Outcomes of laparoscopic artificial urinary sphincter in women with stress urinary incontinence: mid-term evaluation.

PURPOSE: Although artificial urinary sphincter (AUS) has become an established treatment for moderate to severe stress urinary incontinence (SUI), implantation can be challenging. This study aimed to review the outcomes of laparoscopic AUS (LAUS) implantation and revision in women presenting with SUI. METHODS: We reviewed the files of female patients presenting with moderate to severe SUI treated with LAUS implantation from October 2007 to July 2017. Surgeries were performed by one surgeon experienced in open AUS implantation and starting LAUS implantation. The primary endpoint was postoperative urinary continence, which was divided into three categories: complete continence, improved continence, and unchanged incontinence. The secondary outcomes were complications, explantation-free and revision-free time. RESULTS: A total of 49 women (mean age 64 years, range 40-80) had LAUS implantation. Among the 42 patients (85.7%) with an AUS in place at the last follow-up, 25 (59.5%) were fully continent, 16 (38.1%) had improved continence, and 1 (2.4%) had unchanged incontinence. At the last follow-up, 29 (59.2%) patients had their initial AUS and 13 (26.5%) had at least one reintervention. There were 9 (18.4%) intraoperative complications and 25 (51%) postoperative complications, of which 9 (18.4%) were Clavien⩾3. After a median follow-up of 4 years, 9 (18.4%) explantations and 11 (22.5%) revisions occurred. The average period without explantation or revision was 3.7 and 3.1 years, respectively. CONCLUSION: Our study shows that the laparoscopic approach for AUS implantation is an efficient treatment option for women with moderate to severe SUI.

The Neurospora crassa UVS-3 epistasis group encodes homologues of the ATR/ATRIP checkpoint control system.

The mutagen sensitive uvs-3 and mus-9 mutants of Neurospora show mutagen and hydroxyurea sensitivity, mutator effects and duplication instability typical of recombination repair and DNA damage checkpoint defective mutants. To determine the nature of these genes we used cosmids from a genomic library to clone the uvs-3 gene by complementation for MMS sensitivity. Mutation induction by transposon insertion and RIP defined the coding sequence. RFLP analysis confirmed that this sequence maps in the area of uvs-3 at the left telomere of LG IV. Analysis of the cDNA showed that the UVS-3 protein contains an ORF of 969 amino acids with one intron. It is homologous to UvsD of Aspergillus nidulans, a member of the ATRIP family of checkpoint proteins. It retains the N' terminal coiled-coil motif followed by four basic amino acids typical of these proteins and shows the highest homology in this region. The uvsD cDNA partially complements the defects of the uvs-3 mutation. The uvs-3 mutant shows a higher level of micronuclei in conidia and failure to halt germination and nuclear division in the presence of hydroxyurea than wild type, suggesting checkpoint defects. ATRIP proteins bind tightly to ATR PI-3 kinase (phosphatidylinositol 3-kinase) proteins. Therefore, we searched the Neurospora genome sequence for homologues of the Aspergillus nidulans ATR, UvsB. A uvsB homologous sequence was present in the right arm of chromosome I where the mus-9 gene maps. A cosmid containing this genomic DNA complemented the mus-9 mutation. The putative MUS-9 protein is 2484 amino acids long with eight introns. Homology is especially high in the C-terminal 350 amino acids that correspond to the PI-3 kinase domain. In wild type a low level of constitutive mRNA is present for both genes. It is transiently induced upon UV exposure.

Outcomes of open artificial urinary sphincter in women with stress urinary incontinence: long-term follow up.

