The aim of this study was to investigate the relaxant effect of ethanol extract, fractions from Epimedium koreanum (E. koreanum) on penile corpus cavernosum smooth muscle (PCCSM) in a rabbit. The contractility on PCCSM was also evaluated with icariin, active major compound, from E. koreanum quantified using HPLC analysis. The pre-contracted PCCSM with 10 μM phenylephrine (Phe) was accumulatively treated with extract and fractions (n-hexane, ethyl acetate and n-butanol) from E. koreanum at concentrations of 1, 2, 3 and 4 mg/mL. Icariin was performed with final concentrations of 0.1, 1, 10 and 100 μM. The interaction of icariin with phosphodiesterase-5 (PDE-5) inhibitor, udenafil, was also examined on PCCSM contractility. Extract and three fractions had the relaxant effect on PCCSM in a dose-dependent manner and the maximum relaxation was obtained in ethyl acetate fraction. Icariin dose-dependently relaxed the PCCSM and efficiently enhanced the udenafil-induced relaxation at least two-fold. These results indicate the possibility that icariin fromE. koreanum may be a candidate for a new or alternative medicine in erectile dysfunction patients who do not completely respond to PDE-5 inhibitors.

BACKGROUND/OBJECTIVES: Male hypogonadism is a condition where the body does not produce enough testosterone and significantly impacts health. Age, obesity, genetics, and oxidative stress are some physiological factors that may contribute to testosterone deficiency.Previous studies have shown many pharmacological benefits of Schisandra chinensis (S. chinensis) Baillon as an anti-inflammatory and antioxidant. However, the molecular mechanism of attenuating hypogonadism is yet to be well established. This research was undertaken to study the effects of S. chinensis extract (SCE) on testosterone deficiency.MATERIALS/METHODS: S. chinensis fruit was pulverized and extracted using 60% aqueous ethanol. HPLC analysis was performed to analyze and quantify the lignans of the SCE. RESULTS: The 2,2-diphenyl-2-picrylhydrazyl and 2,2’-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) scavenging assays confirmed that the SCE and its major lignans (schisandrol A and gomisin N) inhibit oxidative stress. Effects of SCE analysis on the testosterone level under oxidative stress conditions revealed that both schisandrol A and gomisin N were able to recover the lowered testosterone levels. Through mRNA expression of TM3 Leydig cell, we observed that the SCE lignans were able to induce the enzymes involved in testosterone biosynthesis-related genes such as 3β-HSD4 (P < 0.01 for SCE, and P < 0.001 for schisandrol A and gomisin N), 17β-HSD3 (P < 0.001 for SCE, schisandrol A and gomisin N), and 17, 20-desmolase (P < 0.01 for schisandrol A, and P < 0.001 for SCE and gomisin N). CONCLUSIONS These results support that SCE and its active components could be potential therapeutic agents for regulating and increasing testosterone production.

BACKGROUND: Among the various signs and symptoms of orbital fractures, certain clinical findings warrant immediate surgical exploration, including gaze restriction, computed tomographic (CT) evidence of entrapment, and prolonged oculocardiac reflex. Despite proper surgical reconstruction, prolonged complications such as diplopia and gaze restriction can occur. This article evaluated the prognostic factors associated with prolonged complications of orbital fractures with muscle incarceration. METHODS: The medical records of 37 patients (37 orbits) with an orbital fracture with muscle incarceration from January 2001 to January 2015 were reviewed. The presence of Incarcerated muscle was confirmed via CT, as well as by intraoperative findings. Various factors potentially contributing to complications lasting for over 1 year after the injury were categorized and analyzed, including age, cause of injury, injury-to-operation time, operative time, fracture type, nausea, vomiting and other concomitant symptoms and injuries. RESULTS: All patients who presented with extraocular muscle limitations, positive CT findings, and/or a positive forced duction test underwent surgery. Of the 37 patients, 9 (24%) exhibited lasting complications, such as diplopia and gaze restriction. The mean follow-up period was 18.4 months (range, 1–108 months), while that of patients who experienced prolonged complications was 30.1 months (range, 13–36 months). Two factors were significantly associated with prolonged complications: injury-to-operation time and nausea/vomiting. Loss of vision, worsening of motility, and implant complication did not occur. CONCLUSIONS: Patients who present with gaze limitations, with or without other signs of a blow-out fracture, require a thorough evaluation and emergent surgery. A better prognosis is expected with a shorter injury-to-operation time and lack of nausea and vomiting at the initial presentation.
Diplopia ; Follow-Up Studies ; Humans ; Medical Records ; Nausea ; Operative Time ; Orbit* ; Orbital Fractures* ; Prognosis ; Reflex, Oculocardiac ; Vomiting

