Impact of anthropogenous environmental factors on the marine ecosystem of trophically transmitted helminths and hosting seabirds: Focus on North Atlantic, North Sea, Baltic and the Arctic seas.

Alongside natural factors, human activities have a major impact on the marine environment and thus influence processes in vulnerable ecosystems. The major purpose of this review is to summarise the current understanding as to how manmade factors influence the marine biocenosis of helminths, their intermediate hosts as well as seabirds as their final hosts. Moreover, it highlights current knowledge gaps regarding this ecosystem, which should be closed in order to gain a more complete understanding of these interactions. This work is primarily focused on helminths parasitizing seabirds of the North Atlantic and the Arctic Ocean. The complex life cycles of seabird helminths may be impacted by fishing and aquaculture, as they interfere with the abundance of fish and seabird species, while the latter also affects the geographical distribution of intermediate hosts (marine bivalve and fish species), and may therefore alter the intertwined marine ecosystem. Increasing temperatures and seawater acidification as well as environmental pollutants may have negative or positive effects on different parts of this interactive ecosystem and may entail shifts in the abundance or regional distribution of parasites and/or intermediate and final hosts. Organic pollutants and trace elements may weaken the immune system of the hosting seabirds and hence affect the final host's ability to control the endoparasites. On the other hand, in some cases helminths seem to function as a sink for trace elements resulting in decreased concentrations of heavy metals in birds' tissues. Furthermore, this article also describes the role of helminths in mass mortality events amongst seabird populations, which beside natural causes (weather, viral and bacterial infections) have anthropogenous origin as well (e.g. oil spills, climate change, overfishing and environmental pollution).

[The association of job satisfaction with self-reported burnout among urologists with migration background working at German hospitals : Results of the EUTAKD study]. / Die Assoziation von beruflicher Zufriedenheit mit selbstberichtetem Burnout bei Urologen und Urologinnen mit Migrationshintergrund tätig an deutschen Kliniken : Ergebnisse der EUTAKD-Studie.

INTRODUCTION: Urologists with a migration background currently provide patient care in German hospitals. Study results on job satisfaction and burnout of this important professional group have not been available so far. MATERIALS AND METHODS: Between August and October 2020, a questionnaire (SurveyMonkey® with 101 items) was conducted among urologists with migration background working in German hospitals regarding professional satisfaction and a validated survey of burnout (Maslach Burnout Inventory), among others. The subject of this work was the association of job satisfaction with the critical thresholds of burnout in the domains of emotional exhaustion (EE), depersonalization (DP), and low personal accomplishment (PA). RESULTS: For this work, 68 questionnaires could be completely analyzed. Study participants were dominantly male (90%), between 30 and 39 years of age (69%), married (72%), and working full-time (94%). Above critical thresholds of high burnout in the EE, DP, and PA domains were 27.9% (n = 19), 35.3% (n = 24), and 73.5% (n = 50) of study participants. A sum score was formed from five of a total of 39 satisfaction items, which independently predicted the EE and DP endpoints and a combined EE and DP endpoint in well-adjusted regression models. For each individual score of the sum score (range 5-25 points), the probability of a critical burnout is reduced by a relative 57% (EE), 25% (DP), and 34% (combined endpoint). In contrast, permanent employment contract, the clinic position as senior physician or chief physician, working full-time, and a married marital status significantly reduced the critical PA domain. CONCLUSION: Several dimensions of professional satisfaction were identified, the improvement of which could contribute to a decrease in burnout among urologists with a migrant background. Future intervention studies aimed at improving job satisfaction must follow.

Effect of a newly developed pastille on the salivary flow rate in subjects with dry mouth symptoms: a randomized, controlled, monocentric clinical study.

