Oral phenazopyridine vs intravesical lidocaine for bladder onabotulinumtoxinA analgesia: a randomized controlled trial.

BACKGROUND: The efficacy of intradetrusor onabotulinumtoxinA injections for the management of idiopathic overactive bladder has been well-established. The injections are typically performed in the office setting using local analgesia, most commonly a 20 to 30-minute intravesical instillation of lidocaine. There are limited data evaluating alternative bladder analgesics. OBJECTIVE: To compare pain scores with preprocedure oral phenazopyridine vs intravesical lidocaine in women undergoing intradetrusor onabotulinumtoxinA injections for idiopathic overactive bladder. STUDY DESIGN: Nonpregnant adult females with idiopathic overactive bladder, scheduled for office injection of 100 units of intradetrusor onabotulinumtoxinA were randomized to either 200 mg of oral phenazopyridine taken 1 to 2 hours preprocedure or a 20-minute preprocedure intravesical instillation of 50 mL of 2% lidocaine. We excluded participants with neurogenic bladders, and those who had received intradetrusor onabotulinumtoxinA injections in the previous 12 months. The primary outcome was pain measured by a 100-mm visual analog scale. Demographic characteristics and overall satisfaction with the procedure were also recorded. Providers answered questions about cystoscopic visualization, ease of procedure, and perception of participant comfort. Prespecified noninferiority margin was set to equal the anticipated minimum clinically important difference of 14 mm. A planned sample of 100 participants, 50 in each treatment arm, provided 80% power to detect noninferiority at a significance level of.05. We performed a modified intention-to-treat analysis and compared variables with the t test or the Fisher exact test. RESULTS: A total of 111 participants were enrolled, and complete data were obtained for 100 participants; 47 participants were randomized to phenazopyridine and 53 to lidocaine. Baseline characteristics did not differ between groups. There were 19.6% and 20.8% of participants in the phenazopyridine and lidocaine groups, respectively, who previously underwent intradetrusor onabotulinumtoxinA injections. The mean postprocedure pain was 2.7 mm lower in the phenazopyridine group than in the lidocaine group (95% confidence interval, -11.3 to 10.7), demonstrating noninferiority. More than 90% of participants in both groups stated that the pain was tolerable. Slightly more participants reported being "very satisfied" in the lidocaine group, although this was not statistically significant (50.0% vs 40.4%; P=.34). Providers reported clear visualization in 89.4% of participants in the phenazopyridine group and in 100% of participants in the lidocaine group (P=.02). Provider perception of participant comfort and overall ease of procedure were not different between groups. Length of time in the exam room was significantly shorter in the phenazopyridine than in the lidocaine group (44.4 vs 57.5 minutes; P=.0003). CONCLUSION: In women receiving intradetrusor onabotulinumtoxinA injections for idiopathic overactive bladder, oral phenazopyridine was noninferior to intravesical lidocaine for procedural pain control. Phenazopyridine is well-tolerated by participants, allows for the procedure to be performed with similar ease, and is associated with shorter appointment times.

The PSR13, a tool for evaluating patient-perceived recovery after vaginal prolapse repair surgery.

INTRODUCTION AND HYPOTHESIS: Surgical recovery is the return to preoperative functional, psychologic, and social activity, or a return to normalcy. To date, little is known about the global post-surgical recovery experience from the patients' perspective. The aim of this study was to validate the Post-Discharge Surgical Recovery scale 13 (PSR13) in women undergoing vaginal prolapse repair procedures and evaluate the patient-perceived postoperative recovery experience over a 12-week period. METHODS: Fifty women undergoing vaginal prolapse repairs completed the PSR13 and global surgical recovery scale (GSR) at 1, 2, 4, 6, and 12 weeks post-surgery. Validity, the minimal clinically important difference (MCID), and responsiveness to change over time of the PSR13 was evaluated using descriptive statistics and linear regression models. The proportion of patients deemed fully recovered at each time point (defined as PSR13 score ≥ 80) was also assessed. RESULTS: The PSR13 correlated significantly (p < 0.001) with the single-item recovery scale and showed excellent internal consistency reliability (Cronbach α = 0.91, range 0.77 to 0.93). The MCID was estimated at 7.0 points. The PSR13 scores improved at varying rates over time, with the greatest amount of patient-perceived recovery occurring between 4 and 6 weeks after surgery. The proportion of patients deemed fully recovered at 6- and 12- weeks postoperatively was 37% and 56%, respectively. CONCLUSIONS: The PSR13 is a useful instrument to assess overall return to normalcy from the patient's perspective and can be applied to evaluate the recovery experience among women undergoing vaginal prolapse repairs, in both the research and clinical setting.

