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AIMS: The terminology of obstetric pelvic floor disorders should be defined and reported as part of a wider clinically oriented consensus. METHODS: This Report combines the input of members of two International Organizations, the International Continence Society (ICS) and the International Urogynecological Association (IUGA). The process was supported by external referees. Appropriate clinical categories and a sub-classification were developed to give coding to definitions. An extensive process of 12 main rounds of internal and 2 rounds of external review was involved to exhaustively examine each definition, with decision-making by consensus. RESULTS: A terminology report for obstetric pelvic floor disorders, encompassing 357 separate definitions, has been developed. It is clinically-based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it usable by different specialty groups and disciplines involved in the study and management of pregnancy, childbirth and female pelvic floor disorders. Clinical assessment, investigations, diagnosis, conservative and surgical treatments are major components. Illustrations have been included to supplement and clarify the text. Emerging concepts, in use in the literature and offering further research potential but requiring further validation, have been included as an Appendix. As with similar reports, interval (5-10 year) review is anticipated to maintain relevance of the document and ensure it remains as widely applicable as possible. CONCLUSION: A consensus-based Terminology Report for obstetric pelvic floor disorders has been produced to support clinical practice and research.
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Ginecologia , Medicina , Distúrbios do Assoalho Pélvico , Urologia , Feminino , Humanos , Distúrbios do Assoalho Pélvico/diagnóstico , Distúrbios do Assoalho Pélvico/terapia , Sociedades MédicasRESUMO
In assessing the energy performance of buildings, the thermal performance of the structural components and building materials is crucial. Although reference catalogs are used to determine the thermal properties of construction materials, the use of novel materials or non-homogeneous mixtures, particularly with biomaterials, demands the development of new instruments that are capable of performing rapid, accurate and cost-effective thermal characterization. This study introduces the ambient hot-box, a new tool for measuring the thermal properties of construction components and heterogeneous materials. The paper provides a methodology for measuring a sample's benchmark and fresh materials using a streamlined hot-box-based instrument. Utilizing samples as a benchmark material, the new instrument is assessed, yielding transmittance values with errors below 4%. The electronic circuits, measurements techniques and instrument implementation are all described.
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Finding a partner in an inherently unsteady 3-dimensional system, such as the planktonic marine environment, is a difficult task for nonswimming organisms with poor control over their orientation. We experimentally investigate the process of cell pairing in pennate marine diatoms and present field evidence of its occurrence in the ocean. We describe the mechanism as a 3-step process in which pennate diatoms (i) vertically reorient while sinking from surface turbulent waters to a more stable environment (i.e., under the seasonal pycnocline), (ii) segregate from incompatible partners (e.g., dead or different sized cells), and (iii) pair with other partners as a result of the hydrodynamic instabilities generated by collective cell sinking. This is, eminently, a cell abundance-dependent process, therefore being more effective when population sinking is synchronized. We suggest that this selective process, enabling matching of size-compatible healthy partners, could be fundamental in understanding sexual reproduction in pennate diatoms.
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Diatomáceas/citologia , Movimento , Plâncton/citologia , Microfluídica , ReologiaRESUMO
In situ laser diffractometry (LD) is increasingly used in oceanographic studies to estimate sediment transport, particle fluxes and to assess the concentration of marine phytoplankton. It enables an accurate characterization of the size distribution of suspended particles from the scattering signal produced by their interaction with a collimated laser beam. LD reliably reflects the sizes of suspensions dominated by nearly spherical particles; however, when complex particle morphologies dominate the suspension (e.g. phytoplankton) the resulting particle size distribution (PSD) may present significant variations attributed to different factors. In particular, the orientation of non-spherical particles - which abound in the sea - modifies LD measurements of PSDs. While this may be interpreted as a drawback for some studies (i.e. when precise measurement of the volume concentration is required), we propose that detailed analysis of this signal provides information on particle orientation. We use PDMS micropillars with prescribed elliptical cross-sections to experimentally determine the dependence between the spatial orientation of elongated particles and changes in the PSD measured with a LISST laser diffractometer. We show that LD can be used to adequately characterize the different dimensions of the non-spherical particles at specific orientations. Using this property, we describe and validate a method to infer the preferential orientation of particles in the sea. Our study opens new perspectives in the use of in-situ LD in ocean research.
