PURPOSE: The incidences of four main vascular risk factors (VRFs) - diabetes mellitus (DM), smoking, hyperlipidemia (HLP), and obesity were investigated in men aged over 40 years with or without erectile dysfunction. PATIENTS AND METHODS: There were 943 patients with erectile dysfunction (mean age 55.0 years; range 40-73 years) and 242 normal men (mean age 50.6; range 40-71 years). Blood levels of various lipid fractions (triglycerides, total cholesterol, low-density lipoprotein, high-density lipoprotein), body weight, and height were measured in all subjects. Abnormal VRFs were defined as follows: hypertension = >160 mmHg (systolic pressure) or 95 mmHg (diastoic pressure), hyperlipidemia = at least one abnormal fraction (triglycerides > 160 mg/dl, total cholesterol >250 mg/dl, LDL >150 mg/dl), and obesity = >120% of ideal body weight. The presence or absence of DM, hypertension, smoking, and erectile dysfunction was determined by a self-reported subject questionnaire and history. RESULTS: The incidence of abnormal LDL was significantly (p<0.05) higher in patients than the control men. The incidences of HLP, DM, and hypertension were significantly (all p<0.05) higher in the patients 40 to 59 years of age than in the control men of corresponding ages, but differences in the incidences of smoking and obesity were not statistically significant. Abnormal VRFs were significantly (all p<0.01) more common in patients aged 40 to 59 years than in the control men of the same ages. In men over 60 years of age, there were no differences between the patients and control subjects in number of VRFs or the incidences of HLP, DM, and hypertension. CONCLUSIONS: Especially in men 40 to 59 years of age, DM, HLP, and hypertension were significantly correlated with erectile dysfunction. The aging process, rather than such specific risk factors, might be a main cause of erectile dysfunction in men aged over 60 years.
Aging ; Body Weight ; Cholesterol ; Diabetes Mellitus ; Erectile Dysfunction* ; Humans ; Hyperlipidemias ; Hypertension ; Ideal Body Weight ; Incidence* ; Lipoproteins ; Male ; Obesity ; Surveys and Questionnaires ; Risk Factors* ; Smoke ; Smoking

PURPOSE: Dysbiosis of gut microbiota has been reported to participate in the pathogenesis of colorectal cancer, but changes in microbiota due to radiotherapy have not been studied. In this study, we tried to elucidate the changes in the microbiome in rectal cancer after chemoradiotherapy using RNA sequencing analysis.MATERIALS AND METHODS: We included 11 pairs of human rectal cancer tissues before and after irradiation between August 2016 and December 2017 and performed RNA sequencing analysis. Mapped reads to human reference genomes were used for pair-wise transcriptome comparisons, and unmapped (non-human) reads were then mapped to bacterial marker genes using PathSeq.RESULTS: At microbiome level, interindividual variability of mucosal microbiota was greater than the change in microbial composition during radiotherapy. This indicates that rapid homeostatic recovery of the mucosal microbial composition takes place short after radiotherapy. At single microbe level, Prevotella and Fusobacterium, which were identified as important causative microbes of the initiation and progression of rectal cancer were decreased by radiotherapy. Moreover, changes in Prevotella were associated with changes in the human transcriptome of rectal cancer. We also found that there was a gene cluster that increased and decreased in association with changes in microbial composition by chemoradiation.CONCLUSION: This study revealed changes in tumor-associated microbial community by irradiation in rectal cancer. These findings can be used to develop a new treatment strategy of neoadjuvant therapy for locally advanced rectal cancer by overcoming radio-resistance or facilitating radio-sensitivity.
Chemoradiotherapy ; Colorectal Neoplasms ; Dysbiosis ; Fusobacterium ; Gastrointestinal Microbiome ; Genes, vif ; Genome ; Humans ; Microbiota ; Neoadjuvant Therapy ; Prevotella ; Radiotherapy ; Rectal Neoplasms ; Sequence Analysis, RNA ; Transcriptome

