Introduction and hypothesis
The objective of this narrative review is to describe changes in urethral function that occur during a woman’s lifetime. Evaluation of urethral function includes ...measurements of urethral closure pressure, at rest and during stress, leak point pressure, and the detailed study of anatomical and histological changes of the urethral sphincteric mechanism.
Methods
A literature search in MEDLINE, PubMed, and relevant journals from 1960 until 2020 was performed for articles dealing with urethral function and the impact of aging, pregnancy, and childbirth, female hormones, and menopausal transition on the urethral sphincteric mechanism. Longitudinal and cross-sectional epidemiological surveys, studies on histological changes in urethral anatomy during aging, and urodynamic data obtained at different points in a woman’s lifetime, during pregnancy, after childbirth, as well as the effects of female hormones on urethral sphincter function are reviewed. Relevant studies presenting objective data are analyzed and briefly summarized.
Results and conclusions
The findings lead one to conclude that a constitutional or genetic predisposition, aging, and senescence are the most prominent etiological factors in the development of urinary incontinence and other pelvic floor disorders. Vaginal childbirth dilates and may damage the compressed pelvic supportive tissues and is invariably associated with a decline in urethral sphincter function. Pregnancy, hormonal alterations, menopausal transition, weight gain, and obesity are at best of secondary influence on the pathology of lower urinary tract dysfunction. The decline of circulating estrogens during menopausal transition may play a role in the transition of fibroblasts to cellular senescence.
This paper describes a new approach to motion estimation in video. We represent video motion using a set of particles. Each particle is an image point sample with a long-duration trajectory and other ...properties. To optimize particle trajectories we measure appearance consistency along the particle trajectories and distortion between the particles. The resulting motion representation is useful for a variety of applications and cannot be directly obtained using existing methods such as optical flow or feature tracking. We demonstrate the algorithm on challenging real-world videos that include complex scene geometry, multiple types of occlusion, regions with low texture, and non-rigid deformations.
Nocturia is a bothersome, multifactorial condition with many underlying causes and contributing factors. Nocturnal polyuria (NP; overproduction of urine at night) is a frequent component. The ...prevalence of nocturia increases with age; specific estimates of prevalence are influenced by frequency thresholds used to define it. There is a tendency toward higher prevalence in young women than young men, which is reversed in later life.
The association between frequency of nocturnal voiding and sleep disruption is well-documented. Nocturia correlates strongly with shorter sleep during the first part (2-4 hours) of the night, during which the first nocturnal void often occurs. A short time to first void after sleep onset (often referred to as “first uninterrupted sleep period”) is associated with increased daytime dysfunction and decreased sleep quality and/or sleep efficiency.
Adverse health consequences related to nocturia include poor sleep, depression, reduced quality of life, and increased risk of morbidity, mortality, falls, and fractures; studies have been able to establish a causal role for nocturia in only some of these.
The potential impact of nocturia on health increases with age. By age 80, 80% of people will rise at least once per night to void. Despite its associated bother, nocturia is often accepted as a natural consequence of aging and many people do not seek help. Women, in particular, may be reluctant to report nocturia.
This article reviews the prevalence of nocturia, possible impact on sleep, mortality and morbidity, and falls, and its importance in the elderly/frail population and women.
Introduction and hypothesis
Next to existing terminology of the lower urinary tract, due to its increasing complexity, the terminology for pelvic floor dysfunction in women may be better updated by a ...female-specific approach and clinically based consensus report.
Methods
This report combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted at intervals by many external referees. Appropriate core clinical categories and a subclassification were developed to give an alphanumeric coding to each definition. An extensive process of 15 rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus).
Results
A terminology report for female pelvic floor dysfunction, encompassing over 250 separate definitions, has been developed. It is clinically based with the six most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction. Female-specific imaging (ultrasound, radiology, and MRI) has been a major addition while appropriate figures have been included to supplement and help clarify the text. Ongoing review is not only anticipated but will be required to keep the document updated and as widely acceptable as possible.
Conclusions
A consensus-based terminology report for female pelvic floor dysfunction has been produced aimed at being a significant aid to clinical practice and a stimulus for research.
As Patricia Birnie cautiously and prophetically put it in the inaugural issue of this journal (INEA 1, January 2001, p. 74), “we do not know whether States and the tentative regimes they have so far ...established can withstand the pressures of globalization of trade and degradation and over-exploitation generated by advances in technologies for locating, fertilizing, harvesting, processing and modifying natural resources and biodiversity. This is truly
terra incognita
in which such seeds of destruction may already be implanted.” Among the 600 or so papers and reviews published in INEA from 2001 to 2020, more than 70 deal wholly or partly with legal aspects of environmental problems and the international dimensions of environmental justice. While the main focus of INEA has been on issues of
public international (inter-state) law
, there have also been important inputs drawn from
comparative
legal analysis (of national legislation and judicial decisions) and from
“transnational administrative law”
that influence the effectiveness of multilateral treaties and their associated international institutions. Novel concepts and practices emerging from the environmental field (such as recourse to a range of “soft law” principles; flexible delegated standard-setting in the face of global change; and equitable differentiation of compliance duties) have inspired developments in related areas of contemporary international law-making and law-applying. At the same time, the very proliferation of multilateral and bilateral environmental instruments raised new questions and expressions of alarm over “treaty congestion” and “fragmentation” within the international law system. It is not the intention of this paper to explore the general interaction of international environmental law with neighboring disciplines such as international economic law or human rights law, but simply to record the “seismographic” impact of INEA on legal-intellectual discourse over these past two decades. To some extent, the role of the Journal in identifying both new prospects and new risks in this field could indeed be likened to that of a “canary in the coal-mine.” The lessons so learnt may thus offer new insights to help in averting the destruction which Birnie visualized, and to advance inter-generationally and intra- generationally shared values of environmental justice.
