Régulation par les oestrogènes du contrôle nitrergique du bas appareil urinaire

Chez la femme, la prévalence des symptômes du bas appareil urinaire varie en fonction de la vie hormonale. Ils sont ainsi plus fréquents pendant la grossesse et après la ménopause. Le monoxyde d'azote est un médiateur endogène ubiquitaire produit par la monoxyde d'azote synthase (NOS) dont l'expression est modulée par l'œstradiol au niveau du système nerveux. Nous montrons que l'œstradiol module également l'expression de l'isoforme neuronale de la NOS au niveau uréthral. Alors qu'après castration, elle est augmentée, le traitement au long cours avec des doses gestationnelles d'œstradiol augmente le tonus uréthral et diminue l'expression de l'isoforme neuronale de la NOS (nNOS) à ce niveau. Nous montrons également que le sildénafil diminue les résistances uréthrales et ce quel que soit le statut hormonal et que cet effet passe par la voie de la nNOS. Enfin, nous montrons qu'indépendamment du statut hormonal, le sildénafil augmente la lubrification vaginale et que cet effet est nNOS indépendant. Ces travaux expliquent l'augmentation physiologique du tonus uréthral pendant la grossesse, suggèrent un effet bénéfique de la délivrance locale d'œstrogènes à doses gestationnelles ou d'uroSERM dans le traitement de l'incontinence urinaire postménopausique et que, quel que soit le statut hormonal, le sildénafil pourrait être envisagé comme traitement chez la femme d'une obstruction sous-vésicale fonctionnelle et comme traitement des troubles de la lubrification vaginale.In women, the prevalence of lower urinary tract symptoms changes with hormonal life. Therefore, they are more common during pregnancy and after menopause. Nitric oxide is a ubiquitous transmitter produced by nitric oxide synthase (NOS) whose expression in the central nervous system is modulated by estradiol. We show that estradiol modulates NOS neuronal isoform (nNOS) expression in the urethra. While it is increased after castration, supraestrus levels of estradiol increase urethral tone and decrease nNOS expression in the urethra. We also show that sildenafil decreases urethral resistances irrespective of hormonal status and that this effect depends on the nNOS pathway. Finally, we show that, irrespective of the hormonal status, sildenafil increases vaginal lubrication in a nNOS independent manner. These works explain the physiological increase of urethral tone during pregnancy, suggest a positive effect of supraestrus doses of estradiol or UroSERM as post-menopausal urinary incontinence treatments and that sildenafil may be considered as a treatment for functional bladder outlet obstruction in women and vaginal lubrication disorders, irrespective of hormonal status

A framework for the development of a global standardised marine taxon reference image database (SMarTaR-ID) to support image-based analyses

Video and image data are regularly used in the field of benthic ecology to document biodiversity. However, their use is subject to a number of challenges, principally the identification of taxa within the images without associated physical specimens. The challenge of applying traditional taxonomic keys to the identification of fauna from images has led to the development of personal, group, or institution level reference image catalogues of operational taxonomic units (OTUs) or morphospecies. Lack of standardisation among these reference catalogues has led to problems with observer bias and the inability to combine datasets across studies. In addition, lack of a common reference standard is stifling efforts in the application of artificial intelligence to taxon identification. Using the North Atlantic deep sea as a case study, we propose a database structure to facilitate standardisation of morphospecies image catalogues between research groups and support future use in multiple front-end applications. We also propose a framework for coordination of international efforts to develop reference guides for the identification of marine species from images. The proposed structure maps to the Darwin Core standard to allow integration with existing databases. We suggest a management framework where high-level taxonomic groups are curated by a regional team, consisting of both end users and taxonomic experts. We identify a mechanism by which overall quality of data within a common reference guide could be raised over the next decade. Finally, we discuss the role of a common reference standard in advancing marine ecology and supporting sustainable use of this ecosystem

Régulation par les oestrogènes du contrôle nitrergique du bas appareil urinaire

TOULOUSE3-BU Sciences (315552104) / SudocSudocFranceF

Comparaison de la cystectomie laparoscopique et de la cystectomie par chirurgie ouverte dans deux indications (cancer de vessie, troubles vésico-sphinctériens d'origine neurologique)