BACKGROUND: Among the various signs and symptoms of orbital fractures, certain clinical findings warrant immediate surgical exploration, including gaze restriction, computed tomographic (CT) evidence of entrapment, and prolonged oculocardiac reflex. Despite proper surgical reconstruction, prolonged complications such as diplopia and gaze restriction can occur. This article evaluated the prognostic factors associated with prolonged complications of orbital fractures with muscle incarceration. METHODS: The medical records of 37 patients (37 orbits) with an orbital fracture with muscle incarceration from January 2001 to January 2015 were reviewed. The presence of Incarcerated muscle was confirmed via CT, as well as by intraoperative findings. Various factors potentially contributing to complications lasting for over 1 year after the injury were categorized and analyzed, including age, cause of injury, injury-to-operation time, operative time, fracture type, nausea, vomiting and other concomitant symptoms and injuries. RESULTS: All patients who presented with extraocular muscle limitations, positive CT findings, and/or a positive forced duction test underwent surgery. Of the 37 patients, 9 (24%) exhibited lasting complications, such as diplopia and gaze restriction. The mean follow-up period was 18.4 months (range, 1–108 months), while that of patients who experienced prolonged complications was 30.1 months (range, 13–36 months). Two factors were significantly associated with prolonged complications: injury-to-operation time and nausea/vomiting. Loss of vision, worsening of motility, and implant complication did not occur. CONCLUSIONS: Patients who present with gaze limitations, with or without other signs of a blow-out fracture, require a thorough evaluation and emergent surgery. A better prognosis is expected with a shorter injury-to-operation time and lack of nausea and vomiting at the initial presentation.
Diplopia ; Follow-Up Studies ; Humans ; Medical Records ; Nausea ; Operative Time ; Orbit* ; Orbital Fractures* ; Prognosis ; Reflex, Oculocardiac ; Vomiting

BACKGROUND: Smartphone addiction, academic stress and anxiety of university students are increasing gradually; however, few studies have investigated these factors in medical school students. Therefore, this study investigated associations between smartphone addiction scale and sociopsychological aspects in medical school students. METHODS: A total of 231 Yeungnam University College of Medicine students were enrolled in this study in March 2017. Gender, school grade, type of residence, and smartphone usage patterns of the students were surveyed. The Korean Smartphone Addiction Proneness Scale and each Korean version scale were used to assess sociopsychological aspects such as loneliness, stress and anxiety. RESULTS: There was a direct statistical correlation between loneliness, stress of negative perception, anxiety and smartphone addiction scales. There was also a negative statistical correlation between stress of positive perception and smartphone addiction scales. There was a higher level of anxiety among female students than male students. Additionally, there was a higher level of stress associated with negative perception and anxiety among medical students in the first grade than other students. Moreover there was a higher level of loneliness, stress of negative perception and anxiety among students who live with friends than students who live with their own family. CONCLUSION: Smartphone addiction scale and sociopsychological aspects significantly correlated. Moreover, the results suggest that female medical students in the first grade who have been separated from their family need more attention and management of loneliness, stress and anxiety to avoid smartphone addiction.
Anxiety ; Female ; Friends ; Humans ; Loneliness ; Male ; Schools, Medical* ; Smartphone* ; Students, Medical ; Weights and Measures

