The Oral Microbiome and Cross-Kingdom Interactions during Pregnancy

Pregnancy initiates a temporary transition in the maternal physiological state, with a shift in the oral microbiome and a potential increase in frequency of oral diseases. The risk of oral disease is higher among populations of Hispanic and Black women and those with lower socioeconomic status (low SES), demonstrating a need for intervention within these high-risk populations. To further our understanding of the oral microbiome of high-risk pregnant women, we characterized the oral microbiome in 28 nonpregnant and 179 pregnant low-SES women during their third trimester living in Rochester, New York. Unstimulated saliva and supragingival plaque samples were collected cross-sectionally, followed by assessment of the bacterial (16S ribosomal RNA) and fungal (18S ITS) microbiota communities. Trained and calibrated dentists performed oral examinations to determine the number of decayed teeth and plaque index. Initially, plaque from 28 nonpregnant women and 48 pregnant women were compared; these data showed significant differences in bacterial abundances based on pregnancy status. To further our understanding of the oral microbiome within the pregnant population, we next examined the oral microbiome within this population based on several variables. Streptococcus mutans, Streptococcus oralis, and Lactobacillus were associated with a greater number of decayed teeth. The composition of fungal communities differed between plaque and saliva, demonstrating 2 distinct "mycotypes" that were represented by a greater abundance of Candida in plaque and Malassezia in saliva. Veillonella rogosae, a common oral bacterium, was negatively associated with both plaque index and salivary Candida albicans colonization by culture data. This was further emphasized by in vitro inhibition of C. albicans by V. rogosae. Identification of interactions between the bacterial or fungal oral communities revealed that V. rogosae was positively associated with the oral commensal Streptococcus australis and negatively with the cariogenic Lactobacillus genus, suggesting V. rogosae as a potential biomarker of a noncariogenic oral microbiome.

The paid sick leave and sickness benefits for universal health coverage: a scoping review

Background

The countries with paid sick leave (PSL) and sickness benefits (SB) mostly provide the benefit coverage to specific categories of workers, which results in health inequalities among employees in COVID-19. The PSL and SB are key factors to achieve universal health coverage (UHC) in that they protect access to healthcare and improve population health. This study attempted to investigate whether the policies helped achieve the UHC when they were expanded.

Methods

This review followed the scoping review protocol of PRISMA-ScR. On April 6, 2021, we extracted the literature using the keywords ‘paid sick leave', ‘sickness benefits', ‘paid sick day', and ‘earned sick leave’ from PubMed and Web of Science and added two studies through hand-search. All articles were written in English. We did not limit the publication date.

Results

Forty-four selected studies were based in four single countries and the European Union. Most of the studies were published after 2010 (84.1%) and were conducted as cross-sectional (72.7%) studies. Not only workers who use PSL and SB but also children whose parents use PSL and SB increased their use of healthcare services and getting flu shots. Also, using PSL and SB decreased their unmet healthcare needs and emergency use. The various health status factors, such as infectious disease incidence, mortality, and presenteeism, also decreased.

Conclusions

The provisions of PSL and SB offer individual and public health benefits by allowing employees and their families to use healthcare services. Group of employees, we can expect similar public health impacts on newly covered groups, thus contributing to achieving the UHC. Since more than 90% of articles are published from the United States, future studies need to evaluate the outcomes of health effects in various European or Asian countries.

Key messages

• The provision of PSL and SB positively affects employees and their families by allowing them to use healthcare services.

• The expansion of PSL and SB contributes to the UHC by guaranteeing indirect medical costs that enable universal access to essential healthcare services.

A Sick Benefit Scheme Reduces Unmet Healthcare Needs: An Natural Experiment in Seoul

 

