Lower Urinary Tract Symptoms and Video‐Urodynamic Characteristics of Women with Clinically Unsuspected Bladder Outlet Obstruction

Objective: To analyze the lower urinary tract symptoms (LUTS) and video‐urodynamic characteristics of women with clinically unsuspected bladder outlet obstruction (BOO). Methods: From 1997 to 2010, a total of 1605 women with bothersome LUTS received video‐urodynamic study in our unit. We reviewed the charts of 212 women diagnosed with BOO based on video‐urodynamic criteria and 264 women without abnormal findings. LUTS and urodynamic parameters were compared between obstructed and unobstructed cases and among the BOO subgroups. Results: The mean ages of the BOO (58.2 years) and control groups (58.8 years) were similar. The mean values of detrusor pressure at maximum urinary flow rate (P_detQ_max)/maximum flow rate (Q_max) of the BOO and control groups were 51.83 cm H₂O/10.22 mL/s versus 18.81 cm H₂O/20.52 mL/s. In the BOO group, cinefluoroscopy revealed dysfunctional voiding in 168 patients (79.2%), urethral stricture in 17 (8.0%), and bladder neck dysfunction in 27 (12.7%). Patients with dysfunctional voiding had significantly lower urethral resistance compared with the other two BOO subgroups. Combined lower urinary tract symptoms were present most often in all BOO patients (69.3%), followed by isolated storage symptoms (30.2%) and isolated voiding symptoms (0.5%). Seventy‐seven patients (37.3%) had dysuria and 79 patients (36.3%) had frequency as their main symptom. Conclusion: Women with BOO usually have nonspecific LUTS. Dysfunctional voiding was the most common form among women with clinically unsuspected BOO, but the degree of obstruction was less severe than with primary bladder neck obstruction and urethral stricture.     

Efficacy of Propiverine in Improving Symptoms and Quality of Life in Female Patients with Wet Overactive Bladder

Objectives: The present prospective study was conducted to assess the effects of propiverine hydrochloride in improving symptoms and quality of life (QoL) in female patients with wet OAB. Methods: Propiverine was administered orally for 8 weeks to 58 female patients who had urgency incontinence. Prior to administration, and at 4 and 8 weeks after administration, symptoms and QoL of the patients were assessed using a micturition diary, the International Consultation on Incontinence Questionnaire‐Short Form (ICIQ‐SF), and the King's Health Questionnaire (KHQ). In addition, the relationships between changes in frequency of urinary incontinence or amount of urine leakage following treatment and changes in each domain of the KHQ were investigated by multiple regression analysis. Results: After administration of propiverine, the mean numbers of daily micturitions, incontinence episodes, and urgency episodes assessed on the basis of the micturition diary significantly improved in comparison to the baseline: from 11.7 to 9.6 for daily micturitions, from 2.8 to 1.1 for incontinence episodes, and from 5.9 to 2.3 for urgency episodes in 8 weeks. The mean of the ICIQ‐SF total scores significantly decreased, from 8.4 to 4.6 points at 4 weeks and to 3.6 points at 8 weeks. The mean scores for three individual items in the ICIQ‐SF, namely, frequency of incontinence episodes, amount of leakage, and impact on everyday life also significantly improved. The KHQ scores significantly improved at both 4 and 8 weeks post‐administration in all domains except personal relationships. In the multiple regression analysis, improvement in frequency of incontinence was significantly related to the domain of severity measure of the KHQ, while improvement in amount of leakage was significantly related to the domains of general health perception and social limitations. Conclusion: Propiverine hydrochloride contributed to improvements not only in symptoms but also in QoL in female patients with wet OAB.     

