Therapeutic approaches for UCPPS management: research advances, experimental targets, and future directions.

Urologic Chronic Pelvic Pain Syndrome (UCPPS) is a painful chronic condition with persistent pain originating from the pelvis that often leads to detrimental lifestyle changes in the affected patients. The syndrome develops in both sexes, with an estimated prevalence of 5.7% to 26.6% worldwide. This narrative review summarizes currently recommended therapies for UCPPS, followed by the latest animal and clinical research advances in the field. The diagnosis of UCPPS by clinicians has room for improvement despite the changes in the past decade aiming to decrease the time to treatment. Therapeutic approaches targeting growth factors (i.e., NGF, VEGF), amniotic bladder therapy and stem cell treatments gain more attention as experimental treatment options for UCPPS. The development of novel diagnostic tests based on the latest advances in urinary biomarkers would be beneficial to assist with the clinical diagnosis of UCPPS. Future research directions should address the role of chronic psychological stress and the mechanisms of pain refractory to conventional management strategies in UCPPS etiology. Testing the applicability of cognitive behavioral therapy in this cohort of UCPPS patients might be promising to increase their QoL. The search for novel lead compounds and innovative drug delivery systems requires clinically relevant translational animal models. The role of autoimmune responses triggered by environmental factors is another promising research direction to clarify the impact of the immune system in UCPPS pathophysiology. Significance Statement This minireview provides an up-to-date summary of the therapeutic approaches for UCPPS with focus on recent advancements in the clinical diagnosis and treatments of the disease, pathophysiological mechanisms of UCPPS, signaling pathways and molecular targets involved in pelvic nociception.

Preoperative and postoperative optimisation of patients undergoing thyroid surgery: a multicentre quality improvement project at Barts Health NHS Trust.

Hypocalcaemia following thyroid surgery can occur in up to 38% of patients. With over 7100 thyroid surgeries performed in 2018 in the UK, this is a common postoperative complication. Undertreated hypocalcaemia can result in cardiac arrhythmias and death. Preventing adverse events from hypocalcaemia requires preoperative identification and treatment of at-risk patients with vitamin D deficiency, timely recognition of postoperative hypocalcaemia and prompt appropriate treatment with calcium supplementation. This project aimed to design and implement a perioperative protocol for prevention, detection and management of post-thyroidectomy hypocalcaemia. A retrospective audit of thyroid surgeries (n=67; October 2017 to June 2018) was undertaken to establish baseline practice of (1) preoperative vitamin D levels assessment, (2) postoperative calcium checks and incidence of postoperative hypocalcaemia and (3) management of postoperative hypocalcaemia. A multidisciplinary team approach following quality improvement principles was then used to design a perioperative management protocol with all relevant stakeholders involved. After dissemination and implementation, the above measures were reassessed prospectively (n=23; April-July 2019). The percentage of patients having their preoperative vitamin D measured increased from 40.3% to 65.2%. Postoperative day-of-surgery calcium checks increased from 76.1% to 87.0%. Hypocalcaemia was detected in 26.8% of patients before and 30.43% of patients after protocol implementation. The postoperative component of the protocol was followed in 78.3% of patients. Limitations include low number of patients which precluded from analysis of the impact of the protocol on length of stay. Our protocol provides a foundation for preoperative risk stratification and prevention, early detection and subsequent management of hypocalcaemia in thyroidectomy patients. This aligns with enhanced recovery protocols. Moreover, we offer suggestions for others to build on this quality improvement project with the aim to further advance the perioperative care of thyroidectomy patients.

A method for evaluating population and infrastructure exposed to natural hazards: tests and results for two recent Tonga tsunamis.

