Erectile Function, Sexual Drive, And Ejaculatory Function Analyzed After Reconstructive Surgery For Anterior Urethral Stricture Disease

UroToday- There are few studies that address the subject of sexual function after reconstructive surgery for anterior urethral stricture disease. In an effort to better define sexual dysfunction after urethroplasty for anterior strictures, a recent study was performed by Chris Gonzalez and colleagues from Northwestern University in Chicago. The paper is published in the March 2007 issue of BJU International.

The study group was composed of 52 men with a median age of 44 years who underwent 59 urethral reconstructive procedures for anterior urethral stricture disease between 2001 and 2004. Sexual function was assessed using the O’Leary Brief Male Sexual Function Survey (OBSFI) before and after surgery. The mean follow-up was 22.3 months.

The operations performed included bulbar excision and primary anastomosis (EPA; 23 of 52, 44%), dorsal or ventral buccal mucosa onlay reconstructions (22 of 52, 42%), and two-stage repairs using buccal mucosa (7 of 52, 14%). The mean stricture length was 4.85 cm.

Analysis of the sexual function scores revealed that there were no significant differences in the mean scores within the sexual drive and erectile function domains before and after surgery. It did appear that those patients that had at least 12 months of recovery after their urethroplasties had a better chance of achieving an improved status. In the ejaculatory function domain, there was a significant increase in the overall EjF score after surgery as a whole and the improvement was the most robust in men < 49 years old. This result can be expected partly because of the absence of obstruction but some authors, such as Guido Barbagli, have postulated that some aspect of post-void dribble and EjD can be expected after this surgery due to disruption of the bulbospongiosum expulsion mechanism due to the separation of these muscle fibers during reconstruction.

Bradley A. Erickson, James S. Wysock, Kevin T. McVary and Christopher M. Gonzalez

BJU Int. 2007 Mar; 99(3): 607-11
Reviewed by UroToday Contributing Editor Michael J. Metro, MD

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Recipe For Cell Reprogramming Adds Protein – Embryonic-Like Stem Cells Can Be Created Without Cancer-Causing Gene

A drug-like molecule called Wnt can be substituted for the cancer gene c-Myc, one of four genes added to adult cells to reprogram them to an embryonic-stem-cell-like state, according to Whitehead researchers. Researchers hope that such embryonic stem-cell-like cells, known as induced pluripotent (IPS) cells, eventually may treat diseases such as Parkinson’s disease and diabetes.

Demonstrated in mice, the elimination of c-Myc represents an important step in creating IPS cells in a manner that in the future may be applied to human therapeutics.

“This is a good sign for the possible replacement of the other three genes used to reprogram cells,” says Ruth Foreman, a MD/PhD student in the lab of Whitehead Member Rudolf Jaenisch and a lead co-author on the paper, published online in Cell Stem Cell on August 6. The other lead co-authors are Alex Marson, an MD/PhD student in the labs of Jaenisch and Whitehead Member Richard Young, and Brett Chevalier, a research scientist in the Young lab.

“IPS cells hold great potential for future medicine, but we must learn how to generate these cells in a manner that is safe for clinical therapies,” says Young, who is also a professor of biology at Massachusetts Institute of Technology. “This advance in reprogramming is one key step toward that goal,”

Currently, IPS cells can be created by reprogramming adult cells through the use of viruses to transfer four genes (Oct4, Sox2, c-Myc and Klf4) into the cells’ DNA. The activated genes then override the adult state and convert the cells to embryonic-like IPS cells.

However, this method poses significant risks for potential use in humans.

First, the viruses employed in the process, called retroviruses, are associated with cancer because they insert DNA anywhere in a cell’s genome, thereby potentially triggering the expression of cancer-causing genes, or oncogenes. Second, c-Myc is a known oncogene whose overexpression can also cause cancer. For IPS cells to be employed to treat human diseases such as Parkinson’s, researchers must find safe alternatives to reprogramming with retroviruses and oncogenes.

Earlier research has shown that c-Myc is not strictly required for the generation of IPS cells. However, its absence makes the reprogramming process time-consuming and highly inefficient.