BACKGROUND: Xerostomia is associated with several diseases and is a side effect of certain drugs, resulting from reduced saliva secretion. Often, aged and sometimes younger people suffer from (idiopathic) xerostomia. Chewing gum and sucking pastilles may relieve symptoms of xerostomia by increasing the salivary flow rate due to the mechanical effect of sucking and gustatory stimulation. Swallowing problems and the urge to cough or experiencing a tickling sensation in the throat might be alleviated through a reduction in dry mouth symptoms. We investigated whether a pastille containing four polysaccharides increased the salivary flow rate and relieved the symptoms of dry mouth. METHODS: Participating subjects with xerostomia were randomized into two equally balanced treatment groups. Subjects received the pastille on Day 1 and a control product (Parafilm®) on Day 3, or vice versa. Unstimulated saliva was collected every 2.5 min for 0-10 min. Stimulated saliva was collected after subjects sucked the pastille or the control product. The salivary flow rate was determined gravimetrically, and, in parallel, the feeling of dry mouth was assessed using a visual analog scale. Saliva surface tension was measured in pooled saliva samples (0-5 min of sampling). Additionally, in stimulated saliva from six subjects who sucked the pastille, the presence of the main ingredient-gum arabic-was examined by Raman spectroscopy. RESULTS: Chewing the pastille significantly increased the mean salivary flow rate by 8.03 g/10 min compared to the mean changes after chewing the control product (+ 3.71 g/10 min; p < 0.0001). The mean score of dry mouth was significantly alleviated by the pastille (- 19.9 ± 17.9 mm) compared to the control product (- 3.3 ± 18.1 mm). No difference between the two products was seen regarding the saliva surface tension. Gum arabic was present in the saliva of all investigated subjects for up to 10 min after sucking the pastille. CONCLUSIONS: The pastille was well tolerated and effective in increasing the salivary flow rate and reducing mouth dryness after sucking. These results were in line with the detection of the main ingredient, gum arabic, in saliva for up to 10 min after sucking the pastille. Trial registration German Register Clinical Trials (Deutsches Register Klinische Studien, DRKS) DRKS-ID: DRKS00017393, Registered 29 May 2019, https://www.drks.de/drks_web/navigate.do?navigationId=trial . HTML&TRIAL_ID = DRKS00017393.

Disability and functional burden of disease because of mental in comparison to somatic disorders in general practice patients.

BACKGROUND: Severity of illness is not only depending on the symptom load, but also on the burden in life. Mental disorders are among those illnesses, which in particular cause suffering to the individual and society. METHOD: To study burden of disease for mental in comparison to somatic disorders, 2099 patients from 40 general practitioners filled in (a) the Burvill scale which measures acute and chronic illnesses in ten different body systems and (b) the IMET scale which measures impairment in ten different areas of life. RESULTS: Patients were suffering on average from acute and/or chronic illness in 3.5 (SD: 2.0) body systems and 56.6% of patients complained about acute and/or chronic mental disorders. The most significant negative impact on the IMET total score have acute and chronic mental disorders, followed by chronic neurological and musculoskeletal and acute respiratory and gastrointestinal disorders, while cardiovascular, metabolic, urogenital, haematological and ear/eye disorders have no greater impact. Acute as well as chronic mental disorders cause impairment across all areas of life and most burden of disease (functional burden of disease 1.69), followed by musculoskeletal disorders (1.62). CONCLUSION: Mental disorders are among the most frequent health problems with high negative impact across all areas of life. When combining frequency and impairment mental disorders cause most burden of disease in comparison to other illnesses. This should be reflected in the organization of medical care including family medicine.

Expression of nicotinic acetylcholine receptor subunit mRNA in mouse bladder afferent neurons.

Nicotinic acetylcholine receptors (nAChR) influence bladder afferent activity and reflex sensitivity, and have been suggested as potential targets for treating detrusor overactivity. Mechanisms may include indirect effects, e.g. involving the urothelium, and direct action on nAChR expressed by afferent neurons. Here we determined the nAChR repertoire of bladder afferent neurons by retrograde neuronal tracing and laser-assisted microdissection/reverse transcriptase polymerase chain reaction (RT-PCR), and quantified retrogradely labelled nAChRα3-subunit-expressing neurons by immunohistochemistry in nAChR α3ß4α5 cluster enhanced green fluorescent protein (eGFP) reporter mice. Bladder afferents distinctly expressed mRNAs encoding for nAChR-subunits α3, α6, α7, ß2-4, and weakly α4. Based upon known combinatorial patterns of subunits, this predicts the expression of at least three basically different subunits of nAChR - α3(∗), α6(∗) and α7(∗) - and of additional combinations with ß-subunits and α5. Bladder afferents were of all sizes, and their majority (69%; n=1367) were eGFP-nAChRα3 positive. Immunofluorescence revealed immunoreactivities to neurofilament 68 (NF68), transient receptor potential cation channel vanilloid 1 (TRPV1), substance P (SP) and calcitonin gene-related peptide (CGRP) in eGFP-nAChRα3-positive and -negative neurons. For each antigen, all possible combinations of colocalisation with eGFP-nAChRα3 were observed, with eGFP-nAChRα3-positive bladder neurons without additional immunoreactivity being most numerous, followed by triple-labelled neurons. In conclusion, more than one population of bladder afferent neurons expresses nAChR, indicating that peripheral nicotinic initiation and modulation of bladder reflexes might result, in addition to indirect effects, from the direct activation of sensory terminals. The expression of multiple nAChR subunits offers the potential of selectively addressing functional aspects and/or sensory neuron subpopulations.

