Physiotherapy for continence and muscle function in prostatectomy: a randomised controlled trial.

OBJECTIVE: To assess the effectiveness of pre- and postoperative supervised pelvic floor muscle training (PFMT) on the recovery of continence and pelvic floor muscle (PFM) function after robot-assisted laparoscopic radical prostatectomy (RARP). PATIENTS AND METHODS: We carried out a single-blind randomised controlled trial involving 54 male patients scheduled to undergo RARP. The intervention group started supervised PFMT 2 months before RARP and continued for 12 months after surgery with a physiotherapist. The control group was given verbal instructions, a brochure about PFMT, and lifestyle advice. The primary outcome was 24-h pad weight (g) at 3 months after RARP. The secondary outcomes were continence status (assessed by pad use), PFM function, and the Expanded Prostate Cancer Index Composite (EPIC) score. RESULTS: Patients who participated in supervised PFMT showed significantly improved postoperative urinary incontinence (UI) compared with the control group (5.0 [0.0-908.0] g vs 21.0 [0.0-750.0] g; effect size: 0.34, P = 0.022) at 3 months after RARP based on 24-h pad weight. A significant improvement was seen in the intervention compared with the control group (65.2% continence [no pad use] vs 31.6% continence, respectively) at 12 months after surgery (effect size: 0.34, P = 0.030). Peak pressure during a maximum voluntary contraction was higher in the intervention group immediately after catheter removal and at 6 months, and a longer duration of sustained contraction was found in the intervention group compared with the control group. We were unable to demonstrate a difference between groups in EPIC scores. CONCLUSION: Supervised PFMT can improve postoperative UI and PFM function after RARP. Further studies are needed to confirm whether intra-anal pressure reflects PFM function and affects continence status in UI in men who have undergone RARP.

Morphological examination of pelvic floor muscles in a rat model of vaginal delivery.

OBJECTIVE: This study investigated morphological changes in the composition of the pelvic floor muscles, degree of atrophy, and urethral function in a rat of simulated birth trauma induced by vaginal distension (VD) model. METHODS: Female Sprague-Dawley rats were classified into four groups: a sham group, and 1, 2, and 4 weeks post-VD (1 W, 2 W, and 4 W, respectively) groups. We measured the amplitude of urethral response to electrical stimulation (A-URE) to evaluate urethral function. After measuring the muscle wet weight of the pubococcygeus (Pcm) and iliococcygeus (Icm) muscles, histochemical staining was used to classify muscle fibers into Types I, IIa, and IIb, and the occupancy and cross-sectional area of each muscle fiber were determined. RESULTS: There were 24 Sprague-Dawley rats used. A-URE was significantly lower in the 1 W group versus the other groups. Muscle wet weight was significantly lower in the VD groups versus the sham group for Pcm. The cross-sectional area of Type I Pcm and Icm was significantly lower in the VD groups versus the sham group. Type I muscle fiber composition in Pcm was significantly lower in the VD groups versus the sham groupand lowest in the 2 W group. Type I muscle fiber composition in Icm was significantly lower in the 2 and 4 W groups versus the sham group. CONCLUSION: Muscle atrophy and changes in muscle composition in the pelvic floor muscles were observed even after improvements in urethral function. These results may provide insight into the pathogenesis of stress urinary incontinence after VD.

A newly identified enzyme from Japanese common squid Todarodes pacificus has the ability to biosynthesize d-aspartate.