Background: Coastal communities are highly exposed to ocean- and -related hazards but often lack an accurate population and infrastructure database. On January 15, 2022 and for many days thereafter, the Kingdom of Tonga was cut off from the rest of the world by a destructive tsunami associated with the Hunga Tonga Hunga Ha'apai volcanic eruption. This situation was made worse by COVID-19-related lockdowns and no precise idea of the magnitude and pattern of destruction incurred, confirming Tonga's position as second out of 172 countries ranked by the World Risk Index 2018. The occurrence of such events in remote island communities highlights the need for (1) precisely knowing the distribution of buildings, and (2) evaluating what proportion of those would be vulnerable to a tsunami. Methods and Results: A GIS-based dasymetric mapping method, previously tested in New Caledonia for assessing and calibrating population distribution at high resolution, is improved and implemented in less than a day to jointly map population clusters and critical elevation contours based on runup scenarios, and is tested against destruction patterns independently recorded in Tonga after the two recent tsunamis of 2009 and 2022. Results show that ~ 62% of the population of Tonga lives in well-defined clusters between sea level and the 15 m elevation contour. The patterns of vulnerability thus obtained for each island of the archipelago allow exposure and potential for cumulative damage to be ranked as a function of tsunami magnitude and source area. Conclusions: By relying on low-cost tools and incomplete datasets for rapid implementation in the context of natural disasters, this approach works for all types of natural hazards, is easily transferable to other insular settings, can assist in guiding emergency rescue targets, and can help to elaborate future land-use planning priorities for disaster risk reduction purposes. Supplementary Information: The online version contains supplementary material available at 10.1186/s40677-023-00235-8.

Effect of Enzymatic pre-treatment of microalgae extracts on their anti-tumor activity.

BACKGROUND: There is an increasing need to find natural bioactive compounds for pharmaceutical applications, because they have less harmful side effects compared to their chemical alternatives. Microalgae (MA) have been identified as a promising source for these bioactive compounds, and this work aimed to evaluate the anti-proliferative effects of semi-purified protein extracted from MA against several tumor cell lines. METHODS: Tested samples comprised MA cell extracts treated with cellulase and lysozyme, prior to extraction. The effect of dialysis, required to remove unnecessary small molecules, was also tested. The anti-cancer efficacies of the dialyzed and undialyzed extracts were determined by measuring cell viability after treating four human cancer cell lines, specifically A549 (human lung carcinoma), MCF-7 (human breast adenocarcinoma), MDA MB-435 (human melanoma), and LNCap (human prostate cancer cells derived from a metastatic site in the lymph node). This was compared to the effects of the agents on the human BPH-1 cell line (benign human prostate epithelial cells). The t-test was used to statistically analyze the results and determine the significance. RESULTS: Against LNCap and A549 cells, the performance of cellulase-treated extracts was better (with p-values < 0.05, as compared to the control) than that of lysozyme-treated preparations (with p-values mainly > 0.05, as compared to the control); however, they had similar effects against the other two tumor cell lines (with p-values mainly < 0.05, as compared to the control). Moreover, based on their effect on BPH-1 cells, extracts from lysozyme-treated MA cells were determined to be safer against the benign prostate hyperplasia cells, BPH-1 (with p-values mainly > 0.05, as compared to the control). After dialysis, the performance of MA extracts from lysozyme-treated cells was enhanced significantly (with p-values dropping to < 0.05, as compared to the control). CONCLUSIONS: The results of this work provide important information and could provide the foundation for further research to incorporate MA constituents into pharmaceutical anti-cancer therapeutic formulations.

Enzymatic pre-treatment of microalgae cells for enhanced extraction of proteins.