To bypass these obstacles, the Whitehead researchers replaced c-Myc and its retrovirus with a naturally occurring signaling molecule called Wnt3a. When added to the fluid surrounding the cells being reprogrammed, Wnt3a promotes the conversion of adult cells into IPS cells.

“We’re not sure if the Wnt molecule is doing the same thing as c-Myc or complementing c-Myc’s activity,” says Chevalier. “But it does increase stem cell growth similar to c-Myc.”

“This is a good start toward using external cues instead of genetic manipulation to reprogram cells,” says Marson. “But we still need to eliminate the need for retroviruses for the three other genes.”

Although the technique is promising in mouse cells, its potential applications in humans have not been studied, emphasizes Jaenisch, who is also a professor of biology at MIT. “Is the same pathway acting in the human system and can Wnt molecules be used to reprogram human cells?” he asks. “We don’t know, but I think those are very important questions to investigate.”

This research was supported by the National Institutes of Health.

Nicole Giese

Rudolf Jaenisch and Richard Young’s primary affiliations are with Whitehead Institute for Biomedical Research, where their laboratories are located and all their research is conducted. Jaenisch and Young are also professors of biology at Massachusetts Institute of Technology.

Full citation:

Wnt stimulation substitutes for c-Myc in reprogramming somatic cells to induced pluripotent stem cells
Alexander Marson (1,2), Ruth Foreman (1,2), Brett Chevalier (1), Michael Kahn (3,4), Richard A. Young (1,2), Rudolf Jaenisch (1,2).
Cell Stem Cell August 7, 2008 (online August 6, 2007).

1. Whitehead Institute for Biomedical Research, 9 Cambridge Center, Cambridge, Massachusetts 02142, USA.

2. Department of Biology, Massachusetts Institute of Technology (MIT), Cambridge, Massachusetts 02139, USA.

3. Institute for Stem Cell and Regenerative Medicine, University of Southern California, Los Angeles, California 90033, USA.

4. Department of Biochemistry and Molecular Biology, University of Southern California, Los Angeles, California 90033, USA.

Whitehead Institute for Biomedical Research

High-Risk Stroke Patients More Likely To Get Follow-up Care After Motivational Talk

Even though many Americans learn through community health screenings that they are at high risk for having a stroke, they rarely follow-up with their doctor for care.

But a new University of Michigan study shows high-risk stroke patients are twice as likely to get follow-up care from a primary care doctor if they receive a pep talk over the telephone.

“It is unfortunate that these high-risk patients often have a lower rate of follow-up with their primary care physicians,” says Rajesh Balkrishnan, Ph.D., associate professor in the College of Pharmacy and School of Public Health at the U-M. “They should not ignore their results and seek medical help.”

Stroke is one of the leading causes of death and disability in the United States.
But controlling high blood pressure and high cholesterol helps reduce the chance of fatty deposits building up in the arteries that can lead to a stroke.

The U-M study, published in the July-August issue of the Journal of Stroke and Cerebrovascular Diseases, tested the effectiveness of telephone interventions with those who had two or more stroke risk factors.

More than 200 people participated in the study. All participants lived in North Carolina, a state in the ‘stroke belt,’ the southeastern region of the country with the nation’s highest incidence of stroke.

They received either standard information on strokes, such as risk factors, or a telephone call — a brief intervention known as the Health Belief Model which offers specific health advice and discusses barriers to seeing a primary care physician.

“Patients who had the telephone intervention were twice as likely to visit their primary care physician and discuss stroke screening results,” says Balkrishnan. “Telephone interviewers worked with these patients and reinforced the need for stroke care with a primary care doctor,” he says.

These patients also modified their diet and even talked about seeing stroke specialists, he adds.

Three months after the screening, 56 percent in the intervention group, compared to 38 percent who did not get a call, had visited their primary care doctor specifically to discuss the stroke screening results.

Stroke is the third leading cause of death in the United States. Nearly 800,000 Americans have a stroke each year, and 137,000 die of stroke. Strokes are more common among older people, but there’s evidence of stroke declining in recent decades as more people control high cholesterol and high blood pressure and fewer people smoke.

