Psychometric assessment of female overactive bladder syndrome and antimuscarinics-related effects

Objectives

To investigate the characteristics of psychological distress (PD), personality traits, and family support in women with overactive bladder syndrome (OAB), and the effects of antimuscarinic treatment.

Study design

Women with and without OAB (age- and body mass index [BMI]-matched control group) were prospectively enrolled; they recorded bladder diaries, underwent urodynamic studies, and completed PD, personality traits, and filled family support questionnaires before and after antimuscarinic treatment. OAB women underwent treatment with tolterodine or solifenacin for 12 weeks. The control group completed questionnaires.

Main outcome measures

The differences in PD, personality traits, and family support scores between both groups, and the changes after antimuscarinic treatment in OAB women.

Results

Eighty-five women with OAB (tolterodine, n = 42; solifenacin, n = 43) and 65 without OAB completed the studies. Linear regression analysis with age and BMI adjustment revealed: coefficients of OAB were significant (all P < 0.05) for somatic complaints (mean: 0.87 vs. 0.63, coefficient = 0.21), obsessive–compulsive symptoms (0.69 vs. 0.44, coefficient = 0.25), anxiety symptoms (0.42 vs. 0.27, coefficient = 0.14), General Symptom Index (GSI, 0.48 vs. 0.33, coefficient = 0.14), neuroticism (9.23 vs. 5.17, coefficient = 3.73), and extroversion–introversion (13.64 vs. 15.25, coefficient = −1.73). Anxiety symptoms (0.42 vs. 0.36) and GSI (0.48 vs. 0.39) improved after antimuscarinics (all P < 0.05). High Overactive Bladder Symptom Score questionnaire score (coefficient = −0.39), low hostility score (coefficient = 2.11), and high additional symptoms score (coefficient = −1.46) were associated with good therapeutic effect (all P < 0.05).

Conclusions

OAB women experience more PD, neuroticism, and introversion than asymptomatic women, and antimuscarinics could improve PD.     

Psychometric assessment of female overactive bladder syndrome and antimuscarinics-related effects

ObjectivesTo investigate the characteristics of psychological distress (PD), personality traits, and family support in women with overactive bladder syndrome (OAB), and the effects of antimuscarinic treatment.Study designWomen with and without OAB (age- and body mass index [BMI]-matched control group) were prospectively enrolled; they recorded bladder diaries, underwent urodynamic studies, and completed PD, personality traits, and filled family support questionnaires before and after antimuscarinic treatment. OAB women underwent treatment with tolterodine or solifenacin for 12 weeks. The control group completed questionnaires.Main outcome measuresThe differences in PD, personality traits, and family support scores between both groups, and the changes after antimuscarinic treatment in OAB women.ResultsEighty-five women with OAB (tolterodine, n = 42; solifenacin, n = 43) and 65 without OAB completed the studies. Linear regression analysis with age and BMI adjustment revealed: coefficients of OAB were significant (all P < 0.05) for somatic complaints (mean: 0.87 vs. 0.63, coefficient = 0.21), obsessive–compulsive symptoms (0.69 vs. 0.44, coefficient = 0.25), anxiety symptoms (0.42 vs. 0.27, coefficient = 0.14), General Symptom Index (GSI, 0.48 vs. 0.33, coefficient = 0.14), neuroticism (9.23 vs. 5.17, coefficient = 3.73), and extroversion–introversion (13.64 vs. 15.25, coefficient = −1.73). Anxiety symptoms (0.42 vs. 0.36) and GSI (0.48 vs. 0.39) improved after antimuscarinics (all P < 0.05). High Overactive Bladder Symptom Score questionnaire score (coefficient = −0.39), low hostility score (coefficient = 2.11), and high additional symptoms score (coefficient = −1.46) were associated with good therapeutic effect (all P < 0.05).ConclusionsOAB women experience more PD, neuroticism, and introversion than asymptomatic women, and antimuscarinics could improve PD.     

