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Introduction and Hypothesis: This study was conducted to determine whether urgency-free interval (UFI) was effective to evaluate the outcome of overactive bladder (OAB) and the correlation of changes between this parameter and urgency episodes., Methods: A randomized placebo-controlled trial was conducted involving 73 women with OAB. The interventions for a 12-week period included a vaginal electric stimulation and oxybutynin (2.5 mg) or placebo three times per day. Identical preintervention and postintervention assessments included the measurement of UFI and warning time (WT). The King's Health Questionnaire, Spearman's correlation coefficient (SCC), Kruskal-Wallis, Mann-Whitney U, and Wilcoxon-signed rank tests were used for analysis., Results: A positive and significant correlation between the improvements of WT and UFI was noted in the oxybutynin group (p = 0.009). In all groups, none of the SCC revealed significant correlation between the improvement of UFI and urgency episodes (all p >or= 0.145)., Conclusions: The efficacy of UFI in evaluating treatment outcome of OAB was comparable with that of WT in selected modality.

Introduction and Hypothesis: To investigate the molecular signature underlying experimental interstitial cystitis (IC) using cDNA microarray., Methods: Microarray gene expression profiles are studied in bladder epithelium of C57BL/6 mice with ovalbumin or substance P-induced experimental IC versus Escherichia coli lipopolysaccharide-induced bacterial cystitis., Results: Main findings are summarized as follows: firstly, a "75-gene" model was discovered to contain high expressions of bladder epithelium which feature in experimental IC. Secondly, glucose, lipid, nucleotide, xenobiotics, and amino acid metabolisms are involved in. Thirdly, T-cell-mediated immune and inflammatory responses are observed. Fourthly, Wnt, Tgf-beta, Mapk, and insulin growth factor receptor signaling pathways are also involved in. In addition, experimental IC leads to Ephrin- and Semaphorin-mediated axon guidance promoting parasympathetic inflammatory reflexes., Conclusions: Further characterization of human IC-induced gene expression profiles would enable the use of genome-based expression profiling for the therapeutic targets and diagnosis of IC.

Staphylococcus aureus has been implicated as a cause of antibiotic-associated diarrhea; however, reports rarely originate from the United States. We report 5 cases of antibiotic-associated diarrhea caused by methicillin-resistant S. aureus (MRSA). Eighty percent of the stool specimens were greenish. Heavy growth of MRSA from greenish stool culture may warrant oral vancomycin therapy.

Study Objective: The aim was to evaluate the safety and efficacy of transobturator tape (TOT) using Monarc with extensive vaginal reconstructive surgery in patients with urodynamic stress incontinence (USI) and advanced genital prolapse (stage > or = III pelvic organ prolapse quantification system staging)., Design: Case control study. Canadian Task Force classification II-2., Setting: Medical school-affiliated hospital., Patients: A total of 57 women were surgically treated (28 stage III and 29 stage IV prolapse). Urodynamic stress incontinence was defined as demonstrable involuntary urine leakage with negative pressure transmission observed at stress urethral pressure profile. Severe USI was defined as leak on 1-hour pad test of more than 10 g., Interventions: The indicated extensive pelvic reconstructive procedures including anterior colporrhaphies, posterior colporrhaphies, vaginal total hysterectomies, sacrospinous ligament fixations, and LeFort procedures were completed before the TOT procedure. The TOT procedure using Monarc device was performed through a separate small vaginal incision sparing vaginal reconstructive procedures., Measurements and Main Results: The mean follow-up period was 18.2 months. Objective data were available for 51 patients. In all, 44 (86.3%) were completely dry at 1 year postoperatively. Among the 7 failures, 5 had severe preoperative USI. No major surgical complications, including bladder injury, occurred. The mean blood loss was 154 mL; the mean operating time for complete procedure and TOT alone was 86 minutes and 18 minutes, respectively; and the mean postoperative hospital stay was 4.1 days. Six (10.5%) patients maintained intermittent catheterization for more than 72 hours. All were classified as having severe bladder outlet obstruction preoperatively. Two patients developed recurrent prolapse onto stage II (pelvic organ prolapse quantification system staging). Urodynamic parameters related to voiding dysfunction showed an improvement after the surgery. De nova detrusor instability was observed in 2 patients., Conclusion: Using separate incisions and sequencing the TOT as the last procedure, the combination surgery is safe and effective for USI and advanced pelvic prolapse. The bladder outlet obstructions caused by severe prolapse and preoperative severity of urinary incontinence seem to be a risk factor for prolonged postoperative catheterization and failure of antiincontinent procedure, respectively. Additional information on treatment of recurrent prolapse required a longer period of follow-up.

