Fowler's syndrome: a primary disorder of urethral sphincter relaxation

Key content: Urinary retention is a relatively uncommon presentation in young women. Women with Fowler's syndrome are often found to have an abnormally elevated urethral pressure profile, increased urethral sphincter volume and characteristically abnormal electromyography of the urethral sphincter. The only treatment that has been found to restore voiding in women with Fowler's syndrome is sacral neuromodulation. Sphincter injections of botulinum toxin are a possible outpatient‐based alternative. / Learning objectives: To review the typical symptoms and signs associated with Fowler's syndrome. To share the current understanding about why this condition may occur. To understand how to evaluate and treat a woman with suspected Fowler's syndrome. / Ethical issues: Fowler's syndrome should be considered in women presenting with urinary retention where the cause for retention is uncertain

Botulinum toxin-A for the treatment of overactive bladder: UK contributions

Background: Botulinum toxin-A (BoNT/A) is now established second-line management for refractory overactivebladder (OAB) and recognised in many incontinence guidelines and pathways. For those with neurogenic detrusoroveractivity secondary to spinal cord injury or multiple sclerosis, the toxin is currently licensed in certain parts of theworld, including the UK. It is an effective treatment in those in whom antimuscarinics and conservative measures havefailed who have symptoms of OAB and or detrusor overactivity (DO). Methods: Treatment can be given in an outpatient setting and can be administered under local anaesthesia. Its efficacylasts for between six and 12 months. Results: It has an acceptable safety profile with the biggest risk being urinary tract infection and difficulty emptying thebladder, necessitating clean intermittent self-catheterisation (CISC). Medium-term follow-up suggests repeated injectionsare also safe and efficacious. Conclusions: The mechanism of action of the toxin is more complicated than originally thought, and it seems likelythat it affects motor and sensory nerves of the bladder. In the last 10 years much of the progress of this treatment fromearly experimental trials to mainstream clinical use, and a better understanding of how it works in the bladder, are as aresult of research conducted in the UK. This review summarises the significant and substantial evidence for BoNT/A totreat refractory OAB from UK centres. © British Association of Urological Surgeons 2013

Managing uncertainty in data-derived densities to accelerate density functional theory

Faithful representations of atomic environments and general models for regression can be harnessed to learn electron densities that are close to the ground state. One of the applications of data-derived electron densities is to orbital-free density functional theory. However, extrapolations of densities learned from a training set to dissimilar structures could result in inaccurate results, which would limit the applicability of the method. Here, we show that a non-Bayesian approach can produce estimates of uncertainty which can successfully distinguish accurate from inaccurate predictions of electron density. We apply our approach to density functional theory where we initialise calculations with data-derived densities only when we are confident about their quality. This results in a guaranteed acceleration to self-consistency for configurations that are similar to those seen during training and could be useful for sampling based methods, where previous ground state densities cannot be used to initialise subsequent calculations

Inhibitory properties of ibuprofen and its amide analogues towards the hydrolysis and cyclooxygenation of the endocannabinoid anandamide

A dual-action cyclooxygenase (COX)–fatty acid amide hydrolase (FAAH) inhibitor may have therapeutic usefulness as an analgesic, but a key issue is finding the right balance of inhibitory effects. This can be done by the design of compounds exhibiting different FAAH/COX-inhibitory potencies. In the present study, eight ibuprofen analogues were investigated. Ibuprofen (1), 2-(4-Isobutylphenyl)-N-(2-(3-methylpyridin-2-ylamino)-2-oxoethyl)propanamide (9) and N-(3-methylpyridin-2-yl)-2-(4′-isobutylphenyl)propionamide (2) inhibited FAAH with IC50 values of 134, 3.6 and 0.52 µM respectively. The corresponding values for COX-1 were ~29, ~50 and ~60 µM, respectively. Using arachidonic acid as substrate, the compounds were weak inhibitors of COX-2. However, when anandamide was used as COX-2 substrate, potency increased, with approximate IC50 values of ~6, ~10 and ~19 µM, respectively. Compound 2 was confirmed to be active in vivo in a murine model of visceral nociception, but the effects of the compound were not blocked by CB receptor antagonists. Read More: http://informahealthcare.com/doi/abs/10.3109/14756366.2011.64330

