Multimodality Imaging of Anterior Compartment Pelvic Floor Repair

Pelvic organ prolapse (POP) and stress urinary incontinence (SUI) are two common disorders that affect the anterior compartment of the pelvic floor in women. These can be treated conservatively or surgically. Among patients treated surgically, a substantial number present with pain, recurrent POP or SUI, or other conditions that warrant additional interventions. In many of these cases, imaging is key to identifying and characterizing the type of procedure performed, locating synthetic materials that may have been placed, and characterizing complications. Imaging may be particularly helpful when prior surgical records are not available or a comprehensive physical examination is not possible. US and MRI are the most commonly used modalities for such patients, although radiopaque surgical materials may be visible at voiding cystourethrography and CT. The authors summarize commonly used surgical treatment options for patients with SUI and POP, review imaging techniques for evaluation of such patients, and describe the normal imaging appearance and complications of pelvic floor surgical repair procedures in the anterior compartment of the pelvis. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.

Racial and Ethnic Disparities in Pelvic Organ Prolapse Surgery in the United States: An Analysis of the ACS-NSQIP Clinical Registry

OBJECTIVE

To assess the types of POP surgery performed and patients' morbidity and mortality according to race and ethnicity in the United States.

METHODS

Using the American College of Surgeons National Surgical Quality Improvement Program database, we identified patients who had undergone POP procedures and stratified them by race and ethnicity. We compared differences in patient's baseline comorbidities and distribution of POP repairs performed. We further evaluated racial and ethnic disparities concerning complications, readmissions, reoperations, and mortality rates by performing univariate and multivariate analyses.

RESULTS

From 2012-2017, we identified 50,561 patients who underwent a primary POP repair procedure. The majority of patients were white (89.8%), followed by blacks (5.5%), and others (4.7%). Hispanics made up only 11.2% of the cohort. Black and Hispanic patients were younger, had higher BMI and suffered from a higher number of comorbidities than their white counterparts. There were significant differences in the types of POP procedures performed according to race and ethnicity. Despite no significant differences noted in overall complication rates, the types of complications varied by race and ethnicity. Neither race nor ethnicity was a significant predictor of reoperation or mortality.

CONCLUSION

There are notable racial and ethnic disparities in patients' comorbidities and types of POP repairs performed among women undergoing POP surgery in the United States. Although black patients are at a higher risk for readmission, there were no observed differences in complication, reoperation, or mortality rates according to race and ethnicity.

Low Rates of Urologic Side Effects Following Coronavirus Disease Vaccination: An Analysis of the Food and Drug Administration Vaccine Adverse Event Reporting System

OBJECTIVE

To quantify and describe urologic adverse events and symptoms after vaccination with the Pfizer-BioNTech and Moderna COVID-19 vaccines.

METHODS AND MATERIALS

We queried the FDA Vaccine Adverse Event Reporting System (VAERS) for all reported symptoms following the Pfizer-BioNTech and Moderna vaccines as of February 12th, 2021. All urologic symptoms were isolated and the reported adverse events associated with each symptom were reviewed.

RESULTS

Out of 15,785 adverse event reports, only 0.7% (113) described urologic symptoms. A total of 156 urologic symptoms were described amongst the 113 adverse event reports. The Pfizer-BioNTech vaccine was responsible for 61% of these reports and the Moderna vaccine was responsible for 39%. These symptoms were grouped into five different categories: Lower Urinary Tract Symptoms (n = 34, 22%), Hematuria (n = 22, 14%), Urinary Infection (n = 41, 26%), Skin and/or Soft Tissue (n = 16, 10%), and Other (n = 43, 28%). The median age of the patients reporting urologic symptoms was 63 years (IQR 44-79, Range: 19-96) and 54% of the patients were female.

CONCLUSION

Urologic symptoms reported after COVID-19 vaccination are extremely rare. Given the common prevalence of many of these reported symptoms in the general population, there does not appear to be a correlation between vaccination and urologic symptoms, but as the vaccination criteria expands, further monitoring of the Vaccine Adverse Event Reporting System is needed.

Single-port robotic-assisted laparoscopic sacrocolpopexy with magnetic retraction: first experience using the SP da Vinci platform

The purpose of this study was to describe technical considerations and first outcomes from a single-port robotic-assisted sacrocolpopexy (RSC) using the da Vinci SP platform (Intuitive Surgical, Sunnyvale, CA) and the Levita™ Magnetic Surgical System (San Mateo, CA, USA), a novel magnetic retraction system. Three females with pelvic organ prolapse elected to undergo RSC using the da Vinci SP platform. The supraumbilical incision length was 25 mm through which SP trocar was placed. A 12-mm assistant port was placed in the right upper quadrant. The external magnet was attached to the left side of the bed and used for bowel and bladder retraction. We then proceeded by duplicating the steps of our approach for a RSC performed using a multi-port robotic platform with necessary modifications given the SP approach. Intra-operative outcomes and peri-operative outcomes were collected and reported. The patients were women of 64, 66 and 73 years of age with BMI of 22, 25, and 34, respectively, and POP-Q stage III and IV prolapse. The RSC was performed between 198 and 247 min, estimated blood loss was 10-50 cc, and there were no complications. All patients were discharged home on post-operative day 1. All patients were doing well 1 month out with resolution of bulge symptoms. To our knowledge, this represents the first case series of robotic, magnetic-assisted sacrocolpopexies using the da Vinci SP platform and the Levita™ Magnetic Surgical System. It appears to be a safe and feasible approach, but long-term comparative studies will be necessary to assess functional outcomes.

