Purpose: The relationship between severity of voiding dysfunction and quality of life in children with daytime wetting was analyzed. Materials and Methods: The relationship between age, gender, severity of voiding dysfunction (measured by DVSS) and quality of life (measured by PinQ) in the child with daytime wetting was analyzed. Twenty-four children (4 males, 20 females) aged 5-10 years (x 8.17 years, SD 1.37) and their parents completed the DVSS and PinQ. Results: Parent and child total DVSS and total PinQ Scores had similar results with only a significant mean difference between the parent total DVSS scores based on gender. Only Gender with Parental Total DVSS Score (r = 0.462, p = 0.023) and Child Total DVSS Score with Parent Total DVSS Scores (r = 0.472, p = 0.020) were significant correlations. Conclusions: Results illustrate the importance of early recognition and intervention to minimize the impact daytime wetting has on the child.

This research details the development of a novel process for four commercially available no-flow fluxing underfills for use with flip chip on FR4 substrates. The daisy chain test die was used such that two point resistance measurements could be used to determine the integrity of the solder interconnects post reflow. The impact of the underfill dispensing pattern on underfill void formation is determined in a full factorial dispense DOE that includes two factors: pattern and speed. Evaluation metrics include underfill material voiding and fillet shape. The impact of the placement process is determined in a second full factorial DOE involving three factors at two levels each: dispense pattern, placement force, and dwell time. Metrics include interconnect yield and underfill voiding. The results of these DOEs are used to select an optimal placement process for each material to be used for the remaining reflow experiments. The process developed is a novel approach to no-flow processing; the material is dispensed to the side of the bond site and allowed to flow under the chip after placement by capillary action during the early stages of reflow. This development allows for void free assemblies using no-flow materials. Reflow parameters are investigated using a parametric approach. The following parameters are varied at 2 levels individually off a baseline profile: Peak Temperature, Time > 183 oC, Peak Ramp Rate, Soak Time, and Soak Temperature. A ranking was developed for each material based on the observable metrics: interconnect yield, underfill material voiding, two point resistance, and a grain area fraction term. The results were used to select an optimal assembly process for each material. Test boards were assembled in replicates of 30 according to the optimal process for each material, and AATC -40 to 125 oC thermal cycling test was performed. The MTTF for these assemblies has exceeded 3000 cycles; the void free process successfully avoids premature failure due to solder extrusion into voids. Further process development work has demonstrated that the process is scalable to larger area array die and other edge dispense patterns have also been demonstrated to result in void free assemblies.

No description available.

Objectives: To compare postoperative urinary retention and pain control when bupivacaine versus saline for hydrodissection is used while placing tension-free vaginal tape midurethral slings. Methods: A prospective, randomized, double-blind trial was performed after institutional review board approval. Sixty women were randomized to receive bupivacaine or saline for hydrodissection. Subjects and research team were blinded to subject assignments. Group characteristics were compared using the Student t test, the χ2 test, and the Mann-Whitney U test. Proportions of subjects with a successful postoperative voiding trial along with measurements of postoperative pain and analgesic use were compared using similar appropriate tests. The study was powered to detect differences in voiding trial success from an estimated 58% to greater than 90% with P < 0.05 and 0.8 power using 25 subjects per group. Results: Thirty patients were allocated to each group. One subject in the saline-only group was excluded. Group characteristics were not different. After surgery, pain medication use (20/30 vs 25/29 for bupivacaine vs saline only; P = 0.08), pain scores (36 ± 22 vs 31 ± 24; P = 0.49), and successful voiding trials did not differ (14/30 vs 19/29; P = 0.14), whereas postvoid residuals did differ (225 ± 180 mL vs 140 ± 147 mL; P = 0.043). Conclusions: Bupivacaine was not seen to improve immediate postoperative pain after placement of a tension-free vaginal tape. It did not increase the risk of failing a postoperative voiding trial. Without an obvious benefit, the use of an additional medicine is not supported. We suggest saline alone be used for hydrodissection.

No description available.

No description available.

