Background: and Purpose Treatments for neuromyelitis optica spectrum disorder (NMOSD) such as eculizumab, ravulizumab, satralizumab, and inebilizumab have significantly advanced relapse prevention, but they remain expensive. Rituximab is an off-label yet popular alternative that offers a cost-effective solution, but its real-world efficacy needs better quantification for guiding the application of newer approved NMOSD treatments (ANTs). This study aimed to determine real-world rituximab failure rates to anticipate the demand for ANTs and aid in resource allocation. Methods: We conducted a nationwide retrospective study involving 605 aquaporin-4-antibody-positive NMOSD patients from 22 centers in South Korea that assessed the efficacy and safety of rituximab over a median follow-up of 47 months. Results: The 605 patients treated with rituximab included 525 (87%) who received continuous therapy throughout the follow-up period (median=47 months, interquartile range=15–87 months). During this period, 117 patients (19%) experienced at least 1 relapse. Notably, 68 of these patients (11% of the total cohort) experienced multiple relapses or at least 1 severe relapse.Additionally, 2% of the patients discontinued rituximab due to adverse events, which included severe infusion reactions, neutropenia, and infections. Conclusions This study has confirmed the efficacy of rituximab in treating NMOSD, as evidenced by an 87% continuation rate among patients over a 4-year follow-up period. Nevertheless, the occurrence of at least one relapse in 19% of the cohort, including 11% who experienced multiple or severe relapses, and a 2% discontinuation rate due to adverse events highlight the urgent need for alternative therapeutic options.

Background: and Purpose Treatments for neuromyelitis optica spectrum disorder (NMOSD) such as eculizumab, ravulizumab, satralizumab, and inebilizumab have significantly advanced relapse prevention, but they remain expensive. Rituximab is an off-label yet popular alternative that offers a cost-effective solution, but its real-world efficacy needs better quantification for guiding the application of newer approved NMOSD treatments (ANTs). This study aimed to determine real-world rituximab failure rates to anticipate the demand for ANTs and aid in resource allocation. Methods: We conducted a nationwide retrospective study involving 605 aquaporin-4-antibody-positive NMOSD patients from 22 centers in South Korea that assessed the efficacy and safety of rituximab over a median follow-up of 47 months. Results: The 605 patients treated with rituximab included 525 (87%) who received continuous therapy throughout the follow-up period (median=47 months, interquartile range=15–87 months). During this period, 117 patients (19%) experienced at least 1 relapse. Notably, 68 of these patients (11% of the total cohort) experienced multiple relapses or at least 1 severe relapse.Additionally, 2% of the patients discontinued rituximab due to adverse events, which included severe infusion reactions, neutropenia, and infections. Conclusions This study has confirmed the efficacy of rituximab in treating NMOSD, as evidenced by an 87% continuation rate among patients over a 4-year follow-up period. Nevertheless, the occurrence of at least one relapse in 19% of the cohort, including 11% who experienced multiple or severe relapses, and a 2% discontinuation rate due to adverse events highlight the urgent need for alternative therapeutic options.

Background: and Purpose Treatments for neuromyelitis optica spectrum disorder (NMOSD) such as eculizumab, ravulizumab, satralizumab, and inebilizumab have significantly advanced relapse prevention, but they remain expensive. Rituximab is an off-label yet popular alternative that offers a cost-effective solution, but its real-world efficacy needs better quantification for guiding the application of newer approved NMOSD treatments (ANTs). This study aimed to determine real-world rituximab failure rates to anticipate the demand for ANTs and aid in resource allocation. Methods: We conducted a nationwide retrospective study involving 605 aquaporin-4-antibody-positive NMOSD patients from 22 centers in South Korea that assessed the efficacy and safety of rituximab over a median follow-up of 47 months. Results: The 605 patients treated with rituximab included 525 (87%) who received continuous therapy throughout the follow-up period (median=47 months, interquartile range=15–87 months). During this period, 117 patients (19%) experienced at least 1 relapse. Notably, 68 of these patients (11% of the total cohort) experienced multiple relapses or at least 1 severe relapse.Additionally, 2% of the patients discontinued rituximab due to adverse events, which included severe infusion reactions, neutropenia, and infections. Conclusions This study has confirmed the efficacy of rituximab in treating NMOSD, as evidenced by an 87% continuation rate among patients over a 4-year follow-up period. Nevertheless, the occurrence of at least one relapse in 19% of the cohort, including 11% who experienced multiple or severe relapses, and a 2% discontinuation rate due to adverse events highlight the urgent need for alternative therapeutic options.

