Void Time Research Articles

PD04-02 SUPRASPINAL CONTROL VARIAITONS IN MULTIPLE SCLEROSIS PATIENTS WHO VOID SPONTANOUSLY VERUS PATIENTS WITH VOIDING DYSFUNCTION

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Neurogenic Voiding Dysfunction I1 Apr 2018PD04-02 SUPRASPINAL CONTROL VARIAITONS IN MULTIPLE SCLEROSIS PATIENTS WHO VOID SPONTANOUSLY VERUS PATIENTS WITH VOIDING DYSFUNCTION Rose Khavari, Christof Karmonik, and Timothy Boone Rose KhavariRose Khavari More articles by this author , Christof KarmonikChristof Karmonik More articles by this author , and Timothy BooneTimothy Boone More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.280AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In this study, we seek to compare brain activity processes at the time of initiation of voiding in Multiple Sclerosis (MS) patients who are voiders versus patients with voiding dysfunction. We hypothesize that female MS patients with voiding dysfunction have a distinct Blood Oxygen Level Dependent (BOLD) pattern activation in specific a priori regions of interest (ROIs) at the time of initiation of voiding when compared to patients who void spontaneously. METHODS Twenty seven ambulatory female MS patients with lower urinary tract dysfunction were recruited for this IRB approved study: Group 1; voiders (n=15) and group 2; voiding dysfunction (n=12) which was defined as patients with postvoid residual urine of = 40% of their maximum cystometric capacity or patients who performed self-catheterization. We recorded brain activity via fMRI with simultaneous urodynamic testing (UDS). From the transformed datasets, average fMRI activation maps (student t-test) for both groups were created, and areas of significant activation were identified (p<0.05). A priori ROIs identified by a prior meta-analysis to be involved in voiding were selected. RESULTS Group-averaged BOLD activation maps indicated distinct differences in activation patterns between groups (figure 1a). A reversed (negative) BOLD effect was noted in the PMC, PAG, left cingulate, left thalamus and the reticular formation. Interpretation of results Earlier positron emission topography studies have identified right dorsomedial pontine tegmentum and the right inferior frontal gyrus to be associated with significantly increased blood flow in healthy women at the time of voiding. Our results are consistent with these preliminary data in the literature where PMC, PAG, left cingulate, left thalamus and the reticular formation seem to have different pattern of activation between female MS voiders and the ones with voiding dysfunction. CONCLUSIONS Our preliminary group and network analyses demonstrate that distinct supraspinal patterns of activation and deactivation exists between MS patients who are voiders and who have voiding dysfunction. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e77-e78 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Rose Khavari More articles by this author Christof Karmonik More articles by this author Timothy Boone More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Influence of comprehensive nursing intervention on the self-care ability and rehabili-tation of anal fistula surgical patients

Objective To explore and analyze the influence of comprehensive nursing intervention on the self-care ability and rehabilitation of anal fistula surgical patients. Methods A total of 112 anal fistula surgical patients received in this hospital from February, 2013 to May, 2015 were selected, divided into experimental group and control group randomly.In addition, usual nursing mode was applied to the patients of control group to have postoperative nursing intervention, but comprehensive nursing intervention measures were conducted to the patients of experimental group to clinically observe the self-care ability and rehabilitation of patients in both groups. Results The self-concept, health knowledge level, self-responsibility and other self-care scores of patients in control group were significantly lower than the patients in experimental group.With regard to the data comparison of patients in both groups, the difference had statistical significance(P<0.05). VAS score measured 3 days before surgery of patients in experimental group was significantly lower than the patients in control group.The first voiding time of patients in experimental group was shorter than it of control group.In addition, catheterization rate, uroschesis occurrence rate and urinary irritation occurrence rate of patients in experimental group were significantly lower than it of control group.The hospital stay of patients in control group was significantly longer than it of experimental group.Moreover, the nursing satisfaction of patients in experimental group was higher than it of control group.With regard to the data comparison of patients in both groups, the difference had statistical significance(P<0.05). Conclusions The self-care ability and rehabilitation can have better clinical effect after comprehensive nursing intervention is conducted to anal fistula surgical patients, by which it can largely reduce postoperative pain and uroschesis occurrence rate for the patients. Meanwhile, it also improves the nursing satisfaction with patients, which is worth popularizing and applying clinically. Key words: Comprehensive nursing; Anal fistula; Retention of urine; Postoperative pain

