The impact of Diabetes Mellitus on Lower urinary tract symptoms (LUTS) in both male and female patients

IntroductionContemporary studies examine the connection of Diabetes Mellitus (DM) with Lower urinary tract symptoms (LUTS), alone or associated with other factors of the metabolic syndrome. However, little research has occurred concerning patients with diabetes of both genders and sexes without other diseases of the lower urinary tract. The aim of this study is to examine the relationship between DM and LUTS.MethodsThe study enrolled 110 patients with DM and 134 healthy individuals. The IPSS questionnaire was used for the evaluation of symptoms from lower urinary tract. Data was analyzed with univariate and multivariate logistic regression using SPSS v.24.ResultsAnalysis with moderate/severe LUTS as dependent variable and plausible confounding factors (age group, BMI, hypertension, dyslipidemia, years with DM and reported HbA1c) as covariates revealed that only HbA1c levels correlated independently with the presence of moderate/severe LUTS (p = 0,024, OR:2,729, CI:1,144–6,509) in diabetic women, while there was no statistically significant difference between male groups. HbA1c levels' correlation with IPSS-voiding and IPSS- storage score was not statistically significant. Quality of life is also affected in women with diabetes mellitus (p: 0,02).ConclusionOnly an increase in HbA1c was independently connected with a deterioration of LUTS in the female group.     

Treatment of Vaginal Cuff Prolapses with Posterior Intravaginal Sling and Evaluation of Efficiency with International Consultation on Incontinence Questionnaire—Vaginal Symptoms Method in the Long Term: Preliminary Results

Objectives: The aim of this study was to research the efficiency of posterior intravaginal sling (PIVS) procedure in vaginal cuff prolapse, together with possible complications, long‐term effects and effects of the method on vaginal and sexual function and quality of life of patients. This retrospective study comprised 21 patients with vaginal cuff prolapse. Methods: PIVS procedure was performed in 21 patients with vaginal cuff prolapse with quantification stages 2, 3, or 4 of pelvic organ prolapse. Patients were assessed according to the International Consultation on Incontinence Questionnaire—Vaginal Symptoms before and after operation. Results: The average follow‐up period was 24.6 months. The rate of surgical success was 100%, the rate of mesh erosion was 14.2% and the rate of dyspareunia was 33.3%. Vaginal symptom, sexual matter and quality of life scores were statistically significant in the postoperative period compared to the preoperative period (P = 0.001, P = 0.001, P = 0.001, respectively). Conclusion: PIVS is an effective and reliable method of treating vaginal cuff prolapse. However, its complication profile is not yet at an acceptable level. We believe that the rate of mesh erosion will regress to a more acceptable level with the improvement of mesh technology and postoperative method. The necessary incontinence surgery is easily performed together with PIVS procedure. PIVS restores the vaginal and sexual functions of patients and increases their quality of life significantly.     

Reliability and Validity of the Quality of Life Questionnaire in Iranian Patients with Lower Urinary Tract Symptoms

Objectives

The aim of this study is to evaluate the psychometric properties of the Iranian version of the Quality of Life (QoL) questionnaire in patients with urinary incontinence (UI).

Methods

The English questionnaire on lower urinary tract symptoms was initially translated into Persian, and then back‐translated into English. Final modifications were made after testing the questionnaire on Iranian patients with UI. To validate the translated questionnaire, the following tests were undertaken: content/face validity, internal consistency/reliability and construct validity.

Results

The Lower Urinary Tract Symptoms Quality of Life (LUTS–QoL) questionnaire showed good internal consistency, content validity, and criterion validity, as measured by correlation with scores on the Short‐Form 36 Health Survey (SF‐36). Cronbach's alpha coefficient was 0.951, indicating a high internal consistency. Concerning criterion validity, correlations between the LUTS–QoL and subscales of the SF‐36 were 0.563–0.193. The highest correlation was found between the LUTS–QoL and the social function subscale of the SF‐36.

Conclusion

The Iranian version of the LUTS–QoL questionnaire is a valid and robust instrument that can be used reliably in clinical settings and in research.     

Patients with HBV‐related acute‐on‐chronic liver failure have increased concentrations of extracellular histones aggravating cellular damage and systemic inflammation

