No description available.

Bakgrund: Att ha en dysfunktionell urinblåsa kräver assisterad blåstömning med hjälp av en kateter. En urinkateter kräver daglig skötsel och kunskap, både kring katetern som hjälpmedel och om komplikationer som kan uppstå. Personcentrerad vård handlar om att se, höra och lyssna på personen som är i behov av vård och är grundstenen för ett individanpassat bemötande. Syftet: Var att belysa patienters upplevelse av att vara beroende av assisterad blåstömning. Metod: En allmän litteraturstudie där åtta kvalitativa artiklar användes. Resultat: Det framkom tre huvudkategorier; Påverkan på livskvalitén, skam och rädsla. Underkategorier som framkom var; Betydelsen av kontroll och betydelsen av stöd. Slutsats: Information om urinkatetrar upplevs bristfällig både gällande som hjälpmedel och vid intima relationer vilket påverkar personens livskvalité. Att vara i behov av assisterad blåstömning påverkar personers självbild och genererar begränsningar i vardagen på grund av skam. Stöd från familj eller vårdpersonal är av betydelse. Den personcentrerade omvården behöver förbättras för personer med assisterad blåstömning för att hanteringen i vardagen ska underlättas. / Background: Having a dysfunctional bladder requires assisted bladder emptying using a catheter. A urinary catheter requires daily care and knowledge, both about the catheter as an aid and about complications that may arise. Person-centred care is about seeing, hearing and listening to the person in need of care and is the cornerstone of an individually tailored treatment. Aim: of the study was to shed light on patients' experience of being dependent on assisted bladder emptying. Method: A general literature study with eight qualitative articles were used. Results: Three main categories emerged; Impact on quality of life, shame and fear. Subcategories that emerged were; Importance of control and the importance of support. Conclusion: Information about urinary catheters is perceived to be insufficient both as an aid and in intimate relationships, which affects the person's quality of life. Living with assisted bladder drainage affects people's self-image and generates limitations in everyday life due to shame. Support from family or healthcare professionals is important. The person-centered care needs to be improved for people with assisted bladder emptying to facilitate handling in everyday life.

Background: A hallmark of Notch signaling is its variable role in tumor biology, ranging from tumor-suppressive to oncogenic effects. Until now, the mechanisms and functions of Notch pathways in bladder cancer (BCa) are still unclear. Methods: We used publicly available data from the GTEx and TCGA-BLCA databases to explore the role of the canonical Notch pathways in BCa on the basis of the RNA expression levels of Notch receptors, ligands, and downstream genes. For statistical analyses of cancer and non-cancerous samples, we used R software packages and public databases/webservers. Results: We found differential expression between control and BCa samples for all Notch receptors (NOTCH1, 2, 3, 4), the delta-like Notch ligands (DLL1, 3, 4), and the typical downstream gene hairy and enhancer of split 1 (HES1). NOTCH2/3 and DLL4 can significantly differentiate non-cancerous samples from cancers and were broadly altered in subgroups. High expression levels of NOTCH2/3 receptors correlated with worse overall survival (OS) and shorter disease-free survival (DFS). However, at long-term (>8 years) follow-up, NOTCH2 expression was associated with a better OS and DFS. Furthermore, the cases with the high levels of DLL4 were associated with worse OS but improved DFS. Pathway network analysis revealed that NOTCH2/3 in particular correlated with cell cycle, epithelial–mesenchymal transition (EMT), numbers of lymphocyte subtypes, and modulation of the immune system. Conclusions: NOTCH2/3 and DLL4 are potential drivers of Notch signaling in BCa, indicating that Notch and associated pathways play an essential role in the progression and prognosis of BCa through directly modulating immune cells or through interaction with cell cycle and EMT.

