Role of bioimpedance vectorial analysis in cardio-renal syndromes

The cardio-renal syndromes (CRS) are the result of complex bidirectional organ cross-talk between the heart and kidney, with tremendous overlap of diseases such as coronary heart disease, heart failure (HF), and renal dysfunction in the same patient. Volume overload plays an important role in the pathophysiology of CRS. The appropriate treatment of overhydration, particularly in HF and in chronic kidney disease, has been associated with improved outcomes and blood pressure control. Clinical examination alone is often insufficient for accurate assessment of volume status because significant volume overload can exist even in the absence of peripheral or pulmonary edema on physical examination or radiography. Bioelectrical impedance techniques increasingly are being used in the management of patients with HF and those on chronic dialysis. These methods provide more objective estimates of volume status in such patients. Used in conjunction with standard clinical assessment and biomarkers such as the natriuretic peptides, bioimpedance analysis may be useful in guiding pharmacologic and ultrafiltration therapies and subsequently restoring such patients to a euvolemic or optivolemic state. In this article, we review the use of these techniques in CRS.     

Neue Behandlungskonzepte von Symptomen des unteren Harntraktes beim Mann

For patients with lower urinary tract symptoms (LUTS), ??1-adrenoreceptor inhibitors and 5-alpha reductase inhibitors as well as their combination are considered the gold standard. In addition, anticholinergic agents are being introduced as monotherapy or in combination with ??1-adrenocepetor inhibitors for patients with predominant storage disorders. Phosphodiesterase 5 (PDE5) inhibitors are often the best option for patients with LUTS who also suffer from erectile dysfunction. Recently, novel treatment options have been presented and intraprostatic injection of various agents, such as botulinum toxin A, NX-1207 and PRX302 has shown promising initial results. In addition, innovative minimally invasive treatment options, such as UroLift? appear to be efficacious and safe in this patient cohort. Particular emphasis should be laid on patients with LUTS and concomitant sexual disorders.     

EAU Guidelines on Assessment and Nonsurgical Management of Urinary Incontinence

Context

The previous European Association of Urology (EAU) guidelines on urinary incontinence comprised a summary of sections of the 2009 International Consultation on Incontinence. A decision was made in 2010 to rewrite these guidelines based on an independent systematic review carried out by the EAU guidelines panel, using a sustainable methodology.

Objective

We present a short version of the full guidelines on assessment, diagnosis, and nonsurgical treatment of urinary incontinence, with the aim of increasing their dissemination.

Evidence acquisition

Evidence appraisal included a pragmatic review of existing systematic reviews and independent new literature searches, based on Population, Intervention, Comparator, Outcome questions. Appraisal of papers was carried out by an international panel of experts, who also collaborated on a series of consensus discussions, to develop concise structured evidence summaries and action-based recommendations using a modified Oxford system.

Evidence summary

The full version of the guidelines is available online (http://www.uroweb.org/guidelines/online-guidelines/). The guidelines include algorithms that refer the reader back to the supporting evidence, and they are more immediately useable in daily clinical practice.

Conclusions

These new guidelines present an up-to-date summary of the available evidence, together with clear clinical algorithms and action-based recommendations based on the best available evidence. Where such evidence does not exist, they present a consensus of expert opinion.     

Chronic Multifocal Mycobacterium fortuitum Osteomyelitis Following Penetrating Plantar Trauma

We present the case of a 10-year-old girl with Mycobacterium fortuitum osteomyelitis following a plantar puncture wound with vegetative material. Nontuberculous mycobacterial (NTM) skin and soft tissue infections are well described in immunocompromised populations. However, NTM infection can also be seen in healthy hosts following direct inoculation. Magnetic resonance imaging examination demonstrated multifocal midfoot and metatarsal osteomyelitis. Surgical exploration revealed caseation necrosis and a chronic draining sinus tract. Combined surgical debridement and medical therapy resulted in clinical cure. A high index of suspicion and adequate collection and handling of surgical specimens facilitate the diagnosis and treatment of NTM skin and soft tissue infections.     

神经干/祖细胞移植对脑损伤导致的胶质细胞活化有调节作用并有助于移植细胞与宿主胶质细胞间缝隙连接的建立

移植神经干/祖细胞有助于受损脑组织形态和功能的恢复。移植部位的微环境及移植细胞与宿主细胞间的通讯在神经干/祖细胞移植的神经保护机制中有重要意义。笔者既往研究显示,对中枢轴索损伤动物进行神经干/祖细胞移植有助于恢复损伤神经元的电活动及突触联系,并可增加神经营养因子的释放。本研究拟观察移植的神经干/祖细胞与宿主胶质细胞间的解剖关系,以探讨神经干/祖细胞移植的神经保护作用的可能机制。从新生大鼠的脑室下区提取神经干/祖细胞移植到内侧纵束横断伤模型大鼠脑内。移植后8周取脑进行相关检测。免疫组化检测结果显示,与未移植神经干/祖细胞的大鼠相比,移植了神经干/祖细胞的大鼠脑内更多的小胶质细胞被激活。移植的神经干/祖细胞聚集在激活的小胶质细胞和星形胶质细胞附近。缝隙连接蛋白CX-43表达在损伤部位的神经干/祖细胞和胶质细胞上,且较多的存在于移植细胞和胶质细胞相连接的部位。移植的神经干/祖细胞和宿主胶质细胞及宿主小胶质细胞间均形成了缝隙连接,但移植的神经干/祖细胞和宿主胶质细胞间的缝隙连接较多。本研究结果显示,神经干/祖细胞移植对脑损伤导致的胶质细胞活化有调节作用,并可能通过在移植细胞和宿主细胞间建立缝隙连接来调节细胞间的通讯,这可能是细胞移植的神经保护作用的机制之一。     

Eficacia y seguridad del interferón pegilado,asociado a la criocirugía en el tratamiento del condiloma acuminado

BackgroundThe continuous recurrences of condylomata acuminata makes it necessary to constantly search for therapeutic alternatives.Patients and methodTo evaluate the therapeutic efficacy and safety of pegylated interferon (IFN p) adjuvant to cryosurgery, an open clinical trial was conducted in condylomata acuminata in 30 patients from the «Hermanos Ameijeiras» hospital, who were randomized to receive 6 weeks (group I) subcutaneous recombinant human interferon alfa 2b (IFN), 3 times per week + biweekly cryosurgery or (group II) subcutaneous IFN p, 1 time per week + biweekly cryosurgery. The main variable was the percentage of recurrence at one year of follow-up. There was also a rigorous control of adverse events.ResultsAt the end of the treatment 12/15 (80%) patients in group I and group II 14/15 (93,3%) were without injuries (p < 0.32). During follow-up, none of the patients who received IFN p + cryosurgery had recurrences; while 2/12 (16.7%) of the patients who received IFN + cryosurgery recurred (p < 0.672). Adverse events were significantly more frequent in group I (fever 13/15, headache 7/15, chills 3/15, and myalgia 2/15) (p < 0.003).ConclusionPegylated interferon with a weekly frequency of administration achieves superior therapeutic effects, a lower percentage of recurrences and adverse reactions than the administration of recombinant human IFN alpha 2b 3 times a week.