Amino acids exist in two chiral forms, namely L and D. Although l-amino acids are predominant in vivo, certain limited circumstances have reported the usage of d-amino acids. d-aspartate (Asp), among them, plays crucial physiological roles in living organisms and is biosynthesized from L-Asp by the enzyme named aspartate racemase (AspRase). D-Asp is known to accumulate in large amounts in the nervous system of cephalopods. To understand the function of D-Asp in nervous system in more detail, it is necessary to elucidate its metabolic pathway; however, AspRase gene has not been identified in cephalopods as in the case of mammals. In this study, we successfully identified a novel gene encoding AspRase from the optic ganglion of Japanese common squid Todarodes pacificus. Our discovery of the squid AspRase challenges the prevailing assumption that AspRases across different animals share similar structures. Surprisingly, the squid AspRase is a unique enzyme that differs significantly from known AspRases, being structurally and phylogenetically related to aspartate aminotransferase (AST) and possessing both AspRase and AST activities. The optimum pH and temperature for AspRase activity using L-Asp as a substrate are approximately 7.0 and 20 °C, respectively. Moreover, we have found that AspRase activity is enhanced in the presence of 2-oxoacids. These findings have far-reaching implications for the understanding of enzymology and suggest that yet-to-be-identified mammalian AspRases may also be phylogenetically related to AST, rather than conventional AspRases. Furthermore, our results provide valuable insights into the evolution of the D-Asp biosynthetic pathway.

Detrusor-Overactivity-Related Voiding in Women Mimics Bladder Outflow Obstruction and Conceals Underactivity.

OBJECTIVE: Urodynamics of the storage phase showing detrusor overactivity is com- mon in neurogenic bladder patients. Terminal detrusor overactivity, which is defined by involuntary detrusor contraction that cannot be inhibited, causes urinary incon- tinence. Such incontinence causes a unique voiding in neurogenic bladder patients. During the voiding phase, the detrusor pressure at Qmax (Pdet.Qmax)/maximum flow rate (Qmax) (P/Q) is the gold standard for differentiating between detrusor underactiv- ity and bladder outflow obstruction. We investigated whether a valid identification of lower urinary tract dysfunction could be established from P/Q assessment of detrusor overactivity-related voiding patients. METHODS: This study evaluated 2 types of voiding. Detrusor overactivity-related void- ing is involuntary detrusor contraction that results in micturition or voiding after per- mission to void when detrusor overactivity has occurred, while voluntary voiding is voiding voluntarily after permission to void and without terminal detrusor overactivity. We evaluated female patients with neurogenic bladder who could undergo micturition without catheterization. A pressure flow study compared the 2 groups. RESULTS: Comparison of the detrusor overactivity-related voiding group (n=20) and the voluntary voiding group (n=12) found statistically significant differences with a lower Qmax and higher Pdet.Qmax (P=.01) in the detrusor overactivity-related void- ing group. The linear regression analysis P/Q plot showed the positivity and negativity value of the slope that was reversed in the 2 groups (-0.089 vs. 0.198). CONCLUSION: Current results showed different P/Q plot patterns between 2 types of voiding in patients with neurogenic bladder. These findings suggest there is increased detrusor pressure observed in detrusor overactivity-related voiding that mimics out- flow obstruction.

Episodes of Febrile Urinary Tract Infections Occur More Often in the Winter in Patients with Spina Bifida.

OBJECTIVE: Febrile urinary tract infections, which commonly occur in spina bifida patients, can cause renal dysfunction. To help prevent febrile urinary tract infection occurrence, a better understanding of any seasonal tendencies would be beneficial. MATERIALS AND METHODS: Study points evaluated included: (i) with or without febrile urinary tract infections, (ii) type of urinary management in patients with febrile urinary tract infections, (iii) number of febrile urinary tract infection occurrences, and (iv) season associated with episode. Febrile urinary tract infection was defined by medical records specifically ascribing the term and clinical presentations consistent with the diagnosis. We evaluated febrile urinary tract infection incidence per 1 person, risk odds, expected values, and chi-square analysis. RESULTS: This study examined 140 patients (79 males, 61 females). The patient's age at the first visit ranged from 2 days to 43.7 years old (median: 3.0 years old). The observation period was 0.6-43.7 years (median: 11.5 years). (i) Febrile urinary tract infection occurred in 68 cases, (ii) urinary management included: full clean intermittent catheterization: 49 cases, autoaugmented bladder: 15 cases, self-voiding: 8 cases, clean intermittent catheterization + indwelling catheter at night time: 5 cases, self-voiding + clean intermittent catheterization: 4 cases, vesicocutaneostomy: 2 cases, (iii) number of febrile urinary tract infection episodes: 2 times or less: 40 cases, 3-5 times: 20 cases, over 6 times: 8 cases, and (iv) total number of febrile urinary tract infection episodes was 183, with spring: 41, summer: 44, autumn: 37, and winter: 61. Risk odds of the incidence (one season vs. the other season) were spring: 0.870 (P = .425), summer: 0.954 (P = .784), autumn: 0.755 (P = .120), and winter 1.497 (P = .009).

