OBJECTIVE: To evaluate the usefulness of power spectral analysis on fetal heart rate variability as a new diagnostic method of fetal distress. STUDY DESIGN: Among 76 pregnant women who underwent computerized electronic fetal monitoring and cord blood gas analysis, we divided them into 3 groups, i.e.; normal fetus group (36), presumed distress group (26) and acidemic distress group (14). In order to perform linear analysis on the raw data of the fetal heart rate, after resampling, we performed Fourier transformation and investigated power distributions among very low frequency (VLF), low frequency (LF), high frequency (HF) bands, and autonomic balance (LF/HF). RESULTS: The results of the spectral analysis showed that in normal fetus group, the difference in the distribution of power spectrums of VLF, LF and HF was significantly higher than in presumed distress group and acidemic distress group. In fetal distress, the LF and VLF value (0.0023, 0.0437) were good predictors (sensitivity 97.5%, 75.0% and specificity 86.1%, 94.4%). The LF value (0.0013) was a good predictor in fetal acidemia (sensitivity 97.5% and specificity 86.1%). CONCLUSIONS: A computerized spectral analysis of fetal heart rate variation is a good predictor of fetal distress, which is made automatically and objectively.
Female ; Fetal Blood ; Fetal Distress* ; Fetal Heart* ; Fetal Monitoring ; Fetus ; Fourier Analysis ; Heart Rate, Fetal* ; Humans ; Pregnancy ; Pregnant Women ; Sensitivity and Specificity

BACKGROUND: Improvement of coagulation function by acute normovolemic hemodilution (ANH) is well evidenced in modern medical practice. It has been reported that there are fixed differences in the plasma concentrations of von Willebrand factor and factor VIII according to ABO blood types. Therefore, the changes of coagulation state among ABO blood types during ANH are expected but have not yet been studied. This study was designed to establish the changes of coagulation state among ABO blood types during ANH by intraoperative thrombelastography (TEG). METHODS: Fifty one healthy adult patients scheduled for spine surgery were enrolled in this study. All patients were grouped by ABO blood types and underwent ANH after the induction of general anesthesia. While autologous blood (25% of EBV) was procured, warmed 0.9% saline, 3 times the blood volume deficit, was infused to maintain normovolemia. Platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), factor VIII activity and TEG were performed to evaluate coagulation state before and after ANH. Statistical analysis was conducted to determine the dilutional effects and intergroup differences. RESULTS: Improvement of coagulation function after ANH was visible only by TEG, and not by PT, APTT or factor VIII activity. Fourteen of fifteen patients with type O blood showed decreased factor VIII activity to under the normal limit after ANH. In patients with blood type O, changes of APTT (P = 0.093, P = 0.086) and factor VIII activity (P = 0.001, P = 0.004) during ANH were remarkable in comparison with blood type B and AB. CONCLUSIONS: ANH enhances coagulation function evaluated by means of TEG. No difference was observed in terms of the changes of coagulation state among ABO blood types during ANH. However, ANH should be instituted cautiously in patients with type O blood because there is a possibility of impairing factor VIII activity.
Adult ; Anesthesia, General ; Blood Volume ; Factor VIII ; Hemodilution* ; Humans ; Partial Thromboplastin Time ; Plasma ; Platelet Count ; Prothrombin Time ; Spine ; Thrombelastography ; von Willebrand Factor

PURPOSE: The goal of this study was to investigate the long-term efficacy and safety of a mixture of polymethyl methacrylate (PMMA) and cross-linked dextran Lipen-10(R) used for penile augmentation under the physical impact generated during sexual intercourse. MATERIALS AND METHODS: From March 2010 to October 2011, a total of 20 patients with a mean age of 44 years (interquartile range, 20~70 years) who requested penile augmentation participated in this study. Lipen-10(R) filler is a mixture of 75% cross-linked dextran, 15% PMMA, and 10% hypromellose solution. With the patient in the supine position, Lipen-10(R) was injected into the subcutaneous tissue between the dartos fascia and Buck's fascia of the penis using a fanning technique. Penile length and circumference were measured before the procedure and six, 12, and 18 months after the procedure. Values were compared using the Student's t-test and the paired t-test. RESULTS: A total of 15 patients completed this study. The increases in circumference and length observed six months after the procedure were found to have been maintained without change at 12 and 18 months of follow-up. At 12 and 18 months of follow-up, no abnormal findings were observed. Pelvic magnetic resonance imaging conducted at 18 months of follow-up showed no trace of the injected filler having migrated to other sites, and the volume was well maintained. CONCLUSIONS: Lipen-10(R), a mixture of PMMA and cross-linked dextran, showed good durability and tolerability over 18 months of follow-up during which the participants were sexually active.
Coitus ; Dextrans* ; Fascia ; Follow-Up Studies* ; Humans ; Longevity* ; Magnetic Resonance Imaging ; Male ; Penis ; Polymethyl Methacrylate* ; Subcutaneous Tissue ; Supine Position