Reducing the Use of Indwelling Urinary Catheters During Cesarean Deliveries

One concern for medical professionals and women experiencing cesarean deliveries is the use of indwelling urinary catheters, which is associated with a delay in first void time, slower ambulation time, increased discomfort, longer hospital stays, and an increased risk for urinary tract infections. The purpose of this project was to determine if a practice change regarding the use of urinary catheters among pregnant women decreases the number of women receiving a catheter prior to having a cesarean section in a small community hospital. The knowledge to action and Rosswurm and Larabee’s models were used to guide this project, which was comprised of 2 phases. Phase 1 included a team of 10 experts that created the needs assessment that would establish hemodynamic stability using a 4-point scale. The items for inclusion in the needs assessment included primary cesarean, repeat cesarean, no urinary tract infection present, no fetal distress present, no systemic disorders present, no hypertensive disorders present, and no contraindications for anesthesia. Phase 2 was the implementation and evaluation of the needs assessment and new practice guidelines. Statistical analysis was performed using the Mann Whitney U test. There was 98% compliance (p &lt; 0.001.) with the use of the assessment in women undergoing a cesarean delivery and a 64% reduction in the length of time an indwelling catheter was left in place. However, there was no significant change in the number of women receiving a catheter prior to cesarean delivery after a needs assessment was performed (p = 0.805). This project has potential implications that would support social change by reducing the use of indwelling catheters among hemodynamically stable women undergoing cesarean deliveries. Key words: Indwelling catheter, Urinary catheter, Foley, Cesarean, C-section

Impact of instrument and column parameters on high-throughput liquid chromatography performance

The speed and separation performance of high-throughput liquid chromatography (HT LC) was investigated. We evaluated the contributions of various experimental parameters to the total analysis cycle time, including column length (column void time), gradient delay, flow rate, auto-sampler (A/S) speed, and software related delays. The best case injection-to-injection cycle time of 22s was achieved using 12s gradient time and 2.1×20mm columns packed with 1.7μm C18 particles. The total 22s analytical duty cycle consisted of 2.5s column void time, 1.8s gradient delay, 12s gradient time, and approximately 5.7s for software setup delay time that served as column re-equilibration time. The achieved peak capacity for an alkylphenone sample was approximately 35, giving a peak production rate of 95 peaks per minute. We estimated the impact of LC system dispersion on peak capacity and peak production rate (peak capacity per unit of time). For HT LC scenarios (5–50mm columns and 4.8–120s long gradients) we observed that even a minor amount of system dispersion (2μL2) reduces the achievable peak capacity and peak productivity rate significantly. HT LC–MS analysis using 2.1×5mm guard column with duty cycle of 22s was successfully demonstrated.

Optimal mixing rate in reverse phase liquid chromatography. Experimental evaluations

The topic of this report is experimental verification of previously published theoretical predictions. The mixing rate (Rϕ) is the temporal rate of increasing a fraction of stronger solvent in the mobile phase of gradient LC. The optimal Rϕ (Rϕ,Opt) is the one at which a required peak capacity (n) of gradient LC analysis is obtained in the shortest time. The key factors affecting Rϕ,Opt are the sample molecular weight (M), the void time (tM), and the column pressure condition − Rϕ,Opt in a column operating below the instrumental pressure limit is 2–3 times higher than Rϕ,Opt in a column operating at the instrumental pressure limit. Using previously proposed speed optimization criteria, t/si, where t, s and i are the analysis time, the separation capacity (a metric proportions to n), and the order (i=2 or i=4 for analyses operating below or at the instrumental pressure limit, respectively), parameter Rϕ,Opt for analyses of small-molecule samples has been experimentally found. For both orders, the agreement with the theoretical prediction can be considered as very good. Base on the experimental results, we continue to recommend the earlier proposed theoretically based mixing rate of 5%/tM as a default for all analyses of small-molecule samples (100<M<400), and 50%3/M/tM for larger molecules.Experimental evidence is also provided to explain why earlier published less accurate equations for peak capacity and analysis time are not suitable for theoretical prediction of Rϕ,Opt.