South Korea experiences four times more unmet healthcare needs than OECD countries (11.6% and 2.6% respectively). Unmet healthcare needs are caused by the double burden of direct and indirect costs including income loss, and OECD countries operate a sickness benefit scheme to resolve sudden loss of pay. Seoul introduced the first sickness benefit system, Seoul-Type Paid Sick Leave Support (hereinafter Seoul Sick Leave), for self-employed national healthcare insurance subscribers to reduce the rate of unmet healthcare needs. By comparing the amount of increasing medical expenses between the beneficiary and non-beneficiary before (2018) and after (2019-2020) the introduction of the system, the study was intended to confirm the reduced unmet healthcare needs. This study used data from the National Health Information Database (NHID) and the difference in differences (DID) analytic framework. 96 and 121 patients were included in benefit and non-benefit cohorts, respectively. As a result, the beneficiary group’s expenses were smaller than those of the non-beneficiary group (coef.=-1.24, p = 0.026). However, the beneficiary group had a greater amount of increase in hospitalization expenses before and after the introduction than the non-beneficiary group did (coef.=1.66, p = 0.005). Our finding showed that the Seoul Sick Leave helped the precarious workers as they were able to use inpatient services when they needed. If it is to be scaled up to the national level, it should be applied all people to enhance universal health insurance in Korea.

Key messages

• Identified the effectiveness of the first sickness benefit system as it helped the precarious workers as they were able to use inpatient services when they needed.

• By financially supporting them, the Seoul Sick Leave support can achieve health promotion through early detection and treatment.

[Prosthetics after construction of the outer genitalia for transmen]

BACKGROUND

Growing awareness of gender identity issues and a rising prevalence of female-to-male transsexualism is increasing demand for surgical solutions that deliver both aesthetically and functionally satisfying outer genitalia for transmen.

OBJECTIVE

This article summarizes the available prosthetic options, describes different surgical approaches and reviews the outcome of prosthetics for transmen with a focus on penile prosthesis in phalloplasty.

METHODS

Current international standards of care, reviews and original publications are critically reviewed and correlated with our own experience with more than 400 transmen at two interdisciplinary referral centres in Frankfurt, Germany and London, UK.

RESULTS

Despite of a wide range of different phalloplasty techniques and prosthetic types, the currently most used technique is implantation of a three-piece, inflatable penile prosthesis in a radial-free-flap phalloplasty. There is still an ongoing debate about the number of implanted penile prosthesis cylinders, the use of customised corporoplasty-windsocks for the cylinder(s), and the location for the placement of the reservoir. At present there is only one penile prosthesis design for use in phalloplasties and long-term results are still pending.

CONCLUSION

There is still no ideal implant available for the use in phalloplasties. The current literature does not provide evidence-based treatment algorithms, which is also due to a lack of prospective randomised studies and validated measurement tools for the postoperative outcome. Initial data for the first transmen-specific penile prosthesis as well as an increase of transgender studies might lead to an improvement of treatment and the quality-of-life of the affected transmen.

EcoSun Pass: A tool to evaluate the ecofriendliness of UV filters used in sunscreen products

OBJECTIVE

Sunscreens play a major role in the EU sun protection strategy in order to prevent humans from UV light-induced skin damage. In recent years, the demand for high-quality sunscreen products including aspects of broad range and photostability of the UV protection, showing good spreadability onto human skin and excellent sensorial properties during and after application has increased. Environmental aspects are considered. Sunscreens are complex compositions, with UV filters being the key element in the formulations reaching up to about 30% in content in the final product. Some of these ingredients, however, may be regarded as hazardous for the aquatic environment. Nevertheless, the aquatic ecosystem represents only a single environmental compartment, which may be impacted by UV filters. Therefore, the EcoSun Pass (ESP) tool was developed in order to assess the overall environmental impact of UV filters in combination with its efficacy (Sun Protection Factor, SPF and UVA Protection Factor, UVA-PF).

METHODS

For that purpose, at first 24 of the EU-approved UV filters for sunscreen applications were evaluated for their environmental hazard profiles. Nine example UV filter compositions representing both SPF 30 and 50 were evaluated for ecofriendliness using the ESP tool.

RESULTS

The results revealed that two out of four SPF 30 compositions are considered as ecofriendly. Likewise, from the SPF 50 two out of five did meet the criteria for ecofriendliness. Furthermore, the results showed that most ecofriendly example formulations have also the lowest overall UV filter content in the product, based on the use of highly innovative and least hazardous UV filters.

CONCLUSION

These results demonstrate that the tool is applicable to various formulations being present on the market and thus allows for a selection of most ecofriendly and efficient UV filters to be used in sunscreens.

