Is Our Limited Understanding of the Effects of Nerve Stimulation Resulting in Poor Outcomes and the Need for Better "Rescue Programming" in SNM and PTNS, and Lost Opportunities for New Sites of Stimulation? ICI-RS 2024.

AIMS: Sacral neuromodulation (SNM) and percutaneous tibial nerve stimulation (PTNS) are strongly recommended by international guidelines bodies for complex lower urinary tract dysfunctions. However, treatment failure and the need for rescue programming still represent a significant need for long-term follow-up. This review aimed to describe current strategies and future directions in patients undergoing such therapies. MATERIALS AND METHODS: This is a consensus report of a Think Tank discussed at the Annual Meeting of the International Consultation on Incontinence - Research Society (ICI-RS), June 6-8, 2024 (Bristol, UK): "Is our limited understanding of the effects of nerve stimulation resulting in poor outcomes and the need for better 'rescue programming' in SNM and PTNS, and lost opportunities for new sites of stimulation?" RESULTS: Rescue programming is important from two different perspectives: to improve patient outcomes and to enhance device longevity (for implantable devices). Standard SNM parameters have remained unchanged since its inception for the treatment of OAB, nonobstructive urinary retention, and voiding dysfunction. SNM rescue programming includes intermittent stimulation (cycling on), increased frequency and changes in pulse width (PW). The effect of PW setting on SNM outcomes remains unclear. Monopolar configurations stimulate more motor nerve fibers at lower stimulation voltage; hence, this could be an option in patients who failed bipolar stimulation in the long term. Unfortunately, there is little evidence for rescue programming for PTNS. However, the development of implantable devices for intermittent stimulation of the tibial nerve may increase long-term adherence to therapy and increase interest in alternative programming. There has been recent promising neurostimulation targeting the pudendal nerve (PNS), especially in BPS/IC. More recently, preliminary data addressed the benefits of high-frequency bilateral pudendal nerve block for DESD and adaptive PNS on both urgency and stress UI in women. CONCLUSION: The exploration of rescue programming and new stimulation sites remains underutilized, and there are opportunities that could potentially expand the therapeutic applications of nerve stimulation. By broadening the range of target sites, clinicians may be able to tailor treatments according to individual patient needs and underlying conditions, thereby improving overall outcomes. However, further studies are still needed to increase the level of evidence, potentially allowing for an individualized treatment both in patients who are candidates for electrostimulation and in those who have already received surgical implants but seek a better outcome.

Cutaneous Wound Healing: An Update from Physiopathology to Current Therapies.

The skin is the biggest organ of human body which acts as a protective barrier against deleterious agents. When this barrier is damaged, the organism promotes the healing process with several molecular and cellular mechanisms, in order to restore the physiological structure of the skin. The physiological control of wound healing depends on the correct balance among its different mechanisms. Any disruption in the balance of these mechanisms can lead to problems and delay in wound healing. The impairment of wound healing is linked to underlying factors as well as aging, nutrition, hypoxia, stress, infections, drugs, genetics, and chronic diseases. Over the years, numerous studies have been conducted to discover the correct approach and best therapies for wound healing, including surgical procedures and non-surgical treatments such as topical formulations, dressings, or skin substitutes. Thus, this general approach is necessary to facilitate the direction of further studies. This work provides updated concepts of physiological mechanisms, the factors that can interfere, and updated treatments used in skin wound healing.

Artepillin C as an outstanding phenolic compound of Brazilian green propolis for disease treatment: A review on pharmacological aspects.

