Objective To assess the eBcacy of physical therapies for intensity regimen of PFM exercises. Despite significant eCects of biofeedback after testing as an adjunct to first-line use in the treatment and prevention of stress urinary incontinence (SUI) in women, using a system-PFM exercises, there is no evidence that PFM exercises with biofeedback are more eCective than PFM exercises atic review of randomized clinical trials (RCTs). Materials and methods A computer-aided and manualalone. There is little consistency (of stimulation types and parameters) in the studies of electrical stimulation, search for published RCTs investigating treatment and prevention of SUI using physical therapies, e.g. pelvic but when the results are combined there is strong evidence to suggest that electrostimulation is superior floor muscle (PFM) exercises, with or without other treatment modalities, was carried out. The method-to sham electrostimulation, and limited evidence that there is no diCerence between electrostimulation and ological quality of the included trials was assessed using criteria based on generally accepted principles other physical therapies. In the prevention of SUI the eBcacy of PFM exercises, with or without other of interventional research. Results Twenty-four RCTs (22 treatment and two pre-adjuncts, is uncertain. Conclusions More research of high methodological qual-vention) were identified; the methodological quality of the studies included was moderate and 11 RCTs were ity is required to further evaluate the eCects of physical therapies used to treat and prevent SUI. of suBcient quality to be included in further analysis. Based on levels-of-evidence criteria, there is strong Keywords Systematic review, stress urinary incontinence, conservative treatment, prevention, physical evidence to suggest that PFM exercises are eCective in reducing the symptoms of SUI. There is limited evi-therapy, (pelvic floor muscle) exercises, biofeedback, electrical stimulation, vaginal cones dence for the eBcacy of high-intensity vs a lowwomen; the overall estimated prevalence of UI in women
Summary. We report a patient with autoimmune haemolytic anaemia (AIHA) with reticulocytopenia, who showed excessive apoptosis of erythroblasts. Ultrastructural analysis of bone marrow cells showed that 50% of erythroblasts had characteristic features of apoptosis, which was con®rmed by staining with Annexin-V. In addition, in contrast to normal erythroblasts, Ig staining of the entire erythroblast population could be shown. These data show that apoptosis may contribute to the mechanism of reticulocytopenia in AIHA.
Pharmaceuticals find their way to the aquatic environment via wastewater treatment plants (WWTPs) and biodegradation plays an important role in mitigating environmental risks, however a mechanistic understanding of involved processes is limited. The aim of this study was to evaluate potential relationships between first-order biodegradation rate constants (kb) of nine pharmaceuticals and initial concentration of the selected compounds, and sampling season of the used activated sludge inocula. Four-day bottle experiments were performed with activated sludge from WWTP Groesbeek (The Netherlands) of two different seasons, summer and winter, spiked with two environmentally relevant concentrations (3 and 30 nM) of pharmaceuticals. Concentrations of the compounds were measured by LC-MS/MS, microbial community composition was assessed by 16S rRNA gene amplicon sequencing and kbvalues were calculated. The biodegradable pharmaceuticals, ranked from high to low biodegradation rates, were acetaminophen, metformin, metoprolol, terbutaline, and phenazone. Carbamazepine, diatrizoic acid, diclofenac and fluoxetine were not converted. Summer and winter inocula did not show significant differences in microbial community composition, but resulted in a slightly different kbfor some pharmaceuticals. Likely microbial activity was responsible instead of community composition. In the same inoculum different kbvalues were measured, depending on initial concentration. In general, biodegradable compounds had a higher kbwhen the initial concentration was higher. This demonstrates that Michealis-Menten kinetics theory has shortcomings for some pharmaceuticals at low, environmentally relevant concentrations and that the pharmaceutical concentration should be taken into account when measuring the kbin order to reliably predict the fate of pharmaceuticals in the WWTP.
Aims The combination of calcium channel blockers and b-adrenoceptor blockers is more effective for the treatment of exercise-induced angina pectoris than b-adrenoceptor blocker monotherapy. As ischaemia in exercise-induced angina is preceded by increase in heart rate, calcium channel blockers with negative chronotropic properties may perform better for this purpose than nonchronotropic compounds. Methods A 335 patient double-blind parallel-group study comparing 14 day treatment with amlodipine 5 and 10 mg, with diltiazem 200 and 300 mg, and mibefradil 50 and 100 mg added to baseline b-adrenoceptor blocker treatment was performed. Exercise testing (ETT) was performed by bicycle ergometry. Results Although none of the calcium channel blockers improved duration of exercise or amount of workload, all significantly delayed onset of 1 mm ST-segment depression on ETT (P<0.001 for any treatment vs baseline). In addition, mibefradil, both low and high dose treatment, produced the longest delays (low dose: different from diltiazem and amlodipine by 24.1 and 29.8 s, respectively, P<0.003 and <0.001; high dose: different from diltiazem and amlodipine by 33.7 and 37.0 s, respectively, P<0.001 and <0.001). These effects were linearly correlated with the reduction in rate pressure product (RPP). Serious symptoms of dizziness occurred significantly more frequently on mibefradil (P<0.05), and 19 patients on mibefradil withdrew from trial. Conclusions Calcium channel blockers with negative chronotropic properties provide greater delay of ischaemia in patients with exercise-induced angina, but the concomitant risk of intolerable dizziness attenuates this benefit.
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