Effects of a new selective ß3 -adrenoceptor agonist, vibegron, on bladder and urethral function in a rat model of Parkinson's disease.

OBJECTIVES: Parkinson's disease caused by the loss of dopaminergic neurons induces not only motor dysfunction but also lower urinary tract dysfunction. Patients with Parkinson's disease have recently been reported to experience both urge urinary incontinence (overactive bladder) and stress urinary incontinence, the latter of which occurs when the pressure of the bladder exceeds that of the urethra. Vibegron is a highly selective novel ß3 -adrenoceptor agonist approved for the treatment of overactive bladder. However, how ß3 -adrenoceptor agonists affect urethral function remains unclear. In a clinical report, the urethral function of patients with Parkinson's disease was shown to be degraded. The present study aimed to investigate the effects of vibegron on lower urinary tract activity in a rat model of Parkinson's disease. METHODS: In a rat model of Parkinson's disease induced by unilateral 6-hydroxydopamine injection into the substantia nigra pars compacta, we examined the effects of vibegron on bladder and urethral activity. RESULTS: Cystometric analysis revealed that, compared with vehicle injection, intravenous injection of 3 mg/kg vibegron significantly increased the inter-contraction interval (p < .05) and reduced voiding pressure (p < .01). However, no significant effects on urethral function were observed. CONCLUSIONS: The results of the present study provide corroborating evidence that bladder dysfunction is suppressed by the administration of vibegron in Parkinson's disease model rats, confirming that vibegron is effective for treating overactive bladder without further worsening urethral function. These findings may contribute to a better understanding of the mechanisms of ß3 -adrenoceptor agonists.

Extracellular Leakage Protein Patterns in Two Types of Cancer Cell Death: Necrosis and Apoptosis.

Dead cells release fragments of DNA, RNA, and proteins (including peptides) into the extracellular space. Two major forms of cell death during cancer development have been identified: necrosis and apoptosis. Our group investigated the mechanisms that regulate cell death during the treatment of mouse tumor FM3A cells with the anticancer drug floxuridine (FUdR). In the original strain F28-7, FUdR induced necrosis, whereas in the variant F28-7-A, it induced apoptosis. Here, we report that the extracellular leakage proteome (i.e., the secretome) is involved in these cell death phenomena. The secretome profile, which was analyzed via shotgun proteomic analysis, revealed that altered protein leakage was involved in signal transduction, transcription, RNA processing, translation, and cell death. Notably, the characteristic secretory proteins high mobility group box 1 and 2 were detected in the culture medium of both necrotic and apoptotic cells. Overall, these results indicate that unique cellular events mediated by secretory proteins may be involved in necrosis and apoptosis.

Archaeomegalomus gen. nov.: A remarkable new brown lacewing from mid-Cretaceous Kachin amber from northern Myanmar (Neuroptera: Hemerobiidae).

A new fossil species of Hemerobiidae, Archaeomegalomus burmiticus gen. et sp. nov., is described from mid-Cretaceous Kachin amber of northern Myanmar. This new genus is the third Mesozoic Hemerobiidae with a single stem of the radius posterior (RP) in the forewing. This suggests that A. burmiticus is one of the specialized side branches within the basal Hemerobiidae. Our study sheds more light on the Cretaceous diversity of Mesozoic brown lacewings, suggesting potentially higher generic and species paleodiversity of the hemerobiids in Burmese amber.

