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The urodynamic investigation at hand showed urinary tract dysfunction in 78 of 100 MS patients with lower urinary tract symptoms (LUTS). The long latency between the occurrence of MS and/or the beginning of LUTS and the first neuro-urological evaluation indicates a deficit in treatment. Beyond national guidelines, all MS patients should at regular intervals be questioned about LUTS and receive urodynamic assessment especially according to the presented risk profile.

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The morphological findings point to outstandingly good biocompatibility of SIS. During healing the material is incorporated into the body without any foreign body or inflammatory reaction. The results of the first histological investigation of SIS in human subjects emphasize the special status of SIS among implant materials.

The insertion of thermal dissipation (TD) sensors on tree stems for sap flux density (SFD) measurements can lead to SFD underestimations due to a wound formation close to the drill hole. However, the wound effect has not been assessed experimentally for this method yet. Here, we propose an empirical approach to investigate the effect of the wound healing on measured sap flux with TD probes. The approach was performed for both, diffuse-porous (Fagus sylvatica (Linnaeus)) and ring-porous (Quercus petraea (Lieblein)) species. Thermal dissipation probes were installed on different dates along the growing season to document the effects of the dynamic wound formation. The trees were cut in autumn and additional sensors were installed in the cut stems, therefore, without potential effects of wound development. A range of water pressures was applied to the stem segments and SFDs were simultaneously measured by TD sensors as well as gravimetrically in the laboratory. The formation of wounds around sensors installed in living tree stems led to underestimation of SFD by 21.4 ± 3 and 47.5 ± 3.8% in beech and oak, respectively. The differences between SFD underestimations of diffuse-porous beech and ring-porous oak were, however, not statistically significant. Sensors with 5-, 11- and 22-week-old wounds also showed no significant differences, which implies that the influence of wound formation on SFD estimates was completed within the first few weeks after perforation. These results were confirmed by time courses of SFD measurements in the field. Field SFD values decreased immediately after sensor installation and reached stable values after ~2 weeks with similar underestimations to the ones observed in the laboratory. We therefore propose a feasible approach to correct directly field observations of SFD for potential underestimations due to the wound effect.

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BackgroundElderly people are representative for the patients most likely to be treated with anticholinergics for overactive bladder (OAB). They often receive further drugs with anticholinergic properties for concomitant conditions. This increases the risk for side effects, including central nervous system disorders. Data on comorbidities and baseline anticholinergic burden of OAB patients seen in urological practice is scarce. Therefore, we included an epidemiological survey on these issues in our study which assessed the effectiveness and tolerability of trospium chloride (TC) in established dosages under routine conditions.MethodsOutpatients (≥ 65 years of age), for whom treatment with TC was indicated, were eligible to participate in this non-interventional, prospective study performed in 162 urological practices in Germany. Epidemiological questions were evaluated by the Anticholinergic Burden (ACB) scale and the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) at baseline. Efficacy was assessed by changes in symptom-related variables of OAB after treatment. Dosage regimen, duration of treatment, adverse events, withdrawals, and ease of subdivision of the prescribed SNAP-TAB tablet were documented. Patients and physicians rated efficacy and tolerability of treatment. Statistics were descriptive.ResultsFour hundred fourty-five out of 986 (47.54%) patients in the epidemiological population had a baseline ACB scale score > 0, 100 (24.72%) of whom a score ≥ 3. The median CIRS-G comorbidity index score for all patients was 5. 78.55% (608/774) of patients in the efficacy population received a daily dose of 45 mg TC. 60.03% (365/608) of them took this dose by dividing the SNAP-TAB tablet in three equal parts. Before-after-comparisons of the core symptoms of OAB showed clear improvements. An influence of the dosage scheme (1 × 45 mg TC/d vs 3 × 15 mg TC/d) on clinical outcome could not be observed. Most urologists and patients rated TC treatment as effective and well tolerated. 44 (4.37%) out of 1007 patients in the safety collective ended their treatment prematurely, while 75 patients (7.45%) experienced adverse events.ConclusionsAnticholinergic burden and comorbidities in elderly OAB patients are frequent. The acceptance of the SNAP-TAB tablet, which facilitates flexible dosing with TC, was high, which is supportive in ensuring adherence in therapy.Trial registrationThis non-interventional study was registered on October 29, 2014 with the number DRKS00007109 at the German Register of Clinical Studies (DRKS).

Patients under 5 years were not evaluated in the phase-3 study for enzyme replacement therapy (ERT) in MPS IV A. Here we describe the evolution of a severe Morquio A pediatric patient who was diagnosed at 19 months old and treated by ERT at 21 months old for the next 30 months.Applying the standard ERT protocol on this very young patient appeared to reduce his urinary excretion of glycosaminoglycans (GAGs); the improvements in both the 6 minute-walk test (6MWT) and the stair climb test, however, were no different than those reported in the nature history study. Additionally, this young patient experienced many ERT-associated side effects, and as a result a specific corticosteroid protocol (1 mg/kg of betamethasone the day before and 1 h before the ERT infusion) was given to avoid adverse events. Under these treatments, the height of this patient increased during the first year of the ERT although no more height gain was observed thereafter for 18 months. However, despite of ERT, his bone deformities (including severe pectus carinatum) actually worsened and his medullar cervical spine compression showed no improvement (thus needed decompression surgery).Conclusion: early ERT treatment did not improve the bone outcome in this severe MPS IV A patient after the 30 months-long treatment. A longer term follow up is required to further assess the efficacy of ERT on both the motor and the respiratory function of the patient.