[Gender reassignment surgery from male to female]

For many trans*women, the surgical assignment of the male genital into a female is a fundamental part of the transition. Erogenous sensation of the neoclitoris is achieved by meticulous preparation of the penile glans with the neurovascular bundle. Several techniques are available for the formation of a neovagina, the penile inversion technique developed by Burou in the 1950s being the gold standard. With this technique, the inverted penile shaft skin is used as a pedicled flap to line the neovaginal canal. Alternatively, free skin grafts can be used, which serve primarily as a technique for redo procedures. Another technique is the use of intestinal segments to line the vaginal canal. This method is mostly used for redo procedures, but can also be performed primarily if penile skin is too small. Due to the numerous steps involved in the preparation, a wide variety of complications must be expected. Injury to the rectum during dissection of the neovaginal space, with an incidence of 4.5%, represents the greatest challenge. The most common complications are urethra-associated; hereby both a deviation of the urinary stream and strictures of the urethra are possible. The subjective satisfaction of trans*women with the surgical outcome is high and is reported in various studies to be 72-92%. On the basis of validated questionnaires it could also be shown that gender reassignment surgery leads to an increase in the trans*specific quality of life and promotes both subjectively perceived well-being and sexual satisfaction.

[Gender reassignment from female to male : Phalloplasty]

BACKGROUND

The increasing prevalence of gender dysphoria necessitates an evaluation of the literature of phalloplasty techniques for female to male transgender individuals.

OBJECTIVE

The following article provides an overview of the current surgical concepts and complications of phalloplasty, associated urethrogenitoplasty and the implantation of prostheses in phalloplasty.

MATERIAL AND METHODS

Current international reviews and original publications from 2010 to 2020 were reviewed and correlated with our referral center experience with more than 350 female to male transgender patients over the last 25 years.

RESULTS

Free radial forearm flap phalloplasty is the most widely used technique, followed by an anterolateral thigh flap (ALT flap) and pedicled or microsurgical transplantation. Hydraulic multicomponent prostheses are given preference and supplementary surgical techniques, such as scrotoplasty and glans sculpturing can make sense or be necessary. The complication rates after phalloplasty and after insertion of penile prostheses are substantial. Nevertheless, the overall patient reported satisfaction rate in the majority of studies is often over 80%.

CONCLUSION

Due to the increasing prevalence of gender dysphoria there is currently a need for interdisciplinary referral centers for gender reassignment surgery. A certain standardization of surgical techniques and timing would be desirable but a review of the current literature shows a high heterogeneity so that this cannot be derived from the currently available literature. It is hoped that the recently founded S2K guideline committee on operative treatment of gender dysphoria under the auspices of the German Society for Urology and the Society for Plastic and Reconstructive Surgery can report an initial collection of experiences in 2021.

0840 Sleep Quality in Clinically Indicated In-Laboratory Polysomnography

Introduction

Few studies have explored how patients sleep or what characteristics might be predictive of poor sleep during clinically-indicated polysomnography (PSG) in an in-laboratory setting.

Methods

We reviewed clinically indicated diagnostic PSG studies completed over a 10-year period in a single academic sleep center. Total sleep time (TST) and sleep efficiency (SE) were used as proxies for sleep quality. Patients were categorized as normal or poor sleepers based on TST <4 hours or SE <50%. Multivariate linear and logistic regression analyses were performed to determine factors associated with sleep quality while controlling for demographics, medications, comorbidities and measures of sleep.

Results

We included 4957 patients, who were mostly female (58.9%), middle-aged (52.9 y), Caucasian (69.3%), and overweight or obese (91.3%). 3682 patients (74.2%) were diagnosed with sleep apnea (Apnea Hypopnea Index(AHI)>5/hr).

Average TST was 5.75±1.43 hours (Interquartile range [IQR] = 4.94 - 6.73) and average SE was 75.1%±16.1% (IQR=66.9 - 87.2). TST and SE were lower for males compared to females (5.48 vs 5.93 hr, p<0.001; 73% vs 77%, p<0.001). In multivariable analysis, older age (TST: OR = 1.04, 95% CI:[1.03,1.05]; SE: OR = 1.04, 95% CI:[1.04,1.05]), male sex (TST: 1.38,[1.14,1.68]; SE: 1.34,[1.07,1.68]), normal body habitus (TST: 1.47,[1.02,2.08]; SE: 1.51,[1.01,2.27]) and a higher AHI (TST: 1.02,[1.02,1.03]; SE: 1.02,[1.003,1.03]) were significantly associated with being a poor sleeper for both TST and SE. Antidepressant use was associated with poor sleep for TST (0.77, [0.59,1]), but not for SE (0.98, [0.73,1.3]).