Urodynamic evaluation of the efficacy of vibegron, a new ß3-adrenergic receptor agonist, on lower urinary tract function in children and adolescents with overactive bladder.

INTRODUCTION: Idiopathic overactive bladder (OAB) is defined as an urgency symptom with or without urge incontinence, which is not due to known neurological abnormalities. Since children present with variable symptoms, pediatric nonneurogenic idiopathic OAB is a condition that is difficult to diagnose and treat. Although there are few reports on bladder function in pediatric patients compared to adult patients, it can be useful for diagnosis. Antimuscarinic therapy is the pharmacological mainstay of OAB management. However, antimuscarinic use is limited by side effects and Insufficient effects. Vibegron, a new drug with a different mechanism of action (ß3-adrenoreceptor agonist), was recently introduced for treating OAB in adults but has not been studied in the pediatric population. OBJECTIVE: This study aimed to determine the efficacy and tolerability of vibegron in children and adolescents with idiopathic OAB. STUDY DESIGN: We conducted a retrospective study enrolling pediatric patients with OAB whose symptoms did not improve with behavioral therapy or pharmaceutical therapy. Efficacy and tolerability were assessed via a question, and patients underwent video-urodynamic testing before and during treatment with once-daily 50 mg vibegron. Statistical differences were evaluated using Wilcoxon matched-pairs signed-rank tests. RESULTS: Out of the 17 patients that were recruited, full study with two urodynamic studies were confirmed by 11 patients. OAB symptoms improved in 14 (82.4%) patients, and 3 patients discontinued treatment because of ineffectiveness. No patients discontinued treatment because of intolerance to vibegron. The median (IQR) first desire to void (133 [82-185]-161 [123-227] mL), bladder capacity (158 [136-238]-204 [150-257] mL), and bladder compliance (18.1 [9.1-76.7]-34.0 [30.0-82.3] mL/cm H2O) improved significantly post treatment compared to before treatment. Detrusor overactivity disappeared in one of the eight patients with this condition. The parameters of voiding function did not change significantly after the administration of vibegron. DISCUSSION: Treatment with vibegron significantly improved clinical and urodynamic parameters of pediatric OAB with no adverse effects. Little information is available regarding the feasibility of switching drugs when patients discontinue prior pharmacological therapy because of insufficient efficacy or poor tolerability in children. Vibegron may be a promising OAB treatment option with a better balance of efficacy and tolerability. CONCLUSIONS: Vibegron is an alternative agent for pediatric patients with idiopathic OAB for improving both subjective symptoms and lower urinary tract function. Future prospective randomized studies with larger sample sizes must be conducted to validate the results of the present study.

Evaluation of pelvic floor muscle elasticity in patients with overactive bladder syndrome using real-time tissue elastography.

INTRODUCTION AND HYPOTHESIS: The purpose of this study was to compare the muscle elasticity of the striated urethral sphincter (SUS) using real-time tissue elastography (RTE) as an evaluation of pelvic floor muscle (PFM) function between overactive bladder (OAB) patients and healthy women. METHODS: The subjects were 8 healthy middle-aged women (healthy group; age range 57-65 years) and 9 female OAB patients (OAB group; age range 42-80 years). The target sites of elastography were the striated urethral sphincter (SUS) and adipose tissue as the reference site; muscle elasticity was calculated as the strain ratio (SR) of the SUS to the reference site. Evaluations were performed at rest and during PFM contraction. The OAB group completed OAB symptom and quality of life questionnaires. The SUS SR was compared between the groups. The SUS SR at rest and during PFM contraction was compared within groups using the t-test and Wilcoxon's test. The relationship between the questionnaire results and the SUS SR was evaluated by correlation analysis. RESULTS: Intergroup comparisons between the healthy and OAB groups showed no significant differences in SUS SR at rest and during PFM contraction. On intragroup comparisons, the SUS SR was significantly higher during PFM contraction than at rest in the healthy group (p = 0.011); in the OAB group, there was no significant difference in the SUS SR between rest and PFM contraction. The SUS SR was not significantly correlated with questionnaire results for OAB symptoms. CONCLUSION: This study shows the potential to non-invasively confirm the inability of OAB patients to correctly perform PFM contraction using RTE.