Doripenem is the latest carbapenem on the market to date. Although not an antibiotic in a new class, it offers a glimmer of hope in combating serious infections secondary to multidrug-resistant Gram-negative bacteria when we have not seen a new class of antibacterial, particularly for Gram-negative bacteria, for more than 10 years. In vitro, doripenem exhibits a broad spectrum of activity against Gram-positive and Gram-negative bacteria, including extended-spectrum β-lactamase (ESBL) and Amp-C β-lactamase producing Enterobacteriaceae and anaerobes. Doripenem also exhibits better in vitro activity against Pseudomonas aeruginosa compared to other anti-pseudomonal carbapenems. It combines the desirable activities of both imipenem and meropenem. It has similar activity to imipenem against Gram-positive pathogens and has the antimicrobial spectrum of meropenem against Gram-negative organisms. Several randomized clinical trials have demonstrated that doripenem is non-inferior to meropenem, imipenem, piperacillin/tazobactam, or levofloxacin in its efficacy and safety profile in treating a wide range of serious bacterial infections including intra-abdominal infection, complicated urinary tract infection, and nosocomial pneumonia. Due to its wide spectrum of activity and good safety profile it is susceptible to misuse leading to increasing rates of resistance. Judicious use should be considered when using doripenem as a first-line agent or drug of choice for serious infections. Doripenem is a well-tolerated drug with common adverse effects including headache, nausea and diarrhea. Caution should be used in patients with hypersensitivity to carbapenems and adverse reactions to β-lactam agents. Dosage adjustment is needed for patients with renal impairment. Doripenem has demonstrated economic and clinical benefits. It has been shown to reduce hospital length of stay and duration of mechanical ventilation for intensive care unit (ICU) patients. Therefore, doripenem is a welcome addition to our limited armamentarium of antibiotics available to treat serious bacterial infections in hospitalized patients.

Objective: Our objective was to assess the impacts of menopause, age and parity on voiding function in urogynecology patients., Materials and Methods: The medical records of 4,470 patients with urodynamic studies were reviewed at our center between January 1999 and May 2003. Patients with conditions including a prior continence procedure, advanced pelvic prolapse, hysterectomy or neurologic deficits were excluded from our study. Comprehensive medical histories, physical examinations, bladder diaries and results of multi-channel urodynamic testing were analyzed., Results: The mean age of the 3,161 women enrolled was 50 years, and the mean parity was three. Four urodynamic variables served as voiding parameters: maximum flow rate (Qmax) and post-void residual (PVR) from uroflowmetry, and maximum flow rate (Qmax.p) and detrusor pressure at maximum flow (PdetQmax) from pressure-flow studies. Of the three factors studied (menopause, age, and parity), only parity had a significant impact on uroflowmetry and pressure-flow study results (Qmax, p=0.007; PVR, p<0.001; Qmax.p, p=0.002; PdetQmax, p<0.001). Twenty-five percent of the patients in our study were diagnosed with voiding dysfunction., Conclusion: Our results indicated that parity had a significant impact on voiding function in urogynecology patients. Twenty-five percent of patients in our study were diagnosed with voiding dysfunction. The bladder behavior in women after childbirth may be more complex than previously thought, and special attention should be paid to women who suffer from bladder symptoms after childbirth.

The dynamics of rapid brittle cracks is commonly studied in the framework of linear elastic fracture mechanics where nonlinearities are neglected. However, recent experimental and theoretical work demonstrated explicitly the importance of elastic nonlinearities in fracture dynamics. We study two simple one-dimensional models of fracture in order to gain insights about the role of elastic nonlinearities and the implications of their exclusion in the common linear elastic approximation. In one model we consider the decohesion of a nonlinear elastic membrane from a substrate. In a second model we follow the philosophy of linear elastic fracture mechanics and study a linearized version of the nonlinear model. By analyzing the steady state solutions, the velocity-load relations and the response to perturbations of the two models we show that the linear approximation fails at finite crack tip velocities. We highlight certain features of the breakdown of the linear theory and discuss possible implications of our results to higher dimensional systems.

We hypothesized that elevated postvoid residual volume (PVRV) would resolve postoperatively in women with severe pelvic organ prolapse (POP) and investigated risk factors that might hamper its resolution. Retrospectively, we enrolled 57 patients undergoing surgery for severe POP. All patients had preoperative PVRV > or = 100 ml documented by ultrasound and catheterization. Presurgical voiding difficulty, urodynamic and cystoscopic data, and surgical outcome were analyzed. The incidence of postsurgical elevated PVRV was 15.8% and 3.5% was symptomatic. Patients with postsurgical elevated PVRV had larger preoperative residual volume than those with normal postsurgical PVRV (P = 0.037). By multivariable analysis, concomitant anti-incontinence surgery was the single independent predictor of postsurgical elevated PVRV (odds ratio = 5.38, P = 0.031). A majority of patients with severe POP had their elevated PVRV resolved postoperatively. Although concomitant anti-incontinence surgery increased the risk of developing elevated PVRV after repair, most remained asymptomatic.

A free material surface which supports surface diffusion becomes unstable when put under external nonhydrostatic stress. Since the chemical potential on a stressed surface is larger inside an indentation, small shape fluctuations develop because material preferentially diffuses out of indentations. When the bulk of the material is purely elastic one expects this instability to run into a finite-time cusp singularity. It is shown here that this singularity is cured by plastic effects in the material, turning the singular solution to a regular crack.