Clinical observation of Chinese herbal hot compress combined with moxibustion in the treatment of uroschesis after orthopedic surgery

Objective To observe the clinical curative effect of traditional Chinese medicine hot compress combined with moxibustion in the treatment of urinary retention after orthopedic surgery. Methods 56 patients with postoperative uroschesis who underwent orthopedic surgerywere randomly divided into observation group and control group, and 28 cases in each group. All patients underwent pelvic muscle training, psychological counseling before surgery, and physical therapy with conventional methods such as induction of urination after surgery. The control group was treated with moxibustion Ququan acupoint, and the observation group was treated with Chinese herbal medicine hot compress on the basis of the above treatment. The patients in both two groups were treated for 28 days. At the end of the treatment, the clinical efficacy of the two groups was evaluated, also the time of first voiding after operation, the average effective time, urinary tract infection and urinary catheter replacement rate were compared. Results The total effective rate was 92.86% in the observation group and 78.57% in the control group.The effective rate in the observation group was higher than that in the control group (χ2=46.86, P 0.05). The urinary catheter replacement rate in the observation group was 7.14%, which was lower than 21.43% in the control group, the difference was statistical significance (χ2=2.33, P<0.05). Conclusion The clinical curative effect of traditional Chinese medicine hot compress combined with moxibustion in the treatment of urinary retention after orthopedic surgery is better than moxibustion alone. The time of first urination and the average time of effect are shortened, and the rate of urinary catheter replacement is reduced. It is effective, simply and conductively to clinical use. Key words: Drugs, Chinese herbal; Moxibustion; Urinary Retention

Low-dose Desmopressin and Tolterodine Combination Therapy for Treating Nocturia in Women with Overactive Bladder: A Double-blind, Randomized, Controlled Study.

Evaluation of safety and efficacy of desmopressin/tolterodine combination therapy in women. This double-blind, randomized, proof-of-concept study enrolled 106 patients (≥18 years), with overactive bladder (OAB) and nocturia, with ≥2 nocturnal voids, receiving a 3-month once-daily combination (desmopressin 25 µg, orally-disintegrating tablets [ODT]/tolterodine 4 mg [Detrol® LA]; n = 49) or monotherapy (tolterodine 4 mg/placebo ODT; n = 57). Primary endpoint was change from baseline in mean number of nocturnal voids. Secondary endpoints were change from baseline in nocturnal voided volume, time to first nocturnal void, and quality-of-life. Post-hoc exploratory analysis were performed for patients with and without baseline nocturnal polyuria (NP, n = 47 each). Overall population showed a non-significant reduction in mean number of nocturnal voids with combination versus monotherapy (full analysis set: adjusted treatment contrast [TC], -0.34; P = 0.112). Change in mean nocturnal void volume (TC, -64.16 mL; P = 0.103), mean time to first nocturnal void (TC, 18.00 min; P = 0.385) and Nocturia Impact (NI) Diary© scores were comparable. In post-hoc analysis, NP patients showed a benefit with combination versus monotherapy for nocturnal void volume (P = 0.034) and time to first nocturnal void (P = 0.045), and a non-significant improvement in NI Diary© scores. Safety profile was comparable between treatments. A single transient event of asymptomatic clinically significant hyponatremia in combination group resolved subsequently. Low-dose desmopressin could be safely combined with tolterodine for treating nocturia in women with OAB, with a significant benefit in women with NP. Further, prospective validation studies of combination therapy are warranted in mixed NP/OAB population, based on this favorable proof-of-concept finding.

Ground penetrating radar response from voids: A demonstration using a simple model

A simple Ricker wavelet model can be used to illustrate some fundamental properties of the ground penetrating radar (GPR) response from both air- and water-filled voids. Reflections from the top and the bottom of a void overlap significantly, and generate one common characteristic of a void response: a “bright spot”, analogous to the “bright spot” observed in seismic exploration. For time delays equal to about half the pulsewidth, the reflected wavelets superimpose to yield maximum reflection amplitudes. The top reflected wavelet becomes completely separated from the bottom reflected wavelet when the void time delay exceeds twice the wavelet pulsewidth. The two wavelet reflections can be individually identified at earlier time delays, approximately equal to the wavelet pulsewidth. This is still substantial and explains why it is difficult to use GPR to infer void thicknesses, especially for air-filled voids.

Effects of an EP2 and EP3 Receptor Dual Agonist, ONO-8055, on a Radical Hysterectomy-Induced Underactive Bladder Model in Monkeys.

