Mid-term safety and efficacy of the ALTIS® single-incision sling for female stress urinary incontinence: less mesh, same results.

OBJECTIVE: To analyse the mid-term safety and efficacy of the ALTIS® single-incision sling (Coloplast Corp., Minneapolis, MN, USA) for female stress urinary incontinence (SUI). PATIENTS AND METHODS: We conducted a prospective, single-arm, unsponsored, observational single-centre trial in a cohort of patients undergoing SUI surgery with the ALTIS procedure. All patients were diagnosed according to clinical reports, physical exploration and urodynamics. Body mass index (BMI) was categorised according to World Health Organization classification. Valsalva leak-point pressure (VLPP) was categorised in three groups: <60, 60-90 and >90 cmH2 O. Patients were evaluated postoperatively at 1, 6, 12 and 24 months with physical examination, International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), and satisfaction visual scale (SVS; score 0-10). Adverse events were assessed at each visit. Multivariate analysis for risk factors of surgery failure was performed. RESULTS: We recruited 110 women, with a mean (SD) follow-up of 22.34 (10.34) months. Regarding efficacy, 91 patients (82.7%) were objectively cured and 97 (88.2%) were subjectively cured. Regarding VLPP and BMI, no differences were seen between groups (P > 0.05). There was a ~20% decrease in urge UI (P = 0.04). No variable showed to be an independent risk factor for ALTIS failure (P > 0.05). Overall, nearly 96% of the women reported 9 or 10 points on the SVS. A total of 24 patients (21.8%) had some kind of complication. No mesh erosion was reported in any patient. CONCLUSIONS: The ALTIS sling demonstrated to be an effective and safe procedure for SUI in the mid-term setting. Objective and subjective cure rates are at least comparable to 'gold standard' procedures with a minimal rate of self-limiting non-surgical complications.

Percepción de los estudiantes de medicina del ambiente educativo en una facultad con currículo tradicional(UCH-Chile) y otra con currículo basado en problemas (UNC-Argentina) / Medical students’ perception of the educational environment in a faculty developing a traditional curriculum (UCH-Chile) and another with a problem based learning curriculum (UNC-Argentina)

Objetivo. Evaluar y comparar la percepción que del ambiente educativo tienen los estudiantes de medicina de dos universidades iberoamericanas: Universidad de Chile (UCH) y Universidad Nacional de Cuyo (UNC), que desarrollan un currículo tradicional y un currículo basado en problemas, respectivamente. Sujetos y métodos. Participaron 465 estudiantes: 232 de la UCH y 233 de la UNC. La distribución fue de 84 y 70 estudiantes para el primer curso, 77 y 97 para el tercero, y 71 y 66 para el quinto, respectivamente. Se aplicó el cuestionario DREEM, que consiste en 50 ítems, agrupados en cinco dimensiones: percepción de la enseñanza, percepción de los profesores, autopercepción académica, percepción de la atmósfera educativa y autopercepción social. Resultados. Las puntuaciones totales fueron mayores en los tres cursos de la UNC. Resultaron similares en todos los cursos de ambas universidades, excepto en el quinto curso de la UCH. Respecto a la percepción acerca de los profesores, los estudiantes de quinto curso de la UCH mostraron las puntuaciones más bajas, mientras que los estudiantes del primer curso de la UNC tuvieron la mejor percepción. Resultados similares se obtuvieron en la autopercepción académica. La percepción del ambiente de aprendizaje fue mejor en la UNC y la autopercepción social tuvo puntuaciones similares en todos los cursos de ambas universidades. Conclusiones. Las diferencias observadas entre ambas universidades podrían atribuirse a sus diferentes currículos. El currículo basado en problemas parece ser mejor valorado que el tradicional. Nuestro estudio corrobora la eficacia del cuestionario DREEM para identificar fortalezas y debilidades del currículo y para evaluar la calidad de la enseñanza en facultades de medicina (AU)

Aim. To assess and compare the perception about the educational environment of medical students from two Latin-American universities, University of Chile (UCH) and National University of Cuyo (UNC), which develop a traditional curriculum and a problem based curriculum, respectively. Subjects and methods. A transversal study was performed in 465 students: 232 from the UCH and 233 from the UNC. The distribution was 84/70 for the first course, 77/97 for the third one and 71/66 for the fifth one, respectively. The DREEM questionnaire, which consists of 50 items, was applied. It covers 5 dimensions of the educational environment: perception about learning, perception about teachers, academic self-perception, perception about educational climate and social self-perception. Results. Total DREEM scores were significantly higher in the UNC. Scores were similar in all courses from both universities, with the exception of fifth course UCH. Regarding their perception about teachers, students of the fifth course UCH showed the lowest score, whereas students of the first course UNC had the best perception. Similar results were obtained for the academic auto-perception; while the perception of the learning environment obtained higher scores in the three courses from the UNC. Social auto-perception was similar in all courses tested in this study. Conclusions. Differences observed between both universities could be attributed to their different curricula. Problem based curriculum seems to be better appreciated than the traditional one. Our study corroborates the efficacy of the DREEM questionnaire to identify strengths and weaknesses of the curriculum and for the assessment of teaching quality in medical schools (AU)

Epigenetic inactivation of calcium-sensing receptor in colorectal carcinogenesis.

Ca2+ is a chemopreventive agent for colon cancer. Ion transport systems are often altered in human cancer. The aim of this study was to clarify the alterations of calcium-sensing receptor (CASR), a member of the G protein-coupled receptor family, in colorectal carcinogenesis. We analyzed the expression of CASR in colorectal cancer cell lines and in cancer and adenoma tissues by RT-PCR and immunostaining. In addition, we analyzed methylation of the CASR promoter by using bisulfite sequence analysis and methylation-specific PCR. CASR mRNA and protein expression was significantly downregulated in most of the cancer cell lines. CpG islands were densely methylated in cancer cell lines with reduced CASR mRNA expression. Treatment with a demethylating agent, 5-aza-2'-deoxycytidine, and/or a histone deacetylase inhibitor, trichostatin A, restored CASR expression in the cancer cell lines. Disruption of CASR expression in CASR-unmethylated HCT-8 cells blocked the enhancing effect of Ca2+ on the cytotoxic response to 5-fluorouracil. CASR expression was observed in normal colonic epithelial cells and was retained in most adenoma tissues. CASR mRNA and protein expression was significantly downregulated in cancer tissues. There was an inverse relationship between CASR expression and degree of differentiation. Immunohistochemical CASR staining was reduced more predominantly in less-differentiated cancer tissues and/or in cancer cells at the invasive front, where nuclear/cytoplasmic ß-catenin was often localized. CASR methylation was detected in 69% of colorectal cancer tissues and 90% of lymph node metastatic tissues and was significantly correlated with reduced CASR expression. CASR methylation was also detected in 32% of advanced adenoma tissues but was detected in only 9% of adenoma tissues and was not detected in hyperplastic polyp tissues. CASR methylation seems to occur at an early stage and progress in colorectal carcinogenesis. The results suggest that epigenetic inactivation of CASR has an important role in colorectal carcinogenesis.