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AIMS: Pelvic floor disorders (PFDs) in women are a major public health concern. Current clinical methods for assessing PFDs are either subjective or confounded by interference from intra-abdominal pressure (IAP). This study introduces an intravaginal probe that can determine distributed vaginal pressure during voluntary exercises and measures the degree of vaginal tissue support independent of IAP fluctuations. METHODS: An intravaginal probe was fabricated with 18 independent fiber-optic pressure transducers positioned along its upper and lower blades. Continuous pressure measurement along the anterior and posterior vaginal walls during the automated expansion of the probe enabled the resistance of the tissue to be evaluated as a function of displacement, in a manner reflecting the elastic modulus of the tissue. After validation in a simulated vaginal phantom, in vivo measurements were conducted in the relaxed state and during a series of voluntary exercises to gauge the utility of the device in women. RESULTS: The probe reliably detected variations in the composition of sub-surface material in the vaginal phantom. During in-vivo measurements the probe detected distributed tissue elasticity in the absence of IAP change. In addition, the distribution of pressure along both anterior and posterior vaginal walls during cough, Valsalva and pelvic floor contraction was clearly resolved with a large variation observed between subjects. CONCLUSIONS: Our data highlight the potential for the probe to assess the integrity of the vagina wall and support structures as an integrated functional unit. Further in vivo trials are needed to correlate data with clinical findings to assist in the assessment of PFDs.
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Exame Ginecológico/instrumentação , Exame Ginecológico/métodos , Vagina/patologia , Adolescente , Adulto , Idoso , Tosse/fisiopatologia , Elasticidade , Exercício Físico , Feminino , Tecnologia de Fibra Óptica , Humanos , Pessoa de Meia-Idade , Contração Muscular , Diafragma da Pelve , Distúrbios do Assoalho Pélvico/diagnóstico , Distúrbios do Assoalho Pélvico/patologia , Imagens de Fantasmas , Pressão , Transdutores , Manobra de Valsalva , Adulto JovemRESUMO
One of the challenges in construction is the improvement of energy efficiency of buildings. Development of construction materials of low thermal conductivity is a straightforward way to improve heat isolating capability of an enclosure. Lime mortar has a number of advantageous and peculiar properties and was widely used until the "irruption" of Portland cement. Currently, lime mortar is still used in restoration of traditional buildings or, according to the urban regulations, in catalogued constructions. The goal of the present study is the improvement of the heat isolating capability of lime mortars. The strategy of this work is the addition of iron (III) oxide powder, which is one of the possible components forming the cements, to a base lime mortar. The reason to choose Fe2O3 was two-fold. The first reason is low thermal conductivity of Fe2O3 compared to lime mortar. The second reason is that the low solubility and small size of iron (III) oxide particles have an effect on the thermal conductivity across the lime particles. The effect of iron (III) oxide powder on the thermal conductivity has been experimentally determined by the hot-box method. It has been found that the insulating capacity and thermal inertia of lime mortar is improved significantly by the addition of Fe2O3 powder, increasing the energy saving of the enclosure.
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Communication between conspecific individuals is an essential part of life both in terrestrial and marine realms. Until recently, social behavior in marine phytoplankton was assumed to rely mainly on the secretion of a variety of infochemicals that allowed population-scale collective responses. Here, we demonstrate that pelagic diatoms also use Sun-stimulated fluorescence signals for synchronizing their behavior. These unicellular microorganisms, playing a key biogeochemical role in the ocean, use photoreceptor proteins and redfar-red fluorescent radiation to communicate. A characteristic beaconing signal is generated by rhythmic organelle displacement within the cell cytoplasm, triggering coordinated population behavior. These light-based communication networks could critically determine major facets of diatom ecology and fitness and regulate the dynamics of larger-scale ocean processes.