Efficacy,Safety and Tolerability of Fesoterodine in Asian Patients with Overactive Bladder

Objectives: To assess the efficacy, safety, and tolerability of fesoterodine 4 and 8 mg once daily (QD) compared with placebo in Asian subjects with overactive bladder (OAB) after 12 weeks of treatment. Methods: This phase II, dose‐finding study consisted of a 2‐week placebo run‐in period followed by a 12‐week, randomized, double‐blind, placebo‐controlled, treatment period. Eligible subjects were aged ≥20 years with ≥8 micturitions per 24 h and ≥1 urgency urinary incontinence (UUI) episodes per 24 h reported in a 3‐day diary. The subjects were randomized to receive placebo, fesoterodine 4 mg, or fesoterodine 8 mg QD for 12 weeks. Results: Of 1232 subjects who entered the placebo run‐in period, 951 received double‐blind treatment. The mean number of UUI episodes per 24 h at baseline was 2.2 among the three treatment groups. The two fesoterodine groups showed statistically significant decreases from baseline in the mean number of UUI episodes per 24 h at week 12 (primary endpoint) compared with placebo. Most all‐causality adverse events (e.g. dry mouth and constipation) were mild or moderate. The percentage of subjects with severe adverse events was low and similar among the treatment groups (placebo, 1.3%; fesoterodine 4 mg, 1.9%; fesoterodine 8 mg, 1.0%). Conclusion: Fesoterodine 4 and 8 mg QD were significantly better than placebo in improving OAB symptoms. Overall, the two fesoterodine dosing regimens were well tolerated. These results suggest that fesoterodine 4 and 8 mg QD are effective and well‐tolerated treatments for OAB in Asian subjects.     

Respiratory Viral Detection and Small Airway Inflammation in Lung Tissue of Patients with Stable,Mild COPD

Background: Viral respiratory tract infections are implicated in the pathogenesis of chronic obstructive pulmonary disease (COPD). In lung tissue specimens from patients with stable, mild COPD and from control smokers without airflow obstruction, we determined the prevalence and load of nucleic acid from common respiratory viruses and concomitant inflammation of small airways measuring less than 2-mm in diameter. Methods: Frozen lung tissue obtained from patients with stable, mild COPD (n = 20) and control subjects (n = 20) underwent real-time quantitative PCR (qPCR) for 13 respiratory viruses, and quantitative histology for inflammation of small airways. The two groups were compared for viral prevalence and load, and airway inflammation. The relationship between viral load and airway inflammatory cells was also analyzed. Results: Viral nucleic acid were detected in lung tissue of 18/40 (45.0%) of the individuals studied and included seven co-infections that were characterized by a “dominant virus” contributing to most of the total measured viral load. Lung tissue of COPD patients had a significantly higher prevalence of viral nucleic acid (particularly influenza A virus), and increased inflammation of small airways by macrophages and neutrophils versus controls. In qPCR-positive individuals, linear regression analysis showed a direct correlation between viral load and airway neutrophils, and between influenza A virus load and airway macrophages. Conclusion: The lung tissue of patients with stable, mild COPD has a higher prevalence and load of respiratory viruses versus non-obstructed control subjects, and increased inflammation of small airways. Respiratory viruses may represent potential targets in COPD patient management.     

老年原发性高血压微量白蛋白尿与血管内皮功能及颈总动脉粥样硬化

目的探讨老年原发性高血压(EH)患者微量白蛋白尿(MAU)与内皮依赖性舒张功能(EDF)及颈总动脉粥样硬化的关系。方法筛选老年高血压患者64例,根据24h尿白蛋白排泄率分成正常白蛋白尿组(NAU组)和微量白蛋白尿组(MAU组)。另设30例非EH老年人为对照组(NC组)。采用免疫比浊法测定24h尿白蛋白含量;采用彩色多普勒超声检测肱动脉内皮依赖性舒张功能,颈总动脉内中膜厚度(I MT)及其粥样斑块指数(PI)。结果(1)与对照组(9·1%±1·8%)比较,老年高血压患者NAU组已有内皮依赖性舒张功能降低(6·3%±1·1%,P<0·05),而MAU组内皮依赖性舒张功能则进一步降低(5·0%±1·4%,P<0·05)。(2)MAU组颈总动脉I MT较NAU组增高,且两组均较对照组增高[(1·0±0·2,0·9±0·1vs0·8±0·1)mm,P值均<0·05]。(3)MAU组的微量白蛋白尿与内皮依赖性舒张功能呈负相关(r=-0·597,P<0·001);微量白蛋白尿与颈总动脉I MT呈正相关(r=0·700,P<0·001)。结论老年EH患者均存在内皮依赖性血管舒张功能受损和颈总动脉粥样硬化,内皮依赖性舒张功能和I MT与微量白蛋白尿的发生密切相关。     