The objective was to develop an underactive bladder (UAB) model in primates and to evaluate the potential of prostanoid EP2 and EP3 receptor dual agonist ONO-8055 to become a therapeutic agent for UAB. A surgical procedure resembling radical hysterectomy was performed on female cynomolgus monkeys. Subsequently, in vitro muscle strip studies were performed using bladder muscle strips from normal monkeys and monkeys that underwent surgery. In addition, uroflowmetric data were obtained at specified days after the surgery. To evaluate the effects of ONO-8055 and distigmine (DIS) on voiding function in the UAB monkey model, uroflowmetry was performed approximately 1 week after the surgery, before and after the cumulative intravenous administration of the compounds at 2 h intervals. In the bladder muscle strip studies, the responses to potassium chloride at 2 months, and carbachol and electrical field stimulation from 2 weeks decreased significantly. Voided volume (VV), maximum flow rate (Qmax), and average flow rate (Qave) decreased after surgery, while voiding time (VT) increased. In this model, ONO-8055 and DIS significantly increased VV and Qmax. DIS prolonged VT, while ONO-8055 had no effect. The results also showed that ONO-8055 increased Qave. We developed a neurogenic UAB model in primates. As ONO-8055 improved voiding function in this model to at least the same degree as DIS, this EP2 and EP3 receptor dual agonist has the potential to be a candidate for neurogenic UAB pharmacotherapy.

MP31-05 IMPACT OF BRAIN-TYPE NATRIURETIC PEPTIDE, A REPRESENTATIVE BIOMARKER FOR CARDIAC LOAD, ON NOCTURIA IN MEN.

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction I1 Apr 2017MP31-05 IMPACT OF BRAIN-TYPE NATRIURETIC PEPTIDE, A REPRESENTATIVE BIOMARKER FOR CARDIAC LOAD, ON NOCTURIA IN MEN. Keita Izumi, Masaya Ito, Masaharu Inoue, Toshiki Kijima, Soichiro Yoshida, Minato Yokoyama, Junichiro Ishioka, Yoh Matsuoka, Kazutaka Saito, Kazunori Kihara, and Yasuhisa Fujii Keita IzumiKeita Izumi More articles by this author , Masaya ItoMasaya Ito More articles by this author , Masaharu InoueMasaharu Inoue More articles by this author , Toshiki KijimaToshiki Kijima More articles by this author , Soichiro YoshidaSoichiro Yoshida More articles by this author , Minato YokoyamaMinato Yokoyama More articles by this author , Junichiro IshiokaJunichiro Ishioka More articles by this author , Yoh MatsuokaYoh Matsuoka More articles by this author , Kazutaka SaitoKazutaka Saito More articles by this author , Kazunori KiharaKazunori Kihara More articles by this author , and Yasuhisa FujiiYasuhisa Fujii More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.959AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Congestive heart failure (CHF) has been assumed to be one of the causes of nocturia. The relationship between nocturia and the extent of cardiac load, however, has not been fully examined. Brain-type natriuretic peptide (BNP) is a diuretic and vasodilatory hormone that is secreted in response to the left ventricular load and reported to be associated with the severity of CHF. Moreover, BNP can reflect the cardiac load before cardiac symptoms develop (Adnan Nadir et al., J Am Coll Cardiol HF 2015). In this study, we aimed to investigate the influence of the cardiac load evaluated by BNP on nocturia. METHODS This retrospective study included 431 men whose BNP levels were evaluated before prostate biopsy between 2014 and 2016. We assessed the frequency of nocturnal voiding by International Prostate Symptom Score (IPSS). Nocturia was defined as voiding at night two or more times. The association of BNP and other clinical variables with nocturia was examined using multivariate logistic regression analyses. The other variables were age, prostate-specific antigen (PSA), prostate volume, body mass index, the presence of prostate cancer, estimated glomerular ?ltration rate (eGFR), hypertension, diabetes, sleep disorder, and the use of any a-blocker or muscarinic antagonist. We also assessed the correlation between BNP and each item in the IPSS subgroups. RESULTS Median age, BNP, and PSA were 69 years, 19.8 pg/ml and 8.7 ng/ml, respectively. Median time of nocturnal voiding was 1 and nocturia was observed in 191 men (44.3%). Presence or absence of prostate cancer was not associated with nocturia or BNP levels. Median BNP in men with nocturia was 26.5 pg/ml whereas that in men without nocturia was 13.7 pg/ml (p < 0.01). Median BNP in each frequency group of nocturnal voiding was 13.1 ng/ml in 0 times (n = 65), 14.2 ng/ml in 1 time (n = 175), 23.9 ng/ml in 2 times (n = 118), 37.1 ng/ml in 3 times (n = 52), and 37.9 ng/ml in 4 or more times (n = 21) (p < 0.01). Univariate analyses demonstrated that age, PSA, prostate volume, eGFR, use of any a-blocker, hypertension, diabetes, sleep disorder, and BNP were correlated with nocturia. In multivariate analyses, BNP (p < 0.01) was an independent risk factor of nocturia, as well as age (p < 0.01), prostate volume (p < 0.01), and diabetes (p = 0.04). There were no correlations between BNP and each item in the IPSS subgroups other than nocturia. CONCLUSIONS BNP, a representative biomarker for cardiac load, is associated with nocturia in men. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e400 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Keita Izumi More articles by this author Masaya Ito More articles by this author Masaharu Inoue More articles by this author Toshiki Kijima More articles by this author Soichiro Yoshida More articles by this author Minato Yokoyama More articles by this author Junichiro Ishioka More articles by this author Yoh Matsuoka More articles by this author Kazutaka Saito More articles by this author Kazunori Kihara More articles by this author Yasuhisa Fujii More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Characterization of peak capacity of microbore liquid chromatography columns using gradient kinetic plots

