Haematuria: from identification to treatment

Haematuria has a prevalence of 0.1% to 2.6%. Potential diagnoses may include infection, kidney stones, trauma, exercise or spurious causes, such as foods, drugs or menstruation, and a tumour. Approximately 20% of patients with haematuria have a urological tumour, with a further 20% found to have a significant underlying pathology. Haematuria is subsequently known as the ‘classic presentation’ of bladder cancer with 70-80% of patients experiencing painless, gross (visible) haematuria. However, in all cases of visible haematuria, a tumour should be suspected until proven otherwise. A patient with visible haematuria requires urgent, stringent investigation, warranting specialist assessment and subsequent selective referral through a series of patient-centred investigations at a haematuria clinic. One-stop clinics have been shown to improve the patient experience in early diagnosis of potentially life-threatening conditions. Yet despite morbidity and mortality from bladder cancer increasing, the haematuria service has remained largely unchanged for several decades. This paper will discuss the tests and investigations that need to be undertaken in an individual with either visible or non-visible haematuria, and outline the care that is needed to support patients through the investigation process, with special focus on bladder tumour

Erectile dysfunction following retropubic prostatectomy

Prostate cancer is the most common cancer to affect men in the UK. Treatment options depend on the grade of tumour, the patient's co-existing diseases and choice of treatment. One potentially curative option is surgery, specifically a radical retropubic prostatectomy or variation thereof. As a consequence of the surgery, men commonly experience two side-effects: urinary incontinence and erectile dysfunction (ED). This paper outlines the clinical management of ED following surgery and aims to provide an overview of how to assess a man who has developed ED and discuss the various treatment options available, along with the efficacy in terms of recovery of erections

Joint keynote presentation – “Erectile dysfunction in Neurological Disorders”

The nature and severity of a man’s neurological condition may have a profound effect on erectile function and this warrants careful consideration in relation to providing supportive treatment options that are effective, safe and acceptable for the individual and his partner. Neurological disorders contribute to erectile dysfunction (ED) in a number of different ways and may occur as a direct result of impairment in the central nervous system, the peripheral nervous system, or a combination of both. Functional loss associated with the condition itself and subsequent damage to CNS structures (including spinal tracts, cerebral cortex, spinal cord or the autonomic nerves), may reduce the capacity to physically experience genital sensation, engage in physical intimacy and achieve erection, normally associated with sexual intercourse. In most neurological disorders, comorbid depression, altered body image, and the prescription of various medicines used to manage symptoms such as pain, spasticity, continence (amongst others) may nefariously contribute to patient’s psychological wellbeing, negatively impact on quality of life and affect relationships. Nurses are ideally placed to assess the relative impact of the neurological condition and the effects of various treatments on erectile function. Proactively addressing patients’ sexuality and making it a natural part of holistic nursing care allows for early detection of any problems that otherwise would go unidentified. Availability of guidelines & information about how to access various treatments for ED may be useful in all neurological care units, so that nurses and other health professionals are adequately equipped to provide appropriate information, reassurance and acceptable treatment interventions. Decisions regarding selection of specific treatments should take into account the preferences and expectations of patient and his partner. As first-line therapy and in the absence of contraindications to their use, conventional treatments such as the phosphodiesterase-5 inhibitors (PDE5Is) have been shown to significantly improve erectile function. Taking into account the patient’s mobility, dexterity and ability to self-administer, other treatments such as intracavernosal injections, medicated urethral system for erection (MUSE) and the use of vacuum constriction devices (VCDs) may be reserved for patients who do not have a response to PDE5Is, or in whom these drugs are poorly tolerated, or contraindicated. Psychosexual counselling may be helpful in cases of erectile dysfunction with psychological needs or relationship difficulties. This talk begins by focusing on the neurobiology of sexual arousal and the biological basis for erectile dysfunction in men with a variety of neurological disorders, including stroke, MS, Parkinson’s disease, Epilepsy, autonomic dysfunction and spinal cord injury (SCI). After considering the range of problems men typically experience with ED secondary to neurological impairment, we will discuss the relative benefits of various treatment options and current guidelines and good clinical practice for management of ED

Classical Biological Control of Invasive Legacy Crop Pests: New Technologies Offer Opportunities to Revisit Old Pest Problems in Perennial Tree Crops