BACKGROUND: Hydroxyethyl starches (HES) solutions are the most commonly used colloids for treating hypovolemia and expanding plasma, but they compromise platelet function and reduce the level of coagulation factors. As opposed to other HES solutions, 6% HES (130/0.4) solution may influence hemostasis minimally due to its low mean molecular weight and degree of substitution. This study was designed to establish the safety of HES (130/0.4) infusion in the presence of massive blood loss. METHODS: Twelve healthy adult patients scheduled for spine surgery were enrolled in this study. Before the induction of general anesthesia, all patients underwent acute normovolemic hemodilution (ANH), which was independent of surgical stress and other confounding factors. While approximately 30% of the estimated blood volume was procured, the blood deficit was replaced with the same volume of 6% HES (130/0.4) solution. Hematocrit, platelet count, factor VIII activity and plasma fibrinogen concentration were determined and thrombelastography was performed to evaluate the hemodilution effect and hemostatic impairment before and after ANH. Statistical testing was conducted to analyze the effect of HES on hemostasis. RESULTS: Hematocrit, platelet count, factor VIII activity and plasma fibrinogen concentrations decreased significantly (P < 0.05 respectively) after the ANH. On comparing pre-ANH and post-ANH thrombelastographic findings, the R time was shortened (P = 0.045), the alpha angle increased (P = 0.01) and MA decreased (P = 0.003) significantly. CONCLUSIONS: Summarizing, little effect was observed on the hemostatic system when 20 ml/kg of 6% HES (130/0.4) solution was infused. HES (130/0.4) solution as used to maintain normovolemia during ANH may be free from bleeding risk.
Adult ; Anesthesia, General ; Blood Coagulation Factors ; Blood Platelets ; Blood Volume ; Colloids ; Factor VIII ; Fibrinogen ; Hematocrit ; Hemodilution ; Hemorrhage ; Hemostasis* ; Humans ; Hypovolemia ; Molecular Weight ; Plasma ; Platelet Count ; Spine ; Starch ; Thrombelastography

The purpose of this study was to investigate whether rhBMP-2 (BMP2) could induce synergistic effect with Pro-Root(R) MTA (MTA) in pulpotomized teeth in the rats. Healthy upper first molars from thirty-two, 10 weeks old, Sprague-Dawley rats were used for this investigation. The molars were exposed with round bur, and light pressure was applied with sterilized cotton to control hemorrhage. 1.2 grams of MTA cement was placed in right first molars as a control group. In left first molars, 1 microg of BMP2 was additionally placed on exposed pulps with MTA. All cavities were back-filled with light-cured glass-ionomer cements. The rats were sacrificed after 2 weeks and 7 weeks, respectively. Then histologic sections were made and assessed by light microscopy. Data were statistically analyzed via student t-test with SPSSWIN 12.0 program (p < 0.05). Inflammation observed in 2 weeks groups were severe compared to the 7 weeks groups. But the differences were not statistically significant. BMP2-addition groups had less inflammation than MTA groups in both periods, though these differences were also not statistically significant. In conclusion, the combination of BMP2 and MTA showed no differences with MTA only for pulpotomy of rat teeth.
Animals ; Hemorrhage ; Humans ; Inflammation ; Microscopy ; Molar ; Pulpotomy ; Rats* ; Rats, Sprague-Dawley ; Tooth* ; Pemetrexed