Propolis is a viscous resin consisting of plant material (shoots, flowers, and plant exudates), salivary secretions and waxes produced by Apis mellifera bees. Its popular use aroused the interests of scientific research, which proved to be a potential source of various bioactive substances. The chemical composition of propolis depends on several factors, such as the different types of plant sources collected by bees, geographic origin, and the time of year in which they are produced, but it is known that phenolic represent the main bioactive constituents of propolis. Baccharis dracunculifolia DC (Asteraceae) is the most important botanical source of propolis and a native to southeastern Brazil. It is widely known as the green propolis because of its deep green color. One of its major phenolic acids is artepillin C (Art-C), a diprenyl-p-hydroxycinnamic acid derivative. This review aims to provide a comprehensive summary of the pharmacological effects of Art-C. The limited number of publications on this topic over the past two decades have been collected from databases and summarized. Numerous biological activities have been described for the Art-C, such as gastroprotective, anti-inflammatory, antimicrobial, antioxidant, antitumor. This article describes aspects of occurrence, synthesis, biological activities and pharmacokinetic approaches.

Corrigendum to "Lupeol, a Dietary Triterpene, Enhances Wound Healing in Streptozotocin-Induced Hyperglycemic Rats with Modulatory Effects on Inflammation, Oxidative Stress, and Angiogenesis".

[This corrects the article DOI: 10.1155/2019/3182627.].

Lupeol, a Dietary Triterpene, Enhances Wound Healing in Streptozotocin-Induced Hyperglycemic Rats with Modulatory Effects on Inflammation, Oxidative Stress, and Angiogenesis.

Impaired wound healing is a debilitating complication of diabetes that leads to significant morbidity, particularly foot ulcers. Natural products have shown to be effective in treating skin wounds. Lupeol is known to stimulate angiogenesis, fibroblast proliferation, and expressions of cytokines and growth factors involved in wound healing. The study is performed to evaluate the wound healing activity of lupeol in streptozotocin-induced hyperglycemic rats by macroscopical, histological, immunohistochemical, immunoenzymatic, and molecular methods. Percentage of wound closure and contraction was increased in the lupeol-treated group when compared to the Lanette group. Histopathological observation revealed decreased inflammatory cell infiltration and increased proliferation of fibroblasts, vascularization, and deposition of collagen fibers after lupeol treatment. Immunohistochemical analyses showed decreased intensity of NF-κB and increased intensity of FGF-2, TGF-ß1, and collagen III. ELISA results revealed downregulated IL-6 levels and upregulated IL-10 levels in response to lupeol. The mRNA expression levels of Hif-1α, Sod-2, and Ho-1 were significantly increased in response to lupeol as compared to Lanette whereas Nf-κb and Vegf-A levels were decreased in relation to insulin and lupeol treatment. These findings indicate that lupeol possesses wound healing potential in hyperglycemic conditions and may be useful as a treatment for chronic wounds in diabetic patients.

Lupeol, a Pentacyclic Triterpene, Promotes Migration, Wound Closure, and Contractile Effect In Vitro: Possible Involvement of PI3K/Akt and p38/ERK/MAPK Pathways.

Skin wound healing is a dynamic and complex process involving several mediators at the cellular and molecular levels. Lupeol, a phytoconstituent belonging to the triterpenes class, is found in several fruit plants and medicinal plants that have been the object of study in the treatment of various diseases, including skin wounds. Various medicinal properties of lupeol have been reported in the literature, including anti-inflammatory, antioxidant, anti-diabetic, and anti-mutagenic effects. We investigated the effects of lupeol (0.1, 1, 10, and 20 µg/mL) on in vitro wound healing assays and signaling mechanisms in human neonatal foreskin keratinocytes and fibroblasts. Results showed that, at high concentrations, Lupeol reduced cell proliferation of both keratinocytes and fibroblasts, but increased in vitro wound healing in keratinocytes and promoted the contraction of dermal fibroblasts in the collagen gel matrix. This triterpene positively regulated matrix metalloproteinase (MMP)-2 and inhibited the NF-κB expression in keratinocytes, suggesting an anti-inflammatory effect. Lupeol also modulated the expression of keratin 16 according to the concentration tested. Additionally, in keratinocytes, lupeol treatment resulted in the activation of Akt, p38, and Tie-2, which are signaling proteins involved in cell proliferation and migration, angiogenesis, and tissue repair. These findings suggest that lupeol has therapeutic potential for accelerating wound healing.

