Recent studies (1) demonstrated that the intrinsic interactions between anionic surfactants and the stratum corneum of skin could be monitored from the displacement of a competitive protein-binding probe. The method correlated with direct measurements of surfactant binding and with clinical mildness. However, the level of strongly bound surfactant that remained after rinsing did not agree with an earlier study by Wortzman et al. (2) in which the rinsability of cleansing surfactants from skin was measured using fluorescein as a marker dye for the surfactants in bar slurries. This prompted the present careful reexamination of the fluorescein assay. It is shown that fluorescein does not track the binding of surfactants to skin and thus cannot measure any intrinsic interactions between a cleansing composition and the skin. Thus, the assay reported by Wortzman et al. actually measures the way fluorescein applied to skin from a solution or slurry is rinsed from the skin under unrealistic conditions employing a limited amount of ambient temperature water with no mechanical agitation. Not only do differences in fluorescein retention disappear under rinsing conditions that are more characteristic of everyday use, the differences between products primarily arise from differences in pH and counterion type and the consequent differences in fluorescein solubility. Thus, the assay measures fluorescein rinsability and does not measure the surfactant rinsability! Therefore, any conclusions reached about surfactant rinsability are erroneous, arise from an artifact of the test method, and have little to do with surfactant rinsability or mildness.
Spray coating and spray drying are widely used processes to produce free flowing capsules for a diverse range of applications. Numerous studies have employed water-soluble polymers as a wall material or matrix for such capsules. However, few fundamental studies have dealt with synthetic latex polymers even though the latter can have a number of advantages in these processes. The work reported here attempts to link the performance of latex polymers in spray coating and spray drying to the material properties of the latex and ultimately to its composition. Our studies indicate that the glass transition temperature of the latex, Tg, and its relationship to the processing temperatures characteristic of spray coating and spray drying, has a major effect on the quality of the capsules formed and their yield. Routes to manipulate polymer composition and latex morphology to achieve desired material properties are illustrated by a few examples.
OBJECTIVES: To determine if typical pre-operative clinical measures and validated questionnaires can consistently predict the risk of subjective failure following midurethral sling (MUS) procedures MATERIALS AND METHODS: This prospective cohort included 157 of 550 women who underwent MUS between 2006 and 2008, returned mailed PFDI/PFIQ surveys and met inclusion criteria. Pre-operative data included urodynamics, age, weight, menopausal status, prior incontinence and prolapse surgery, co-morbid diseases and concomitant reconstructive surgery. Subjective improvement was defined as achievement of the minimally important difference (MID) for the UDI-6, UIQ-7 and UDI stress subscale (Barber, AJOG 2009). RESULTS: Overall the mean age of the study sample was 57 years, parity 2.5, BMI 28 with a mean of 21 months of subjective follow-up. 23% had prior prolapse surgery and 5% had prior incontinence surgery. Following multivariate analysis, preoperative intrinsic sphincter deficiency (ISD) remained significantly associated with a lower symptom improvement on the UDI (P = 0.03) and failure to achieve the MID-UDI (P = 0.03). Subjects with high preoperative UIQ scores were more likely to achieve the MID on the UIQ postoperatively (P < 0.0001). On the UDI stress subscale, menopausal status was associated with achievement of the MID (P = 0.02) although advancing age predicted failure to achieve the MID (P = 0.02). Mean preoperative urodynamic parameters include MUCP of 43.1 cm H2O and LPP of 86.5 cm H2O. Twenty percent had straining Q-tip angles less than 30 degrees. MUCP ≤20 cm H2O and LPP ≤60 cm H2O identified ISD equally (12.9%). The MUS was performed with anterior repair in 40.8% and with apical suspension in 34.4% and the cohort equally represented the retropubic and transobturator routes. The mean decrease in the UDI-6, UIQ-7 and UDI stress subscale scores was −34.0 (±29.3, range −87.5 to 33.3), −19.1 (±30.5, range −100 to 61.9) and −46.6 (±42.8, −100 to 75), respectively. Univariate analysis performed for each outcome measure showed that age, BMI, cystocele Grade/Stage, duration of follow-up, ISD and concomitant apical suspension were associated with less symptom improvement whereas the Q-tip angle, preoperative UIQ score and concomitant anterior repair predicted greater symptom improvement. CONCLUSION: Preoperative diagnosis of ISD was a consistent predictor of less subjective improvement after MUS in this cohort. We did not find the expected relationship between failure to achieve the MID and other clinical measures that have previously been associated with poor MUS outcome. Our results suggest that further studies are needed to effectively correlate preoperative indicators and subjective outcomes following MUS.