Bladder cancer (BCa) is one of the most common malignancies and has a relatively poor outcome worldwide. However, the molecular mechanisms and processes of BCa development and progression remain poorly understood. Therefore, the present study aimed to identify candidate genes in the carcinogenesis and progression of BCa. Five GEO datasets and TCGA-BLCA datasets were analyzed by statistical software R, FUNRICH, Cytoscape, and online instruments to identify differentially expressed genes (DEGs), to construct protein‒protein interaction networks (PPIs) and perform functional enrichment analysis and survival analyses. In total, we found 418 DEGs. We found 14 hub genes, and gene ontology (GO) analysis revealed DEG enrichment in networks and pathways related to cell cycle and proliferation, but also in cell movement, receptor signaling, and viral carcinogenesis. Compared with noncancerous tissues, TPM1, CRYAB, and CASQ2 were significantly downregulated in BCa, and the other hub genes were significant upregulated. Furthermore, MAD2L1 and CASQ2 potentially play a pivotal role in lymph nodal metastasis. CRYAB and CASQ2 were both significantly correlated with overall survival (OS) and disease-free survival (DFS). The present study highlights an up to now unrecognized possible role of CASQ2 in cancer (BCa). Furthermore, CRYAB has never been described in BCa, but our study suggests that it may also be a candidate biomarker in BCa.

Als viert häufigste Karzinomerkrankung bei Männern und zwölft häufigste bei Frauen in Deutschland ist das BCa weitverbreitet in der Gesellschaft. Dies macht die Erforschung der komplexen, molekularen Mechanismen und die Entwicklung individualisierter Therapiestrategien notwendig. Neben externen Umwelteinflüssen wie der Konsum von Tabak, die Exposition von Chemikalien und chronische Entzündungen spielen auch genetische und molekulare Aberrationen eine relevante Rolle in der Tumorinitiation. Zu den molekularen Aberrationen gehört unter anderem die Dysregulation der miRNA-vermittelten RNA-Interferenz. Interessant für diese Arbeit waren die beiden Moleküle NRP2 und VEGFC, welchen in diversen Tumorentitäten eine onkogene Wirkung zugeschrieben wurde und welche bei vermehrter Expression die Tumorentstehung, -progression und Metastasierung über die Tumor-assoziierte Lymphangiogenese fördern. Um die Rolle von NRP2 und VEGFC im BCa näher zu untersuchen, wurden die Expressionen und die Korrelationen dieser und potentiell interagierender miRNAs in BCa- Geweben mittels in silico-Verfahren und in BCa-Zelllinien mittels qPCR-Analysen näher untersucht. Zur weiteren Analyse wurden anschließend auch die Expressionen und Korrelationen alternativer Targetgene und Hostgene sowie gemeinsame Signalwege von vier ausgewählten miRNAs evaluiert. In den in silico- und qPCR-Analysen zeigten sich NRP2 und VEGFC in den BCa-Geweben und -Zelllinien verglichen zu den gesunden Urothelgeweben und Zelllinien niedriger exprimiert. Diese Ergebnisse stehen im Widerspruch zu der Annahme, dass eine verstärkte Expression beider Targetgene mit der Tumorinitiation einhergeht. Jedoch zeigten sich NRP2 und VEGFC verstärkt exprimiert in allen CDDP-resistenten BCa-Zelllinien. Dies spricht dafür, dass beide Targetgene zur Resistenzbildung beitragen. Auch in den Auswertungen der BC- BET-Datenbank war die erhöhte Expression von NRP2 und VEGFC mit aggressiveren Tumoreigenschaften und einer schlechteren Prognose assoziiert. Diese Assoziation unterstützt die Annahme, dass die zunehmende Expression beider Targetgene mit einer Tumorprogression, Metastasierung und der Rezidivbildung in Verbindung steht. In einem weiteren Schritt wurde nach NRP2/VEGFC-regulierenden miRNAs geschaut. Dabei ergaben sich nach in silico- und Literaturrecherche 33 Kandidaten, wovon nach näherer Betrachtung die vier miRNAs miR-27a, -128, -195 und -338-5p zur weiteren