Hilmi Ozden

Acute urodynamic effects of percutaneous posterior tibial nerve stimulation on neurogenic detrusor overactivity in patients with Parkinson's disease

Lower urinary tract dysfunction is often occurs in patients with Parkinsons disease (PD), that is primarily induced by neurogenic detrusor overactivity (NDO) and negatively effect the quality of the patients life. The aim of this study is to evaluate the acute effects of posterior tibial nerve stimulation (PTNS) on the urodynamic findings in the PD patients with NDO.

The clinical and urodynamic results of a 3-month percutaneous posterior tibial nerve stimulation treatment in patients with multiple sclerosis-related neurogenic bladder dysfunction†‡

The aim of this study was to investigate the effect of PTNS after 12 weeks, on the urodynamic findings in the Multiple Sclerosis (MS) patients with neurogenic detrusor overactivity (NDO).

Efficiency of Posterior Tibial Nerve Stimulation in Category IIIB Chronic Prostatitis/Chronic Pelvic Pain: A Sham-Controlled Comparative Study

Objectives: To evaluate the efficacy of percutaneous posterior tibial nerve stimulation (PTNS) for treatment of the patients with category IIIB chronic non-bacterial prostatitis/chronic pelvic pain syndrome. Methods: A total of 89 patients with therapy-resistant pelvic pain were randomized to receive either nerve stimulation (n = 45) or sham treatment (n = 44). The National Institutes of Health Chronic Prostatitis Symptom Index and visual analogue scale were used to assess treatment success after 12 weeks of intervention. Objective success was defined as a minimum 50% decrease in the mean scores. A decrease of over 25% to below 50% was considered to be a partial response. Results: An objective response was observed with the pain and symptom scores after 12 weeks of PTNS in 18 (40%) and 30 (66.6%) of the patients, whereas a partial response was observed in 27 (60%) and 15 (33.3%) of the patients, respectively. Mean symptom scores and visual analogue scale scores for pain and urgency were significantly changed from 23.6 ± 6.3 at baseline to 10.2 ± 3.6, 7.6 ± 0.8 at baseline to 4.3 ± 0.6, 5.7 ± 0.8 at baseline to 3.4 ± 0.7, respectively. Scores for the symptoms, urgency and pain were not changed with sham treatment. Conclusions: These results have demonstrated that percutaneous PTNS may relieve pain in the patients with category IIIB chronic non-bacterial prostatitis/chronic pelvic pain syndrome.

Three-dimensional evaluation of chemotherapy response in malignant pleural mesothelioma

OBJECTIVES Measurement of tumor response to chemotherapy in malignant pleural mesothelioma (MPM) is problematic because of non-spherical tumor growth patterns and difficulty in choosing target lesion. In this study, we aimed to determine the effectiveness of tumor volume measurement for evaluating chemotherapy response. METHODS Fifty-seven MPM patients were included. Chemotherapy responses were evaluated by computed tomography (CT) using volumetric method, World Health Organization (WHO), and modified Response Evaluation Criteria in Solid Tumor (RECIST). The tumor volume was measured using the Cavalieri principle of stereological approaches. RESULTS According to the volumetric method, median survival was 10.0 months for progressive disease (PD), 14.0 months for stable disease (SD) and 16.0 months for objective response (OR). According to the WHO method, median survival was 11.3, 14.0, and 13.0 months, respectively. For modified RECIST, median survival was 10.0, 14.0, and 14.0 months, respectively. The correspondence between the WHO and modified RECIST methods was substantial (K=0.66), as was that between the volumetric and WHO methods (K=0.64); however the correspondence between the volumetric and modified RECIST methods was only moderate (K=0.52). CONCLUSIONS The most suitable chemotherapy response measurement technique is the volumetric method because of non-spherical tumor growth patterns in MPM. However, larger studies should be performed to better establish the suitability of this method. We recommend our method for determining the chemotherapy response in mesothelioma cases. However, modified RECIST criteria can also be applied due to favourable prediction of survival, ease of application, and moderate correspondence with the volumetric method.