The interactions of stratum corneum proteins with formulated cleansing bar compositions as well as with several of their constituent surfactants were studied by a steady-state fluorescence probe technique. The binding of anionic surfactants to corneum proteins was monitored by their displacement of the well known protein-binding fluorescence probe ANS (1-anilinonaphthalene-8-sulfonic acid). The changes in fluorescence generally correlated with direct measurements of surfactant binding to the corneum using radiolabeled pure surfactants. The results indicate that both a high-glycerol triethanolammonium soap based cleansing bar composition and a pure-alkali metal soap composition appear to have higher binding affinity for corneum proteins and leave more residue bound to these proteins after rinsing than cleansing bars based on the synthetic detergent, sodium fatty acyl isethionate. The extent of surfactant binding to the corneum proteins in a realistic washing situation correlates well with clinical measurements of the in vivo harshness potential of these cleansers. The pitfalls in using other probe molecules, such as fluorescein, that possess hydrolyzable groups to quantify surfactant binding and the correct interpretation of the data are also discussed.
Five anally continent nulliparas of reproductive age were studied with magnetic resonance imaging. The internal and external anal sphincters could be easily delineated, as could the intervening longitudinal musculature, puborectalis muscle, anococcygeal raphe, anorectal lumen, vagina, uterus, bladder, urethra, coccyx, and pubis. The shape of the sphincters was nearly cylindrical, with an anterior component averaging 18.3 mm thick and 28.0 mm long. Fifty-four percent of this anterior thickness was attributable to the internal sphincter. The anorectal angle varied considerably, with a mean of 86.8 ± 19.1° (range 60-112). The angle between the portion of the rectal lumen supported by the anococcygeal raphe, or levator plate, and the plane of the puborectalis muscle was consistent at 149.0 ± 6.3° (138-154). The finding of anterior anal sphincters with substantial thickness and length contrasts markedly with a view often pictured in the literature of a female anal sphincter that narrows anteriorly to half its posterior length and forms a small bundle of muscle rather than a broad band. Knowledge of these relationships is important in primary repair of obstetric sphincter lacerations as well as in surgical correction of anal incontinence.(Obstet Gynecol 76:846, 1990)
In Brief OBJECTIVE: More than 20,000 women, aged 70 years or older, undergo surgery for stress urinary incontinence each year. Our objective was to review the published randomized trials of the surgical treatment of stress urinary incontinence and estimate the proportion of women 70 years or older enrolled in those trials. DATA SOURCES: MEDLINE and Cochrane Databases of Clinical Trials were searched from January 1966 through December 2003 with the terms “urinary incontinence,” “stress incontinence,” “urethropexy,” “needle suspension,” “pubovaginal sling,” “tension-free vaginal tape,” “urethral injection,” “collagen injection,” “anterior colporrhaphy,” and “clinical trial,” “controlled trial,” or “randomized trial” as both subject headings and words contained in article titles. We supplemented this search with manual searches of meta-analyses and review articles from 2000 to 2003. METHODS OF STUDY SELECTION: All studies that included at least one group undergoing an invasive treatment for stress incontinence (including urethral bulking injections) were reviewed. We excluded reports without sufficient data to estimate the number of women aged 70 and older who participated, those published only in abstract form, and those studies in languages other than English, French, German, Italian, or Spanish. Twenty studies met our inclusion criteria. TABULATION, INTEGRATION, AND RESULTS: The number of women aged 70 or older in each study was estimated using the demographic data provided. The median percentage of subjects aged 70 or older was 3.8% (interquartile range 0.37–15%). There was no significant difference in the proportion of subjects 70 years of age or older based on the year of publication. CONCLUSION: Our review of the published literature suggests that elderly women are underrepresented in clinical trials of stress incontinence surgery. Efforts should be made to include more elderly women in clinical trials of stress incontinence surgery. Thousands of elderly women undergo surgical treatment for urinary leakage each year, but very few have been included in randomized controlled trials of incontinence surgery.