Overactive Bladder in Female Patients with Chronic Diseases Visiting Primary Care Doctors: Effect of Age on Prevalence and Bothersomeness

Objectives: We evaluated the effects of age on the prevalence and bothersomeness of overactive bladder (OAB) in female patients with chronic diseases visiting primary care doctors. Methods: We used the pooled data of the SURPRISE survey in which 121 doctors and 1388 female patients aged 40 years or older responded to questionnaires. Results: The OAB prevalence rate in patients was estimated by doctors to be 9.5%. However, the OAB prevalence rate according to patients, as defined by the OAB symptom score, was 22.3%. The rate was increased with age. The number of patients with OAB was much higher than estimated by doctors. Approximately 25% of patients were dissatisfied with their present urinary condition. The rate was increased with age. Dissatisfaction with present urinary condition was strongly correlated with severe urgency score in all age groups. In elderly patients, contribution of urgency incontinence and nocturia to dissatisfaction was also increased. Thirteen percent of patients were receiving treatment for their OAB. However, 15.8% were untreated, regardless of having OAB, suggesting that treated patients comprise less than half of all OAB patients. This tendency was observed in all age groups. In the correlation between satisfaction with pharmacological treatment and each OAB symptom, contribution of urgency to satisfaction with pharmacological treatment was the highest. Conclusion: Urgency is the most bothersome symptom and shows the highest contribution to treatment satisfaction. In elderly patients, urgency incontinence and nocturia are proportionally greater problems. Management of urgency is essential for improving quality of life and satisfaction with treatment in OAB patients.     

自发性高血压大鼠心肌细胞蛋白激酶C活性的变化及其与心肌细胞凋亡的关系

目的 :研究自发性高血压大鼠 (SHR)心肌细胞蛋白激酶 C(PKC)活性的动态变化及其与心肌细胞调亡的关系。　　方法 :将 17只 SHR分为 3组 :1月龄 SHR组 (n=6 )、10月龄 SHR组 (n=6 )和 18～ 2 0月龄 SHR组 (n=5 )。每组均等数按鼠龄、体重及雌雄配对配予 WKY大鼠做对照。采用同位素法、电镜技术和末端脱氧核糖核苷酸转移酶介导的脱氧三磷酸尿苷缺口末端标记法检测 SHR左心室心肌细胞 PKC活性和心肌细胞凋亡的变化。采用直线回归分析确定PKC活性与心肌细胞凋亡的关系。　　结果 :11月龄 SHR组和 18～ 2 0月龄 SHR组心肌细胞膜 PKC活性显著低于同龄 WKY大鼠组 ,而心肌细胞凋亡却显著高于同龄 WKY大鼠组 (P均 <0 .0 1) ;但 10月龄 SHR组心肌细胞膜 PKC活性显著高于同龄 WKY大鼠组、1月龄 SHR组和 18～ 2 0月龄 SHR组而心肌细胞凋亡却显著低于同龄 WKY大鼠组 (P均 <0 .0 1) ;各组间心肌细胞浆 PKC活性无显著性差异 (P均 >0 .0 5 )。 2 SHR心肌细胞膜 PKC活性与心肌细胞凋亡指数呈显著负相关 (P<0 .0 5 ) ,但心肌细胞浆 PKC活性与心肌细胞凋亡指数不相关 (P>0 .0 5 )。　　结论 :心肌细胞膜 PKC活性降低可能与 SHR心肌细胞凋亡增加和充血性心力衰竭相关 ,而心肌细胞膜 PKC活性增加可能与 SHR心肌细胞凋亡减少和     

The Association between Severity of Atherosclerosis and Lower Urinary Tract Function in Male Patients with Lower Urinary Tract Symptoms