Social singing, culture and health: interdisciplinary insights from the CHIME project for perinatal mental health in The Gambia.

Arts in Health initiatives and interventions to support health have emerged from and been applied to mainly WEIRD (Western, Educated, Industrialized, Rich and Democratic) contexts. This overlooks the rich cultural traditions that exist across the globe, where community groups often make prolific use of participatory song and dance as a part of ceremonies, ritual and gatherings in everyday life. Here, we argue that these practices can provide a valuable starting point for the co-development of health interventions, illustrated by the CHIME project for perinatal mental health in The Gambia, which worked with local Kanyeleng groups (female fertility societies) to design and evaluate a brief intervention to support maternal mental health through social singing. Here, we use the project as a lens through which to highlight the value of co-creation, cultural embeddedness and partnership building in global health research.

Incidence and characteristics of arterial thromboemboli in patients with COVID-19.

BACKGROUND: Studies have reported COVID-19 as an independent risk factor for arterial thromboemboli. METHODS: From a cross-sectional sample, we determined the incidence and location of arterial thromboemboli (myocardial infarction, ischemic stroke, peripheral artery), stratified by COVID-19 status, in the RECOVER database, which included data on patients at 45 United States medical centers in 22 states. Epidemiological factors, clinical characteristics and outcomes were collected through a combination of individual chart review and automatic electronic query and recorded in REDCap®. We investigated the association of baseline comorbidities on the development of arterial thromboemboli and analyzed results based on the presence or absence of concomitant COVID-19 infection, testing this association with Chi-squared. We also described use of anticoagulants and statins. RESULTS: Data were collected on 26,974 patients, of which 13,803 (51.17%) tested positive for COVID-19. Incidence of arterial thromboemboli during hospitalization was 0.13% in patients who tested positive for COVID-19 and 0.19% in patients who tested negative. Arterial thromboemboli tended to be more common in extremities than in core organs (heart, kidney, lung, liver) in patients with COVID-19, odds ratio 2.04 (95% CI 0.707 - 5.85). Patients with COVID-19 were less likely to develop an arterial thrombus when on baseline statin medication (p=0.014). Presence of metabolic syndrome predicted presence of core arterial thrombus (p=0.001) and extremity arterial thrombus (p=0.010) in those with COVID-19. Arterial thromboemboli were less common in patients with COVID-19 than in those who tested negative for COVID-19. CONCLUSIONS: Presence of a composite metabolic syndrome profile may be associated with arterial clot formation in patients with COVID-19 infection.

How music may support perinatal mental health: an overview.

There is strong evidence that engaging with music can improve our health and well-being. Music-based interventions, approaches and practices, such as group music-making (singing or playing musical instruments), listening to music and music therapy, have all been shown to reduce symptoms of depression and anxiety. Although the existing literature needs expanding, mounting evidence suggests that music-based interventions, approaches and practices may help support maternal mental health prenatally and postnatally. The purpose of this descriptive overview is to provide a broad view of this area by bringing together examples of research across different practices and research disciplines. Selected evidence is examined, showing how music-based interventions, approaches and practices can reduce labour anxiety and pain, anxiety symptoms in pregnancy, postnatal depression symptoms and support maternal-infant bonding. The examined research includes single studies and reviews that use both qualitative and quantitative methods. Drawing on animal and human models, the effect of music on foetal behaviour and various possible biological, psychological and social mechanisms are discussed. The potential preventive effect of music-based interventions, approaches and practices and their possible use across different cultures are also considered. Overall, we highlight how music, employed in a variety of ways, may support perinatal mental health with the aim of stimulating more interest and research in this area.