Analyse ausgewählt wurden. Für die ausgewählten miRNAs wurden anschließend die Expressionen in BCa-Geweben mittels TCGA-Datenbank und die zellulären Grundexpressionen mittels qPCR-Analyse bestimmt. Hierbei zeigten sich miR-27a und -128 in den BCa-Geweben signifikant erhöht. MiR-195 hingegen war signifikant erniedrigt. Auch miR-338-5p war erniedrigt, jedoch nicht signifikant. Die Auswertungen der zellulären Grundexpressionen zeigte für miR-128 und miR-195 den Trend zu einer verstärkten Expression in den BCa- Zelllinien. Für miR-27a und miR-338-5p zeigte sich keine relevante Expressionsdifferenz. Um eine Aussage über die Signifikanz der Expressionsdifferenzen zu treffen, ist die Analyse einer größeren Anzahl von BCa- und gesunden Zelllinien notwendig. Die genauere Betrachtung der miRNA-Targetgen-Korrelationen sollte Auskunft über mögliche miRNA-mRNA-Interaktionen geben. Eine negative miRNA-Targetgen-Korrelation spricht für eine Inhibierung der Targetgene durch die miRNA. Eine positive Korrelation spricht für eine miRNA-induzierte Verstäkung der Targetgenexpression. Signifikant negative Korrelationen zeigten sich in den BCa-Geweben für miR-27a/NRP2, miR-128/NRP2 und miR-128/VEGFC. Ebenfalls konnten diese negativen Korrelationen in den CDDP-sensitiven und CDDP-resistenten BCa-Zelllinien für miR-27a/NRP2, miR-128/NRP2 und miR- 128/VEGFC verzeichnet werden. Das inverse Verhältnis in den CDDP-resistenten Zelllinien unterstreicht, dass die reduzierte Expression von miR-27a und miR-128 in einer Hochregulierung von NRP2 und VEGFC resultieren könnte, welche die Tumorprogression und Resistenzentwicklung fördern könnte. Gegensätzlich dazu waren die miR-195/VEGFC- und miR-195/NRP2-Korrelationen in den CDDP-resistenten BCa-Zelllinien positiv. In den BCa-Geweben der TCGA-Datenbank waren sie signifikant bzw. per Trend positiv. Dieses Expressionsmuster spricht dafür, dass miR-195 die Expression der beiden Targetgene induzieren könnte. Während sich miR-338-5p in den BCa-Geweben schwach herabreguliert zeigte, ergab die qPCR-Analyse keine relevante Expressionsdifferenz in den malignen und nicht-malignen Zelllinien. Jedoch war die Zelllinie mit der stärksten Expression, gegensätzlich zu den anderen drei miRNAs, eine gesunde Zelllinie. Auch war miR-338-5p, mit Ausnahme von 5637CDDP, in den beiden anderen CDDP-resistenten Zelllinien herabreguliert. Aufgrund der schwachen und nicht signifikanten Korrelationen von miR-338-5p mit den beiden Targetgenen NRP2 und VEGFC konnte keine klare Schlussfolgerung bezüglich der Rolle von miR-338-5p in der Tumorinitiation und –progression gezogen werden. Weiterhin wurde auch das Verhältnis der intragen liegenden miRNAs zu ihren Hostgenen genauer betrachtet. Dabei waren für miR-128/ARPP21 und miR-338-5p/AATK die Korrelationen jeweils signifikant positiv. Auch zeigten sich ARPP21 und AATK in den BCa- Geweben der TCGA-Datenbank signifikant stärker exprimiert. Das spricht dafür, dass eine Koexpression von miRNA und Hostgen vorliegt. Die Recherche nach weiteren alternativen Targetgenen ergab eine Liste von acht Kandidaten, wovon vier (CPD, EDEM3, EYA4, RELN) eine signifikante Expressionsdifferenz zwischen BCa- und gesunden Urothelgewebe aufwiesen. Diese vier alternativen Targetgene zeigten sich zudem in der Literaturrecherche vielfach in die Karzinogenese und Resistenzbildung diverser Tumorentitäten involviert. Die Korrelationen mit den miRNAs zeigten sich für miR-128/CPD, miR-27a/EDEM3, miR-27a/EYA4, miR-128/EYA4, miR- 27a/RELN, miR-128/RELN und miR-195/RELN signifikant. CPD und EDEM3 zeigten sich in den BCa-Geweben der TCGA-Datenbank höher exprimiert, ebenso wie miR-128 und miR- 27a. Die Ergebnisse der Literaturrecherche und die positiven Korrelationen sprechen dafür, dass miR-128 und miR-27a die Expression von CDP bzw. EDEM3 induzieren und die Tumorinitiation und Tumorprogression fördern