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Objective: Wound healing is a complex process that involves the interaction between different cell types and bioactive factors. Impaired wound healing is characterized by a loss in synchronization of these interactions, resulting in nonhealing chronic wounds. Chronic wounds are a socioeconomic burden, one of the most prominent clinical manifestations of diabetes, however, they lack satisfactory treatment options. The objective of this study was to develop polymeric composites that deliver ions having wound healing properties and evaluate its performance using a pressure ulcer model in diabetic mice. Approach: To develop a polymeric composite wound dressing containing ion-releasing nanoparticles for chronic wound healing. This composite was chemically and physically characterized and evaluated using a pressure ulcer wound model in diabetic (db/db) mice to explore their potential as novel wound dressing. Results: This dressing exhibits a controlled ion release and a good in vitro bioactivity. The polymeric composite dressing treatment stimulates angiogenesis, collagen synthesis, granulation tissue formation, and accelerates wound closure of ischemic wounds created in diabetic mice. In addition, the performance of the newly designed composite is remarkably better than a commercially available dressing frequently used for the treatment of low-exuding chronic wounds. Innovation: The developed nanoplatforms are cell- and growth factor free and control the host microenvironment resulting in enhanced wound healing. These nanoplatforms are available by cost-effective synthesis with a defined composition, offering an additional advantage in potential clinical application. Conclusion: Based on the obtained results, these polymeric composites offer an optimum approach for chronic wound healing without adding cells or external biological factors.
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Diabetes Mellitus Experimental/patologia , Nanofibras/química , Neovascularização Fisiológica/efeitos dos fármacos , Polímeros/farmacologia , Cicatrização/efeitos dos fármacos , Animais , Bandagens , Sobrevivência Celular/efeitos dos fármacos , Análise Custo-Benefício , Regulação da Expressão Gênica/efeitos dos fármacos , Tecido de Granulação/patologia , Masculino , Camundongos , Camundongos Knockout , Nanofibras/ultraestrutura , Pele/patologiaRESUMO
A clinical investigation program was carried out to replace endogenous albumin of patients with mild to moderate Alzheimer's disease (AD) with 5% Human Albumin Grifols(R) through a plasma exchange (PE) schedule, in order to alter the dynamic equilibrium between albumin-bound Abeta in plasma and Abeta in cerebrospinal fluid. In a pilot proof-of-concept study, 7 patients underwent 6 PE in 3 weeks and 1 year of follow-up. Plasma Abeta determinations demonstrated a variation pattern in levels in relation with the PEs. Cognitive status scores (MMSE and ADAS-Cog) were more stable than expected. In a phase II clinical trial, 29 patients were randomized into PEtreated and control groups with 1 year follow-up. Interim results point toward the occurrence of Abeta40 mobilization in the PE-treated patients, who scored better in cognitive tests (differences at 9 months: 2.5 in MMSE and 5.5 in ADAS-cog). These results suggest that a PE program with 5% Human Albumin Grifols may have a promising role in the treatment of mild to moderate AD.