New developments in the medical management of overactive bladder

Overactive bladder (OAB) is a clinical syndrome describing the symptom complex of urgency, with or without urgency incontinence and is usually associated with frequency and nocturia. Whilst the majority of women will benefit from initial management with conservative and behavioural intervention a significant number will require medical therapy. Antimuscarinics are currently the most widely prescribed drugs for OAB although very often persistence with medication is limited due to lack of efficacy or intolerable adverse effects.     

Autonomic activity and baroreflex sensitivity in patients submitted to carotid stenting

Arterial baroreflex and cardiac autonomic control play important roles in hemodynamic instability after carotid artery stenting (CAS). Spontaneous baroreflex sensitivity (BRS), heart rate variability (HRV) and blood pressure variability (BPV) are established tools for the assessment of arterial baroreflex and cardiac autonomic activity. Aim of the study was to evaluate cardiac autonomic activity (by means of HRV, BPV and BRS) after CAS and to explore the impact of internal carotid artery stenosis on BRS changes after CAS. 37 patients (68±10.45 years) with internal carotid stenosis underwent CAS. HRV, BPV and BRS were measured in all subjects before and at 1 and 72h after CAS. ANOVA was performed to compare BRS, HRV and BPV parameters before and after CAS. Spearman analysis was performed to determine a possible correlation between carotid stenosis degree (or carotid plaque diameter) and BRS changes (ΔBRS). LF/HF (index of sympatho-vagal balance) decreased during postoperative period, in comparison with baseline (2.32±1.70 vs 1.65±1.40, p<0.05). There was a significant negative correlation between carotid stenosis degree and ΔBRS (r=-0.35, p=0.03) and between carotid plaques thickness and ΔBRS (r=-0.36, p=0.02). CAS procedure may cause an alteration of carotid wall mechanical properties, increasing baroreflex sensitivity. BRS does not increase in all the patients, because arterial wall damage and nerve destruction determined by atherosclerotic plaque may reduce ΔBRS.     

Increased ambulatory arterial stiffness index and blood pressure load in normotensive obese patients

ObjectivesIt has been shown that blood pressure (BP) values measured in obese subjects are higher than the individuals with normal weight, even in normotensive limits. However, data concerning the Ambulatory Arterial Stiffness Index (AASI) and blood pressure load in normotensive obese subjects is lacking. This study was aimed to compare the ambulatory arterial stiffness index and blood pressure load in normotensive obese and healthy controls.MethodsOne hundred normotensive obese and one hundred normal weight subjects were included in this study. All subjects underwent 24-hour ambulatory blood pressure monitoring. Ambulatory arterial stiffness index was calculated from 24-hour ambulatory blood pressure monitoring records. Ambulatory arterial stiffness index was defined as one minus the regression slope of unedited 24-h diastolic on systolic blood pressures. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) load values were calculated from 24-hour ambulatory blood pressure monitoring analysis.ResultsAmbulatory arterial stiffness index of the obese subjects was significantly higher than the healthy controls (0.48±0.2 vs. 0.33±0.11, p<0.001). 24-hours systolic blood pressure and diastolic blood pressure loads were significantly higher in obese subjects. Logistic regression analysis revealed that body mass index (BMI) was an independent predictor for an abnormal ambulatory arterial stiffness ındex (≥0.50) (OR: 1.137, 95% CI: 0.915-1.001, p=0.004).ConclusionBlood pressure load and ambulatory arterial stiffness index are increased in normotensive obese patients. Moreover, body mass index is an independent predictor for an abnormal ambulatory arterial stiffness index. Our results indicate that obese subjects are at higher risk for future cardiovascular events despite normal office BP levels.     

人体动脉硬度测量方法与仪器研究进展

动脉粥样硬化和动脉硬化所导致的动脉功能改变是心肌梗死、脑卒中等心脑血管疾病的共同病理学基础.早期发现动脉血管的功能病变,并进行及时、有效的干预,是预防这些严重致死性疾病发生或减缓疾病进程的有效措施.动脉硬度是动脉最重要的功能指标之一.分析总结了当前三类主要的无创测量动脉硬度的方法和设备,它们分别是基于脉搏传递时间、脉搏波波形分析、动脉几何变化与血压变化的直接测量,相应得到区域性、全身性和局部性的动脉硬度估计.     

