Restoration of micturition in patients with acontractile and hypocontractile detrusor by transurethral electrical bladder stimulation

The aim of transurethral electrical bladder stimulation (TEBS) treatment in patients with diminished detrusor contractility is to attain complete voiding, i.e., micturition without residual urine, which is under volitional control. In contrast to other types of electrical bladder stimulation, the physiological basis for this kind of treatment is sensitizing of the bladder mechanoreceptor afferents. The latency of afferent stimuli in normal conditions indicates that myelinated A-δ-fibers are used for neurotransmission from these mechanoreceptors. Forty-eight patients with hypocontractile or acontractile detrusor underwent intravesical electrical stimulation. All patients had a history pointing to neurogenic pathology. Forty patients had an acontractile and 8 a hypocontractile bladder. Prior to therapy, the mean residual urine volume was 461 ml. After stimulation, 32 of 48 patients were able to void with a mean residual of 57 ml. Detrusor contraction was achieved in 39% and bladder sensation was perceived by 75% of patients who failed these conditions before treatment. Following therapy, 19 of 35 patients were able to empty their bladder without the previously needed catheterization. Side effects were epididymitis in 1 and cystitis in 7 patients. © 1996 Wiley-Liss, Inc.     

A roadmap to surgery in osteogenesis imperfecta: results of an international collaboration of patient organizations and interdisciplinary care teams

Background and purpose — Involvement of patient organizations is steadily increasing in guidelines for treatment of various diseases and conditions for better care from the patient’s viewpoint and better comparability of outcomes. For this reason, the Osteogenesis Imperfecta Federation Europe and the Care4BrittleBones Foundation convened an interdisciplinary task force of 3 members from patient organizations and 12 healthcare professionals from recognized centers for interdisciplinary care for children and adults with osteogenesis imperfecta (OI) to develop guidelines for a basic roadmap to surgery in OI.Methods — All information from 9 telephone conferences, expert consultations, and face-to-face meetings during the International Conference for Quality of Life for Osteogenesis Imperfecta 2019 was used by the task force to define themes and associated recommendations.Results — Consensus on recommendations was reached within 4 themes: the interdisciplinary approach, the surgical decision-making conversation, surgical technique guidelines for OI, and the feedback loop after surgery.Interpretation — The basic guidelines of this roadmap for the interdisciplinary approach to surgical care in children and adults with OI is expected to improve standardization of clinical practice and comparability of outcomes across treatment centers.

Expert consensus remains the best available method for guiding surgical care in most rare diseases, due to the relative lack of evidence-based practices. With a prevalence between 1:10,000 and 1:20,000, osteogenesis imperfecta (OI) is a rare genetic disease affecting the quality and quantity of collagen I. Not only bone with frequent fractures and deformities, but all tissues containing collagen I are affected (Marini et al. 2017, Chougui et al. 2020). The somewhat unpredictable phenotypic variability of the disease is often grouped according to the clinical Sillence classification I–V (Van Dijk and Sillence 2014). However, each patient is unique not only in impairments but also in treatment needs. The most severe type III has the weakest bone and not all these individuals reach the level of standing and walking. Many patients undergo surgery more than once. On the initiative of the Osteogenesis Imperfecta Federation Europe (OIFE) and the Care4BrittleBones (Care4BB) Foundation, an international interdisciplinary task force was invited to create a roadmap for a standardized, integrated approach for optimal outcomes of surgery, not only from a surgical view, but also from the patient’s perspective.     