Interleukin-10 Gene Transfer: Prevention of Multiple Organ Injury in a Murine Cecal Ligation and Puncture Model of Sepsis

IntroductionThe aim of this study was to determine the effect of immunoregulatory cytokine interleukin-10 (IL-10) gene therapy on multiple organ injury (MOI) induced by a cecal ligation and puncture (CLP) model of sepsis in mice.MethodsMale Balb/c mice subjected to CLP were treated with either an hIL-10-carrying vector or an empty control vector. We assessed the degree of lung, liver, and kidney tissue destruction biochemically by measuring myeloperoxidase (MPO) and malondialdehyde (MDA) activity. Histologic assessments were based on neutrophil infiltration in lung and liver tissue. IL-10 protein expression was examined immunohistochemically, and ultrastructural changes in the liver were studied by transmission electron microscopy. We analyzed the expression of tumor necrosis factor-α (TNFα) mRNA by reverse transcription polymerase chain reaction 3, 8, and 24 hours after CLP in all organs.ResultsOrgan damage was significantly reduced by hIL-10 gene transfer, which was associated at the tissue level with reduced MPO activity in the liver, lung, and kidney and decreased leukocyte sequestration and MDA formation in the lung. The liver MDA was not significantly higher in the hIL-10 gene therapy group than in the controls and seemed not to be affected by hIL-10 gene transfer. The reduced portal tract neutrophilic infiltration and preserved ultrastructure of the hepatocytes also showed that tissue function was not impaired. The lung and kidney TNFα mRNA expression was suppressed markedly in the hIL-10 gene therapy group, but liver TNFα mRNA expression varied over time.ConclusionsThese findings showed that IL-10 gene therapy significantly attenuated sepsis-induced MOI.

The Clinical and Urodynamic Results of Percutaneous Posterior Tibial Nerve Stimulation on Neurogenic Detrusor Overactivity in Patients With Parkinson's Disease

OBJECTIVE To investigate the effect of percutaneous posterior tibial nerve stimulation (PTNS) treatment after 12 weeks on urodynamic and clinical findings in patients with Parkinsons disease (PD) with neurogenic detrusor overactivity. METHODS A total of 47 patients with PD with neurogenic detrusor overactivity were enrolled in the study. Urodynamic studies before and after 12-week PTNS treatment were performed. International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), Overactive Bladder Questionnaire (OAB-V8), and Overactive Bladder Questionnaire Short Form (OAB-q SF) have been assessed before and after PTNS treatment. RESULTS The mean first involuntary detrusor contraction volume (1st IDCV) on standard cystometry was 133.2 ± 48.1 (24-265) mL, whereas it was 237.3 ± 43.1 (145-390) mL after PTNS. The mean maximum cystometric capacity (MCC) on standard cystometry was 202.2 ± 36.5 (115-320) mL, whereas it was 292.1 ± 50.6 (195-395) mL after stimulation. The improvements in the first involuntary detrusor contraction volume and maximum cystometric capacity were statistically significant after stimulation. The mean Pdetmax at first involuntary detrusor contraction, maximal detrusor pressure at maximum cystometric capacity, PdetQmax, Qmax, and post-void residual volume were statistically significant after 12-week stimulation. Mean parametric improvements at 12-week PTNS treatment from baseline included daytime frequency decreased by 5.6 voids daily, urge incontinence decreased by 3.1 episodes daily, urgency episodes decreased by 6.3 episodes daily, nocturia decreased by 2.7 voids, and voided volume improved by a mean of 92.6 mL. The change from baseline on the ICIQ-SF, OABv8, and OAB-q at 12-week PTNS treatment demonstrated statistically significant improvements. CONCLUSION These results have demonstrated that PTNS improves the lower urinary tract symptoms and urodynamic parameters in patients with PD.

Erythropoietin prevents nitric oxide and cathepsin-mediated neuronal death in focal brain ischemia.