könnten. Gegensätzlich dazu stehen die negativen Korrelationen von miR-27a und miR-128 mit NRP2 und VEGFC. Auch die Korrelationen mit EYA4 und RELN zeigten sich jeweils negativ. EYA4 konnte vielfach als Tumorsuppressor identifiziert werden, unter anderem im BCa. Es spricht dafür, dass miR- 27a und miR-128 hier eine onkogene Rolle einnehmen könnten. RELN hingegen wurde in der Literatur vielfach als Onkogen identifiziert. Die negative Korrelation mit miR-27a und miR-128 lässt daher annehmen, dass die beiden miRNAs auch tumorsuppressiv wirken. MiR-195 zeigte jeweils eine positive Korrelation mit NRP2, VEGFC und RELN. Unter der Annahme, dass NRP2, VEGFC und RELN, wie vielfach in der Literatur beschrieben, onkogen agieren, sprechen die positiven Korrelationen dafür, dass miR-195 eine Tumor- fördernde Rolle einnimmt. Die erniedrigte Expression der drei Targetgene und miR-195 in den BCa-Geweben der TCGA-Datenbank widersprechen jedoch dieser Annahme. Abschließend wurden gemeinsame Signalwege der vier ausgewählten miRNAs herausgefiltert. Hierbei ergab sich eine Liste von 77 Signalwegen, welche vielfach in diverse Tumorsignalwege involviert sind, unter anderem in den Signalweg der Karzinogenese des BCa. Insgesamt scheinen miRNAs und ihre Zielgene an den komplexen Mechanismen der BCa- Karzinogenese und -Chemoresistenz beteiligt zu sein, wobei sie sowohl onkogene als auch tumorsuppressive Funktionen ausüben können.

Extensive use of the organophosphate diazinon has led to its accumulation in aquatic environments and negative effects on fish health. Most studies focus on the effects of short term exposure to high levels of organophosphate pesticides. This research was conducted to assess the effect of chronic sub-lethal exposure to 0, 0.01, and 0.1 mg/L diazinon for 15 and 30 days on blood parameters and histopathological damage in alligator gar, Atractosteus spatula. Fish exposed to either concentration were motionless, produced excess mucous, had lighter skin color, and had skin lesions. Blood indices of red blood cells, leukocytes and hematocrit values significantly decreased but there was no significant change in mean cell volume. Hemoglobin values significantly increased in fish exposed to the low dose for 15 days, but significantly decreased for the other exposure doses and times. On the contrary, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration values significantly increased in fish exposed to both concentrations and duration times. Leukocyte differentials showed significant decreases in lymphocytes with significant increases of monocytes in fish exposed to the high dose in both exposure times. The most frequent biomarker for exposure to organophosphate pesticides is the inhibition of cholinesterase (ChE). Diazinon significantly reduced plasma ChE activity in a dose-dependent manner, with 62% and 72% in the low and high concentrations for 30 days, respectively. Plasma ChE could be determined from peripheral blood samples and did not require sacrifice of the fish. Fish exposed to either diazinon concentration or duration time developed histopathological changes in skin, gills, liver, and kidney tissues. The skin lesions were on the head and body, and progressed into deep ulcerations. The histopathological changes in the liver included hepatic vacuoles, swollen hepatocytes, steatosis, aggregation of macrophages, necrosis, and hepatic fibrosis. Also, exposed fish demonstrated vacuolar degeneration in the hematopoietic tissues of the kidney. Gills showed epithelial hyperplasia in the secondary lamellae. In conclusion, long term exposure to sub-lethal concentrations of diazinon induced significant changes in hematological indices and histopathological alteration in various tissues. Plasma ChE can be used to monitor diazinon exposure in wild gar populations.

No description available.

No description available.