Source: University of Michigan Health System

The Number Of Lungs Available For Transplant Could Be Doubled By Ventilation Changes

Simple changes to how ventilators are used could almost double the number of lungs available for transplants, according to new international research involving a doctor at St. Michael’s Hospital.

Many potential donor lungs deteriorate between the time a patient is declared brain dead and the time the lungs are evaluated to determine whether they are suitable for transplant. The study involving Dr. Arthur Slutsky, the hospital’s vice president of research, said the deterioration could be in part because of the ventilatory strategy used while potential donors were observed just prior to being declared brain dead.

His team, lead by Dr. Marco Ranieri of the University of Turin in Italy, tested a “lung protective strategy” on patients in 12 hospitals in Spain and Italy that resulted in a significant increase in the number of viable donor lungs that were transplanted. Their results are published in the current issue of the Journal of the American Medical Association.

The strategy involved using smaller “tidal volumes,” meaning less air was pumped into the lungs with each breath, to prevent injury to the lungs. It also used higher “positive-end expiratory pressure,” the amount of pressure applied by the ventilator at the end of an exhalation, to prevent lungs from collapsing.

“A lot of patients who are waiting for lung transplants die before they get a transplant because there aren’t enough organs,” said Dr. Slutsky, the only Canadian on the research team. “By using this lung protective strategy, one can essentially double the number of lungs available for transplant.”

The randomized study involved 118 patients. Of the 59 patients treated with conventional ventilation, 32 (54 per cent) met lung donor eligibility criteria. Of those on the lung protective strategy, 56 (95 per cent) met the criteria. Ultimately, double the number of lungs was transplanted in the group treated with the lung protective strategy.

According to the Canadian Institute for Health Information, 1,222 lung transplants were performed in Canada between 1997 and 2006, but 299 people died while waiting for a transplant. There were 252 people waiting to receive lung transplants in 2006, up from 119 in 1997.

“This is pretty simple and easy to implement,” Dr. Slutsky said. “It’s not like a fancy new drug or equipment. You just have to change the ventilator a little bit.”

Dr. Slutsky said some doctors and hospitals may already be following a similar “lung protective strategy” but this is the first published randomized clinical trial showing it works, which could lead to standards that all hospitals would follow.

“If this is adopted widely, we think it will increase the number of lungs available for transplant, increase the quality of life for some people and probably save the lives of some people who are on the waiting list,” he said.

Source:
Leslie Shepherd
St. Michael’s Hospital

After An Operation Patients With Larger Social Networks May Fare Better

A new study published in the February issue of the Journal of the American College of Surgeons shows that patients with a large support network of family and friends report feeling less pain and anxiety prior to having a surgical procedure, which can have a substantially positive impact on their postoperative recovery.

The findings suggest that it is important for clinicians to be aware of the close relationship between patients’ social networks and their impact on preoperative pain and anxiety, and how these relationships can affect patient recovery after major operations.

“Strong social connectedness can have a tremendous impact on patient recovery by helping blunt the effect of stress caused by postoperative pain, as well as ease concerns about health, finances and separation from family members,” said Allison R. Mitchinson, MPH, NCTMB, research health science specialist, Department of Veterans Affairs, Ann Arbor (MI) Healthcare System.

Social network size and social connectedness have long been known to affect health and well-being. Stressful events such as having an operation can further increase the need for social support.

“Since patients with limited social connections will likely require more pain medications, have longer hospital stays, and need additional caregiver attention after a surgical procedure, it is important that physicians are aware of this link,” added study co-author Daniel B. Hinshaw, MD, FACS, a researcher with the Department of Veterans Affairs, Ann Arbor Healthcare System. “Patients should be preoperatively screened for pain and anxiety because these are strong predictors of a more difficult postoperative recovery.”

Patients undergoing major thoracic or abdominal operations at two Veterans Affairs’ medical centers (n=605) participated in a randomized controlled trial of massage as adjuvant treatment for postoperative pain. Prior to the operations, patients were given a questionnaire assessing their number of friends and relatives and how frequently contact was made with the members of their social networks. Patients rated levels of pre- and postoperative pain intensity and unpleasantness, as well as postoperative levels of anxiety, depression, relaxation, and inner peace using visual analogue scales. Daily opiate use, postoperative complications, and length of stay were also evaluated. The study found that patients reporting a smaller social network had higher preoperative pain intensity, unpleasantness, and anxiety (p

Another Step Forward For Muscle Stem Cells

Research by Dr Amy Wagers and her team at Harvard University, USA, has shown promise for the use of muscle stem cell as a therapy for conditions such as muscular dystrophy. The researchers successfully transplanted muscle stem cells from healthy mice into the muscles of mice that show symptoms similar to Duchenne muscular dystrophy.