The performance of micro-liquid chromatography columns with an inner diameter of 0.3mm was investigated on a dedicated micro-LC system for gradient elution. Core-shell as well as fully porous particle packed columns were compared on the basis of peak capacity and gradient kinetic plot limits. The results for peak capacity showed the superior performance of columns packed with sub-2μm fully porous particles compared to 3.0μm fully porous and 2.7μm core-shell particles within a range of different gradient time to column void time ratios. For ultra-fast chromatography a maximum peak capacity of 16 can be obtained using a 30s gradient for the sub-2μm fully porous particle packed column. A maximum peak capacity of 121 can be achieved using a 5min gradient. In addition, the influence of an alternative detector cell on the basis of optical waveguide technology and contributing less to system variance was investigated showing an increased peak capacity for all applied gradient time/column void time ratios. Finally, the influence of pressure was evaluated indicating increased peak capacity for maximum performance whereas a limited benefit for ultra-fast chromatography with gradient times below 30s was observed.

Effect of filling rate on cystometric parameters in young and middle aged mice.

OBJECTIVESTo investigate the effect of changing the bladder filling rate during cystometry in younger (2–3 months) and older (13–14 months) C57BL/6J male mice.METHODSCystometry was performed on mice under anesthesia. Voiding cycles were established in each mouse at a pump delivery rate of 17 μl/min. After 30 min, the rate was increased sequentially to 25, 33, 41 and 49 μl/min. Each rate was maintained for 30 min. The following cystometric parameters were quantified: peak pressure amplitude, intercontractile interval (ICI), compliance, micturition pressure threshold and voiding efficiency.RESULTSBladder weights were significantly greater in older mice (42 mg vs. 27 mg, P < 0.01), but functional capacities were not different. The pressure amplitudes did not change as filling rate increased, nor did they differ between the 4-month and 13-month-old males. ICIs were not significantly different between young and mature mice. However, both groups exhibited a non-linear reduction in ICI with increasing filling rate, best described by a power curve (R2 > 0.93). Compliance was higher in the older mice at low filling rates (17 and 25 μl/min) but this difference diminished at higher rates. Compliance decreased with increasing flow rate in a non-linear manner, again with greater effects at low filling rates. Micturition pressure thresholds increased with increasing flow rate in a linear manner and older mice began voiding at higher pressures than younger. Both young and old mice exhibited voiding efficiencies of ~70%.CONCLUSIONSThe rate of volume delivery has complex effects on the timing of voiding and compliance. These findings argue for greater standardization of cystometry protocols and further investigation into afferent signaling to higher centers at different filling rates.

