Promise of Urinary Nerve Growth Factor for Assessment of Overactive Bladder Syndrome

Overactive bladder syndrome (OAB) is highly prevalent bladder disorder in men and women. About 10–15% of the population suffers from urgency frequency with or without urgency urinary incontinence. It is estimated that 50–75% of patients with OAB may have urodynamic detrusor overactivity (DO). Urodynamic study invasive and most of the OAB patients might not accept it as a routine assessment. Therefore, a more objective and non‐invasive test for diagnosis and assessing DO from OAB patients is needed. Recently, urinary nerve growth factor (NGF) has gained great interest in detecting DO in patients with OAB. Urinary NGF level was found to increase in OAB and urodynamic DO. Urinary NGF levels correlated with severity of OAB symptoms. Patients with either idiopathic or neurogenic DO may have increased urinary NGF levels. Urinary NGF levels have been shown to decrease in patients with patients with OAB and DO who have been well treated with antimuscarinics or botulinum toxin injection, but not in those with persistent OAB after treatment. Not all patients with OAB can have an elevated urinary NGF level; it may also be increased in patients with interstitial cystitis/painful bladder syndrome and other lower urinary tract diseases, suggesting urinary NGF expression could be a product of bladder inflammation and a limited specificity of urinary NGF for diagnosing DO. The source of urinary NGF has not yet been fully explored yet. Nevertheless, urinary NGF level is likely to be a promising biomarker for diagnosis of DO from OAB patients, to monitor therapeutic outcome and predict disease progression.     

Iron status and cardiovascular risk factors in patients with haemodialysis versus patients with ischaemic heart disease

Aim:   The study aimed to investigate whether imbalanced iron status in patients with haemodialysis coexisted with abnormal lipid profile, higher inflammatory status and altered growth hormone–insulin-like growth factor (GH–IGF)-I axis and to compare these biochemical markers with patients with ischaemic heart disease.
Methods:   Serum samples for biochemical and immunological analyses were collected from 74 normal subjects, 138 patients with ischaemic heart disease (IHD) and 115 patients on haemodialysis (HD).
Results:   Compared with normal subjects, lower serum iron, lower total iron-binding capacity (TIBC) and higher ferritin in HD patients coexisted with decreases in high-density lipoprotein cholesterol and total bilirubin as well as increases in lactate dehydrogenase (LDH), interleukin (IL)-6, C-reactive protein (CRP) and IL-10. Decreased IGF-I and increased GH were found in HD patients whereas unchanged GH–IGF axis were found in IHD patients. Compared with IHD, much higher ferritin, lower TIBC, lower bilirubin and higher LDH levels were found in HD patients.
Conclusion:   Imbalanced iron status in patients on HD coexisted with abnormal lipid profiles, increased anaerobic activity and higher inflammatory status, which suggests that imbalanced iron status in HD patients may play a deleterious role in cardiovascular pathophysiology. Altered GH–IGF axis found in HD patients was more obvious than in IHD patients. This may imply that the GH–IGF axis system is modulated or adapted by HD.     

小儿甲型副伤寒29例临床分析

目的：探讨小儿甲型副伤寒的临床特征。方法：分析29例病例资料的临床表现，实验室资料、发病特点、诊断、治疗要点及其流行特征。结果：本组病例以农村儿童为多发病例，发病年龄主要集中在2—10岁之间，临床以发热为主要表现，呈稽留热和驰张热型；消化道症状较轻；感染中毒症状，相对缓脉，玫瑰疹少见；外周血白细胞与嗜酸性粒细胞减少。血培养是明确诊断最主要的方法之一。头孢类和氨基糖甙类为敏感药物。结论：甲型副伤寒，临床未显现典型的消化造症状及体征，用药应以药物敏感试验为指导，避免滥用抗生素。     

Involvement of sympathetic function in the sleep-related change of gastric myoelectrical activity in rats

The gastric myoelectrical activity (GMA) fluctuates across sleep–wake states as a result of modulation by the brain–gut axis. The role of the autonomic nervous system in this phenomenon, however, was not elucidated fully. Through simultaneous recording and subsequent continuous power spectral analysis of electroencephalogram, electromyogram, electrocardiogram and electrogastromyogram (EGMG) in 16 freely moving Wistar rats, the sleep–wake states of the animals were defined and indices of cardiac autonomic regulation and GMA were calculated. We found that both cardiac autonomic regulation and GMA fluctuated through sleep–wake cycles. Correlation analysis further revealed significant correlations between EGMG power and each of the R–R interval, high-frequency power, low-frequency power, very-low-frequency power, low-frequency power to high-frequency power ratio and normalized low-frequency power of heart rate variability with respect to their trend of change across different sleep–wake states. These results suggest that the sleep–wake-related change of GMA was related to sympathovagal balance. The sympathetic nerve may play a more important role in the central modulation of GMA than perceived previously.     

