Contraction Pressure Research Articles

The efficacy and safety of temperature controlled dual-mode radiofrequency in women with vaginal laxity

ObjectiveVaginal laxity could negatively influence women’s sexual function. This study aimed to explore the efficacy and safety of temperature controlled dual-mode (monopolar and bipolar) radiofrequency (RF) in women with vaginal laxity.MethodsA total of 102 patients with vaginal laxity were treated with temperature-controlled RF. The present study implemented Vaginal Laxity Questionnaire (VLQ), Female Sexual Function Index (FSFI) questionnaire and Sexual Satisfaction Questionnaire (SSQ) on all patients at baseline and after treatment. Pelvic Organ Prolapse Quantification System (POP-Q) system was applied to physical examination, and vaginal manometer to examine the strength of voluntary contractions of the pelvic floor muscles.ResultsThe VLQ score was gradually increased after RF treatment at 1, 3, 6 and 12 months, accompanying by the significant improvement in total FSFI scores and the six domains (sexual desire, sexual arousal, lubrication, orgasm, satisfaction, pain). The increased sexual satisfaction based on the SSQ score was found after temperature-controlled RF. The result of POP-Q stage showed significant difference in women after treatment, with the women having Stage I of 45.10% at baseline, 36.27% at 1 month, 28.43% at 3 months, 19.61% at 6 months and 10.78% at 12 months. The mean pressure and mean duration of pelvic contractions were increased gradually at the 1-, 3-, 6- and 12- month follow-up.ConclusionTemperature controlled dual-mode (monopolar and bipolar) radiofrequency may be associated with improvement of vaginal laxity, and contribute to enhancement to female sexual function and pelvic floor muscles.

Association of delivery mode and number of pregnancies with anorectal manometry data in patients with postpartum constipation

ObjectiveTo explore the association of delivery mode and the number of pregnancies with anorectal manometry data in patients with postpartum constipation.MethodsThis retrospective study included women with postpartum constipation treated at the pelvic floor rehabilitation department of Huzhou Maternity & Child Health Care Hospital between January 2018 and December 2019.ResultsAmong 127 patients included, 55 (43.3%) had one pregnancy, 72 (56.7%) had two pregnancies, 96 (75.6%) delivered spontaneously, 25 (16.7%) underwent Cesarean section, and six (4.7%) needed a Cesarean section despite spontaneous labor. The median duration of constipation was 12 months (range, 6–12). There were no differences between the two groups for any manometry parameters (all P > 0.05). The patients with a spontaneous delivery had a lower change in maximal contracting sphincter pressure compared with those with Cesarean section (14.3 (4.5–25.0) vs. 19.6 (13.4–40.0), P = 0.023). Only the delivery mode (Cesarean vs. spontaneous) independently affected the changes in contracting sphincter pressure (B = 10.32, 95%CI: 2.95–17.69, P = 0.006); age (P = 0.201), number of pregnancies (P = 0.190), and constipation duration (P = 0.161) were not associated.ConclusionThe patients with a spontaneous delivery had a lower change in maximal contracting sphincter pressure compared with those with a Cesarean section, suggesting that patients with Cesarean may retain a better “push” function during defecation.

A Bayesian Network Model for the Impacts of Psychosocial Hazards on the Mental Health of Site-Based Construction Practitioners

Although the influence of psychosocial hazards on mental health has been widely recognized, the complex pattern of psychosocial hazards in the prediction of mental health still needs to be identified. Bayesian networks serve as an important, and as yet untapped, method to achieve this aim. As such, a Bayesian network (BN) was developed to assess the influence of psychosocial hazards on mental health based on survey data from 186 site-based construction practitioners and informed by the literature and expert knowledge. Results indicated that 66% of this target population suffered from poor mental health (i.e., mild, moderate, and severe states). Poor physical environment, contract pressure, and lack of coworker support were the root nodes in the model, which played an important role in determining the probability of other psychosocial hazards. Lack of job control, lack of coworker support, role ambiguity, role conflict, and lack of supervisor support were, relatively, the most influential hazards to mental health. Jointly controlling multiple psychosocial hazards was found to be better for increasing the probability of good mental health than controlling one individual hazard. The predictive inference revealed that managing the combination of lack of job control, lack of coworker support, role conflict, and job insecurity achieved the highest probability (77%) of good mental health among all four-hazard scenarios. Based on this particular scenario, further optimizing poor physical environment resulted in the highest probability (83%) of good mental health for five-hazard scenarios. The proposed BN model can be used as a powerful decision support tool to improve mental health in the construction industry via managing a more targeted subset of psychosocial hazards.

