Fulfilment of patient goals after tension-free vaginal tape operation for stress urinary incontinence

Introduction and hypothesis

The aim of this study was to investigate patient-reported goals after a tension-free vaginal tape operation for stress urinary incontinence and the correlation with postoperative incontinence.

Methods

A prospective study involving 70 women was carried out. Preoperatively, patients completed the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF) and stated three goals for the operation. A telephone interview was performed 3 months postoperatively.

Results

A Visual Analogue Scale (VAS) score from zero to ten estimated the extent to which goals were achieved. Goals were divided into five groups: 1, symptoms; 2, quality of life (physical); 3, quality of life (emotional); 4, sexual function; 5, avoidance. ICIQ-UI SF preoperative mean was 14.9 and postoperative mean was 1.5 (p?<?0.05). A total of 210 goals were stated. The majority of the goals (38 %) were in group 2 concerning quality of life in the physical domains. Mean VAS score for all goals was 9.1 (SD 2). Thirty-seven patients (53 %) fulfilled all their goals. Twenty-one patients (30 %) did not have a VAS score of 10, although continent with an ICIQ-UI SF score of zero. Reasons for not achieving a full VAS score were that some still used pads out of fear (n?=?10), that their mental focus was still on incontinence (n?=?7) or that they had not yet tried some of the physical aims (n?=?7).

Conclusions

Most patients achieved their goals. The majority of the goals concerned quality of life in the physical domains.

     

Genetic variants and blood pressure in a population-based cohort: the Cardiovascular Risk in Young Finns study

Clinical relevance of a genetic predisposition to elevated blood pressure was quantified during the transition from childhood to adulthood in a population-based Finnish cohort (N=2357). Blood pressure was measured at baseline in 1980 (age 3-18 years) and in follow-ups in 1983, 1986, 2001, and 2007. Thirteen single nucleotide polymorphisms associated with blood pressure were genotyped, and 3 genetic risk scores associated with systolic and diastolic blood pressures and their combination were derived for all of the participants. Effects of the genetic risk score were 0.47 mm Hg for systolic and 0.53 mm Hg for diastolic blood pressures (both P<0.01). The combination genetic risk score was associated with diastolic blood pressure from age 9 years onward (β=0.68 mm Hg; P=0.015). Replications in 1194 participants of the Bogalusa Heart Study showed essentially similar results. The participants in the highest quintile of the combination genetic risk score had a 1.82-fold risk of hypertension in adulthood (P<0.0001) compared with the lowest quintile, independent of a family history of premature hypertension. These findings show that genetic variants are associated with preclinical blood pressure traits in childhood; individuals with several susceptibility alleles have, on average, a 0.5-mm Hg higher blood pressure, and this trajectory continues from childhood to adulthood.     

Analysis of Cdh22 expression and function in the developing mouse brain

Classical cadherins are important cell adhesion molecules specifying and separating brain nuclei and developmental compartments. Cadherin‐22 (Cdh22) belongs to type II subfamily of classical cadherins, and is expressed at the midbrain‐hindbrain boundary during early embryogenesis. In Fgfr1 mutant mouse embryos, which have a disturbed midbrain‐hindbrain border, Cdh22 is down‐regulated. Here, we studied expression of Cdh22 in developing mouse brain in more detail and compared it to expression of related family members. This revealed both complementary and overlapping patterns of Cdh22, Cdh11, Cdh8, and Cdh6 expression in distinct regions of the forebrain and midbrain. We used a mutated allele of Cdh22 to study its function in brain development. Loss of Cdh22 caused reduced postnatal viability. Despite strong Cdh22 expression in the developing brain, we did not observe defects in compartmentalization or abnormalities in the midbrain and forebrain nuclei in Cdh22 mutants. This may be explained by functional redundancy between type II cadherins. Developmental Dynamics 240:1989–2001, 2011. © 2011 Wiley‐Liss, Inc.     

Germ cell tumors in children and adolescents in Finland: trends over 1969–2008

Purpose

Malignant germ cell tumors (GCTs) are a heterogeneous group of neoplasms putatively originating from the primordial germ cell. In adults, an increasing incidence of GCTs, particularly testicular tumors, has been reported in recent decades. However, population-based evidence in children and adolescents remains limited. We investigated the incidence of malignant GCTs diagnosed in childhood or adolescence, using population-based nationwide data from Finland.

Methods

We obtained information from the Finnish Cancer Registry on all malignant GCTs registered in 1969–2008 in children or adolescents aged 0–19 years. Data on tumor location, histology, stage, and survival were collected. Age-standardized incidence and survival rates were calculated.

Results

A total of 334 cases of malignant GCT were identified. Their proportion among all malignant tumors among 0- to 19-year-olds increased from 3 to 9.7 % in boys with time, but remained stable in girls (3 %). The overall incidence rate was 0.6 per 100,000 (0.8 in boys and 0.4 in girls), and differed significantly between the age groups. A significant increase in the incidence of testicular GCTs was seen in boys in the age group of 15–19 years.

Conclusions

Although malignant GCTs are rare, their relative frequency in children and adolescents has increased during recent decades, the change being mainly due to an increasing frequency of the testicular tumors among teenagers. The causes of the increase remain unknown, but environmental exposures are likely to be involved.     

Activating killer-cell immunoglobulin-like receptors (KIR) and their cognate HLA ligands are significantly increased in autism

Killer-cell immunoglobulin-like receptor (KIR) proteins are expressed on natural killer (NK) cells and appear important in innate and adaptive immunity. There are about 14 KIR genes on chromosome 19q13.4, composed of those that inhibit and those that activate NK cell killing. Haplotypes have different combinations of these genes meaning that not all genes are present in a subject. There are two main classes of cognate human leukocyte antigen (HLA) ligands (HLA-Bw4 and HLA-C1/C2) that bind to the inhibitory/activating receptors. As a general rule, the inhibitory state is maintained except when virally infected or tumor cells are encountered; however, both increased activation and inhibition states have been associated with susceptibility and protection against numerous disease states including cancer, arthritis, and psoriasis. Utilizing DNA from 158 Caucasian subjects with autism and 176 KIR control subjects we show for the first time a highly significant increase in four activating KIR genes (2DS5, 3DS1, 2DS1 and 2DS4) as measured by chi square values and odds ratios. In addition, our data suggests a highly significant increase in the activating KIR gene 2DS1 and its cognate HLA-C2 ligand (2DS1+C2; p=0.00003 [Odds ratio=2.87]). This information ties together two major immune gene complexes, the human leukocyte complex and the leukocyte receptor complex, and may partially explain immune abnormalities observed in many subjects with autism.