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Doença de Alzheimer/terapia , Troca Plasmática/métodos , Albumina Sérica/administração & dosagem , Doença de Alzheimer/fisiopatologia , Peptídeos beta-Amiloides/metabolismo , Animais , Ensaios Clínicos como Assunto , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/terapia , Sistemas de Liberação de Medicamentos , Humanos , Albumina Sérica/metabolismoRESUMO
The use of bioactive glasses (e.g. silicates, phosphates, borates) has demonstrated to be an effective therapy for the restoration of bone fractures, wound healing and vascularization. Their partial dissolution towards the surrounding tissue has shown to trigger positive bioactive responses, without the necessity of using growth factors or cell therapy, which reduces money-costs, side effects and increases their translation to the clinics. However, bioactive glasses often need from stabilizers (e.g. SiO44-, Ti4+, Co2+, etc.) that are not highly abundant in the body and which metabolization is not fully understood. In this study, we were focused on synthesizing pure calcium phosphate glasses without the presence of such stabilizers. We combined a mixture of ethylphosphate and calcium 2-methoxyethoxide to synthesize nanoparticles with different compositions and degradability. Synthesis was followed by an in-depth nuclear magnetic resonance characterization, complemented with other techniques that helped us to correlate the chemical structure of the glasses with their physiochemical properties and reaction mechanism. After synthesis, the organically modified xerogel (i.e. calcium monoethylphosphate) was treated at 200 or 350⯰C and its solubility was maintained and controlled due to the elimination of organics, increase of phosphate-calcium interactions and phosphate polycondensation. To the best of our knowledge, we are reporting the first sol-gel synthesis of binary (P2O5-CaO) calcium phosphate glass nanoparticles in terms of continuous polycondensated phosphate chains structure without the addition of extra ions. The main goal is to straightforward the synthesis, to get a safer metabolization and to modulate the bioactive ion release. Additionally, we shed light on the chemical structure, reaction mechanism and properties of calcium phosphate glasses with high calcium contents, which nowadays are poorly understood. STATEMENT OF SIGNIFICANCE: The use of bioactive inorganic materials (i.e. bioactive ceramics, glass-ceramics and glasses) for biomedical applications is attractive due to their good integration with the host tissue without the necessity of adding exogenous cells or growth factors. In particular, degradable calcium phosphate glasses are completely resorbable, avoiding the retention in the body of the highly stable silica network of silicate glasses, and inducing a more controllable degradability than bioactive ceramics. However, most calcium phosphate glasses include the presence of stabilizers (e.g. Ti4+, Na+, Co2+), which metabolization is not fully understood and complicates their synthesis. The development of binary calcium phosphate glasses with controlled degradability reduces these limitations, offering a simple and completely metabolizable material with higher transfer to the clinics.
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Compostos de Cálcio/química , Vidro/química , Espectroscopia de Ressonância Magnética , Nanopartículas/química , Óxidos/química , Fosfatos/químicaRESUMO
INTRODUCTION: Single incision slings (SIS) were introduced in an attempt to decrease the complications associated with retropubic and transobturator slings. The TVT Abbrevo is a modification of the TVT-O with a reduced length and less immediate postoperative pain. The Miniarc SIS has been shown to be equivalent to outside-in transobturator sling, Monarc at 12 month follow-up. OBJECTIVE: To evaluate objective and subjective outcomes of MiniArc SIS and TVT Abbrevo midurethral sling (MUS) in women with stress urinary incontinence. METHODS: Female subjects who were assessed and referred for stress urinary incontinence surgery were eligible to participate in this study. Exclusion criteria included women with intrinsic sphincter deficiency previous failed midurethral or fascial sling, untreated detrusor overactivity or significant voiding dysfunction. Patients' randomisation was performed with computer-generated blocks of 4-8, with concealed allocation. Assuming an objective cure rate of 90% for TVT AbbrevoTMwith a power of 80%, a sample size of 79 in each arm was required to detect a clinical difference of 15%, using a one sided alpha of 0.05. The target recruitment number was 220 allowing for an attrition rate of 15%. Institution ethics approval (11261B) was obtained and the trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12611001151921). Routine preoperative assessment was conducted for objective data, whilst patient reported outcome tools (PRO) were utilised for subjective outcomes. These include ICIQ UI SF, ICIQ OAB, IIQ7, EQ5D, PISQ12, PGIs & PGII. TVT AbbrevoTM or MiniarcTMwere performed in a standardized fashion, together with any concomitant prolapse surgery. Review was conducted at 6 weeks and at 6 and 12 months. Objective cure was defined as a negative cough stress test with a comfortably full bladder. Subjective cure was defined as no report of leakage with physical exertion. All Data was collected and outcomes were analysed statistically. RESULTS: Between February 2011 and January 2016,a total of 246 women were randomized to receive MiniArc (121) or TVT Abbrevo (125). Baseline characteristics were clinically balanced in both groups. At 6 months subjective (94.4% vs 95.7% p=0.74) and Objective (92.9% vs 95.9% p=0.49) cure rates were high and not statistically different. At 12 months there were also no differences in subjective (73.6% vs 76.9% p=0.73) or objective (90.5% vs 96.0% p=0.21) cure rates. No differences were found in functional outcomes or when adjusted for potential confounding factors such as age, parity, BMI or menopausal status. CONCLUSION: We found no significant differences in subjective and objective cure rates at 6 and 12months between MiniArc and TVT Abbrevo.