Crude proteins and pigments were extracted from different microalgae strains, both marine and freshwater. The effectiveness of enzymatic pre-treatment prior to protein extraction was evaluated and compared to conventional techniques, including ultrasonication and high-pressure water extraction. Enzymatic pre-treatment was chosen as it could be carried out at mild shear conditions and does not subject the proteins to high temperatures, as with the ultrasonication approach. Using enzymatic pre-treatment, the extracted proteins yields of all tested microalgae strains were approximately 0.7 mg per mg of dry cell weight. These values were comparable to those achieved using a commercial lytic kit. Ultrasonication was not very effective for proteins extraction from Chlorella sp., and the extracted proteins yields did not exceed 0.4 mg per mg of dry cell weight. For other strains, similar yields were achieved by both treatment methods. The time-course effect of enzymatic incubation on the proteins extraction efficiency was more evident using laccase compared to lysozyme, which suggested that the former enzyme has a slower rate of cell disruption. The crude extracted proteins were fractionated using an ion exchange resin and were analyzed by the electrophoresis technique. They were further tested for their antioxidant activity, the highest of which was about 60% from Nannochloropsis sp. The total phenolic contents in the selected strains were also determined, with Chlorella sp. showing the highest content reaching 17 mg/g. Lysozyme was also found to enhance the extraction of pigments, with Chlorella sp. showing the highest pigments contents of 16.02, 4.59 and 5.22 mg/g of chlorophyll a, chlorophyll b and total carotenoids, respectively.

Hindcasting water clarity from Landsat satellite images of unmonitored shallow lakes in the Waikato region, New Zealand.

Cost-effective monitoring is necessary for all investigations of lake ecosystem responses to perturbations and long-term change. Satellite imagery offers the opportunity to extend low-cost monitoring and to examine spatial and temporal variability in water clarity data. We have developed automated procedures using Landsat imagery to estimate total suspended sediments (TSS), turbidity (TURB) in nephlometric turbidity units (NTU) and Secchi disc transparency (SDT) in 34 shallow lakes in the Waikato region, New Zealand, over a 10-year time span. Fifty-three Landsat 7 Enhanced Thematic Mapper Plus images captured between January 2000 and March 2009 were used for the analysis, six of which were captured within 24 h of physical in situ measurements for each of 10 shallow lakes. This gave 32-36 usable data points for the regressions between surface reflectance signatures and in situ measurements, which yielded r (2) values ranging from 0.67 to 0.94 for the three water clarity variables. Using these regressions, a series of Arc Macro Language scripts were developed to automate image preparation and water clarity analysis. Minimum and maximum in situ measurements corresponding to the six images were 2 and 344 mg/L for TSS, 75 and 275 NTU for TURB, and 0.05 and 3.04 m for SDT. Remotely sensed water clarity estimates showed good agreement with temporal patterns and trends in monitored lakes and we have extended water clarity datasets to previously unmonitored lakes. High spatial variability of TSS and water clarity within some lakes was apparent, highlighting the importance of localised inputs and processes affecting lake clarity. Moreover, remote sensing can give a whole lake view of water quality, which is very difficult to achieve by in situ point measurements.

Risks and complications of coronary angiography: a comprehensive review.

Coronary angiography and heart catheterization are invaluable tests for the detection and quantification of coronary artery disease, identification of valvular and other structural abnormalities, and measurement of hemodynamic parameters. The risks and complications associated with these procedures relate to the patient's concomitant conditions and to the skill and judgment of the operator. In this review, we examine in detail the major complications associated with invasive cardiac procedures and provide the reader with a comprehensive bibliography for advanced reading.

Nonlinear coupling is absent in acute myocardial patients but not healthy subjects.

We investigated whether autonomic nervous system imbalance imposed by pharmacological blockades and associated with acute myocardial infarction (AMI) is manifested as modifications of the nonlinear interactions in heart rate variability signal using a statistically based bispectrum method. The statistically based bispectrum method is an ideal approach for identifying nonlinear couplings in a system and overcomes the previous limitation of determining in an ad hoc way the presence of such interactions. Using the improved bispectrum method, we found significant nonlinear interactions in healthy young subjects, which were abolished by the administration of atropine but were still present after propranolol administration. The complete decoupling of nonlinear interactions was obtained with double pharmacological blockades. Nonlinear couplings were found to be the strongest for healthy young subjects followed by degradation with old age and a complete absence of such couplings for the old age-matched AMI subjects. Our results suggest that the presence of nonlinear couplings is largely driven by the parasympathetic nervous system regulation and that the often-reported autonomic nervous system imbalance seen in AMI subjects is manifested as the absence of nonlinear interactions between the sympathetic and parasympathetic nervous regulations.