Vesicoureteral reflux (VUR) is a common cause of urinary tract infection in children. The primary goals of managing VUR are to prevent pyelonephritis, renal damage, and long-term complications. Management may be either medical or surgical. The rationale of medical therapy is that spontaneous resolution of reflux often occurs with time. Surgical therapy is based on the principle that eliminating the reflux will minimize the likelihood of renal damage and other reflux related complications. Open ureteral reimplantation is 95~98% effective for correcting reflux, and has been the standard surgical treatment for many years. In recent years, the management of VUR has changed dramatically, mostly because of the widespread acceptance of endoscopic treatment. Optimal materials for endoscopic treatment need to be easy to inject, nontoxic, and not to migrate to other organs, result in minimal local inflammation, and be well encapsulated. Since the first clinical application of endoscopic treatment for VUR in 1984 employed subureteric polytetrafluoroethylene injection, the materials and techniques have improved considerably. Following the approval of dextranomer/hyaluronic acid by the U.S. Food and Drug Administration in 2001, the endoscopic treatment of VUR has become increasingly popular in many parts of the world. The combination of increased success, minimal morbidity, a reasonable safety profile, and short operative time has strengthened the role of endoscopic treatment for VUR. The long-term durability and reproducibility of results will make endoscopic treatment an effective alternative to antibiotic prophylaxis in low-grade reflux and to open surgery in high-grade reflux.
Antibiotic Prophylaxis ; Child ; Endoscopy ; Humans ; Inflammation ; Operative Time ; Pediatrics ; Polytetrafluoroethylene ; Pyelonephritis ; Replantation ; Reproducibility of Results ; United States Food and Drug Administration ; Ureter ; Urinary Tract Infections ; Vesico-Ureteral Reflux

PURPOSE: We aimed to evaluate the overall outcomes of endoscopic dextranomer/hyaluronic acid copolymer (Deflux) injection for vesicoureteral reflux (VUR) and analyze the factors predicting success. MATERIALS AND METHODS: A total 99 patients (58 males, 41 females) and 154 refluxing ureter units were treated with a endoscopic Deflux injection for VUR. At 3 months, radioisotope-voiding cystograms were performed to evaluate treatment responsiveness; success was defined as a resolving of VUR to less than grade I. We evaluated various perioperative factors such as gender, operation age, preoperative antibiotics duration, urinary tract infection, relative renal function and cortical defect, preoperative VUR grade, maximal flow rate in uroflowmetry, laterality of reflux, voiding dysfunction, constipation, orifice shape and trabeculation, injection technique, injection volume, number of punctures, and learning curve. RESULTS: The overall success rate was 62.3% (96/154) in refluxing ureter units (50.5% in patients). According to grade of VUR, the success rate was 87.5% (8/9), 82.2% (37/45), 67.8% (38/56), 33.3% (13/39), and 16.7% (1/6) in grade I, II, III, IV, and V, respectively (p=0.001). In multivariate analysis, preoperative VUR grade and mound morphology were identified as predictive factors (p<0.05). No significant surgery-related complications developed. CONCLUSIONS: Endoscopic Deflux injection for VUR was effective for grade I-III VUR, although the cure rate was low for grade IV-V. The factors predicting success were preoperative VUR grade and mound morphology.
Anti-Bacterial Agents ; Constipation ; Dextrans ; Endoscopy ; Humans ; Hyaluronic Acid ; Learning Curve ; Male ; Multivariate Analysis ; Punctures ; Ureter ; Urinary Tract Infections ; Vesico-Ureteral Reflux