Recent studies have revealed a significant relationship between erectile dysfunction (ED) and lower urinary tract symptoms (LUTS), both of which commonly affect middle-aged and older men. These conditions share underlying causes, particularly endothelial dysfunction, atherosclerosis, and chronic pelvic ischemia (CPI). This study investigated the therapeutic potential of LDD175, a large-conductance Ca 2+ -activated K + channel (BKCa channel) opener, in simultaneously treating both conditions using a CPI animal model of male Sprague Dawley rats. Our study investigated the induction of CPI through surgical endothelial damage combined with a high-cholesterol diet. We assessed erectile and voiding functions by measuring intracavernosal pressure (ICP) and intraurethral pressure (IUP), respectively, after nerve stimulation. We performed histological examinations of vascular changes and western blot analyses of cavernous and prostate tissues to understand the underlying mechanisms. This study evaluated the effectiveness of LDD175 compared to standard treatments, such as sildenafil for ED and tamsulosin for LUTS. Therefore, the CPI model successfully demonstrated ED and LUTS symptoms with decreased ICP and increased IUP. Analysis revealed elevated levels of hypoxia-inducible factor-1α, transforming growth factor-β1 and β2 in cavernous tissue, and increased α1A-adrenoceptor expression in prostate tissue. LDD175 administration showed promising results, with dose-dependent improvements in ICP and IUP, and therapeutic effects comparable to those of established treatments. Our findings suggest a novel therapeutic approach that can simultaneously address ED and LUTS, opening new possibilities for clinical application in the treatment of these interconnected conditions.
Male ; Animals ; Erectile Dysfunction/etiology* ; Rats, Sprague-Dawley ; Lower Urinary Tract Symptoms/etiology* ; Ischemia/drug therapy* ; Rats ; Tamsulosin ; Hypoxia-Inducible Factor 1, alpha Subunit/drug effects* ; Sildenafil Citrate/therapeutic use* ; Penis/blood supply* ; Disease Models, Animal ; Transforming Growth Factor beta1/metabolism* ; Pelvis/blood supply* ; Prostate/metabolism* ; Sulfonamides/therapeutic use* ; Large-Conductance Calcium-Activated Potassium Channels/agonists*

Background: Intravesical Bacillus Calmette-Guérin (BCG) instillation is the most effective treatment for reducing intravesical recurrence in non-muscle invasive bladder cancer (NMIBC). However, due to the recent global shortage of BCG, there is an increasing need for alternative treatments. This study aimed to retrospectively compare the outcomes of patients treated with intravesical gemcitabine instillation and BCG instillation as initial treatment options for NMIBC. Methods: Seventy-eight patients with NMIBC who underwent transurethral resection of bladder tumors between January 2022 and September 2023 were reviewed. Of these, 42 patients received intravesical gemcitabine instillation, and 36 patients received BCG instillation. Recurrence-free survival (RFS) was analyzed, along with tumor multiplicity, grade, T stage, size, and bladder storage time after instillation, which could influence RFS. Results: The mean follow-up period was 18.7 months for the gemcitabine group and 20.6 months for the BCG group. Recurrence occurred in 46.15% of patients (52.38% in the gemcitabine group and 38.92% in the BCG group). Tumor characteristics, including multiplicity, grade, stage, and size, were not significantly different between the two groups. The mean RFS was 15.92 months in the gemcitabine group and 19.84 months in the BCG group, with no statistically significant difference (p=0.397). However, gemcitabine instillation caused more severe bladder irritation, with shorter bladder storage time. Conclusions Intravesical gemcitabine and BCG instillation yielded comparable RFS outcomes. However, gemcitabine led to more severe bladder irritation, highlighting the need for further studies to optimize its application.