Melodic expectations in 5- and 6-year-old children.

It has been argued that children implicitly acquire the rules relating to the structure of music in their environment using domain-general mechanisms such as statistical learning. Closely linked to statistical learning is the ability to form expectations about future events. Whether children as young as 5 years can make use of such internalized regularities to form expectations about the next note in a melody is still unclear. The possible effect of the home musical environment on the strength of musical expectations has also been under-explored. Using a newly developed melodic priming task that included melodies with either "expected" or "unexpected" endings according to rules of Western music theory, we tested 5- and 6-year-old children (N = 46). The stimuli in this task were constructed using the information dynamics of music (IDyOM) system, a probabilistic model estimating the level of "unexpectedness" of a note given the preceding context. Results showed that responses to expected versus unexpected tones were faster and more accurate, indicating that children have already formed robust melodic expectations at 5 years of age. Aspects of the home musical environment significantly predicted the strength of melodic expectations, suggesting that implicit musical learning may be influenced by the quantity of informal exposure to the surrounding musical environment.

Effect of combinations of morphine, dexmedetomidine and maropitant on the electroencephalogram in response to acute electrical stimulation in anaesthetized dogs.

This study was conducted to compare the efficacy of combinations of morphine, dexmedetomidine and maropitant in preventing the changes in electroencephalographic (EEG) indices of nociception in anaesthetized dogs subjected to a noxious electrical stimulus. In a crossover study, eight healthy adult dogs were randomly allocated to four groups: Mor: morphine 0.6 mg/kg; Dex + Mor: morphine 0.3 mg/kg + dexmedetomidine 5 µg/kg; Maro + Mor: morphine 0.3 mg/kg + maropitant 1 mg/kg; and Dex + Maro + Mor: morphine 0.2 mg/kg + dexmedetomidine 3 µg/kg + maropitant 0.7 mg/kg. Following intramuscular administration of test drugs in a minimal anaesthesia model, a supramaximal electrical stimulus (50 V at 50 Hz for 2 s) was applied and the EEG data were recorded. There were significant increases (p < .05) in the poststimulus median frequency (F50) only in groups Mor and Maro + Mor. Dex + Mor group had a significantly lower change in F50 and F95 compared to all other treatment groups. There was no correlation of the changes in EEG frequencies with blood plasma concentration of the drugs during and after noxious stimulation. Combination of dexmedetomidine and morphine was most effective in abolishing the changes in EEG indices in response to a noxious stimulus indicating a supra-additive interaction between these two drugs.

Cystoscopy at the time of incontinence and prolapse surgery.

PURPOSE OF REVIEW: This article provides an update on the use of cystoscopy at the time of prolapse and incontinence surgery. RECENT FINDINGS: Iatrogenic lower urinary tract injury is a known complication of antiincontinence procedures and surgical repair of pelvic organ prolapse. Intraoperative cystoscopy improves detection of lower urinary tract injuries in women undergoing pelvic floor surgery. The pelvic surgeon has a number of agents available to aid in the cystoscopic visualization of ureteral efflux. When injuries of the urinary tract are identified and treated intraoperatively, there is decreased morbidity, lower healthcare costs, and a lower risk of litigation than when detection is delayed. Therefore, many organizations, including the American College of Obstetricians and Gynecologists (ACOG), the American Urogynecologic Society (AUGS), and the American Urological Association (AUA) recommend cystoscopy at the time of pelvic floor surgery. SUMMARY: Cystoscopy should be universally employed at the time of prolapse and incontinence surgery, except in instances of isolated repair of the posterior compartment.

Involuntary and voluntary recall of musical memories: A comparison of temporal accuracy and emotional responses.