A novel percutaneous magnetically guided gastrostomy technique without endoscopy or imaging guidance: a feasibility study in a porcine model.

BACKGROUND: In order to simplify a percutaneous gastrostomy procedure and avoid the need of endoscopy or imaging methods, a novel percutaneous magnetically guided gastrostomy (PMG) technique was conceived. The aim of the present study is to evaluate the feasibility of a novel PMG technique with no endoscopy or any imaging guidance in a porcine model. METHODS: Fourteen crossbred domestic pigs were used for prototype development (cadaveric experiments) and proof-of concept, survival study. The magnetic device was conceived using commercially available rare-earth neodymium-based magnets. The experimental design consisted of developing an internal magnetic gastric tube prototype to be orally inserted and coupled to an external magnet placed on the skin, which facilitated stomach and abdominal wall apposition for blind percutaneous gastrostomy tube placement. Then, a gastrostomy tube was percutaneously and blindly placed. RESULTS: Twelve procedures were undertaken in animal cadavers and two in live models. The technique chosen consisted of using a magnetic gastric tube prototype using six 1 × 1-cm-ring magnets attached to its end. This device enabled successful magnetic coupling with a large (5 cm in diameter) magnet disc placed on the skin. For gastric tube placement, a direct trocar insertion allowed easier and safer placement of a gastric tube as compared to a needle-guide-wire dilation (Seldinger-based) technique. Gastropexy was added to avoid early gastric tube displacement. This novel PMG technique was feasible in a live model experiment. CONCLUSIONS: A novel magnetically guided percutaneous gastrostomy tube insertion technique without the use of endoscopy or image-guidance was successful in a porcine model. A non-inferiority experimental controlled study comparing this technique to percutaneous endoscopic gastrostomy is needed to confirm its efficacy and safety.

High Altitude and Acute Mountain Sickness and Changes in Circulating Endothelin-1, Interleukin-6, and Interleukin-17a.

INTRODUCTION: Hypoxia induces an inflammatory response, which is enhanced by exercise. High altitude (HA) leads to endothelial activation and may be proinflammatory. The relationship between endothelial activation, inflammation, and acute mountain sickness (AMS) and its severity has never been examined. METHODS: Forty-eight trekkers were studied during a progressive trek at 3833, 4450, and 5129 m at rest postascent (exercise), and then again at rest 24 hours later. Twenty of the subjects were also tested at rest pre- and postexercise at sea level (SL) at 6 weeks preascent. We examined plasma levels of the interleukin 6 (IL-6), 17a (IL-17a), and endothelin-1 (ET-1) along with oxygen saturation (SpO2) and Lake Louise scores (LLS). RESULTS: ET-1 (5.7 ± 2.1 vs. 4.3 ± 1.9 pg/mL; p < 0.001), IL-6 (3.3 ± 3.3 vs. 2.4 ± 2.3 pg/mL; p = 0.007), and IL-17a (1.3 ± 3.0 vs. 0.46 ± 0.4 pg/mL; p < 0.001) were all overall significantly higher at HA versus SL. There was a paired increase in ET-1 and IL-6 with exercise versus rest at SL, 3833, 4450, and 5129 m (p < 0.05). There was a negative correlation between LLS and SpO2 (r = -0.32; 95% confidence interval [CI] -0.21 to -0.42; p < 0.001) and a positive correlation between LLS and IL-6 (r = 0.16; 0.0-0.27; p = 0.007) and ET-1 levels (r = 0.29; 0.18-0.39; p < 0.001. Altitude, ET-1, IL-6, and SpO2 were all univariate predictors of AMS. On multivariate analysis, ET-1 (p = 0.002) and reducing SpO2 (p = 0.02) remained as the only independent predictors (overall r(2) = 0.16; p < 0.001) of AMS. ET-1 (p = 03) and SpO2 were (p = 0.01) also independent predictors of severe AMS (overall r(2) = 0.19; p < 0.001). CONCLUSIONS: HA leads to endothelial activation and an inflammatory response. The rise in ET-1 and IL-6 is heavily influenced by the degree of exercise and hypoxia. ET-1 is an independent predictor of both AMS and its severity.