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Slings Suburetrais , Incontinência Urinária por Estresse/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Desenho de Equipamento , Feminino , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento , Incontinência Urinária por Estresse/etiologiaRESUMO
Advection by ocean currents modifies phytoplankton size structure at small scales (1-10 cm) by aggregating cells in different regions of the flow depending on their size. This effect is caused by the inertia of the cells relative to the displaced fluid. It is considered that, at larger scales (greater than or equal to 1 km), biological processes regulate the heterogeneity in size structure. Here, we provide observational evidence of heterogeneity in phytoplankton size structure driven by ocean currents at relatively large scales (1-10 km). Our results reveal changes in the phytoplankton size distribution associated with the coastal circulation patterns. A numerical model that incorporates the inertial properties of phytoplankton confirms the role of advection on the distribution of phytoplankton according to their size except in areas with enhanced nutrient inputs where phytoplankton dynamics is ruled by other processes. The observed preferential concentration mechanism has important ecological consequences that range from the phytoplankton level to the whole ecosystem.
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Ecossistema , Oceanos e Mares , Fitoplâncton/fisiologiaRESUMO
BACKGROUND: Studies conducted in animal models and humans suggest the presence of a dynamic equilibrium of amyloid-ß (Aß) peptide between cerebrospinal fluid (CSF) and plasma compartments. OBJECTIVE: To determine whether plasma exchange (PE) with albumin replacement was able to modify Aß concentrations in CSF and plasma as well as to improve cognition in patients with mild-moderate Alzheimer's disease (AD). METHODS: In a multicenter, randomized, patient- and rater-blind, controlled, parallel-group, phase II study, 42 AD patients were assigned (1â:â1) to PE treatment or control (sham) groups. Treated patients received a maximum of 18 PE with 5% albumin (Albutein®, Grifols) with three different schedules: two PE/weekly (three weeks), one PE/weekly (six weeks), and one PE/bi- weekly (12 weeks), plus a six-month follow-up period. Plasma and CSF Aß1-40 and Aß1-42 levels, as well as cognitive, functional, and behavioral measures were determined. RESULTS: CSF Aß1-42 levels after the last PE compared to baseline were marginally higher in PE-treated group versus controls (adjusted means of variation: 75.3 versus -45.5âpg/mL; 95% CI: -19.8, 170.5 versus 135.1, 44.2; pâ=â0.072). Plasma Aß1-42 levels were lower in the PE-treated group after each treatment period (pâ<â0.05). Plasma Aß1-40 levels showed a saw-tooth pattern variation associated with PE. PE-treated patients scored better in the Boston Naming Test and Semantic Verbal Fluency (pâ<â0.05) throughout the study. Neuropsychiatric Inventory scores were higher in controls during the PE phase (pâ<â0.05). CONCLUSION: PE with human albumin modified CSF and plasma Aß1-42 levels. Patients treated with PE showed improvement in memory and language functions, which persisted after PE was discontinued.