Spinal cord injuries and other neurological disorders can disturb the regulation of normal bladder function including continence and micturition. Developing new neuronal pathways by surgically rerouting nerves is a potential approach for restoring bladder function. Our laboratory successfully rerouted somatic nerves to the anterior vesical branch of the pelvic nerve to reinnervate the bladder muscle in canines. Electrical stimulation of these transferred nerves induced detrusor pressure and bladder emptying and we confirmed regrowth of these rerouted nerves using retrograde neurotracing methods. In these studies, reinnervation was proved at 1st and 3rd months after decentralization. We believe that our aim of developing an approach to surgically reinnervate the bladder after long-term decentralization is critical to the success of the reinnervation surgery due to the possibility that patients would delay having a surgery until they try other non-surgical approaches or therapies. We also demonstrated the reinnervation of urethral and anal sphincters by femoral to pudendal nerve transfer after sacral ventral root transection to restore continence. However, these studies did not demonstrate the reinnervation of bladder, urethra and anal sphincter, all in same animal that would be helpful to human patients with lower motor neuron lesioned bladders to restore both continence and emptying. Therefore, prior to applying these surgical procedures to human patients, further investigation is required to prove the effectiveness of nerve transfer strategies in this canine model using multiple experimental techniques. This dissertation is a part of a larger project in canines examining whether surgical rerouting of obturator to pelvic nerve and sciatic to pudendal nerve allows restoration of bladder, urethral and anal sphincter functions, including continence (storage) and emptying (voiding and defecation) functions, in lower motor neuron lesioned bladders. In this study, it was aimed to explore bladder and urethral reinnervation using behavioral observation and in-vivo electrophysiological techniques. In order to completely prove that the reinnervation surgeries are responsible for restoration of bladder and urethral functions, it was first necessary to demonstrate the absence of these functions in animals with long term decentralized bladders and to determine whether the same animals were able to recover functions after reinnervation. In specific aim 1, we addressed this goal by tracking squat-and-void behaviors at monthly intervals after decentralization and reinnervation, using home cage video recordings and evaluation of bladder sensation and emptying after bladder filling. Immediately prior to euthanasia, reinnervation was also explored by electrical stimulation of transferred nerves to evaluate motor function. Retrograde neuronal tracing was also performed to explore sensory reinnervation. Results showed evidence of functional restoration of bladder and urethral function in reinnervated animals based on behavior observation and electrical stimulation of transferred nerves. Also, regrowth of neuronal cells in the new neuronal pathways was observed that were developed by the nerve transfer surgeries. This study also aimed to establish an electroneurogram recording method (part of in-vivo electrophysiological experiments) to explore afferent (sensory) neuronal activity in transferred nerves induced by bladder filling. However, the extraction of neuronal activity from the peripheral nerves is a challenging task. Several factors including noise, interference from surrounding muscle activities and the electronic components can affect these microvolts level recordings. Choice of recording electrode in configuration with the whole recording setup also plays a significant role while performing these low amplitude signal recordings. In specific aim 2, we addressed this issue by refining electroneurogram recording techniques to obtain high strength signal during multifiber recording. We first developed custom electrodes, suitable for varying nerve diameters and available implantation sites, were tested for functionality. Then, we performed multiple testing using these electrodes with different amplifiers to calibrate noise in saline. Testing results helped to establish the recording setup suitable for in-vivo experimental environment. Later, these refined techniques were applied to record afferent (sensory) activity of sciatic nerves and afferent (sensory) and efferent (motor) activity of hypogastric nerves in rats. Based on the recording results, it was aimed to employ similar techniques in order to record nerve activity in the canine model. Prior to applying these refined techniques to explore sensory reinnervation from new neuronal pathways after nerve transfer surgeries, in specific aim 3, we aimed to assess the hypogastric nerve activity in normal intact and acutely lumbosacral decentralized bladders using these refined techniques. The effects of electrical stimulation of hypogastric nerves or lumbar roots on detrusor pressure were determined, as