Objectives: The present study was undertaken to investigate the association between the severity of atherosclerosis and lower urinary tract function in male patients with lower urinary tract symptoms. Methods: Male patients with lower urinary tract symptoms were examined with routine investigation. The severity of atherosclerosis was assessed by ultrasound examination of carotid artery. Patients were divided into two groups: control group and atherosclerosis group. The voiding function and storage function were compared between the two groups. Results: A total of 50 men (69.9 ± 9.1 years [mean ± standard deviation]) entered the study. There was no significant difference in age distribution (control group: 68.7 ± 7.6 years; atherosclerosis group: 72.5 ± 9.7 years) and prostate volume (control group: 26.5 ± 17.3 mL; atherosclerosis group: 22.2 ± 11.0 mL) between the two groups. In the voiding parameters, maximum flow rate in the atherosclerosis group (13.4 ± 5.5 mL/s, P < 0.05) was significantly lower than that in the control group (16.7 ± 7.7 mL/s). Postvoid residual urine volume showed no significant difference between the two groups. In the storage parameters, voided volume was significantly reduced in the atherosclerosis group (161.8 ± 46 mL, P < 0.05), as compared to control group (201.1 ± 78 mL). Moreover, daytime frequency was 7.13 ± 3.02 times in the control group, and significantly higher in the atherosclerosis group (8.75 ± 2.50 times, P < 0.05). Conclusion: Development of atherosclerosis impairs both voiding and storage function independently of age, suggesting atherosclerosis leads to lower urinary dysfunction.     

Arrhythmias in Patients ≥80 Years of Age: Pathophysiology,Management, and Outcomes

Advances in medical care have led to an increase in the number of octogenarians and even older patients, forming an important and unique patient subgroup. It is clear that advancing age is an independent risk factor for the development of most arrhythmias, causing substantial morbidity and mortality. Patients ≥80 years of age have significant structural and electrical remodeling of cardiac tissue; accrue competing comorbidities; react differently to drug therapy; and may experience falls, frailty, and cognitive impairment, presenting significant therapeutic challenges. Unfortunately, very old patients are under-represented in clinical trials, leading to critical gaps in evidence to guide effective and safe treatment of arrhythmias. In this state-of-the-art review, we examine the pathophysiology of aging and arrhythmias and then present the available evidence on age-specific management of the most common arrhythmias, including drugs, catheter ablation, and cardiac implantable electronic devices.     

Atrioventricular Nodal Reentry Tachycardia in Patients with Sinus Node Dysfunction: Electrophysiologic Characteristics, Clinical Presentation, and Results of Slow Pathway Ablation

AVNRT and Sinus Node Dysfunction. Introduction: Sinus node dysfunction (SND) is frequently associated with impaired AV conduction. This study investigated the electrophysiologic properties of dual AV nodal pathways in patients suffering from both SND and AV nodal reentrant tachycardia (AVNRT). Methods and Results: Two groups of patients with slow-fast AVNRT underwent invasive electrophysiologic testing and catheter ablation of the slow pathway. Group A comprised 10 patients with SND (age 70 ± 8 years), (Group B included 10 age-matched patients without SND (age 69 ± 7 years; P = NS) who served as controls. Patients of group A exhibited prolongation of the anterograde Wenckebach cycle lengths (WBCLs) of both the fast pathway (559 ± 96 vs 361 ± 38 msec; P < 0.01) and the slow pathway (409 ± 57 vs 339 ± 32 ms; P < 0.01). However, the delta between the WBCLs of the fast and the slow pathways was larger in patients of group A (150 ± 80 vs 22 ± 20 msec; P < 0.01). Retrograde fast pathway conduction was well preserved with no difference in WBCLs (356 ± 42 vs 330 ± 47 msec; P = NS). Cycle lengths of AVNRT were longer in group A (468 ± 46 vs 363 ± 37 msec; P < 0.01). Clinically, all patients of group A suffered from multiple episodes of AVNRT per week, which was not the case in any patient of group B (P < 0.01). Catheter ablation of the slow pathway eliminated AVNRT in all patients without complications. Conclusions: Patients with AVNRT and SND exhibit characteristic electrophysiologic alterations of both AV nodal pathways. Clinically, this results in significantly more frequent episodes of tachycardia. Slow pathway ablation appears to be safe and effective in these patients.