Microvasculature of the rabbit urinary bladder

Background: The urinary bladder requires a rich blood supply to maintain its functions, the storage and release of urine. Specialized properties of the bladder vasculature might be anticipated to ensure the integrity of this blood supply, because it is known that blood flow is reduced by distension during bladder filling. However, the bladder vasculature has been described in detail only at the gross level. A comprehensive, threedimensional view of the blood supply to the bladder wall is presented here. Methods: The microvasculature of the bladder of male New Zealand white rabbits was described using the combination of vascular corrosion casting, alkali digestion, light microscopy, and scanning and transmission electron microscopy. Following administration of an anticoagulant and an overdose of anesthetic, the abdominal aorta was cannulated just above the inferior mesenteric artery to permit flushing of the distal vasculature. The bladder vasculature was cleared of blood with buffered saline and then either perfuse-fixed with buffered 2% glutaraldehyde and sectioned, or filled with “Mercox” resin to prepare vascular corrosion casts. Casts were cleaned with NaOH, formic acid, and water. In some cases fixed bladders were partially digested with NaOH to expose the mucosal capillary plexus. Results: The bladder is supplied with blood by single, left and right vesicular branches of the internal or external iliac arteries. The serpentine vesicular arteries extend along the lateral borders of the bladder from base to apex just deep to the serosal surface and send dorsal and ventral branches to supply the dorsal and ventral bladder walls. Veins accompany the arteries and exhibit numerous valves. A very dense complex of vessels at the apex of the bladder apparently serves to accommodate bladder distension. The muscularis and submucosa contains few vessels, but the mucosa is well vascularized. An especially dense capillary plexus is present in the lamina propria at its junction with the transitional epithelium. In the relaxed bladder these capillaries lie in grooves formed by the basal layers of the epithelium. The endothelial cells of these capillaries display few cytoplasmic vesicles and are continuous or fenestrated. These capillaries are often invested with pericytes. The mucosal capillary plexus may be associated with an epithelial transport function or may be necessary for urothelial metabolism or maintenance of the barrier function of the urothelium. Unusual capillary tufts, possibly associated with vascular lymphatic tissue, are found associated with the main vessels on the lateral walls in the basal half of the bladder. Conclusions: These methods present a clear, comprehensive, three-dimensional view of the microvasculature of the bladder wall. They also identify several unique features of this vasculature and provide a basis for studies of the response of this vasculature to pathologic states and experimental manipulation. © 1995 Wiley-Liss, Inc.     

A European perspective on nosocomial urinary tract infections I. Report on the microbiology workload, etiology and antimicrobial susceptibility (ESGNI−003 study)

Objectives   To obtain information on the microbiology workload, etiology and antimicrobial susceptibility of urinary tract infection (UTI) pathogens isolated in European hospitals.
Materials and methods   We collected data available in the microbiology units of a large sample of European hospitals regarding the laboratory workload, diagnostic criteria, and etiology and antimicrobial resistance of the urinary isolates collected on one day (the study day).
Results   Data were received from a total of 228 hospitals from 29 European countries. The average rate of urine samples cultured per 1000 admissions in 1999 was 324. The criteria to consider a positive urine culture as significant were quite variable; ≥10⁴ colony-forming units (CFU)/mL for bacteria or ≥10³ CFU/mL in the case of yeasts were the most used cut-off points. On the study day, a total of 607 micro-organisms from 522 patients with nosocomial UTI were isolated. The six most commonly isolated micro-organisms were, in decreasing order: Escherichia coli (35.6%), Enterococci (15.8%), Candida (9.4%), Klebsiella (8.3%), Proteus (7.9%) and Pseudomonas aeruginosa (6.9%). Pseudomonas was isolated more frequently in non-EU countries. The study data reveal high rates of antimicrobial resistance in UTI pathogens, especially in non-EU countries, where Pseudomonas aeruginosa presented rates of aminoglycoside resistance as high as 72% to gentamicin, 69.2% to tobramycin and 40% to amikacin.
Conclusions   Nosocomial UTI accounts for an important proportion of the workload in microbiology laboratories. A consensus on the practice and interpretation of urine cultures in Europe is needed. The levels and patterns of resistance of UTI pathogens must be a serious cause for concern and a clear reason for stricter guidelines and regulations in antimicrobial policy.     

大鼠膀胱粘膜抗菌蛋白的分离

以１％乙酸冲洗雌性Ｗｉｓｔａｒ大鼠膀胱粘膜获得膀胱粘膜酸溶性提取物，ＡＵ－ＰＡＧＥ分析表明，膀胱粘膜提取物含１０余条主蛋白带，但不含已知的杀菌物质溶菌酶和防御素样分子。利用琼脂糖弥散法和电泳凝胶琼脂糖弥散法杀菌试验发现，膀胱粘膜提取物有两条主蛋白带对致病性大肠杆茵ＭＬ－３５Ｐ耐药株有强杀菌活性，这两条杀菌蛋白带命名为ＲａｔＢＰ－１和ＲａｔＢＰ－２，分别占膀胱粘膜提取物蛋白质总量的５％和２％。本实验的结果首次提示，大鼠膀胱粘膜内存在的抗菌蛋白，可能是膀胱粘膜杀菌的分子基础。     

