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

Large head metal-on-metal cementless total hip arthroplasty versus 28mm metal-on-polyethylene cementless total hip arthroplasty: design of a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Osteoarthritis of the hip is successfully treated by total hip arthroplasty with metal-on-polyethylene articulation. Polyethylene wear debris can however lead to osteolysis, aseptic loosening and failure of the implant. Large head metal-on-metal total hip arthroplasty may overcome polyethylene wear induced prosthetic failure, but can increase systemic cobalt and chromium ion concentrations. The objective of this study is to compare two cementless total hip arthroplasties: a conventional 28 mm metal-on-polyethylene articulation and a large head metal-on-metal articulation. We hypothesize that the latter arthroplasties show less bone density loss and higher serum metal ion concentrations. We expect equal functional scores, greater range of motion, fewer dislocations, fewer periprosthetic radiolucencies and increased prosthetic survival with the metal-on-metal articulation.</p> <p>Methods</p> <p>A randomized controlled trial will be conducted. Patients to be included suffer from non-inflammatory degenerative joint disease of the hip, are aged between 18 and 80 and are admitted for primary cementless unilateral total hip arthroplasty. Patients in the metal-on-metal group will receive a cementless titanium alloy acetabular component with a cobalt-chromium liner and a cobalt-chromium femoral head varying from 38 to 60 mm. Patients in the metal-on-polyethylene group will receive a cementless titanium alloy acetabular component with a polyethylene liner and a 28 mm cobalt-chromium femoral head. We will assess acetabular bone mineral density by dual energy x-ray absorptiometry (DEXA), serum ion concentrations of cobalt, chromium and titanium, self reported functional status (Oxford hip score), physician reported functional status and range of motion (Harris hip score), number of dislocations and prosthetic survival. Measurements will take place preoperatively, perioperatively, and postoperatively (6 weeks, 1 year, 5 years and 10 years).</p> <p>Discussion</p> <p>Superior results of large head metal-on-metal total hip arthroplasty over conventional hip arthroplasty have been put forward by experts, case series and the industry, but to our knowledge there is no randomized controlled evidence.</p> <p>Conclusion</p> <p>This randomized controlled study has been designed to test whether large head metal-on-metal cementless total hip arthroplasty leads to less periprosthetic bone density loss and higher serum metal ion concentrations compared to 28 mm metal-on-polyethylene cementless total hip arthroplasty.</p> <p>Trial registration</p> <p>Netherlands Trial Registry NTR1399</p

Solid Friction from stick-slip to pinning and aging

We review the present state of understanding of solid friction at low velocities and for systems with negligibly small wear effects. We first analyze in detail the behavior of friction at interfaces between wacroscopic hard rough solids, whose main dynamical features are well described by the Rice-Ruina rate and state dependent constitutive law. We show that it results from two combined effects : (i) the threshold rheology of nanometer-thick junctions jammed under confinement into a soft glassy structure (ii) geometric aging, i.e. slow growth of the real arrea of contact via asperity creep interrupted by sliding. Closer analysis leads to identifying a second aging-rejuvenation process, at work within the junctions themselves. We compare the effects of structural aging at such multicontact, very highly confined, interfaces with those met under different confinement levels, namely boundary lubricated contacts and extended adhesive interfaces involving soft materials (hydrogels, elastomers). This leads us to propose a classification of frictional junctions in terms of the relative importance of jamming and adsoprtion-induced metastability.Comment: 28 page

Intermittent catheterisation after botulinum toxin injections : the time to reassess our practice

INTRODUCTION AND HYPOTHESIS Botulinum toxin has become a widely adopted treatment for patients with recalcitrant overactive bladder (OAB) symptoms. Some recommend clean intermittent self-catheterisation (CISC) if a postvoid residual (PVR) >200 ml posttreatment, but there is no evidence for this recommendation. The aim of this study was to identify whether abstinence from CISC as a routine strategy for patients with a PVR following intradetrusor botulinum toxin injections is associated with any measurable adversity. METHODS This was a cohort observation study. Patients with lower urinary tract symptoms (LUTS) attending a medical urology centre were observed before and after botulinum toxin treatment. Intradetrusal botulinum toxin injections were administered in the day-treatment centre at a medical urology centre in London, UK. Patients were reviewed at follow-up consultations to measure PVR. RESULTS Of the 240 patients studied, 215 were women and 25 were men, of whom, 196 (82%) received botulinum toxin injections and were not managed with CISC; 18% were using CISC prior to injections and continued. None of the 196 patients developed acute retention or significant voiding symptoms. CONCLUSIONS Our study indicates that routine administration of CISC based on an arbitrary PVR volume is unlikely to confer benefit. In order to avoid patients being deterred from botulinum treatment, we recommend that CISC be reserved for those who have troublesome voiding symptoms as well as a raised PVR. It is unlikely that CISC, initiated on the basis of an arbitrary PVR volume, would benefit the patient