Standing cough test for evaluation of post-prostatectomy incontinence: a pilot study

INTRODUCTION

We implemented a standardized Standing Cough Test (SCT) for assessment of men with post-prostatectomy incontinence (PPI) and stratified results according to an objective clinical grading scale in an attempt to facilitate male anti-incontinence surgical procedure selection.

MATERIALS AND METHODS

SCT was routinely performed during the initial outpatient consultation for PPI. Incontinence severity was recorded based on a novel Male Stress Incontinence Grading Scale (MSIGS) to stratify PPI. Each patient was assigned an incontinence grade score of 0 through 4 during the SCT. Men with mild stress urinary incontinence (SUI) (grades 0-2) were offered sling surgery while those with heavier SUI (grades 3-4) were offered artificial urinary sphincter (AUS). MSIGS grade was correlated to preoperative patient-reported pads per day (PPD), and patient-reported outcomes of anti-incontinence surgery were assessed.

RESULTS

Among 62 consecutive PPI patients, 20 (32%) were graded as mild based on SCT, while the majority (42/62, 68%) were graded as moderate-severe. Average time from prostatectomy to treatment was 6 years. MSIGS grade demonstrated a strong correlation with preoperative PPD (r = 0.74). Among the 53 patients who underwent surgery for PPI, 14 with mild SUI received a sling, while 39 (74%) more severe cases received an AUS. Patient-reported improvement was high overall in both groups (median 95%).

CONCLUSION

Most men with chronic PPI present for definitive treatment in a delayed manner after prostatectomy despite having severe incontinence. The SCT provides immediate, objective information about the severity of PPI which strongly correlates with patient-reported pads-per-day and may expedite anti-incontinence surgical procedure selection.

Elastic modulus for long-term evaluation of the tensile properties of polypropylene meshes in an in vivo rat model

PURPOSE

Mid-urethral slings have become the gold standard treatment of stress urinary incontinence in women. Their tensile properties should be evaluated in order to measure how they wear off with time. Our objective was a long-term assessment of the tensile properties of 2 synthetic tapes (TVT-O and I-STOP) after in vivo implantation in rats in terms of elastic modulus.

METHODS

Strips from both meshes were implanted in the abdominal wall of 30 rats, which were sacrificed at 5 time intervals. Their fibers were untangled to single components. Ultimate tensile strength (UTS), strain at UTS and the elastic modulus of each fiber type were measured.

RESULTS

I-STOP maintained UTS and strain over time, while TVT-O UTS and strain were significantly reduced. However, the elastic modulus of both tapes remained constant.

CONCLUSIONS

Both meshes maintained their stiffness and elasticity with time. Elastic modulus could be an appropriate factor to predict long-term implantation outcomes. The clinical significance of such findings remains to be demonstrated by long-term analysis.

Male Stress Incontinence Grading Scale (MSIGS) for Evaluation of Men with Post-Prostatectomy Incontinence: A Pilot Study

INTRODUCTION

We developed an objective clinical grading scale to characterize post-prostatectomy incontinence (PPI) and evaluated its use as a tool to facilitate male anti-incontinence procedure selection.

PROTOCOL

Between September 2014 and July 2015, we prospectively implemented a novel Male Stress Incontinence Grading Scale (MSIGS) to stratify PPI patients based on incontinence severity. Patients included were those referred for PPI who had no prior anti-incontinence surgery. During the initial outpatient consultation, each patient was prospectively assigned an incontinence grade score of 0 through 4 based on the consensus of 2 examiners performing a standing cough test (SCT). All patients refrained from voiding for at least 60 minutes prior to the SCT. Men with mild SUI (MSIGS grades 0-2) were offered AdVance sling surgery while those with heavier SUI (MSIGS grades 3-4) were offered artificial urinary sphincter (AUS). MSIGS grade was correlated to patient-reported pads-per-day (PPD), and patient-reported outcomes of anti-incontinence surgery were assessed.

OUTCOME

Of 62 consecutive new PPI patients, 20 were graded as mild based on SCT [five (8%) grade 0, 10 (16%) grade 1, five (8%) grade 2] while 42 were graded as moderate-severe [10 (16%) grade 3, 32 (52%) grade 4]. MSIGS grade demonstrated a strong correlation with preoperative PPD (r=0.74). Among the 53 patients who underwent surgical intervention for PPI, 14 with mild SUI were treated with AdVance® male urethral sling (MSIGS grade 0, 1, or 2) while 39 more severe cases received AUS (MSIGS grade 3 or 4). Patient-reported improvement was high overall (median 95%) and similar for sling and AUS patients (95% and 96.5% respectively, p=0.596). The median time from radical prostatectomy to anti-incontinence surgery was 5.4 years (range 1-20).

DISCUSSION

The Male Stress Incontinence Grading Scale provides a rapid, simple, non-invasive, objective assessment of PPI severity which strongly correlates with patient-reported pads-per-day and appears to facilitate anti-incontinence surgical procedure selection.