The existence of a finite threshold, the yield stress, for the onset of plastic yielding is a universal feature of plasticity. This jamming-unjamming transition is naturally accounted for by the dynamics of a bistable internal state field. We show, within the athermal shear transformation zone theory of amorphous plasticity, that the transition is accompanied by the propagation of plastic fronts. We further show that the mean-field theory cannot select the velocity of these fronts, and go beyond the mean-field description to include fluctuations and correlations effects, resulting in additional nonlocal terms in the equations. Finally, we demonstrate that these terms, with an associated intrinsic length scale, provide a velocity selection mechanism for the plastic fronts.

Recently, the existence and properties of unbounded cavity modes, resulting in extensive plastic deformation failure of two-dimensional sheets of amorphous media, were discussed in the context of the athermal shear-transformation-zones (STZ) theory. These modes pertain to perfect circular symmetry of the cavity and the stress conditions. In this paper we study the shape stability of the expanding circular cavity against perturbations, in both the unbounded and the bounded growth regimes (for the latter the unperturbed theory predicts no catastrophic failure). Since the unperturbed reference state is time dependent, the linear stability theory cannot be cast into standard time-independent eigenvalue analysis. The main results of our study are as follows: (i) sufficiently small perturbations are stable; (ii) larger perturbations within the formal linear decomposition may lead to an instability; this dependence on the magnitude of the perturbations in the linear analysis is a result of the nonstationarity of the growth; and (iii) the stability of the circular cavity is particularly sensitive to perturbations in the effective disorder temperature; in this context we highlight the role of the rate sensitivity of the limiting value of this effective temperature. Finally we point to the consequences of the form of the stress dependence of the rate of STZ transitions. The present analysis indicates the importance of nonlinear effects that were not taken into account yet. Furthermore, the analysis suggests that details of the constitutive relations appearing in the theory can be constrained by the modes of macroscopic failure in these amorphous systems.

A major challenge in turbulence research is to understand from first principles the origin of the anomalous scaling of velocity fluctuations in high-Reynolds-number turbulent flows. One important idea was proposed by Kolmogorov [J. Fluid Mech. 13, 82 (1962)], which attributes the anomaly to variations of the locally averaged energy dissipation rate. Kraichnan later pointed out [J. Fluid Mech. 62, 305 (1973)] that the locally averaged energy dissipation rate is not an inertial-range quantity and a proper inertial-range quantity would be the local energy transfer rate. As a result, Kraichnan's idea attributes the anomaly to variations of the local energy transfer rate. These ideas, generally known as refined similarity hypotheses, can also be extended to study the anomalous scaling of fluctuations of an active scalar, such as the temperature in turbulent convection. We examine the validity of these refined similarity hypotheses and their extensions to an active scalar in shell models of homogeneous turbulence and turbulent convection. We find that Kraichnan's refined similarity hypothesis and its extension are valid.

Study Objective: The purpose of this study was to compare tension-free vaginal tape (TVT) and the TVT-obturator (TVTO) procedures., Design: Multicenter retrospective cohort study (Canadian Task Force classification II-2)., Setting: Tertiary teaching hospitals., Patients: We reviewed 82 women with urodynamically proven stress incontinence undergoing either TVT (n = 53) or TVTO (n = 29) without concomitant surgery., Intervention: TVT and TVTO procedure., Measurements and Main Results: All subjects underwent urinalyses, 1-hour pad testing, perineal ultrasonography, and urodynamic studies, as well as validated questionnaires before and 1 year after surgery. Mean operative time was significantly shorter in the TVTO group (16.8 +/- 10.7 minutes vs 28.6 +/- 6.9min, p <.01; unpaired t-test). The subjective and objective cure rates were comparable for the TVT and TVTO groups (p = .085 vs .19, respectively; Fisher's exact test). At rest or during Valsalva, the middle of the TVTO tape localized more distally than that of TVT on ultrasound scanning (p <.01; unpaired t-test). A higher rate of urethral kinking during straining was noted in the TVT group compared with the TVTO group after surgery (87% vs 25%, p <.01; chi2 test). After TVT, maximum urethral closure pressure increased significantly (83.6 +/- 24.6 cm H2O vs 69.2 +/- 25.9 cm H2O, p <.05), but this was not the case in the TVTO group (67.8 +/- 15.0 cm H2O vs 63.2 +/- 12.3 cm H2O, p >.05; paired t test)., Conclusion: With comparable subjective and objective cure rates, TVTO has the advantages over TVT with shorter operative time. However, the TVTO tape is at a less acute angle and localizes to a more distal part of the urethra, resulting in a lower rate of urethral kinking and less urethral compression.

Despite alarming data showing the ever increasing number of bacteria becoming resistant to different classes of antibiotics through various mechanisms, the carbapenems remain a unique class of antibiotics that possess the broadest spectrum against Gram-positive, Gram-negative, aerobic and anaerobic organisms. However, bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa, carry mechanisms that can inactivate the carbapenems. This article gives a review of the carbapenems that are currently in clinical use as well as discusses the new carbapenems that are in clinical trials. These new carbapenems show promising potential to overcome the resistance against the presently existing carbapenems. The present article shows the recent patents using carbapenems as an effective antibiotic.