The rising importance of Triatoma rubrofasciata

The migration of invasive vector species has contributed to the worldwide extension of infectious diseases such as dengue (Aedes aegypti) and chikungunya (Aedes albopictus). It is probably a similar behaviour for certain vectors of Chagas disease which allowed it to become a continental burden in Latin America. One of them, Triatoma rubrofasciata has also been spreading throughout the tropical and subtropical world. Here, the recent and massive peridomestic presence of T. rubrofasciata in Vietnam cities is reported, and tentatively explained, highlighting the need for improved entomological surveillance.

The rising importance of Triatoma rubrofasciata.

The migration of invasive vector species has contributed to the worldwide extension of infectious diseases such as dengue (Aedes aegypti) and chikungunya (Aedes albopictus). It is probably a similar behaviour for certain vectors of Chagas disease which allowed it to become a continental burden in Latin America. One of them, Triatoma rubrofasciata has also been spreading throughout the tropical and subtropical world. Here, the recent and massive peridomestic presence of T. rubrofasciata in Vietnam cities is reported, and tentatively explained, highlighting the need for improved entomological surveillance.

Validade de construto da versão brasileira do Inventário Espectral de Externalização: evidências a partir de uma amostra de estudantes universitários / Construct validity of the Brazilian version of the Externalizing Spectrum Inventory: evidence from a university student sample

CONTEXTO: Externalização é uma dimensão das diferenças individuais que dá substrato e unifica traços impulsivos e agressivos de personalidade a transtornos mentais relacionados ao uso de substância e à conduta antissocial. OBJETIVOS: O presente estudo objetivou apresentar indicadores de validade de construto da versão brasileira do Inventário Espectral de Externalização. MÉTODO: Trata-se de um estudo psicométrico de orientação correlacional. Foram utilizadas duas técnicas clássicas de representação de construto: análise exploratória de fatores comuns e análise de consistência interna. A amostra consistiu de 258 participantes de ambos os sexos, provenientes de diferentes cursos universitários de duas instituições públicas do estado de Minas Gerais. RESULTADOS: A análise fatorial resultou em um modelo de um fator de segunda ordem (Externalização) com três fatores de primeira ordem (dimensões de agressão, de uso de substância e de impulsividade/alienação). Os coeficientes alfa mostraram-se bastante elevados, com índices acima de 0,9 tanto para os três fatores de primeira ordem quanto para o fator geral. CONCLUSÃO: Combinados, os resultados trazem evidências de validade e de fidedignidade para a versão brasileira do Inventário Espectral de Externalização no que tange à sua aplicabilidade a estudantes universitários.

BACKGROUND: Externalizing is a dimension of individual differences that undergirds and unites aggressive and impulsive personality traits to psychopathological disorders related to substance use and antisocial behavior. OBJECTIVES: The present study aims to establish parameters of construct validity for the Brazilian version of the Externalizing Spectrum Inventory. METHOD: This is a psychometrical correlacional study design. Two classical techniques of construct representation were implemented: unweighted least squares exploratory factor analysis and internal consistency analysis. The sample consisted of 258 participants of both sexes, from different undergraduate majors in two public universities in the state of Minas Gerais. RESULTS: As expected in theoretical grounds, common factor analysis revealed a one second-order factor (externalizing dimension) with three subfactor structure (substance, antisocial and impulsivity/alienation dimensions). The alfa coefficients were very high, with indexes greater than 0,9 for the three subfactor as well as for the general factor. DISCUSSION: Taken together, results bring evidences of validity and reliability of the Brazilian version of the Externalizing Spectrum Inventory in regard to it applicability in university students.

