Die überaktive Blase. Differenzialdiagnostik und therapeutisches Management

Die über- oder hyperaktive Blase kann die Befindlichkeit der Betroffenen erheblich stören. Abklärung und Therapie sollen patientinnenorientiert in verschiedenen Stufen erfolgen. Bei Therapieversagen trotz Verhaltensänderung, Blasentraining und Anticholinergika als primäre Therapien ist die intravesikale Injektion von Botulinumneurotoxin, aber auch Neuromodulation eine sehr wirksame Option. Neu erweitern β3-Adrenozeptor- Agonisten in Europa seit 2013* das therapeutische Spektrum

Genital Dysplasia and Immunosuppression: Why Organ-Specific Therapy Is Important

Background Young patients with Crohn's disease (CD) show a high prevalence of human papillomavirus (HPV) which is the main cause of high-grade squamous intraepithelial lesions (HSIL). A major complication for patients undergoing immunocompromising therapy is the development of genital dysplasia. Methods We report the case of a 32-year-old patient with recurrent genital dysplasia under long-term therapy for CD with a focus on different drug-related, immunosuppressive mechanisms. Results Gynecological examination and biopsy revealed high-grade vulvar intraepithelial neoplasia (VIN) positive for HPV 16 treated with laser vaporization. Due to the combination of HPV positivity, intraoperative multilocularity, and CD, follow-up examinations were performed every 6 months. One year later, the patient showed a VIN at a new location and additionally, a cervical intraepithelial neoplasia (CIN), which were surgically treated. Catch-up HPV vaccination was applied accessorily. After the switch from a TNF-α blocker to vedolizumab, which acts as a gut-selective anti-integrin, the subsequent PAP smear, vulvoscopy, and colposcopy showed no more evidence of dysplasia. Conclusions This case report highlights that gut-selective immunosuppression with vedolizumab might be favorable in young HPV-positive patients due to a good side effect profile. Regular screening and HPV vaccination are a mainstay of dysplasia prevention and control. The risk for HPV-associated dysplasia in immunosuppressed patients is highly dependent on the choice of immunosuppressive therapy

Twelve months effect on voiding function of retropubic compared with outside-in and inside-out transobturator midurethral slings

Introduction and hypothesis: The purpose of this study is to compare retropubic tension-free vaginal tape (TVT) with transobturator out-in TOT and in-out TVT-O for female stress urinary incontinence. Uroflow rate was primary; continence rates, quality of life (QoL) and complication pattern were secondary endpoints. Methods: A prospective randomised trial with 2:1:1 randomisation at two Swiss teaching hospitals. Patients were followed up at 12months. Results: Eighty TVT, 40 transobturator tape (TOT) and 40 TVT-O were randomised. At 12months, there was no difference in Qmax among the groups. Continence was comparable (≥89%). QoL was improved significantly in all groups (P < 0.05). Five vaginal tape exposures occurred (one TVT, four TOT, zero TVT-O; P = 0.028). Two percent (1/52) of sexually active patients after TVT, 17% (5/29) after TOT, but 0% (0/25) after TVT-O reported de novo female sexual dysfunction (P = 0.011). We considered this clinically important enough to stop enrolment. Conclusions: There was no difference for Qmax at 12months between TVT, TOT and TVT-O. Female sexual dysfunction and tape exposure may be higher with a transobturator tap

Patient satisfaction after retropubic and transobturator slings: first assessment using the Incontinence Outcome Questionnaire (IOQ)

Introduction and hypothesis: The aim of the Incontinence Outcome Questionnaire (IOQ) is to assess quality of life and patient-reported outcome after midurethral slings. Methods: In this retrospective study, 626 patients with a minimum follow-up period of 1year were sent the IOQ. Four hundred twenty-two of 626 (67.4%) patient responses were evaluated. Results: The mean IOQ QoL extended score was 33.7 ± 17.5 and comparable for tension-free vaginal tape (TVT), outside-in transobturator tape (TOT), and inside-out transobturator vaginal tape (TVT-O). Evaluation of IOQ question about readmission revealed a total of 32 patients (18 TVT, 12 TOT, and 2 TVT-O) who underwent a subsequent operation due to sling-related complications. Freedom from reoperation for recurrent SUI at 1, 2, and 5years was 100%, 99.7 ± 0.3%, and 99.7 ± 0.3% for TVT, 100% for TVT-O, and 94.2 ± 2.5%, 91.9 ± 2.9%, and 89.9 ± 3.5% for TOT, respectively (p < 0.001). Conclusions: Patient satisfaction, assessed using the IOQ, is high after retropubic and transobturator slings. In our collective, relapse incontinence is higher after TO