Although this shows promise for the therapy of human muscle disease, there are many practical hurdles. In humans, avoiding immune rejection of transplanted cells and distributing the cells evenly throughout the muscles of the body would be a major challenge. This paper does however give us valuable information on the identification and isolation of muscle stem cells, which will allow us to learn more about these vital cells.

Dr Marita Pohlschmidt, Director of Research at the Muscular Dystrophy Campaign, commented: “Increasingly more research is being carried out to further the understanding of stem cell biology. The results reported by Dr Amy J Wagers and her team show that it is possible in an animal model to isolate muscle stem cells from a healthy adult mouse and transplant them successfully into a mouse with muscular dystrophy. Although stem cell technology is still in it’s in infancy this is another step towards developing this technology into a viable treatment for people with muscle disease.”

The research paper can be read at cell

More about the report can also be read at news.bbc/1/hi/health

Muscular Dystrophy Campaign

Teen Health Threatened By Binge Drinking And Smoking

As teens head back to school, health teachers may want to revise their lesson plans. Temple researchers have found that kids who engage in heavy drinking will more than likely also engage in heavy smoking, and they say educators can help combat the trend by addressing both topics as one health risk.

“These are important findings because they emphasize the need for education and intervention programs that target the co-occurrence of these two health risks,” said Brian Daly, assistant professor of public health in the College of Health Professions and Social Work.

Daly and colleagues in the department of public health and psychology determined rates of smoking and binge drinking through the collection of anonymous survey data from 2,450 African-American, Hispanic and Caucasian students in grades 9-12 at Philadelphia public high schools. Students’ responses were compiled from the 2007 Philadelphia Youth Behavioral Risk Survey (YRBS).

Respondents were asked how many cigarettes they’d had per day over 30 days, and how many days over a 30 day period they’d had 5 or more drinks in a row. Data was broken down by race/ethnicity and gender. Researchers found that while Caucasian adolescents were more likely than African-Americans to engage in either binge drinking or smoking, both groups were equally likely to engage in both at the same time.

“In the past 30 years or so, African Americans have traditionally had the lowest instance of smoking and binge drinking,” said Daly, who presented his research at the American Psychological Association’s annual meeting this week. “Those low numbers resulted in very few studies which looked at both smoking and binge drinking in a diverse sample; most focused only on instances of these in Caucasian or Hispanic adolescents.”

Daly says that the equal instances of smoking and binge drinking among both groups highlights the need for a multi-pronged approach to education and intervention.

“We can’t just focus on educating adolescents about the dangers of just smoking or drinking,” he said. “We need to address both as one health risk, and we need to do that for all adolescents, not just one particular group.”

For example, Daly says that when health education teachers talk about the dangers of smoking, they should also touch on the dangers of binge drinking too, illustrating the connection.

The next phase of Daly’s research will break down these rates by grade level to determine exactly when binge drinking and smoking start.

“The difference in the mindset of a ninth grader versus a 12th grader is pretty vast,” he said. “And if we can determine when kids start this behavior – whether it’s the summer after 8th grade, or when they’re a sophomore or a senior – it can help us tailor education and treatment plans even more.”

Daly directs the YRBS in Philadelphia, a survey that focuses on six major areas, including unintentional injuries and violence, tobacco use, alcohol and other drug use, sexual behaviors, dietary behaviors, and physical inactivity, to determine health risk factors among young people.

Other authors on the study include Dawn Eichen and Rinad Beidas in the department of psychology, and Jenn Ibrahim and Brad Collins in the department of public health. Funding for this research was provided by a grant from the Centers for Disease Control and Prevention to the School District of Philadelphia, with Temple University serving as a subcontractor.

