Vaginal distention rodent model for fecal incontinence: a pilot study on the effect on defecation behavior

Objectives: Vaginal balloon inflation simulates the compressive forces on the pelvic floor during the second phase of natural delivery. The foremost use of this animal model of vaginal distention (VD) is to study the mechanisms underlying urinary incontinence. As damage to the pelvic floor during natural birth is a common cause of fecal incontinence, the present paper aimed to investigate the effect of VD on defecation behavior in adult rats. Methods: Vaginal distention was performed in 8 rats for 2 hours, and in 3 rats for 4 hours, and sham inflation was performed in 4 rats. With the use of a latrine box in the rat home-cage and 24/7 video tracking, the defecation behavior was examined. The time spent in and outside the latrine was monitored for two weeks preoperatively and three weeks postoperatively, and a defecation behavior index (DBI; range: 0 [continent] to 1 [incontinent]) was defined. Pelvic floor tissue was collected postmortem and stained with hematoxylin and eosin. Results: Vaginal balloon inflation for 2 hours resulted in fecal incontinence in 29% of the animals (responders) whereas the DBI scores of non-responders (71%) and control animals did not change in the postoperative phase compared with the baseline score. A 4-hour balloon inflation resulted in fecal incontinence in 1 animal and caused a humane endpoint in 2 animals with markedly more tissue damage in the 4-hour responder compared with the 2-hour responders. Conclusions: Vaginal balloon inflation, with an optimum duration between 2 and 4 hours, can be used as a model to study changes in defecation behavior in rats induced by pelvic floor damage. (AU)

Efecto de la temperatura del baño de hemodiálisis en diabéticos / Effect of the temperature of the dialysis bath in diabetics

During the dialysis procedure, arterial hypotension is one of the most common problems and it has been object of many studies. In hemodialysis, changes are produced in body volume through ultrafiltration that generate an increase in the production of thermic energy, which is removed during the treatment. The hypovolemia resulting from the removal of volume activates the sympathetic system, avoiding in this way heat loss and increasing body temperature that promotes vascular vasodilatation and interferes with the compensatory constrictive response to volume fall with consequent arterial hypotension. Patients with autonomic neuropathy would be the most affected by volume depletion and they are usually the ones that show the highest frecuency of hypotension episodes, typical of patients with diabetes. It has been proved before that the use of a cold bath does not decrease the efficiency of the dialysis treatment and improves the cardiovascular stability as well, mostly in patients proned to it, such as diabetics, elderly, and patients with cardiac failure. In this study, it was observed that patients showed low basal temperatures before dialysis treatment and that the use of bath temperature of 35.5 degrees C increased the temperature post dialysis less than with the standard bath at 37 degrees C. The bath at 35.5 degrees C decreased the episodes of arterial hypotension, with an improvement in patient's welfare, and lower requirement of attention and treatment costs.

Efecto de la temperatura del baño de hemodiálisis en diabéticos / Effect of the temperature of the dialysis bath in diabetics

During the dialysis procedure, arterial hypotension is one of the most common problems and it has been object of many studies. In hemodialysis, changes are produced in body volume through ultrafiltration that generate an increase in the production of thermic energy, which is removed during the treatment. The hypovolemia resulting from the removal of volume activates the sympathetic system, avoiding in this way heat loss and increasing body temperature that promotes vascular vasodilatation and interferes with the compensatory constrictive response to volume fall with consequent arterial hypotension. Patients with autonomic neuropathy would be the most affected by volume depletion and they are usually the ones that show the highest frecuency of hypotension episodes, typical of patients with diabetes. It has been proved before that the use of a cold bath does not decrease the efficiency of the dialysis treatment and improves the cardiovascular stability as well, mostly in patients proned to it, such as diabetics, elderly, and patients with cardiac failure. In this study, it was observed that patients showed low basal temperatures before dialysis treatment and that the use of bath temperature of 35.5 degrees C increased the temperature post dialysis less than with the standard bath at 37 degrees C. The bath at 35.5 degrees C decreased the episodes of arterial hypotension, with an improvement in patients welfare, and lower requirement of attention and treatment costs.(AU)

HDL oxidability and its protective effect against LDL oxidation in Type 2 diabetic patients.