Conclusion

Sleep quality during the in-laboratory PSG differed by sex, age and presence of sleep apnea. Sleep quality during in-lab PSG is thought to be compromised by obtrusive monitoring and an unfamiliar environment, but average sleep quality may be higher than expected for patients in the laboratory. Future studies should consider examining in-lab sleep quality in different patient populations.

Support

N/A

[Microsurgical penile reconstruction in case of intersexuality and after penis carcinoma]

BACKGROUND

 The goals of penile reconstruction and phalloplasty include aesthetics as natural as possible and the ability of patients to void while standing and to have sexual intercourse. This article presents two more rare indications and techniques, the phalloplasty using free radial forearm flapin case of intersexuality and after penectomy due to penis carcinoma.

PATIENTS AND METHODS

 In transsexual individuals numerous phalloplasties in Gottlieb and Levine`s technique, by means phalloplasty of free radial forearm-flap of the non-dominant forearm, were performed in our department over the last few years. However, this technique also has its significance for phalloplasty in non-transgender persons.Two patients are considered in detail with regard to indication and surgical technique and were followed up in a multimodal setting.Patient 1 is genetically male, thirty-five years old with a micropenis in the case of pseudohermaphroditism masculine and androgen resistance.Patient 2 is a fifty-one-year old genetically male and as a result of a penis carcinoma his penis had to be amputated at the level of penis root. After absence of recurrence for 1,5 years, the penile reconstruction took place after complete resection of the remaining residual penile stump and corpora cavernosa. Both patients underwent multimodal follow-up 15 months postoperatively with regard to phalloplasty sensors and donor-site restrictions.

RESULTS

 An aesthetic and functional acceptable result could be obtained for both patients. Both patients are able to void while standing. The multimodal follow-up 15 months postoperatively revealed relevant differences in the sensory findings of both patients, which are due to the different anatomy of reinnervation.

CONCLUSION

 In microsurgical experienced departments, the technique of A. radialis phalloplasty can also be used successfully in more rare indications, as shown here, a satisfying result can be achieved in terms of function and aesthetics. The complications shown here do not differ from those using phalloplasty in transgender persons.

Patient perception and approval of faecal microbiota transplantation (FMT) as an alternative treatment option for obesity

INTRODUCTION

Fecal microbiota transplantation (FMT) represents a treatment option for some diseases, e.g. recurring Clostridium difficile-associated colitis. However, there is also evidence that FMT can be effective in treating obesity. This pilot study established the approval and willingness of obese patients to undergo FMT.

METHODS

We conducted a survey of adults with obesity using a questionnaire containing 21 both multiple choice and open questions was dispatched to a cohort of 101 persons with obesity. It included questions aiming at the process of FMT itself, donors as well as possible concerns. Additionally aspects of social background and disease activity were dealt with.

RESULTS

The response rate amounted to 30.1% (n = 31). In our population, mean BMI was 40.5 kg/m2 while the vast majority already tried out treatment modalities to lose weight before. 25.8% of persons with obesity were aware of FMT. 62.1% were willing to undergo FMT if the donor was healthy and anonymous while only 6.9% clearly refused this option. Sixty preferred an anonymous donor or a person proposed by their doctor while colonoscopy was the preferred application by 76.7%. The absence of risks of the procedure (47.8%) formed the principal motivation while reduction of medication was considered as least important reason (in 26.1). Insufficient testing of the faeces concerning infections raised the most concerns (in 61.6%).

CONCLUSION

For the majority of the persons with obesity surveyed FMT represents a treatment option. Approximately two thirds of the questionees would consider FMT as an alternative treatment option, even in spite of a satisfactory disease response to current standard therapies. Unsurprisingly there are concerns in regard to the transmission of possible infectious agents as well as to the hygieneic implementation of FMT itself.