Neonatal reticulocytes among preterm infants of small for gestational age.

BACKGROUND: We previously reported that higher reticulocyte counts were observed in earlier preterm infants. Here we present an additional study that focused on reticulocyte counts among preterm infants of small for gestational age (SGA). To assess the relationship between SGA and perinatal variables during the early postnatal period. METHODS: A single-center study was undertaken at Ohta Nishinouchi Hospital between April 1, 2016 and June 30, 2021, using blood samples prospectively collected from infants admitted to the neonatal intensive care unit. These were assessed by univariate analysis and multivariate logistic regression analysis. RESULTS: A total of 467 preterm infants were analyzed, 367 (78.6%) non-SGA and 100 (21.4%) SGA. The median [interquartile range (IQR)] GA (weeks) for the two groups was 33 (31-35) and 34 (31-36), respectively (p = 0.058). The median (IQR) BW (g) for the two groups was 1888 (1480 to 2195) and 1381 (1019 to 1782), respectively (p < 0.001). There were significant relationships between SGA and BW (p < 0.001, OR, 0.997; 95% CI, 0.996 to 0.998), umbilical artery pH (p = 0.038, OR, 0.031; 95% CI, 0.010 to 0.827), Apgar at 5 min (p < 0.001, OR, 1.816; 95% CI, 1.301 to 2.536), nucleated erythrocyte count (p = 0.027, OR, 1.013; 95% CI, 1.001 to 1.024), reticulocyte count (p < 0.001, OR, 0.992; 95% CI, 0.988 to 0.995) and chorioamnionitis (p = 0.019, OR, 0.427; 95% CI, 0.210 to 0.868). CONCLUSION: These results suggest that preterm infants with SGA adapted more rapidly to the postnatal environment than did non-SGA preterm infants. Moreover, a lower reticulocyte count among preterm infants born SGA may be an indicator of good adaptation to the extra-uterine environment during the early postnatal period.

Mechanisms of D1/D2-like dopaminergic agonist, rotigotine, on lower urinary tract function in rat model of Parkinson's disease.

Parkinson's disease (PD) is a neurodegenerative condition caused by the loss of dopaminergic neurons in the substantia nigra pars compacta. As activation of dopaminergic receptors is fundamentally involved in the micturition reflex in PD, the objective of this study was to determine the effect of a single dose of rotigotine ([-]2-(N-propyl-N-2-thienylethylamino)-5-hydroxytetralin) on intercontraction interval (ICI) and voiding pressure (VP) in a rat model of PD. We used 27 female rats, PD was induced by injecting 6-hydroxydopamine (6-OHDA; 8 µg in 2 µL of 0.9% saline containing 0.3% ascorbic acid), and rotigotine was administrated at doses of 0.125, 0.25, or 0.5 mg/kg, either intravenous or subcutaneous injection. In rats with 6-OHDA-induced PD, intravenous injection of 0.25 or 0.5 mg/kg rotigotine led to a significantly lower ICI than after vehicle injection (p < 0.05). Additionally, VP was significantly lower in animals administered rotigotine compared to those injected with vehicle (p < 0.05). Compared to vehicle-injected animals, subcutaneous administration of rotigotine (0.125, 0.25, or 0.5 mg/kg) led to a significantly higher ICI at 2 h after injection (p < 0.05); however, there was no change in ICI after injection with (+)-SCH23390 hydrochloride. Dermal administration of rotigotine in a rat model of PD could suppress an overactive bladder.

Examination of pelvic floor muscle elasticity in patients with interstitial cystitis/bladder pain syndrome using real-time tissue elastography.