Change in Overactive Bladder Symptoms After Surgery for Stress Urinary Incontinence in Women

OBJECTIVE

To assess change in overactive bladder (OAB) symptoms up to 5 years after surgery and to identify associated predictors of change from baseline.

METHODS

This is a secondary analysis of data from three multicenter urinary incontinence (UI) surgical trials of women with stress-predominant mixed UI assigned to Burch colposuspension, autologous fascial sling, or retropubic or transobturator midurethral slings. The primary outcome was improvement of 70% or greater from baseline in symptoms measured by the Urinary Distress Inventory-Irritative subscale. Surgical groups were compared within respective trials. Generalized linear models were fit using 1-year and up to 5-year data.

RESULTS

Significant improvements in Urinary Distress Inventory-Irritative scores were reported by each surgical group 1 year after surgery (P<.001). Most women (50-71%) reported improvement in OAB symptoms. Improvements were similar between midurethral sling groups at 1 year (65.5% compared with 70.7%, P=.32; odds ratio [OR] 0.83, 95% confidence interval [CI] 0.57-1.20 for retropubic compared with transobturator sling) and throughout the 5-year follow-up period. More women reported OAB symptom improvement after Burch compared with pubovaginal sling (67.9% compared with 56.6%, P=.01; OR 1.59, 95% CI 1.10-2.31 for Burch compared with sling); this group difference at 1 year persisted throughout the 5-year follow-up. At 1-year, 50.0-64.3% of patients reported 70% greater improvement in UI. This proportion declined to 36.5-54.1% at 5 years (P<.001). Preoperative use of anticholinergics and urodynamic parameters was not predictive of OAB symptom change after surgery.

CONCLUSION

Most women with stress-predominant mixed UI experienced significant improvement in OAB symptoms after incontinence surgery although this initial improvement diminished over time. Obesity blunted symptom improvement.

LEVEL OF EVIDENCE

II.

Expression and role of the angiotensin II AT2 receptor in human prostate tissue: in search of a new therapeutic option for prostate cancer

BACKGROUND

Evidence shows that angiotensin II type 1 receptor (AT1R) blockers may be associated with improved outcome in prostate cancer patients. It has been proposed that part of this effect could be due to angiotensin II type 2 receptor (AT2R) activation, the only active angiotensin II receptor in this situation. This study aimed to characterize the localization and expression of AT2R in prostate tissues and to assess its role on cell morphology and number in prostatic epithelial cells in primary culture.

METHODS

AT2R and its AT2R-interacting protein (ATIP) expression were assessed on non-tumoral and tumoral human prostate using tissue microarray immunohistochemistry, binding assay, and Western blotting. AT2R effect on cell number was measured in primary cultures of epithelial cells from non-tumoral human prostate.

RESULTS

AT2R was localized at the level of the acinar epithelial layer and its expression decreased in cancers with a Gleason score 6 or higher. In contrast, ATIP expression increased with cancer progression. Treatment of primary cell cultures from non-tumoral prostate tissues with C21/M024, a selective AT2R agonist, alone or in co-incubation with losartan, an AT1R antagonist, significantly decreased cell number compared to untreated cells.

CONCLUSIONS

AT2R and ATIP are present in non-tumoral human prostate tissues and differentially regulated according to Gleason score. The decrease in non-tumoral prostate cell number upon selective AT2R stimulation suggests that AT2R may have a protective role against prostate cancer development. Treatment with a selective AT2R agonist could represent a new approach for prostate cancer prevention or for patients on active surveillance.

A modified approach to patient’s selection with improved clinical outcomes in sacral nerve modulation

Introduction: Since the marketing of the percutaneous permanenttined leads (PPTL), many centres rely solely on these instead ofthe percutaneous nerve evaluation (PNE) as a screening tool. Atour centre, we routinely perform PNE. Moreover, with our limitedhospital resources, we have adopted a stricter definition of successin the patient selection process using an improvement of morethan 60% as a cut-off point. This study presents our experiencewith sacral nerve stimulation using PPTL as an adjunct to PNE toimprove the outcome of the screening method for patients sufferingfrom refractory voiding dysfunction.Methods: We reviewed the charts of 106 patients who underwenta PNE between 2001 and 2008. The outcome of the procedures,the complication rates and its long-term effect were reviewed.Results: Overall, 116 PNE were performed and it was successfulin 54%. Forty-five out of the 62 patients with a successful PNEunderwent the stage I procedure. Of these, 93% had a successfulstage I and were later implanted with the implantable pulse generator(IPG). The remaining 12 patients underwent the simultaneousimplantation of the PPTL and IPG using the open procedure andit was successful in 10 of them.Conclusion: The PNE is a good adjunct to the staged procedureto select the appropriate candidates for sacral nerve stimulation,especially with limited resources.

A modified approach to patient's selection with improved clinical outcomes in sacral nerve modulation

INTRODUCTION

Since the marketing of the percutaneous permanent tined leads (PPTL), many centres rely solely on these instead of the percutaneous nerve evaluation (PNE) as a screening tool. At our centre, we routinely perform PNE. Moreover, with our limited hospital resources, we have adopted a stricter definition of success in the patient selection process using an improvement of more than 60% as a cut-off point. This study presents our experience with sacral nerve stimulation using PPTL as an adjunct to PNE to improve the outcome of the screening method for patients suffering from refractory voiding dysfunction.