[Medical rehabilitation by general practitioners in patients with chronic mental disorders]. / Rehabilitationsbedarf bei Hausarztpatienten mit psychischen Störungen.

BACKGROUND: Rehabilitation medicine is the medical specialty for the prevention, diagnosis and treatment of chronic disorders. This is especially relevant in mental disorders. Treatment of chronic disorders requires a complex and multidisciplinary long-term-treatment which is regularly done by general practitioners. However, concepts for rehabilitation-medicine in outpatient settings are until now by and large insufficient. METHODS: 40 general practitioners were asked to give an estimate on how many patients with chronic psychological disorders were among their patients.Next, 1 451 patients between 18 and 60 years filled in the WHO-5 wellbeing-rating, the IMET scale on participation disorders, the Burvill scale on multimorbidity and answered questions on their mental and work status. RESULTS: The general practitioners estimated that on average 41,9% (SD=18,2; Range 15-90%) were suffering from chronic mental disorders. 46,5% of the patients said that they suffered from mental problems, 38,3% had mental problems longer than 6 months, i. e., chronic, and in 26,9% even persistent. 29,7% of the patients suffered from chronic mental problems with relevant participation disorders. CONCLUSION: Patients with chronic mental disorders and participation problems are frequent in general practice. Rehabilitation medicine is an important part the daily activities of general practitioners, including diagnosis, treatment, treatment coordination, and sociomedical interventions like sick leave certificates, or initiating inpatient rehabilitation. General practitioners should get more scientific attention when concepts of rehabilitation are discussed.

Lack of irritative potential of nadifloxacin 1% when combined with other topical anti-acne agents.

BACKGROUND: Diverse options are available for the treatment of acne. Topical therapy is standard, especially in cases of mild to moderate acne, while the current treatments for acne vulgaris are topical keratolytics and topical antibiotics. Tolerability is a critical factor in patient compliance with topical acne therapies. The simultaneous use of more than one topical preparation with different active ingredients may cause increased irritation. However, the multifactorial aetiologies of acne, and the need to prevent development of bacterial resistance, require new acne-treatment combinations. Combining agents that target the different aetiological factors of acne can help increase efficacy and reduce response time. AIM: To compare the dermal irritation produced by an anti-acne cream containing 1% nadifloxacin with that produced by additional treatment with four different topical anti-acne products in a 21-day open application test in 40 healthy volunteers. METHODS: This was a randomized, double-blind (observer-blind), single-centre, phase I clinical study with an intraindividual comparison. The topic anti-acne products (nadifloxacin, adapalene, benzoyl peroxide, azelaic acid and isotretinoin) were applied without occlusion, either alone or in combination with nadifloxacin, to the skin test areas. One test area was left untreated. RESULTS: Most of the mean irritation scores were 0, and all were < 1. CONCLUSIONS: Combined application of nadifloxacin with any of the other four topical anti-acne products did not lead to substantial intolerance reactions compared with the effects after application of the products alone.

Muscarinic acetylcholine receptor subtypes expressed by mouse bladder afferent neurons.

