record the current trends between urologists with regard to the application of endourological stone management to identify trends and differences in treatment strategies among urologists.

METHODS

A total of 695 certified urologists and urological residents answered the ESUT Endourological Stone Management Questionnaire. There were 136 (28.7%) chief urologists, 240 (50.6%) staff urologists and 98 (20.7%) residents. The respondents were classified according to both the geographical origin (in four groups: Northern Europe (NE), Southern Europe (SE), Eastern Europe (EE) and Outside Europe (OE)), and department size (number of urological beds per department: small < or = 25, medium 26-50 beds, large > 50 beds) in order to identify any differences in the replies.

RESULTS

On average, 40.1 newly diagnosed patients and 73.6 revisits with urolithiasis are seen a month per department. According to the replies, there are no significant differences in total numbers of treatments in ESWL and/or endourological stone managements amongst the geographically based groups. Monthly, on average 68.5 ESWL treatments and 23.0 URS are performed per department. A significant majority of surveyed urologists performs URS with a rigid or semi-rigid instrument (79%) instead of a flexible instrument (21%, p = 0.003). URS is more frequently performed outside Europe (p = 0.02) with a more frequent use of dormia catheters (p < 0.001). On average, 20.9 double g-stents are placed monthly in each department, most commonly before or after endourological procedures (p < 0.001). Percutaneous procedures are performed by 69.6% of the respondents with a mean of 16.8 PNL procedures a month. PNL for stone management is mainly performed in Eastern Europe and non-European countries (p = 0.017). Nephrostomy tubes are used by 77.7% of the responding urologists. Monthly, 13.1 nephrostomy tubes are placed, mostly during PNL or after endourological procedures (40.7%).

CONCLUSION

The data obtained from the 695 urologists and residents provides information on the performed procedures and the use of material. In general, respondents from different geographical locations perform similar procedures and use identical material; however URS and PNL are performed more frequently outside of Europe, whereas laser lithotripsy is frequently used in Northern European counties.

Genomic imprinting of a placental lactogen gene in Peromyscus

The mammalian genome contains over 30 genes whose expression is dependent upon their parent-of-origin. Of these imprinted genes the majority are involved in regulating the rate of fetal growth. In this report we show that in the deer mouse Peromyscusthe placental lactogen-1-variant ( pPl1-v) gene is paternally expressed throughout fetal development, whereas the linked and closely related pPl1gene is expressed in a biallelic manner. Neither the more distantly related pPl2Agene, nor the Mus Pl1gene displays any preferential expression of the paternal allele, suggesting that the acquisition of imprinting of pPl1-v is a relatively recent event in evolution. Although pPl1 expression is temporally mis-regulated in the dysplastic placentae of hybrids between two Peromyscus species, its over-expression cannot account for the aberrant phenotypes of these placentae. We argue that the species-specific imprinting of pPl1-v, encoding a growth factor that regulates nutrient transfer from mothers to their offspring, is consistent with the parent-offspring conflict model that has been proposed to explain the evolution of genomic imprinting.

Sleep-disordered breathing and cognitive functioning in preschool children with and without Down syndrome

BACKGROUND

Sleep affects children's cognitive development, preparedness for school and future academic outcomes. People with Down syndrome (DS) are particularly at risk for sleep-disordered breathing (SDB). To our knowledge, the association between SDB and cognition in preschoolers with DS is unknown.

METHODS

We assessed sleep by using cardiorespiratory polygraphy in 22 typically developing (TD) preschoolers and 22 with DS. Cognition was assessed by using the Mullen Scales of Early Learning and behaviour by using the Strengths and Difficulties Questionnaire (SDQ). The MacArthur Communicative Development Inventory (MCDI) measured language level. We predicted that sleep problems would be associated with lower cognitive and behavioural functioning.