Inledning: Miktionsuretrocystografi (MUCG) är en röntgenundersökning som används vid diagnostisering av vesikoureteral reflux på barn. Undersökningen är både fysiskt och psykiskt påfrestande och för barn kan det upplevas som en ångestfylld undersökning. Föräldrarna har en viktig roll vid undersökningen och röntgensjuksköterskan behöver ha kunskap om hur barnens ångest kan lindras för att kunna hjälpa föräldrar att stötta sina barn. Syfte: Syftet med denna litteraturöversikt var att belysa faktorer som kan minska ångest hos barn inför och under en MUCG-undersökning. Metod: Studien genomfördes som en allmän litteraturöversikt. En systematisk litteratursökning i databaserna PubMed och CINAHL utfördes. Tolv vetenskapliga artiklar vilka svarade på syftet valdes ut till kvalitetsgranskning, analyserades därefter och resultatet av detta identifierades i kategorier. Resultat: Ur dataanalysen identifierades tre kategorier som beskriver faktorer som kan minska barns ångest; information och förberedelser, vuxnas påverkan på barnet och alternativa metoder. Konklusion: Information och förberedelser samt påverkan från föräldrarna har en stor betydelse för barns ångest. Genom ökad förståelse för dessa faktorer kan röntgensjuksköterskan stötta både barnen och föräldrarna under undersökningen samt medverka till utformning av nya rutiner. / Introduction: Voiding cystourethrogram (VCUG) is an x-ray examination that is used to diagnose vesicoureteral reflux in children. The examination is both physically and mentally stressful and for children it can be experienced as an anguished examination. Parents have an important role in the examination and the radiographer needs to know how children's anxiety can be eased in order to help parents support their children. Children’s anxiety can be demonstrated in several ways during the examination, which may complicate the diagnosis. Purpose: The aim of this literature review was to highlight factors that may reduce anxiety in children before and during a VCUG examination. Method: The study was performed as a literature review. A systematic literature search in the databases PubMed and CINAHL was performed. Twelve scientific articles which replied to the aim of this study were collected for quality review, then those articles were analyzed and the result were divided into categories. Results: From the data analysis three categories were identified to describe factors that can reduce children’s anxiety; information and preparation, adult influence on the child and alternative methods. Conclusion: Information and preparation as well as the influence of parents have great importance to children’s anxiety. Through increased understanding, the radiographer can support both the children and parents during the examination and also contribute to the design of new routines.

Objective: To test the hypothesis that body mass index (BMI) is a factor associated with passing a voiding trial after midurethral sling procedures for stress urinary incontinence (SUI). Study Design: The medical records of 136 consecutive patients who underwent placement of either tension-free vaginal tape (TVT) or transobturator tape (TOT) for SUI during a 1-year period (September 1, 2007 to August 31, 2008) were retrospectively reviewed. Variables assessed were BMI, age, and passing or failing a postoperative urinary voiding trial. Patients with concomitant pelvic organ prolapse surgeries were not included in this analysis. Results: Sixty-seven patients underwent TVT, whereas 69 had TOT procedures. In the TVT group, 30 patients (42%) were unable to void immediately postoperatively compared with 11 patients (16%) in the TOT group (P = 0.0003). The mean (SD) age and BMI of patients who failed or passed voiding trials was 58.6 (12.0) years and 28.0 (4.9) kg/m2 or 53.5 (12.3) years and 29.8 (5.7) kg/m2, respectively. Of 38 patients who did not pass a voiding trial on the day of the procedure, 31 (82%) passed on postoperative day 1, and all patients had passed a voiding trial by postoperative day 11. The mean (SD) BMI for 7 patients who did not pass voiding trial by postoperative day 1 was 28.3 (5.2) kg/m2. Conclusions: Women with higher BMIs were more likely to pass voiding trials after midurethral sling procedures. Patients who had TOT placement had greater success passing a postprocedure voiding trial than did patients who had TVT placement.

Cholinergic input to, and cholinergic mechanisms within the lower lumbar (L6) and upper sacral (S1) spinal cord of rat may influence neuronal excitability and afferent transmission (Thor et al, 2000) and may provide the environment necessary for appropriate central nervous system control of bladder and bowel function. It is unclear, however, if cholinergic terminals and receptors are present in the L6 & S1 spinal segments of rat and when this may develop. Cholinergic mechanisms have been shown to alter sensory afferent transmission, enhance motoneuron excitability, induce plateau potentials via non-linear membrane properties in motoneurons and reveal oscillations in locomotor-related interneurons. The enhanced activity of sphincter motoneurons was attributed to non-linear properties during the continence phase of distention-evoked voiding in the decerebrate cat (Paroschy & Shefchyk, 2000). Candidate neurotransmitters inducing non-linear properties in cat sphincter motoneurons are 5-HT (Paroschy & Shefchyk, 2000) and acetylcholine via motoneuron axon collaterals (Sasaki, 1994) and other spinal sources. We have established using the antibody to the vesicular acetylcholine transporter (VAChT) that cholinergic terminals are present on ventrolateral Onuf (VLO), dorsomedial Onuf (DMO) motoneurons and parasympathetic preganglionic motoneurons (PGN) in the L6 and S1 rat spinal cord segments. Muscarinic receptor (M2), nicotinic-α4 and α7 receptor subunit immunoreactivity was also present on Onuf motoneurons and in regions dorsal to the PGN. One source of the cholinergic puncta on Onuf motoneurons may be from motoneuron axon collaterals which we observed on a postnatal day 15 VLO motoneuron. Cholinergic terminals were observed on vasoactive intestinal polypeptide-immunoreactive (VIP) afferents, interneurons in the intermediolateral (IML) region and perhaps on other afferents in the lateral and medial collateral pathway of L6 and S1 spinal segments. In the ventral horn, the cholinergic puncta and receptors appear to have a mature distribution around two weeks postnatal and the cholinergic terminals appeared to have a mature distribution in the IML region by three weeks postnatal. Using whole cell patch clamp recording techniques and thick slices of the L6 and S1 rat spinal cord, we observed excitatory responses of ventral horn neurons and motoneurons to carbachol (10-50 μM), a non-specific cholinergic agonist. Ventral horn neurons (postnatal day 8- 16) exhibited prolonged firing and prolonged depolarizations (plateau potentials) beyond the duration of the applied excitatory input from cholinergic (n=6/33) and other (n= 4/37) neurotransmitter systems. In a selection of the neurons with plateau potentials, the L-type calcium current played a role in the plateau production (n=5/5) and low frequency oscillations (n=2/2) as revealed by nifedipine. Postnatally, the voiding reflex changes from a perineal-evoked reflex, to the adult bladder-bladder reflex. Cholinergic input may be responsible in part for the bursting activity of the external urethral sphincter and the activation of the bladder, which is required for complete voiding reflexes in the adult rat. Plateau potentials and enhanced excitability due to cholinergic mechanisms could render inessential a constant excitatory drive that is required in the perineal-evoked voiding reflex in the neonatal rat and may underlie changes in the voiding reflexes that occur during postnatal development. / February 2006

