Objectives
We summarized the clinical and radiological characteristics of meningitis-retention syndrome (MRS), its therapeutic options, and urological outcome, to better understand the pathogenesis ...of this syndrome and to evaluate the effectiveness of corticosteroids in reducing the period of urinary retention.
Methods
We reported a new case of MRS in a male adolescent. We also reviewed the previously 28 reported cases of MRS, collected from inception up to September 2022.
Results
MRS is characterized by aseptic meningitis and urinary retention. The mean length of the interval between the onset of the neurological signs and the urinary retention was 6.4 days. In most cases, no pathogens were isolated in cerebrospinal fluid, except for 6 cases in which Herpesviruses were detected. The urodynamic study resulted in a detrusor underactivity, with a mean period for urination recovery of 4.5 weeks, regardless of therapies.
Discussion
Neurophysiological studies and electromyographic examination are not pathological, distinguishing MRS from polyneuropathies. Although there are no encephalitic symptoms or signs, and the magnetic resonance is often normal, MRS may represent a mild form of acute disseminated encephalomyelitis, without radiological detectable medullary involvement, due to the prompt use of steroids. It is believed that MRS is a self-limited disease, and no evidence suggests the effectiveness of steroids, antibiotics, and antiviral treatment in its clinical course.
Abstract
Introduction:
To date, empirical research has focused on many risk factors known to contribute to academic functioning, such as lack of social support, depression, posttraumatic stress, and ...suicidality, to name a few. When focusing on student veterans, there has been a lack of research on insomnia in general. The presence of such disturbances alone may impair several domains of functioning, such as emotional well-being, physical health, relationships, and academics. The purpose of this study is to determine if higher rates of insomnia increase the risk for academic distress and dropout in this population.
Methods:
The sample focused on 193 veterans enrolled at a Gulf Coast university (M = 32.43 years old, SD = 9.15). Participants completed a questionnaire consisting of four items assessing academic retention on a four-point Likert scale (i.e., “How confident are you that this university is right for you?” very confident - very unconfident, “How much thought have you given to stopping your education?” very little thought - a lot of thought, “How likely is it that you will re-enroll?” very likely - very unlikely, and “How likely will you earn a degree?” very likely - very unlikely), and the Insomnia Severity Index (ISI). Four multiple regression models were conducted to determine if insomnia predicted retention after controlling for age, ethnicity, and gender.
Results:
Correlation analyses demonstrated that ISI positively associated with retention question one (r = .18, p = .013), retention question two (r = .19, p = .008), and retention question three (r = .17, p = .019). Regression results indicated that ISI significantly predicted retention question two (F(4,178) = 3.18, p = .015, R2 = .07), retention question three (F(4,180) = 4.10, p = .003, R2 = .08), and retention question four (F(4,180) = 5.66, p < .001, R2 =.11).
Conclusion:
The results highlight the importance of considering insomnia as a barrier to successful post-secondary matriculation for Gulf Coast veterans. Data support the notion that the inability to obtain restful sleep may influence the decision to discontinue education.
Support (If Any):
N/A
Objective
To evaluate if immediate catheter removal (ICR) after laparoscopic hysterectomy is associated with similar retention outcomes compared with delayed removal (DCR).
Study design
...Non‐inferiority randomised controlled trial.
Population
Women undergoing laparoscopic hysterectomy in six hospitals in the Netherlands.
Methods
Women were randomised to ICR or DCR (between 18 and 24 hours after surgery).
Primary outcome
The inability to void within 6 hours after catheter removal.
Results
One hundred and fifty‐five women were randomised to ICR (n = 74) and DCR (n = 81). The intention‐to‐treat and per‐protocol analysis could not demonstrate the non‐inferiority of ICR: ten women with ICR could not urinate spontaneously within 6 hours compared with none in the delayed group (risk difference 13.5%, 5.6–24.8, P = 0.88). However, seven of these women could void spontaneously within 9 hours without additional intervention. Regarding the secondary outcomes, eight women from the delayed group requested earlier catheter removal because of complaints (9.9%). Three women with ICR (4.1%) had a urinary tract infection postoperatively versus eight with DCR (9.9%, risk difference −5.8%, −15.1 to 3.5, P = 0.215). Women with ICR mobilised significantly earlier (5.7 hours, 0.8–23.3 versus 21.0 hours, 1.4–29.9; P ≤ 0.001).