RESULTS

In TD children, longer sleep duration was associated with higher scores on MCDI expressive language and fewer emotional symptoms such as fear and unhappiness on the SDQ, whilst SDB was associated with increased conduct problems and less prosocial behaviour on the SDQ. Conversely, for children with DS, SDB was associated with increased language understanding and use of actions and gestures on the MCDI.

CONCLUSIONS

The findings in the TD group support our hypotheses. We recommend that sleep problems are screened for and treated as even mild SDB may prompt poorer cognition and behaviour. For children with DS, we expect that multiple factors in this complex syndrome mask or mediate the association between sleep and cognitive development and tighter controls are necessary to uncover effects of sleep. We propose longitudinal studies as a necessary tool to assess the precise impact of sleep on cognitive development in accounting for individual differences in DS.

Do calcium antagonists contribute to gastro-oesophageal reflux disease and concomitant noncardiac chest pain?

AIMS

A cohort retrospective observational study was undertaken to determine the relationship between calcium antagonist (CA) use and gastro-oesophageal reflux disease (GORD), as well the ability of CAs to precipitate or exacerbate noncardiac chest pain, an atypical symptom of GORD.

METHODS

Eligible patients were those prescribed CAs for hypertension without a history of ischaemic heart disease or nitrate use. Patients were recruited through 15 pharmacies (hospital 1, community 14). Patients giving informed consent were administered a standard questionnaire to obtain information including history of reflux symptoms before and during treatment with CAs, and the management of these symptoms.

RESULTS

Three hundred and seventy-one participants were enrolled. Their mean age was 64 years (SD +/- 12.7 years), 51.2% were females and 48.8% males. Of the 130 patients with pre-existing gastrointestinal (GI) symptoms, 59 (45.4%) reported a worsening of reflux symptoms during CA therapy. Increases in both frequency and severity of symptoms were most common amongst patients on amlodipine (61.3%; P <or= 0.0001) and least common amongst those taking diltiazem (12.5%). Reflux-related symptoms developed in 85 (35.3%) of the 241 previously asymptomatic patients during CA therapy, with verapamil having the greatest number of reports (39.1%; P = 0.001) and diltiazem the least (30.7%).

CONCLUSIONS

Diltiazem appears the least likely of the CAs to precipitate or exacerbate reflux symptoms. Further research using a prospective design could test whether it may be more appropriate to use diltiazem in patients with ischaemic heart disease and could assess the appropriateness of CA therapy in patients with moderate to severe GORD. Increasing prescriber and pharmacist awareness of these adverse effects may result in better patient outcomes and potentially reduce treatment costs.

BASHH UK guideline for the management of epididymo-orchitis, 2010

The BASHH UK guideline for the management of epididymo-orchitis has been updated in 2010. Consideration should be made of the changing potential aetiologies of epididymo-orchitis - mumps in non-immune individuals and tuberculosis in the immunocompromised and men from countries of high prevalence. The treatment of sexually acquired epididymo-orchitis has changed given the high levels of quinolone-resistant gonorrhoea such that ceftriaxone and doxycycline are recommended in those at high risk of gonorrhoea and doxycycline or ofloxacin in those patients where gonorrhoea is considered unlikely (negative microscopy for Gram-negative intracellular diplococci and no risk factors for gonorrhoea identified). A clinical care pathway has also been produced to simplify the management of epididymo-orchitis.

Rural pharmacy not delivering on its health promotion potential

OBJECTIVE

To investigate the level and perceived quality of health promotion advice received from rural pharmacists.

DESIGN

Self-administered written survey on access to and quality of pharmacy services in rural Western Australia completed by rural residents.

SETTING

Rural pharmacy.

PARTICIPANTS

Four hundred and eighty-three respondents who regularly used a pharmacy.

OUTCOME MEASURES

Items in the survey included frequency of receiving prevention advice and satisfaction ratings on health and pharmacy services.

RESULTS

Eighty-eight per cent of respondents had never discussed exercise or diet with their pharmacist and 65% had never discussed preventing health problems. Receiving good prevention advice predicted satisfaction with health services in general but not satisfaction with pharmacy services.