Endopeptidase inhibition attenuates the contraction induced by big endothelin-1 of isolated human penile erectile tissue

Peptides, such as C-type natriuretic peptide (CNP), vasoactive intestinal polypeptide (VIP) and endothelin 1 (ET-1), are involved in the control of penile erectile tissue (corpus cavernosum = CC). Inhibiting the degradation of CNP and VIP or conversion of Big ET-1 into ET-1 by endopeptidase enzymes should result in an enhancement of CC smooth muscle relaxation. Using the tissue bath technique, responses of isolated CC, challenged by noradrenaline (NA, 1 μm), to increasing concentrations of the endopeptidase inhibitor KC 12615 (1 nm - 10 μm), CNP and VIP (0.1 nm - 1 μm), were investigated. Effects of CNP, VIP and Big ET-1 (0.1 nm - 100 nm) on the tissue tension were also evaluated following pre-exposure to 10 μm of KC 12615. Big ET-1 induced contraction of the CC amounting to a force generation of 1,200 mg. The contraction was attenuated in the presence of KC 12615 by 35% and 50%, respectively. The tension induced by NA was reversed by VIP and CNP to 38.7% ± 15.8% and 61% ± 13%, respectively, of the initial force. The findings might be of significance with regard to future pharmacological treatment options for male ED, where an endothelial dysfunction exists.

In vitro water resistance testing using SPF simulation based on spectroscopic analysis of rinsed sunscreens

OBJECTIVE

Water resistance retention (WRR) is the third performance attribute of sunscreens. Today, the standardized method for testing WRR is performed in vivo. For screening purposes, an in vitro method is highly preferable. Up to now, however, available methods have failed in accurately predicting in vivo WRR. In this study, we examine a novel in vitro approach aimed at enhancing in vivo prediction of WRR.

METHODS

We investigated two approaches, including a traditional procedure referred to as the 'plate method', which involves measuring in vitro sun-protection factor (SPF) before and after water immersion, and a new approach termed the 'solution method'. The latter employed a computational method to calculate the SPF using UV transmittance measurements of a sunscreen solution, obtained by rinsing the substrate without water immersion and with water immersion. It also had a model function for describing film irregularity. The aim was to avoid the effect of substrate-to-product affinity on the film distribution, which impacts the measured absolute value of the in vitro SPF occurring in the conventional approach. For both methodologies, we assessed two substrates for the sunscreen application based on different polymers, the widely used polymethylmethacrylate (PMMA) and the ethylene methacrylate acid copolymer (EMA).

RESULTS

The agreement between in vivo and in vitro WRR values obtained from each of the four test conditions was analysed using different sunscreens. No correlation was found between in vivo and in vitro WRR using the plate method, independently of the plate type. In contrast, the solution method, using EMA plates, revealed a significant correlation between in vivo and in vitro results, with an especially high correlation for in vivo non-water-resistant sunscreens. The results of two operators were comparable. The solution method was unsuitable for PMMA plates.

CONCLUSION

Despite the small discrepancy remaining between WRR values obtained from the in vitro solution method and in vivo method, which itself shows variability in results, this work provided a new insight into the in vitro testing of water resistance of sunscreens.

Nachweis des Skelettbefalls maligner Erkrankungen durch Immunszintigraphie des Knochenmarks

Immunszintigraphie des hämatopoetischen Knochenmarks und konventionelle Skelettszintigraphie wurden bei 141 Patienten mit malignen Grunderkrankungen verglichen. Die Immunszintigraphie des Knochenmarks wies in allen Patientenuntergruppen mehr metastasentypische Herdbefunde und einen ausgedehnteren Skelettbefall als das Skelettszintigramm nach. In 323 computertomographisch kontrollierten Skelettabschnitten fanden sich in 83,3% übereinstimmende Befunde zur Knochenmarkszintigraphie. Lediglich in 7 von 2135 (0,3%) Skelettabschnitten von 30 Patienten mit Fieber unklarer Ursache ohne maligne Grunderkrankung fanden sich immunszintigraphisch pathologische Herdbefunde. Bei 36 Patienten mit malignen Lymphomen waren immunszintigraphischer und histologischer/zytologischer Befund bei 14 Patienten übereinstimmend positiv und bei 17 Patienten übereinstimmend negativ. Die Immunszintigraphie des Knochenmarks stellt ein vielversprechendes, einfaches und routinefähiges Verfahren zum empfindlichen nichtinvasiven Nachweis des Skelettbefalls maligner Erkrankungen dar.