Acute‐on‐chronic liver failure (ACLF) is the most common type of liver failure and associated with grave consequences. Systemic inflammation has been linked to its pathogenesis and outcome, but the identifiable triggers are absent. Recently, extracellular histones, especially H4, have been recognized as important mediators of cell damage in various inflammatory conditions. This study aimed to investigate whether extracellular histones have clinical implications in patients with hepatitis B virus (HBV)‐related ACLF. One hundred and twelve patients with HBV‐related ACLF, 90 patients with chronic hepatitis B, 88 patients with HBV‐related liver cirrhosis and 40 healthy volunteers were entered into this study. Plasma histone H4 levels, cytokine profile and clinical data were obtained. Besides, patient's sera were incubated overnight with human L02 hepatocytes or monocytic U937 cells in the presence or absence of antihistone H4 antibody, and cellular damage and cytokine production were evaluated. We found that plasma histone H4 levels were greatly increased in patients with ACLF as compared with chronic hepatitis B, liver cirrhosis and healthy control subjects and were significantly associated with disease severity, systemic inflammation and outcome. Notably, ACLF patients' sera incubation decreased cultured L02 cell integrity and induced profound cytokine production in the supernatant of U937 cells. Antihistone H4 antibody treatment abrogated these adverse effects, thus confirming a cause‐effect relationship between extracellular histones and organ injury/dysfunction. The data support the hypothesis that the increased extracellular histone levels in ACLF patients may aggravate disease severity by inducing cellular injury and systemic inflammation. Histone‐targeted therapies may have potentially interventional value in clinical practice.     

The off‐ versus on‐label use of medical devices in interventional cardiovascular medicine: Clarifying the ambiguity between regulatory labeling and clinical decision‐making,Part 1: PCI

The Food and Drug Administration convened a special public meeting of the Circulatory System Devices Advisory Panel in late 2006 in response to data suggesting a small but potentially significant increased risk of stent thrombosis with drug‐eluting stents (DES). This panel concluded that “off‐label” DES use was associated with an increased risk of adverse outcomes compared with “on‐label” use. In this commentary, we will discuss the role of product labeling in clinical decision‐making during percutaneous coronary intervention, elucidate the issues that may arise from the conflation of the responsibilities of regulatory bodies and physicians, and offer a potential framework for their resolution. © 2008 Wiley‐Liss, Inc.     

Cost‐Effectiveness of Cardiac Resynchronization Therapy in the MADIT‐CRT Trial

Cost Effectiveness of MADIT‐CRT. Background: The Multicenter Automatic Defibrillator Implantation Trial‐Cardiac Resynchronization Therapy (MADIT‐CRT) trial demonstrated that cardiac resynchronization therapy (CRT) when added to the implantable cardiac defibrillator (ICD) reduces risk of heart failure or death in minimally symptomatic patients with reduced cardiac ejection fraction and wide QRS complex. Objectives: To evaluate 4‐year cost‐effectiveness of CRT‐ICD compared to ICD alone using MADIT‐CRT data. Research Design: Patients enrolled in the trial were randomized to implantation of either ICD or CRT‐ICD in a 2:3 ratio, with up to 4‐year follow‐up period. Cost‐effectiveness analyses were conducted, and sensitivity analyses by age, gender, and left bundle branch block (LBBB) conduction pattern were performed. Subjects: A total of 1,271 patients with ICD or CRT‐ICD (US centers only) who reported healthcare utilization and health‐related quality of life data. Measures: We used the EQ‐5D (US weights) to assess patient HRQOL and translated utilization data to costs using national Medicare reimbursement rates. Results: Average 4‐year healthcare expenditures in CRT‐ICD patients were higher than costs of ICD patients ($62,600 vs 57,050, P = 0.015), mainly due to the device and implant‐related costs. The incremental cost‐effectiveness ratio of CRT‐ICD compared to ICD was $58,330/quality‐adjusted life years (QALY) saved. The cost effectiveness improved with longer time horizon and for the LBBB subgroup ($7,320/QALY), with no cost‐effectiveness benefit being evident in the non‐LBBB group. Conclusions: In minimally symptomatic patients with low ejection fraction and LBBB, CRT‐ICD is cost effective within 4‐year horizon when compared to ICD‐only. (J Cardiovasc Electrophysiol, Vol. 24, pp. 66‐74, January 2013)     

Apoptosis versus necrosis rate as a predictor in acute liver failure following acetaminophen intoxication compared with acute‐on‐chronic liver failure

Cell death is known to play a crucial role in liver diseases. We compared the clinical courses of two cases of liver failure of different origins correlated with the extent of cell death (apoptosis and/or necrosis), measured in the patient's blood. Patient 1 was admitted with acute liver failure following acetaminophen intoxication. Intravenous therapy with acetylcysteine was performed. The percentage of apoptotic cell death measured by M30 was three times higher than normal and the overall cell death measured by M65 was more than 30 × higher than normal. High levels of aminotransferases were detected, indicating high rates of necrosis. M30 and M65 values rapidly returned to normal levels, while the liver function test (LFT) levels decreased with latency. Patient 2 was admitted with acute‐on‐chronic liver failure with known liver fibrosis. M30 values were 16 × higher than normal. In contrast, M65 values were lower than in the first case. This time, no movement in M30 levels was seen until the M30 levels rapidly increased indicating the inevitable death of the patient, while LFTs did not change. These results indicate the role of M30 and M65 immunoexpression as markers for functioning liver cell mass, capacity for recovery and therefore as predictive markers in acute liver failure.     