Low density lipoprotein (LDL) oxidation is a crucial step in the atherosclerotic process. High density lipoprotein (HDL)-associated enzymes such as paraoxonase could exert a protective effect on LDL oxidation in the arterial wall, an effect which could be impaired in Type 2 diabetes mellitus (T2DM). We studied copper-induced oxidation in LDL and HDL isolated from 17 T2DM patients with fair glycaemic control and HDL-cholesterol within normal range and 17 healthy normolipidaemic control subjects. To evaluate the effect of HDL on LDL oxidation in diabetic and control subjects, we assessed copper-induced oxidation in HDL/LDL mixtures, with each lipoprotein isolated from the same subject. Relationships with HDL chemical composition, alpha-tocopherol content and serum paraoxonase activity were investigated. Oxidation was promoted by lipoprotein incubation with copper and then thiobarbituric acid reactive substances (TBARS), conjugated diene production and electrophoretic mobility in agarose gel were measured. In T2DM subjects HDL oxidation was higher than in controls. However, HDL from diabetics was as effective as control HDL to inhibit LDL oxidation. Neither HDL chemical composition nor serum paraoxonase activity showed any difference as compared to control subjects. In contrast, HDL from T2DM subjects showed a higher alpha-tocopherol content which positively correlated with HDL oxidability. Paraoxonase activity positively and strongly correlated with HDL inhibitory effect on LDL oxidation in patients and controls belonging to the heterozygous activity phenotype. Besides, LDL oxidability showed no differences between patients and controls. These results suggest that fairly-controlled T2DM patients with HDL-cholesterol levels within normal range show: 1) normal HDL ability to inhibit LDL oxidation related to normal paraoxonase activity; 2) higher HDL oxidability in spite of its high alpha-tocopherol content, which could favour tocopherol-mediated peroxidation and 3) normal LDL oxidability possibly due to the lack of significant lipoprotein structural alterations.

Urinary heparan sulphate is increased in normoalbuminuric diabetic patients.

Forty-nine normoalbuminuric diabetic patients were studied: 22 males and 27 females, in whom urinary heparan sulphate (HS), albuminuria, creatininemia, creatininuria, creatinine clearance, HbA1c and arterial pressure (AP) were determined. Two groups were discerned: group 1, Type 1 DM, diabetic cases (n = 16); and group 2, Type 2 DM diabetic cases (n = 33). Patients were compared with 24 healthy controls: 12 men and 12 women, who showed a mean value +/- SD of 0.36 +/- 0.18 mg/24 h HS with significant differences between males and females (0.43 +/- 0.15 versus 0.28 +/- 0.17, respectively; p = 0.02). The total population of diabetic cases rendered a mean of 0.68 +/- 0.44 and comparison with controls proved highly significant (p < 0.001). Globally, male patients had a mean of 0.82 +/- 0.48 and females 0.54 +/- 0.35, with p < 0.02. Group 1 and 2 values of HS were not significantly different. HS levels failed to correlate either with age, body mass index (BMI), time since onset of diabetes, albuminuria, creatininemia, creatininuria, creatinine clearance, HbA1c or arterial hypertension. To conclude: both normal and diabetic males eliminate a greater quantity of HS than females. Normoalbuminuric diabetic patients of both types eliminate a greater quantity of HS regardless of arterial pressure and time since onset of diabetes.

Urinary heparan sulphate is increased in normoalbuminuric diabetic patients.

Forty-nine normoalbuminuric diabetic patients were studied: 22 males and 27 females, in whom urinary heparan sulphate (HS), albuminuria, creatininemia, creatininuria, creatinine clearance, HbA1c and arterial pressure (AP) were determined. Two groups were discerned: group 1, Type 1 DM, diabetic cases (n = 16); and group 2, Type 2 DM diabetic cases (n = 33). Patients were compared with 24 healthy controls: 12 men and 12 women, who showed a mean value +/- SD of 0.36 +/- 0.18 mg/24 h HS with significant differences between males and females (0.43 +/- 0.15 versus 0.28 +/- 0.17, respectively; p = 0.02). The total population of diabetic cases rendered a mean of 0.68 +/- 0.44 and comparison with controls proved highly significant (p < 0.001). Globally, male patients had a mean of 0.82 +/- 0.48 and females 0.54 +/- 0.35, with p < 0.02. Group 1 and 2 values of HS were not significantly different. HS levels failed to correlate either with age, body mass index (BMI), time since onset of diabetes, albuminuria, creatininemia, creatininuria, creatinine clearance, HbA1c or arterial hypertension. To conclude: both normal and diabetic males eliminate a greater quantity of HS than females. Normoalbuminuric diabetic patients of both types eliminate a greater quantity of HS regardless of arterial pressure and time since onset of diabetes.

[Current situation of diabetic patients in hemodialysis in Buenos Aires]. / Estado actual de los pacientes diabéticos en hemodiálisis en Buenos Aires.