Acetylcholine precursor, citicoline (cytidine 5'-diphosphocholine), reduces hypoglycaemia-induced neuronal death in rats

Citicoline (cytidine 5'-diphosphocholine) is an important precursor for the synthesis of neuronal plasma membrane phospholipids, mainly phosphatidylcholine. The administration of citicoline serves as a choline donor for the synthesis of acetylcholine. Citicoline has been shown to reduce the neuronal injury in animal models with cerebral ischaemia and in clinical trials of stroke patients. Citicoline is currently being investigated in a multicentre clinical trial. However, citicoline has not yet been examined the context of hypoglycaemia-induced neuronal death. To clarify the therapeutic impact of citicoline in hypoglycaemia-induced neuronal death, we used a rat model with insulin-induced hypoglycaemia. Acute hypoglycaemia was induced by i.p. injection of regular insulin (10 U kg^-1 ) after overnight fasting, after which iso-electricity was maintained for 30 minutes. Citicoline injections (500 mg/kg, i.p.) were started immediately after glucose reperfusion. We found that post-treatment of citicoline resulted in significantly reduced neuronal death, oxidative injury and microglial activation in the hippocampus compared to vehicle-treated control groups at 7 days after induced hypoglycaemia. Citicoline administration after hypoglycaemia decreased immunoglobulin leakage via blood-brain barrier disruption in the hippocampus compared to the vehicle group. Citicoline increased choline acetyltransferase expression for phosphatidylcholine synthesis after hypoglycaemia. Altogether, the present findings suggest that neuronal membrane stabilisation by citicoline administration can save neurones from the degeneration process after hypoglycaemia, as seen in several studies of ischaemia. Therefore, the results suggest that citicoline may have therapeutic potential to reduce hypoglycaemia-induced neuronal death.

[Gender confirming surgery : Female-to-male and male-to-female]

BACKGROUND

Gender confirming surgery (GCS) represents a new and interdisciplinary urological field of activity.

OBJECTIVES

Based on more than 20 years of experience, the development of interdisciplinary strategies in the surgical management of male-to-female (MtF) and female-to-male (FtM) transgenders is summarized.

MATERIALS AND METHODS

The current national and international literature, as well as the surgical experience of the authors in the field of GCS, were evaluated, and aspects relevant for urologists are presented in a comprehensive review.

RESULTS

Since 1990 more than 1200 primary GCS in MtF transgenders and more than 230 primary GCS in FtM transgenders have been performed in the authors' institutions. Presuming an incidence of at least 1:20,000 for patients with gender dysphoria (GD) in the general population, the overall number of patients is limited. The complex surgical procedures should be realized in an interdisciplinary team, trained and specialized in this field of surgery, given the high rate of complications and secondary procedures with MtF GCS.

CONCLUSION

Postoperative satisfaction rates of FtM and MtF transgenders at over 80% are satisfactory. During the last few decades, surgical procedures have been widely standardized. In the field of penile reconstruction, the free forearm lap represents the preferred method, while several surgical alternatives arise from the current literature in this field.

Expression and distribution of the transient receptor potential cationic channel A1 (TRPA1) in the human clitoris-comparison to male penile erectile tissue

The transient receptor potential cationic channel ankyrin 1 (TRPA1) is a channel protein assumed to act in various human tissues as mechano- and pain sensor and play a role in neurotransmission. The expression of TRPA has already been investigated in the human prostate and urethra, however, only very few studies have addressed the expression and distribution in the male and female genital tract. The present study aimed to investigate by means of immunohistochemistry (double-labeling technique, laser fluorescence microscopy) in the human clitoris and penile erectile tissue the localization of TRPA1 in relation to nNOS, the vasoactive intestinal polypeptide (VIP) and vesicular acetylcholine transporter (VAChT). In the clitoral tissue, TRPA1 was observed in basal epithelial cells and slender nNOS-positive nerve fibers transversing the subepithelial space. To a certain degree, in the clitoral epithelial cells, TRPA1 was found co-localized with vimentin. In human corpus cavernosum, immunoreactivity for TRPA1 was seen in nerves transversing the cavernous sinusoidal space and running alongside small arteries, these nerves also displayed expression of the vesicular acetylcholine transporter protein (VAChT). Varicose nerves containing nNOS or VIP were not immunoreactive for TRPA1. It seems likely that TRPA1 is involved in nitric oxide-mediated afferent sensory transmission in the clitoris while, in penile erectile tissue, a role for TRPA1 in cholinergic signaling might be assumed.