Penile necrosis is a rare, serious complication of penile prosthesis implantation. Severas factors, including systemic disease, compressive dressing, hematoma, edema, indwelling urethral catheter, and local infection may contribute to the complication. We report two cases of penile necrosis caused by hematoma and compressive dressings applied to control the bleeding.
Bandages ; Edema ; Hematoma ; Hemorrhage ; Necrosis ; Penile Implantation ; Penile Prosthesis* ; Urinary Catheters

PURPOSE: To evaluate the effectiveness of transurethral microwave thermotherapy (TUMT) using the Prostatron with Prostasoft 2.5 software in the patients with benign prostatic hyperplasia(BPH). PATIENTS AND METHODS: Patients with a Madsen symptom score (MSS) and International Prostate Symptom Score (IPSS) of 8 or more and a maximal uroflow rate of 15mL/sec or less were treated. Fifty-five patients (mean age 64.5 years, range 54~75 years) were followed up for 3 months and 23 patients (mean age 63.9 years, range 52~72 years) for 6 months. The MSS, IPSS, and uroflowmetry values (maximal flow rate, average flow rate, delay time, flow time, voiding time, time to maximal flow, and postvoiding residual volume), and quality of life were measured at baseline and 3 and 6 months after TUMT. RESULTS: The MSS (14.7 vs. 5.42, 14.2 vs. 3.90), IPSS (21.6 vs. 9.57, 20.0 vs. 6.73), and quality of life (4.37 vs. 2.53, 4.24 vs. 1.86) were significantly improved at 3 and 6 months after treatment (p<0.01). All uroflowmetry values except delay time were significantly improved at 3 months (p<0.01); at 6 months, the maximal flow rate (11.0 vs. 14.3 mL/sec), residual urine (70.3 vs. 22.6 mL) (p<0.01), and average flow rate (5.26 vs. 7.19 mL/sec) (p<0.05) were improved. CONCLUSIONS: High-energy TUMT could be an effective and safe method for the treatment of symptomatic BPH. Further studies on the long-term outcome of this procedure are necessary.
Humans ; Prostatic Hyperplasia* ; Quality of Life ; Transurethral Resection of Prostate*

BACKGROUND: The nutritional status of critical-ill patients is important for recovering from the disease itself. Therefore, this present study was designed to assess the biochemical and nutritional parameters of Intensive-Care Unit (ICU) patients on mechanical ventilation. METHODS: We retrospectively reviewed the medicial records of 126 patients (male/female=72/54) who were on mechanical ventilationin the ICU. The nutritional parameters such as serum total protein, albumin, hemoglobin, hematocrit, calcium, phosphorus, total cholesterol, % lymphocytes, blood urea nitrogen (BUN), and creatinine (Cr) were measured at the beginning of mechanical ventilation. We also measured the outcome variables such as the duration of mechanical ventilation, the ICU length of stay and the hospitalization period. We analyzed the relationship between the nutritional parameters and the outcome variables of ICU patients on mechanical ventilation. RESULTS: The level of hemoglobin was negatively correlated with the outcome variables; the ICU length of stay (p<0.05), the hospitalized period (p<0.01), and the duration of mechanical ventilation (p<0.01). The creatinine level was positively correlated with the outcome variables; the ICU length of stay (p<0.01), the hospitalized period (p<0.01) and the duration of mechanical ventilation (p<0.05). On the multiple regression analysis, the serum total protein, albumin, calcium, inorganic phosphorus, BUN and creatinine were independent factors affecting the duration of mechanical ventilation. CONCLUSIONS: These findings indicate that ICU patients with mechanical ventilation have a risk for malnutrition and anemia. So, an adequate nutritional intervention is required for these patients in order to decrease the prevalence of malnutrition and anemia.
Anemia ; Blood Urea Nitrogen ; Calcium ; Cholesterol ; Creatinine ; Hematocrit ; Hospitalization ; Humans ; Length of Stay ; Lymphocytes ; Malnutrition ; Nutrition Assessment ; Nutritional Status ; Phosphorus ; Prevalence ; Regression Analysis ; Respiration, Artificial* ; Retrospective Studies

