Self-reported urogenital symptoms in postmenopausal women: Women's Health Initiative

OBJECTIVE: To examine the prevalence and correlates of self-reported urogenital symptoms (dryness, irritation or itching, discharge, dysuria) among postmenopausal women aged 50-79. DESIGN: A cross-sectional analysis based on n=98,705 women enrolled in the US-based Women's Health Initiative observational study and clinical trials. Urogenital symptoms, symptom severity (mild, moderate, severe), and all covariates were self-reported through questionnaires at enrollment. Prevalence rates of each urogenital symptom were examined and logistic regression was used to identify potential correlates. RESULTS: Prevalence rates for each symptom were: dryness, 27.0%; irritation or itching, 18.6%; discharge, 11.1%; and dysuria, 5.2%. Four factors were correlated with two or more symptoms: Hispanic ethnicity (adjusted odds ratio (AOR)=2.1-3.1 versus white women across all symptoms), obesity (AOR=2.2 severe discharge versus none, AOR=3.6 severe irritation/itching versus none), treated diabetes (pills or shots) compared to no diabetes (AOR=2.4 severe dysuria versus none, AOR=3.2 severe irritation/itching versus none), and vaginal cream HRT/ERT compared to those who never used HRT/ERT (AOR=4.4 severe dryness versus none, AOR=4.6 severe irritation/itching versus none). Factors not associated with the symptoms included sexual activity, age, years since menopause, current smoking, marital status, gravidity, and natural versus surgical menopause. CONCLUSIONS: This is the first report to document urogenital symptoms by race/ethnicity among an exclusively postmenopausal population. We found an elevated prevalence of urogenital symptoms among women who are Hispanic, obese, and/or diabetic. Confirmation of our findings in these subgroups, and, if confirmed, analysis on why these populations are at greater risk, are areas for future research.     

Efferent connections of an auditory area in the caudal insular cortex of the rat: anatomical nodes for cortical streams of auditory processing and cross-modal sensory interactions

In the rat cortex, the two non-primary auditory areas, posterodorsal and ventral auditory areas, may constitute the two streams of auditory processing in their distinct projections to the posterior parietal and insular cortices. The posterior parietal cortex is considered crucial for auditory spatial processing and directed attention, while possible auditory function of the insular cortex is largely unclear. In this study, we electrophysiologically delineated an auditory area in the caudal part of the granular insular cortex (insular auditory area, IA) and examined efferent connections of IA with anterograde tracer biocytin to deduce the functional significance of IA. IA projected to the rostral agranular insular cortex, a component of the lateral prefrontal cortex. IA also projected to the adjacent dysgranular insular cortex and the caudal agranular insular cortex and sent feedback projections to cortical layer I of the primary and secondary somatosensory areas. Corticofugal projections terminated in auditory, somatosensory and visceral thalamic nuclei, and the bottom of the thalamic reticular nucleus that could overlap the visceral sector. The ventral part of the caudate putamen, the external cortex of the inferior colliculus and the central amygdaloid nucleus were also the main targets. IA exhibited neural response to transcutaneous electrical stimulation of the forepaw in addition to acoustic stimulation (noise bursts and pure tones). The results suggest that IA subserves diverse functions associated with somatosensory, nociceptive and visceral processing that may underlie sound-driven emotional and autonomic responses. IA, being potentially involved in such extensive cross-modal sensory interactions, could also be an important anatomical node of auditory processing linked to higher neural processing in the prefrontal cortex.     

Somatostatin selectively ablates post-inspiratory activity after injection into the Bötzinger complex