Comparisons between involuntarily and voluntarily retrieved autobiographical memories have revealed similarities in encoding and maintenance, with differences in terms of specificity and emotional responses. Our study extended this research area into the domain of musical memory, which afforded a unique opportunity to compare the same memory as accessed both involuntarily and voluntarily. Specifically, we compared instances of involuntary musical imagery (INMI, or "earworms")-the spontaneous mental recall and repetition of a tune-to deliberate recall of the same tune as voluntary musical imagery (VMI) in terms of recall accuracy and emotional responses. Twenty participants completed two 3-day tasks. In an INMI task, participants recorded information about INMI episodes as they occurred; in a VMI task, participants were prompted via text message to deliberately imagine each tune they had previously experienced as INMI. In both tasks, tempi of the imagined tunes were recorded by tapping to the musical beat while wearing an accelerometer and additional information (e.g., tune name, emotion ratings) was logged in a diary. Overall, INMI and VMI tempo measurements for the same tune were strongly correlated. Tempo recall for tunes that have definitive, recorded versions was relatively accurate, and tunes that were retrieved deliberately (VMI) were not recalled more accurately in terms of tempo than spontaneous and involuntary instances of imagined music (INMI). Some evidence that INMI elicited stronger emotional responses than VMI was also revealed. These results demonstrate several parallels to previous literature on involuntary memories and add new insights on the phenomenology of INMI.

Prenatal listening to songs composed for pregnancy and symptoms of anxiety and depression: a pilot study.

BACKGROUND: Prenatal anxiety and depression are distressing for the expectant mother and can have adverse effects on her fetus and subsequently, her child. This study aimed to determine whether listening to specially composed songs would be an effective intervention for reducing symptoms of prenatal anxiety and depression. METHODS: Pregnant women were recruited online and randomly assigned to one of two groups: the music group (daily listening to specially composed songs) or control group (daily relaxation) for 12 weeks each. Self-report questionnaires were used to assess symptoms of State and Trait anxiety (Spielberger) and depression (Edinburgh Postnatal Depression Scale (EPDS)). Trait anxiety was measured as the primary outcome, while State anxiety and depression were the secondary outcomes. 111 participants were randomised to each group. 20 participants in the intervention group and 16 participants in the active control group completed the study. RESULTS: The music group demonstrated lower Trait Anxiety (p = .0001) (effect size 0.80), State Anxiety (p = .02) (effect size 0.64), and EPDS (p = .002) (effect size 0.92) scores at week 12 compared to baseline, by paired t test. There were no such changes in the control group. CONCLUSIONS: Though this pilot study had high levels of attrition, the results do suggest that regular listening to relaxing music should be explored further as an effective non-pharmacological means for reducing prenatal anxiety and depression. TRIAL REGISTRATION: ClinicalTrials.gov NCT02776293 LV-001. Registered 17 May 2016. Retrospectively registered.

Group music performance causes elevated pain thresholds and social bonding in small and large groups of singers.

Over our evolutionary history, humans have faced the problem of how to create and maintain social bonds in progressively larger groups compared to those of our primate ancestors. Evidence from historical and anthropological records suggests that group music-making might act as a mechanism by which this large-scale social bonding could occur. While previous research has shown effects of music making on social bonds in small group contexts, the question of whether this effect 'scales up' to larger groups is particularly important when considering the potential role of music for large-scale social bonding. The current study recruited individuals from a community choir that met in both small (n = 20 - 80) and large (a 'megachoir' combining individuals from the smaller subchoirs n = 232) group contexts. Participants gave self-report measures (via a survey) of social bonding and had pain threshold measurements taken (as a proxy for endorphin release) before and after 90 minutes of singing. Results showed that feelings of inclusion, connectivity, positive affect, and measures of endorphin release all increased across singing rehearsals and that the influence of group singing was comparable for pain thresholds in the large versus small group context. Levels of social closeness were found to be greater at pre- and post-levels for the small choir condition. However, the large choir condition experienced a greater change in social closeness as compared to the small condition. The finding that singing together fosters social closeness - even in large contexts where individuals are not known to each other - is consistent with evolutionary accounts that emphasize the role of music in social bonding, particularly in the context of creating larger cohesive groups than other primates are able to manage.