To obtain more powerful assessment of the prognostic value of fractional flow reserve
testing we performed a systematic literature review and collaborative meta-analysis of studies that assessed ...clinical outcomes of CT-derived calculation of FFR (FFR
) (HeartFlow) analysis in patients with stable coronary artery disease (CAD).
We searched PubMed and Web of Science electronic databases for published studies that evaluated clinical outcomes following fractional flow reserve
testing between 1 January 2010 and 31 December 2020. The primary endpoint was defined as 'all-cause mortality (ACM) or myocardial infarction (MI)' at 12-month follow-up. Exploratory analyses were performed using major adverse cardiovascular events (MACEs, ACM+MI+unplanned revascularisation), ACM, MI, spontaneous MI or unplanned (>3 months) revascularisation as the endpoint.
Five studies were identified including a total of 5460 patients eligible for meta-analyses. The primary endpoint occurred in 60 (1.1%) patients, 0.6% (13/2126) with FFR
>0.80% and 1.4% (47/3334) with FFR
≤0.80 (relative risk (RR) 2.31 (95% CI 1.29 to 4.13), p=0.005). Likewise, MACE, MI, spontaneous MI or unplanned revascularisation occurred more frequently in patients with FFR
≤0.80 versus patients with FFR
>0.80. Each 0.10-unit FFR
reduction was associated with a greater risk of the primary endpoint (RR 1.67 (95% CI 1.47 to 1.87), p<0.001).
The 12-month outcomes in patients with stable CAD show low rates of events in those with a negative FFR
result, and lower risk of an unfavourable outcome in patients with a negative test result compared with patients with a positive test result. Moreover, the FFR
numerical value was inversely associated with outcomes.
We performed a clinical feasibility trial to evaluate the safety and efficacy of a fully implanted, primary battery powered, nickel sized and shaped neuromodulation device called the eCoin® for ...tibial nerve stimulation to treat refractory urgency urinary incontinence.
This prospective, single arm, open label study included 46 participants with refractory urgency urinary incontinence. It was performed at multiple sites in the United States and New Zealand. The device was implanted in the lower leg over the tibial nerve and activated after 4 weeks. Bladder diary data and validated quality of life instruments were collected 3 and 6 months after activation and compared to baseline values.
The mean ± SD age of participants was 63.4 ± 11.5 years and 45 (98%) were female. Episodes of urgency urinary incontinence were reduced a relative median of 71% after 3 months of treatment (4.2 vs 1.7 daily episodes at 3 months, p = 0.001). A 50% or greater decrease in reported episodes of urgency urinary incontinence was observed in 32 of 46 participants (69.6%) at 3 months with more than 20% dry at 3 and 6 months. I-QOL (Incontinence Quality of Life) scores improved an average of 25.9 points and 33 of 46 patients (72%) indicated improvement in symptoms. A single serious adverse event secondary to wound care resolved with intravenous antibiotics.
The implantable neuromodulation device was a safe and effective treatment of urgency urinary incontinence associated with overactive bladder syndrome with a significant reduction or resolution of symptoms and no significant safety concerns.
To evaluate the safety and efficacy of the eCoin - a nickel-sized, primary battery-powered, neuromodulation device for the treatment of urgency urinary incontinence which is implanted in the lower ...leg in a 20-minute procedure under local anesthesia. A feasibility clinical trial was conducted and the results after 1 year of treatment with the eCoin are presented.
A total of 46 participants with refractory urgency urinary incontinence were included in this prospective, single-arm, open-label study. This study was conducted at 7 sites in the United States and New Zealand. Participants in this study were implanted with the eCoin in the lower leg over the tibial nerve and activated after 4 weeks. Bladder diary data and validated quality-of-life instruments, collected at 3, 6, and 12 months’ post-activation, were compared to baseline values.
Responders were defined as those who had a ≥50% reduction in reported episodes of urgency urinary incontinence. At 12 months’, 65% of participants were considered responders with 26% of participants achieving complete continence. The median number of urgency urinary incontinence episodes per day decreased from 4.2 at baseline to 1.7 at 12 months’. Seventy percent of participants reported feeling “better”, “much better”, or “very much better” on the Likert 7-point maximum scale. One participant experienced a related serious adverse event.
The eCoin is a safe and effective treatment for urgency urinary incontinence associated with overactive bladder syndrome, with significant reduction or complete resolution of symptoms and no significant safety concerns.
‘Climate change law’ is considered by a number of legal scholars as an emergent novel discipline. The question, then, is whether the advent (and future prospect) of climate change has resulted in a ...coherent autonomous new body of law, be it a nascent one; or is it nothing more or less than the application of existing national and international environmental law to climatic problems? It is perhaps worth recalling that international environmental law itself only ascended to the rank of a recognized discipline of its own in the 1990s, over considerable academic scepticism at the time. Not un-similarly, the ongoing new project of the UN International Law Commission (ILC) for the drafting of guidelines on “protection of the atmosphere” has met with resistance from a few powerful States claiming that there is no need for further codification of international law in this field. Yet, considering our common interest in conserving the quality of the Earth’s atmosphere and climate, the ILC project may indeed encourage further development of a concept of inter-generational “planetary trusteeship”, owed by States as public trustees to present and future citizens as the beneficiaries.
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