No abstract

The findings in the present cases indicate neuraxial analgesia may be of benefit, in terms of managing pain and improving functional status, in MPS patients with insufficient pain control by multimodal analgesic treatment. Physicians should consider the use of neuraxial analgesia in cases of MPS where pain is uncontrolled with multimodal analgesic treatment to provide the best possible quality of life for patients with MPS.

Background:The ankle-brachial pressure index (ABI), the ratio of the systolic blood pressure of the ankle to the systolic brachial pressure, is commonly measured at rest, but ABI values post-exercise enhance the sensitivity of the test and can be used to identify atherosclerotic vascular damage. However, it has not been established whether or not enhanced post-exercise ABI is also associated with endothelial dysfunction. We hypothesized that a decrease in post-exercise ABI is related to impaired endothelial function.Purpose:To investigate alterations in post-exercise ABI values and endothelial dysfunction in the elderly.Methods:The study population comprised 35 men and women aged 51–77 years (mean age: 66 years). Patients with peripheral arterial disease or a history of heart failure were excluded. The ABI was estimated at rest and immediately after exercise. The exercise protocol comprised 2.5 min of active pedal flexion exercises at a speed of 60 times/min. Endothelial function was assessed by measuring flow-mediated vasodilation (FMD) in the brachial artery using ultrasound imaging.Results:No correlation was found between FMD and the ABI at rest. However, a weak correlation was found between FMD and post-exercise ABI (r = 0.46, P = 0.06). A strong correlation was observed between FMD and a decrease in post-exercise ABI compared to baseline readings (r = −0.52, P = 0.01). Multiple linear regression analysis was used to generate a prediction equation for FMD using the percentage decrease in post-exercise ABI. Significant correlations were observed between the ultrasound imaging-measured FMD and the predicted FMD (R2 = 0.27, P = 0.001).Conclusions:Post-exercise ABI appears to be a simple surrogate marker for endothelial function in the elderly, although larger studies are required for validation.

Background: Although there have been a number of reports on urinary voiding symptoms associated with surgical interventions for gynecologic cancer and post-voiding symptoms, there have been few reports on urinary storage symptoms such as urinary incontinence (UI) and overactive bladder (OAB). The purpose of this study was to examine the rates and impact on quality of life (QOL) of urinary storage symptoms after gynecologic cancer surgery. Methods: A questionnaire survey, including Japanese-language versions of the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), Overactive Bladder Symptom Score (OABSS), and Incontinence Impact Questionnaire-7 (IIQ-7), was distributed to gynecologic cancer patients who underwent hysterectomy between 2008 and 2013. Results: Of the 145 patients analyzed, 49 (33.8%) had UI pre-surgery, and 76 (52.4%) had UI post-surgery, including 34 (35.4%) first-time UI patients, with a significant difference between pre-and post-surgery. Of the 49 subjects with UI pre-surgery, 43 (87.7%) had stress incontinence, while of the 76 patients with UI post-surgery, 44 (57.1%) had stress incontinence, and 24 (31.2%) had mixed incontinence. Seven (4.8%) subjects had OAB pre-surgery, whereas 19 (13.1%) had OAB symptoms post-surgery (including 15 first-time OAB patients), with a significant difference between pre-and post-surgery. IIQ-7 scores were markedly higher for patients with mixed incontinence post-surgery than for those with stress incontinence, indicating a lower QOL. Logistic regression analysis identified the number of Cesarean sections and days of urinary bladder catheterization as risk factors for postoperative UI. Conclusions: UI and OAB rates were higher after gynecologic cancer surgery than in the general female population. The mixed incontinence rate was markedly higher post-surgery; QOL was low for such patients due to the combination of urge and stress incontinence. Multiple Cesarean sections and urinary bladder catheterization postsurgery were risk factors for post-surgical UI.

In this study, we investigated the retention of technetium-99m sestamibi (MIBI), a radiopharmaceutical that accumulates in mitochondria, in patients with type 2 diabetes. We hypothesized that patients with type 2 diabetes had lower MIBI counts in their legs than nondiabetic volunteers, and that these abnormalities reflected a low anaerobic threshold (AT) during cardiopulmonary exercise testing (CPX). Eight non-diabetic volunteers (Group N) and 11 patients with type 2 diabetes (Group D) underwent CPX. Mitochondrial function was assessed using MIBI imaging of both legs. The MIBI counts in the legs were significantly lower in Group D than in Group N (D vs. N: 74.1 vs. 94.1 counts/pixel, p < 0.05). Similarly, peak oxygen uptake (peakV ・ O 2 ) and AT were lower in Group D than in Group N (peakV ・ O 2 : 19.8 vs. 26.5 ml/kg/min, p < 0.05; AT: 13.1 vs. 17.2 ml/kg/min, p < 0.05). A strong correlation was observed between MIBI counts and the peakV ・ O 2 and AT (peakV ・ O 2 : r = 0.62, p < 0.01; AT: r = 0.76, p < 0.01). After the exclusion of an outlying subject, the correlation between peakV ・ O 2 and MIBI count in the legs was lost (r = 0.28, p = 0.26); however, the AT correlation was maintained (r = 0.59, p = 0.01). Patients with type 2 diabetes had reduced skeletal muscle MIBI counts, indicating reduced mitochondrial function. This abnormality may be linked to a low AT.