PURPOSE: The aim of the present study was to evaluate the effects of low-dose tamsulosin on sexual function in patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia. MATERIALS AND METHODS: A total of 138 male LUTS patients aged more than 50 years with an International Prostate Symptom Score (IPSS) > or =8 were enrolled in this open-label, multicenter, prospective, noncomparative observational study. Clinical assessments included IPSS, quality of life (QoL) index, International Index of Erectile Function (IIEF), Danish Prostate Symptom Score (DAN-PSS), and an early morning erection questionnaire. The data were recorded at baseline and at 1 and 3 months after treatment with tamsulosin 0.2 mg/d. Adverse events were analyzed in all patients. RESULTS: During the study period of 3 months, the IPSS and QoL index significantly improved from baseline by -11.40+/-9.40 and -1.11+/-1.36, respectively (p<0.001). However, there were no clinically relevant changes in total IIEF score (mean difference, 1.63+/-15.50; p=0.406) or the 5 subdomains (p>0.05). Furthermore, DAN-PSS weighted scores (AxB) showed no clinically relevant changes (mean difference on Q1, Q2, and Q3: -0.45+/-2.94, 0.27+/-2.50, and -1.27+/-2.27, p>0.05). In addition, there were no clinically significant changes in responses on the early morning erection questionnaire. CONCLUSIONS: Tamsulosin at the dose of 0.2 mg significantly improved the IPSS and the QoL index compared with baseline. However, tamsulosin did not exhibit any significant impact on sexual function or any negative impact on ejaculatory function.
Aged ; Ejaculation ; Erectile Dysfunction ; Humans ; Lower Urinary Tract Symptoms ; Male ; Prospective Studies ; Prostate ; Prostatic Hyperplasia ; Quality of Life ; Sulfonamides

PURPOSE: To investigate the tissue distribution of PDE5 isoforms in type 2 diabetic rat penile tissues. MATERIALS AND METHODS: We prepared ten male Otsuka Long-Evans Tokushima Fatty (OLETF) rats, which develop NIDDM naturally, and ten control male Long-Evans Tokushima Fatty (LETO) rats. An oral glucose tolerance test confirmed diabetes development in OLETF rats at 26 weeks. At 42 weeks, we checked serum glucose, testosterone, triglyceride, insulin, and adiponectin before sacrifice. We performed semi-quantitative multiplex RT-PCR for rat PDE5, PDE5A1, and PDE5A2. Immunohistochemistry was performed using mouse monoclonal anti-cGB-PDE5 and anti-smooth muscle alpha-actin. RESULTS: OLETF rats were significantly more hyperglycemic, hypogonadal, hyperinsulinemic, hypercholesterolemic, hypertriglycemic, and had lower adiponectin levels than LETO rats. Levels of PDE5 mRNA were decreased in OLETF rats, but there were no changes in PDE5A1 or PDE5A2 mRNA levels. CONCLUSION: Diabetes may contribute to decreased expression of PDE5 mRNA, but not PDE5A1 or PDE5A2, in rat penile tissue. Furthermore, serum free testosterone was decreased in diabetic rats. PDE5 has an important role in the development of diabetic erectile dysfunction, but it is not clear whether PDE5A1 and PDE5A2 gene have specific roles.
Actins ; Adiponectin ; Animals ; Cyclic Nucleotide Phosphodiesterases, Type 5 ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Erectile Dysfunction ; Glucose ; Glucose Tolerance Test ; Humans ; Immunohistochemistry ; Insulin ; Male ; Mice ; Muscles ; Penis ; Protein Isoforms ; Rats ; Rats, Inbred OLETF ; RNA, Messenger ; Testosterone ; Tissue Distribution

PURPOSE: To investigate the tissue distribution of PDE5 isoforms in type 2 diabetic rat penile tissues. MATERIALS AND METHODS: We prepared ten male Otsuka Long-Evans Tokushima Fatty (OLETF) rats, which develop NIDDM naturally, and ten control male Long-Evans Tokushima Fatty (LETO) rats. An oral glucose tolerance test confirmed diabetes development in OLETF rats at 26 weeks. At 42 weeks, we checked serum glucose, testosterone, triglyceride, insulin, and adiponectin before sacrifice. We performed semi-quantitative multiplex RT-PCR for rat PDE5, PDE5A1, and PDE5A2. Immunohistochemistry was performed using mouse monoclonal anti-cGB-PDE5 and anti-smooth muscle alpha-actin. RESULTS: OLETF rats were significantly more hyperglycemic, hypogonadal, hyperinsulinemic, hypercholesterolemic, hypertriglycemic, and had lower adiponectin levels than LETO rats. Levels of PDE5 mRNA were decreased in OLETF rats, but there were no changes in PDE5A1 or PDE5A2 mRNA levels. CONCLUSION: Diabetes may contribute to decreased expression of PDE5 mRNA, but not PDE5A1 or PDE5A2, in rat penile tissue. Furthermore, serum free testosterone was decreased in diabetic rats. PDE5 has an important role in the development of diabetic erectile dysfunction, but it is not clear whether PDE5A1 and PDE5A2 gene have specific roles.
Actins ; Adiponectin ; Animals ; Cyclic Nucleotide Phosphodiesterases, Type 5 ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Erectile Dysfunction ; Glucose ; Glucose Tolerance Test ; Humans ; Immunohistochemistry ; Insulin ; Male ; Mice ; Muscles ; Penis ; Protein Isoforms ; Rats ; Rats, Inbred OLETF ; RNA, Messenger ; Testosterone ; Tissue Distribution