Molecular dynamics simulations are used to study the spatiotemporal dynamics of charge fluctuations around a polyelectrolyte molecule at charge densities above and below the classic counterion condensation threshold. Surprisingly, the counterions form weakly interacting clusters which exhibit slowly decaying short range orientational order. Local charge fluctuations create energy fluctuations at the order of k&#95;(B)T that is sufficient to affect the polyelectrolyte interaction with an approaching ligand molecule. The predictions of the classical theory appear to be appropriate only over much longer time scales.

The understanding of dynamic failure in amorphous materials via the propagation of free boundaries like cracks and voids must go beyond elasticity theory, since plasticity intervenes in a crucial and poorly understood manner near the moving free boundary. We focus on failure via a cavitation instability in a radially symmetric stressed material and set up the free boundary dynamics taking both elasticity and viscoplasticity into account using the recently proposed athermal shear transformation zone theory. We demonstrate that this theory predicts the existence (in amorphous systems) of fast cavitation modes accompanied by extensive plastic deformations and discuss the revealed physics.

Background: The purpose of this study was to perform an ultrasonographic comparison of tension-free vaginal tape (TVT) and the TVT-obturator (TVT-O) procedure in women with stress urinary incontinence (SUI)., Methods: We retrospectively reviewed 159 women with SUI undergoing either TVT (n=91) or TVT-O (n=68). All subjects underwent perineal ultrasonographies, pelvic examination, urinalyses, 1-h pad tests, multichannel urodynamic studies and a personal interview using the Bristol Female Lower Urinary Tract Symptoms Questionnaire before and 1 year after surgery., Results: At rest or during Valsalva, the middle of the TVT-O tape localised more distally than the TVT on ultrasound (p<0.01). A higher rate of urethral kinking during straining was observed in the TVT group compared with the TVT-O group after surgery (86.9 versus 23.9%, p<0.01). Mean operative time was significantly shorter in the TVT-O group (16.2 versus 28.6 min, p<0.01). The rate of objective cure was comparable for the TVT and TVT-O groups (94.5 versus 88.2%, p<0.05). However, subjective cure rate was significantly lower for the TVT-O than the TVT group (82.4 versus 93.4%, p=0.042). There was no statistical difference between the 2 groups regarding patient characteristics and complication rates., Conclusions: TVT-O tape results in a less acute angle and localises to a more distal part of the urethra, resulting in less urethral compression and a lower rate of urethral dynamic kinking.

Since the introduction of the use of the radial artery as the means of access for coronary angiography by Campeau in 1989 and for angioplasty by Kiemeneij and Laarman in 1993, this artery is increasingly becoming the preferred route of access for percutaneous coronary intervention. The two main driving forces behind this have been the colossal advances in technology that led to miniaturization of catheters and the excellent results achieved with regard to vascular complications, despite the aggressive use of multiple potent antiplatelet and anticoagulant agents during percutaneous coronary interventions. More and more interventional centers are in the process of setting up a transradial program to adopt the transradial approach. This article concentrates on the practical aspects of setting up a transradial program and offers practical advice on how to go about it.

We study a recently introduced model of one-component glass-forming liquids whose constituents interact with an anisotropic potential. This system is interesting per se and as a model of liquids such as glycerol (interacting via hydrogen bonds) which are excellent glass formers. We work out the statistical mechanics of this system, encoding the liquid and glass disorder using appropriate quasiparticles (36 of them). The theory provides a full explanation of the glass transition phenomenology, including the identification of a diverging length scale and a relation between the structural changes and the diverging relaxation times.

We develop an athermal shear-transformation-zone (STZ) theory of plastic deformation in spatially inhomogeneous, amorphous solids. Our ultimate goal is to describe the dynamics of the boundaries of voids or cracks in such systems when they are subjected to remote, time-dependent tractions. The theory is illustrated here for the case of a circular hole in an infinite two-dimensional plate, a highly symmetric situation that allows us to solve much of the problem analytically. In spite of its special symmetry, this example contains many general features of systems in which stress is concentrated near free boundaries and deforms them irreversibly. We depart from conventional treatments of such problems in two ways. First, the STZ analysis allows us to keep track of spatially heterogeneous, internal state variables such as the effective disorder temperature, which determines plastic response to subsequent loading. Second, we subject the system to stress pulses of finite duration, and therefore are able to observe elastoplastic response during both loading and unloading. We compute the final deformations and residual stresses produced by these stress pulses. Looking toward more general applications of these results, we examine the possibility of constructing a boundary-layer theory that might be useful in less symmetric situations.