GD3+ cells in the adult rat optic nerve are ramified microglia rather than 0–2Aadult progenitor cells

The adult central nervous system (CNS) contains a population of adult oligodendrocyte-type-2 astrocyte (O-2A) progenitor cells (O-2A^adult progenitor cells). These cells may provide a source of the new oligodendrocytes that are needed to repair demyelinated lesions. In order to examine the role of O-2A^adult progenitor cells in the regeneration of the oligodendrocyte population following demyelinating damage, it is essential to be able to identify such cells unambiguously in sections of adult CNS tissue. The present study examined whether antibodies to the ganglioside G_D3 specifically label O-2A^adult progenitor cells in cultures and sections of adult optic nerve, since previous studies on the developing CNS had suggested that O-2A^perinatal progenitor cells were G_D3⁺ in vitro and in vivo. Evidence is presented indicating that, although O-2A^adult progenitor cells in vitro were labelled with the R24 mAb (an anti-G_D3 mAb), all G_D3⁺ cells in sections of adult optic nerve bound the OX-42 mAb and the B₄ isolectin derived from Griffonia Simplicifolia, and thus were not O-2A^adult progenitor cells, but ramified microglia. The data suggest that O-2A^adult progenitor cells become G_D3⁺ when placed in culture and that ramified microglia lose G_D3-expression in vitro. © 1994 Wiley-Liss, Inc.     

Fluorescent antigen-transfected target cell cytotoxic T lymphocyte assay for ex vivo detection of antigen-specific cell-mediated cytotoxicity

Ex vivo detection of virus-specific cytotoxic T lymphocyte (CTL) responses is limited to the use of methods assessing cytokine production, degranulation, or perforin contents of antigen-specific CD8+ T cells. Generally, their cytotoxic activity is detectable only after cultivation. We describe the fluorescent antigentransfected target cellCTL (FATT-CTL) assay, which measures antigen-specific cytotoxicity ex vivo. Target cells were generated by nucleofection with DNA vectors encoding antigengreen fluorescent protein (GFP) fusion proteins. After coculture at various effector : target (E : T) cell ratios, viable and dead GFP-positive cells were quantified by flow cytometry, and antigen-specific target-cell elimination was calculated. The assay was validated with human immunodeficiency virus (HIV) and influenza virusspecific CTL clones and revealed cytotoxicity at lower E : T cell ratios than standard 51Cr-release assays. Moreover, antigen-specific cytotoxicity was detected ex vivo within 1 day in peripheral blood mononuclear cells from HIV-infected individuals. The FATT-CTL assay provides a versatile tool that will advance our understanding of cell-mediated immunity.     

Content validity,construct validity,and reliability of the WHOQOL-Bref in a population of Dutch adult psychiatric outpatients

In this study, the psychometric properties of a quality of life scale, the WHOQOL-Bref, were examined in a population of 533 Dutch adult psychiatric outpatients. Participants underwent two semistructured interviews in order to obtain Axis-I and II diagnoses, according to DSM-IV. Besides the WHOQOL-Bref they also completed questionnaires for measuring psychopathological symptoms (SCL-90) and perceived social support (PSSS). Scores on 25 of the 26 questions of the WHOQOL-Bref had a good distribution. Similar to previous findings, exploratory factor analysis revealed a four-factor structure. A priori expected associations were found between the domains of the WHOQOL-Bref, on the one hand, and dimensions of the SCL-90 and the PSSS-score, on the other hand, indicating good construct validity. The internal consistency of the four domains of the WHOQOL-Bref ranged from 0.66 to 0.80. Domain scores of the WHOQOL-Bref correlated around 0.92 with the WHOQOL-100 domain scores. Relatively low correlations were found between demographic characteristics (age and sex) and WHOQOL-Bref domain scores. It is concluded that the content validity, construct validity, and the reliability of the WHOQOL-Bref in a population of adult Dutch psychiatric outpatients are good. The WHOQOL-Bref, therefore, is an adequate measure for assessing quality of life at the domain level in a population of adult psychiatric outpatients.     