Cell bodies of afferent neurons located in lumbosacral dorsal root ganglia (DRG) provide Adelta- and C-fibres to the urinary bladder, reporting bladder wall tension, volume and noxious stimuli. Recent studies suggested an involvement of muscarinic acetylcholine receptors (mAChRs) not only in detrusor contractility but also in modulating afferent function, and this has been linked to the beneficial effects of muscarinic antagonists in the treatment of overactive bladder. Here, we aimed to determine the inventory of mAChR subtypes expressed by bladder afferent neurons in the mouse. Bladder afferent neurons were identified by retrograde neuronal tracing using Fast Blue (FB) or 1, 1'-dioctadecyl-3, 3, 3', 3'-tetramethylindocarbocyanine perchlorhydrate (DiI) injection into the detrusor muscle. DRG L6-S1 were recognized as the major location of bladder afferent perikarya with an additional smaller peak at L1/L2. Retrogradely labelled bladder afferents located in DRG L4-S2 were subjected to immunohistochemistry or to laser-assisted microdissection with subsequent RT-PCR to study expression of mAChRs subtypes M1R-M5R. Immunolabelling for mAChR subtype M2R, validated on DRG from M2R gene-deficient mice, demonstrated this subtype on 35% of FB-labelled bladder afferents. RT-PCR demonstrated expression of subtypes M2R, M3R and M4R, but not of M1R and M5R, in pooled samples (30 section profiles each) of laser microdissected DiI-labelled bladder afferent cell bodies. In conclusion, bladder afferent neurons express different subtypes of mAChRs (M2R, M3R and M4R). Thus, processing of sensory information from the bladder appears to be under direct cholinergic control.

[Health screening and vaccination status--results from a patient survey in German general practices]. / Gesundheitsuntersuchung und Impfstatus--Ergebnisse einer Patientenbefragung in deutschen Hausarztpraxen.

The vaccination status of German adults needs improvement. Low participation is also known in health screening programmes like the "Check up 35" which is offered every two years for adults aged 35 or above. However, the number of participants in health screening increases with age whereas vaccination status decreases. Within a study about patients' attitudes towards prevention in primary care, we investigated the knowledge about the vaccination status. Therefore, an anonymous survey was conducted among 333 patients from five general practices in 2007. 76% of the potential participants in health screening declared that they utilise it at least infrequently. In contrast to those who participate frequently in health screening (67%), those who participate infrequently (38%) or never (33%) but declare that their vaccination status is complete are significantly rare. Due to the results of our study it has to be discussed whether the health screening "Check up 35" should be regularly accompanied with vaccination counselling.

Trospium chloride in patients with neurogenic detrusor overactivity: is dose titration of benefit to the patients?

OBJECTIVE: To determine whether dose titration based on therapeutic response is superior to standard dosing of oral trospium chloride in patients with neurogenic detrusor overactivity and, moreover, to investigate the possible underlying causes of differences in efficacy at equal doses in some patients. PATIENTS AND METHODS: Using a double-blind approach, two groups (standard dose and adjustable dose) with a total of 80 patients were treated with trospium chloride coated tablets for a period of 3 - 5 weeks. Treatment duration and daily doses varied depending on change ofurodynamic parameters defined as therapeutic response. In Week 1, both groups started on 45 mg/day (3 x 15 mg). In the adjustable dose group, it was permissible to increase the daily dose to 90 or 135 mg/day depending on the urodynamic treatment response. In contrast, doses remained unchanged in the standard dose group although a need for dose adjustment had been recognized under the double-blind conditions. Therapeutic response was defined as improvement of at least two of the following three urodynamic parameters: bladder compliance 2 20 ml/cmH20, maximum cystometric capacity > 250 ml and maximum detrusor pressure < 40 cmH20. Changes in individual urodynamic parameters were defined as secondary efficacy variables. Primary and secondary parameters were assessed by comparing baseline values with those at the end of treatment. Therapeutic response was analyzed by using the Fisher-Yates test, and the Mann-Whitney U-test was used for secondary parameters. Trospium plasma concentration was measured to assess patient's compliance and as a tool to elucidate possible factors influencing treatment efficacy. Safety and tolerability were evaluated based on withdrawal rates and adverse events. RESULTS: Both dose groups had comparable baseline characteristics. Therapeutic response was achieved in 58% of patients in the adjustable dose group (ADG) and in 72% of those in the standard dose group (SDG, p -0.23). Clinically relevant increases in maximum cystometric capacity and bladder compliance were observed, and there was a clear decrease in detrusor pressure. After Day 7, the daily dose was increased in 52.8% of all patients in the adjustable dose group and (seemingly) in 32.5% of those of the standard dose group. Further dose escalation after Day 14 was assessed as necessary in 15% of the standard dose group and 22% of the adjustable dose group. The main changes in urodynamic parameters occurred during the first 7 days of treatment, but in some patients it takes a longer time. No statistically significant differences between plasma trospium chloride levels in the two dose groups were observed at any time, but increase of plasma concentration with higher doses became obvious when patients were differentiated to individual dose stages. In both groups, the most common treatment-related adverse event was dry mouth (ADG 35%, SDG 37%), which never led to discontinuation of treatment. Rates of other adverse events such as dry skin, dysopia, increased heart rate and gastrointestinal disorders were much lower. CONCLUSION: Generally, in patients with neurogenic detrusor overactivity daily doses of 45 mg trospium chloride can be considered as being the standard dose, and dose adjustment, e.g. due to increased body weight, might usually not be necessary. However, increased daily doses of up to 135 mg appear to be safe when prescribed in individual patients less responsive to the drug.