Effects of endopeptidase inhibition on the relaxation response of isolated human penile erectile tissue to vasoactive peptides

Peptides, such as CNP, CGRP and VIP, are involved in the function of male penile erectile tissue. Tissue levels of said peptides are controlled by the endopeptidase enzymes. Theoretically, the inhibition of the degradation of CNP, CGRP and/or VIP should result in an enhancement in penile smooth muscle relaxation. The effects were investigated of CNP or VIP (0.1 nm-1 μm), without and following pre-exposure of the tissue to a threshold concentration of the endopeptidase inhibitor KC 12615 (10 μm, for 20 min), on the reversion of tension induced by means of electrical field stimulation. Drug effects on the production of cyclic AMP/GMP were also evaluated. Neither KC 12615, CNP and VIP nor the combination of CNP plus KC 12615 or VIP plus KC 12615 increased the response of the tissue to EFS. While no effects were observed of a pre-exposure of the tissue to KC 12615 on the production of cyclic AMP in the presence of VIP, an enhancement was registered in the accumulation of cyclic AMP in the presence of CNP plus KC 12615. Further studies are indicated to investigate whether endopeptidase inhibitors might tend to be more effective in tissues affected by a decreased local production of vasoactive peptides.

[Stump closure in laparoscopic appendectomy. Influence of endoloop or linear stapler on patient outcome]

BACKGROUND

Even though laparoscopic appendectomy is one of the most frequent procedures in abdominal surgery, the technique of appendiceal stump closure is still not standardized. The aim of this retrospective study was to analyze the effect of the use of endoloops or linear staplers for appendiceal stump closure concerning surgical site infections (SSI) and intra-abdominal abscesses (IAA).

PATIENTS AND METHODS

All laparoscopic appendectomies between January 1st 2007 and May 31st 2010 were split into an endoloop group (ELG) and a linear stapler group (LSG). The groups were compared with respect to the outcome parameters SSI and IAA.

RESULTS

A total of 430 appendectomies were performed in the study period of which 105 operations were conducted laparoscopically. In this study 47.6 % (n = 50) were alloted to the LSG and 52.4 % (n = 55) to ELG. In LSG 3.1 % (n = 1) developed an SSI versus 10.0 % (n = 4, p = 0.254) in ELG. No IAAs occurred in LSG compared to 2 (5.1 %, p = 0.499) in ELG.

CONCLUSION

The use of EL for appendiceal stump closure is safe and cost effective for low-grade appendicitis but high-grade appendicitis should be treated with LS.

Ahnak functions as a tumor suppressor via modulation of TGFβ/Smad signaling pathway

We provide detailed mechanisms of Ahnak-mediated potentiation of transforming growth factor β (TGFβ) signaling, which leads to a negative regulation of cell growth. We show that Smad3 interacts with Ahnak through MH2 domain and that Ahnak stimulates Smad3 localization into nucleus leading to potentiating TGFβ-induced transcriptional activity of R-Smad. Moreover, overexpression of Ahnak resulted in growth retardation and cell cycle arrest through downregulation of c-Myc and cyclin D1/D2. We describe results from analyses of Ahnak^−/− mouse model expressing middle T antigen in a mammary gland-specific manner (MMTV^Tg/+Ahnak^−/−), which showed significantly progressed hyperplasia of mammary glands compared with MMTV^Tg/+Ahnak^+/+. Finally, we screened multiple human breast cancer tissues and showed that the expression of Ahnak in cancer tissues is lower than that in control tissues by 50%. Taken together, these data indicate that Ahnak mediates a negative regulation of cell growth and acts as novel tumor suppressor through potentiation of TGFβ signaling.