Somatostatin (SST) neurons in the ventral respiratory column (VRC) are essential for the generation of normal breathing. Little is known about the neuromodulatory role of SST on ventral respiratory neurons other than that local administration induces apnoea. Here, we describe the cardiorespiratory effects of microinjecting SST into the preBötzinger and Bötzinger complexes which together elaborate a normal inspiratory augmenting and expiratory respiratory pattern, and on spinally projecting respiratory subnuclei (rostral ventral respiratory group; rVRG). Microinjections (20–50 nl) of SST (0.15, 0.45, 1.5 mM) were made into respiratory subnuclei of urethane-anaesthetized, paralysed, vagotomized and artificially ventilated Sprague–Dawley rats (n=46). Unilateral microinjection of SST into the Bötzinger complex converted the augmenting activity of phrenic nerve discharge into a square-wave apneustic pattern associated with a lengthening of inspiratory period and shortening of expiratory time. Following bilateral microinjection the apneusis became pronounced and was associated with a dramatic variability in inspiratory duration. Microinjection of SST into the Bötzinger complex also abolished the post-inspiratory (post-I) motor activity normally observed in vagal and sympathetic nerves. In the preBötzinger complex SST caused bradypnoea and with increasing dose, apnoea. In the rVRG SST reduced phrenic nerve amplitude, eventually causing apnoea. In conclusion, SST powerfully inhibits respiratory neurons throughout the VRC. Of particular interest is the finding that chemical inhibition of the Bötzinger complex with SST ablates the post-I activity that is normally seen in respiratory activity and leads to apneusis. This loss of post-I activity is a unique feature of inhibition with SST and is not seen following inhibition with other agents such as galanin, GABA and endomorphin. The effect seen on post-I activity is similar to the effect of inhibiting the Kölliker–Fuse nucleus in the pons. The mechanism by which SST exerts this effect on Bötzinger neurons remains to be determined.     

快速点燃海马杏仁核建立癫癎鼠模型

目的：快速建立实验性癫癎动物模型。方法：１７ 只大鼠右侧海马和１１ 只鼠右侧杏仁核均埋植电极,用ＩＳ２ 型智能刺激器,以２００６００ μＡ 电脉冲刺激点燃海马杏仁核。结果：电刺激可诱发癎性发作和后放电,癎性行为分为五级,后放电呈高幅棘波。在点燃过程中,可记录到两种脑电活动：癎性脑电活动和自发性癎性脑电活动。随着电刺激次数的增多,发现Ⅱ、Ⅲ级癎性行为伴随较短的后放电时程,Ⅳ级以上癎性行为伴随较长的后放电时程。对原参数的刺激,大鼠癎性发作的敏感性增强并可持续数周。结论：应用低频短间隔电脉冲刺激大鼠海马或杏仁核可快速建立稳固的动物癫癎模型。     

Stroke discharges from a rehabilitation unit: 1-year and 5-year domicile outcomes. Function is important

Background: Stroke units save lives, reduce disability and increase the chances of the person returning to their own home. Following the introduction of a stroke rehabilitation unit, we assessed the durability of stroke discharges over a 1-year period and predictors of early 'failed' home discharges. Stability of discharge domicile and survival over 5 years was also reviewed.
Methods: A 6-month cohort of all discharges was followed for 5 years. Changes in domicile, including entry into institutional care, were recorded out to 5 years or until death. Predictors of early (3 months) and later (1 year) discharge stability were assessed.
Results: There were 142 discharges. Fifty-eight (76%) of those who returned home were still at home 12 months later. In contrast, there was a high mortality of dependent patients who were discharged to high dependency care (9 (29%) and 13 (42%) at 3 and 12 months, respectively). The chance of an early failed discharge was associated with lower functional ability on discharge ( P = 0.012). Lower function on discharge was also independently associated with death in the next 12 months ( P < 0.0001). At 5 years the mortality for the whole sample was 55% (78 of 141) and 38 (61%) of the survivors still lived in the community whereas 24 (39%) resided in institutional care.
Conclusion: Functional ability on discharge is a key predictor of ability to remain at home as well as survival and therefore every effort should be made to maximize function.     

刺激乳头在硬膜外麻醉分娩镇痛产妇中的应用

我科2007年3月-2009年3月对硬膜外麻醉分娩镇痛的初产妇实施刺激乳头方法,有利于加强宫缩,缩短产程,减少产后阴道出血量,提高新生儿早吸吮成功率。比静滴催产素加强宫缩更加经济、安全,减少产妇的痛苦,取得了较好的临床效果,现报告如下。     

The effect of “breathable” panty liners on the female lower genital tract

Objective

To evaluate whether the use of “breathable” panty liners (BPLs) alters the normal vaginal flora, increases the incidence of bacterial vaginosis and/or vaginal candidiasis, or causes vulvar irritation.

Methods

A randomized controlled trial assessed the vaginal ecosystem of women without complaints of vaginal discharge. The study group (n = 53) wore BPLs for 10-12 hours each day for 75 consecutive days, whereas the control group (n = 54) wore only their usual underwear. At each of 6 visits during 3 menstrual cycles, participants underwent gynecologic examination with colposcopic evaluation and pH measurement, in addition to assessment of vaginal microbial flora, intensity of inflammatory processes, and presence of vaginal candidiasis/bacterial vaginosis in Gram-stained smears.

