Feasibility study of a novel rectal cooling system for hypothermic radical prostatectomy in a swine model.

Thermal damage and inflammatory responses of the sphincter and neurovascular bundles (NVBs) are responsible for post-prostatectomy incontinence and erectile dysfunction. Intraoperative hypothermia in the pelvic cavity may reduce the occurrence of these complications. We evaluated the feasibility of a novel rectal cooling system using an animal model. A novel rectal cooling system consisting of a cooling console and a multi-lumen rectal balloon was developed. We conducted animal tests on male pigs to evaluate the efficacy and safety of the system. The primary endpoint was to maintain the temperature of the NVBs at 25℃ (±5℃) during and after the electrocauterization of the bladder neck for 10 seconds. The safety endpoint was device-related complications or significant changes in the core body temperature of the pigs. The NVB temperature was below 30℃ within 3 minutes of activation of the rectal balloon. The temperature of the proximal NVB was consistently maintained below 25℃ in all cases. The temperature 1 cm from the bladder neck did not rise above 38℃ and dropped to the initial level within 1 minute after electrocauterization. During cooling, the minimum temperature at the apex of the prostate was reduced to 10.1℃. There were no device-related complications or significant changes in core body temperature throughout the experiment. Animal tests suggest the feasibility and safety of this novel rectal cooling system. A first-in-human trial to assess the safety and efficacy of this system during radical prostatectomy is warranted.

Endoscopic Botulinum Toxin Injection for Refractory Enuresis Based on Urodynamic Assessment.

PURPOSE: This study aimed to determine the urodynamic characteristics of refractory enuresis and explored whether those characteristics can be managed through differential endoscopic injections with botulinum toxin. METHODS: In total, 27 patients with nonmonosymptomatic enuresis who showed no response after conservative treatment for more than 12 months were included. The patients then underwent a videourodynamic study and received a differential endoscopic injection of botulinum toxin on the same day. Reduced capacity, detrusor overactivity, and bladder neck widening were the 3 major abnormal findings assessed during the filling phase, while sphincter hyperactivity was the only abnormality assessed during the emptying phase. An intravesical or intrasphincteric injection of botulinum toxin was attempted according to the videourodynamic study findings. Follow-up was conducted at 1, 3, 6, and 12 months after treatment. RESULTS: The median age was 10 years (range, 7-31 years). Although 19 and 8 patients had a preoperative diagnosis of overactive bladder or dysfunctional voiding, respectively, the urodynamic diagnosis was different in more than half of the patients. Those showing detrusor overactivity benefited from intravesical botulinum toxin injection, whereas those with only sphincter hyperactivity benefited from both intravesical and intrasphincteric injections. Treatment resistance to botulinum toxin seemed to be attributable to bladder neck widening. Time had no apparent effect on efficacy, which persisted 6 months after the injection. More than 80% of the patients maintained the benefits of the injection after 1 year. CONCLUSION: Videourodynamic studies were useful for identifying the reasons underlying refractory nonmonosymptomatic enuresis and helpful for determining the appropriate site of botulinum toxin injection.

Changes in attention variables in those who treated with anticholinergic agents for nonmonosymptomatic enuresis.

Purpose: Brain dysfunction related to areas regarding attention and arousal may occur not only in patients with attention-deficit/hyperactivity disorder (ADHD) but also in patients with enuresis and daytime symptoms. This study aimed to investigate changes in computerized comprehensive attention tests (CATs), a psychometric test for ADHD when patients with nonmonosymptomatic enuresis (NME) were treated with anticholinergic agents. Materials and Methods: Thirty patients with NME featuring overactive bladder were prospectively enrolled. They were treated with 5 mg of solifenacin to control daytime symptoms. Using CATs, patients were evaluated during 12 weeks of treatment. Four subtests of attention (visual and auditory selective attention, sustained attention, and flanker tests) were measured. For each subtest, four domains (omission error, commission error, response time [RT], and standard deviation of RT) were assessed. Results: Only one domain of the flanker test was in the deficient range at baseline. The presence of urge incontinence affected follow-up results on the sustained attention tests. Treatment with anticholinergic agents did not significantly affect attention variables but changes in several variables were correlated with bladder symptoms and enuresis. Conclusions: Minimal baseline defects in attention function were seen in patients with NME. Follow-up results for some attention variables were affected by daytime symptoms and enuresis. These results suggest that altered brain function in enuretic patients influences improvement in both attention and bladder function.

A note on some identities of derangement polynomials.

The problem of counting derangements was initiated by Pierre Rémond de Montmort in 1708 (see Carlitz in Fibonacci Q. 16(3):255-258, 1978, Clarke and Sved in Math. Mag. 66(5):299-303, 1993, Kim, Kim and Kwon in Adv. Stud. Contemp. Math. (Kyungshang) 28(1):1-11 2018. A derangement is a permutation that has no fixed points, and the derangement number [Formula: see text] is the number of fixed-point-free permutations on an n element set. In this paper, we study the derangement polynomials and investigate some interesting properties which are related to derangement numbers. Also, we study two generalizations of derangement polynomials, namely higher-order and r-derangement polynomials, and show some relations between them. In addition, we express several special polynomials in terms of the higher-order derangement polynomials by using umbral calculus.

Series of sums of products of higher-order Bernoulli functions.

It is shown in a previous work that Faber-Pandharipande-Zagier's and Miki's identities can be derived from a polynomial identity, which in turn follows from the Fourier series expansion of sums of products of Bernoulli functions. Motivated by and generalizing this, we consider three types of functions given by sums of products of higher-order Bernoulli functions and derive their Fourier series expansions. Moreover, we express each of them in terms of Bernoulli functions.

Fourier series of finite products of Bernoulli and Genocchi functions.

In this paper, we consider three types of functions given by products of Bernoulli and Genocchi functions and derive some new identities arising from Fourier series expansions associated with Bernoulli and Genocchi functions. Furthermore, we will express each of them in terms of Bernoulli functions.