BACKGROUND: Smartphone addiction, academic stress and anxiety of university students are increasing gradually; however, few studies have investigated these factors in medical school students. Therefore, this study investigated associations between smartphone addiction scale and sociopsychological aspects in medical school students.METHODS: A total of 231 Yeungnam University College of Medicine students were enrolled in this study in March 2017. Gender, school grade, type of residence, and smartphone usage patterns of the students were surveyed. The Korean Smartphone Addiction Proneness Scale and each Korean version scale were used to assess sociopsychological aspects such as loneliness, stress and anxiety.RESULTS: There was a direct statistical correlation between loneliness, stress of negative perception, anxiety and smartphone addiction scales. There was also a negative statistical correlation between stress of positive perception and smartphone addiction scales. There was a higher level of anxiety among female students than male students. Additionally, there was a higher level of stress associated with negative perception and anxiety among medical students in the first grade than other students. Moreover there was a higher level of loneliness, stress of negative perception and anxiety among students who live with friends than students who live with their own family.CONCLUSION: Smartphone addiction scale and sociopsychological aspects significantly correlated. Moreover, the results suggest that female medical students in the first grade who have been separated from their family need more attention and management of loneliness, stress and anxiety to avoid smartphone addiction.
Anxiety ; Female ; Friends ; Humans ; Loneliness ; Male ; Schools, Medical ; Smartphone ; Students, Medical ; Weights and Measures

Familial Parkinson's disease (PD) has been linked to point mutations and duplication of the α-synuclein (α-syn) gene. Mutant α-syn expression increases the vulnerability of neurons to exogenous insults. In this study, we developed a new PD model in the transgenic mice expressing mutant hemizygous (hemi) or homozygous (homo) A53T α-synuclein (α-syn Tg) and their wildtype (WT) littermates by treatment with sub-toxic (10 mg/kg, i.p., daily for 5 days) or toxic (30 mg/kg, i.p., daily for 5 days) dose of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Tyrosine hydroxylase and Bcl-2 levels were reduced in the α-syn Tg but not WT mice by sub-toxic MPTP injection. In the adhesive removal test, time to remove paper was significantly increased only in the homo α-syn Tg mice. In the challenging beam test, the hemi and homo α-syn Tg mice spent significantly longer time to traverse as compared to that of WT group. In order to find out responsible proteins related with vulnerability of mutant α-syn expressed neurons, DJ-1 and ubiquitin enzyme expressions were examined. In the SN, DJ-1 and ubiquitin conjugating enzyme, UBE2N, levels were significantly decreased in the α-syn Tg mice. Moreover, A53T α-syn overexpression decreased DJ-1 expression in SH-SY5Y cells. These findings suggest that the vulnerability to oxidative injury such as MPTP of A53T α-syn mice can be explained by downregulation of DJ-1.
1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine ; Adhesives ; Animals ; Apoptosis ; Dopamine* ; Dopaminergic Neurons* ; Down-Regulation* ; Hominidae ; Humans ; Mice* ; Mice, Transgenic ; Neurons ; Parkinson Disease ; Point Mutation ; Synucleins ; Tyrosine 3-Monooxygenase ; Ubiquitin

