In morbidly obese women both infectious and separation type WC are more common in vertical than low transverse incisions; therefore transverse should be preferred.
Aims: Previous studies have shown increased density of M 2 receptors in hypertrophied rat bladders that possess an M 2 contractile phenotype. The aim of the current study is to determine whether human bladders with an M 2 contractile phenotype also have a greater density of bladder M 2 receptors. Materials and Methods: Human bladders were obtained from 24 di¡erent organ transplant donors. Darifenacin and methoctramine a⁄nity was determined by the rightward shift of cumulative carbachol concentration contractile response curves for each bladder. Radioligand binding and immunoprecipitation was used to quantify M 2 and M 3 subtypes in isolated detrusor muscle and urothelium. In addition, pig bladder muscle and urothelial receptors were quanti¢ed for comparison. Results: In the human urothelium total, M 2 and M 3 muscarinic receptor density is signi¢cantly negatively correlated with the a⁄nity of darifenacin for inhibition of contraction of the detrusor muscle. In the detrusor muscle there is no correlation between receptor density and darifenacin a⁄nity for inhibition of contraction. Muscarinic receptor density is greater in the muscle than in the urothelium in human bladders whereas in the pig bladder the density is greater in the urothelium than in the muscle. Conclusions: The greater density of urothelial muscarinic receptors in human bladders with lower darifenacin a⁄nity, indicative of a greater contribution of M 2 receptors to the contractile response, points towards a possible role of the urothelium in controlling M 2 mediated contractile phenotype. In comparison between human and pig bladders, the distribution of muscarinic receptor subtypes in the muscle and urothelium are quite di¡erent.
Background Signs of anosmia can help detect COVID-19 infection when testing for viral positivity is not available. Inexpensive mass-produced disposable olfactory sensitivity tests suitable for worldwide use might serve not only as a screening tool for potential infection but also to identify cases at elevated risk of severe disease as anosmic COVID-19 patients have a better prognosis.
Methods and Findings We adopted paired crushable ampules with two concentrations of a standard test odorant (n-butanol) as standard of care in several clinics as community prevalence of COVID-19 infection waxed and waned. This was not a clinical trial; a chart review was undertaken to evaluate the operating characteristics and potential utility of the test device as RT-PCR testing became routine. The risk of anosmia was greater in COVID-19 patients. Olfactory sensitivity was concentration-dependent and decreased with aging. Hyposmia was detected across a wider age range than expected from the literature, and tests can be optimized to characterize different age groups.
Conclusions n-Butanol at 0.32 and 3.2% in crushable ampules can be used to characterize olfactory function quickly and inexpensively and thus has potential benefits in pandemic screening, epidemiology, and clinical decision-making.
Purpose: The aim was to determine the impact of steroid dose on effectiveness of CT-guided pudendal nerve blocks. Secondary aim was to assess predictors for response. Materials and methods: A retrospective cohort study was performed. Two-hundred-and-seventeen patients with pudendal neuralgia were identified. Of these, 189 patients had data on response and 511 pudendal nerve blocks were analyzed. Demographics, social history, initial pain data, treatment data including steroid dosing, and follow-up data were collected. Non-responders to treatment were compared to responders. Results: The majority of patients were female (92.1%) and most common areas of pain involved the vulva/labia/ perineum/vagina (scrotum) (44.2%). Treatment response rates increased with number of blocks with maximum response rate of 92.2% after fourth injection. Responders underwent more blocks within the first year (3.1 ± 1.5 vs 2.6 ± 1.6, p = 0.026). Steroid dose did not have a significant effect on response rate nor did site of injection. Non-responders were more commonly on disability due to pain ( p = 0.043). History of childhood/adolescent sexual abuse was more common in non-responders (p=0.046) and was a significant predictor of response (OR = 0.27 [0.08–0.94 95% confidence interval], p = 0.04). Conclusion: Steroid dose does not appear to have an impact on the short-term response rates to CT-guided pudendal nerve blocks in patients with clinically diagnosed pudendal neuralgia and our data may further support the discontinuation of steroids from CT block protocols. Current long-term disability leave status was a predictor of poor response along with history of childhood/adolescent sexual abuse. Adverse childhood events are easily assessed and may represent a clinical predictor of lack of response in this patient population. Clinical relevance: Approaches to managing pudendal neuralgia are varied. Steroid dose may not impact response to pudendal nerve blocks. Current disability status and history of childhood/adolescent sexual abuse may be clinical predictors of poor response to treatment.
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