Effect of intermittent (traffic) noise on man — Temporary threshold shift,and change in urinary 17-OHCS and saliva cortisol levels

Summary Eight healthy male college students were selected and eight noise exposure conditions were planned. The noise exposure time of all the experiments was 14 h. Measurement of the TTS growth at 4 kHz was investigated during these 14 h. Saliva collected every 3 h was also examined for cortisol throughout the 24-h period. The exposure noises used in this experiment were pink noise and pure tone of 3 kHz. The time patterns of trapezoidal noise were as follows. The rise and decay times were 1 s respectively and the peak level was 1 s for the (A I type), being 500 ms and 1.5 s respectively for the (A II type).Three measurement were made:TTSUnder intermittent noise exposure at 80 dB(A), exposure of 20% of the on fraction induced significant TTS growth, but exposure of 13% of the on fraction did not induce TTS growth. Under exposure at 75 dB(A), exposure of 66% of the on fraction did not induce TTS growth. Under pure tone exposure of 3 kHz at 75 dB(A), exposures of 20% and 30% of the on fraction did not induce TTS growth. There was a significant difference between the TTS induced by a steady state of 73 dB (A) (Leq of Exp. 2) and that of Exp. 2.Urinary 17-OHCS LevelDuring the noise exposure period (14 h), there was a statistically significant difference between the urinary 17-OHCS level of the control condition and that of Exp. 3. In addition, there was no statistically significant difference among the urinary 17-OHCS levels of post-noise exposure.Saliva CortisolWith intermittent pink noise of 75 or 80 dB(A) (Exp. 2, 3, and 4), however, temporary elevation of the saliva cortisol level occurred only at the initial stage of exposure, and lasted for only one hour. Moreover, with steady state noise exposure, evanescent elevation occurred at the lower level of 71 dB(A).Supported by the Environment Agency of Japan     

Basic anatomical investigation of semitendinosus and the long head of biceps femoris muscle for their possible use in electrically stimulated neosphincter formation

Summary Anal neosphincter formation with electrically stimulated gracilis muscle is used increasingly for the surgical treatment of fecal incontinence. An alternative to gracilis might be of interest if this muscle is not available. 30 semitendinosus muscles and 15 long heads of biceps femoris were investigated on human cadavers. In particular, the nerve and vascular supply of these muscles was studied, both representing basic factors for muscle transposition. The long head of biceps femoris m. was found to receive its dominant vascular supply from the first and second perforating artery and its nerve supply from one motor branch out of the sciatic nerve, both as described in literature. The examination of semitendinosus m., however, revealed new anatomical aspects in its vascular supply. In all cases semitendinosus m. was found to receive dominant vascular pedicles from the medial circumflex femoral artery close to the ischial tuberosity and the second perforating artery. The nerve supply consisted of two motor branches out of the sciatic nerve. Both muscles fulfilled several basic criterias for transposition to the anus. However, regarding these requirements, semitendinosus offered distinct advantages in comparison with the long head of biceps femoris. Due to its vascular and nerve topography, semitendinosus seems suitable to serve as an alternative to gracilis.

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Bases anatomiques de l'utilisation du muscle semitendineux et du chef long du biceps fémoral comme néosphincter anal électro-stimulé

Résumé La graciloplastie électro-stimulée est utilisée de plus en plus fréquemment dans le traitement chirurgical de l'incontinence anale. L'utilisation d'un autre muscle peut être intéressante si le muscle gracile n'est pas utilisable. 30 muscles semitendineux et 15 longs chefs du biceps fémoral ont été étudiés sur des cadavres humains. Ce travail a porté particulièrement sur l'innervation et la vascularisation de ces muscles, dont dépendent les possibilités de transposition. Le long chef du m. biceps fémoral recevait sa vascularisation principale de la première et de la deuxième artère perforante et son innervation d'une branche motrice venant du nerf sciatique, tel que cela est décrit dans la littérature. L'étude du m. semitendineux a montré de nouveaux aspects anatomiques dans sa vascularisation. Dans tous les cas ce muscle recevait sa vascularisation principale de l'artère circonflexe médiale près de la tubérosité ischiatique et de la deuxième a. perforante. Son innervation venait de deux branches motrices du nerf sciatique. Ces deux muscles répondaient aux critères nécessaires pour leur transposition comme néo sphincter. Cependant, compte-tenu de sa vascularisation et de son innervation, le m. semitendineux répond mieux aux impératifs anatomiques que le long chef du biceps et représente une alternative au muscle gracile pour la création d'un néo sphincter anal.