Cesarean Section without Urethral Catheterization

Introduction: Urethral catheterization is done as a routine procedure in cesarean section. It is associated with great discomfort, high incidence of urinary tract infection, delayed ambulation and longer hospital stay.Objectives: To determine the feasibility and safety of cesarean section without urethral catheterization.Materials and Methods: A prospective, observational study was carried out from April 2012 to March 2013, in the Department of Obstetrics and Gynaecology, CMH Dhaka and IBN Sina Hospital Dhaka among 65 patients who had undergone cesarean section without catheterization. There were some limitations of this study. We had excluded previous cesarean from our study, so the results of this study cannot be generalized.Results: Firs void discomfort was not significantly associated without the use of indwelling catheter. Hospital stay was shorter (94% was discharged on 3rd post operative day). None of the patients had bladder injury. Mean duration of surgery was 45 minutes (44%) and ambulation time 11-14 hours (60%). Average estimated blood loss was 500 ml (41%) and time of 1st voiding was 5-8 hrs (58%). Need for catheterization was significantly low (3%).Conclusion: Cesarean section can be done safely without urethral catheterization with reduced morbidities.Journal of Armed Forces Medical College Bangladesh Vol.11(1) 2015: 3-6

The Analgesic Efficacy of Intrathecal Bupivacaine and Fentanyl with Added Neostigmine or Magnesium Sulphate.

BackgroundAn appropriate anesthesia duration with minimal side effects and prolonged postoperative analgesia are the ideal characteristics of an intrathecal drug used during spinal anesthesia. Neostigmine and magnesium sulphate have been used as spinal anesthetic additives with narcotics and local anesthetics.ObjectivesThis study aimed to assess the analgesic properties of intrathecal neostigmine and magnesium sulphate by adding them to intrathecal bupivacaine-fentanyl.Methods: In total, 210 patients undergoing tibial fracture surgery were enrolled in a double-blinded clinical trial study. Patients were randomly allocated to one of three groups: group F received 10 mg of bupivacaine and 25 µg of fentanyl as intrathecal drug for spinal anesthesia, group N received 150 µg of neostigmine added to 10 mg of bupivacaine and 25 µg of fentanyl, and group M received 50 mg of magnesium sulphate added to 10 mg of bupivacaine and 25 µg of fentanyl. Analgesia duration, motor blockade scores, postoperative pain scores 6 and 12 hours after surgery, postoperative voiding time, and the incidence of hypotension, bradycardia, respiratory depression, and nausea and vomiting were recorded.ResultsGroup M showed significantly longer analgesia duration (330.76 ± 80.98 minutes) than group F (280.98 ± 60.33 minutes). The pain scores in group M 6 hours (NRS: 2.44 ± 0.98) and 12 hours (NRS: 4.10 ± 0.88) after surgery were significantly lower than those of the other two groups. Before discharge from recovery, motor blockade scores and voiding time were not significantly different between the three groups. Hypotension (40%), bradycardia (25%), and nausea and vomiting (70%) were more obvious among group N patients. Respiratory depression did not occur in any patients.ConclusionsThe addition of 50 mg of magnesium sulfate to a bupivacaine–fentanyl solution for intrathecal anesthesia improved the efficacy and duration of the analgesia without any significant side effects. The addition of 150 µg of neostigmine increased the incidence of hypotension, bradycardia, and nausea and vomiting. Moreover, neostigmine failed to prolong analgesia duration.

Variability in the amount of fluorine-18 fluorodeoxyglucose excreted in urine measured from oncology patients during PET/computed tomography imaging.

The objectives of this work were to estimate the amount of fluorine-18 fluorodeoxyglucose (F-FDG) excreted (AFE) in the patient urine during the uptake phase as percentage of the injected activity and to examine the effect of blood glucose levels (BGL) on the excreted amount and whether it varies among men and women using statistical analysis methods. Radiation dose rates were measured at 1 m from 50 patients, 24 men and 26 women, before and after the first void using a calibrated ionization chamber. The F-FDG was injected in the patients using a calibrated automatic dose injection system. Statistical analysis using hypothesis testing was carried out. Patients with BGL above 5 mmol/l had a higher AFE of 12.3% in comparison with 8.3% of the patients with BGL below 5 mmol/l. A statistically nonsignificant correlation (r=0.183, P<0.249) between AFE and BGL was found; a nonsignificant difference was found in the AFE measured among the male and female patients. The AFE measured was 12±6%, with a range of (2-30%). There was a wide variation in the first void time of 39±8 min, with a range of (17-68) min. A simple noninvasive measurement method is presented that enabled the estimation of the amount of F-FDG excreted from the patient during voiding. Statistical analysis concluded that the amount of F-FDG excreted does not depend on sex, but is perhaps influenced by BGL.

Pressure Tuning of First Dimension Columns in Comprehensive Two-Dimensional Gas Chromatography.