CONCLUSION

Pharmacies are being underutilised with respect to their capacity to deliver heath prevention advice and ways to capitalise on this potential need to be investigated.

Reducing the environmental impact of dietary choice: perspectives from a behavioural and social change approach

Climate change is recognised as a significant public health issue that will impact on food security. One of the major contributors to global warming is the livestock industry, and, relative to plant-based agriculture, meat production has a much higher environmental impact in relation to freshwater use, amount of land required, and waste products generated. Promoting increased consumption of plant-based foods is a recommended strategy to reduce human impact on the environment and is also now recognised as a potential strategy to reduce the high rates of some chronic diseases such as cardiovascular disease and certain cancers. Currently there is a scant evidence base for policies and programs aiming to increase consumption of plant-based diets and little research on the necessary conditions for that change to occur and the processes involved in such a change. This paper reviews some of the environmental and health consequences of current dietary practices, reviews literature on the determinants of consuming a plant-based diet, and provides recommendations for further research in this area.

Present practice and development of minimally invasive techniques, imaging and training in European urology: results of a survey of the European Society of Uro-Technology (ESUT)

OBJECTIVES

The European Society of Urological Technology (ESUT) conducted a survey in order to assess and record the current trend between European urologists with regard to the application of new technologies in BPH, stone disease and imaging and to identify differences amongst urologists.

MATERIAL AND METHODS

A total of 854 certified urologists and residents coming from European countries answered the ESUT survey during the XVIth Annual EAU Meeting in Geneva in 2001. The respondents were classified according to the geographical origin (Eastern, Southern and Northern Europe), year of certification (before 1980, and every 5 years hereafter) and power of the department in beds (less than 25, 26-50, and more than 50) in order to identify any differences in the replies mainly due to economical reasons, national or hospital policy and personal attitudes.

RESULTS

According to the replies, in Eastern Europe more procedures related to BPH and stones are performed comparing to Northern and Southern Europe (165.8 versus 77.1 and 100.6/month/department, respectively). However, the Northern European urologists have access to every type of lithotriptor and most of the different minimally invasive treatments for BPH in a higher percentage, followed by the Southern and the Eastern European urologists. The most widespread intracorporeal lithotriptor is the pneumatic and the most common alternative minimally invasive BPH treatment is electrovaporization (80.7% and 45.6%, respectively). Holmium laser is the most frequent choice (40.1%) when the surveyed urologists were asked to choose which of the minimally invasive techniques would like to have access to. In total 79.4% (54.1% alone and 25.3% in collaboration with the radiologists) of the respondents perform the ultrasound studies while the remaining 20.6% declare that only the radiologists do the studies. Of the surveyed urologists, 92.8%, 89.6% and 94.9% are interested in hands-on courses, simulators and live surgery, respectively.

CONCLUSIONS

The data obtained from the 854 surveyed European urologists and residents can be used as a tool to highlight the disparity between European countries and to advance training of European urologists.

Photoelastic comparison of stress induced by using stainless-steel versus nickel-titanium spreaders in vitro

The vertical force applied to an endodontic spreader generates stress along the canal walls. Recognizing the potential for this stress may reduce the incidence of vertical root fractures. A photoelastic acrylic model was fabricated to exhibit the stress produced during obturation of curved canals using the lateral condensation technique. Twenty standardized models simulating curved canals (32 degrees) were formed within PL-2 photoelastic acrylic resin blocks. The canals were fitted with a gutta-percha point, and either a stainless-steel or nickel-titanium finger spreader was inserted. An Instron 4502 universal testing machine applied a vertical force of 20 Newtons to the spreader. Quarter wave and polarizing filters were used with backlighting to generate the fringe patterns in the models. Photographs of the resulting stress lines showed that the stainless-steel spreaders created three areas of concentrated stress. The nickel-titanium spreaders induced stress patterns spread out along the surface of the canals, thus reducing the concentration of stress and the potential for vertical root fracture.