Complicaciones del tratamiento de incontinencia urinaria y prolapso de la pelvis

ResumenEste artículo tiene como objetivo proporcionar una visión general de las complicaciones asociadas al tratamiento quirúrgico por incontinencia urinaria y prolapso pélvico relacionado con el uso de mallas quirúrgicas. Asimismo, otro de sus objetivos es revisar la nueva clasificación de complicaciones relacionadas con la inserción de prótesis o injertos en la cirugía de piso pélvico femenino otorgada por la Asociación Uroginecológica Internacional (IUGA, por su sigla en inglés) / Sociedad de Continencia Internacional (ICS, por su sigla en inglés) y por las recientes notificaciones proporcionadas por la Administración de Medicamentos y Alimentación (FDA, por su sigla en inglés)

Seven Months in America

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Conceptual issues for screening in the genomic era – time for an update?

screening from clinical testing remains strangely elusive. Although numerous definitions of screening have been suggested, there is considerable variation amongst them, leading to confusion and disagreement amongst clinicians and public health professionals alike. In light of developments in genomics, we emphasise the need to differentiate between opportunistic screening and clinical testing because of the differing prior probability of disease and thus ethical burden of responsibility placed upon the physician in each scenario. Screening requires higher standards, first because screening tests are performed in asymptomatic individuals, and second because these tests are generally offered to individuals who otherwise believe themselves to be healthy. All the other characteristics commonly invoked to describe screening – including the systematic use of a rapid test for risk stratification within a particular population – can be better categorised as either practical requirements or by-products of screening programmes rather than screening tests. Physicians need to appreciate the shifting moral burden placed upon them relating to clinical testing versus screening, and the differing legal obligations that may ensue

Sindbis virus proteins nsP1 and nsP2 contain homology to nonstructural proteins from several RNA plant viruses

Although the genetic organization of tobacco mosaic virus (TMV) differs considerably from that of the tripartite viruses (alfalfa mosaic virus [AlMV] and brome mosaic virus [BMV]), all of these RNA plant viruses share three domains of homology among their nonstructural proteins. One such domain, common to the AlMV and BMV 2a proteins and the readthrough portion of TMV p183, is also homologous to the readthrough protein nsP4 of Sindbis virus (Haseloff et al., Proc. Natl. Acad. Sci. U.S.A. 81:4358-4362, 1984). Two more domains are conserved among the AlMV and BMV 1a proteins and TMV p126. We show here that these domains have homology with portions of the Sindbis proteins nsP1 and nsP2, respectively. These results strengthen the view that the four viruses share mechanistic similarities in their replication strategies and may be evolutionarily related. These results also suggest that either the AlMV 1a, BMV 1a, and TMV p126 proteins are multifunctional or Sindbis proteins nsP1 and nsP2 function together as subunits in a single complex

A scalable bioreactor for the expansion of anchorage-dependent stem cells

Figure 1 - (a) Pump driven continuous perfusion 3D bioreactor. (b) The 3D bioreactor matrix. (c) Matrix cross-section (d) Assembled bioreactor. Currently, there is a lack of suitable bioreactors for the expansion of stem cells and other anchorage-dependent cells. Existing bioreactors are either limited in scalability, have a significantly different culture environment from the traditional 2D culture, or difficult to harvest single-cells suspensions. Cell manufacturing using existing bioreactors is an expensive, labor-intensive cell culture process, and typically requires a high-cost ISO 5 cleanroom environment. Southwest Research Institute® (SwRI®) has developed a novel cell expansion bioreactor to propagate cells using a 3D printed, single-use, scalable device, and a closed-loop system. SwRI’s patented bioreactor (Figure 1) features tightly packed interconnected spherical voids providing a large surface-to-volume ratio for cell proliferation under perfusion flow. The concave spherical surfaces reduce the hydrodynamic shear to less than 3×10-4 Pa, suitable for shear-sensitive anchorage-dependent cell proliferation [2]. This average shear stress in the bioreactor is much lower than the average shear stress in hollow fiber and microcarrier-based bioreactors [3, 4]. The 3D printed bioreactor is easy to scale up while maintaining the same structure. Please click Additional Files below to see the full abstract

Recurrent urinary tract infections in healthy and nonpregnant women

AbstractRecurrent urinary tract infections (RUTI) are prevalent and pose significant clinical challenges. Although the term RUTI has long been vaguely defined, a consensus definition has emerged in recent years. The exact etiology behind RUTI remains under debate, with valid arguments for both ascending reinfections as well as persistent infection inside the bladder. These persistent infections exist in the form of quiescent intracellular reservoirs in the mouse model and may represent a novel concept to explain UTI recurrence in humans. Manageable risk factors such as behavioral patterns alongside nonmanageable risk factors including genetic susceptibility are growing fields of investigation. Acute UTI have been studied through two model bacterial strains: Escherichia coli UTI89 and CFT073. However, the clinical relevance to RUTI of these two strains has not been firmly established. Current treatment strategies for RUTI are limited and remain dominated by antibiotic usage despite variable efficacy. The majority of studies in humans have focused on younger groups of women with little information available about the postmenopausal population despite a heightened risk of RUTI in this age group

Die Keilschriftbriefe aus Jerusalem.

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Missing Data Frequency and Correlates in Two Randomized Surgical Trials for Urinary Incontinence in Women

INTRODUCTION AND HYPOTHESIS: Missing data is frequently observed in clinical trials; high rates of missing data may jeopardize trial outcome validity. PURPOSE: We determined the rates of missing data over time, by type of data collected and compared demographic and clinical factors associated with missing data among women who participated in two large randomized clinical trials of surgery for stress urinary incontinence, the Stress Incontinence Surgical Treatment Efficacy Trial (SISTEr) and the Trial of Midurethral Sling (TOMUS). METHODS: The proportions of subjects who attended and missed each follow-up visit were calculated. The chi-squared test, Fisher\u27s exact test and t test were used to compare women with and without missing data, as well as the completeness of the data for each component of the composite primary outcome. RESULTS: Data completeness for the primary outcome computation in the TOMUS trial (62.3%) was nearly double that in the SISTEr trial (35.7%). The follow-up visit attendance rate decreased over time. A higher proportion of subjects attended all follow-up visits in the TOMUS trial and overall there were fewer missing data for the period that included the primary outcome assessment at 12 months. The highest levels of complete data for the composite outcome variables were for the symptoms questionnaire (SISTEr 100 %, TOMUS 99.8%) and the urinary stress test (SISTEr 96.1%, TOMUS 96.7%). In both studies, the pad test was associated with the lowest levels of complete data (SISTEr 85.1%, TOMUS 88.3%) and approximately one in ten subjects had incomplete voiding diaries at the time of primary outcome assessment. Generally, in both studies, a higher proportion of younger subjects had missing data. This analysis lacked a patient perspective as to the reasons for missing data that could have provided additional information on subject burden, motivations for adherence and study design. In addition, we were unable to compare the effects of the different primary outcome assessment time-points in an identically designed trial. CONCLUSIONS: Missing visits and data increased with time. Questionnaire data and physical outcome data (urinary stress test) that could be assessed during a visit were least prone to missing data, whereas data for variables that required subject effort while away from the research team (pad test, voiding diary) were more likely to be missing. Older subjects were more likely to provide complete data