Dietary Fish Oil Supplementation Attenuates Myocardial Dysfunction and Injury Caused by Global Ischemia and Reperfusion in Isolated Rat Hearts

To determine the effect of dietary fish oil supplementation on myocardial dysfunction following ischemia-reperfusion, independent of plasma and blood cells, Sprague-Dawley rats were fed fish oil-rich nonpurified diet or butter-enriched diet for 5 d. Myocardial content of long-chain and (n-3) polyunsaturated fatty acids was greater in the fish oil-fed rats (P < 0.01), whereas (n-6) fatty acid content was lower compared with controls (P < 0.01). Platelet aggregation in fish oil-fed rats was also inhibited. Hearts from all rats were subjected to 15 min of global ischemia and 10 min of reperfusion. In hearts of control rats, ischemia-reperfusion resulted in a marked decrease in force of cardiac contraction, increase in coronary perfusion pressure, appearance of ventricular arrhythmias and release of creatine kinase and thromboxane B2 in the coronary effluent. Dietary fish oil supplementation attenuated myocardial dysfunction induced by ischemia-reperfusion, as indicated by smaller change in force of cardiac contraction (-77% vs. -89%, P < 0.05) and coronary perfusion pressure (+37% vs. +71%, P < 0.001). Concomitantly, release of creatine kinase as well as thromboxane B2 in coronary effluent was lower (P < 0.01). Ventricular arrhythmias occurred less frequently in hearts from fish oil-fed rats. Thus, short-term dietary fish oil supplementation attenuates myocardial dysfunction caused by ischemia-reperfusion by a direct effect on the heart independent of blood and plasma components.

Low frequency neuromuscular electrical stimulation applied to the bulbospongiosus muscle prolongs the ejaculation latency in a rat model.

Premature ejaculation (PE) is common, but its true pathophysiology is not clear, and treatments are limited. We aimed to investigate the effect of neuromuscular electrical stimulation applied in different modes and frequencies to the bulbospongiosus muscle on ejaculation parameters. In this study, 24 male Wistar albino rats were used. The rats were equally divided into three groups: control, high-frequency burst (HFB) and low-frequency (LF) (n = 8 each). Neuromuscular electrical stimulation was applied to the rats for 30 min. In the HFB group, this stimulation was applied in the burst mode at 80 Hz frequency using 200 microseconds (µs) transition time. In the LF group, manual stimulation was applied using a 2 Hz frequency and 200 µs transition time. Following the intraperitoneal administration of para-chloroamphetamine at a dose of 5 mg/kg, ejaculation time, increase in basal seminal vesicle pressure, seminal vesicle maximum pressure, number and interval time of seminal vesicle contractions and bulbospongiosus muscle electromyography activities were evaluated over 30 min. There was a significant difference between the groups in terms of ejaculation time (p = 0.002). The ejaculation times of the LF, HFB and control groups were 1344.71 ± 105.9, 908 ± 62 and 672 ± 149.7 s, respectively. The post hoc analysis revealed that the ejaculation time of the LF group was significantly longer than that of the HFB and control groups (p = 0.033 and p = 0.001, respectively). The remaining parameters did not differ significantly between the groups. The results showed that low-frequency (2 Hz) electrical stimulation applied to the male rats significantly prolonged the ejaculation time. It is thus considered that applying neuromuscular electrical stimulation before planned sexual activity can prevent the rhythmic contractions necessary for completing the ejaculatory process by maintaining subtetanic continuous contraction and prolonging the ejaculation time in patients with premature ejaculation complaints.