BACKGROUND: Autologous or implant-based breast reconstruction after nipple-sparing mastectomy is increasingly preferred worldwide as a breast cancer treatment option. However, postoperative nipple-areola complex (NAC) necrosis is the most significant complication of nipple-sparing mastectomy. The purpose of our study was to identify the risk factors for NAC necrosis, and to describe the use of our skin-banking technique as a solution. METHODS: We reviewed cases of immediate autologous breast reconstruction after nipple-sparing mastectomy at our institution between June 2005 and January 2014. The patients' data were reviewed and the risk of NAC necrosis was analyzed based on correlations between patient variables and NAC necrosis. Moreover, data pertaining to five high-risk patients who underwent the donor skin-banking procedure were included in the analysis. RESULTS: Eighty-five patients underwent immediate autologous breast reconstruction after nipple-sparing mastectomy during the study period. Partial or total NAC necrosis occurred in 36 patients (43.4%). Univariate analysis and binary regression modeling found that body mass index, smoking history, radiation therapy, and mastectomy volume were significantly associated with NAC necrosis. Of the 36 cases of NAC necrosis, 31 were resolved with dressing changes, debridement, or skin grafting. The other five high-risk patients underwent our prophylactic skin-banking technique during breast reconstruction surgery. CONCLUSIONS: NAC necrosis is common in patients with multiple risk factors. The use of the skin-banking technique in immediate autologous breast reconstruction is an attractive option for high-risk patients. Banked skin can be used in such cases without requiring additional donor tissue, with good results in terms of aesthetic and reconstructive outcomes.
Bandages ; Body Mass Index ; Breast Neoplasms ; Breast* ; Debridement ; Female ; Humans ; Mammaplasty* ; Mastectomy* ; Necrosis* ; Nipples ; Risk Factors ; Skin ; Skin Transplantation ; Smoke ; Smoking ; Surgical Flaps ; Tissue Donors

BACKGROUND: The radial forearm flap is a versatile, widely used flap. However, the possibility of donor site complications has led to concern over its use. Some surgeons prefer using other flaps whose donor sites can be closed primarily with less morbidity, including avoiding unpleasant scarring. However, in our experience, donor site stability of the radial forearm flap can be reliably achieved by using well-implemented specific procedures. Here, we present a collection of donor site cases of the radial forearm flap and investigate factors that affect the aesthetic results as the basis for a reference for selecting a radial forearm flap. METHODS: In this retrospective study, we reviewed 171 cases in which a radial forearm flap was used for free tissue transfer after resecting head and neck cancer. We focused on donor site morbidity rates. Each operation involved a detailed procedure designed to minimize donor site morbidity. Moreover, statistical investigations were conducted for 22 cases to determine factors affecting the scar appearance. RESULTS: Only one case developed total skin graft necrosis as a major complication. Scar-related aesthetic results were acceptable, and the body-mass index, body weight, diabetes, and cardiac problems were significant factors related to the appearance of scars. CONCLUSIONS: Performing the radial forearm flap using a well-implemented detailed technique helps achieve acceptable donor site morbidity results. The aesthetic results were more promising for patients without excess body weight, diabetes, or cardiac problems. Therefore, anxiety about donor site morbidity should not be a reason to avoid selecting the radial forearm flap in suitable patients.
Anxiety ; Body Weight ; Cicatrix ; Esthetics ; Forearm* ; Free Tissue Flaps* ; Head and Neck Neoplasms ; Humans ; Necrosis ; Retrospective Studies ; Skin ; Skin Transplantation ; Tissue Donors* ; Transplants

BACKGROUND: The fibular free flap has been used as the standard methods of segmental mandibular reconstruction. The objective of mandibular reconstruction not only includes restored continuity of the mandible but also the recovery of optimal function. This paper emphasizes the advantage of the fibular free flap reconstruction over that of locking mandibular reconstruction plate fixation. METHODS: The hospital charts of all patients (n=20) who had a mandibular reconstruction between 1994 and 2013 were retrospectively reviewed. Eight patients had plate-only fixation of the mandible, and the remaining 12 had vascularized fibular free flap reconstruction. Complications and outcomes were reviewed and compared between the 2 groups via statistical analysis. RESULTS: Overall complication rates were significantly lower in the fibular flap group (8.3%) than in the plate fixation group (87.5%; p =0.001). Most (7/8) patients in the plate fixation group had experienced plate-related late complications, including plate fracture or exposure. In the fibular flap group, no complications were observed, except for a single case of donor-site wound dehiscence (1/12). CONCLUSION: The fibular free flap provides a more stable support and additional soft tissue support for the plate, thereby minimizing the risk of plate-related complications. Fibular free flap is the most reliable option for mandibular reconstruction, and we believe that the flap should be performed primarily whenever possible.
Free Tissue Flaps* ; Humans ; Mandible ; Mandibular Reconstruction* ; Retrospective Studies ; Wounds and Injuries