The aim of this study was to evaluate the clinical and biochemical characteristics and the different types of treatment of diabetic patients in hemodialysis (HD) due to their end-stage renal disease (ESRD). The protocol was organized as a multicentric, case-control study and comprised twenty-nine HD centres from the city and province of Buenos Aires (PRODIHEM). The population sample included all diabetic patients in HD (n = 103) and the non diabetic patients hemodialyzed in the morning hours (n = 230) as controls. In this sample, the recorded prevalence for diabetes mellitus was 12%. Among diabetic patients, 61% were non insulin dependent, 23% were insulin dependent and 16% were of the non insulin dependent type treated with insulin (Fig. 1). The results obtained in this study show that the current situation of diabetic patients in HD is far from being satisfactory: they require HD treatment at an early age; the disease is commonly associated with various comorbid factors not always appropriately treated; they show a fast deleterious progress towards ESRD, and they have a short halflife period in HD. The results also showed that there are no defined and common criteria for the treatment and control of these patients; thus, due to their poor clinical performance, only a small percentage reach a priority for a renal transplant.

Estudio de prevalencia de microalbuminuria y macroproteinuria en diabéticos y su relación con otras complicaciones / A collaborative study on the prevalence of microalbuminuriaand macroproteinuria in diabetic patients and their relation to other complications

Se determinó la prevalencia de microalbuminuria(Mi) y macroproteinuria(Ma) y otras complicaciones en diabéticos en un estudio multicéntrico en la Argentina. Se entrevistaron 214 pacientes sin selección previa, se evaluó historia clínica, se dividió por tipo de diabetes. La Mi se realizó por radioinmunoanálisis o inmunoturbidimétrico la Ma por método sulfosalicílico. Se relacionaron con edad, antigüedad y prevalencia de hipertensión,dislipemia y retinopatía. Se aplicó para análisis el método estadístico DBase con programa EPI INFO 50. Se calcularon estadísticas descriptivas, se aplicó prueba de chi cuadrado con unnivel de significación p=0.05. La población insulinodependiente (DID)n73(34,1), la no insulinodependinte (DNID) n101(47,2), la insulinorrequiriente(DIR)n40(18,7), la edad promedio del DID 34,88+ 16,3; el DNID 64,27 + 9,83; DIR 61,85 + 9,37,lo que mostró una diferencia estadísticamente significativa para el DID con respecto al DNID y al DIR. La antigüedad de la diabetes no mostró diferencias significativas, lo mismo sucedió con la hemoglobina glicosilada para los diferentes grupos.La prevalencia de Mi fue 26,22,23.17,30 y la Ma fue 21,13, 10,9,26,66 respectivamente. El 19,20 careció de datos para la proteinuria. La prevalencia de hipertensión arterial fue para el DID 15.06,DNID 54,45,DIR 57.50, la dislipemia 13,69, 39,60,47,50 y retinopatía 35,10,24.757 y 57,50 respectivamente,la hipertensión y dislipemia mostraron diferencias estadísticamente significativas si se comparaba los DNID y DIR con respecto DID

Estudio de prevalencia de microalbuminuria y macroproteinuria en diabéticos y su relación con otras complicaciones / A collaborative study on the prevalence of microalbuminuriaand macroproteinuria in diabetic patients and their relation to other complications

Se determinó la prevalencia de microalbuminuria(Mi) y macroproteinuria(Ma) y otras complicaciones en diabéticos en un estudio multicéntrico en la Argentina. Se entrevistaron 214 pacientes sin selección previa, se evaluó historia clínica, se dividió por tipo de diabetes. La Mi se realizó por radioinmunoanálisis o inmunoturbidimétrico la Ma por método sulfosalicílico. Se relacionaron con edad, antig³edad y prevalencia de hipertensión,dislipemia y retinopatía. Se aplicó para análisis el método estadístico DBase con programa EPI INFO 50. Se calcularon estadísticas descriptivas, se aplicó prueba de chi cuadrado con unnivel de significación p=0.05. La población insulinodependiente (DID)n73(34,1), la no insulinodependinte (DNID) n101(47,2), la insulinorrequiriente(DIR)n40(18,7), la edad promedio del DID 34,88+ 16,3; el DNID 64,27 + 9,83; DIR 61,85 + 9,37,lo que mostró una diferencia estadísticamente significativa para el DID con respecto al DNID y al DIR. La antig³edad de la diabetes no mostró diferencias significativas, lo mismo sucedió con la hemoglobina glicosilada para los diferentes grupos.La prevalencia de Mi fue 26,22,23.17,30 y la Ma fue 21,13, 10,9,26,66 respectivamente. El 19,20 careció de datos para la proteinuria. La prevalencia de hipertensión arterial fue para el DID 15.06,DNID 54,45,DIR 57.50, la dislipemia 13,69, 39,60,47,50 y retinopatía 35,10,24.757 y 57,50 respectivamente,la hipertensión y dislipemia mostraron diferencias estadísticamente significativas si se comparaba los DNID y DIR con respecto DID (AU)