The experimental approach and mechanism of pressure tuning (PT) are introduced for the first stage of a comprehensive two-dimensional gas chromatography (GC × GC) separation. The PT-GC × GC system incorporates a first dimension ((1)D) coupled column ensemble comprising a pair of (1)D columns ((1)D1 and (1)D2) connected via a microfluidic splitter device, allowing variable decompression of carrier gas across each (1)D column, and a conventional (2)D narrow bore column. By variation of junction pressure between the (1)D1 and (1)D2 columns, tunable total (1)D retentions of analytes are readily derived. Separations of a standard mixture comprising a number of different chemical classes (including alkanes, monoaromatics, alcohols, aldehydes, ketones, and esters) and Australian tea tree oil (TTO) were studied as practical examples of the PT-GC × GC system application. This illustrated the change of analyte retention time with experimental conditions depending on void time and retention on the different columns. In addition to void time change, variation of carrier gas relative decompression in the (1)D ensemble leads to tunable contribution of the (1)D1/(1)D2 columns that changes apparent polarity and selectivity of the ensemble. The resulting changes in (1)D elution order further altered elution temperature and thus retention of each analyte on the (2)D column in temperature-programmed GC × GC. 2D orthogonality measurements were then conducted to evaluate overall separation performance under application of different (1)D junction pressure. As a result, distribution and selectivity of particular target compounds, monoterpenes, sesquiterpenes, and oxygenated terpenes in 2D space, and thus orthogonality, could be adequately tuned. This indicates the potential of PT-GC × GC to be applicable for practical sample separation and provides a general approach to tune selectivity of target compounds.

Uroflowmetry in healthy women: A systematic review.

Although uroflowmetry is a widely used diagnostic test, reference values of uroflowmetry parameters in women are lacking making it difficult to interpret the test results. To quantify the range of results in uroflowmetry parameters in healthy women based on a systematic review. A search was made in the International Continence Society standardization articles, PubMed, Embase and the Cochrane Library (from inception to 27 February 2014). Studies on uroflowmetry in healthy women were included. The selected articles were examined using a critical appraisal process based on the QUADAS-2 tool and the Critical Appraisal Skills Program. Mean values of uroflowmetry parameters in healthy women (mean age 37.1 years) were: voided volume (VV) 338 ml (SD 161), maximum flow rate (Qmax) 23.5 ml/s (SD 10), average flow rate (Qave) 13 ml/s (SD 6), postvoid residual (PVR) 15.5 ml (SD 25), voiding time (VT) 29 sec (SD 17), and time to maximum flow rate (time to Qmax) 8 sec (SD 6). Qmax was dependent on VV. There was no clear relationship between Qmax and age, and no correlation between parity and Qmax. A normal shape of the uroflowmetry curve was seen in 70-80% of the flows. This systematic review provides an overview of the range of results of uroflowmetry parameters in healthy women. Neurourol. Urodynam. 36:953-959, 2017. © 2016 Wiley Periodicals, Inc.

Effect of thoracic epidural analgesia on recovery of bowel function after major upper abdominal surgery

Study ObjectiveWe investigated whether thoracic epidural analgesia (TEA) shortens the first gas-out time compared to intravenous patient-controlled analgesia (iv-PCA) and promotes earlier discharge after major upper abdominal surgery. DesignProspective observational study. SettingA tertiary care university hospital. PatientsFifty-six patients undergoing major upper abdominal surgery. InterventionsTEA (n=28) was performed using a paramedian approach at T6-7 or T7-8. Hydromorphone (8 μg/mL) was added to 0.15% ropivacaine (bolus/lockout time/basal: 3 mL/15 minutes/5 mL). The iv-PCA regimen (n=28) included 20 μg/mL fentanyl (bolus/lockout time/basal: 0.5 mL/15 minutes/0.5 mL). The 2 analgesic methods were maintained for 3 days. MeasurementThe primary end point was first gas-out time, and the secondary end points were hospital discharge, pain scores, and first voiding time. Main ResultsNo differences in first gas-out time (TEA, 4.1±1.2 days; iv-PCA, 3.4±1.9 days; P=.15) or hospital stay (TEA, 9.8±2.2 days; iv-PCA, 11.4±5.2 days; P=.19) were observed between the 2 groups. A visual analog pain scale scores during rest and coughing were lower in the TEA than those for iv-PCA even with 40% to 46% less rescue analgesic. However, TEA delayed first voiding time (3.6±0.9 vs 2.8±1.6 days; P=.02) and required more frequent bladder catheterization (46% vs 11%; P=.008) than those of iv-PCA. ConclusionTEA with a regimen of hydromorphone (8 μg/mL) added to 0.15% ropivacaine did not provide earlier gas-out compared to that of iv-PCA in patients who underwent major upper abdominal surgery.