     

儿童泌尿道感染合并惊厥的炎性指标及病原菌研究

背景　儿童泌尿道感染是常见的感染性疾病,多由大肠埃希菌感染所致,部分泌尿道感染患儿在疾病发展过程中会出现惊厥发作,从而加重病情、延长治疗时间。然而截至目前,关于儿童泌尿道感染发生惊厥的炎性指标情况、泌尿道感染合并惊厥患儿的病原菌与非惊厥者有无区别尚无报道。目的　分析泌尿道感染患儿合并惊厥的炎性指标、常见病原菌及药物耐药性,为临床治疗提供参考。方法　选取2010-2019年无锡市儿童医院收治的81例泌尿道感染合并惊厥患儿（惊厥组）,同时选取100例泌尿道感染不伴惊厥患儿（非惊厥组）。收集研究对象的性别、年龄、实验室检查结果〔C反应蛋白（CRP）水平、白细胞计数（WBC）、降钙素原（PCT）〕、尿培养+药敏试验结果。结果　惊厥组PCT水平高于非惊厥组（P<0.05）。惊厥组尿培养出病原菌40株（49.4%）,其中革兰阴性菌19株（47.5%）,革兰阳性菌21株（52.5%）,真菌0株。非惊厥组尿培养出病原菌27株（27.0%）,其中革兰阴性菌23株（85.2%）,革兰阳性菌4株（14.8%）,真菌0株。两组间均以大肠埃希菌最多见。两组间病原菌（大肠埃希菌、非大肠埃希菌）比较,差异有统计学意义（P<0.05）。大肠埃希菌对氨苄西林、头孢唑林、头孢曲松耐药率均较高（93.3%、86.7%、73.3%）,对亚胺培南、头孢替坦、厄他培南耐药率均较低（0、0、0）。屎肠球菌对氨苄西林、克林霉素、红霉素、青霉素G 耐药率均在80.0%以上（92.3%、100.0%、84.6%、92.3%）,对万古霉素、利奈唑胺及呋喃妥因耐药率低（0、0、23.1%）。结论　泌尿系感染患儿,临床上要重视炎性指标（PCT）的检测,及时有效地评估感染程度,指导临床治疗、尽快控制感染,减少惊厥发作。同时应特别重视泌尿道感染合并惊厥患儿的中段尿培养检查,注意病原菌耐药性,尽早合理选择有效抗菌药物,及时控制病情进展。     

感觉输入训练在产后压力性尿失禁患者中的作用研究

目的探讨感觉输入训练在产后压力性尿失禁患者中的临床疗效。方法选取2018年1月至2019年5月本院收治的产后压力性尿失禁患者40例作为研究对象,随机分为两组,每组20例。对照组予以经阴道生物电刺激治疗及家庭Kegel训练,观察组在对照组基础上进行15 min的感觉输入训练。比较两组盆底肌肉表面肌电值和治疗前后尿失禁生活质量问卷评分。结果治疗前,两组盆底肌肉表面肌电值比较差异无统计学意义;治疗后,两组快速收缩阶段肌电值比较差异有统计学意义(P<0.05),前静息、紧张性收缩阶段、耐力收缩阶段及后静息比较差异无统计学意义;治疗前后,观察组快速收缩阶段、紧张性收缩阶段、耐力收缩阶段值比较差异有统计学意义(P<0.05);治疗前后,对照组快速收缩阶段、紧张性收缩阶段、耐力收缩阶段值比较差异有统计学意义(P<0.05)。结论感觉输入训练配合经阴道生物电刺激治疗能提高产后压力性尿失禁患者的快速收缩阶段的盆底肌肌电值,即提高Ⅱ类肌纤维的肌力,值得临床推广应用。     

不同分娩方式对产后早期盆底功能的影响分析

目的分析不同分娩方式对产后早期盆底功能的影响。方法选取2017年6月至2018年9月本院收治的产妇116例为研究对象,根据分娩方式不同分为两组,各58例。阴道分娩作为对照组,剖宫产作为观察组。比较两种不同分娩方式下对产妇早期盆底功能影响和恢复干预后效果。结果观察组产妇盆底肌恢复良好率高于对照组,差异有统计学意义(P<0.05);两组患者尿失禁、大便失禁和子宫脱垂发生率比较差异无统计学意义;观察组患者前壁脱垂、后壁脱垂状况明显低于对照组,差异有统计学意义(P<0.05);两组产妇性生活困难及失禁等发生率差异无统计学意义。结论无论何种方式分娩均会引发盆底功能降低,剖宫产对盆底功能影响更小,因此,需重视阴道分娩产妇盆底功能锻炼。     

Snodgrass术与Duckett术在治疗尿道下裂的Meta分析

目的通过Meta分析比较Snodgrass术与Duckett术后的感染及输尿管狭窄发生率。方法通过计算机检索Pubmed、Embase、Cochrane、中国知网(CKNI)及万方数据库,检索截止日期为2020年3月1日,按照纳入及排除标准整理相关文献,使用RevMan 5.3对纳入的文献数据进行分析。结果共纳入7个研究共624例患者,Meta分析显示,S组术后尿漏[OR=0.49,95%CI(0.28,0.86),P=0.01]、尿道狭窄[OR=0.26,95%CI(0.16,0.78),P=0.009]的发生率明显低于T组。结论Snodgrass术后尿漏及尿道狭窄的发生率均低于Duckett术。