Effects of bladder training and/or tolterodine in female patients with overactive bladder syndrome: a prospective, randomized study

We compared the effects of bladder training and/or tolterodine as first line treatment in female patients with overactive bladder (OAB). One hundred and thirty-nine female patients with OAB were randomized to treatment with bladder training (BT), tolterodine (To, 2 mg twice daily) or both (Co) for 12 weeks. Treatment efficacy was measured by micturition diary, urgency scores and patients' subjective assessment of their bladder condition. Mean frequency and nocturia significantly decreased in all treatment groups, declining 25.9% and 56.1%, respectively, in the BT group; 30.2% and 65.4%, respectively, in the To group; and 33.5% and 66.3%, respectively in the Co group (p<0.05 for each). The decrease in frequency was significantly greater in the Co group than in the BT group (p<0.05). Mean urgency score decreased by 44.8%, 62.2% and 60.2% in the BT, To, and Co groups, respectively, and the improvement was significantly greater in the To and Co groups than in the BT group (p<0.05 for each). Although BT, To and their combination were all effective in controlling OAB symptoms, combination therapy was more effective than either method alone. Tolterodine alone may be instituted as a first-line therapy, but may be more effective when combined with bladder training.     

Simvastatin-induced cardiac autonomic control improvement in fructose-fed female rats

OBJECTIVE:

Because autonomic dysfunction has been found to lead to cardiometabolic disorders and because studies have reported that simvastatin treatment has neuroprotective effects, the objective of the present study was to investigate the effects of simvastatin treatment on cardiovascular and autonomic changes in fructose-fed female rats.

METHODS:

Female Wistar rats were divided into three groups: controls (n = 8), fructose (n = 8), and fructose+simvastatin (n = 8). Fructose overload was induced by supplementing the drinking water with fructose (100 mg/L, 18 wks). Simvastatin treatment (5 mg/kg/day for 2 wks) was performed by gavage. The arterial pressure was recorded using a data acquisition system. Autonomic control was evaluated by pharmacological blockade.

RESULTS:

Fructose overload induced an increase in the fasting blood glucose and triglyceride levels and insulin resistance. The constant rate of glucose disappearance during the insulin intolerance test was reduced in the fructose group (3.4±0.32%/min) relative to that in the control group (4.4±0.29%/min). Fructose+simvastatin rats exhibited increased insulin sensitivity (5.4±0.66%/min). The fructose and fructose+simvastatin groups demonstrated an increase in the mean arterial pressure compared with controls rats (fructose: 124±2 mmHg and fructose+simvastatin: 126±3 mmHg vs. controls: 112±2 mmHg). The sympathetic effect was enhanced in the fructose group (73±7 bpm) compared with that in the control (48±7 bpm) and fructose+simvastatin groups (31±8 bpm). The vagal effect was increased in fructose+simvastatin animals (84±7 bpm) compared with that in control (49±9 bpm) and fructose animals (46±5 bpm).

CONCLUSION:

Simvastatin treatment improved insulin sensitivity and cardiac autonomic control in an experimental model of metabolic syndrome in female rats. These effects were independent of the improvements in the classical plasma lipid profile and of reductions in arterial pressure. These results support the hypothesis that statins reduce the cardiometabolic risk in females with metabolic syndrome.     

Bone metabolism regulators and arterial stiffness in postmenopausal women

Background

Osteoprotegerin (OPG), osteopontin (OPN) and matrix Gla protein (MGP) are markers of bone metabolism but they are also involved in vascular calcification. However, their precise role is not completely understood. Arterial stiffness is considered an independent predictor of cardiovascular events and it may be one of the causes of the increased cardiovascular risk associated with postmenopausal status. Medial and intimal calcification may increase arterial stiffness. The aim of our study was to assess the relationship of OPG, OPN and MGP with aortic pulse wave velocity (aPWV) as a marker of arterial stiffness in postmenopausal women.

Materials and methods

Circulating OPG, OPN and serum total MGP were measured in 144 postmenopausal women using the enzyme-linked immunosorbent assay method. Aortic PWV was determined by an oscillometric method.