Depression and cognitive impairment following recovery from thrombotic thrombocytopenic purpura.

After recovery from an acute episode of acquired thrombotic thrombocytopenic purpura (TTP), patients often describe problems with memory, concentration, and endurance. We have previously reported the occurrence of depression and cognitive impairment in these patients. In this study, we describe the frequency, severity, and clinical course of depression and cognitive impairment. Fifty-two (85%) out of 61 eligible Oklahoma Registry patients who had recovered from TTP, documented by ADAMTS13 activity <10%, have had at least one (median, four) evaluation for depression over 11 years using the Beck Depression Inventory-II; 31 (59%) patients screened positive for depression at least once; in 15 (29%), the results suggested severe depression at least once. Nine of these 15 patients had a psychiatric interview, the definitive diagnostic evaluation; the diagnosis of major depressive disorder was established in eight (89%) patients. In 2014, cognitive ability was evaluated in 33 patients by the Montreal Cognitive Assessment and the Repeatable Battery for Assessment of Neuropsychological Status (RBANS). Both tests detected significant cognitive impairment in the patients as a group. Fifteen out of the 33 patients had been evaluated by extensive cognitive tests in 2006. The 2014 RBANS results were significantly worse than the 2006 results for the overall score and two out of the five RBANS domains (immediate and delayed memory). Neither depression nor cognitive impairment was significantly associated with the occurrence of relapses or ADAMTS13 activity <10% during remission. These observations emphasize the importance of screening evaluations for depression and cognitive impairment after recovery from acquired TTP.

Tunes stuck in your brain: The frequency and affective evaluation of involuntary musical imagery correlate with cortical structure.

Recent years have seen a growing interest in the neuroscience of spontaneous cognition. One form of such cognition is involuntary musical imagery (INMI), the non-pathological and everyday experience of having music in one's head, in the absence of an external stimulus. In this study, aspects of INMI, including frequency and affective evaluation, were measured by self-report in 44 subjects and related to variation in brain structure in these individuals. Frequency of INMI was related to cortical thickness in regions of right frontal and temporal cortices as well as the anterior cingulate and left angular gyrus. Affective aspects of INMI, namely the extent to which subjects wished to suppress INMI or considered them helpful, were related to gray matter volume in right temporopolar and parahippocampal cortices respectively. These results provide the first evidence that INMI is a common internal experience recruiting brain networks involved in perception, emotions, memory and spontaneous thoughts.

Contribution of fibrinolysis to the physical component summary of the SF-36 after acute submassive pulmonary embolism.

Acute pulmonary embolism (PE) can diminish patient quality of life (QoL). The objective was to test whether treatment with tenecteplase has an independent effect on a measurement that reflects QoL in patients with submassive PE. This was a secondary analysis of an 8-center, prospective randomized controlled trial, utilizing multivariate regression to control for predefined predictors of worsened QoL including: age, active malignancy, history of PE or deep venous thrombosis (DVT), recurrent PE or DVT, chronic obstructive pulmonary disease and heart failure. QoL was measured with the physical component summary (PCS) of the SF-36. Analysis included 76 patients (37 randomized to tenecteplase, 39 to placebo). Multivariate regression yielded an equation f(8, 67), P < 0.001, with R(2) = 0.303. Obesity had the largest effect on PCS (ß = -8.6, P < 0.001), with tenecteplase second (ß = 4.73, P = 0.056). After controlling for all interactions, tenecteplase increased the PCS by +5.37 points (P = 0.027). In patients without any of the defined comorbidities, the coefficient on the tenecteplase variable was not significant (-0.835, P = 0.777). In patients with submassive PE, obesity had the greatest influence on QoL, followed by use of fibrinolysis. Fibrinolysis had a marginal independent effect on patient QoL after controlling for comorbidities, but was not significant in patients without comorbid conditions.