METHODS

We reviewed the charts of 106 patients who underwent a PNE between 2001 and 2008. The outcome of the procedures, the complication rates and its long-term effect were reviewed.

RESULTS

Overall, 116 PNE were performed and it was successful in 54%. Forty-five out of the 62 patients with a successful PNE underwent the stage I procedure. Of these, 93% had a successful stage I and were later implanted with the implantable pulse generator (IPG). The remaining 12 patients underwent the simultaneous implantation of the PPTL and IPG using the open procedure and it was successful in 10 of them.

CONCLUSION

The PNE is a good adjunct to the staged procedure to select the appropriate candidates for sacral nerve stimulation, especially with limited resources.

Long-term efficacy of the bone-anchored male sling for moderate and severe stress urinary incontinence

OBJECTIVE

To present a prospective long-term evaluation of the bone-anchored male sling (InVance™, American Medical Systems, Minnetonka, MN, USA) for patients with moderate to severe stress urinary incontinence (SUI) after prostate surgery

PATIENTS AND METHODS

Forty-five patients had a male sling implanted for SUI after prostate surgery. The evaluation before and after surgery included a complete history and physical examination, various questionnaires (American Urological Association Symptom Score, University of California Los Angeles/RAND prostate index), cysto-urethroscopy, International Continence Society (ICS) 1-h pad test and a urodynamic study. The follow-up assessments were at 2, 6 and 12 months after surgery, and yearly thereafter. The success rate was defined as the percentage of patients 'dry' and 'improved'.

RESULTS

The median (range) follow-up was 36 (2-64) months. Twelve patients (27%) had previous adjuvant radiotherapy. Eighteen patients (40%) had moderate SUI (two or three pads/day) and 27 (60%) had severe SUI (more than three pads/day). All preoperative ICS 1-h pad tests were positive. The success rate was 76%; 16 patients were dry (36%), 18 were improved (one or two pads/day, 40%) and in 11 the sling was a failure (24%); 76% of ICS 1-h pad tests were negative after surgery. The postoperative urodynamic study showed no signs of bladder outlet obstruction. In all, 72% of patients were satisfied/very satisfied with the surgery and 86% considered themselves cured/almost cured. The success rate was not affected by the presence of previous radiotherapy or the severity of SUI. Ten patients had perineal numbness, but in all it resolved within 1-3 months. There was one mesh infection which required its removal. There was no urethral erosion.

CONCLUSION

Compared to previous studies, the InVance male sling had a good success rate for moderate and severe SUI, with a median follow-up of 36 months. The results did not differ for moderate or severe SUI or with the presence of previous radiotherapy.

Multi-Centre Study of Intraurethral Valve-Pump Catheter in Women with a Hypocontractile or Acontractile Bladder

OBJECTIVES

To compare the safety, effectiveness and patient satisfaction of an intraurethral valve-pump catheter (In-Flow) versus the current standard of care, clean intermittent catheterization (CIC), for females with hypocontractile or acontractile bladder.

MATERIALS AND METHODS

The study was a multi-centre, prospective, single-arm crossover study. Eligible patients underwent a 1-week In-Flow tolerability trial. Successful patients then continued through an 8-week baseline phase using CIC, followed by a 16-week In-Flow treatment phase, and a final 4-week treatment withdrawal phase. Outcome measures included post-void residual (PVR), Wagner incontinence-specific quality of life (I-QOL), rate of urinary tract infection and adverse events. At study completion, open enrollment was offered.

RESULTS

A total of 273 women with a mean age of 48.9 years using CIC entered the study in 18 centres under either the original (n=88) or revised protocols (n=185). The revised protocol included the addition of a 1-week tolerability trial. The reasons for the large early withdrawal of subjects (169/273) were mainly related to initial discomfort and leakage. A total of 77 patients completed the In-Flow treatment phase. PVR was comparable during baseline CIC phase and In-Flow treatment phase (20.3 ml vs. 16.1 ml), with significantly improved quality of life (QOL; mean improvement of I-QOL score +25.9; p<0.001).

CONCLUSION

The In-Flow catheter appears to be a viable alternative to CIC. A subgroup of patients, mainly those unsatisfied with the currently available treatments, was more likely to tolerate In-Flow catheters, and they may achieve enhanced independence and QOL.