Occurrence and variability of Panstrongylus lutzi in the State of Ceará, Brazil

O Panstrongylus lutzi é um triatomíneo de ocorrência restrita às áreas de "caatinga" do Nordeste brasileiro. Apesar da presença de adultos no ambiente artificial ser freqüente, a ocorrência de colônias nunca havia sido assinalada pelas estatísticas do Programa de Controle da Doença de Chagas. No Estado do Ceará, a ocorrência desta espécie aumentou paulatinamente ao longo do período estudado, com taxas de infecção natural com Trypanosoma cruzi geralmente altas, sempre associadas a adultos que invadem o ambiente artificial. Chama a atenção o encontro de ninfas no peridomicílio e no intradomicílio. No ambiente silvestre duas fêmeas foram coletadas em troncos de árvores, que podem representar ecótopos naturais alternativos para a espécie neste Estado. As amostras de Panstrongylus lutzi dos municípios de Sobral e Crateús estudadas morfológica e morfometricamente, demonstraram alta variabilidade, sendo os insetos de Crateús significativamente menores e de coloração pálida, apresentando alguns indivíduos padrão da morfologia do falo compatível com a descrição da espécie; os insetos de Sobral eram escuros e as genitálias coincidentes com o padrão de Panstrongylus sherlocki, mas sendo todos considerados por nós como Panstrongylus lutzi.

Occurrence and variability of Panstrongylus lutzi in the State of Ceará, Brazil.

Panstrongylus lutzi is generally restricted to the "caatinga" areas of north-eastern Brazil. Adult insects are frequently found in local houses, but colonies have not previously been registered in the statistics of the Control Programme of Chagas Disease. In Ceará State, our study revealed increasing occurrence of this species, usually with high infection rates for Trypanosoma cruzi, and always represented by adults that invaded the artificial environment. We also found nymphs in the peridomicile and inside the houses. In silvatic habitats we collected two adult females from hollow tree trunks, which may represent an alternative natural ecotope for the species in this state. Panstrongylus lutzi entomological collections from Sobral and Crateús, studied by morphology and morphometrics, showed great variability; those from Crateús were larger smaller and paler in colour, with individuals showing genital features consistent with those described for Panstrongylus lutzi or Panstrongylus sherlocki, whereas those from Sobral were darker and with genitalia compatible with P. sherlocki, nevertheless, all were considered to be Panstrongylus lutzi.

Doença de Chagas na Amazônia: esboço da situação atual e perspectivas de prevenção / Chagas' disease in the Amazon: an overview of the current situation and perspectives for prevention

A tripanossomíase por Trypanosoma cruzi na Região Amazônica tem sido motivo de preocupaçäo ao longo dos tempos, dada a grande dispersão de vetores infectados e crescentes migrações humanas. Um seminário internacional da ECLAT em julho/2002 analisou a situaçäo e perspectivas quanto à dispersäo da doença humana concluindo ser a mesma ainda esporádica e com potencial de ampliaçäo na área, requerendo objetivo e integrado esforço de vigilância, compartido por todos os Países da Região

Eye colour as a genetic marker for fertility and fecundity of Triatoma infestans (Klug, 1834) Hemiptera, Reduviidae, Triatominae.

Eye colour of Triatoma infestans is controlled at a single autosomal locus, with black-eye as the dominant gene and red-eye as the recessive. Inheritance of these characters follows a classical Mendelian system, enabling eye colour to be used as a marker for studies of mating frequency. We found no significant differences in oviposition rates and egg hatching rates irrespective of parental phenotypes. Different mating schedules between red-eye and black-eye parents showed that eye colour did not affect mating competence. Females mated with a single male or with different males together or in succession produced similar numbers of fertile eggs, with the eye colour of the offspring reflecting exposure to the different males. We conclude that although a single mating can provide sufficient sperm for the whole reproductive life of the female, multiple matings can result in balanced assortative sperm usage from the spermatheca.