PURPOSE: The retroauricular flap has many advantages for facial reconstruction and is performed by many surgeons. However, it is difficult to perform due to limited rotation arc and length of pedicle. We successfully reconstructed the upper region of the auricle and its surroundings with retroauricular flap by using the superior auricular artery as a supplying pedicle. The purpose of this study is to present an anatomic study about the superior auricular artery and its clinical application. METHODS: We investigated the relationship between the superior auricular artery and its surrounding structures through anatomic studies with 7 fresh cadavers and then applied the findings clinically. From February to December 2008, we performed 7 cases of the superior auricular artery island flap to reconstruct the defects in patients operated on skin cancer. Sizes of the defects varied form 0.8 x 0.8 cm to 3.5 x 3.0 cm. RESULTS: We found that the superior auricular artery is a reliable pedicle for the retroauricular flap, based on anatomical studies. All wounds of the patients were successfully closed. The flap donor site was primary closed except in one patient with a large defect. The aesthetic outcomes of the donor and recipient sites were satisfactory. CONCLUSION: The superior auricular artery island flap has several advantages. Therefore, we suggest that the superior auricular artery island flap is a treatment of choice for reconstructing soft tissue defect at the upper region of the auricle and its surrounding area.
Arteries ; Cadaver ; Humans ; Skin Neoplasms ; Tissue Donors

PURPOSE: Stress is associated with depression, which induces many psychiatric disorders. Serotonin, also known as 5-hydroxy-tryptamine (5-HT), acts as a biochemical messenger and regulator in the brain. It also mediates several important physiological functions. Depression is closely associated with an overactive bladder. In the present study, we investigated the effect of treadmill exercise on stress-induced depression while focusing on the expression of 5-HT 1A (5-H(1A)) receptors in the dorsal raphe. METHODS: Stress was induced by applying a 0.2-mA electric foot shock to rats. Each set of electric foot shocks comprised a 6-second shock duration that was repeated 10 times with a 30-second interval. Three sets of electric foot shocks were applied each day for 7 days. For the confirmation of depressive state, a forced swimming test was performed. To visualize the expression of 5-HT and tryptophan hydroxylase (TPH), immunohistochemistry for 5-HT and TPH in the dorsal raphe was performed. Expression of 5-H(1A) receptors was determined by western blot analysis. RESULTS: A depressive state was induced by stress, and treadmill exercise alleviated the depression symptoms in the stress-induced rats. Expressions of 5-HT, TPH, and HT 1A in the dorsal raphe were reduced by the induction of stress. Treadmill exercise increased 5-HT, TPH, and HT 1A expressions in the stress-induced rats. CONCLUSIONS: Treadmill exercise enhanced 5-HT synthesis through the up-regulation of 5-HT(1A) receptors, and improved the stress-induced depression. In the present study, treadmill exercise improved depression symptoms by enhancing 5-HT(1A) receptor expression. The present results suggest that treadmill exercise might be helpful for the alleviation of overactive bladder and improve sexual function.
Animals ; Blotting, Western ; Brain ; Depression* ; Exercise Test ; Exercise* ; Foot ; Immunohistochemistry ; Physical Exertion ; Rats* ; Receptor, Serotonin, 5-HT1A* ; Serotonin ; Shock ; Stress, Psychological ; Tryptophan Hydroxylase ; Up-Regulation* ; Urinary Bladder, Overactive