Bioavailability of trospium chloride after intravesical instillation in patients with neurogenic lower urinary tract dysfunction: A pilot study.

Oral drug treatment of detrusor overactivity often causes undesirable side effects in other organs. For some patients, in particular those with neurogenically induced detrusor overactivity (detrusor hyperreflexia), the tolerance level for adverse effects is low and oral treatment may become ineffective. Intravesical administration of the drug can diminish the side effects or increase treatment effectivity in patients who are (partially) refractory to oral treatment because the relative concentration of the drug is increased in the target organ and decreased in the circulation. Six men (19-34 years old) with traumatic spinal cord lesions between C2 and Th11 were randomized to intravesical instillation with 15 or 30 mg trospium chloride in 40 ml saline into the empty bladder. Catheterization was postponed until at least 3 h after instillation, and fluid intake was not allowed during the first 4 h. Blood samples were taken before and 11 times after instillation; the last sample 12 h post instillation. Four positive samples were found in three patients: 0.10 ng/ml after 1 h and 0.13 ng/ml after 2(1/2) h in two patients with 15 mg, and 0.24 ng/ml after 30 min and 0.70 ng/ml after 6 h in one patient with 30 mg instilled trospium chloride. Three adverse effects were reported and were rated as probably not related to the drug. It is concluded that intravesically instilled trospium chloride is not absorbed into the circulation in significant amounts and, thus, it may be expected that this mode of administration will improve the efficacy of trospium chloride therapy by reducing the side effects. Neurourol. Urodynam. 18:447-453, 1999.

Importance of pharmacological and physicochemical properties for tolerance of antimuscarinic drugs in the treatment of detrusor instability and detrusor hyperreflexia--chances for improvement of therapy.

BACKGROUND: Antimuscarinic side-effects are relatively frequent problems in oral pharmacotherapy of detrusor instability and neurogenic dysfunction of the urinary bladder. Results of recent clinical trials demonstrate differences in tolerance between antimuscarinic drugs. It is the purpose of this paper to relate the available clinical data to the pharmacological and physicochemical properties of the different antimuscarinic drugs, in order to discuss the reasons for this enhanced tolerance and to make possible modes for improvement of antimuscarinic therapy plainly visible. METHODS: Therefore, we reviewed the available literature using among others the computerized library systems Medline (National Library of Medicine, Bethesda, Maryland, USA) and Embase (Excerpta Medica, Amsterdam, the Netherlands). Differences in tolerance of oral antimuscarinic drugs may result from muscarine-receptor selectivity, organ selectivity, and pharmacokinetic as well as physicochemical properties. While the roles of m-receptor and organ selectivity need more detailed clarification, influences of differences in bioavailability and physicochemical properties on the tolerance of antimuscarinic drugs are more sufficiently investigated. RESULTS: Generally, tolerance as well as efficacy of antimuscarinic drugs seem to be a complex result of a combination of various pharmacological properties distinguishing the individual substances. The enhancement of tolerance of propiverine hydrochloride, tolterodine tartrate and trospium chloride compared to oxybutynin chloride seems to be reached by different modes, from which the molecular structure -- propiverine and tolterodine are tertiary amines, trospium chloride possesses a quarternary ammonium structure -- may be of great importance. First investigations with alternative transdermal and intravesical application routes show interesting possibilities for further improvement of antimuscarinic therapy in urological indications. CONCLUSION: In conclusion, from pharmacological and clinical data it becomes obvious that there are significant differences between antimuscarinic drugs, which are of clinical relevance and include possible starting points for the development of new drugs and application forms.

Effect of Trospium Chloride on Duodenal Motility during Upper Gastrointestinal Endoscopy: A Randomised, Double-Blind, Placebo-Controlled Trial.