[Baron Dominique-Jean Larrey: the founder of urological traumatology]

Dominique-Jean Larrey (1766-1842) was Surgeon-in-Chief of the Grande Army under Napoleon Bonaparte (1769-1821) and personal physician of the Emperor. Against the opposition of the traditionalists he introduced the "ambulances volantes", the so-called flying ambulances. The aim was the medical treatment of the injured soldiers immediately on the battlefield. This revolutionary treatment led to a benefit not only for the own soldiers, but also for the wounded enemies. His innovation in the field of immediate assistance of wounded persons, together with Larreys' outstanding medical competence, saved thousands of soldiers lives on the battlefield of the Napoleonic wars. His memories concerning the military campaigns, have been even up to the 20th century one of the standard works of modern military surgery. He had as well great interest in urolological injuries of the urinary system and their conservative and operative care. Up to these days, his work shows a surprising actuality and perfect anatomic understanding. In a time without anaesthetics, antibiotics and under primitive circumstances, Larrey and his collegues accomplished surgical feats. Larreys flying ambulances were copied by many different countries. The American Mobile Army Surgical Hospital (M.A.S.H) is clearly based on his thoughts and ideals. In our opinion he is the father of the modern war surgery as well the urological traumatology.

[The history of prostate cancer from the beginning to DaVinci]

For hardly any other organ can the development of medicine and technical advances in the last 150 years be so clearly illustrated as for the prostate. The history of radical prostatectomy was initially characterised by the problems in approaching this relatively difficulty accessible organ. In 1867, Theodor Billroth in Vienna performed the first partial prostatectomy via a perineal access. In 1904, Hugh Hampton Young and William Stewart Halsted at the Johns Hopkins Hospital in Baltimore / USA carried out the first successful extracapsular perineal prostatectomy and opened up a new era. In Germany, Prof. Friedrich Voelcker in Halle in 1924 developed the so-called ischiorectal prostatectomy. But it was left to Terence Millin to publish in 1945 the first series of retropubic prostatectomies. In 1952, the sacroperineal approach according to Thiermann and the sacral prostatectomy according to were introduced. Finally, in 1991 another new era in prostate surgery started with the first laparoscopic prostatectomy. This development peaked in 2011 with the presentation of the laparoscopic DaVinci prostatectomy by Binder. Originally a stepchild of urological surgery that was to be avoided whenever possible due to the fear of serious complications, the prostate has progressed in the course of time to an obscure object of lust. The stepchild has become the favorite child.

[A bowling ball as the cause of a renal artery embolism]

A 46-year-old man presented with severe pain in our emergency department. In addition he had macrohematuria, the further medical history was inconspicuous. The pain showed to be resistant to therapy, therefore we performed a CT scan of the abdomen. The CT scan showed a partial embolism of the right renal artery, a thrombus of the aorta thoracica as well as partial infarction of the spleen and the liver. An immediately initiated therapy with implantation of an aortal stent graft for fixation of the thrombus and an Actilyse® therapy led to full recovery of the patient. Closer questioning of the patient showed that the patient undertook an extended abdominal and thoracic muscle training programme by letting an eight-kilogram bowling ball fall down onto his abdomen from about 80 cm height. The diagnosis embolism of the renal artery cannot be made without extended diagnostics in the emergency room. A good hint for perfusion disorders of the kidney can be obtained with duplex ultrasound. Therapy-resistant pain without hydronephrosis and concomitant arrhythmia of the patient can lead to the diagnosis. The initiation of an adequate diagnosis and therapy is essential as otherwise persisting perfusion disorders of the kidney may occur.

[Sacrocolpopexy - pro laparoscopic]

Innovative techniques have a really magical attraction for physicians as well as for patients. The number of robotic-assisted procedures worldwide has almost tripled from 80,000 procedures in the year 2007 to 205,000 procedures in 2010. In the same time the total number of Da Vinci surgery systems sold climbed from 800 to 1,400. Advantages, such as three-dimensional visualization, a tremor-filter, an excellent instrument handling with 6 degrees of freedom and better ergonomics, together with aggressive marketing led to a veritable flood of new Da Vinci acquisitions in the whole world. Many just took the opportunity to introduce a new instrument to save a long learning curve and start immediately in the surgical master class.If Da Vinci sacrocolpopexy is compared with the conventional laparoscopic approach, robotic-assisted sacrocolpopexy shows a significantly longer duration of the procedure, a higher need for postoperative analgesics, much higher costs and an identical functional outcome without any advantage over the conventional laparoscopic approach. Although the use of robotic-assisted systems shows a significantly lower learning curve for laparoscopic beginners, it only shows minimal advantages for the experienced laparoscopic surgeon. Therefore it remains uncertain whether robotic-assisted surgery shows a significant advantage compared to the conventional laparoscopic surgery, especially with small reconstructive laparoscopic procedures such as sacrocolpopexy.