We aimed to investigate the clinical value of persistent but downgraded vesicoureteral reflux (VUR) after dextranomer/hyaluronic acid (Dx/HA) injection in children. The medical records of 128 children (195 ureters) who underwent Dx/HA injections for VUR were reviewed. The incidences of pre- and post-operative febrile urinary tract infections (UTIs) were analyzed in children with or without persistent VUR on voiding cystourethrography (VCUG) 3 months postoperatively. The surgical results of VUR persistent children who underwent a single additional injection were assessed. The VUR resolved completely in 100 ureters (51.3%), was persistent in 95 ureters, and newly developed in 2 ureters. The incidence of pre/post-operative febrile UTIs were 0.35 +/- 0.39 per year and 0.07 +/- 0.32 per year in VUR resolved children (P < 0.001), and 0.76 +/- 1.18 per year and 0.20 +/- 0.61 per year in VUR persistent children (P < 0.001). A single additional Dx/HA injection (44 ureters) resolved VUR in 29 ureters (65.9%), and also reduced the VUR to grade I in 7 ureters (15.9%), II in 4 (9.1%), and III in 4 (9.1%). Even in children with persistent VUR after Dx/HA injection, the incidence of febrile UTIs decreased markedly. The VUR grade significantly decreases after single additional Dx/HA injection.
Antibiotic Prophylaxis ; Child ; Child, Preschool ; Dextrans/*therapeutic use ; Female ; Fever/complications/epidemiology ; Humans ; Hyaluronic Acid/*therapeutic use ; Incidence ; Male ; Retrospective Studies ; Treatment Outcome ; Urinary Tract Infections/complications/drug therapy/*epidemiology ; Vesico-Ureteral Reflux/*drug therapy/surgery

This study aimed to investigate pressure changes of renal pelvis and histological change of kidneys in a surgically induced sterile rabbit vesicoureteral reflux (VUR) model. Five rabbits served as a control group, 7 as the sham-operated group, and 8 served as the VUR group. Three weeks later, urodynamic studies were performed, and histological examinations evaluated degree of inflammation, fibrosis, and tubular damage in the kidneys. At a low infusion rate, renal pelvic pressure in the VUR group was stable until late filling phase and then increased slightly. At a high infusion rate, the renal pelvic pressures of the sham-operated and control groups were stable until late filling phase and then increased slightly, whereas the renal pelvic pressure in the VUR group steadily increased from mid filling phase. Focal thinning of the tubular epithelium and interstitial widening were observed in certain cortical areas of refluxing kidneys, without inflammatory cell infiltration. Obvious changes in the mean diameters of distal tubules and extracellular matrix volume fractions were observed in two highly refluxing kidneys. High pressure reflux with bladder instability may result in renal cortical changes.
Animals ; Disease Models, Animal ; Female ; Kidney/pathology/physiopathology ; Rabbits ; Urinary Bladder/pathology/physiopathology ; Urodynamics ; Vesico-Ureteral Reflux/etiology/*pathology/*physiopathology

This study evaluated the additive impact of ethylenediamine tetraacetic acid (EDTA) on erythrosine-mediated photodynamic therapy (PDT) against Streptococcus mutans (S. mutans) biofilm by measuring colony-forming units and applying confocal laser scanning microscopy. Fifty-six bovine incisors, free from dental caries or structural defects, were utilized in this study. Dentin specimens were created by cutting with a low-speed diamond disk under a continuous flow of water, resulting in dimensions of 6.0 mm × 3.0 mm × 2.0 mm. The specimens were categorized into 4 groups: Control, EDTA, PDT, and EDTA + PDT. S. mutans ATCC 25175 was employed to establish biofilm on the dentin specimens. A 17% EDTA solution was applied for 1 min. For PDT, erythrosine served as the photosensitizer. Finally, a light-emitting diode source (385 - 515 nm) was employed in this study. The PDT group exhibited a significantly lower bacterial count than both the control and EDTA groups (p < 0.001). The EDTA + PDT group demonstrated a significantly reduced bacterial count compared to the other 3 groups (p < 0.001). This study demonstrated that EDTA enhances the antimicrobial efficacy of PDT on S. mutans biofilm. Even at a low concentration of photosensitizer, the combination of EDTA and PDT yields a significant antibacterial effect.