La cystectomie totale laparoscopique pour cancer de vessie est une technique moins morbide que la cystectomie par chirurgie ouverte. La cystectomie laparoscopique donne des résultats oncologiques comparables à ceux de la chirurgie ouverte pour les patients ayant un stade tumoral inférieur ou égal pT3a et quelque soit le statut ganglionnaire. On constate un taux significativement plus faible de marges positives, même dans les cas les plus évolués localement. La cystectomie laparoscopique pour des troubles vésico-sphinctériens d'origine neurologique est faisable, permet une réduction des morbidités post-opératoires précoce et tardive. L'urétérostomie trans-iléale selon Bricker améliore la qualité de vie urinaire et mentale des patients neurologiques, en diminuant les gênes et les craintes engendrées par les troubles urinaires. Enfin, à moyen terme, il n'existe pas de dégradation de la fonction rénale chez les patients neurologiques ayant eu une urétérostomie trans-iléale selon Bricker.TOULOUSE3-BU Santé-Centrale (315552105) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Spina bifida avec une myéloméningocèle (fonctions sexuelles et vésico-sphinctériennes à l'âge adulte)

TOULOUSE3-BU Santé-Centrale (315552105) / SudocTOULOUSE3-BU Santé-Allées (315552109) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Comparison of the impact on health-related quality of life of repeated detrusor injections of botulinum toxin in patients with idiopathic or neurogenic detrusor overactivity

OBJECTIVETo compare the effect of repeated detrusor injections of botulinum toxin (BoNT-A) on health-related quality of life (HRQL) in patients with idiopathic (IDO) or neurogenic detrusor overactivity (NDO).PATIENTS AND METHODSBetween 2003 and 2009, 151 patients (109 with NDO and 42 with IDO) were treated by BoNT-A (Botox (R), Allergan Inc., Irvine, CA, USA). Changes in HRQL were assessed using the validated short forms of Urogenital Distress Inventory (UDI-6), the Incontinence Impact Questionnaire (IIQ-7) and EuroQOL-5D (EQ-5D) before and 4 weeks after BoNT-A.RESULTSThe maximum number of repeated injections was five (mean +/- SD, 2.8 +/- 1.05). Mean +/- SD follow-up was 27.49 +/- 17.01 months.The UDI-6 and IIQ-7 questionnaires showed a consistent improvement after repeated injections in both groups with detrusor overactivity. The EQ-5D was not statistically different before and after each injection in either the NDO or IDO population.After repeated injections, no statistical differences in the change on the UDI-6 and IIQ-7 scores were found between NDO and IDO, except after the first treatment, when the decrease in UDI-6 was higher in NDO than in IDO.The EQ-5D anxiety and depression subscore improved in both groups after each injection and with the number of injections.In IDO, after the second injection, no patient reported extreme anxiety or depression and, after the fourth injection, none had anxiety or depression.The inter-injection interval was shorter after the first injection in those with NDO than in IDO but was similar thereafter.CONCLUSIONSIntradetrusor injections of BoNT-A improved the HRQL of both NDO and IDO patients.Although improvement in HRQL was greater and the duration of efficacy shorter in NDO patients after the first injection, there was no significant difference after subsequent injections.Mean inter-injection interval in IDO and in NDO patients was similar from the second injection onwards and improvements in HRQL score were the same

Treatment of large plasma volumes using specific immunoadsorption to desensitize ABO-incompatible kidney-transplant candidates

Background: ABO-incompatible (ABOi) kidney-transplantation has very good long-term results, i.e. similar to those observed for living-kidney ABO-compatible transplantation. This is because patients are desensitized at pretransplant using apheresis and rituximab therapy, with tacrolimus-based immunosuppression. Objectives: To assess the efficacy of a single, pretransplant (Day –1), specific immunoadsorption session using Glycosorb® columns (anti-A or anti-B; Glycorex Sweden) to treat large volumes of plasma (up to 18 L). Patients and Methods: Prospective single-center study evaluating 12 consecutive patients (6 males), aged 40 (23–59) years. Incompatibilities were A into 0 (8), B into 0 (3), and AB into 0 (1). Pretransplant desensitization relied on rituximab (D–30), tacrolimus, mycophenolic acid, and steroids (all started on D–13), and a single session of specific immunoadsorption on D–1. Immunoadsorption was coupled in tandem with a hemodialysis session. Results: Overall, 15 L (11–18) of plasma were treated per patient, i.e., 0.2 (0.11–0.36 L/kg). Isoagglutinin titers were 1/16 (1/5–1/64) before the procedure, decreasing after 6 hours to 1/5 (1/1–1/16 P = 0.008), and to 1/2 (1/1–1/8; P = 0.05) at completion of the session. The next day, i.e., the day of transplantation, there was no rebound of isoagglutinins [1/4 (1/1–1/5); P = ns]. The procedure was well tolerated with no side-effects and no significant changes in hemoglobin level, platelet counts, fibrinogen, or albumin levels. Conclusions: For ABOi kidney-transplantation, a single, longer, specific immunoadsorption session was very efficient at 1-day pre-transplantation with no rebound. These results should be confirmed when isoagglutinin titers are higher (≥120)