The I1307K APC polymorphism: prevalence in non-Ashkenazi Jews and evidence for a founder effect

A missense mutation within the APC gene, I1307K, was described in Ashkenazi individuals at risk for colorectal cancer (CRC) and in the general population. The anecdotal reporting of the occurrence of this mutation in some non-Ashkenazi individuals led us to hypothesize that within the Jewish people, the I1307K polymorphism may reflect a founder mutation, and that the mutation is not restricted to ethnic Ashkenazis. To test that notion, and to establish the occurrence rate of the I1307K polymorphism in non-Ashkenazi Jewish populations, we screened Iraqi and Moroccan Jews and consecutive Jewish CRC patients and performed haplotype analysis with APC-linked markers in two I1307K carrier families. We analyzed Jewish individuals: 210 Moroccans, 160 Iraqis, 148 Ashkenazi, and 349 CRC patients (227 Ashkenazi and 122 non-Ashkenazi). The mutation detection scheme included PCR followed by denaturing gradient gel electrophoresis (DGGE) or modified restriction analysis (MRA). Haplotypes were assessed using three intragenic and three flanking markers. The I1307K polymorphism was detected in 29/227 Ashkenazi (12.8%), 2/122 (1.6%) non-Ashkenazi CRC patients, and in 2 individuals each (approximately 1%) within the Moroccan and Iraqi populations. Allelic pattern analysis in all our I1307K carriers, revealed a common haplotype for the three intragenic markers tested, in all mutation carriers, regardless of ethnic origin. The I1307K polymorphism, therefore, exists in all ethnic Jewish populations: Ashkenazi and non-Ashkenazi, with or without colon cancer. Jewish I1307K mutation carriers share a common allelic pattern with APC-linked markers. This strongly supports the notion of a founder mutation for I1307K.

Role of positive and negative regulation in modulation of the Fer promoter activity

p94(fer) is a cytoplasmic and nuclear tyrosine kinase whose function has been linked to cell growth. p94(fer) accumulates at different levels in various cell types and is not detected in pre-B, pre-T and T-cells (Halachmy, S., Bern, O., Schreiber, L., Carmel, M., Sharabi, Y., Shoham, J., Nir, U., 1997. p94(fer) facilitates cellular recovery of gamma irradiated pre-T cells. Oncogene 14, 2871-2880). The fer RNA, encoding p94fer, is transcribed from the FER locus in human rat and mouse. In the present work, a Fer gene transcription initiation point was determined, and the Fer promoter was cloned. A DNA genomic fragment, extending 3698bp upstream of the fer RNA start site, was isolated, sequenced and functionally characterized. A transient transfection assay, carried out in fibroblastic cell lines, revealed the presence of the Fer promoter within the cloned genomic fragment. The Fer promoter contains neither an obvious 'TATA' element nor a putative initiator sequence, but is composed of positive and negative, cis-acting elements. Negative regulation was found to be the main cause for dysfunctioning of the Fer promoter in a T-cell leukemia cell line (Jurkat). The minimal Fer promoter that is still active in fibroblasts consists of an AP1 binding site located 14bp upstream of the fer transcription initiation point. This minimal promoter was not active in the Jurkat T-cell leukemia cells and did not bind AP1 in these cells. Three additional AP1 sites were identified in functional sequences of the Fer promoter. Thus, the availability of AP1 activity may contribute as well to the modulation of the Fer promoter activity. The presumed regulatory role of AP1 in modulating the Fer promoter activity implies a link between cell growth and the Fer gene expression level. Indeed, exposure of fibroblasts to low serum growth conditions reduced the cellular level of the fer RNA.

Regional library and information services in the NHS--why, where, what and whither?

A general introduction showing the need for a regional structure, how the regional networks were set up, what they do and how they facilitate better library and information services (LIS) for their users, is followed by descriptions of the setting up, work and development of four different regions; South West England, Midland, Wales and Scotland. A list with contacts is given for all the regional networks, the NHS Regional Librarians Group (RLG) and the LINC Health Panel.

[Arterial embolism of the lower limb after extracorporeal lithotripsy. A case report]

The authors report a case of arterial embolism of the right lower limb after extracorporeal lithotripsy for left pelvic ureteric stone. This probable complication of lithotripsy has never been reported in the literature.

p94fer facilitates cellular recovery of gamma irradiated pre-T cells

p94fer is a ubiquitous, nuclear and cytoplasmic tyrosine kinase, whose accumulation has been demonstrated in all mammalian cell lines analysed. In the present work, the p94fer expression profile was determined in cell lines which were not tested before. While being present in several hematopoietic and non hematopoietic cell lines including thymic stromal cells, the p94fer kinase could not be detected in pre-T and T cell lines. p94fer was also absent in pre-B line, but accumulated in these cells upon their induced development to antibody producing cells. This is in agreement with the absence of p94fer in primary thymic and splenic T lymphocytes and its induced accumulation in stimulated B cells. Relatively high p94fer levels were detected in primary thymic and splenic stromal cells. Ectopic expression of p94fer in pre-T cells slightly affected their cell cycle profile but it did not affect their apoptotic death which was induced by ionizing radiation. However, p94fer facilitated dramatically, the cellular recovery of gamma irradiated pre-T cells which have escaped the apoptotic death. The enhanced recovery of the irradiated, p94fer expressing pre-T cells, resulted most probably from their increased survival, rather than from a prominent change in their proliferation rate. The absence of p94fer from pre-B and pre-T cells, may thus contribute to the relative sensitivity of these cells to ionizing radiation and to their dependence on the functioning of other nuclear tyrosine kinasese.