Results

Osteoprotegerin correlated with age (p < 0.001, r = 0.27), aPWV (p < 0.001, r = 0.32) and hypersensitive C reactive protein (hsCRP) (p < 0.001, r = 0.37), OPN correlated directly with hsCRP (p < 0.001, r = 0.39) and inversely with high density lipoprotein cholesterol (p = 0.02, r = −0.02). No significant association was found between total MGP and clinical, biochemical and vascular parameters. The correlation between OPG and aPWV persisted even after the adjustment for various potential confounders (p = 0.02, r = 0.19). In multiple regression analysis in the whole study population the most important predictors of aPWV were OPG (β = 0.230, p = 0.006), hsCRP (β = 0.212, p = 0.01) and systolic blood pressure (β = 0.163, p = 0.04). After exclusion of patients treated with statins the independent predictors were hsCRP (β = 0.275, p = 0.005) and OPG (β = 0.199, p = 0.04).

Conclusion

Circulating OPG, but not OPN and total MGP, is associated with aPWV and may be a marker of the increased arterial stiffness and cardiovascular risk in postmenopausal women.     

原发性高血压患者颈动脉斑块及动脉僵硬度与血清尿酸水平的关系*

 目的：研究原发性高血压（essential hypertension,EH）患者颈动脉斑块性质及动脉僵硬度与血清尿酸（uric acid,UA）水平的关系。方法：选择EH患者92例,健康对照组30例;对所有研究对象行相关血液生化检查,检测颈总动脉内中膜厚度（IMT）、颈动脉斑块和颈股动脉脉搏波传导速度（CFPWV）。结果：EH组的血清UA明显高于对照组［（361.51±83.81)μmol/L vs (317.03±62.22) μmol/L,P<0.05］;EH组IMT及异常检出率较对照组明显升高［(0.69±0.14) mm vs (0.60±0.12) mm,42.39% vs 10.00%,P<0.05］;45例EH患者检出颈动脉斑块,随着颈动脉斑块严重程度增高,血清UA水平依次增高［（285.25±78.41) μmol/L、(341.19±63.99) μmol/L和(401.33±88.49) μmol/L,P<0.05］;软斑块组（n=11）的血清UA水平较硬斑块组（n=34）显著增高［（389.00±69.45) μmol/L vs (323.03±72.71) μmol/L,P<0.05］。多元线性逐步回归分析显示CFPWV与年龄（r=0.414）、收缩压（r=0.224）、脉压（r=0.270）和血清UA（r=0.219）呈显著正相关（P<0.05）。结论：血清UA水平增高是EH发病的危险因素之一,血清UA水平可反映颈动脉斑块的严重程度及稳定性,EH患者随着血清UA水平增高大动脉弹性减退。     

Association of spironolactone treatment and arterial stiffness and cardiovascular disease in hypertensive patients

IntroductionThe aim of the current study was to evaluate the association of spironolactone and arterial stiffness and composite cardiovascular disease (CVD, including coronary heart disease, congestive heart failure and ischemic stroke) in hypertensive patients.Material and methodsBaseline data were collected and arterial stiffness was presented by carotid-femoral pulse wave velocity (cf-PWV) using applanation tonometry. Serum levels of fasting plasma glucose, total cholesterol, C-reactive protein and creatinine were measured using an automatic biochemistry analyzer. Plasma aldosterone concentration and plasma renin activity were determined by radioimmunoassay. The associations of spironolactone and arterial stiffness and composite CVD were evaluated.ResultsCompared to patients without spironolactone (n = 274), those with spironolactone (n = 170) were older and more likely to have diabetes and chronic heart failure. No differences in antihypertensive medications used were observed except for spironolactone. Mean number of antihypertensive medications used was significantly higher in the spironolactone group (2.6 ±0.8 vs. 2.2 ±0.6). Compared to patients without spironolactone, those with spironolactone had significantly lower cf-PWV (9.4 ±1.8 vs. 10.1 ±2.2 m/s). After adjustment for covariates, spironolactone was still associated with 10% lower risk of arterial stiffness, with a 95% confidence interval (CI) of 0.85–0.97. In patients without arterial stiffness, after adjustment for covariates, no significant association of spironolactone and composite CVD was observed. However, in patients with increased arterial stiffness, after adjustment for covariates, spironolactone was still independently associated with 11% lower risk of composite CVD (95% CI: 0.83–0.97).ConclusionsSpironolactone treatment is independently associated with lower cf-PWV and lower prevalence of composite CVD in patients with increased arterial stiffness.     