Factors affecting continuation of clean intermittent catheterisation in people with multiple sclerosis: results of the COSMOS mixed-methods study

Background:  Clean intermittent catheterisation (CIC) is often recommended for people with multiple sclerosis (MS).  Objective:  To determine the variables that affect continuation or discontinuation of the use of CIC.  Methods:  A three-part mixed-method study (prospective longitudinal cohort (n = 56), longitudinal qualitative interviews (n = 20) and retrospective survey (n = 456)) was undertaken, which identified the variables that influenced CIC continuation/discontinuation. The potential explanatory variables investigated in each study were the individual’s age, gender, social circumstances, number of urinary tract infections, bladder symptoms, presence of co-morbidity, stage of multiple sclerosis and years since diagnosis, as well as CIC teaching method and intensity.  Results:  For some people with MS the prospect of undertaking CIC is difficult and may take a period of time to accept before beginning the process of using CIC. Ongoing support from clinicians, support at home and a perceived improvement in symptoms such as nocturia were positive predictors of continuation. In many cases, the development of a urinary tract infection during the early stages of CIC use had a significant detrimental impact on continuation.  Conclusion:  Procedures for reducing the incidence of urinary tract infection during the learning period (i.e. when being taught and becoming competent) should be considered, as well as the development of a tool to aid identification of a person’s readiness to try CIC

Exploring the fatty acid amide hydrolase and cyclooxygenase inhibitory properties of novel amide derivatives of ibuprofen

Inhibition of fatty acid amide hydrolase (FAAH) reduces the gastrointestinal damage produced by non-steroidal anti-inflammatory agents such as sulindac and indomethacin in experimental animals, suggesting that a dual-action FAAH-cyclooxygenase (COX) inhibitor could have useful therapeutic properties. Here, we have investigated 12 novel amide analogues of ibuprofen as potential dual-action FAAH/COX inhibitors. N-(3-Bromopyridin-2-yl)−2-(4-isobutylphenyl)propanamide (Ibu-AM68) was found to inhibit the hydrolysis of [3H]anandamide by rat brain homogenates by a reversible, mixed-type mechanism of inhibition with a Ki value of 0.26 µM and an α value of 4.9. At a concentration of 10 µM, the compound did not inhibit the cyclooxygenation of arachidonic acid by either ovine COX-1 or human recombinant COX-2. However, this concentration of Ibu-AM68 greatly reduced the ability of the COX-2 to catalyse the cyclooxygenation of the endocannabinoid 2-arachidonoylglycerol. It is concluded that Ibu-AM68 is a dual-acting FAAH/substrate-selective COX inhibitor

Design and pharmacological evaluation of Ibuprofen amides derivatives as dual FAAH/COX inhibitors

Fatty acid amide hydrolase (FAAH) is a serine hydrolase enzyme responsible of the hydrolytic degradation of N-acylethanolamine endocannabinoids, such as the Arachidonoylethanolamide (anandamide, AEA), which it has been shown to alleviate pain and inflammation (1). In particular, the anti-nociceptive and anti-inflammatory effects of AEA could be enhanced by the simultaneous block of FAAH and COX enzymes (2). For this reason, several studies have been carried out in order to develop new FAAH/COX inhibitors (2). In 1997 it was reported that the NSAID ibuprofen inhibited FAAH, although with a modest potency (3), and successively the first dual inibhitor, the amide derivative of ibuprofen with a 2-amino-3-methylpyridine side chain (Ibu-AM5) was reported (4). -5). Benzylamides and piperazinoamides analogs of Ibuprofen have been also designed as less potent FAAH inhibitors than Ibu-AM5 (5). Here, I discuss the computational studies and the structure–activity relationships leading to the design, of novel Ibuprofen amide derivatives with a higher inhibition potency of FAAH and COX, which represent novel powerful anti-nociceptive agents