Insulin resistance/β‐cell function and serum ferritin level in non‐diabetic patients with hepatitis C virus infection

Background/Aims: Since impaired glucose tolerance and iron overload are frequently demonstrated in hepatitis C virus (HCV)‐related liver diseases, in this study we investigated insulin resistance, pancreatic β‐cell function, i.e., insulin secretion, and serum ferritin levels in patients with HCV infection, especially non‐diabetic patients. Methods: Homeostasis model assessments for insulin resistance (HOMA‐IR) and β‐cell function (HOMA‐β) were performed in 92 HCV‐infected patients. Results: The levels of plasma immunoreactive insulin (IRI), HOMA‐IR, and HOMA‐β were significantly correlated with fasting plasma glucose (FPG) levels. Among the 86 non‐diabetics (with an FPG of <126 mg/dl), IRI, HOMA‐IR, and HOMA‐β were significantly higher in patients with liver cirrhosis than in patients with persistently normal alanine aminotransferase levels. The IRI and HOMA‐IR values, but not the HOMA‐β values, were correlated with both serum transaminase and ferritin levels in the 65 non‐diabetic chronic hepatitis patients. Conclusion: Insulin resistance was connected with impaired glucose tolerance and the severity of liver diseases in non‐diabetic patients with HCV infection. Iron overload may be responsible for insulin resistance, or vice versa. Pancreatic β‐cell function was unrelated to the patients' serum ferritin levels.     

Multi‐loci diagnosis of acute lymphoblastic leukaemia with high‐throughput sequencing and bioinformatics analysis

High‐throughput sequencing (HTS) is considered a technical revolution that has improved our knowledge of lymphoid and autoimmune diseases, changing our approach to leukaemia both at diagnosis and during follow‐up. As part of an immunoglobulin/T cell receptor‐based minimal residual disease (MRD) assessment of acute lymphoblastic leukaemia patients, we assessed the performance and feasibility of the replacement of the first steps of the approach based on DNA isolation and Sanger sequencing, using a HTS protocol combined with bioinformatics analysis and visualization using the Vidjil software. We prospectively analysed the diagnostic and relapse samples of 34 paediatric patients, thus identifying 125 leukaemic clones with recombinations on multiple loci (TRG, TRD, IGH and IGK), including Dd2/Dd3 and Intron/KDE rearrangements. Sequencing failures were halved (14% vs. 34%, P = 0.0007), enabling more patients to be monitored. Furthermore, more markers per patient could be monitored, reducing the probability of false negative MRD results. The whole analysis, from sample receipt to clinical validation, was shorter than our current diagnostic protocol, with equal resources. V(D)J recombination was successfully assigned by the software, even for unusual recombinations. This study emphasizes the progress that HTS with adapted bioinformatics tools can bring to the diagnosis of leukaemia patients.     

Factors affecting the diagnostic accuracy of endoscopic ultrasonography‐guided fine‐needle aspiration (EUS‐FNA) for upper gastrointestinal submucosal or extraluminal solid mass lesions

Aim: A number of potential variables are associated with the diagnostic accuracy of endoscopic ultrasonography‐guided fine‐needle aspiration (EUS‐FNA). The aim of this study was to evaluate factors affecting the diagnostic accuracy of EUS‐FNA for upper gastrointestinal submucosal or extraluminal solid lesions. Methods: Patients with such lesions who underwent EUS‐FNA between January 2009 and December 2010 were studied retrospectively. Needles of 22, 25 and 19 gauge were used. The associations between the EUS‐FNA results and factors such as mass location, mass size, needle size, number of needle passes, combined histologic‐cytologic analysis and final diagnosis were analyzed. Results: A total of 170 EUS‐FNA procedures were performed in 158 patients with upper gastrointestinal submucosal or extraluminal solid lesions. The overall accuracy of EUS‐FNA was 86.5% (147/170). The diagnostic accuracy with three or more needle passes was higher than with less than 3.0 needle passes (90.0%, 108/120 vs 78.0%, 39/50; P < 0.05). Mass location, mass size, and final diagnosis were not associated with EUS‐FNA accuracy. Combined cytologic‐histologic analysis had significantly higher diagnostic accuracy than either cytologic or histologic analysis alone (P < 0.001). In a subgroup of 90 patients, both 22 and 25 gauge needles were used for EUS‐FNA. The overall diagnostic accuracy was similar for 25 gauge needles and 22 gauge needles (80.0% vs 78.9% P = 1.000) in this subgroup. Conclusion: Overall, 25 and 22 gauge needles have a similar diagnostic accuracy. Our results suggest that 3.0 or more needle passes and combined cytologic‐histologic analysis enhance the diagnostic accuracy of EUS‐FNA.