A machine learning pipeline to classify foetal heart rate deceleration with optimal feature set

Deceleration is considered a commonly practised means to assess Foetal Heart Rate (FHR) through visual inspection and interpretation of patterns in Cardiotocography (CTG). The precision of deceleration classification relies on the accurate estimation of corresponding event points (EP) from the FHR and the Uterine Contraction Pressure (UCP). This work proposes a deceleration classification pipeline by comparing four machine learning (ML) models, namely, Multilayer Perceptron (MLP), Random Forest (RF), Naïve Bayes (NB), and Simple Logistics Regression. Towards an automated classification of deceleration from EP using the pipeline, it systematically compares three approaches to create feature sets from the detected EP: (1) a novel fuzzy logic (FL)-based approach, (2) expert annotation by clinicians, and (3) calculated using National Institute of Child Health and Human Development guidelines. The classification results were validated using different popular statistical metrics, including receiver operating characteristic curve, intra-class correlation coefficient, Deming regression, and Bland-Altman Plot. The highest classification accuracy (97.94%) was obtained with MLP when the EP was annotated with the proposed FL approach compared to RF, which obtained 63.92% with the clinician-annotated EP. The results indicate that the FL annotated feature set is the optimal one for classifying deceleration from FHR.

딥벨트의 가로막 수축압력과 초음파영상의 가로막 움직임 및 폐활량과의 상관성

Purpose: This study was designed to determine the correlation between the diaphragmatic contraction pressure using diaphragmatic pressure belt (DiP Belt) and the ultrasound imaging of diaphragmatic motion and forced vital capacity. This study was conducted to confirm the usefulness of assessing the diaphragmatic function using the DiP Belt.&#x0D; Methods: This study included 41 healthy subjects (13 males and 28 females). The diaphragmatic motion was measured using sonography, and the forced vital capacity (FVC) was measured using a portable digital spirometer device. After 2 weeks, the diaphragmatic contraction pressure was measured during maximal inspiration using the DiP Belt.&#x0D; Results: The mean diaphragmatic contraction pressure (MDCP) and peak diaphragmatic contraction pressure (PMCP) using the DiP Belt were not significantly correlated with sonography imaging of diaphragmatic motion during quiet breathing but were significantly positively correlated with the diaphragmatic motion during deep breathing. Both the MDCP and PMCP were significantly positively correlated with FVC, forced expiratory volume in 1 second (FEV1), and peak expiratory flow (PEF). However, diaphragmatic motion was significantly positively correlated with FVC, FEV1, and PEF in only deep breathing.&#x0D; Conclusion: The Dip Belt can provide valuable information about the diaphragmatic function, particularly ultrasound imaging of diaphragmatic motion and lung capacity.

Urodynamic characteristics of adult men with mixed detrusor overactivity with detrusor underactivity: A database analysis

Objective: To examine the urodynamic characteristics of men with mixed detrusor overactivity with detrusor underactivity (DODU) across the entire adult-age spectrum. Materials and Methods: Data included all adult men who underwent urodynamics for refractory non-neurogenic lower tract symptoms between 2011 and 2019. DODU was defined as the concomitant presence of detrusor overactivity (DO) during storage with underactivity (bladder contractility index, BCI &lt; 100) during voiding. Nonparametric tests with multiple hypothesis correction were used (SPSS 25.0). Results: DODU was noted in 199/1596 men (12.5%; median, 62 years). Men with DODU were older than men with detrusor underactivity (DU) or DO alone (median, 62, 48 and 56 years, respectively). DODU was commoner in older men but was noted across all age groups. As compared to men with isolated DU, men with DODU were more likely to be obstructed (38.7% versus 23.6%) and had better contractility (median BCI 81 versus 75). Peak detrusor contraction pressure during overactivity was lower in men with DODU than men with isolated DO. Conclusion: DODU should not be regarded as an exclusively geriatric disease. Differences in urodynamic characteristics suggest that this condition might not just be the coincidental occurrence of DO and underactivity in the same individual. Level of evidence: III

Evaluation of Dysphagia and Inhalation Risk in Neurologically Impaired Children Using Esophageal High-Resolution Manometry with Swallowing Analysis.