Purpose: Several types of dermal fillers have been recently introduced and used for penile augmentation (PA). However, few studies have compared outcomes after the injection of different fillers. This study aimed to compare the clinical outcomes of hyaluronic acid (HLA), polylactic acid (PLA), and polymethyl methacrylate (PMA) filler injections, which are the most commonly used for aesthetic purposes. Materials and Methods: This prospective study was conducted for 24 weeks after a filler injection by a surgeon between March 2017 and December 2021. Healthy adult men complaining of small penis were enrolled. Penile girth, satisfaction, and injection-associated adverse events (AEs) were assessed at baseline and 4, 12, and 24 weeks after injection. Results: Of the 301 men who received filler injections, 125, 134, and 42 received HLA, PLA, and PMA fillers, respectively. The augmentation effect was in the order of PMA, HLA, and PLA, respectively, at 24 weeks (PMA vs. HLA, p<0.001; HLA vs. PLA, p=0.006). Satisfaction levels increased significantly at 24 weeks in all groups (each with p<0.001). However, the increase in satisfaction levels was smaller in the PMA group (PMA vs. HLA or PLA, p<0.05, for both penile appearance and sexual life). No serious or systemic AEs were recorded. Filler injection-associated local AEs in the HLA, PLA, and PMA groups occurred in 9 (7.2%), 16 (11.9%), and 6 (14.3%) men, respectively. There was no significant difference in AEs among the groups (p=0.299). Conclusions The augmentative effect was greater in the PMA group than in the HLA and PLA groups, whereas the increase in satisfaction levels was smaller in the PMA group. Our study demonstrated the clinical course of different types of fillers and suggests that the filler type should be selected after detailed counseling considering individual characteristics and preferences.

Purpose: Several types of dermal fillers have been recently introduced and used for penile augmentation (PA). However, few studies have compared outcomes after the injection of different fillers. This study aimed to compare the clinical outcomes of hyaluronic acid (HLA), polylactic acid (PLA), and polymethyl methacrylate (PMA) filler injections, which are the most commonly used for aesthetic purposes. Materials and Methods: This prospective study was conducted for 24 weeks after a filler injection by a surgeon between March 2017 and December 2021. Healthy adult men complaining of small penis were enrolled. Penile girth, satisfaction, and injection-associated adverse events (AEs) were assessed at baseline and 4, 12, and 24 weeks after injection. Results: Of the 301 men who received filler injections, 125, 134, and 42 received HLA, PLA, and PMA fillers, respectively. The augmentation effect was in the order of PMA, HLA, and PLA, respectively, at 24 weeks (PMA vs. HLA, p<0.001; HLA vs. PLA, p=0.006). Satisfaction levels increased significantly at 24 weeks in all groups (each with p<0.001). However, the increase in satisfaction levels was smaller in the PMA group (PMA vs. HLA or PLA, p<0.05, for both penile appearance and sexual life). No serious or systemic AEs were recorded. Filler injection-associated local AEs in the HLA, PLA, and PMA groups occurred in 9 (7.2%), 16 (11.9%), and 6 (14.3%) men, respectively. There was no significant difference in AEs among the groups (p=0.299). Conclusions The augmentative effect was greater in the PMA group than in the HLA and PLA groups, whereas the increase in satisfaction levels was smaller in the PMA group. Our study demonstrated the clinical course of different types of fillers and suggests that the filler type should be selected after detailed counseling considering individual characteristics and preferences.