Development of a health risk appraisal for the elderly (HRA-E)

The purpose of this project is to develop a health risk appraisal for the elderly (HRA-E) and test its application in both medical and nonmedical settings. The HRA-E system consists of a questionnaire and software for computer-generation of personalized reports to participants, 55 years and older, and their physicians. Items in the questionnaire cover a comprehensive range of content domains relevant to health promotion in the elderly. The goal of the HRA-E system is to prevent functional decline. Samples of eligible subjects from the American Association of Retired Persons (AARP), a group practice, and a senior center were extended invitations to participate. Those responding affirmatively to the invitation were given a questionnaire and evaluation form. Each person who returned the questionnaire received his or her personal report and a second evaluation form. Four months after receiving their reports, respondents were questioned about behavior changes during the interim. Preliminary findings, based on 1895 respondents, indicate that nearly all participants found the questionnaire easy to complete and were pleased with its overall length. In addition, most participants read their reports, and many planned to take action, based on report recommendations. In the next phase of this project, the intent is to refine the questionnaire, extend the intervention protocols for longitudinal application, and evaluate its impact on health-related behaviors, medical care utilization, and functional decline.

Analysis of the erythropoietin receptor gene in patients with myeloproliferative and myelodysplastic syndromes

The human erythropoietin receptor (EpoR) gene has been cloned and characterized. Very few EpoR genetic abnormalities have been reported so far. Polycythemia vera (PV) is characterized by low/normal serum erythropoietin (Epo) levels with proposed Epo hypersensitivity. Myelodysplastic syndromes (MDS) are characterized by refractory anemia with variable serum Epo levels. Several reports have suggested EpoR abnormalities in both types of stem cell disorders. We analyzed DNA obtained from peripheral blood mononuclear cells of seven healthy controls, 20 patients with myeloproliferative disorders (MPD, 11 patients with PV, five agnogenic myeloid metaplasia with myelofibrosis, four essential thrombocytosis) and eight patients with refractory anemia with ringed sideroblasts (RARS), an MDS variant. The DNA was digested with four restriction enzymes (BamHI, Bgl II, Sacl and HindIII), followed by Southern blot, using a 32P radiolabeled probe, containing 1.5 kb of the human EpoR cDNA. All 20 MPD patients and seven out of the eight MDS patients demonstrated a restriction pattern which was identical to the seven normal controls, as well as to the erythroid cell line K562, and also consistent with the expected restriction map, for all four enzymes tested. One RARS patient had a normal pattern with three enzymes but a different one with HindIII. The HindIII 12 kb large band was replaced by a faint 12 kb band and a new (about 9 kb) band appeared. The EpoR restriction map and the normal pattern obtained with the other three enzymes suggest that this patient has a 3 kb upstream deletion in one allelic EpoR gene. The same molecular pattern was detected in the patient's sister, who suffers from anemia with mild bone marrow (BM) dyserythropoiesis and plasmacytosis. Northern blot analysis showed that the patient's BM RNA carried normal EpoR message. This familial pattern may represent polymorphism. However, the patient's very high serum Epo level, her resistance to treatment with recombinant Epo, and the abnormally low growth rate of in vitro erythroid cultures, suggesting poor response to Epo in this MDS patient as well as the hematological abnormalities in her sister, support the speculation that the different EpoR gene might serve as a genetic predisposing marker and potentially could be involved (probably via post-transcriptional mechanisms and by an interaction with other factors or cytokines) in the pathogenesis. Our data suggest that the EpoR is intact in MPD and in most patients with RARS. One RARS patient had a familial different genetic structure, which could represent polymorphism. However, we can speculate also that it might be involved in the pathogenesis of the disease.

[Transitional cell carcinoma of the ureter and cyclophosphamide: apropos of a case]

The authors present a case of transitional cell carcinoma of the ureter in a patient treated by cyclophosphamide-based chemotherapy and radiotherapy for Hodgkin's disease. In the light of this case, they review the eight previously reported cases of cyclophosphamide-induced ureteric tumours.

[Hemorrhagic rupture of an angiomyolipoma during pregnancy. Review of the literature apropos of a case]

The authors present a case of retroperitoneal rupture of an angiomyolipoma in a pregnant woman at 31 weeks of gestation and emphasize the diagnostic difficulties and severity of this tumour. They review eleven cases already reported in the literature.

[A simple alteration in a ureteral double J stent to improve its clinical acceptability]

The authors describe a modification of the classical double J stent designed to improve its clinical acceptability. It consists of cutting the lower J so that the catheter, inserted in the ureter, does not protrude into the bladder. A loop of nonresorbable suture attached to the lower extremity of the stent is passed through the ureteric orifice, allowing its easy extraction. This procedure has been used in eight patients with no complications.

ferT encodes a meiosis-specific nuclear tyrosine kinase

ferT is a mouse testis-specific mRNA, shown previously to potentially encode a 51 kilodalton tyrosine kinase termed p51ferT. The accumulation of ferT RNA is restricted to primary spermatocytes that are at the prophase stage of the first spermatogenic meiotic division. By using antibodies raised against a synthetic peptide which was designed according to a putative p51ferT unique amino acid sequence, we have shown that testicular cells indeed contain a 51 kilodalton protein that is recognized by the anti-p51ferT antibodies. The protein was not detected in six nontesticular mouse tissues, nor was it detected, like the ferT RNA, in the testes of 14-day-old mice. These findings strongly suggest that the 51 kilodalton protein is p51ferT. Immunohistochemical staining localized p51ferT to meiotically dividing spermatocytes. Transfection experiments in CHO cells confirmed the nuclear localization of p51ferT in eukaryotic cells. p51ferT seems thus to be the first meiosis-specific nuclear tyrosine kinase described to date.