Dysphagia in neurologically impaired children is associated with feeding difficulties, malnutrition and aspiration pneumonia. Esophageal high-resolution manometry (HRM) has been used in the diagnosis of motility disorders affecting the swallowing process. The aim of this study was to analyze swallowing functions in NI children by using HRM in order to establish swallow parameters identifying inhalation risk. Twenty-five NI children with cerebral palsy were submitted to esophageal HRM with UES analysis, comparing the results with non-NI children. The following parameters were evaluated: maximum pressure and duration of contraction of the velopharynx (VP) and tongue base (TB), and maximal, minimal, resting pressure and relaxation duration of the upper esophageal sphincter (UES). pVP max, pTB max, pUES max and resting pressure were lower, while p UES minimal was higher and relaxation duration was shorter in NI children vs. the control group. Predictive values of inhalation risk were evaluated. This study evaluates inhalation risk in NI children using HRM to study UES function. Our results confirm the alterations described in NI children: insufficient contraction and clearing force for bolus transmission through the pharynx and incomplete UES relaxation can predispose to pharyngeal residues and inhalation independently of swallowing because of lower values of UES resting.

The Effect of the Contraction Pressure of the Hip Adductor Muscles on Thickness of Transversus Abdominis: A Randomized Controlled Trial

The Effect of the Contraction Pressure of the Hip Adductor Muscles on Thickness of Transversus Abdominis: A Randomized Controlled Trial

Novel botulinum neurotoxin-A tibial nerve perineural injection to alleviate overactive bladder symptoms in male rats

ABSTRACT Although tibial nerve modulation has shown to induce positive changes in the overactive bladder (OAB), prolonged therapeutic effects using percutaneous stimulation have not yet been achieved. Intradetrusor onabotulinum toxin A injection can provide prolonged therapeutic effects; however, its delivery requires invasive measures. By applying local relief of tibial nerve neural entrapment with onabotulinum toxin A injection, this study investigated the feasibility and efficacy of combining the abovementioned two therapeutic strategies. An OAB animal model was developed using 12 adult Sprague–Dawley rats with cyclophosphamide intraperitoneal injection. A perineural injection site comparable to the tibial nerve perineural injection site and corresponding to that in humans was identified and developed in rats. The toxin was injected five days after establishing the OAB. The incision was made in the skin on the lateral surface of the thigh. The biceps femoris muscle was cut across, exposing the sciatic nerve and its three terminal branches: the sural, common peroneal, and tibial nerves, and 100 units of onabotulinum toxin A was injected into the surrounding tissue. Five days following injection, cystometry was performed. Inter-contraction time, contraction pressure, and interval of the disease state improved with statistical significance. The OAB animal model showed significant improvement with the tibial nerve perineural injection of botulinum toxin, thereby suggesting the possibility of a comparable treatment adaptation in humans.

Contraction pressure analysis using optical imaging in normal and MYBPC3-mutated hiPSC-derived cardiomyocytes grown on matrices with tunable stiffness

Current in vivo disease models and analysis methods for cardiac drug development have been insufficient in providing accurate and reliable predictions of drug efficacy and safety. Here, we propose a custom optical flow-based analysis method to quantitatively measure recordings of contracting cardiomyocytes on polydimethylsiloxane (PDMS), compatible with medium-throughput systems.Movement of the PDMS was examined by covalently bound fluorescent beads on the PDMS surface, differences caused by increased substrate stiffness were compared, and cells were stimulated with β-agonist. We further validated the system using cardiomyocytes treated with endothelin-1 and compared their contractions against control and cells incubated with receptor antagonist bosentan. After validation we examined two MYBPC3-mutant patient-derived cell lines.Recordings showed that higher substrate stiffness resulted in higher contractile pressure, while beating frequency remained similar to control. β-agonist stimulation resulted in both higher beating frequency as well as higher pressure values during contraction and relaxation. Cells treated with endothelin-1 showed an increased beating frequency, but a lower contraction pressure. Cells treated with both endothelin-1 and bosentan remained at control level of beating frequency and pressure. Lastly, both MYBPC3-mutant lines showed a higher beating frequency and lower contraction pressure.Our validated method is capable of automatically quantifying contraction of hiPSC-derived cardiomyocytes on a PDMS substrate of known shear modulus, returning an absolute value. Our method could have major benefits in a medium-throughput setting.