The TNFalpha gene relates to clinical phenotype in alpha-1-antitrypsin deficiency

<p>Abstract</p> <p>Background</p> <p>Genetic variation may underlie phenotypic variation in chronic obstructive pulmonary disease (COPD) in subjects with and without alpha 1 antitrypsin deficiency (AATD). Genotype specific sub-phenotypes are likely and may underlie the poor replication of previous genetic studies. This study investigated subjects with AATD to determine the relationship between specific phenotypes and <it>TNFα </it>polymorphisms.</p> <p>Methods</p> <p>424 unrelated subjects of the PiZZ genotype were assessed for history of chronic bronchitis, impairment of lung function and radiological presence of emphysema and bronchiectasis. A subset of subjects with 3 years consecutive lung function data was assessed for decline of lung function. Four single nucleotide polymorphisms (SNPs) tagging <it>TNFα </it>were genotyped using TaqMan^®genotyping technologies and compared between subjects affected by each phenotype and those unaffected. Plasma TNFα levels were measured in all PiZZ subjects.</p> <p>Results</p> <p>All SNPs were in Hardy-Weinberg equilibrium. A significant difference in rs361525 genotype (p = 0.01) and allele (p = 0.01) frequency was seen between subjects with and without chronic bronchitis, independent of the presence of other phenotypes. TNFα plasma level showed no phenotypic or genotypic associations.</p> <p>Conclusion</p> <p>Variation in <it>TNFα </it>is associated with chronic bronchitis in AATD.</p

Continuously Adjustable, Molecular-Sieving "Gate" on 5A Zeolite for Distinguishing Small Organic Molecules by Size

Zeolites/molecular sieves with uniform, molecular-sized pores are important for many adsorption-based separation processes. Pore size gaps, however, exist in the current zeolite family. This leads to a great challenge of separating molecules with size differences at ~0.01 nm level. Here, we report a novel concept, pore misalignment, to form a continuously adjustable, molecular-sieving “gate” at the 5A zeolite pore entrance without sacrificing the internal capacity. Misalignment of the micropores of the alumina coating with the 5A zeolite pores was related with and facilely adjusted by the coating thickness. For the first time, organic molecules with sub-0.01 nm size differences were effectively distinguished via appropriate misalignment. This novel concept may have great potential to fill the pore size gaps of the zeolite family and realize size-selective adsorption separation

A framework for increasing the availability of life cycle inventory data based on the role of multinational companies

Purpose The aim of the paper is to assesses the role and effectiveness of a proposed novel strategy for Life Cycle Inventory (LCI) data collection in the food sector and associated supply chains. The study represents one of the first of its type and provides answers to some of the key questions regarding the data collection process developed, managed and implemented by a multinational food company across the supply chain. Methods An integrated LCI data collection process for confectionery products was developed and implemented by Nestlé, a multinational food company. Some of the key features includes: (1) management and implementation by a multinational food company, (2) types of roles to manage, provide and facilitate data exchange, (3) procedures to identify key products, suppliers and customers, (4) LCI questionnaire and cover letter, and (5) data quality management based on the pedigree matrix. Overall, the combined features in an integrated framework provides a new way of thinking about the collection of LCI data from the perspective of a multinational food company. Results The integrated LCI collection framework spanned across five months and resulted in 87 new LCI datasets for confectionery products from raw material, primary resource use, emission and waste release data collected from suppliers across 19 countries. The data collected was found to be of medium-to-high quality compared with secondary data. However, for retailers and waste service companies only partially completed questionnaires were returned. Some of the key challenges encountered during the collection and creation of data included: lack of experience, identifying key actors, communication and technical language, commercial compromise, confidentiality protection, and complexity of multi-tiered supplier systems. A range of recommendations are proposed to reconcile these challenges which include: standardisation of environmental data from suppliers, concise and targeted LCI questionnaires, and visualising complexity through drawings. Conclusions The integrated LCI data collection process and strategy has demonstrated the potential role of a multinational company to quickly engage and act as a strong enabler to unlock latent data for various aspects of the confectionery supply chain. Overall, it is recommended that the research findings serve as the foundations to transition towards a standardised procedure which can practically guide other multinational companies to considerably increase the availability of LCI data