Conclusion
The non‐inferiority of ICR could not be demonstrated in terms of urinary retention 6 hours after procedure. However, 70% of the women with voiding difficulties could void spontaneously within 9 hours after laparoscopic hysterectomy. It is therefore questionable if all observed urinary retention cases were clinically relevant. As a result, the clinical advantages of ICR may still outweigh the risk of bladder retention and it should therefore be considered after uncomplicated laparoscopic hysterectomy.
Tweetable
The advantages of immediate catheter removal after laparoscopic hysterectomy seem to outweigh the risk of bladder retention.
Tweetable
The advantages of immediate catheter removal after laparoscopic hysterectomy seem to outweigh the risk of bladder retention.
In the Pacific Northwest (PNW) region of the contiguous United States, retention of live (green) trees in harvest units is an integral part of forest management practices on federal lands, yet the ...ecological benefits that result from various levels or patterns of retained trees remain speculative. The Demonstration of Ecosystem Management Options (DEMO) study was established to address these informational gaps. The experimental design consists of six treatments, each 13
ha in size, replicated at six locations (blocks) in western Washington and Oregon. Treatments represent strong contrasts in retention level (15–100% of original basal area) and pattern (trees dispersed vs. aggregated in 1-ha patches) in mature Douglas-fir (
Pseudotsuga menziesii) forests. A wide variety of ecological responses and public perceptions of visual quality have been examined; this paper provides a comprehensive review of the short-term (1–7 years) results of these studies. Level of retention had a strong effect on many responses. At 15% retention, regardless of pattern, microclimate, ecological responses, and public perceptions of visual quality did not differ from those measured in the “clearcut” areas of aggregated treatments. In contrast to level of retention, pattern of retention had limited effect on most measures of biological response. Small changes within forest aggregates were balanced by large changes in adjacent harvested areas, thus on average, responses within aggregated treatments were comparable to those in dispersed treatments. Nevertheless, retaining trees in 1-ha aggregates provided several benefits over dispersed retention. Aggregates greatly reduced damage to and mortality of residual trees (particularly at lower levels of retention) and provided short-term refugia for forest organisms sensitive to disturbance or environmental stress (e.g., bryophytes and late-seral herbs). However, aggregates were susceptible to edge effects (e.g., elevated light and temperature), which may compromise their ability to serve as sources for recolonization of adjacent harvested areas. Collectively, our findings suggest that retention levels >15% are needed to effectively retain sensitive plants and animals, ameliorate harsh microclimatic conditions, and gain public acceptance of retention harvests in these forests. A combination of relatively large (≥1
ha) aggregates and dispersed trees at levels considerably greater than current minimum standards in the PNW may be the most effective strategy for sustaining a broad array of forest values in managed stands.
Purpose
To report on the long‐term outcomes of vesicostomy in elderly patients with chronic urinary retention.
Materials and methods
We conducted a study of 16 elderly patients with chronic urinary ...retention who underwent Blocksom vesicostomy between April 2010 and March 2021. Postoperative follow‐up was conducted every 3 months to check for abnormal findings, such as stoma outlet obstruction, infection, bleeding, bladder prolapse, and bladder stones. The incidence of these findings and the time until they occurred, as well as the rate of achieving a catheter‐free status and the time until catheter reinsertion, were then calculated using the Kaplan–Meier curve.
Results
The mean age (±standard deviation) of patients whose cases were observed was 78.6 (±7.8) years; the oldest patient was 87 years of age. The study population included 14 male patients and 2 female patients, with a higher number of males. The causes of urinary retention included neurogenic bladder in 12 patients (including patients with 3 spinal cord injury), advanced prostate cancer in 2 patients, and iatrogenic urethral stricture in 2 patients. The average follow‐up period was 55.7 months. During follow‐up, 14 patients (87.5% of the total) achieved a catheter‐free status under conditions that required no additional treatment. Complications were observed in 6 cases (37.5%); among them, two cases required reoperation. All complications were observed within 2 years after surgery.
Conclusion
Blocksom vesicostomy may become a viable option in the treatment of elderly patients with chronic urinary retention whose symptoms do not improve with medical therapy.