The speed of our mental soundtracks: Tracking the tempo of involuntary musical imagery in everyday life.

The study of spontaneous and everyday cognitions is an area of rapidly growing interest. One of the most ubiquitous forms of spontaneous cognition is involuntary musical imagery (INMI), the involuntarily retrieved and repetitive mental replay of music. The present study introduced a novel method for capturing temporal features of INMI within a naturalistic setting. This method allowed for the investigation of two questions of interest to INMI researchers in a more objective way than previously possible, concerning (1) the precision of memory representations within INMI and (2) the interactions between INMI and concurrent affective state. Over the course of 4 days, INMI tempo was measured by asking participants to tap to the beat of their INMI with a wrist-worn accelerometer. Participants documented additional details regarding their INMI in a diary. Overall, the tempo of music within INMI was recalled from long-term memory in a highly veridical form, although with a regression to the mean for recalled tempo that parallels previous findings on voluntary musical imagery. A significant positive relationship was found between INMI tempo and subjective arousal, suggesting that INMI interacts with concurrent mood in a similar manner to perceived music. The results suggest several parallels between INMI and voluntary imagery, music perceptual processes, and other types of involuntary memories.

Reduced sensitivity to emotional prosody in congenital amusia rekindles the musical protolanguage hypothesis.

A number of evolutionary theories assume that music and language have a common origin as an emotional protolanguage that remains evident in overlapping functions and shared neural circuitry. The most basic prediction of this hypothesis is that sensitivity to emotion in speech prosody derives from the capacity to process music. We examined sensitivity to emotion in speech prosody in a sample of individuals with congenital amusia, a neurodevelopmental disorder characterized by deficits in processing acoustic and structural attributes of music. Twelve individuals with congenital amusia and 12 matched control participants judged the emotional expressions of 96 spoken phrases. Phrases were semantically neutral but prosodic cues (tone of voice) communicated each of six emotional states: happy, tender, afraid, irritated, sad, and no emotion. Congenitally amusic individuals were significantly worse than matched controls at decoding emotional prosody, with decoding rates for some emotions up to 20% lower than that of matched controls. They also reported difficulty understanding emotional prosody in their daily lives, suggesting some awareness of this deficit. The findings support speculations that music and language share mechanisms that trigger emotional responses to acoustic attributes, as predicted by theories that propose a common evolutionary link between these domains.

Comparison of two minimally invasive approaches to endometrial cancer staging: a single-surgeon experience.

OBJECTIVE: To compare the clinical outcomes of endometrial cancer staging procedures performed by a single surgeon utilizing traditional and robotic-assisted laparoscopic techniques. STUDY DESIGN: A retrospective review of minimally invasive endometrial cancer staging performed by a single surgeon. RESULTS: There were no significant differences in operative time, blood loss, surgical complications, or length of hospitalization between laparoscopic (n = 45) and robotic-assisted (n = 77) procedures. On multivariable analysis controlling for surgical chronology, robotic assistance was independently associated with a significantly greater number of lymph nodes (23 vs. 19, p < 0.05; beta 0.163, p < 0.05). When comparing the first chronologic half of robotic-assisted surgeries to the second half, the latter had shorter operative time (208 vs. 246 min, p = 0.01) and a greater number of lymph nodes (27 vs. 19, p = 0.001). Finally, compared to the laparoscopic cases, the second half of robotic-assisted cases had a greater number of total (27 vs. 19, p < 0.001) and pelvic (23 vs. 17, p < 0.001) lymph nodes harvested. CONCLUSION: There was a learning curve associated with robotic-assisted laparoscopic endometrial cancer staging, with decreased operative time and increased lymph node yield over time. In our study population, robotic assistance was independently associated with a greater lymph node harvest with no increase in operative time or perioperative complications.

Barriers And Motivators for Smoking Cessation in Patients With Systemic Lupus Erythematosus (SLE).

