Evaluation of Stress Predominant Urinary Incontinence

Urodynamic studies (UDS) have been used to objectively characterize a patient’s complaint of urinary incontinence. Presumably, the clinician can utilize the UDS data to guide treatment options. It is even hoped that UDS can help predict which treatments should be utilized to produce the most effective outcomes. However, is this currently the case? The Urinary Incontinence Treatment Network (UITN) has completed four large randomized clinical trials related to treatments for urinary incontinence. Two trials compared outcomes of different surgeries for stress urinary incontinence (SUI) in which standardized UDS protocols were used. Secondary analyses of these UDS data showed that UDS were neither prognostic of treatment outcomes nor correlative with severity of UI symptoms, suggesting limited utility of UDS in the evaluation and management of the uncomplicated SUI patient. A third trial was designed to answer whether a basic office examination is not noninferior to UDS in affecting SUI surgical outcomes. The results of this study are currently in press. A fourth trial examined treatment of urgency urinary incontinence (UUI). Because UDS was not part of this trial, the utility of UDS in management and treatment of UUI could not be assessed. In summary, UDS will need to undergo further refinements to increase its clinical effectiveness in the area of urinary incontinence.     

Perioperative infliximab application has marginal effects on ischemia–reperfusion injury in experimental small bowel transplantation in rats

Purpose  

Ischemia-reperfusion injury leads to impaired smooth muscle function and inflammatory reactions after intestinal transplantation. In previous studies, infliximab has been shown to effectively protect allogenic intestinal grafts in the early phase after transplantation with resulting improved contractility. This study was designed to reveal protective effects of infliximab on ischemia–reperfusion injury in isogenic transplantation.     

Urban Health Challenges in Europe

This article synthesizes diverse official reports, statistics, and scientific papers that present demographic, economic, environmental, and social trends impacting on the health and quality of life of citizens living in European cities. A literature review led to the identification of some key challenges including an aging society, migration flows, inequalities in health, global change, and risk behaviors that should be addressed in order to promote urban health. Other challenges, such as food production and consumption, are also relevant, but not included. Cities that have participated in one or more of the phases of the WHO European Healthy Cities Network have implemented a number of policies, programs, and measures to deal with the challenges discussed in this article. Some contributions are presented to illustrate how health and quality of life in urban areas can be promoted by local authorities.     

Affectivity and narrativity in depression: a phenomenological study

In this study I explore from a phenomenological perspective the relationship between affectivity and narrative self-understanding in depression. Phenomenological accounts often conceive of the disorder as involving disturbances of the narrative self and suggest that these disturbances are related to the alterations of emotions and moods typical of the illness. In this paper I expand these accounts by advancing two sets of claims. In the first place, I suggest that, due to the loss of feeling characteristic of the illness, the narratives with which the patients identified prior to the onset of depression are altered in various ways, thus leading to the weakening or abandonment of the narratives themselves. I then move to show that these autobiographical narratives are replaced by new stories which possess a distinctive structure and I argue that this is dependent upon specific configurations of affective experience, such as existential feelings of guilt, hopelessness, and isolation, and particular forms of temporal and spatial experience.     

Advances in heart failure therapy in pediatric patients with dilated cardiomyopathy

While in adults major advances in heart failure therapy in patients with dilated cardiomyopathy were documented in the last two decades, research on the mechanism and therapies of heart failure in children with left ventricular dilated cardiomyopathy has lagged behind. Despite the lack of sufficient randomized prospective studies, ACE inhibitors are first line and ß-receptor antagonists are second-line strategies in children. Following the adult guidelines, without having data concerning the pediatric population, mineral corticoids are also accepted in the treatment of pediatric heart failure, while diuretics should only be used to achieve a euvolemic status. In cases of complete left bundle bunch block or prolonged QRS duration, cardiac resynchronization is an option. If these instruments are exploited, and the child is still listed for heart transplantation as destination, evolving therapies like pulmonary artery banding in cases of preserved right ventricular function and cardiac cell therapy in cases of localized ventricular dysfunction might represent additional treatment options. This review summarizes the actual guidelines and provides an outlook for evolving therapies.