Rehabilitation vs drug therapy for urge urinary incontinence: short-term outcome

The objective of this study was to compare the short-term effectiveness of rehabilitation treatment with a standard drug treatment for urge urinary incontinence (UUI). The study design includes parallel clinical trial in an outpatient urogynecologic clinic setting. The subjects were 44 women who suffered from UUI and who were systematically assigned to a rehabilitation group (REH) (N=24) or a medication group (MED) (N=20). The intervention for REH was consisted of five visits during a 3-month period of pelvic floor muscle training and behavioral training, whereas for MED was extended release oxybutynin at 5 mg/day, for 3 months. The urinary symptoms considered were frequency of voiding per day and night (freq/day and freq/night), number of incontinent episodes per week based on a bladder diary, and data based on the Incontinence Quality of Life Instrument (I-QoL). In the within-group comparison, both groups had improved significantly over time with respect to urinary symptoms and I-QoL (p<0.01). In addition, there was a significant group–time interaction effect on freq/day. While REH improved during the 3-month follow-up period, the MED group deteriorated to mean baseline value (p<0.01). A significant negative association was found between the urinary symptoms and the I-QoL at the end of follow-up (r _p=−0.35 to −0.62, p<0.05). Three months after the intervention, both groups maintained the achievements of the intervention period. In addition, the REH group demonstrated additional improvement in mean freq/day while the condition of MED patients deteriorated to baseline values. At the time this paper was prepared, Prof. Langer passed away at the age of 57. This paper is therefore in memory of an outstanding physician, mentor and researcher.     

噻托溴铵在慢性阻塞性肺疾病中的应用进展

支气管扩张剂可减轻气流受限,被认为是改善慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)症状的主要治疗药物.目前随着药物研究的发展,长效抗胆碱能药物--噻托溴铵在COPD治疗中发挥了重要的作用.它能改善COPD患者肺功能,与其它支气管扩张剂疗效比较具有明显的优势,同时联合两种或两种以上其它不同作用机制的支气管扩张剂可增加支气管扩张程度而不增加不良反应,故被认为是COPD维持治疗的一线药物之一.     

Use of botulinum toxin in individuals with neurogenic detrusor overactivity: State of the art review

Background

Botulinum neurotoxin (BoNT) injection into the bladder wall has been shown to be an effective alternative to anticholinergic (antimuscarinic) medications and more invasive surgery in those with multiple sclerosis and spinal cord injury with neurogenic detrusor overactivity (NDO) and urinary incontinence who are not tolerating anticholinergic medications. In August 2011, Botox^® (onabotulinumtoxinA) received Food and Drug Administration (FDA) approval for this use. Clinically, intradetrusor injection of BoNT has been found to decrease urinary incontinence and improve quality of life. Its impact on urodynamic parameters is an increase in the maximum cystometric (bladder) capacity and decrease in the maximum detrusor pressures. The most common side effects are urinary tract infections and urinary retention. There have been rare reports and a black box warning of distant spread of BoNT. BoNT has gained popularity because of its effectiveness and long duration of action, relative ease of administration, easy learning curve, reproducibility of results on repeated administration, and low incidence of complications.

Objective

To discuss the structure and function, mechanisms of action, clinical and urodynamic studies, injection technique, potential beneficial and adverse effects, and potential areas of research of BoNT.

Methods

Literature search focused on botulinum toxin in MEDLINE/PubMed. Search terms included botulinum toxin, neurogenic bladder, NDO, botox bladder, botox spinal cord injury, botox, FDA, botox side effects. All papers identified were English language, full-text papers. In addition, English abstracts of non-English papers were noted. The reference list of identified articles was also searched for further papers.

Conclusion

Botulinum toxin is an alternative treatment for individuals with NDO who fail to tolerate anticholinergic medications. Its popularity has increased because of the literature, which has supported its effectiveness, safety, easy use and learning curve, reproducibility of results on repeated use, and recent FDA approval of Botox^® (onabotulinumtoxinA).     

Understanding older adults' medication decision making and behavior: A study on over-the-counter (OTC) anticholinergic medications

Background

Older adults purchase and use over-the-counter (OTC) medications with potentially significant adverse effects. Some OTC medications, such as those with anticholinergic effects, are relatively contraindicated for use by older adults due to evidence of impaired cognition and other adverse effects.

Effects of anticholinergic drugs on DRL performance of rhesus monkeys

Four adult rhesus monkeys were trained to stable performance baselines on a differential reinforcement of low rates (DRL) 28 sec schedule for food pellet presentation. The effects of graded doses of atropine SO₄, benactyzine HCl, and scopolamine HBr on performance were studied. All three anticholinergic compounds produced dose-related decreases in the number of food pellets earned. The number of responses was decreased only by the highest scopolamine dose. The unimodal peak of interresponse times (IRTs) was flattened under drug conditions such that there were roughly equal frequencies of responding in all IRT intervals. Drug potencies for producing these effects were: scopolamine > atropine > benactyzine.     

Possible anticholinesterase-like effects of trans(−)δ8 and -δ9tetrahydrocannabinol as observed in the general motor activity of mice

The general motor activity of mice, measured by photobeam interruption, was depressed following dosage with trans(–) ⁸ and - ⁹tetrahydrocannabinol. The effect was similar to that obtained with synhexyl, pentobarbital, and eserine, but directly opposite to the stimulatory effect obtained with Ditran and scopolamine. The depressant effect of the tetrahydrocannabinols, synhexyl and eserine was potentiated by tacrine while the stimulant effect of Ditran and scopolamine was antagonized. Pentobarbital did not reveal any interaction with tacrine. Thus, the tetrahydrocannabinols appeared to possibly have an anticholinesterase sedative-like action. The compatibility of the finding with earlier reports suggesting anticholinergic-like actions of tetrahydrocannabinols and the drug-behavior interaction implications are discussed.The research reported herein was supported by Grant No. 607-23-1 from the Canadian Department of National Health and Welfare. The tetrahydrocannabinol samples were generously supplied by Dr. A. B. Morrison, Deputy Director-General, Canadian Food and Drug Directorate.     

Differential attenuation of some effects of haloperidol in rats given scopolamine

In a series of pharmacologica tests the ability of 0.6 mg/kg of the anticholinergic scopolamine to decrease the effectiveness of the neuroleptic haloperidol varied widely. Most severely attenuated was production of catalepsy followed in order of decreasing interference by inhibition of amphetamine-induced rotation, inhibition of amphetamine- or apomorphine-induced stereotyped behavior, inhibition of conditioned avoidance responding and lastly attenuation of the haloperidol-induced increase in striatal HVA. By use of such a relatively low dose of scopolamine the behavioral effects of haloperidol were dissociated from effects on dopamine turnover in the striatum. If behavioral tests in animals can be related to the clinical effects of neuroleptic drugs, those effects of haloperidol severely reduced by scopolamine may be related to extrapyramidal effects.     

新抗胆碱化合物TBBB的M-受体拮抗作用与丁基东莨菪碱HBB及阿托品的比较

阿托品样药物是胆碱能M-受体的拮抗剂,用于胃肠道解痉及阻断其他胆碱能突触传递,副作用较多。近年来,溴丁东茛菪碱HBB用于胃肠道纤维内窥镜检查及解除平滑肌痉挛性疼痛,疗效满意,对心率影响较小。溴丁东莨菪碱的合成原料较困难,成本高。因此,希望找到有相仿效果的季胺类阿托品类药物。我院药化教研室合成了新化合物TBBB,试比较它与