Source:
Renee Cree

Temple University

USA Today Examines Financial Strain On Retirees With Fixed Incomes As Costs Of Health Care, Other Essentials Increase

USA Today on Tuesday, in the first article of a series about retirement issues in the 21st century, examined how retirees are seeing “inflation wring much of the value out of their fixed incomes.” Jim Dau, a spokesperson for AARP, said, “By any measure, people who are retired are bearing the worst brunt of the economic slump,” adding, “Because they’re living on fixed incomes, they’re just getting crushed on food and medicine that they can’t do without.” A recent AARP survey found that 59% of residents ages 65 and older were experiencing increasing difficulty paying for their medications, food and gas. According to USA Today, the situation has led “a growing number of financially squeezed seniors” to seek credit counseling.

John Rother, policy director for AARP, said an alternative inflation index that tends to rise faster than other inflation gauges should be used for Social Security because it reflects items that more directly affect people ages 62 and older. However, Rother said he doubts such action will be taken by Congress unless there is a major effort to overhaul the Social Security system. The inflation adjustment in 2008 for Social Security payments was 2.3%, USA Today reports.

According to USA Today, “No one disputes, though, that in one specific way, seniors are losing ground with Social Security” through Medicare costs, which are “gobbling up a big chunk of their Social Security checks.” CMS figures show that about 26% of a typical Social Security check goes to Medicare premiums, drug coverage, copayments, deductibles and other costs related to the program (O’Shaughnessy, USA Today, 7/2).

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.

© 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

e-Cigarette Aerosol Decreases Over Time In Smoke-Out Interval, Requiring Stronger Puffs

Stronger suction is required to smoke “electronic cigarettes” – marketed as tobacco-free nicotine delivery systems – than conventional brands, with possible adverse effects on human health, researchers at the University of California, Riverside report.

The researchers used a smoking machine to compare the smoking properties of eight conventional cigarettes with five e-cigarette brands. They examined the vacuum required to produce smoke (in the case of conventional cigarettes) or aerosol (in the case of e-cigarettes), and compared the density of the smoke/aerosol over time.

The researchers found that except for one brand (Liberty Stix), higher vacuums were required to smoke e-cigarettes than conventional brands.

The researchers also found that in the case of e-cigarettes, the aerosol density dropped after the first ten puffs, requiring still stronger suction thereafter to produce aerosol.

Study results appeared last week in Nicotine and Tobacco Research.

“It is too early to know exactly what effect stronger inhaling and diminishing amounts of aerosol will have on human health, but these factors are likely to lead to compensatory smoking, as has been seen previously with ‘light’ tobacco cigarettes,” said Prue Talbot, a professor of cell biology and the senior author of the research paper.

Talbot’s research team examined the following conventional cigarettes: Merit Ultra Lights, Marlboro Ultra Lights, Marlboro Lights, Marlboro Reds, Camel unfiltered, Camel Lights, Camel filtered, and Pall Mall unfiltered cigarettes. In the case of e-cigarettes, the researchers tested the following kits: Liberty Stix, Crown Seven’s Hydro Kit, NJOY, Smoking Everywhere’s Gold Kit, and a VapCigs starter kit.

“Our work shows that aerosol density decreases as e-cigarettes are used, requiring stronger puffs over time to sustain density,” Talbot said. “Manufacturers often claim that e-cigarettes cartridges are equivalent to a certain number of conventional cigarettes. However, this information seems misleading.”

Talbot’s lab found that while the first ten puffs of an e-cigarette are similar to a conventional cigarette, later puffs were highly variable in aerosol density and do not duplicate smoking of conventional brands. The researchers found that even though one e-cigarette cartridge may smoke for 200 puffs, cartridges do not smoke uniformly for those 200 puffs and therefore do not duplicate nicotine delivery of individual conventional cigarettes.

“Our results show that e-cigarettes smoke very differently than conventional brands,” Talbot said. “In preliminary trials, we observed that some brands of e-cigarettes were difficult to smoke possibly because they have relatively small air intake holes. Moreover, the interior of e-cigarettes is dense compared to the relatively porous tobacco-containing cigarettes.”