Initiating daily acute intermittent hypoxia (dAIH) therapy at 1-week after contusion spinal cord injury (SCI) improves lower urinary tract function in rat

Spinal cord injury (SCI) above the level of the lumbosacral spinal cord produces lower urinary tract (LUT) dysfunction, resulting in impairment of urine storage and elimination (voiding). While spontaneous functional recovery occurs due to remodeling of spinal reflex micturition pathways, it is incomplete, indicating that additional strategies to further augment neural plasticity following SCI are essential. To this end, acute intermittent hypoxia (AIH) exposure has been proposed as a therapeutic strategy for improving recovery of respiratory and other somatic motor function following SCI; however, the impact of AIH as a therapeutic intervention to improve LUT dysfunction remains to be determined. Therefore, we examined the effects of daily AIH (dAIH) on both spontaneous micturition patterns and reflex micturition event (rME) behaviors in adult female Sprague-Dawley rats with mid-thoracic moderate contusion SCI. For these experiments, dAIH gas exposures (five alternating 3 min 12% O2 and 21% O2 episodes) were delivered for 7 consecutive days beginning at 1-week after SCI, with awake micturition patterns being evaluated weekly for 2–3 sessions before and for 4 weeks after SCI and rME behaviors elicited by continuous infusion of saline into the bladder being evaluated under urethane anesthesia at 4-weeks after SCI; daily normoxia (dNx; 21% O2 episodes) served as a control. At 1-week post-SCI, both an areflexic phenotype (i.e., no effective voiding events) and a functional voiding phenotype (i.e., infrequent voiding events with large volumes) were observed in spontaneous micturition patterns (as expected), and subsequent dAIH, but not dNx, treatment led to recovery of spontaneous void frequency pattern to pre-SCI levels; both dAIH- and dNx-treated rats exhibited slightly increased void volumes. At 4-weeks post-SCI, rME behaviors showed increased effectiveness in voiding in dAIH-treated (compared to dNx-treated) rats that included an increase in both bladder contraction pressure (delta BP; P = 0.014) and dynamic voiding efficiency (P = 0.018). Based on the voiding and non-voiding bladder contraction behaviors (VC and NVC, respectively) observed in the BP records, bladder dysfunction severity was classified into mild, moderate, and severe phenotypes, and while rats in both treatment groups included each severity phenotype, the primary phenotype observed in dAIH-treated rats was mild and that in dNx-treated rats was moderate (P = 0.044). Taken together, these findings suggest that 7-day dAIH treatment produces beneficial improvements in LUT function that include recovery of micturition pattern, more efficient voiding, and decreased NVCs, and extend support to the use of dAIH therapy to treat SCI-induced LUT dysfunction.

Vascular smooth muscle ion channels in essential hypertension.

Hypertension is a highly prevalent chronic disease and the major risk factor for cardiovascular diseases, the leading cause of death worldwide. Hypertension is characterized by an increased vascular tone determined by the contractile state of vascular smooth muscle cells that depends on intracellular calcium levels. The interplay of ion channels determine VSMCs membrane potential and thus intracellular calcium that controls the degree of contraction, vascular tone and blood pressure. Changes in ion channels expression and function have been linked to hypertension, but the mechanisms and molecular entities involved are not completely clear. Furthermore, the literature shows discrepancies regarding the contribution of different ion channels to hypertension probably due to differences both in the vascular preparation and in the model of hypertension employed. Animal models are essential to study this multifactorial disease but it is also critical to know their characteristics to interpret properly the results obtained. In this review we summarize previous studies, using the hypertensive mouse (BPH) and its normotensive control (BPN), focused on the identified changes in the expression and function of different families of ion channels. We will focus on L-type voltage-dependent Ca2+ channels (Cav1.2), canonical transient receptor potential channels and four different classes of K+ channels: voltage-activated (Kv), large conductance Ca2+-activated (BK), inward rectifiers (Kir) and ATP-sensitive (KATP) K+ channels. We will describe the role of these channels in hypertension and we will discuss the importance of integrating individual changes in a global context to understand the complex interplay of ion channels in hypertension.