Management by agreement: contracting for library services in South West Thames

On 1 April 1991, the financial base of the NHS underwent its most dramatic change since its inception in 1948. All NHS services are now based on contracts and this has major implications for library services. This change was perceived by the South West Thames Regional Library Service as presenting a unique opportunity and the paper outlines the background to the thinking and the strategy adopted to meet the challenges. Sources of library funding and precise spending details were identified by means of a survey and contracts agreed covering all NHS staff in each of the 13 districts. The contracts are operating as 'shadow contracts' for 1991-92 allowing a valuable period of evaluation and monitoring before any money actually changes hands. The survey form for collecting library budgetary information and the service agreement are included as Appendices to the article.

Characterization and partial purification of the 8-9S androgen receptor from benign prostatic hyperplasia tissues

The present study reports a 3,800-fold purification of the 8-9S androgen-receptor complex from benign prostate hyperplasia (BPH) tissues using differential chromatography. In addition, the BPH androgen receptor complexes have been characterized using sucrose density gradient (SDG) ultracentrifugation, gel permeation, and anion exchange high performance liquid chromatography (HPLC). Results indicate that a) under nontransforming conditions, BPH cytosols contained both 8-9S (40-78%) and 4S (22-60%) androgen-receptor forms, b) apparent molecular weights of these androgen-receptor apparent molecular weights of these androgen-receptor complexes, as analyzed by gel permeation HPLC, were estimated to correspond at 270 kDa, and 90 kDa respectively, c) 8-9S androgen-receptor complexes were retained on an anion exchange HPLC column and could be eluted at 0.22 M KCl at a linear gradient, whereas 4S complexes were not retained on anion exchange columns under identical experimental conditions, d) 10X dilution of BPH cytosols containing only the 4S (0.6 M KCl) form and subsequent chromatography on anion exchange HPLC system was indicative of fragmentation (these fragments were retained on anion exchange columns and could be eluted by 0.33 M KCl on a linear gradient HPLC), and e) increased temperature (22 C) was permissive of proteolytic fragmentation (fragments were estimated to correspond at 30, 15, and 5 kDa). The results are discussed in relationship with the composition of the nontransformed androgen-receptor molecules.

Studies on the characterization of rat prostate androgen receptors

In the presence of sodium molybdate and protease inhibitors, two forms of androgen-receptor complexes were observed which sedimented in the areas of 8-9S and 5-7S by SDG centrifugation. The intermediary 5-7S form was better seen when complexes were incubated at low KCl concentrations. The sedimentation coefficient of this form fluctuated between 5 and 7S depending on the KCl concentration. At high ionic strength (0.6M KCl) in all media, one form only was observed having a sedimentation coefficient value of 4.3S. By gel exclusion chromatography, we also observed two specific entities at 75A and 68A; in the presence of 0.6M KCl, however, two entities were found at 68A and 43A. The constant presence of protease inhibitors in all buffers was necessary to separate the intermediary 68A form. We calculated molecular weights of about 270 kDa, 190 kDa, and 80 kDa respectively for these three forms. [3H]R1881-receptor complexes bound to DEAE-cellulose and were eluted in the absence of glycerol at 0.1M and 0.2M KCl. Material found at 0.1M KCl sedimented in the areas of 5-7S and 8-9S in nearly equal proportion, and that found at 0.2M KCl sedimented in the 8-9S area only. When the cytosol was chromatographed at a fast flow rate (4 ml/min), untransformed 8-9S receptors did not bind to phosphocellulose, but transformed complexes were retained, could be eluted with 0.4M KCl and sedimented in the 4S area on KCl free SDG centrifugation. When the excluded untransformed 8-9S complexes were re-chromatographed at a slow flow rate (1 ml/min), they were retained on phosphocellulose, and could be eluted with 0.3M KCl.(ABSTRACT TRUNCATED AT 250 WORDS)

Action of clonidine on micturitional reflexes in decerebrate cats

We explored the urodynamic action of clonidine (preferential alpha 2-agonist) and yohimbine (preferential alpha 2-blocker) in decerebrate cats. These animals retain catecholaminergic fibers from the complex of the locus coeruleus to the spinal cord and have synergic and faster micturition cycles than normal cats. Twenty-nine male cats were made decerebrate at intercollicular level under ether anesthesia. Voiding, vesical, urethral and blood pressures, and the EMG of the external sphincter-pelvic floor and leg muscles were studied. Preparations with the urethrovesical junction opened and closed were used. Control activity was characterized by two types of vesical pressure waves: (1) low frequency, high intensity, and (2) high frequency, low intensity. Type-2 preceded Type-1 waves. Clonidine caused: (A) reduction of Type-1 and enhancement of Type-2 Pves waves; (B) diminution of vesical capacity; (C) facilitation of external sphincter relaxation; (D) inhibition of skeletal muscle activity; (E) systemic hypotension and bradycardia. Yohimbine inhibited clonidine's actions. When injected alone, it inhibited vesical and increased sphincteric activities. It also produced systemic hypertension and enhanced crisis of autonomic dysreflexia. The overall effect of clonidine on urodynamics in acute decerebrate cats was to bring about an active, small (normotonic) bladder with urinary frequencies. We suggest that clonidine: (1) inhibited Type-1 waves by inhibiting cellular activity in the locus coeruleus. As a result, the vesico-vesical contraction long loop reflex was abolished; (2) facilitated Type-2 waves by inhibiting inhibitory interneurons in the sacral parasympathetic center. As a result, the vesicovesical contraction short loop reflex was facilitated.