Effects of a short health education intervention on physical activity,arterial stiffness and cardiac autonomic function in individuals with moderate-to-high cardiovascular risk

ObjectiveThis study evaluated the effects of a short health education and counseling intervention program, in a primary healthcare setting, on daily physical activity (PA), arterial stiffness, and cardiac autonomic function in individuals with moderate-to-high risk of cardiovascular disease.MethodsThis was a parallel-group study with a 4-month-long intervention, plus 8 months of follow-up. 164 individuals with moderate-to-high cardiovascular risk were allocated to either an intervention (n = 87) or a control group (n = 77). The intervention consisted of 3 walking and face-to-face group sessions plus text messages. Primary outcome was daily PA (sedentary time, light and moderate-to-vigorous PA, all in min/day); secondary outcomes were arterial stiffness i.e., carotid-femoral pulse wave velocity (cfPWV, m/s)] and cardiac autonomic function [(i.e., standard deviation of all N-N intervals (SDNN, ms) and absolute high frequency (HF, ms²)].ResultsThere were not significant group*time interactions for sedentary time [−7.4 (7.6); p = 0.331)], light PA [4.4 (6.4); p = 0.491] or moderate-to-vigorous PA [0.1 (2.6); p = 0.938]. Considering secondary outcomes, there were not significant group*time interactions for cfPWV [0.09 (0.18); p = 0.592], Ln_SDNN [0.09 (0.06); p = 0.148], or Ln_HF [0.16 (0.14); p = 0.263].ConclusionThe program did not improve daily PA, arterial stiffness, or the autonomic cardiac function.Practice ImplicationsPrimary care staff should consider longer or other types of intervention to improve daily PA.     

Autonomic function tests as related to age and gender in normal man

Summary To obtain a comparative assessment of 5 different clinical autonomic function tests as related to age and gender in normal man, the beat-to-beat variation during deep breathing (BBV), orthostatic 30/15 R-R ratio, heart rate response to the Valsalva manoeuvre, blood pressure response to sustained handgrip and orthostatic blood pressure response were evaluated in 120 healthy subjects (60 women and 60 men) aged 22 to 92 yrs. Each of the functional parameters depending on cardiac parasympathetic integrity, i.e. the beat-to-beat variation, orthostatic 30/15 R-R ratio and Valsalva ratio, decreased (P<0.0001) progressively with increasing age. The blood pressure response to handgrip, which depends on the efferent sympathetic function, was unchanged, while the orthostatic response of systolic blood pressure, which depends on the function of the entire reflex arch, was augmented only minimally (P<0.001) with increasing age. No significant dependence on gender was noted, although blood pressure responses to handgrip tended to be slightly greater in men than women. Beat-to-beat variation expressed as the standard deviation of the mean R-R interval correlated with mean heart rate (P<0.05), while the coefficient of variation and the exspiration/inspiration ratio of beat-to-beat variation did not. The orthostatic 30/15 R-R ratio and beat-to-beat variation tended to be more closely interrelated (r=0.56 to 0.63) than any of these tests with the Valsalva ratio (r=0.51). The findings indicate that consideration of age may improve the diagnostic value of the orthostatic 30/15 R-R ratio. Beat-to-beat variation expressed as exspiration/inspiration ratio may serve as a simple, complementary test of parasympathetic cardiac integrity, and the handgrip test as a sympathetic screening procedure which is also applicable in the geriatric age group.Abbreviations BBV beat-to-beat variation - BP blood pressure - SDRR standard deviation of mean R-R interval expressed in mm - SDHR standard deviation of mean R-R interval as translated into beats per min - CVRR coefficient of variation of R-R intervals This study was supported in part by the Swiss National Science Foundation     