This study aimed to compare the fluoride-releasing ability and degree of microbial attachment of a newly developed glass-hybrid restorative material (GH) with those of a high-viscosity glass ionomer (HvGIC), resin-modified glass ionomer (RMGI), and composite resin (CR). In addition, the correlation between fluoride-releasing ability and microbial attachment between materials was evaluated. Specimens were prepared in a disc shape and divided into 4 groups according to the materials (GH, HvGIC, RMGI, and CR). The fluoride release experiments were performed in each group (n = 15). The amount of fluoride released was measured on days 1, 3, 7, 14, 28, and 42 after storage. For the microbial attachment experiment, 12 specimens were produced per group using Mutans Streptococci (S.mutans ), a cariogenic microorganism. S. mutans was cultured on the specimens for 24 hours, and the number of bacteria was measured. GH had the highest cumulative fluoride release and showed a significant difference when compared with RMGI (p = 0.001) and CR (p < 0.0001). Microbial attachment was the lowest in GH; however, no significant difference was observed between the materials (p = 0.169). There was no significant correlation between fluoride release from materials and microbial attachment (p > 0.05). From this perspective, remineralization of low-mineralized areas could be expected due to the high fluoride release of GH, and the effect of delaying the progression of dental caries could be predicted from the low cariogenic microbial attachment. Therefore, GH might be a useful restorative material for treating immature permanent teeth with hypomineralized enamel. However, further studies are needed about the degree of remineralization of hypomineralized areas after restoration and the capacity to recharge fluoride.

PURPOSE: Our study aimed to determine whether the severity of damage to the contralateral testis by ipsilateral testicular torsion/detorsion in pubertal rats, which have an incomplete blood-testis barrier, is different from that in adult rats. MATERIALS AND METHODS: We divided pubertal (6 weeks, n=17) and adult (10 weeks, n=17) Sprague-Dawley (SD) rats into group S (sham; n=5), group O (orchiectomy; n=6), and group D (detorsion; n=6). After 4 hours' torsion of the ipsilateral testis, we applied orchiectomy (group O) and detorsion (group D) depending on the group and compared the histopathologic changes and germ cell apoptosis of the contralateral testis at the age of 13 weeks. RESULTS: In each age group, increased interstitial area, edema, and germ cell sloughing were observed in group D. The mean seminiferous tubule diameter decreased more in group D than in group S or O in each age group (p<0.05). The mean germ cell layer thickness and number of spermatids per tubule decreased more in group D than in group S or O in each age group; additionally, in group D, values decreased more in pubertal rats than in adult ones (p<0.05, respectively). The mean numbers of terminal deoxyuridine nick-end labeling (TUNEL)-positive cells were less than 1.0 in groups S and O, which was smaller than in group D (p<0.05); additionally, in group D, this value tended to be higher in pubertal rats than in adult ones (p=0.057). CONCLUSIONS: SD rats with a detorsioned testis had more severe damage to the contralateral testis than did those undergoing orchiectomy of the torsioned testis. Also, when comparing the severity of damage to the contralateral testis after ipsilateral torsion/detorsion between pubertal and adult rats, rats at a pubertal age, when most testicular torsions occur in clinical situations, had more severe damage than did those at an adult age.
Adult ; Age Factors ; Animals ; Apoptosis ; Blood-Testis Barrier ; Deoxyuridine ; Edema ; Germ Cells ; Humans ; Orchiectomy ; Rats ; Seminiferous Tubules ; Spermatic Cord Torsion ; Spermatids ; Testis