Efficacy of antifungal agents against fungal spores: an in vitro study using microplate laser nephelometry and an artificially infected 3D skin model

Dermal fungal infections seem to have increased over recent years. There is further a shift from anthropophilic dermatophytes to a growing prevalence of zoophilic species and the emergence of resistant strains. New antifungals are needed to combat these fungi and their resting spores. This study aimed to investigate the sporicidal effects of sertaconazole nitrate using microplate laser nephelometry against the microconidia of Trichophyton , chlamydospores of Epidermophyton , blastospores of Candida , and conidia of the mold Scopulariopsis brevicaulis . The results obtained were compared with those from ciclopirox olamine and terbinafine. The sporicidal activity was further determined using infected three‐dimensional full skin models to determine the antifungal effects in the presence of human cells. Sertaconazole nitrate inhibited the growth of dermatophytes, molds, and yeasts. Ciclopirox olamine also had good antifungal activity, although higher concentrations were needed compared to sertaconazole nitrate. Terbinafine was highly effective against most dermatophytes, but higher concentrations were required to kill the resistant strain Trichophyton indotineae . Sertaconazole nitrate, ciclopirox olamine, and terbinafine had no negative effects on full skin models. Sertaconazole nitrate reduced the growth of fungal and yeast spores over 72 h. Ciclopirox olamine and terbinafine also inhibited the growth of dermatophytes and molds but had significantly lower effects on the yeast. Sertaconazole nitrate might have advantages over the commonly used antifungals ciclopirox olamine and terbinafine in combating resting spores, which persist in the tissues, and thus in the therapy of recurring dermatomycoses

Silicon Photomultiplier Research and Development Studies for the Large Size Telescope of the Cherenkov Telescope Array

The Cherenkov Telescope Array (CTA) is the the next generation facility of imaging atmospheric Cherenkov telescopes; two sites will cover both hemispheres. CTA will reach unprecedented sensitivity, energy and angular resolution in very-high-energy gamma-ray astronomy. Each CTA array will include four Large Size Telescopes (LSTs), designed to cover the low-energy range of the CTA sensitivity ($\sim$20 GeV to 200 GeV). In the baseline LST design, the focal-plane camera will be instrumented with 265 photodetector clusters; each will include seven photomultiplier tubes (PMTs), with an entrance window of 1.5 inches in diameter. The PMT design is based on mature and reliable technology. Recently, silicon photomultipliers (SiPMs) are emerging as a competitor. Currently, SiPMs have advantages (e.g. lower operating voltage and tolerance to high illumination levels) and disadvantages (e.g. higher capacitance and cross talk rates), but this technology is still young and rapidly evolving. SiPM technology has a strong potential to become superior to the PMT one in terms of photon detection efficiency and price per square mm of detector area. While the advantage of SiPMs has been proven for high-density, small size cameras, it is yet to be demonstrated for large area cameras such as the one of the LST. We are working to develop a SiPM-based module for the LST camera, in view of a possible camera upgrade. We will describe the solutions we are exploring in order to balance a competitive performance with a minimal impact on the overall LST camera design.Comment: 8 pages, 5 figures. In Proceedings of the 34th International Cosmic Ray Conference (ICRC2015), The Hague, The Netherlands. All CTA contributions at arXiv:1508.0589

Successful Treatment of Myasthenia Gravis Following PD-1/CTLA-4 Combination Checkpoint Blockade in a Patient With Metastatic Melanoma