In a placebo-controlled, double-blind study the effects of depressing duodenal motility by administration of intravenous trospium chloride during gastroduodenoscopy were studied in 72 patients randomised to receive trospium chloride or saline (controls). Intravenous trospium chloride 1.2mg stopped the visible contractile activity of the duodenum as assessed by 3 independent observers during videoendoscopy within 76 seconds (median). During a 4-minute observation period of duodenal peristalsis, duodenal motor activity was found to stop in 18 of 36 patients after trospium chloride but in only 5 of 36 patients in the placebo group (p = 0.002). Adverse effects were dry mouth, micturition difficulties, sweat retention, accommodation disturbance and tachycardia. Trospium chloride was effective in reducing contractile activity in the duodenum. Its potent action and minor adverse effect profile appear to be promising for gastroduodenoscopy and especially for sphincter of Oddi motility in patients during routine endoscopic retrograde cholangiopancreatography.

[Continuing education seminar for general practice in the North Rhine District Medical Group. Results of of survey of participants during March to June 1995]. / Seminarweiterbildung für Allgemeinmedizin im Bereich der Arztekammer Nordrhein. Ergebnisse einer Teilnehmerbefragung im Zeitraum März bis Juni 1995.

Since 1994, new rules for continuing medical education (CME) for general practitioners have been implement in Germany. It is currently necessary to participate in internal medicine, surgery and general medicine for three years. For the first time, CME seminars have been implemented. Postgraduates have to absolve 240 hours for becoming general practitioner. A first evaluation from the area of the "Nordrheinische Akademie für árztliche Fort- und Weiterbildung" (Academy of continuing medical education) is presented. The results are discussed in the context of further questions looking into the future of CME training of general practitioners.

Lack of influence of glycine on the single dose pharmacokinetics of acetylsalicylic acid in man.

Galenic formulations consisting of acetylsalicylic acid and glycine were developed to improve solubility of the drug, even in case of ingestion without intake of water. It was the aim of this study to investigate the potential influence of glycine on pharmacokinetics after single oral administration of 1,000 mg of acetylsalicylic acid. Therefore, a bioequivalence study using a randomized crossover design (reference = without glycine, test = with glycine) in 12 healthy male volunteers (age 22 - 38 (median 26) years, body weight 64 - 83 (median 75) kg) was performed. Pharmacokinetic characteristics (AUC, Cmax, tmax, t1/2, MRT) were taken or calculated on the basis of plasma concentration/time profiles. For both acetylsalicylic acid and salicylic acid the 90% confidence intervals of the ratios of the expected median values (microT and microR) for the primary characteristics AUC and Cmax of the test and reference formulation were included in the equivalence range of 80 - 125%, which in case of multiplicative model is accepted for concluding bioequivalence. Therefore, lack of influence of glycine on the pharmacokinetics of acetylsalicylic acid including its major metabolite salicylic acid was concluded.

[Rational therapy of chronic pain conductions by the family physician]. / Rationale Therapie chronischer Schmerzzustände durch den Hausarzt.

Despite numerous efforts to establish an adequate pain treatment, many patients still do not receive a proper pain therapy. This is unfortunate as it is estimated that between 5 and 7.6 Mi. people are suffering from chronic pain in Germany. This paper is demonstrating an adequate pain management for different diseases including an interdisciplinary approach. Further, we hope to reduce the fear of many physicians for the administration of opioid analgetics to realize a proper pain treatment where indicated.

Influences of trospium chloride and oxybutynin on quantitative EEG in healthy volunteers.

Trospium chloride and oxybutynin are two antimuscarinergic agents used in the treatment of unstable bladder, urge incontinence, combined stress urge incontinence and detrusor hyperreflexia. The possibility that these two drugs produce changes in central nervous electrical activity was examined in an open, prospective, phase I study involving 12 volunteers. Quantitative evaluation of the multichannel electroencephalogram obtained from young healthy volunteers showed statistically significant decreases in alpha and beta 1 activity after oxybutynin, but not after intravenous or oral administration of trospium chloride. The biological activity of both drugs was ascertained by continuous simultaneous recording of the heart rate. A decrease in heart rate was detected after oral administration of oxybutynin, and an increase was seen after i.v. administration of trospium chloride. The results suggest that trospium chloride is less likely to produce central nervous adverse effects than to oxybutynin.