Background: Intravesical Bacillus Calmette-Guérin (BCG) instillation is the most effective treatment for reducing intravesical recurrence in non-muscle invasive bladder cancer (NMIBC). However, due to the recent global shortage of BCG, there is an increasing need for alternative treatments. This study aimed to retrospectively compare the outcomes of patients treated with intravesical gemcitabine instillation and BCG instillation as initial treatment options for NMIBC. Methods: Seventy-eight patients with NMIBC who underwent transurethral resection of bladder tumors between January 2022 and September 2023 were reviewed. Of these, 42 patients received intravesical gemcitabine instillation, and 36 patients received BCG instillation. Recurrence-free survival (RFS) was analyzed, along with tumor multiplicity, grade, T stage, size, and bladder storage time after instillation, which could influence RFS. Results: The mean follow-up period was 18.7 months for the gemcitabine group and 20.6 months for the BCG group. Recurrence occurred in 46.15% of patients (52.38% in the gemcitabine group and 38.92% in the BCG group). Tumor characteristics, including multiplicity, grade, stage, and size, were not significantly different between the two groups. The mean RFS was 15.92 months in the gemcitabine group and 19.84 months in the BCG group, with no statistically significant difference (p=0.397). However, gemcitabine instillation caused more severe bladder irritation, with shorter bladder storage time. Conclusions Intravesical gemcitabine and BCG instillation yielded comparable RFS outcomes. However, gemcitabine led to more severe bladder irritation, highlighting the need for further studies to optimize its application.

Background: Intravesical Bacillus Calmette-Guérin (BCG) instillation is the most effective treatment for reducing intravesical recurrence in non-muscle invasive bladder cancer (NMIBC). However, due to the recent global shortage of BCG, there is an increasing need for alternative treatments. This study aimed to retrospectively compare the outcomes of patients treated with intravesical gemcitabine instillation and BCG instillation as initial treatment options for NMIBC. Methods: Seventy-eight patients with NMIBC who underwent transurethral resection of bladder tumors between January 2022 and September 2023 were reviewed. Of these, 42 patients received intravesical gemcitabine instillation, and 36 patients received BCG instillation. Recurrence-free survival (RFS) was analyzed, along with tumor multiplicity, grade, T stage, size, and bladder storage time after instillation, which could influence RFS. Results: The mean follow-up period was 18.7 months for the gemcitabine group and 20.6 months for the BCG group. Recurrence occurred in 46.15% of patients (52.38% in the gemcitabine group and 38.92% in the BCG group). Tumor characteristics, including multiplicity, grade, stage, and size, were not significantly different between the two groups. The mean RFS was 15.92 months in the gemcitabine group and 19.84 months in the BCG group, with no statistically significant difference (p=0.397). However, gemcitabine instillation caused more severe bladder irritation, with shorter bladder storage time. Conclusions Intravesical gemcitabine and BCG instillation yielded comparable RFS outcomes. However, gemcitabine led to more severe bladder irritation, highlighting the need for further studies to optimize its application.