Advances in scientific disciplines that support classical biological control have provided “new tools” that could have important applications for biocontrol programs for some long-established invasive arthropod pests. We suggest that these previously unavailable tools should be used in biological control programs targeting “legacy pests”, even if they have been targets of previously unsuccessful biocontrol projects. Examples of “new tools” include molecular analyses to verify species identities and likely geographic area of origin, climate matching and ecological niche modeling, preservation of natural enemy genetic diversity in quarantine, the use of theory from invasion biology to maximize establishment likelihoods for natural enemies, and improved understanding of the interactions between natural enemy and target pest microbiomes. This review suggests that opportunities exist for revisiting old pest problems and funding research programs using “new tools” for developing biological control programs for “legacy pests” could provide permanent suppression of some seemingly intractable pest problems. As a case study, we use citricola scale, Coccus pseudomagnoliarum, an invasive legacy pest of California citrus, to demonstrate the potential of new tools to support a new classical biological control program targeting this insect

Pseudohypoparathyroidism type 1b due to paternal uniparental disomy of chromosome 20q

Context: Pseudohypoparathyroidism type 1b (PHP1b) is the result of end-organ resistance to PTH and other hormones such as TSH in the absence of any features of Albright's hereditary osteodystrophy. Patients with PHP1b show imprinting abnormalities at the complex GNAS locus. The molecular cause of autosomal dominant familial PHP1b has been well-defined with identification of microdeletions within the GNAS locus or the nearby STX16, but the molecular mechanism of the GNAS imprinting defects in sporadic PHP1b cases remains elusive.Objective: We investigated the underlying molecular mechanism of GNAS imprinting defects in two patients with sporadic PHP1b.Results: We identified paternal uniparental disomy of the long arm of chromosome 20 (patUPD20) in two unrelated patients with sporadic PHP1b. This provides an explanation for the patients' GNAS methylation abnormalities and hormone resistance. Our data and a review of the six published cases of patUPD20 suggest that high birth weight and/or early-onset obesity and macrocephaly may also represent features of patUPD20.Conclusion: We suggest that patUPD20 should be considered in the evaluation of patients with sporadic PHP1b

Novel chromosome findings in bladder cancer cell lines detected with multiplex fluorescence in situ hybridization

Bladder cancer is a common neoplasm worldwide, consisting mainly of transitional cell carcinomas, while squamous, adenocarcinoma, and sarcomatoid bladder cancers account for the remaining cases. In the present study, multiplex fluorescence in situ hybridization (M-FISH) has been used to characterize chromosome rearrangements in eight transitional and one squamous cell carcinoma cell line, RT112, of UMUC-3, 5637, CAT(wil), FGEN, EJ28, J82, 253J, and SCaBER. Alterations of chromosome 9 are the most frequent cytogenetic and molecular findings in transitional cell carcinomas of all grades and stages, while changes of chromosomes 3, 4, 8, 9, 11, 14, and 17 are also frequently observed. In the present study, alterations previously described, including del(8)(p10), del(9)(p10), del(17)(p10), and overrepresentation of chromosome 20, as well as several novel findings, were observed. These novel findings were a del(15)(q15) and isochromosome 14q, both occurring in three of nine cell lines examined. These abnormalities may reflect changes in bladder tumor biology. M-FISH represents an effective preliminary screening tool for the characterization of complex tumor karyotypes

HIITing the brain with exercise; mechanisms, consequences and practical recommendations

The increasing number of older adults has seen a corresponding growth in those affected by neurovascular diseases, including stroke and dementia. Since cures are currently unavailable, major efforts in improving brain health need to focus on prevention, with emphasis on modifiable risk factors such as promoting physical activity. Moderate-intensity continuous training (MICT) paradigms have been shown to confer vascular benefits translating into improved musculoskeletal, cardiopulmonary and cerebrovascular function. However, the time commitment associated with MICT is a potential barrier to participation, and high-intensity interval training (HIIT) has since emerged as a more time-efficient mode of exercise that can promote similar if not indeed superior improvements in cardiorespiratory fitness for a given training volume and further promote vascular adaptation. However, randomised controlled trials (RCTs) investigating the impact of HIIT on the brain are surprisingly limited. The present review outlines how the HIIT paradigm has evolved from a historical perspective and describes the established physiological changes including its mechanistic bases. Given the dearth of RCTs, the vascular benefits of MICT are discussed with a focus on the translational neuroprotective benefits including their mechanistic bases that could be further potentiated through HIIT. Safety implications are highlighted and components of an optimal HIIT intervention are discussed including practical recommendations. Finally, statistical effect sizes have been calculated to allow prospective research to be appropriately powered and optimise the potential for detecting treatment effects. Future RCTs that focus on the potential clinical benefits of HIIT are encouraged given the prevalence of cognitive decline in an ever-ageing population. (Figure presented.)