To understand the molecular events of ovarian development in penaeid shrimp, RNA arbitrarily primed polymerase chain reaction (RAP-PCR) was used to identify differentially expressed genes during ovarian maturation in Metapenaeus ensis. From a screening of 700 clones in a cDNA library of the shrimp ovary by the products of RAP-PCR of different maturation stages, 91 fragments with differentially expressed pattern as revealed by dot-blot hybridization were isolated and sequenced. Forty-two of these fragments show significant sequence similarity to known gene products and the differentially expressed pattern of 10 putative genes were further characterized via Northern hybridization. Putative glyceraldehyde-3-phosphate dehydrogenase and arginine kinase are related to provision of energy for active cellular function in oocyte development. Translationally controlled tumor protein, actin, and keratin are related to the organization of cytoskeleton to accomplish growth and development of oocytes. High mobility group protein DSP1, heat shock protein 70, and nucleoside diphosphate kinase may act as repressors before the onset of ovarian maturation. Peptidyl-prolyl cis-trans isomerase and glutathione peroxidase are related to the stabilization of proteins and oocytes. This study provides new insights on the molecular events in the ovarian development in the shrimp.

Background: To analyze the urodynamic-defined prevalence of urinary incontinence and the associated risk factors in Taiwanese women with lower urinary tract symptoms (LUTS)., Methods: We reviewed the medical records of 4,470 women who were referred to our urodynamic center between January 1999 and May 2003. Their records including a comprehensive medical history, physical examination, bladder diary and results of multi-channel urodynamic testing were analyzed., Results: 3,161 of 4,470 women recruited were eligible for the analyses. The distribution of urodynamic prevalence in 3,161 women revealed that urodynamic stress incontinence (USI) was 1,755/3,161 (55.5%), detrusor overactivity (DO) 231/3,161 (7.3%), mixed incontinence (MI) 142/3,161 (4.5%), voiding dysfunction (VD) 793/3,161 (25.1%) and normal result (N) 240/3,161 (7.6%). The highest prevalence of USI was observed in women aged 40-49 (40.3%) and the prevalence of DO and MI seemed to be lower as compared with the literature reports. Linear regression analysis showed parity (p < 0.001) and three urodynamic study (UDS) variables [maximum free flow rate (p = 0.003), maximum urethral closure pressure (p = 0.003) and functional profile length (p = 0.014)] were significantly related to the urinary incontinence in women with LUTS. Menopause (p = 0.865) had no impact on the urinary incontinence., Conclusion: Risk factors contributing to Taiwanese women with LUTS to develop urinary incontinence included multiparity and three specific parameters observed during UDS. Of interest, our data also indicated 25% of patients were diagnosed as voiding dysfunction deserved future study.

Drag reduction by polymers is bounded between two universal asymptotes, the von Kármán log law of the law and the maximum drag reduction (MDR) asymptote. It is theoretically understood why the MDR asymptote is universal, independent of whether the polymers are flexible or rodlike. The crossover behavior from the Newtonian von Kármán log law to the MDR is, however, not universal, showing different characteristics for flexible and rodlike polymers. In this paper we provide a theory for this crossover phenomenology.

Background: Stopping oral anticoagulants prior to cardiac catheterization is associated with an increased risk of thromboembolism. Performing the procedures via the femoral artery and vein without interruption of anticoagulation is associated with a high rate of major access site complications. The transradial technique for left heart catheterization is safe in fully anticoagulated patients but few data are available on the percutaneous right and left heart catheterization utilizing a combination of the radial artery and antecubital vein in this group of patients., Methods: We report our experience in 28 consecutive patients that underwent left and right heart catheterizations via this percutaneous arm approach without interruption of anticoagulation. These were compared to 31 consecutive non-anticoagulated patients that underwent the procedure via a conventional femoral artery and vein approach., Results: Arterial and venous accesses were achieved and complete angiographic and hemodynamic data obtained in all patients. There were no access site complications in the anticoagulated patients despite an International normalized ratio (INR) of 2.5 +/- 0.5. Procedural duration was longer in the anticoagulated group of patients, but fluoroscopy time and patient radiation dose were similar in both groups., Conclusion: Our experience suggests that left and right heart catheterization can be safely performed in most fully anticoagulated patients using this technique with a low bleeding and thromboembolic risk and no increase in radiation exposure.

Purpose: We studied the efficacy of shortening the pre-implanted suburethral tape in patients with recurrent urodynamic stress incontinence after a TVT operation., Materials and Methods: A total of 14 women, including 6 with ISD, were treated for recurrent urodynamic stress incontinence after the initial TVT operation by performing the shortening procedure under local anesthesia. Urodynamics, a 1-hour pad test, introital ultrasonography of the urethra and a cotton swab test were done before the procedure and 1 year postoperatively., Results: All 14 patients completed the shortening procedure. Mean patient age was 47.2 years (range 43 to 66). Mean time between initial TVT and the shortening procedure was 4 months (range 3 to 14). Ten patients (71.4%) were objectively cured and treatment failed in 4 (2 with ISD and 2 with a fixed urethra). Mean operative time was 17 minutes (range 10 to 25). No intraoperative surgical complications were observed. The 1-hour pad test showed a decrease from a median of 9.0 gm to 1.0. Median postoperative hospital stay was 1 day (range 1 to 4). Spontaneous voiding with adequate post-void residual urine was noted in all patients before discharge home., Conclusions: Shortening a pre-implanted TVT tape for the treatment of recurrent urodynamic stress incontinence is a safe, effective and minimally invasive option requiring only a short hospital stay. However, ISD and an immobile urethra seem to be risk factors for failure. Long-term followup is needed to determine if this surgery achieves long-lasting results.