INTRODUCTION AND HYPOTHESIS: The aim was to compare pelvic floor muscle (PFM) elasticity between interstitial cystitis/bladder pain syndrome (IC/BPS) patients and healthy women using real-time tissue elastography. METHODS: The subjects were 17 IC/BPS female patients (IC/BPS group; age 34-84 years), 10 healthy middle-aged women (middle-aged group; 50-80 years), and 17 healthy young adult women (young group; 23-37 years). The target sites of elastography were the striated urethral sphincter (SUS) and adipose tissue as the reference site; muscle elasticity was calculated as the strain ratio (SR) of the SUS to the reference site. Evaluations were performed at rest and during PFM contraction. The IC/BPS group completed lower urinary tract symptom and pain questionnaires. SUS SR was compared among the three groups. SUS SR at rest and during PFM contraction was compared among the three groups with the t-test and the Wilcoxon test. Associations between questionnaire results and SUS SR were evaluated by correlation analysis. RESULTS: There was no significant difference in age between the IC/BPS and middle-aged groups, but the young group was significantly younger than the other groups (p < 0.001). SUS SR at rest was significantly higher in the IC/BPS group than in the middle-aged (p = 0.014) and young groups (p = 0.002). Furthermore, in the IC/BPS group, there was no significant difference in SUS SR between at rest and during PFM contraction. SUS SR was not significantly correlated with questionnaire results for lower urinary tract symptoms. CONCLUSIONS: SUS SR at rest was significantly higher in the IC/BPS group than in the young and middle-aged groups.

Mendelson's syndrome complicated by bacterial aspiration pneumonia triggered by right putamen bleeding: A case report.

We present the case of an 80-year-old woman with Mendelson's syndrome complicated by bacterial aspiration pneumonia caused by consciousness loss followed by vomiting resulting from putamen bleeding. Her condition worsened rapidly to develop respiratory failure, within a few hours; thereafter, she was intubated. Streptococcus agalactiae and Klebsiella oxytoca were detected from the aspirated sputum sample culture. She was diagnosed with acute respiratory distress syndrome with Mendelson's syndrome complicated by bacterial aspiration pneumonia. Corticosteroid and antibiotic administration improved her condition and led to successful extubation; therefore, these treatment modalities were invaluable. We suggest the clinical considerations for the corticosteroid and antibiotic use in such cases.

Can ultrasound measurement of bladder wall thickness be a useful adjunct for regular urodynamics in children with spina bifida?

INTRODUCTION: Spina bifida is a major cause of neurologic bladder dysfunction among children. The goal of neurogenic bladder treatment is to preserve renal function. Close follow-up is essential, as lower urinary tract functions can change with patient growth. Presently, invasive urodynamics is the gold standard for precisely assessing lower urinary tract function. Ultrasound is a low-cost, non-invasive, uncomplicated examination that can be easily repeated. Bladder wall thickness (BWT) measurement by ultrasound has been proposed as a non-invasive alternative for identifying lower urinary tract dysfunctions. OBJECTIVE: Currently there are few reports on BWT in children with spina bifida, and BWT assessment methodology has yet to be defined. The present study aim was to investigate whether BWT could be a useful adjunct for regular urodynamics in children with spina bifida. We especially focused on the precise bladder volume during BWT measurements that were simultaneously performed with urodynamics. STUDY DESIGN: This prospective observational study investigated 33 patients with spina bifida who underwent video urodynamics. We assessed BWT measurements using ultrasound simultaneously performed with video urodynamics. BWT was calculated for the ventral and dorsal walls at 0%, 20%, 40%, 60%, 80%, and 100% of the expected bladder capacity. RESULTS: Median of bladder capacity was 240 mL, and bladder compliance was 19.2 mL/cmH2O. Detrusor overactivity was present in 66.7% and vesicoureteral reflux was present in 27.3% of the patients. BWT of the ventral wall was significantly lower than the dorsal wall. During increases in the bladder volume, both the ventral and dorsal walls exhibited proportional thinning (p < 0.05). There were no significant differences for BWT between males and females. Although there was a higher statistical tendency for detrusor overactivity versus without detrusor overactivity (p = 0.085), there were no significant differences found between patients with and without detrusor overactivity. DISCUSSION: This is the first report where multiple BWT measurements points with video urodynamics were simultaneously performed. Selection of bladder volumes for BWT measurements is critical. Our current study measured six points for each patient during urodynamics. However, available data was not sufficient for detecting bladder function. Until now, there has been no valid standard condition defined for measuring BWT and thus, lack of a standardized method has resulted in discrepancies among studies. CONCLUSION: Our measurement conditions showed BWT may not correlate with the degree of bladder detrusor dysfunction. As BWT ultrasound cannot identify bladder dysfunction of children with spina bifida, this cannot be used as a substitute for invasive urodynamics.