Energy Analysis and Verification of a Constant-Pressure Elastic-Strain Energy Accumulator Based on Exergy Method

Focusing on the low energy-storage efficiency and unstable energy output of existing accumulators, this paper proposes a novel constant-pressure elastic-strain energy accumulator based on the rubber material hyperelastic effect. The proposed accumulator can store and release energy at a constant pressure. Based on the exergy analysis method, the charging/discharging energy storage efficiency of a constant-pressure elastic-strain energy accumulator was analyzed. Then, the Mullins effect on the rubber airbag over multiple charging/discharging cycles was studied. Finally, a test platform was established to verify the energy storage efficiency, as well as the expansion and contraction pressure stability of the rubber accumulator during charging/discharging cycles. The experimental results showed that the energy storage efficiency calculation by the exergy analysis method was more accurate compared with the enthalpy analysis method. In tests with more than 200 cycles, the rubber airbag energy storage efficiency was always higher than 76%, and the expansion and contraction pressure errors at a steady state were less than 2.92 and 1.79 kPa, respectively. The results showed that the rubber airbag could be used as an effective energy storage component, which is very meaningful for energy recovery in pneumatic or hydraulic systems.

Некоторые особенности экстрахрусталиковой аккомодации в условиях горизонтальных конвергентных и дивергентных напряжений

Purpose. To study the features of extralenticular accommodation in horizontal convergence and divergence stresses. Material and methods. The study involved 25 students including 18 girls and 7 boys (50 eyes) with mild myopia, whose average age was 21.7 years. The refraction value was determined by the subjective method and averaged (-) 1.5 dptr. Pairs of prismatic lenses with a power of 2.0 dptr were used as an effective optical accommodation model. The lenses were mounted in a spectacle frame with their bases either to the temple or to the nose. A comparative assessment of the features of the extralenticular capabilities of the visual system was carried out by determining the binocular stability of visual perception to hypermetropic retinal defocus. Results. The study of visual perception stability in far-vision mode in the absence of vergence stress revealed that the total value of the visual resolution was 564 %. Under convergence stress, the total value of the visual resolution was equal to 989 %, and under divergence stress, it was 988 %. In studies without any vergenсe stress, the avergence accommodation curve had a smooth downward trend. In studies of visual systems under vergence stresses, curves had a concave arc shape and turned downward abruptly in the middle. Conclusions. Convergence and divergence movements can stimulate combined lenticular and extralenticular accommodation caused by ciliary muscle contraction and oculomotor muscle pressure on the eye sclera. Extraocular muscle pressure causes temporary deformation of the eyeball, that leads to a temporary change in the eye refraction. Keywords: extralenticular accommodation, convergence and divergence stresses, temporary deformation of the eyeball.

Black Holes as the Source of All Matter and Radiation in the Universe

An in-depth study of general relativity has led to the development of a theory, CBU for the continuously breeding universe, in which the universe emerges from a quantum fluctuation and continues to expand due to the inflow of new matter, foremostly electrons and positrons. According to a novel model for black holes, a continuous inflow of matter prevents the black holes from becoming singularities, the contraction pressure is counteracted by the expansion pressure. The study shows that the gravitational energy gap between the event horizon and the inner photon sphere of a black hole is the source of incoming real matter from a QED vacuum foam of virtual particles. The calculated CBU results are in good agreement with current observations.

Effects of trigeminal nerve stimulation on parameters derived from pulse wave analysis in young healthy subjects.

Studies on trigeminal nerve stimulation (TNS) by facial cooling (FC) could give an insight to physiological mechanisms of cardiovascular response to activation of both parasympathetic and sympathetic nervous systems. We hypothesised that trigeminal nerve stimulation would positively influence on the factors which increase left ventricle work. The aim of the present study was to investigate hemodynamic changes assessed by pulse wave analysis (PWA) in the very early phase of this reflex. In 15 young (aged 20.3±1.3 y/o; mean ±SD) healthy individuals (10 males) PWA was performed before and after 30 seconds of FC. TNS caused decrease in heart rate (76.8±9.4 bpm vs 66.6±9.8 bpm; p=0.0038; mean ±SD) and increase in peripheral diastolic blood pressure (68±5.9 mmHg vs. 70.9±8.6 mmHg; p=0.028; mean ±SD) and no changes in other blood pressure values (peripheral and central), nor augmentation index were observed. PWA showed decrease in time of the peak pressure of left ventricle contraction (107.6±15.9 ms vs. 100.2±12.06 ms; p=0.027; mean ±SD), increase in time of the peak pressure of the reflected wave return (cT2, 187±28.03 ms vs 198.6±27.9 ms; p=0.028; mean ±SD) and increase in the difference between cT2 and time of the beginning of the reflected wave return (43.3±18.7 ms vs. 59.7 vs. 59.7±20.99 ms; p=0.0076; mean ±SD). We conclude that in the early phase of response to TNS, there is an increase in contractility of left ventricle and aortic compliance, as well as increase in peripheral vascular resistance and pressure load of returning pulse wave occurs.