Drag reduction by bubbles in stationary turbulent flows is sensitive to the compressibility of the bubbles. Without this dynamical effect the bubbles only renormalize the fluid density and viscosity, an effect that by itself can only lead to a small percentage of drag reduction. We show in this paper that the dynamics of bubbles and their effect on the compressibility of the mixture can lead to a much higher drag reduction.

We present a lattice formulation of a dynamic self-consistent field (DSCF) theory that is capable of resolving interfacial structure, dynamics, and rheology in inhomogeneous, compressible melts and blends of unentangled homopolymer chains. The joint probability distribution of all the Kuhn segments in the fluid, interacting with adjacent segments and walls, is approximated by a product of one-body probabilities for free segments interacting solely with an external potential field that is determined self-consistently. The effect of flow on ideal chain conformations is modeled with finitely extensible, nonlinearly elastic dumbbells in the Peterlin approximation, and related to stepping probabilities in a random walk. Free segment and stepping probabilities generate statistical weights for chain conformations in a self-consistent field, and determine local volume fractions of chain segments. Flux balance across unit lattice cells yields mean field transport equations for the evolution of free segment probabilities and of momentum densities on the Kuhn length scale. Diffusive and viscous contributions to the fluxes arise from segmental hops modeled as a Markov process, with transition rates reflecting changes in segmental interaction, kinetic energy, and entropic contributions to the free energy under flow. We apply the DSCF equations to study both transient and steady-state interfacial structure, flow, and rheology in a sheared planar channel containing either a one-component melt or a phase-separated, two-component blend.

Objective: Our goal was to study the efficacy of performing the repeated sacrospinous ligament fixation with mesh interposition and reinforcement in women with recurrent vaginal vault prolapse., Materials and Methods: Fifteen consecutive patients with symptomatic severe vaginal vault or uterus prolapse after previous sacrospinous ligament fixation were enrolled. The sacrospinous ligament fixation was performed with a mesh interposition between sacrospinous ligament complex and vaginal apex. The mesh was extended to anterior and posterior vaginal wall for the repair of concurrent cystocele and rectocele, if indicated. The surgical results and complications were evaluated. The prolapse evaluation was performed according to International Continence Society (ICS) ordinal stages of pelvic organ prolapse., Results: The mean age was 55 years. The mean follow-up was 2.9 years (range 1.0-5.5 years). Repeated sacrospinous ligament fixation was performed for all patients. Eleven were performed unilaterally to the right and four to the left. The average time for sacrospinous fixation was 20 min. The average blood loss for sacrospinous fixation was 75 ml. No major complication except one accidental rectotomy was observed. It was repaired intraoperatively without sequel. The concurrent pelvic surgeries included vaginal total hysterectomies, anterior colporrhaphies, posterior colporrhaphies, and tension-free vaginal tape procedures. No recurrence of apical prolapse was observed. However, two patients developed stage I prolapse on anterior vaginal wall (cystocele) and required no further repair. Minor postoperative complications were observed., Conclusion: Repeated sacrospinous ligament fixation with mesh interposition and reinforcement is a safe and effective procedure for the correction of recurrent vault prolapse. The extended implanted mesh can be used for the repair of concurrent cystorectocele effectively. A long-term follow-up is necessary to detect any late complication.

Objectives: To compare the efficacy and safety of the conventional caudocranial tension-free vaginal tape (TVT) procedure and craniocaudal TVT procedure for the treatment of primary stress urinary incontinence., Methods: Ninety patients with urodynamic stress incontinence and without prolapse underwent a caudocranial TVT (45 women) or craniocaudal TVT (45 women) procedure. The two patient groups were comparable in terms of age, parity, body weight, previous pelvic surgery, and menopausal status. Both methods were performed under local anesthesia with adequate sedation. Introital ultrasound evaluation on the mid-urethra TVT tapes and urodynamic evaluation was performed before and after surgery., Results: The average follow-up period for caudocranial TVT and craniocaudal TVT was 1.9 years and 1.4 years, respectively. Objective evaluations were performed at similar times at 1 year postoperatively. No significant differences were found in the cure rate at 88.9% (40 of 45 women) after caudocranial TVT and 91.1% (41 of 45 women) after craniocaudal TVT (P = 1.000). The intraoperative complications were minor. No patient had long-term voiding difficulty or required long-term catheterization. Both groups had the vaginal tape implanted at the mid-urethra, with a urethral knee angle observed during maximal straining. A more proximal tape position, less elasticity of the tape, and more obstruction by the sling were found using the craniocaudal approach. Postoperative dysfunctional voiding was minor., Conclusions: The caudocranial and craniocaudal TVT procedures are highly effective, minimally invasive, and safe procedures in the treatment of urinary stress incontinence. The variations in implanted tape position and postoperative sling obstruction were most likely caused by the mode of insertion.