MP74-14 INTERNATIONAL CONTINENCE SOCIETY DEFINITION OF DETRUSOR UNDERACTIVITY; ANALYSIS OF CLINICAL PARAMETERS AND COMPARISON WITH CONTRACTILITY GRADING METHODS

INTRODUCTION AND OBJECTIVES: Lower urinary tract symptoms (LUTS) experienced by elderly men may be due to bladder outlet obstruction, detrusor underactivity (DU) or a combination of both. The International Continence Society (ICS) defines DU as ‘a contraction of reduced strength and/or duration, resulting in prolonged bladder emptying and/or a failure to achieve complete bladder emptying within a normal time span’. This definition is quantifiable by the following non-invasive urodynamic parameters: voiding time (VT), post void residual (PVR) and voiding efficiency (void%). The best method to determine DU is by pressure flow study. Three parameters to grade detrusor voiding contraction are Schafer pressure/flow nomogram (LinPURR), bladder contractility index (BCI) and maximum Watt Factor (Wmax). The goal of this study was to compare three methods of grading detrusor contraction and to correlate results with noninvasive measurements of DU VT, PVR and void%. METHODS: We evaluated 1420 urodynamic pressure flow studies of men > 50 years of age with LUTS. Patients with abnormal urinalysis, neurological disorders, pelvic or urological surgery, or with evidence of urethral stricture were excluded. We determined VT, PVR and void% of all measurements and graded contractility with LinPURR, BCI and Wmax. Correlation of different grading methods regarding contractility groups was done using either Spearman or Pearson correlation test. A threshold of 80% for void% was chosen as a normal limit. We tested diagnostic values of VT, PVR and void% and combinations of this parameters related to contractility groups by calculating specificity and sensitivity. RESULTS: LinPURR and BCI as well as LinPURR and Wmax contractility groups showed a highly significant correlation (0.975, p<0.000), (0.620, p<0.001) respectively. Sensitivity and specificity of VT, PVR and void% have been calculated for LinPURR contractility. Combining VT and void% showed a sensitivity of 71.0% and a specificity of 62.5%. Combining VT and PVR showed a sensitivity of 38.9% and a specificity of 38.2%. Combining VT and void% diagnosed 35.7% and combining VT and PVR diagnosed 42.8% of the DU as normal contractility in LinPURR contractility grading. CONCLUSIONS: Results of LinPURR, BCI and Wmax contractility grading were highly correlated. Therefore, because of simplicity, we suggest to use LinPURR classification in daily practice. The combination of void% and VT nor PVR and VT is specific in predicting detrusor underactivity.

A comparison of two different doses of morphine added to spinal bupivacaine for inguinal hernia repair

The aim of this study was to compare the effects of two different doses of intrathecal morphine on postoperative analgesia, postoperative first mobilization and urination times and the severity of side effects. After Institutional Ethical Committee approval, 48 ASA I-II patients were enrolled in this randomized double-blinded study. Spinal anesthesia was performed with 0.1mg (Group I, n=22) or 0.4mg (Group II, n=26) ITM in addition to 7.5mg heavy bupivacaine. The first analgesic requirement, first mobilization and voiding times, and postoperative side effects were recorded. Statistical analyses were performed using SPSS 15.0 and p<0.05 was considered as statistically significant. The numeric data were analyzed by the t-test and presented as mean±SD. Categorical data were analyzed with the chi-square test and expressed as number of patients and percentage. Demographic data were similar among groups. There were no differences related to postoperative pain, first analgesic requirements, and first mobilization and first voiding times. The only difference between two groups was the vomiting incidence. In Group II 23% (n=6) of the patients had vomiting during the first postoperative 24h compared to 0% in Group I (p=0.025). For inguinal hernia repairs, the dose of 0.1mg of ITM provides comparable postoperative analgesia with a dose of 0.4mg, with significantly lower vomiting incidence when combined with low dose heavy bupivacaine.