Industrial forestry typically leads to a simplified forest structure and altered species composition. Retention of trees at harvest was introduced about 25 years ago to mitigate negative impacts on ...biodiversity, mainly from clearcutting, and is now widely practiced in boreal and temperate regions. Despite numerous studies on response of flora and fauna to retention, no comprehensive review has summarized its effects on biodiversity in comparison to clearcuts as well as un‐harvested forests. Using a systematic review protocol, we completed a meta‐analysis of 78 studies including 944 comparisons of biodiversity between retention cuts and either clearcuts or un‐harvested forests, with the main objective of assessing whether retention forestry helps, at least in the short term, to moderate the negative effects of clearcutting on flora and fauna. Retention cuts supported higher richness and a greater abundance of forest species than clearcuts as well as higher richness and abundance of open‐habitat species than un‐harvested forests. For all species taken together (i.e. forest species, open‐habitat species, generalist species and unclassified species), richness was higher in retention cuts than in clearcuts. Retention cuts had negative impacts on some species compared to un‐harvested forest, indicating that certain forest‐interior species may not survive in retention cuts. Similarly, retention cuts were less suitable for some open‐habitat species compared with clearcuts. Positive effects of retention cuts on richness of forest species increased with proportion of retained trees and time since harvest, but there were not enough data to analyse possible threshold effects, that is, levels at which effects on biodiversity diminish. Spatial arrangement of the trees (aggregated vs. dispersed) had no effect on either forest species or open‐habitat species, although limited data may have hindered our capacity to identify responses. Results for different comparisons were largely consistent among taxonomic groups for forest and open‐habitat species, respectively. Synthesis and applications. Our meta‐analysis provides support for wider use of retention forestry since it moderates negative harvesting impacts on biodiversity. Hence, it is a promising approach for integrating biodiversity conservation and production forestry, although identifying optimal solutions between these two goals may need further attention. Nevertheless, retention forestry will not substitute for conservation actions targeting certain highly specialized species associated with forest‐interior or open‐habitat conditions.
Previous studies found that working memory maintenance contributes to long-term memory formation, and some evidence suggests that this effect could be larger when individuals are informed of the ...final long-term memory test. However, no study so far has explored whether and how working memory maintenance adapts when long-term retention is intentional. In this study, we conducted two experiments using verbal complex span tasks followed by delayed-recall tests. In both experiments, we evaluated working memory maintenance by varying the cognitive load of the concurrent task and with memory strategics reports. We manipulated intentions to remember at long term by warning participants of the final delayed recall or not (Experiment 1) or by monetarily rewarding immediate or delayed-recall performance (Experiment 2). We found no evidence that intentions changed the working memory maintenance mechanisms and strategies used, yet the cognitive load (Experiment 1) and rewards (Experiment 2) effects on delayed recalls were increased with a higher intention to remember at long term. We discuss possible interpretations for these results and suggest that the effect of intentions may not be due to a change in the kind of maintenance mechanisms used. As our results cannot be explained solely by encoding or maintenance processes, we instead propose that intentions produce a combined change in encoding and maintenance. However, the exact nature of this modulation will need further investigation. We conclude that understanding how intentions modulate the effect of working memory on long-term memory could shed new light on their relationship.
Water vapor thermal therapy (Rezūm) is a minimally invasive treatment for benign prostatic enlargement (BPE). We report on safety and efficacy of this method for treatment of recurrent urinary ...retention and relief of catheter dependency owing to BPE in multimorbid patients, considered unfit for surgery.
We retrospectively evaluated 136 patients with recurrent urinary retention who underwent water vapor therapy in an ambulatory setting with periprostatic block and optional sedation between 11/2017 and 02/2021 in three urological departments. The objective was successful catheter withdrawal and continuing catheter independency after 3- and 12-months following treatment.
Mean patient age was 80.3 years (±7.8), mean prostate volume 54 ml (±27.3), and mean catheter dependency before treatment was 4.8 months (±6.0). ASA classification was a followed: II: 10%, III: 71%, and IV: 19%. All procedures were performed successfully in an ambulatory setting. Perioperative complications were infrequent and minor (Clavien-Dindo Grade 1-2) and included haematuria in 4.4% and urinary tract infection in 3.9% of all cases. A total of 103 patients (78.6%) were able to void spontaneously after a median of 31 days. No significant differences in age, prostate volume, duration of catheter dependency, vapor injections, and ASA score were found between patients with successful or unsuccessful outcome. The mean follow-up period was 6.1 months (±5.9, range 1-22 months). A 3-month follow-up was available for 77 patients (75%) and 34 patients (33%) were followed for 12 months. After 3 and 12 months, 93.5 and 91% of patients remained catheter independent. Fifteen patients (11%) died during follow-up, with a mean overall survival of 7.7 months (±4.7).
Water vapor therapy may prove to be a useful, minimally invasive treatment in a multimorbid population with catheter dependency after urinary retention, secondary to BPE, considered at highest risk or unfit for surgery. Future studies are warranted.
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