Characterization of androgen receptor by high performance liquid chromatography and sucrose density gradient ultracentrifugation in normal and malignant human prostatic tissues

In the present study we have characterized androgen-receptor complexes of normal and malignant human prostate cytosols using sucrose density gradient centrifugation, gel permeation and anion exchange high performance liquid chromatography (HPLC). Our results indicated that: 1) malignant tissue cytosols differed from normal by the presence of a 4-5S androgen receptor form which accounted for 30% of total specific-binding of malignant tissue cytosols, 2) 8-9S androgen-receptor complexes in normal and malignant prostate cytosols were estimated as 270kDa by gel permeation HPLC, 3) 8-9S complexes were retained and could be eluted by 0.22M KCl on a linear gradient anion exchange HPLC, 4) 4-5S androgen-receptor complexes were estimated as 90kDa by gel permeation HPLC and were not retained on anion exchange HPLC in our experimental conditions, and 5) either 10X dilution of the 4-5S complexes and subsequent anion exchange HPLC, or anion exchange chromatography of 8-9S complexes at 22 degrees C were causing fragmentation of the androgen receptor molecule from normal and malignant tissues. These fragments had enhanced affinity for anion exchange columns. These results are discussed in relation to the composition of the nontransformed androgen receptor macromolecule.

Sucrose density gradient and exchange high performance liquid chromatography characteristics of rat prostate androgen receptor forms

In this study, we characterized rat prostate androgen receptor using sucrose density gradient ultracentrifugation, gel permeation and anion exchange high performance liquid chromatography (HPLC). Our results indicated that 1) androgen receptor complexes in rat prostate cytosols containing no KCl were of 8-9S form corresponding to 270kDa, and in cytosols containing 0.6M KCl were of 5-6S form corresponding to 90kDa; 2) 8-9S androgen receptor complexes were retained and could be eluted by 0.22M KCl in a linear gradient anion exchange HPLC; 3) Dilution (10X) of the 8-9S and of the 5-6S receptor complexes and subsequent chromatography on anion exchange columns was indicative of fragmentation. Fragments were of 3-4S form and were eluted by 0.33M KCl on anion exchange HPLC. Temperature (22 degrees C) was permissive of proteolysis generating a 30kDa androgen receptor fragment. These results are discussed in the context of the composition of non-transformed rat prostate androgen receptor.

Substance P and neurokinins as stimulants of the human isolated urinary bladder

Neurokinins are active stimulants of the human isolated urinary bladder. In a preliminary study, performed on bladders taken from four donors, we attempted the characterization of neurokinin receptors. It was shown that neurokinin A is more active than neurokinin B and substance P. Neurokinin receptors selective agonists were also tested and it was found that the most active compound was the NK-A selective agonist, [Nle10]NKA 4-10: A substance P antagonist was able to reduce the effect of neurokinin A but its affinity was rather low. This suggests that the receptor mediating the contraction of the human urinary bladder to neurokinins is of the NK-A (NK2) type. The action of neurokinins on the human urinary bladder appears to be a direct one and mediated by specific receptors different from those of other agents. On the contrary, kinins were found to be active through a new mechanism which was not influenced by either anti-B1 or anti-B2 receptor antagonists.

Purification and characterization of the untransformed androgen receptor in rat prostate

The isolation and characterization of the untransformed form of androgen receptors has not yet been successful, owing to their inherent lability as well as to their ready proteolysis. In this study, we have stabilized rat prostate androgen receptors by sodium molybdate and by rapid filtration on phosphocellulose. Proteases were inhibited by bacitracin, aprotinin, leupeptin and PMSF. Under these conditions the untransformed complex was purified approx 3000-fold, corresponding to 18% yield, by differential chromatography on DEAE cellulose and phosphocellulose gels. The partially purified receptor has the same ionic characteristics as the original untransformed receptor of crude cytosol; in addition, it possesses a Stokes' radius of 75 A, as determined by Sephacryl S-300 gel filtration, a sedimentation coefficient of 8.8S, a calculated molecular weight of 275 kDa and a friction coefficient of 1.6. The [3H]R1881 receptor complex was specific to androgens since unlabelled R1881 and dihydrotestosterone were able to completely displace bound [3H]R1881, whereas estradiol, cortisol, and triamcinolone acetonide did not compete. The purified complex was a multimer dissociable by 0.6 M KCl, resulting in a form migrating in the 4S area on sucrose density gradient. After treatment with 0.5% formaldehyde, three forms were obtained, migrating in the areas of 8-9, 5-6 and 3-4S respectively, of a sucrose density gradient containing 0.6 M KCl. This is the first step towards the purification to homogeneity of the untransformed androgen receptor.