BACKGROUND: The aim of this study was to report the outcomes of artificial urinary sphincter (AUS) in women with stress urinary incontinence (SUI) resulting from intrinsic sphincter deficiency after a follow up of 10 years. METHODS: The charts of female patients with moderate-to-severe SUI who underwent open AUS implantation between November 1994 and April 2007 were reviewed retrospectively. All patients were operated on by a single experienced surgeon through an open retropubic approach with systematic bladder incision. Primary endpoint was postoperative continence categorized as complete continence (no pads used), improved incontinence, or unchanged incontinence. RESULTS: A total of 63 women (mean age: 58 years, range: 17-82) underwent open AUS implantation. There were seven (11.1%) intraoperative complications. At the last follow up, 26 (41.3%) initial AUSs remained in situ and 21 (33.3%) patients had at least one revision or reimplantation. Of these 47 patients (74.6%), 35 (74.5%) were fully continent, 3 (6.4%) had improved incontinence, and 9 (19.1%) had unchanged incontinence. A total of 20 patients (31.7%) experienced postoperative complications, but only 2 (3.2%) were Clavien ⩾3. After a median follow up of 14 ± 6 years, 20 (31.7%) explantations and 29 (46%) revisions occurred. The average time without explantation or revision was 11.6 and 9 years, respectively. CONCLUSIONS: In our experience, AUS is a good option for women with moderate to severe SUI, with good long-term outcomes.

Effects of the human amniotic membrane on axonal outgrowth of dorsal root ganglia neurons in culture.

PURPOSE: In order to investigate the potential underlying neurotrophic mechanisms of human amniotic membrane (AM) in the treatment of neurotrophic corneal ulcers, we evaluated whether or not there are significant differences in the neuritic growth of neuronal cell cultures on different surfaces of AM. METHODS: Neurite outgrowth of dorsal root ganglia neurons was examined under two separate conditions: (1) in serum-free medium consisting of minimal essential medium (MEM), glucose, and L-glutamine, (2) in same medium additionally supplemented with horse serum, chick embryonic extract, and nerve growth factor. Neuritic outgrowth was labeled with antibodies against neurofilaments and tubulin and screened by confocal laser scanning microscopy. Moreover, Western blot analysis was performed with antibodies to neuronal cell adhesion molecule (NCAM), L1, pan-cadherin, semaphorin-3F, as well as various ephrins. RESULTS: The basement membrane and the stromal surface promoted the outgrowth of an extensive neuritic network, whereas the epithelial surface did not. Interestingly, these differences of neuritic growth were evident in cell cultures treated with serum-free medium lacking neurotrophic factors and in standard medium containing neurotrophic factors. Western blot analysis revealed an abundant expression of ephrin A4 in intact AM but not in epithelium-denuded AM, and no significant difference of pan-cadherin and NCAM expression was found in intact AM compared with denuded AM. Additionally, no expression of L1, semaphorin-3F, and the ephrins A1, A2, B1, and B3 was detected. CONCLUSIONS: This study shows that AM exhibits location-dependent neuritic growth-promoting effects that might influence the clinical outcome of (amniotic membrane transplantation) in neurotrophic conditions.

T wave oversensing in implantable cardioverter defibrillators.

The implantable cardioverter defibrillator is the treatment of choice for patients with ventricular tachycardia, especially in the setting of structural heart disease, but inappropriate therapy continues to be a problem. In this report we describe a short case series of patients who presented with T wave oversensing. We propose a classification in 2 categories, T wave oversensing occuring in the setting of persistently low R wave amplitude, and T wave oversensing occuring in the setting of transiently low R wave amplitude.

Ionizing irradiation effects on S-phase in checkpoint mutants of the yeast Saccharomyces cerevisiae.

In mammalian cells, gamma-irradiation activates checkpoint controls to delay entry into, or passage through S-phase, while chronic exposure to methyl methanesulfonate or hydroxyurea causes a similar delay in yeast. In yeast, at least five genes are involved: RAD9, RAD17, RAD24, RAD53 and MEC1, a homologue of ATM. Here, using flow cytometry analysis and alkaline sucrose gradient centrifugation of labeled, newly made DNA, we demonstrate, in synchronized RAD wild-type Saccharomyces cerevisiae cells, that: (1) gamma-irradiation at START delays entry into S-phase, (2) irradiation shortly before or during early S-phase delays completion of S-phase and (3) the latter response is largely a consequence of replicon initiation inhibition. The delay produced by irradiation during early S-phase depends on the function of the checkpoint genes RAD9, RAD17, RAD24, RAD53, MEC1 and MEC3. However, at least four, RAD17, RAD53, MEC1, MEC3, are not needed to delay S-phase progression when cells are irradiated shortly before S-phase begins.