Eye colour as a genetic marker for fertility and fecundity of Triatoma infestans (Klug, 1834) Hemiptera, Reduviidae, Triatominae

Eye colour of Triatoma infestans is controlled at a single autosomal locus, with black-eye as the dominant gene and red-eye as the recessive. Inheritance of these characters follows a classical Mendelian system, enabling eye colour to be used as a marker for studies of mating frequency. We found no significant differences in oviposition rates and egg hatching rates irrespective of parental phenotypes. Different mating schedules between red-eye and black-eye parents showed that eye colour did not affect mating competence. Females mated with a single male or with different males together or in succession produced similar numbers of fertile eggs, with the eye colour of the offspring reflecting exposure to the different males. We conclude that although a single mating can provide sufficient sperm for the whole reproductive life of the female, multiple matings can result in balanced assortative sperm usage from the spermatheca

[Chagas' disease in the Amazon: an overview of the current situation and perspectives for prevention]. / Doença de Chagas na Amazônia: esboço da situação atual e perspectivas de prevenção.

American Trypanosomiasis (Chagas' disease) due to Trypanosoma cruzi in the Amazon Region has become a target of scientific preoccupation in recent years because of the wide dispersion of infected vectors and intensive human migration into the region. An European Community and Latin America Triatominae Network international workshop held in July 2002 analyzed the general situation and the perspectives of human Chagas' disease in the area, concluding that although its occurrence remains sporadic, there is strong potential for the disease to spread, and a requirement for an integrated surveillance effort to be shared by all countries of the region.

Pesquisas prioritárias sobre doença de Chagas na Amazônia: agenda de curto-médio prazo / Priority researches on Chagas' disease in the Amazonia Region: a short-medium term schedule

Na programaçao da V Jornada de Diagnostico, Tratamento e Controle de Doencas Tropicais do Baixo Amazonas, em face ao crescente interesse que a doença de Chagas vem despertando na regiao, foi levada a cabo uma extensa e rica reuniao cientifica sobre os diversos aspectos da tripanossomíase americana na Amazonia. Como objetivo central destas atividades, buscou-se proporcionar informaçóes atualizadas e elevar o conhecimento técnico, despertando para a pesquisa e favorecendo o intercâmbio científico entre os diferentes profissionais, setores e instituições envolvidos com o tema. De modo geral, os relatos reiteraram a existência de uma 'enzootia peculiar e com particularidades sub-regionais em toda a Amazonia, com ampla dispersáo de vetores silvestres e do agente etiológico, este geralmente classificado como do zimodema Z1 (Miles)...

Excito-repellency effect of deltamethrin on triatomines under laboratory conditions

No presente trabalho procurou-se constatar-se a deltametrina em baixas doses produz excito-repelência em triatomíneos, conforme já observado para mosquitos. O experimento foi realizado utilizando-se uma caixa de madeira recoberta com tecido impregnado com deltametrina nas doses de 2,5 e 5mg ia/m². As espécies de triatomíneos estudadas foram o T. infestans, P. megistus, R. neglectus e T. sordida. Exemplares adultos eram liberados em um dos lados da caixa, e a posiçäo dos mesmos era anotada em períodos subsequentes. A experiência foi realizada no dia da impregnaçäo do tecido, e repetida aos 30 e 60 dias para o T. sordida; aos 120 dias incluíram-se as demais espécies. Também foram observadas a mortalidade dos insetos e a tentativa de fuga da caixa através do vôo. A excito-repelência foi evidente para todas às espécies e doses até o 120§ dia. A única espécie que voou foi o P. megistus. O efeito excito-repelente pode ser considerado uma vantagem adicional ao poder do inseticida pois dificultaria a instalaçäo de novas colônias a partir de fêmeas que ingressassem nas casas através do vôo, além de promover o desalojamento de exemplares presentes nas frestas das paredes e outros esconderijos