Additional secure circular suture during sphincteroplasty — preliminary results on the efficacy of fecal incontinence surgery in urogynecological patients

Objectives: The paper is a ten case series study presenting women with complex pelvic floor disorders involving fecal incontinence (FI) with stress urinary incontinence or pelvic organ prolapse.  Our study aimed at ascertaining whether FI-induced sphincteroplasty with an additional secure circular suture around the external anal sphincter muscle (EAS) may improve long term success rates.  Materials and methods: Twelve patients had scheduled urogynecological surgery and overlapping sphincteroplasty with the placement of an additional circular suture around the EAS. Of these, the status of ten women was established by way of the Cleveland Clinic Fecal Incontinence Score/Wexner Score before and about 70 months after surgery.  Results: Statistical analysis of fecal incontinence score showed that patients were not completely cured from FI, but were significantly better (p = 0.011).  Conclusions: A circular secure suture around the external anal sphincter in FI patients may help to improve anal sphincter function. 

Regional specific idiosyncrasies and fiscal policy : evidence from 47 regions of the central and eastern European countries

Purpose: The purpose of our article is to explore and study how shocks of fiscal policy are transmitted across Central and Eastern European (CEE) regions. Design/Methodology/Approach: We employ Bayesian panel VAR model to estimate and study the dynamic effects of fiscal policy on regional economic activity. Our sample of study includes 47 regions focusing on the CEE countries over the period 2001-2016. Findings: Having incorporated a possible structural break following the aftermath of the 2007 Crisis, the impulse response functions derived from the estimated models reveal cross-region variations in policy responses in terms of their magnitude and timing. Given the fact that the asymmetric effects of fiscal policy shocks across regions exist, we proceed in examining the sources of regional heterogeneities. We show that liquidity constraints, access to banking sector and participant rate in tertiary education have significant impact on regional fiscal multipliers. Practical Implications: The results have practical implication for macroeconomic policy - they show regional heterogeneities of fiscal policy effectiveness. Originality/value: The main value added of our paper is explaining heterogeneity of fiscal policy effects within the theoretical background of Ricardian and non-Ricardian households. Firstly, we are the first to show that regional fiscal multipliers depend on households’ access to banking sector. Secondly, the novelty of our paper is that we show that participant rate in tertiary education significantly decreases regional fiscal multipliers.peer-reviewe

Natural <i>versus</i> anthropogenic influences on the chemical composition of bulk precipitation in the southern Apennines, Italy: a case study of the town of Potenza

This paper presents new data on the chemical composition of precipitation in a selected area of the southern Apennines of Italy; these data are used to assess natural and anthropogenic contributions to the precipitation. The town of Potenza was used as a representative urban site, and the major and minor element (Na+, K+, Ca2+, Mg2+, NH+4, Cl−, NO-3, SO2−4, and Li+, NO-2, F−, Br−, PO3−4) and trace element (Zn, Fe, Al, Sr, Mn, Ba, Cu, Cr, V, As, Pb, Ni, and Cd) concentrations of bulk precipitation from three different sampling sites within the study area were determined between June 2011 and May 2012. The majority of the collected rainwater has pH values higher than 5.6. The composition of this rainwater was dominated by Ca2+ the element with the highest total volume-weightedmean concentration (TVWA), followed by Cl−, SO2−4, Na+, NO−3, K+,Mg2+, and NH+4. The TVWA of the trace metals decreased in the order Zn N Fe N Al N Ba N Sr N Mn N Pb N Cu N As. Neutralising factor (NFXi) values indicate that Ca2+ is the dominant neutralising cation within this rainwater, with lower contribution from NH+4 and Mg2+. The precipitation analysed during this study has a negligible marine influence as determined using Cl− concentrations as a proxy for the abundance of sea salts. Precipitation Fi values (marine fraction of element i) indicate that Na+ is the element with the highest seawater component, and we found partial marine contributions for the SO2−4 and Mg2+ concentrations within this rainwater. Enrichment factors (EF) of selected elements were calculated to identify the sources of non-crustal elements: K+, Mg2+, Fe, and Ca2+ are the only elements dominantly sourced from the crust, whereas Mn and Ba have highly variable EF values (10–100) suggesting that a small proportion of these elements was derived from anthropogenic sources in addition to a more significant crustal contribution. Sr, Cu, Pb, Zn, and As are highly enriched with respect to average crustal compositions, confirming that the concentrations of these elements within precipitation are significantly controlled by human activities

Parthenolide Relieves Pain and Promotes M2 Microglia/Macrophage Polarization in Rat Model of Neuropathy

Neuropathic pain treatment remains a challenge because pathomechanism is not fully understood. It is believed that glial activation and increased spinal nociceptive factors are crucial for neuropathy. We investigated the effect of parthenolide (PTL) on the chronic constriction injury to the sciatic nerve (CCI)-induced neuropathy in rat. We analyzed spinal changes in glial markers and M1 and M2 polarization factors, as well as intracellular signaling pathways. PTL (5 µg; i.t.) was preemptively and then daily administered for 7 days after CCI. PTL attenuated the allodynia and hyperalgesia and increased the protein level of IBA1 (a microglial/macrophage marker) but did not change GFAP (an astrocyte marker) on day 7 after CCI. PTL reduced the protein level of M1 (IL-1β, IL-18, and iNOS) and enhanced M2 (IL-10, TIMP1) factors. In addition, it downregulated the phosphorylated form of NF-κB, p38MAPK, and ERK1/2 protein level and upregulated STAT3. In primary microglial cell culture we have shown that IL-1β, IL-18, iNOS, IL-6, IL-10, and TIMP1 are of microglial origin. Summing up, PTL directly or indirectly attenuates neuropathy symptoms and promotes M2 microglia/macrophages polarization. We suggest that neuropathic pain therapies should be shifted from blanketed microglia/macrophage suppression toward maintenance of the balance between neuroprotective and neurotoxic microglia/macrophage phenotypes