We have developed a dynamic self-consistent field theory, without any adjustable parameters, for unentangled polymer blends under shear. Our model accounts for the interaction between polymers, and enables one to compute the evolution of the local rheology, microstructure, and the conformations of the polymer chains under shear self-consistently. We use this model to study the interfacial dynamics in sheared polymer blends and make a quantitative comparison between this model and molecular dynamics simulations. We find good agreement between the two methods.

Objective: To evaluate the effectiveness and safety of placing tension-free vaginal tape (TVT) during a laparoscopically assisted vaginal hysterectomy (LAVH) in women with stress urinary incontinence and coexistent benign gynaecological disease., Design: Retrospective clinical study (Canadian Task Force classification II-2)., Sample: Thirty patients diagnosed with genuine stress incontinence and benign gynaecological disease were studied., Methods: All the patients underwent LAVH and concomitant TVT procedure., Results: There was no significant difference in urodynamic parameters before and after surgery. All patients were followed postoperatively for a mean duration of 24.6 +/- 11.5 months (range 12-40). The cure rate of stress urinary incontinence was 96.7%., Conclusions: Concomitant placement of tension-free vaginal tape during a laparoscopically assisted vaginal hysterectomy proved to be an efficacious and safe procedure for women with benign gynaecological disease and coexistent stress urinary incontinence.

Objective: To evaluate the influence of intracervical saline injection on inexperienced operators and on laparoscopically assisted vaginal hysterectomy (LAVH)., Study Design: This retrospective study included 273 women undergoing LAVH. From July 1997 to June 2002, 138 LAVHs were performed with laparoscopically approached colpotomies and bladder mobilization. Among 135 LAVHs with a vaginal approach, colpotomies/bladder mobilization was done directly in 62 and in the other 73 after a circumferential intracervical saline injection. All operations were performed by inexperienced operators under the supervision of senior surgeons. Blood loss, operative time and complications were analyzed., Results: The average follow-up period was 41.2 +/- 17.4 months (range, 12-72). No statistically significant differences were observed in age, hemoglobin levels or length of postoperative hospital stay. The incidence of postoperative infection, hematoma and bowel injury was not significantly different. LAVH with vaginal colpotomies/bladder mobilization and intracervical saline injection was associated with the smallest estimated blood loss (p = 0.002) and operative time (p < 0.001). LAVH with laparoscopic colpotomies and bladder mobilization had the longest operative time (p<0.001) and the highest bladder injury rate (p= 0.004)., Conclusion: A circumferential injection of normal saline at the cervicovaginal junction is a good option for inexperienced operators.

The objective of this retrospective study was to compare the prevalence of community-associated methicillin-resistant Staphylococcus aureus (CAMRSA) and healthcare-associated MRSA (HAMRSA) using healthcare risk factor exposure criteria with that obtained using Centers for Disease Control and Prevention (CDC) criteria. Cases were defined as CAMRSA or HAMRSA based on the general CDC guidelines for nosocomial infections, and then re-assessed with healthcare risk factor exposure criteria using a medical chart review. One hundred MRSA cases occurred at a mid-Western veterans affairs medical centre from November 2001 to November 2003. The proportion of these cases classified as CAMRSA differed dramatically when classified by healthcare risk factor exposure criteria (5%) compared with CDC nosocomial infection criteria (49%). Estimating the role of healthcare-related exposures and developing strategies to control MRSA can be markedly affected by the criteria used to determine CAMRSA and HAMRSA.

We address the additive equivalence discovered by Virk and co-workers: drag reduction affected by flexible and rigid rodlike polymers added to turbulent wall-bounded flows is limited from above by a very similar maximum drag reduction (MDR) asymptote. Considering the equations of motion of rodlike polymers in wall-bounded turbulent ensembles, we show that although the microscopic mechanism of attaining the MDR is very different, the macroscopic theory is isomorphic, rationalizing the interesting experimental observations.

We provide an analytic theory to explain Anghel et al's recent numerical finding whereby a maximum in the global performance emerges for a sparsely connected competitive population [Phys. Rev. Lett. 92, 058701 (2004)]. We show that the effect originates in the highly correlated dynamics of strategy choice, and can be significantly enhanced using a simple modification to the model.

Isolation and characterization of androgenic hormone in decapod crustaceans depend on an effective bioassay of its action. In the present study, the effect of androgenic gland on ovarian development in the mud crab Scylla paramamosain was investigated with a view to develop a bioassay for androgenic hormone. Ovarian regression with degeneration of oocytes occurred in some female crabs implanted with androgenic gland in vivo. In vitro incubation of ovarian tissues at secondary vitellogenesis in extract of androgenic gland resulted in a significant decrease in amino acid uptake by the tissues. We propose that this inhibitory effect could be established as an effective bioassay for the isolation of androgenic hormone in the mud crab.