We examined the preventive effect of human recombinant erythropoietin (HrEPO) on nitric oxide (NO)-mediated toxicity to neurons and cysteine protease release into cytoplasm, which is attributed to neuronal death in brain ischemia. Focal cerebral ischemia was induced by permanent occlusion of middle cerebral artery in two sets of rat. The first set was used to monitor NO concentration and cathepsin activity, while the second was used for histological examination with hematoxylin and eosin, and TUNEL staining. A group in both set was administered human recombinant erythropoietin (HrEPO). NO content, cathepsins B and L activity increased significantly in the post-ischemic cerebral tissue (p<0.05). HrEPO treatment reduced NO concentration and cathepsin activity to control level (p>0.05). A significant increase in the number of necrotic and apoptotic neurons was observed in the post-ischemic cerebral cortex (p<0.05). HrEPO treatment was markedly lowered both of these (p<0.05). It is concluded that HrEPO prevents neuronal death by protecting neuronal liposomes from NO-mediated toxicity and suppressing the release of cathepsins.

Long term sustained therapeutic effects of percutaneous posterior tibial nerve stimulation treatment of neurogenic overactive bladder in multiple sclerosis patients: 12-months results

The aim of this study is to determine the sustained therapeutic efficacy and treatment intervals for PTNS in NOAB with MS, offering periodic additional treatments during 1 year in patients who completed an initial course of 12 consecutive weekly sessions.

The protective effects of vitamin E on urinary bladder apoptosis and oxidative stress in streptozotocin-induced diabetic rats.

OBJECTIVES To determine whether vitamin E has protective effects or not on streptozotocin-induced diabetic rats in diabetic urinary bladder dysfunction, with interrelationships between oxidative stress and apoptosis. METHODS Thirty-two Wistar albino male rats were divided into 4 groups. Group A (n = 8), control; group B (n = 8), diabetic control; group C (n = 8), control + vitamin E; and group D (n = 8), diabetic + vitamin E. Vitamin E was injected 40 mg/kg every other day intraperitoneally for 2 weeks. In the diabetic groups, diabetes was induced by a single intraperitoneal injection of 65 mg/kg of streptozotocin. Apoptosis studies were performed using apoptosis detection kit and the TUNEL (TdT-mediated dUTP nick-end labeling) technique. The levels of glucose, malondialdehyde (MDA), superoxide dismutase, catalase, and glutathione peroxidase were detected in hemolysate. RESULTS It was observed that apoptosis number in urothelial cells of the bladder in diabetic rats increased significantly compared with control and decreased after vitamin E treatment. MDA levels of the diabetic group were significantly higher than those on the control and vitamin E groups. Diabetic + vitamin E group had significantly increased MDA levels compared with control group, although these values were lower than those in the diabetic group. All enzyme activities of the vitamin E group did not differ compared with the control group. In diabetic + vitamin E group, superoxide dismutase and glutathione peroxidase activities were similar to controls. Catalase activity of the diabetic + vitamin E group decreased significantly compared with control, although it was higher than that in the diabetic group. CONCLUSIONS Our study revealed that vitamin E decreases apoptosis and may be protective for uroepithelial cells of diabetic bladder.

The effects of levetiracetam on urinary 15f-2t-isoprostane levels in epileptic patients

PURPOSE We aimed to investigate the effects of levetiracetam on oxidative stress which is one of the new antiepileptic drugs in epileptic patients. METHODS The study consisted of 21 patients with cryptogenic partial epilepsy. We determined the urinary 15F-2t-isoprostane levels of the 30 patients which is a marker of oxidative stress. Morning urine samples were collected from the patients before beginning LEV and after 3 months treatment. Of these patients 9 were excluded from the study that had seizure history in the last 1 month. Urinary levels of 15-F2t-isoprostane determined by ELISA initially and after 3 months treatment for each patient. RESULTS Mean age of the 21 patients was 29.6, of these 11 were females and 10 males. Mean urinary 15F-2t-isoprostane level of the patients was 876 ± 447 ng/mg Cr before the treatment of LEV. After 3 months treatment the mean 15F-2t-isoprostane level of the patients was 1560 ± 630. The patients had significantly higher levels of urinary 15F-2t-isoprostane when compared with initial levels (p = 0.025). CONCLUSION Our results showed the increase of urinary 15F-2t-isoprostane levels in epileptic patients whom were treated with LEV which may indicate that LEV induces the oxidative stress in epileptic patients.