Currently, the blockade of certain immune checkpoints such as the cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and programmed cell death-1 (PD-1) using checkpoint inhibitors is standard of care in patients with metastatic melanoma, especially with BRAF wild-type. However, several checkpoint inhibitor-related complications have been reported, including severe adverse events in the central and peripheral nervous system. In particular, in the recent past, the occurrence of myasthenia gravis following checkpoint inhibitor monotherapy, particularly nivolumab or ipilimumab, has been reported. In contrast, reports on PD-1/CTLA-4 combination blockade—usually with fatal clinical outcome—are scarce. We here report a case with combination immune checkpoint blockade-related myasthenia gravis with favorable clinical outcome

Earlier seasonal onset of intense Mesoscale Convective Systems in the Congo Basin since 1999

Mesoscale Convective Systems (MCSs) produce some of the most intense rainfall on the planet, and their response to climate variability and change is rather uncertain. Under global warming, increased water vapour is expected to intensify the most extreme rain events and enhance flood frequency. However, MCS dynamics are also sensitive to other atmospheric variables, most notably, wind shear. Here we build on a recent study showing strong MCS intensification in the African Sahel, and examine evidence of similar trends elsewhere in tropical Africa. Using satellite data, we find a remarkable increase post‐1999 in intense MCS frequency over the Congo Basin during the month of February. This earlier onset of the spring rainy season has been accompanied by strong increases in the February meridional temperature gradient and associated wind shear. This supports the hypothesis that contrasts in warming across the continent can drive important decadal‐scale trends in storm intensity

FAM111A is a novel molecular marker for oocyte aging

Aging is the main cause of decline in oocyte quality, which can further trigger the failure of assisted reproductive technology (ART). Exploring age-related genes in oocytes is an important way to investigate the molecular mechanisms involved in oocyte aging. To provide novel insight into this field, we performed a pooled analysis of publicly available datasets, using the overlapping results of two statistical methods on two Gene Expression Omnibus (GEO) datasets. The methods utilized in the current study mainly include Spearman rank correlation, the Wilcoxon signed-rank test, t-tests, Venn diagrams, Gene Ontology (GO), Protein–Protein Interaction (PPI), Gene Set Enrichment Analysis (GSEA), Gene Set Variation Analysis (GSVA), and receiver operating characteristic (ROC) curve analysis. We identified hundreds of age-related genes across different gene expression datasets of in vitro maturation-metaphase II (IVM-MII) oocytes. Age-related genes in IVM-MII oocytes were involved in the biological processes of cellular metabolism, DNA replication, and histone modifications. Among these age-related genes, FAM111A expression presented a robust correlation with age, seen in the results of different statistical methods and different datasets. FAM111A is associated with the processes of chromosome segregation and cell cycle regulation. Thus, this enzyme is potentially an interesting novel marker for the aging of oocytes, and warrants further mechanistic study

Reference Gene Validation for RT-qPCR, a Note on Different Available Software Packages

Background: An appropriate normalization strategy is crucial for data analysis from real time reverse transcription polymerase chain reactions (RT-qPCR). It is widely supported to identify and validate stable reference genes, since no single biological gene is stably expressed between cell types or within cells under different conditions. Different algorithms exist to validate optimal reference genes for normalization. Applying human cells, we here compare the three main methods to the online available RefFinder tool that integrates these algorithms along with R-based software packages which include the NormFinder and GeNorm algorithms. Results: 14 candidate reference genes were assessed by RT-qPCR in two sample sets, i.e. a set of samples of human testicular tissue containing carcinoma in situ (CIS), and a set of samples from the human adult Sertoli cell line (FS1) either cultured alone or in co-culture with the seminoma like cell line (TCam-2) or with equine bone marrow derived mesenchymal stem cells (eBM-MSC). Expression stabilities of the reference genes were evaluated using geNorm, NormFinder, and BestKeeper. Similar results were obtained by the three approaches for the most and least stably expressed genes. The R-based packages NormqPCR, SLqPCR and the NormFinder for R script gave identical gene rankings. Interestingly, different outputs were obtained between the original software packages and the RefFinder tool, which is based on raw Cq values for input. When the raw data were reanalysed assuming 100% efficiency for all genes, then the outputs of the original software packages were similar to the RefFinder software, indicating that RefFinder outputs may be biased because PCR efficiencies are not taken into account. Conclusions: This report shows that assay efficiency is an important parameter for reference gene validation. New software tools that incorporate these algorithms should be carefully validated prior to use