The assessment of regional gut transit times in healthy controls and patients with gastroparesis using wireless motility technology

Background Wireless pH and pressure motility capsule (wireless motility capsule) technology provides a method to assess regional gastrointestinal transit times. Aims To analyse data from a multi‐centre study of gastroparetic patients and healthy controls and to compare regional transit times measured by wireless motility capsule in healthy controls and gastroparetics (GP). Methods A total of 66 healthy controls and 34 patients with GP (15 diabetic and 19 idiopathic) swallowed wireless motility capsule together with standardized meal (255 kcal). Gastric emptying time (GET), small bowel transit time (SBTT), colon transit time (CTT) and whole gut transit time (WGTT) were calculated using the wireless motility capsule. Results Gastric emptying time, CTT and WGTT but not SBTT were significantly longer in GP than in controls. Eighteen percent of gastroparetic patients had delayed WGTT. Both diabetic and idiopathic aetiologies of gastroparetics had significantly slower WGTT (P < 0.0001) in addition to significantly slower GET than healthy controls. Diabetic gastroparetics additionally had significantly slower CTT than healthy controls (P = 0.0054). Conclusions In addition to assessing gastric emptying, regional transit times can be measured using wireless motility capsule. The prolongation of CTT in gastroparetic patients indicates that dysmotility beyond the stomach in GP is present, and it could be contributing to symptom presentation. Aliment Pharmacol Ther 31 , 313–322     

Camptocormia as a presentation of generalized inflammatory myopathy

Camptocormia is an abnormal truncal flexion posture that occurs while walking or standing. It is usually caused by various hypokinetic movement disorders such as Parkinson disease and multiple system atrophy. Myopathy or motor neuron disease can also be infrequent causes of camptocormia. Paraspinous muscle biopsy usually reveals focal myositis, regardless of the etiology of camptocormia. We describe the first case of generalized inflammatory myopathy with prominent camptocormia and proximal muscle weakness. Muscle biopsy of the quadriceps confirmed the diagnosis of polymyositis, and the posture showed modest improvement in response to steroid treatment. Muscle Nerve, 2009     

Urinary Nerve Growth Factor Levels in Urinary Tract Diseases With or Without Frequency Urgency Symptoms

Objectives: To measure urinary nerve growth factor (NGF) levels in patients with several urinary tract diseases under different conditions and compare with NGF levels in patients with overactive bladder (OAB) and interstitial cystitis/painful bladder syndrome (IC/PBS). Methods: Urinary NGF levels were measured using enzyme‐linked immunosorbent assay (ELISA) and normalized by urinary creatinine concentration. Patients with acute bacterial cystitis, urinary tract stone, urothelial cell carcinoma, and OAB patients after antimuscarinic therapy were evaluated. The urinary NGF levels of OAB, IC/PBS and controls from previous studies were used for comparison. NGF levels were compared among subgroups and between urinary tract diseases with or without associated OAB symptoms. The urinary NGF levels were also compared among natural filling, after normal saline filling and after potassium chloride test in a group of OAB and IC/PBS patients. Results: Patients with acute bacterial cystitis, urinary tract stones or urothelial cell carcinoma had elevated NGF levels that were not associated with the presence of OAB symptoms. Symptomatic cystitis patients who had resolved OAB symptoms after antibiotic treatment had a significant decrease in urinary NGF levels. The urinary NGF levels decreased significantly in OAB patients with effective antimuscarinic treatment for 6 months, but remained stationary and higher than the controls for up to 12 months after treatment. Conclusion: Urinary NGF is not produced solely in patients with OAB or IC/PBS. Acute bacterial cystitis, urinary tract stones and urothelial cell carcinoma can have high urinary NGF production.