Background: Intravesical Bacillus Calmette-Guérin (BCG) instillation is the most effective treatment for reducing intravesical recurrence in non-muscle invasive bladder cancer (NMIBC). However, due to the recent global shortage of BCG, there is an increasing need for alternative treatments. This study aimed to retrospectively compare the outcomes of patients treated with intravesical gemcitabine instillation and BCG instillation as initial treatment options for NMIBC. Methods: Seventy-eight patients with NMIBC who underwent transurethral resection of bladder tumors between January 2022 and September 2023 were reviewed. Of these, 42 patients received intravesical gemcitabine instillation, and 36 patients received BCG instillation. Recurrence-free survival (RFS) was analyzed, along with tumor multiplicity, grade, T stage, size, and bladder storage time after instillation, which could influence RFS. Results: The mean follow-up period was 18.7 months for the gemcitabine group and 20.6 months for the BCG group. Recurrence occurred in 46.15% of patients (52.38% in the gemcitabine group and 38.92% in the BCG group). Tumor characteristics, including multiplicity, grade, stage, and size, were not significantly different between the two groups. The mean RFS was 15.92 months in the gemcitabine group and 19.84 months in the BCG group, with no statistically significant difference (p=0.397). However, gemcitabine instillation caused more severe bladder irritation, with shorter bladder storage time. Conclusions Intravesical gemcitabine and BCG instillation yielded comparable RFS outcomes. However, gemcitabine led to more severe bladder irritation, highlighting the need for further studies to optimize its application.

Background: Intravesical Bacillus Calmette-Guérin (BCG) instillation is the most effective treatment for reducing intravesical recurrence in non-muscle invasive bladder cancer (NMIBC). However, due to the recent global shortage of BCG, there is an increasing need for alternative treatments. This study aimed to retrospectively compare the outcomes of patients treated with intravesical gemcitabine instillation and BCG instillation as initial treatment options for NMIBC. Methods: Seventy-eight patients with NMIBC who underwent transurethral resection of bladder tumors between January 2022 and September 2023 were reviewed. Of these, 42 patients received intravesical gemcitabine instillation, and 36 patients received BCG instillation. Recurrence-free survival (RFS) was analyzed, along with tumor multiplicity, grade, T stage, size, and bladder storage time after instillation, which could influence RFS. Results: The mean follow-up period was 18.7 months for the gemcitabine group and 20.6 months for the BCG group. Recurrence occurred in 46.15% of patients (52.38% in the gemcitabine group and 38.92% in the BCG group). Tumor characteristics, including multiplicity, grade, stage, and size, were not significantly different between the two groups. The mean RFS was 15.92 months in the gemcitabine group and 19.84 months in the BCG group, with no statistically significant difference (p=0.397). However, gemcitabine instillation caused more severe bladder irritation, with shorter bladder storage time. Conclusions Intravesical gemcitabine and BCG instillation yielded comparable RFS outcomes. However, gemcitabine led to more severe bladder irritation, highlighting the need for further studies to optimize its application.

Purpose: Several studies have evaluated the impact of sarcopenic obesity (SO) on postoperative complications, including postoperative pancreatic fistula (POPF), in patients undergoing pancreatoduodenectomy (PD). Previous studies have shown that SO increases POPF, but it remains unclear whether SO increases postoperative complications. In this study, we aimed to determine the relationship between SO and immediate postoperative complications. Methods: From January 2005 to December 2019, the medical records of patients who underwent PD for periampullary cancer were retrospectively reviewed. Skeletal muscle index (SMI) and visceral fat area (VFA) were calculated from preoperative computed tomography images. Patients with high VFA were classified as obese, while those with low SMI were classified as sarcopenic. Patients were divided into 4 groups: normal group, sarcopenia only group, obesity only group, and SO group. Postoperative outcomes were compared between groups, and factors affecting postoperative complications were analyzed by multivariate analysis. Results: Normal group (n = 176), sarcopenia only group (n = 130), obesity only group (n = 207), and SO group (n = 117) were analyzed retrospectively. SO group had significantly more frequent major complications compared to the normal group (P = 0.006), as well as a significantly more frequent clinically relevant POPF compared to the other groups (P = 0.002). In multivariate analysis, SO was an independent risk factor for major complications (P = 0.008) and clinically relevant POPF (P = 0.003). Conclusion SO is a factor associated with poor immediate postoperative outcomes after PD for periampullary cancer.