Objective: To report our experience on lateral excision of tape in women with iatrogenic urethral obstruction after the tension-free vaginal tape (TVT) procedure., Methods: Seven women had iatrogenic urethral obstruction based on their clinical and urodynamic findings. All underwent lateral excision of the tape using the vaginal approach. Lower urinary tract symptoms, postvoid residual volume and urodynamic data were evaluated before and after excision., Results: Before excision, all subjects had either irritative symptoms or increased postvoid residual volume (more than 100 mL), and 6 (85.7%) voided with strain. The mean time from initial surgery to tape excision was 28 days (range 4 to 108), with an average follow-up of 32 months (range 24-39). After the excision, voiding dysfunction was resolved in 6 of 7 patients. The remaining patient had significant improvement with only occasional symptoms of irritation. Two (28.6%) women reported recurrent stress incontinence and 1 (14.3%) required surgical treatment. The intervals for the 2 recurrent patients from TVT to excision were 4 days. The intervals for the 5 continent women were 15 to 108 days., Conclusion: Urethral obstruction after TVT is a relatively uncommon condition. It can be effectively treated with transvaginal lateral excision of the tape. Recurrent stress incontinence seems to be less likely to occur when the takedown procedure occurs beyond 14 days after the initial TVT operation.

We formulate a theory of agent-based models in which agents compete to be in a winning group. The agents may be part of a network or not, and the winning group may be a minority group or not. An important feature of the present formalism is its focus on the dynamical pattern of strategy rankings, and its careful treatment of the strategy ties which arise during the system's temporal evolution. We apply it to the minority game with connected populations. Expressions for the mean success rate among the agents and for the mean success rate for agents with k neighbors are derived. We also use the theory to estimate the value of connectivity p above which the binary-agent-resource system with high resource levels makes the transition into the high-connectivity state.

In today's medical care environment, clinicians are challenged to order clinically relevant, cost effective laboratory tests and antibiotic therapy. Together, physicians and laboratories must have guidelines and strategies that can provide quality patient care, while minimising costs and preventing further emergence of antimicrobial drug resistance. Five clinical vignettes that demonstrate these principles are presented.

Purpose of Review: Although the tension-free vaginal tape procedure has emerged as a feasible and effective alternative for a majority of urinary stress incontinence patients, the adaptation of the technique for genital prolapse has recently attracted much attention. This review focuses on the development of the tension-free vaginal tape procedure performed with transvaginal pelvic reconstructive surgery., Recent Finding: Articles since 1 April 2003 with older articles included for historical purposes were focused. Tension-free vaginal tape procedures used in prolapse surgery have mainly been performed according to the original technique. Adjustment of the vaginal tape is carried out after completion of the necessary prolapse procedures. The objective and subjective cure rate for urinary incontinence after tension-free vaginal tape with concurrent prolapse procedures is between 84.9 and 94%, and 67.3 and 88.6%, respectively. The mean complication rate, bladder perforation rate, transient urinary retention rate, period of catheterization and postoperative hospital stay are between 2.7 and 34%, 0 and 13%, 9 and 43%, 3.7 and 5.1 days, and 3.4 and 6.9 days, respectively. The implanted vaginal tape seems to 'give way' to the urethra and causes no urinary obstruction at least in studies with a short follow-up period., Summary: The tension-free vaginal tape procedure performed with concurrent pelvic relaxation surgery appears to be a safe and effective treatment for urinary stress incontinence with co-existing vaginal pelvic prolapse. The implanted vaginal tape is prolapsed with the adjacent pelvic tissue, but the possibility of voiding dysfunction needs to be observed in a longer follow-up period.

Transradial cardiac catheterization is an increasingly popular technique mainly because of the low vascular complication rate. We report a case of arm deep vein thrombosis that may be related to a common puncture site hemostasis technique. This complication supports the use of specific unilateral compression hemostatic systems following transradial procedures., (Copyright 2004 Wiley-Liss, Inc.)

Objectives: To evaluate the anatomic changes in the polypropylene mesh sling after a tension-free vaginal tape (TVT) procedure using introital ultrasonography in a prospective study., Methods: Eighty women with genuine stress incontinence but without pelvic relaxation syndrome underwent surgery. Introital ultrasound evaluation of the mid-urethra TVTs was performed after surgery., Results: Of the 70 women available for evaluation at postoperative year 3, 62 (88.5%) were objectively cured and 6 had improvement; in 2 patients, the procedure had failed. The measurement of the tape position from the bladder neck at the first and third year compared with the tape position at 1 month revealed no statistically significant differences. The tapes were located at the mid-urethra in 60 patients (85.7%) and at the proximal urethra in 10. The measurement of the tape from the lower margin of the symphysis pubis using the rectangular coordinate system showed the tape had a downward descent of 1.7 mm at 3 years of follow-up. The rate of descent decreased during the study period. The mean thickness and width of the tape increased with time. A urethral knee angulation during maximal straining was found in 60 patients (92%), with the tape positioned at the mid-urethra for the follow-up period., Conclusions: The observations of the tape position and characteristics suggest that shrinkage and compromise of the TVT sling does not occur. The TVT sling fixes to its original implanted site along the urethra and appears to slowly descend with the surrounding tissue with time. The urethra dynamic kinking contributes to the postoperative urinary continence when the TVT sling is placed at the mid-urethra.