Effects of magnetic stimulation in the treatment of pelvic floor dysfunction

OBJECTIVE: To correlate, in a pilot study, the clinical results of extracorporeal magnetic innervation therapy (ExMI) of the pelvic floor muscles with functional changes in the pelvic floor musculature, urodynamics and quality of life. PATIENTS AND METHODS: In all, 74 patients (65 women and nine men) with urge incontinence, urgency/frequency, stress incontinence, mixed incontinence and defecation problems were included in a prospective study of ExMI using a 'electromagnetic chair'. All patients were treated twice weekly for 8 weeks. Digital palpation and biofeedback with a vaginal or anal probe were used for registration of the pelvic floor musculature. A urodynamic evaluation, a voiding diary, a pad-test, the King's Health Questionnaire (KHQ) and a visual analogue scale (VAS) were completed by the patient at baseline and at the end of the study. RESULTS: In the group as a whole, there were no significant differences in the voiding diary, pad-test, quality of life, VAS score, biofeedback registration and urodynamics before and after treatment. Additional stratification was applied to the total patient group, related to the pretreatment rest tone of the pelvic floor, the basal amplitude registered on electromyography, to age and to previous treatments. However, there were no significant differences in the data before and after treatment within all subgroups (stress incontinence, urge incontinence, urgency/frequency, defecation problems, overactive pelvic floor, age, previous treatments), except for the KHQ domain of 'role limitations', where there was a significant improvement in all groups. CONCLUSION: ExMI did not change pelvic floor function in the present patients. The varying outcomes of several studies on ExMI stress the need for critical studies on the effect and the mode of action of electrostimulation and magnetic stimulation. In our opinion 'the chair' is suitable to train awareness of the location of the pelvic floor. However, active pelvic floor muscle exercises remain essential.     

Internal carotid bifurcation aneurysms: frequency, angiographic anatomy and results of coiling in 50 aneurysms

INTRODUCTION: Internal carotid artery (ICA) bifurcation aneurysms are uncommon. Little is known about incidence, anatomical characteristics and results of endovascular treatment. We report our experience with endovascular treatment of 50 ICA bifurcation aneurysms in 46 patients. METHODS: There were 13 men (28%) and 33 women (72%) with a mean age of 49.3 years (range 23-76 years). Of 50 aneurysms, 26 (52%) were ruptured and 24 (48%) were unruptured. Of the 46 patients, 23 (50%) had one to five additional aneurysms. RESULTS: The frequency of ICA bifurcation aneurysms was 2.4% (53 of 2,249, 95% CI 1.8-3.1%). Their mean size was 9.6 mm (median 6 mm, range 2-55 mm). Aneurysm neck was symmetrically on A1 and M1 in 30 aneurysms (60%), dominant on A1 in 14 (28%), on M1 in 2 (4%) and on the ICA in 4 (8%). Aneurysm fundus projection was superior in 28 aneurysms (56%), posterior in 9 (18%), anterior in 10 (20%) and lateral in 3 (6%). Four aneurysms were coiled with balloon assistance. Procedural morbidity and mortality of coiling was 2% each. During follow-up, 7 of 50 aneurysms (all 10 mm or larger) were additionally treated (retreatment rate 14%). CONCLUSION: ICA bifurcation aneurysms are rare with a frequency of 2.4% of treated aneurysms in our institution. They are often associated with additional aneurysms. Most aneurysm necks are located symmetrically on A1 and M1 and fundus projection is mostly superior. Coiling is safe and effective for the management of these aneurysms. The aneurysms that needed retreatment were >/=10 mm.     

In Vitro Assessment of the Immunological Significance of a Human Monoclonal Antibody Directed to the Influenza A Virus Nucleoprotein

Influenza A viruses cause annual epidemics and occasionally pandemics. Antibodies directed to the conserved viral nucleoprotein (NP) may play a role in immunity against various influenza A virus subtypes. Here, we assessed the immunological significance of a human monoclonal antibody directed to NP in vitro. This antibody bound to virus-infected cells but did not display virus-neutralizing activity, complement-dependent cell cytotoxicity, or opsonization of viral antigen for improved antigen presentation to CD8⁺ T cells by dendritic cells.