Cerebrospinal fluid sodium concentration and osmosensitive sites related to arterial pressure in anaesthetized rats

Intracerebroventricular injection of hypertonic saline induces experimental hypertension. To measure [Na] in the vicinity of osmosensitive sites, we continuously measured [Na] in cerebrospinal fluid ([Na]_csf) in the lateral ventricle (LV, n = 6), in the third ventricle (V3, n = 6) and in the medial preoptic nucleus (MPO, n = 6) ([Na]_MPO) with a Na-sensitive electrode together with mean arterial pressure (MAP) during infusion of hypertonic artificial cerebrospinal fluid (ACSF, [Na] = 1,000 meq/kg H₂O) at 5 μl/min for 3 min into the LV in urethane- anaesthetized rats. [Na]_csf in the LV began to increase at the beginning of infusion, reaching a peak of 48 ± 9 meq/kg H₂O (mean ± SE) around the end of infusion, then recovering to the pre-infusion level by 17 min. [Na]_csf in V3 changed similarly to that in the LV without any delay, although the peak value was reduced (61% , P < 0.05). In the MPO, in contrast the increase in [Na]_MPO was delayed (3 min, P < 0.002) and the peak reduced even further (to 37%, P < 0.01) compared with that in V3. Thereafter, it remained higher than the pre-infusion level until the end of recovery (P < 0.05). MAP began to increase at the onset of infusion (P < 0.05); the maximum increase of 16 ± 2 mm Hg (n = 18) was reached at the end of infusion, whereafter this level was almost sustained until the end of the 22-min recovery period. To analyse quantitatively the relationship between MAP and [Na]_csf, hypertonic ACSF was infused at 2.5 μl/min into the LV. [Na]_csf in the LV and MAP increased at half the rates seen with 5 μl/min. These results suggest that the first increase in MAP after hypertonic infusion into the LV is due to the increase in [Na] in the LV and V3, and that the subsequent sustained increase in MAP is related to the delayed increase in [Na] in the periventricular tissues of the V3. Received: 30 June 1995/Received after revision: 8 December 1995/Accepted: 12 December 1995     

Verylow frequency variability in arterial blood pressure and blood volume pulse

Several parameters of the cardiovascular system fluctuate spontaenously owing to the activity of the autonomic nervous system. In the study, the simultaneous very low frequency (VLF) fluctuations of the arterial blood pressure, the tissue blood content and the tissue blood volume pulse are investigated. The latter two parameters are derived from the baseline BL and the amplitude AM of the photoplethysmographic (PPG) signal, measured on the fingertips of 20 healthy male subjects: the changes in the PPG parameters AM and BV, defined by BV=const.-BL, are related to the change in the tissue blood volume pulse and the total tissue blood volume, respectively. The VLF fluctuations in BV and AM are directly correlated, those of AM preceding those of BV by 4–13 heart-beats. The VLF fluctuations in the systolic (SBP) and the diastolic (DBP) blood pressure are inversely correlated to those of AM and BV, those of AM preceding those of SBP and lagging behing those of DBP by about one heart-beat. For most subjects, the period P of the PPG pulse, which is equal to the cardiac cycle period, directly correlates with AM and BV and inversely correlates with DBP and SBP. On average, the fluctuations fluctuations in tissue blood volume, systolic blood volume pulse, diastolic and systolic blood pressure, and heart period, together with their interrelationship, can provide a better understanding of the autonomic nervous control of the peripheral circulation and a potential tool for the evaluation of its function.     

Carotid intima-media thickness and arterial stiffness in type 1 diabetic patients with and without microangiopathy

Introduction

The aim of the study was to assess carotid intima-media thickness (CIMT) as a subclinical marker of atherosclerosis and arterial stiffness in type 1 diabetic patients in relation to microangiopathy.