BACKGROUND: Electroconvulsive therapy (ECT) is effective for major psychosis and affective disorder. The ideal anesthetics for ECT provide rapid induction and recovery, and they attenuate the adverse effects of ECT. We compared the effects of etomidate, propofol and thiopental sodium during ECT. METHODS: Nine patients were enrolled in this double blinded cross over design study. The ECT was done 3 times per week for two weeks. We monitored the patients with electrocardiography, pulse oximetry, the bispectral index score and the blood pressure. We recorded the data at the time of arrival to the therapy room, just before ECT and at 1, 2, 3, 4, 5, 7 and 10 minutes after ECT. Hypnosis was induced with 3 mg/kg of thiopental sodium (group T), 1.5 mg/kg of propofol (group P) or 0.15 mg/kg of etomidate (group E). The ECT was done after administering 1 mg/kg of succinylcholine. The duration of seizure were measured after ECT. RESULTS: There were significantly different durations of motor seizure among the three groups. The duration of EEG seizure in group E was longer than that of group P and group T. The blood pressure and the heart rate of group P were significantly lower than that of the other groups (P < 0.05). CONCLUSIONS: Compared to thiopental sodium and etomidate, propofol was not associated with clinically significant changes in the duration of seizure and hemodynamic stability. It has a good hypnotic effect and it did not affect the therapeutic efficacy of ECT. Etomidate is effective for patients for achieving a short duration of seizure after ECT is applied.
Anesthetics ; Blood Pressure ; Cross-Over Studies ; Electrocardiography ; Electroconvulsive Therapy ; Electroencephalography ; Etomidate ; Heart Rate ; Hemodynamics ; Humans ; Hypnosis ; Hypnotics and Sedatives ; Mood Disorders ; Oximetry ; Propofol ; Psychotic Disorders ; Seizures ; Succinylcholine ; Thiopental

To validate ventricular diastolic phase parameters of reconstructed transmitral flow rate curve by M-mode, 2-dimensional and pulsed Doppler Echocardiography, these parameters were compared with same parameters by left ventriculography. The study population was 22 patients who received both coronary arteriography and echocardiographic examination. Transmitral flow rate curve and left ventricular filling volume curve were reconstructed from transmitral flow velocity curve by pulsed Doppler, mitral annulus diameter by two diameter by two dimensional and diastolic motion of both mitral leafltes by M-mode echocardiography. From left ventriculography, left ventricular filling volume curve and transmitral flow rate curve were made using area-length method by Sandler and Dodge. From trasmitral flow fraction, 1/2 diastolic time filling fraction, normalized peak filling volume, 1/3 diastolic time filling fraction, 1/2 diastolic time fraction, normalized peak early filling rate and ratio of early to late peak filling rate were measured. Correlation between same parameters derived from echocardiography and left ventriculography were observed. 1) Total diastolic filling volume:correlation coefficient r=0.47, P<0.05. 2) 1/3 diastolic time filling fraction:correlation coefficient r=0.90, P<0.001. 3) 1/2 diastolic time filling fraction:correlation coefficient r=0.80, P<0.001. 4) Normalized peak early filling rate:correlation coefficient r=0.57, P<0.01. 5) Ratio of early to late peak filling rate:correlation coefficient r=0.85, P<0.001. Therefore, left ventricular diastolic phase parameters of reconstructed transmitral flow rate curve using, M-mode, 2-dimensional and pulsed Doppler echocardiography seems to be useful for the noninvasive evaluation of the left ventricular diastolic function.
Angiography ; Echocardiography ; Echocardiography, Doppler* ; Echocardiography, Doppler, Pulsed ; Humans

Acute fatty liver of pregnancy are relatively rare but extremely dangerous, because they may quickly develop into a fulminant disease and become a serious life-threatening disorder for mother and fetus in the third trimester. Therefore, early diagnosis, prompt delivery and intensive supportive care the cornerstones in the management of acute fatty liver of pregnancy. Clinical findings in acute fatty liver of pregnancy vary because it may occur with varying degrees of clinical severity and in conjunction with other third trimester symptoms, making early diagnosis difficult. However, careful history and physical examination, in conjunction with compatible laboratory and imaging results, are often sufficient to make the diagnosis, and liver biopsy is rarely indicated. We have experienced a case of acute fatty liver of pregnancy presenting as early hepatic encephalopathy, renal failure which developed during the third trimester. We diagnosed acute fatty liver of pregnancy based on clinical presentation and laboratory abnormalities. Despite of prompt delivery and adequate supportive care management, this severe complication of pregnancy has had an adverse outcome for mother.
Biopsy ; Early Diagnosis ; Fatty Liver ; Female ; Fetus ; Hepatic Encephalopathy ; Humans ; Liver ; Mothers ; Physical Examination ; Pregnancy ; Pregnancy Complications ; Pregnancy Trimester, Third ; Renal Insufficiency