PURPOSE: This investigation was undertaken to determine the damage to the testes and epididymides following torsion and detorsion of the testes. MATERIALS AND METHODS: The right testes of 8-week-old male rats(n=30) were subjected to torsion for 10 min. At 0, 1, 4, 8, and 24 hours, and 1 week after the repair of a torsion, the ipsilateral and contralateral testes and epididymides were harvested. The mean number of spermatids per tubule, the mean seminiferous tubular diameter(MSTD), and the germinal epithelial cell thickness(GECT) were used to evaluate changes to the testes. The histologic changes to the epididymal ductal epithelium were also evaluated. RESULTS: The mean number of spermatids per tubule, GECT, and MSTD were significantly decreased in the 24-hour ipsilateral detorsion group, but minimal changes to ipsilateral testes were observed in the 1-week detorsion group. There was no evidence of histologic changes to the testes in any of the contralateral detorsion groups. The interstitial fibroblast proliferation and hemorrhage of the ipsilateral epididymis were found in the 4-hour detorsion group and increased in the 8-hour detorsion group. Interstitial fibroblast proliferation was prominent in the ipsilateral epididymis of the 24-hour detorsion group, but was only occasionally observed in the contralateral epididymides. Shortening of the tubular epithelial cell height and tubule dilatation were observed in the ipsilateral and contralateral epididymis 1 week after detorsion. CONCLUSIONS: Torsion/detorsion damage was found earlier and at a higher intensity in the epididymides than in the testes. This finding may be due to the protection afforded by the blood-testis barrier.
Male ; Humans ; Rats ; Animals

OBJECTIVES: This study investigated the epidemiologic features of the confirmed cases of Middle East Respiratory Syndrome (MERS) in Pyeongtaek St. Mary's Hospital, where the outbreak first began, in order to identify lessons relevant for the prevention and control of future outbreaks. METHODS: The patients' clinical symptoms and test results were collected from their medical records. The caregivers of patients were identified by phone calls. RESULTS: After patient zero (case #1) was admitted to Pyeongtaek St. Mary's Hospital (May 15-May 17), an outbreak occurred, with 36 cases between May 18 and June 4, 2015. Six patients died (fatality rate, 16.7%). Twenty-six cases occurred in the first-generation, and 10 in the second-generation. The median incubation period was five days, while the median period from symptom onset to death was 12.5 days. While the total attack rate was 3.9%, the attack rate among inpatients was 7.6%, and the inpatients on the eighth floor, where patient zero was hospitalized, had an 18.6% attack rate. In contrast, caregivers and medical staff showed attack rates of 3.3% and 1.1%, respectively. CONCLUSIONS: The attack rates were higher than those of the previous outbreaks in other countries. The outbreak spread beyond Pyeongtaek St. Mary's Hospital when four of the patients were moved to other hospitals without appropriate quarantine. The best method of preventing future outbreaks is to overcome the vulnerabilities observed in this outbreak, such as ward crowding, patient migration without appropriate data sharing, and the lack of an initial broad quarantine.
Caregivers ; Cross Infection ; Crowding ; Disease Outbreaks ; Epidemiology ; Gyeonggi-do* ; Humans ; Information Dissemination ; Inpatients ; Korea* ; Medical Records ; Medical Staff ; Middle East ; Quarantine

Purpose: Assessing the metastasis status of the sentinel lymph nodes (SLNs) for hematoxylin and eosin–stained frozen tissue sections by pathologists is an essential but tedious and time-consuming task that contributes to accurate breast cancer staging. This study aimed to review a challenge competition (HeLP 2019) for the development of automated solutions for classifying the metastasis status of breast cancer patients. Materials and Methods: A total of 524 digital slides were obtained from frozen SLN sections: 297 (56.7%) from Asan Medical Center (AMC) and 227 (43.4%) from Seoul National University Bundang Hospital (SNUBH), South Korea. The slides were divided into training, development, and validation sets, where the development set comprised slides from both institutions and training and validation set included slides from only AMC and SNUBH, respectively. The algorithms were assessed for area under the receiver operating characteristic curve (AUC) and measurement of the longest metastatic tumor diameter. The final total scores were calculated as the mean of the two metrics, and the three teams with AUC values greater than 0.500 were selected for review and analysis in this study. Results: The top three teams showed AUC values of 0.891, 0.809, and 0.736 and major axis prediction scores of 0.525, 0.459, and 0.387 for the validation set. The major factor that lowered the diagnostic accuracy was micro-metastasis. Conclusion In this challenge competition, accurate deep learning algorithms were developed that can be helpful for making a diagnosis on intraoperative SLN biopsy. The clinical utility of this approach was evaluated by including an external validation set from SNUBH.