were effects of isoflurane versus propofol anesthetics on hypogastric nerve stimulation evoked pressure. Hypogastric nerve activity was recorded using custom-made bipolar cuff electrodes during bladder filling. To confirm or refute that any increase in electroneurogram during bladder filling is due to afferent activity from the end organ, the hypogastric nerve was transected between the recording electrode and the spinal cord and the effects of bladder filling on afferent but not efferent activity were recorded. Results showed that electrical stimulation of hypogastric nerves evoked low amplitude detrusor pressures that did not differ between the two anesthetics. Upper lumbar (L2) ventral root stimulation evoked detrusor pressures were suppressed, yet not eliminated after transection of hypogastric nerves and all spinal roots below L5. Afferent and efferent hypogastric nerve activity did not change with bladder filling in neuronally intact bladders but decreased in decentralized bladders. No change in afferent activity were observed during bladder filling in normal intact and decentralized bladders. Overall findings in this research indicate that the new neuronal pathways created by nerve transfer can restore bladder sensation and emptying function in lower motor neuron-lesioned canines. A more complete decentralized bladder model needs to include transection of both the lumbosacral spinal roots innervating the bladder and the hypogastric nerves prior to performing nerve transfer surgeries. The refined electroneurogram recording methods may be suitable for evaluating the effectiveness of nerve transfer surgeries by monitoring the sensory activities of the transferred nerve. / Electrical and Computer Engineering

Las infecciones urinarias asociadas al catéter vesical son un problema de salud pública que con mayor frecuencia se presentan en los servicios de emergencia, amenaza la seguridad del paciente, origina daños en el estado de salud y aumenta las probabilidades morbilidad y mortalidad. Ante ello, los profesionales de enfermería deben capacitarse en el manejo adecuado del cateterismo vesical a través de las estrategias de prevención; logrando desarrollar la inserción, mantenimiento y retiro apropiado del catéter vesical, cumpliendo con la técnica aséptica. Por esta razón, la investigación consideró como objetivo: Describir y analizar las estrategias de prevención en el manejo del cateterismo vesical utilizadas por enfermeras de un hospital II-2 Chiclayo, 2023. El tipo de investigación empleó un abordaje descriptivo y la población estuvo conformada por enfermeras que trabajan o trabajaron en el servicio de emergencia del Hospital Las Mercedes Chiclayo. La muestra fue de 12 enfermeras, se estableció por saturación y redundancia, se abordó el muestreo no probabilístico por conveniencia. Los resultados demostraron que las estrategias preventivas se aplican antes, durante y después de la inserción del catéter vesical, evidenciándose en las siguientes categorías: Intervenciones de enfermería como estrategias efectivas previas al cateterismo vesical, Intervenciones de enfermería estratégicas para el mantenimiento y retiro del catéter vesical, Care bundle como estrategia para la seguridad del paciente. En conclusión, las estrategias de prevención de infecciones urinarias más relevantes fueron la higiene de manos, la higiene de la zona genital, la esterilidad del procedimiento y rotular la fecha de colocación y de cambio del catéter vesical. / Urinary infections associated with bladder catheters are a public health problem that most frequently occur in emergency services, threatening patient safety, causing damage to health status and increasing the likelihood of morbidity and mortality. Given this, nursing professionals must be trained in the proper management of bladder catheterization through prevention strategies; managing to develop the appropriate insertion, maintenance and removal of the bladder catheter, complying with aseptic technique. For this reason, the research considered the objective: To describe and analyze the prevention strategies in the management of bladder catheterization used by nurses at a hospital II-2 Chiclayo, 2023. The type of research used a descriptive approach and the population was made up of nurses who work or worked in the emergency service of the Hospital Las Mercedes Chiclayo. The sample consisted of 12 nurses, it was established by saturation and redundancy, non-probabilistic sampling was used for convenience. The results demonstrated that preventive strategies are applied before, during and after the insertion of the bladder catheter, evident in the following categories: Nursing interventions as effective strategies prior to bladder catheterization, Strategic nursing interventions for the maintenance and removal of the bladder catheter , Care bundle as a strategy for patient safety. In conclusion, the most relevant urinary infection prevention strategies were hand hygiene, hygiene of the genital area, sterility of the procedure and labeling the date of placement and change of the bladder catheter.