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Albuminas/uso terapêutico , Peptídeos beta-Amiloides/sangue , Peptídeos beta-Amiloides/líquido cefalorraquidiano , Transtornos Cognitivos/terapia , Troca Plasmática/métodos , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/complicações , Doença de Alzheimer/diagnóstico por imagem , Transtornos Cognitivos/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Escalas de Graduação Psiquiátrica , Tomógrafos ComputadorizadosRESUMO
Insufficient angiogenesis remains a major hurdle in current bone tissue engineering strategies. An extensive body of work has focused on the use of angiogenic factors or endothelial progenitor cells. However, these approaches are inherently complex, in terms of regulatory and methodologic implementation, and present a high cost. We have recently demonstrate the potential of electrospun poly(lactic acid) (PLA) fiber-based membranes, containing calcium phosphate (CaP) ormoglass particles, to elicit angiogenesis in vivo, in a subcutaneous model in mice. Here we have devised an injectable composite, containing CaP glass-ceramic particles, dispersed within a (Hydroxypropyl)methyl cellulose (HPMC) matrix, with the capacity to release calcium in a more sustained fashion. We show that by tuning the release of calcium in vivo, in a rat bone defect model, we could improve both bone formation and increase angiogenesis. The bone regeneration kinetics was dependent on the Ca2+ release rate, with the faster Ca2+ release composite gel showing improved bone repair at 3weeks, in relation to control. In the same line, improved angiogenesis could be observed for the same gel formulation at 6weeks post implantation. This methodology allows to integrate two fundamental processes for bone tissue regeneration while using a simple, cost effective, and safe approach. STATEMENT OF SIGNIFICANCE: In current bone tissue engineering approaches the achievement of sufficient angiogenesis, during tissue regeneration, is a major limitation in order to attain full tissue functionality. Recently, we have shown that calcium ions, released by the degradation of calcium phosphate ormoglasses (CaP), are effective angiogenic promoters, in both in vitro and in a subcutaneous implantation model. Here, we devised an injectable composite, containing CaP glass-ceramic particles, dispersed within a HPMC matrix, enabling the release of calcium in a more sustained fashion. We show that by tuning the release of calcium in vivo, in a rat bone defect model, we could improve both bone formation and increase angiogenesis. This simple and cost effective approach holds great promise to translate to the clinics.
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Avaliação Pré-Clínica de Medicamentos , Células Progenitoras Endoteliais , Neovascularização Fisiológica/efeitos dos fármacos , Osteogênese/efeitos dos fármacos , Animais , Cálcio/química , Cálcio/farmacologia , Preparações de Ação Retardada/química , Preparações de Ação Retardada/farmacologia , Células Progenitoras Endoteliais/citologia , Células Progenitoras Endoteliais/metabolismo , Células Progenitoras Endoteliais/transplante , Xenoenxertos , Humanos , Camundongos , Poliésteres/química , Poliésteres/farmacologia , Ratos , Ratos WistarRESUMO
In current bone tissue engineering strategies the achievement of sufficient angiogenesis during tissue regeneration is still a major limitation in order to attain full functionality. Several strategies have been described to tackle this problem, mainly by the use of angiogenic factors or endothelial progenitor cells. However, when facing a clinical scenario these approaches are inherently complex and present a high cost. As such, more cost effective alternatives are awaited. Here, we demonstrate the potential of electrospun poly(lactic acid) (PLA) fiber-based membranes, containing calcium phosphate ormoglass (CaP) particles, to elicit angiogenesis in vivo, in a subcutaneous model in mice. We show that the current approach elicited the local expression of angiogenic factors, associated to a chemotactic effect on macrophages, and sustained angiogenesis into the biomaterial. As both PLA and CaP are currently accepted for clinical application these off-the-shelf novel membranes have great potential for guided bone regeneration applications. STATEMENT OF SIGNIFICANCE: In current bone tissue engineering approaches the achievement of sufficient angiogenesis, during tissue regeneration, is a major limitation in order to attain full tissue functionality. Recently, our group has found that calcium ions released by the degradation of calcium phosphate ormoglasses (CaP) are effective angiogenic promoters. Based on this, in this work we successfully produced hybrid fibrous mats with different contents of CaP nanoparticles and thus with different calcium ion release rates, using an ormoglass - poly(lactic acid) blend approach. We show that these matrices, upon implantation in a subcutaneous site, could elicit the local expression of angiogenic factors, associated to a chemotactic effect on macrophages, and sustained angiogenesis into the biomaterial, in a CaP dose dependent manner. This off-the-shelf cost effective approach presents great potential to translate to the clinics.