Early endoscopic injection may prevent new scarring in idiopathic detrusor overactivity disorder with vesicoureteral reflux in children.

To present baseline characteristics and the long-term treatment results of three groups of patients with idiopathic detrusor overactivity (IDOD) and vesicoureteral reflux (VUR) according to different treatment regimens, which underwent endoscopic subureteric injection (STING) in the early phase of targeted treatment (TT) (ES group), underwent STING in the late phase of TT (LS group) and with TT only (TT group). A total of 49 IDOD cases with VUR which were divided into three groups according to treatment regimens were evaluated in terms of age, symptoms, bladder capacities, involuntary contraction pressures (ICP), presence and degree of renal scar, differential renal functions (DF), new scar formation and STING success. There was no significant difference between the groups in terms of age, side, symptoms, presence of urinary tract infection (UTI), DF, ICP and bladder capacity at diagnosis. A high grade of reflux was found to be significantly lower in the TT group (p = 0.037). There was no significant difference in terms of ICP, DF, bladder capacity and reflux grade between ES and LS Group. But new scar formation was more in LS Group (p = 0.003). The STING success is satisfactory in IDOD cases with VUR, waiting a long period of time for diminishing symptoms may cost new scar formation.

Use of Polymyxin B Hemoperfusion in Heart Transplant Patient for Septic Shock

<h3>Introduction</h3> We report the case of a 61-year-old heart transplant patient who developed <i>A. baumannii</i> bilateral pneumonia (MDR-AB) which progressed into septic shock. The patient was treated with antibiotics and Polymyxin B Hemoperfusion resulting in complete resolution of the septic shock. <h3>Case Report</h3> A 61-year-old patient with idiopathic dilatated cardiomyopathy underwent heart transplantation with a regular post-operative course. Post-transplant echocardiogram showed satisfying biventricular contraction (EF 55 %, Tapse 23 mm) and normal pulmonary pressures (PAPs 29 mmHg). On the 15^th day after surgery, he suffered from hyperpyrexia and marked hypotension. The chest X-ray revealed a bilateral pneumonia. He was transferred to the intensive care unit where he was treated with catecholaminergic therapy with IV norepinephrine (0,2 y/kg/min) and antibiotic therapy with meropenem, colistin and ampicillin/sulbactam. In the following 24 hours, we observed a worsening of the respiratory function and oliguria (10 ml/h); therefore, the patient was sedated and intubated and started dialytic treatment. Severe myelosuppression also occurred with a white blood cell count lower than 600 cells/mmc. The scoring systems for the evaluation of critical patients in the ICU were elevated (SOFA score 13; Apache II Score 21; MODS Score 13). The immunosuppressant therapy with tacrolimus was reduced in order to reach a range of serum levels of 5-7 ng/ml. Endotoxemia was 1172 pg/mL (<b>EAA™</b>1 0,63 <b>EAA™</b>2 0,66). A cycle of Polymyxin B Hemoperfusion connected to the dialysis circuit was performed. At the end of two treatments, with a pause of 22 hours in between, we witnessed a significant reduction of endotoxemia: 150 pg/mL (<b>EAA™</b>1 0,11 <b>EAA™</b>2 0,14). In the following days, inflammation indexes decreased (PCT 31 ng/mL→ 1,7 ng/mL), respiratory function recovered (p02 65 → 110), leading to extubation, hemodynamics improved and inotrope support was suspended, white blood cell count increased (WBC 600 cells/mmc → 3300 cells/mmc). <h3>Summary</h3> In our experience, the prompt use of combined IV antibiotic therapy and Polymyxin B Hemoperfusion for septic shock with heart transplant patients has improved the outcome, thus reducing the duration of inotrope and antibiotic therapy and intubation.