Cholinergic input to, and cholinergic mechanisms within the lower lumbar (L6) and upper sacral (S1) spinal cord of rat may influence neuronal excitability and afferent transmission (Thor et al, 2000) and may provide the environment necessary for appropriate central nervous system control of bladder and bowel function. It is unclear, however, if cholinergic terminals and receptors are present in the L6 & S1 spinal segments of rat and when this may develop. Cholinergic mechanisms have been shown to alter sensory afferent transmission, enhance motoneuron excitability, induce plateau potentials via non-linear membrane properties in motoneurons and reveal oscillations in locomotor-related interneurons. The enhanced activity of sphincter motoneurons was attributed to non-linear properties during the continence phase of distention-evoked voiding in the decerebrate cat (Paroschy & Shefchyk, 2000). Candidate neurotransmitters inducing non-linear properties in cat sphincter motoneurons are 5-HT (Paroschy & Shefchyk, 2000) and acetylcholine via motoneuron axon collaterals (Sasaki, 1994) and other spinal sources. We have established using the antibody to the vesicular acetylcholine transporter (VAChT) that cholinergic terminals are present on ventrolateral Onuf (VLO), dorsomedial Onuf (DMO) motoneurons and parasympathetic preganglionic motoneurons (PGN) in the L6 and S1 rat spinal cord segments. Muscarinic receptor (M2), nicotinic-α4 and α7 receptor subunit immunoreactivity was also present on Onuf motoneurons and in regions dorsal to the PGN. One source of the cholinergic puncta on Onuf motoneurons may be from motoneuron axon collaterals which we observed on a postnatal day 15 VLO motoneuron. Cholinergic terminals were observed on vasoactive intestinal polypeptide-immunoreactive (VIP) afferents, interneurons in the intermediolateral (IML) region and perhaps on other afferents in the lateral and medial collateral pathway of L6 and S1 spinal segments. In the ventral horn, the cholinergic puncta and receptors appear to have a mature distribution around two weeks postnatal and the cholinergic terminals appeared to have a mature distribution in the IML region by three weeks postnatal. Using whole cell patch clamp recording techniques and thick slices of the L6 and S1 rat spinal cord, we observed excitatory responses of ventral horn neurons and motoneurons to carbachol (10-50 μM), a non-specific cholinergic agonist. Ventral horn neurons (postnatal day 8- 16) exhibited prolonged firing and prolonged depolarizations (plateau potentials) beyond the duration of the applied excitatory input from cholinergic (n=6/33) and other (n= 4/37) neurotransmitter systems. In a selection of the neurons with plateau potentials, the L-type calcium current played a role in the plateau production (n=5/5) and low frequency oscillations (n=2/2) as revealed by nifedipine. Postnatally, the voiding reflex changes from a perineal-evoked reflex, to the adult bladder-bladder reflex. Cholinergic input may be responsible in part for the bursting activity of the external urethral sphincter and the activation of the bladder, which is required for complete voiding reflexes in the adult rat. Plateau potentials and enhanced excitability due to cholinergic mechanisms could render inessential a constant excitatory drive that is required in the perineal-evoked voiding reflex in the neonatal rat and may underlie changes in the voiding reflexes that occur during postnatal development.