Results

After 75 consecutive days of BPL use, 40/44 (90.9%) and 42/44 (95.5%) women reported no complaints of vaginal discharge or vulvar itching/burning, respectively. There was no significant difference between the study group and the control group with regard to positive vaginal fungus cultures (5/44 [11.4%] vs 8/50 [16.0%]; P = 0.7848) or bacterial vaginosis (3/44 [6.8%] vs 2/50 [4.0%]; P = 0.7974) at the end of the study period.

Conclusion

After 75 days of BPL use, there was no significant increase in vulvovaginal candidiasis, bacterial vaginosis, vulvovaginal irritation, or vulvovaginal inflammation.     

Tonic rhythmic activity of rat cerebellar neurons

Simultaneous recordings of multiple single unit activity in both cerebral and cerebellar cortex, cortical EEG, and both nuchal and vibrissal EMG were obtained in nine unrestrained rats. Putative Purkinje cells of the deep vermal cerebellar cortex exhibited rhythmic discharge of simple spikes with extremely low variability in interspike intervals for several hours. The highly rhythmic nature of spike discharge was remarkably stable across all states of sleep (both slow-wave and rapid eye movement sleep) and wake including quiet waking, grooming, eating, running in a familiar environment, and exploring a novel environment. The frequencies at which oscillatory discharges took place varied, among different cells, between 16 and 142 Hz; however, 75% of the recorded cells discharged at frequencies between 20 and 50 Hz. From recordings in which two to four such cells were recorded simultaneously, evidence was found for multiple cells firing at the same frequency as well as for multiple cells firing at different frequencies. The precise timing of spike discharge in these cells makes them potential candidates to participate in timing functions thought to depend on the cerebellum     

The effect of heating rate on the surface chemistry of NiTi

The impact of the heating rate on the Ni content at the surface of the oxide layer of biomedical NiTi is explored. Heat treatment emulating common shape-setting procedures was performed by means of conventional and inductive heating for similar annealing time and temperature, applying various heating rates from ∼0.25 K s⁻¹ to 250 K s⁻¹. A glow discharge optical emission spectroscopy method was established and employed to evaluate concentration profiles of Ni, Ti and O in the near-surface region at high resolution. The Ni content at the surface of the differently treated samples varies significantly, with maximum surface Ni concentrations of ∼20 at.% at the lowest and ∼1.5 at.% at the highest heating rate, i.e. the total amount of Ni contained in the surface region of the oxide layer decreases by >15 times. Consequently, the heating rate is a determinant for the biomedical characteristics of NiTi, especially since Ni available at the surface of the oxide layer may affect the hemocompatibility and be released promptly after surgical application of a respective implant. Furthermore, apparently contradictory results presented in the literature reporting surface Ni concentrations of ∼3 at.% to >20 at.% after heat treatment are consistently explained considering the ascertained effect of the heating rate.     

儿童与成人起病的伴海马硬化的颞叶癫癎对比分析

目的对比分析儿童与成人起病组的伴海马硬化的颞叶癫癎（TLE-HS）患者临床特点的异同,以提高对该病的认识。方法：回顾性收集我院癫癎诊疗中心就诊的TLE-HS患者201例,依据患者起病年龄分成儿童起病组和成人起病组,收集病史、发作类型和频率、药物治疗、头部影像学、24 h视频脑电图（V—EEG）等临床资料,作对比分析。结果：儿童起病组较成人起病组伴热性惊厥（FS）史多、间断发作少,频繁发作多,差异均有统计学意义（P=0．013、0．013、0．013）;儿童起病组较成人起病组在发作间期EEG颞区以外癎样放电较多,差异有统计学意义（P=0．015）。两组患者在HS侧别、发作起源、发作类型、单用或联合用药、头部外伤史、脑炎史、家族史、精神发育迟滞、精神异常等方面比较差异均无明显统计学意义。结论：与成人起病组相比,儿童起病组伴FS史多,发作频率更高,这提示FS是导致癫癎患者更早起病的原因之一;儿童起病组发作间期EEG颞区以外癎样放电较多。