Talbot, who is also the director of the UCR Stem Cell Center, was joined in the research by Anna Trtchounian, the first author of the paper, and Monique Williams of UC Riverside.

The study was supported by the University of California Tobacco-Related Disease Research Program; the University of California Academic Senate; and the Hispanic Serving Institutions-California Cost Reduction and Access Act Science, Technology, Engineering, and Mathematics Pathway Project.

“This paper is the first detailed study showing that greater inhalation pressure is required to smoke e-cigarettes as compared to conventional cigarettes,” said Kamlesh Asotra, a research administrator at the University of California Tobacco-Related Disease Research Program. “An important implication is that users must exert greater inhalation pressure and, therefore, it may predictably cause the aerosol to reach deeper tissue in the user’s lungs. As in the case of conventional harm reduction cigarettes with lower nicotine content, users of e-cigarettes may also need to smoke greater number of puffs to receive sufficient amount of nicotine to satisfy their craving.

“Based on the results of this paper, not only do users become more aware of the vapor characteristics and smoking properties of e-cigarettes but also manufacturers of e-cigarettes will take notice of the functional inconsistencies of their products,” he said.

About electronic cigarettes:

e-cigarettes are marketed as a relatively new type of tobacco-free nicotine delivery device, consisting of a battery, a charger, a power cord, an atomizer, and a cartridge containing nicotine and propylene glycol.

When a smoker draws air through an e-cigarette, an airflow sensor activates the battery that turns the tip of the cigarette red to simulate smoking and heats the atomizer to vaporize the propylene glycol and nicotine. Upon inhalation, the aerosol vapor delivers a dose of nicotine into the lungs of the smoker, after which, residual aerosol is exhaled into the environment.

While produced mainly in China, e-cigarette use has rapidly proliferated worldwide. E-cigarettes do not burn tobacco and therefore do not deliver the numerous chemicals and toxicants found in conventional cigarette smoke.

To date, little has been published in the scientific literature about the health benefits and risks of e-cigarettes.

About the smoking machine:

The smoking machine consists of a puffer box connected via tubing to a peristaltic pump. The line between the puffer box and the pump contain two untapered T connectors. The connector closest to the puffer box holds the conventional or electronic cigarette. The second connector is attached to an upright U-shaped water manometer built at UC Riverside. The manometer measures the vacuum in the line drawing a puff from each cigarette.

Source:
Iqbal Pittalwala
University of California – Riverside

Smokers May Be At Greater Risk Of HIV Infection

Smokers may be at greater risk of HIV infection than non-smokers, reveals an analysis of published research issued ahead of print in the journal Sexually Transmitted Infections.

Cigarette smoking has already been linked to a higher than normal chance of contracting other infections generally, including those that have been sexually transmitted.

The researchers trawled through 13 academic research databases, three abstract databases from recent international AIDS conferences, as well as viewing relevant websites and contacting experts in the field.

Six studies assessed the association between cigarette smoking and becoming HIV positive. Five of them concluded that smokers ran a greater risk of this varying from around 60% to a more than tripling of the risk.

Ten further papers looked at the association between smoking and progression to AIDS, nine of them concluding that smokers were not at increased risk.

“The consistency of the findings is striking and represents a major strength of this review,” comment the authors, adding: “while the studies vary in quality, they include reports of high quality investigations using large sample sizes.”

Tobacco smoke may enhance vulnerability to infection by modifying the structure of the lungs and changing an array of immune system responses, including curbs on the production of antibodies and the activity of infection fighting white cells, say the authors.

There are almost 40 million people in the world living with HIV/AIDS, and the global death toll of deaths related to tobacco is expected to reach 8.4 million in 2020.

The authors suggest that as well as encouraging people to give up smoking as an essential public health measure, this may also contribute to the effectiveness of HIV/AIDS prevention programmes.

###

Source:
[Is smoking tobacco an independent risk factor for HIV infection and progression to AIDS? A systematic review
Online First: Sex Transm Infect 2006; doi: 10.1136/sti.2005/019503]
Journal Of Sexually Transmitted Infections:
BMJ-British Speciality Journals

Contact:
Dr Andrew Furber
South East Sheffield Primary Care Trust, Sheffield, UK

Click here to view the paper in full.