Incidence and Relapse Triggers of Childhood Idiopathic Nephrotic Syndrome between 2006 and 2016: A Population-Based Study in Fukushima, Japan.

Childhood idiopathic nephrotic syndrome (NS) is defined by proteinuria and hypoproteinemia. The incidence of childhood idiopathic NS varies with age, race, residential areas, and social conditions. In Japan, its incidence was estimated to be 6.49 cases/100,000 children. Our study aimed to investigate the incidence, characteristics, and rate of relapse of idiopathic NS in Fukushima between 2006 and 2016. Overall, 158 children aged from 6 months to 15 years old (65.8% male) developed idiopathic NS (median age at onset, 5.3 years). The peak age at onset was three years. The average annual incidence of childhood idiopathic NS was 5.16 (range, 3.47-9.26) cases/100,000 children. The highest incidence was in 2011, which was the year of the Great East Japan Earthquake and nuclear power plant accident, and reportedly caused psychological distress in the children at the time. Conversely, the five-year birth cohort showed minor difference from 2008 to 2012. The rate of incidence in males aged < 5 years was thrice greater than in females of the same age and almost the same for males and females aged 11-15 years. Of 507 total relapses in 115 NS children, common triggers of relapses were steroid discontinuation or reduction and infection. The average annual incidence of childhood NS based on the Fukushima population was lower than previously reported in Japan, and the annual incidence has changed over an 11-year period. These changes may be affected by social or environmental factors, including mental stress associated with lifestyle changes after the disaster.

Are sham-operated mice a valid comparator in studies using a bladder outlet obstruction model? A pitfall reveals a meaningful insight.

OBJECTIVE: To evaluate voiding behavior characteristics in intact and sham mice, and to examine whether intact mice show changes in "normal" micturition with aging. METHODS: A total of 72 8-week-old mice were divided into two groups - intact and sham - and the latter group was subjected to a sham of partial bladder outlet obstruction surgery. Urination frequency was evaluated (through metabolic cages) at 1, 2, 3, 6 and 12 months after the surgery (or at the equivalent time points for the intact mice). To address possible mechanisms for aging and surgical effects on urinary behavior, quantitative real-time polymerase chain reaction assays were carried out. Primary data were evaluated using scatter plots and descriptive statistics. RESULTS: In sham mice, urination frequency showed strong variation at the earlier post-surgical time points (especially at 1 month), with variation decreasing with time. Quantitative real-time polymerase chain reaction showed that the serotonin 2C receptor-encoding mRNA accumulated to >28-fold higher levels at 24 months compared with 3 months in intact mice. A major limitation of the quantitative real-time polymerase chain reaction experiments was that we did not separate whole bladder into muscle and mucosa. CONCLUSIONS: Although a sham operation is typically used in partial bladder outlet obstruction experiments to provide control animals, the sham group might itself show increased variation in micturition frequency at early times after surgery, compared with intact animals.

Synergistic effects of MDMA and ethanol on behavior: Possible effects of ethanol on dopamine D2 -receptor-related signaling.