Material and methods

We included 87 type 1 diabetic patients (44 women, 43 men), median age 34 years (interquartile range [IQR] 29-43), median disease duration 10 years (IQR: 9-14), mean ± standard deviation (SD) glycated haemoglobin (HbA_1c) 8.4 ±1.4%. Fifty patients had at least one microangiopathic complication. Intima-media thickness (IMT) of the common carotid artery was measured using high resolution ultrasonography. Arterial stiffness was assessed using digital volume pulse analysis and tonometric measurement of wave reflection and central haemodynamics.

Results

Subjects with microangiopathy compared with those without had higher values of CIMT (median [IQR]: 0.53 mm [0.45-0.60 mm] vs 0.47 mm [0.34-0.52 mm], p = 0.002), higher central augmentation index (CAI_x) (mean ± SD: 120.2 ±19.4% vs. 110.5 ±17.1%, p = 0.016) and higher peripheral augmentation index (PAI_x) (65.7 ±18.1% vs. 57.2 ±14.9%, p = 0.023). In the logistic regression analysis, the duration of diabetes, systolic and diastolic blood pressure, postprandial glycaemia, HbA_1c and triglycerides predicted the presence of diabetic microangiopathy independently of age and sex. The CIMT, CAI_x and PAI_x were associated with the presence of diabetic microangiopathy only in the univariate model.

Conclusions

In type 1 diabetic patients with microangiopathic complications, increased carotid IMT and arterial stiffness were observed. The study confirms the role of traditional risk factors for late diabetic complications, such as the duration of the disease and metabolic control in the development of microangiopathy.     

女性膀胱癌患者原位回肠和乙状结肠尿流改道效果的比较

背景：原位尿流改道在膀胱癌根治术后具有良好的控尿能力,但针对女性膀胱癌患者行原位回肠重建新膀胱和原位乙状结肠重建新膀胱后疗效及随访方面的研究很少。 目的：比较女性膀胱癌患者原位回肠和乙状结肠尿流改道的临床疗效。 方法：回顾性分析1996至2008年行膀胱癌术后原位回肠尿流改道(回肠组,n=29)和乙状结肠尿流改道(乙状结肠组,n=23)的女性膀胱癌患者的临床资料。比较分析两组患者修复中及修复后的一般情况、尿动力学结果、控尿能力和修复后储尿囊相关并发症等。 结果与结论：平均随访时间回肠组57个月,乙状结肠组55个月。两种修复方式术中失血量、术后控尿效果接近,但两组在手术时间、治疗后下床时间、新膀胱容量等方面差异有显著性意义(P < 0.05)。回肠组治疗后早期及晚期储尿囊相关并发症发生率均高于乙状结肠组。回肠组治疗后储尿囊再发肿瘤2例,乙状结肠组未见发生,说明两种重建方式应用于女性膀胱癌患者疗效均良好。     

Rhythmic oscillations of blood pressure and R-R interval in patients with chronic renal failure

Rhythmic blood pressure (BP) and R-R interval (R-R) oscillations at low-mid and high-frequency bands (LF: 0·02–0·06 Hz; MF; 0·07–0·14 Hz; HF; 0·15–0·40 Hz) were compared between uraemic patients maintained on haemodialysis and control subjects. The LF and MF powere spectra of BP were attenuated more in patients than in controls. With subjects standing, the MF power spectrum of BP increased significantly in both groups. With subjects supine, the plasma norepinephrine concentration was higher, and its increment upon standing was greater in patients than in controls. Each R-R frequency power spectrum decreased more in patients than in control subjects. The HF power spectrum of R-R, i.e. a vagal tone index, systematically decreased upon standing in the control subjects but not in the patients. The linear coupling between BP and R-R oscillations was strongest in the HF band, decreasing in the MF and LF bands. Transfer function analysis indicated that, in uraemic patients, linear BP/R-R relationships were altered in the HF band but remained normal in the LF and MF bands. The present results suggest that, first, the decreased amplitude of Mayer waves, i.e. the MF power spectrum of BP, observed in uraemic patients can be attributed to low sensitivity of the vasculature to sympathetic stimuli, and, secondly, autonomic modulation of linear BP/R-R relationships is frequency-dependent.