Functional and histologic imaging of urinary bladder wall after exposure to psychological stress and protamine sulfate

To quantify the urinary bladder wall T1 relaxation time (T1) before and after the instillation contrast mixture in rats previously subjected to water avoidance stress (WAS) and/or acute exposure to protamine sulfate (PS). Female Wistar rats were randomized to receive either sham (control) or 1 h of WAS for ten consecutive days before the evaluation of nocturnal urination pattern in metabolic cages. T1 mapping of urinary bladder wall at 9.4 T was performed pre- and post- instillation of 4 mM Gadobutrol in a mixture with 5 mM Ferumoxytol. Subsequently, either T1 mapping was repeated after brief intravesical PS exposure or the animals were sacrificed for histology and analyzing the mucosal levels of mRNA. Compared to the control group, WAS exposure decreased the single void urine volume and shortened the post-contrast T1 relaxation time of mucosa- used to compute relatively higher ingress of instilled Gadobutrol. Compromised permeability in WAS group was corroborated by the urothelial denudation, edema and ZO-1 downregulation. PS exposure doubled the baseline ingress of Gadobutrol in both groups. These findings confirm that psychological stress compromises the paracellular permeability of bladder mucosa and its non-invasive assay with MRI was validated by PS exposure.

Assessment of sleep problems with the Insomnia Severity Index (ISI) and the sleep item of the Patient Health Questionnaire (PHQ-9) in cancer patients

Objective The objectives of this study were to examine sleep problems in cancer patients, to test the psychometric properties of the Insomnia Sleep Index (ISI) in comparison with the sleep item of the Patient Health Questionnaire-9 (PHQ-9), and to analyze disrupting factors which might cause the sleep problems. Methods A sample of 1026 mixed-site cancer patients in treatment at a German oncological rehabilitation clinic was examined. Results The reliability of the ISI was very good (Cronbach’s alpha = 0.92), and the results of the confirmatory factor analysis were acceptable. Females reported worse sleep quality (ISI mean: 13.7 ± 6.6) than males (10.7 ± 6.4). Sleep problems as measured with the PHQ-9 sleep item were markedly higher than those in the general population (effect size d = 1.15). Patients reported that, of the factors that disrupted their sleep, psychological factors (brooding, worries) were more relevant than symptom factors (pain, nocturnal urination, or restless legs). Conclusions The ISI is effective in detecting sleep problems in cancer patients. Normative studies with the ISI would be helpful for assessing ISI mean scores. Sex differences should be taken into account when groups of patients are compared. The sleep item of the PHQ-9 can be used in epidemiological studies.

Nocturnal Urination May Determine Dipping Status: A 24 Hour Ambulatory Blood Pressure Study.

P128 Non-dipping, i.e. failure to reduce blood pressure (BP) by 10% or more, is considered an important prognostic variable of 24h ambulatory blood pressure monitoring (ABPM). However, some people wake up, rise and go to urinate at night. Usually, 24h ABPM derived means include these rises in the nighttime BP mean, by presenting total-day and total night (TDTN) levels. In 80 consecutive patients (33 females) age 63±10years, undergoing 24h ABPM who reported waking up to urinate at night we compared TDTN with actual day-awake and night-sleep (DANS) levels. Daytime awake BP, and nighttime awake BP were 141±15/83±11, and 140±18/82±12mmHg respectively p≥0.16. Nocturnal BP was 128±16/71±10mmHg by TDTN and 126±16/70±10mmHg by DANS p≤0.00001. The difference between TDTN and DANS calculations, increased from 1.2±0.9/1.0±0.8mmHg in those who woke once a night(n=51) to 1.8±1.4/1.7±1.3mmHg in those who woke more frequently(n=29) p≤0.02. Nocturnal decline of BP by TDTN was 13±11/11±7, and by DANS 15±12/13±7mmHg p≤0.0001. Although the absolute difference between TDTN and DANS was small, the effect on nocturnal dip was profound. Average systolic BP (SBP) dipping was 9.3±0.1% for TDTN, and 10.5±0.1% for DANS p≤0.0003, and that of diastolic BP (DBP), 13.5±0.1% and 15.6±0.1%, respectively p≤0.0001. The prevalence of SBP non-dipping decreased from 51.3% by TDTN, to 35% by DANS p≤0.038, and that of DBP from 36.3% to 21.3% respectively p≤0.036. The TDTN non-dipping status of waking once (n=51), twice (n=22), or thrice or more (n=7) at night was 45.1%, 54.5%, and 100% for SBP p≤0.024, and for DBP it was 27.5%, 45.5%, and 71.4%, respectively p≤0.044. By DANS the number of non-dippers decreased substantially, as compared with TDTN for each number of awakenings, 37.3%, 40.9%, and 85.6% for SBP p≥0.051, and 15.7%, 22.7%, and 57.1% for DBP, p≤0.042. Inclusion of awake BP measurements during the night obscures the normal dipping pattern of ABPM, in people who wake up to urinate. Non-dipping increases with number of awakenings, and leads to its substantial overestimation. Thus in 24h ABPM, as in anything else, taking into account people’s actual behavior increases accuracy of results.