Polydrug abuse is common among drug abusers. In particular, psychostimulants are often taken with ethanol, and the combination of 3,4-methylenedioxymethamphetamine (MDMA) and alcohol is one of the most common forms of polydrug abuse. However, the mechanism by which these drugs influence behavior remains unclear. The present study was designed to delineate the mechanisms that underlie the effects of the interaction between MDMA and ethanol on behavior in rodents. The combination of MDMA with ethanol enhanced their locomotor-increasing, rewarding, and discriminative stimulus effects without enhancing their effects on the release of dopamine from the nucleus accumbens in rodents. In addition, ethanol potently enhanced locomotor activity produced by the dopamine receptor agonist apomorphine in mice. In antagonism tests, the dopamine D1 -receptor antagonist SCH23390, but not the D2 -receptor antagonist haloperidol, completely suppressed hyperlocomotion induced by MDMA. However, hyperlocomotion induced by the co-administration of MDMA and ethanol was potently suppressed by haloperidol. These results suggest that the synergistic effects of MDMA and ethanol are mediated through dopamine transmission, especially through postsynaptical regulation of D2 -receptor-mediated functions.

Myeloperoxidase anti-neutrophil cytoplasmic antibody-associated vasculitis with a unique imaging presentation of organizing pneumonia: A case report.

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) constitutes a group of blood vessel inflammation diseases of autoimmune origin. Myeloperoxidase (MPO) ANCA is closely related to ANCA associated AAV. The MPO-ANCA positive AAV patients have lung involvement at high rates; however, there are only a few reported cases with organizing pneumonia (OP). A 78-year-old man was presented to our hospital due to a fever of 38 °C despite a whole month of antibiotics treatment. Chest computed tomography image revealed restricted consolidations visible in the middle lobe of the right lung and the upper lobe of the left lung, which suggested an OP pattern. MPO-ANCA and urine occult blood tests were positive. Histopathological examination of the transbronchial biopsy revealed OP and mucus plug. Histological findings on renal biopsy showed necrotizing glomerulonephritis related to AAV. The patient was diagnosed with MPO-ANCA positive AAV and was treated with systemic corticosteroid therapy, from which he recovered rapidly. Thus, when diagnosing OP, the possibility of AAV should be considered by ordering patients' serum ANCA and occult hematuria tests.

Reliability and validity of pelvic floor muscle strength assessment using the MizCure perineometer.

BACKGROUND: The purpose of this study was to clarify the reliability and validity of pelvic floor muscle (PFM) strength assessment using the MizCure perineometer in healthy women. METHODS: Twenty healthy women (age 20-45 years) participated in this study. The vaginal pressure measured using the MizCure and validated Peritron perineometers were repeated during PFM contraction in the supine and standing positions. All women were evaluated twice by examiners 1 and 2. Following the measurements in the first session (Test 1), they were repeated after an interval of between 2 and 6 weeks (Test 2). Within- and between-session intra- and inter-rater reliabilities in vaginal pressure were analyzed using intraclass correlation coefficients (ICC) (1, 1) and (2, 1), respectively. Validity was assessed by Pearson's product-moment correlation coefficient and Spearman's rank correlation analysis. RESULTS: Within-session intra-rater reliabilities for both examiners 1 and 2 for all vaginal pressures in Tests 1 and 2 were 0.90-0.96 for both perineometers. Between-session intra-rater reliability for the MizCure was 0.72-0.79 for both positions for examiner 1, and 0.63 in the supine position and 0.80 in the standing position for examiner 2. Inter-rater reliability for Test 1 was 0.91 in the supine position and 0.87 in the standing position for the MizCure. The vaginal pressures using the MizCure and Peritron were significantly associated with the supine position (r = 0.68, P < .001) and the standing position (rs = 0.82, P < .001). CONCLUSION: MizCure perineometer is a validated tool to measure PFM strength in both supine and standing positions in healthy nulliparous women.