UNLABELLED: Although studies have shown that smoking is detrimental to the health of patients with systemic lupus erythematosus (SLE), studies regarding barriers and motivators for smoking cessation are lacking. The purpose of this study was to generate hypotheses regarding the barriers and motivators for smoking cessation in SLE patients. METHODS: This study was based on the theoretical framework of the stages of change model. All participants met SLE classification criteria. Interviews were conducted with 16 current and 10 former smokers. RESULTS: Motivators included: medical reasons, readiness, and concern for others. Barriers included: enjoyment, coping mechanism, and an emotional connection. Participants were unsure of the impact of smoking on their medication and disease, and had mixed feelings regarding the impact on pain. CONCLUSION: The main motivator for cessation in this population was concern for one's health. Rheumatologists need to include disease specific harms and assess pain management strategies as part of cessation counseling.

Cost Analysis of Oral Phenazopyridine vs Intravesical Lidocaine for Preprocedural Analgesia for Intradetrusor OnabotulinumtoxinA Injections.

INTRODUCTION: Office administration of intradetrusor onabotulinumtoxinA is commonly used to treat overactive bladder. For preprocedure analgesia, either 50 mL 2% intravesical lidocaine instillation for 20 to 30 minutes or 200 mg oral phenazopyridine can be used. Phenazopyridine is associated with shorter appointment times and is noninferior to lidocaine for pain control in this setting. We performed a cost analysis of phenazopyridine vs lidocaine for analgesia before office intradetrusor onabotulinumtoxinA injection for the treatment of idiopathic overactive bladder. METHODS: A health care sector-perspective cost analysis was performed. The following assumptions were made: (1) similar efficacy of each medication in providing adequate analgesia, (2) similar physician ease of performing the procedure with either analgesic, and (3) similar patient satisfaction with either analgesic. Average cost of medications, adverse reactions, nursing tasks, and office visit time were found in publicly available data. Sensitivity analyses were performed using TreeAge Pro 2021, R1 software. RESULTS: Phenazopyridine is less costly compared to lidocaine per visit for office intradetrusor onabotulinumtoxinA injection ($827 vs $925). A difference of $98 per procedure provides a total annual cost savings of over $24 million if all procedures are performed with phenazopyridine instead of lidocaine. Sensitivity analysis showed that phenazopyridine remained less costly under most circumstances, and threshold analysis provided exact circumstances under which phenazopyridine is no longer cost saving. CONCLUSIONS: Phenazopyridine provides cost savings compared to lidocaine for analgesia before office intradetrusor onabotulinumtoxinA injection for the treatment of idiopathic overactive bladder. If adopted by providers nationwide, phenazopyridine may reduce health care spending and minimize office visit time while maintaining patient pain control and satisfaction.

Navigating the auditory scene: an expert role for the hippocampus.

Over a typical career piano tuners spend tens of thousands of hours exploring a specialized acoustic environment. Tuning requires accurate perception and adjustment of beats in two-note chords that serve as a navigational device to move between points in previously learned acoustic scenes. It is a two-stage process that depends on the following: first, selective listening to beats within frequency windows, and, second, the subsequent use of those beats to navigate through a complex soundscape. The neuroanatomical substrates underlying brain specialization for such fundamental organization of sound scenes are unknown. Here, we demonstrate that professional piano tuners are significantly better than controls matched for age and musical ability on a psychophysical task simulating active listening to beats within frequency windows that is based on amplitude modulation rate discrimination. Tuners show a categorical increase in gray matter volume in the right frontal operculum and right superior temporal lobe. Tuners also show a striking enhancement of gray matter volume in the anterior hippocampus, parahippocampal gyrus, and superior temporal gyrus, and an increase in white matter volume in the posterior hippocampus as a function of years of tuning experience. The relationship with gray matter volume is sensitive to years of tuning experience and starting age but not actual age or level of musicality. Our findings support a role for a core set of regions in the hippocampus and superior temporal cortex in skilled exploration of complex sound scenes in which precise sound "templates" are encoded and consolidated into memory over time in an experience-dependent manner.