Psychogenic Urinary Dysfunction in Children and Adults

This paper reviews current concepts of psychogenic urinary dysfunction (PUD) in children and adults from a uro-neurologist’s point of view. Although it is not common in urodynamic practice, PUD is an important category that all urologists have to consider. Regarding urologic aspects, PUD is basically a diagnosis of exclusion, particularly from urologic, gynecologic, and neurologic causes. In our patients, the characteristics of lower urinary tract symptoms in PUD are the situational occurrence of overactive bladder and/or difficult urination and, in some patients, extremely infrequent toileting. The characteristics of urodynamics in PUD are increased bladder sensation during bladder filling and underactive/acontractile detrusor during voiding. Regarding neuropsychiatric aspects, PUD is usually accompanied by more obvious psychologic/psychiatric features. In fact, the majority of our patients had hysterical neurosis/conversion disorder and anxiety disorders. Alteration in both emotion and micturition under such conditions most probably originates from the brain, which may reflect functional alteration in γ-aminobutyric acid (GABA)ergic, serotonergic, and corticotropin-releasing factor (CRF)ergic neuronal circuits. In addition, even in cases suggestive of PUD, a possible non-PUD pathology behind the symptoms should always be explored.     

Strain-Specific Variation in Murine Natural Killer Gene Complex Contributes to Differences in Immunosurveillance for Urethane-Induced Lung Cancer

Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related deaths worldwide and results from a complex interaction between carcinogen exposure and inherent susceptibility. Despite its prevalence, genetic factors that predispose to the development of lung cancer remain elusive. Inbred mouse models offer a unique and clinically relevant tool to study genetic factors that contribute to lung carcinogenesis due to the development of tumors that resemble human adenocarcinoma and broad strain-specific variation in cancer incidence after carcinogen administration. Here, we set out to investigate whether strain-specific variability in tumor immunosurveillance contributes to differences in lung cancer. Using bone marrow transplantation, we determined that hematopoietic cells from lung cancer-resistant mice could significantly impede the development of cancer in a susceptible strain. Furthermore, we show that this is not due to differences in tumor-promoting inflammatory changes or variability in immunosurveillance by the adaptive immune system but results from strain-specific differences in natural killer (NK) cell cytotoxicity. Using a newly discovered congenic strain of mice, we show a previously unrecognized role for strain-specific polymorphisms in the natural killer gene complex (NKC) in immunosurveillance for carcinogen-induced lung cancer. Because polymorphisms in the NKC are highly prevalent in man, our data may explain why certain individuals without obvious risk factors develop lung cancer whereas others remain resistant to the disease despite heavy environmental carcinogen exposure. Cancer Res; 72(17); 4311-7. ?2012 AACR.     

The Strategy for Predicting Future Exacerbation of Asthma Using a Combination of the Asthma Control Test and Lung Function Test

Background. Various factors have been reported to be useful for predicting future exacerbations. Objective. This study was intended to determine a usefulness of a combination of a patient-based questionnaire, such as the Asthma Control Test (ACT) score with objective assessments, such as forced expiratory volume in 1 second (FEV₁) and/or exhaled nitric oxide (FE_NO), for predicting future exacerbations in adult asthmatics. Methods. We therefore enrolled 78 subjects with mild to moderate asthma, who were clinically stable for 3 months who all had been regularly receiving inhaled steroid treatment. All subjects underwent a routine assessment of asthma control including the ACT score, spirometry, and FE_NO, and then were followed up until a severe exacerbation occurred. The predictors of an increased risk of severe exacerbation were identified and validated using decision trees based on a classification and regression tree (CART) analysis. The properties of the developed models were the evaluated with the area under the ROC curve (AUC) (95% confidence interval [CI]). Results. The CART analysis automatically selected the variables and cut-off points, the ACT score ≤23 and FEV₁ ≤ 91.8%, with the greatest capacity for discriminating future exacerbations within one year or not. When the probalility was calculated by the likelihood ratio of a positive test (LP), the ACT score ≤23 was identified with a 60.3% probability, calculated by 1.82 of LP, whereas the combined ACT score ≤23 and the percentage of predicted FEV₁ ≤ 91.8% were identified with an 85.0% probability, calculated by an LP score of 5.43, for predicting future exacerbation. Conclusion. These results demonstrated that combining the ACT score and percentage of predicted FEV₁, but not FE_NO, can sufficiently stratify the risk for future exacerbations within one year.     

Postmarketing surveillance evaluating the safety and effectiveness of golimumab in Japanese patients with rheumatoid arthritis

Objectives: The purpose of this study was to evaluate the real-world safety and effectiveness of golimumab (GLM) in Japanese patients with rheumatoid arthritis.

Methods: A postmarketing surveillance of 5154 patients was conducted with a follow-up duration of at least 24 weeks. Patients were divided into four groups based on the initial treatment: 50?mg or 100?mg of GLM with concomitant use of methotrexate (MTX) and 50?mg or 100?mg of GLM monotherapy. Patient characteristics at baseline, safety and effectiveness were assessed for each group.

Results: Over 70% of patients received 50?mg of GLM with concomitant MTX, and approximately, 20% received monotherapy. The incidence rate of adverse events was 45.40 per 100 patient-years. The incidence of adverse events including serious adverse events was comparable across all groups. The proportion of patients showing remission or low disease activity increased from 13.69% to 46.21% at the final evaluation, and no differences were observed in the percentage of remission across the four groups. Concomitant MTX use was associated with higher probability of continuing therapy.

Conclusions: GLM showed effectiveness in Japanese rheumatoid arthritis patients with an acceptable safety profile.     

A case of conversion of a NIPRO ventricular assist system to an EVAHEART left ventricular assist system

Bridge to bridge (BTB) is a promising strategy for the treatment of end-stage heart failure that involves the left ventricular assist system (LVAS). We describe our experience with the conversion of an extracorporeal ventricular assist system (VAS), the NIPRO VAS, to an implantable LVAS, the EVAHEART LVAS. A 32-year-old man underwent a NIPRO VAS implantation as a bridge to decision for a condition consistent with Interagency Registry for Mechanically Assisted Circulatory Support profile 1. He was later diagnosed with secondary cardiomyopathy due to cardiac sarcoidosis. During the period in which he had NIPRO VAS support, no significant bacterial cultures were obtained from the cannula-piercing site, and no systemic infection occurred. Approximately 5 months after the NIPRO VAS implantation, he underwent an EVAHEART LVAS implantation as a BTB. The procedure required technical modifications, including the anastomosis of outflow grafts, trimming of the apical cuff, and creation of a pump pocket. The operation was completed uneventfully. The patient completed the discharge program for awaiting heart transplantation at home. Approximately 6 months after the EVAHEART LVAS implantation, he continues to do well without any complications, including infection, and visits our hospital as an outpatient. Conversion to an implantable LVAS can be beneficial in carefully selected patients after ascertaining the operative indications and operation timing.