Classification of Hippocampal Ripples: Convolutional Neural Network Learns Episode-Specific Changes.

The hippocampus is known to play an important role in memory by processing spatiotemporal information of episodic experiences. By recording synchronized multiple-unit firing events (ripple firings with 300 Hz-10 kHz) of hippocampal CA1 neurons in freely moving rats, we previously found an episode-dependent diversity in the waveform of ripple firings. In the present study, we hypothesized that changes in the diversity would depend on the type of episode experienced. If this hypothesis holds, we can identify the ripple waveforms associated with each episode. Thus, we first attempted to classify the ripple firings measured from rats into five categories: those experiencing any of the four episodes and those before experiencing any of the four episodes. In this paper, we construct a convolutional neural network (CNN) to classify the current stocks of ripple firings into these five categories and demonstrate that the CNN can successfully classify the ripple firings. We subsequently indicate partial ripple waveforms that the CNN focuses on for classification by applying gradient-weighted class activation mapping (Grad-CAM) to the CNN. The method of t-distributed stochastic neighbor embedding (t-SNE) maps ripple waveforms into a two-dimensional feature space. Analyzing the distribution of partial waveforms extracted by Grad-CAM in a t-SNE feature space suggests that the partial waveforms may be representative of each category.

Long-term follow-up of congenital hydronephrosis in a single-center study.

OBJECTIVES: Many congenital hydronephroses spontaneously resolve. This study evaluated a long-term follow-up of more than 4 years of patients with congenital hydronephrosis at a single center. METHODS: In total, 215 patients (286 kidneys) with congenital hydronephrosis were included. Hydronephrosis outcomes (resolution, improvement, and persistence) and time-to-outcome were evaluated. RESULTS: Fourteen patients underwent early surgical intervention until the age of 2 years. A total of 189 congenital hydronephrosis cases (66%) showed resolution at a median of 16 months (interquartile range: 7-21 months) and 169 (80%) of 210 kidneys with grade I to II hydronephrosis showed resolution at a median of 14 months (interquartile range: 6-23 months). Of 76 kidneys with grade III to IV hydronephrosis, 24 (32%) showed resolution at a median of 29 months (interquartile range: 24-41 months), and 56 (74%) showed improvement to grade II or less at a median of 12 months (interquartile range: 5-23 months). Of the 76 kidneys with grade III to IV hydronephrosis, five required delayed pyeloplasty at a median of 66 months (interquartile range: 42-89 months). One patient was asymptomatic, with a marked worsening of hydronephrosis and decreased renal function 6 years after the resolution of hydronephrosis. CONCLUSIONS: None of the patients with grade I to II hydronephrosis required surgical treatment, and a shorter follow-up may be sufficient. Grade III to IV severe hydronephrosis should be considered for a longer and more careful follow-up, given the possibility of asymptomatic exacerbation of hydronephrosis.

Assessment of diagnostic accuracy for cryptorchidism and risk factors for delayed orchidopexy.

OBJECTIVES: Cryptorchidism (CO) diagnosis by palpation is challenging. Patients with suspected CO are primarily referred to pediatric urologists by general pediatricians and urologists. Currently, surgical treatment for CO is recommended earlier than in previous guidelines. In this study, we evaluated factors that lead to diagnosis discordance and delayed orchidopexy in patients referred with suspected CO in addition to timing of initial screening. METHODS: In total, 731 patients (1052 testes) with suspected CO were included. Risk factors for diagnostic discrepancy in CO diagnosis by pediatric urologists and risk of delayed orchiopexy were evaluated. RESULTS: Herein, 659 (90%) patients were diagnosed during routine public health checkups for infants and young children, and 419 (57%) patients were referred by pediatric practitioners. Of 1052 testes, 374 (36%) were diagnosed with CO by pediatric urologists. In multivariate analysis, risk factors of diagnostic discrepancy for CO diagnosis by pediatric urologists were bilateral testis (odds ratio [OR] = 9.17, p < 0.0001), >6 months old at initial diagnosis (OR = 1.036, p < 0.0001), and pediatric referral (OR = 4.60, p < 0.0001). In total, 296 patients underwent orchiopexy for CO. In multivariate analysis, risk factors for delayed orchiopexy were presence of comorbidities (OR = 3.43, p = 0.003) and >10 months old at referral (OR = 12.62, p < 0.0001). CONCLUSIONS: Pediatric referral is a risk factor for discordant CO diagnostics, and late age at referral brings a risk of delayed orchiopexy. It is necessary to enlighten pediatricians, who are mainly responsible for routine health checkups, in teaching CO diagnostic techniques to ensure early referral.

Dual-Arm Visuo-Haptic Optical Tweezers for Bimanual Cooperative Micromanipulation of Nonspherical Objects.

Cooperative manipulation through dual-arm robots is widely implemented to perform precise and dexterous tasks to ensure automation; however, the implementation of cooperative micromanipulation through dual-arm optical tweezers is relatively rare in biomedical laboratories. To enable the bimanual and dexterous cooperative handling of a nonspherical object in microscopic workspaces, we present a dual-arm visuo-haptic optical tweezer system with two trapped microspheres, which are commercially available end-effectors, to realize indirect micromanipulation. By combining the precise correction technique of distortions in scanning optical tweezers and computer vision techniques, our dual-arm system allows a user to perceive the real contact forces during the cooperative manipulation of an object. The system enhances the dexterity of bimanual micromanipulation by employing the real-time representation of the forces and their directions. As a proof of concept, we demonstrate the cooperative indirect micromanipulation of single nonspherical objects, specifically, a glass fragment and a large diatom. Moreover, the precise correction method of the scanning optical tweezers is described. The unique capabilities offered by the proposed dual-arm visuo-haptic system can facilitate research on biomedical materials and single-cells under an optical microscope.

An Empirical Identification Issue of the Bifactor Item Response Theory Model.

Using the bifactor item response theory model to analyze data arising from educational and psychological studies has gained popularity over the years. Unfortunately, using this model in practice comes with challenges. One such challenge is an empirical identification issue that is seldom discussed in the literature, and its impact on the estimates of the bifactor model's parameters has not been demonstrated. This issue occurs when an item's discriminations on the general and specific dimensions are approximately equal (i.e., the within-item discriminations are similar in strength), leading to difficulties in obtaining unique estimates for those discriminations. We conducted three simulation studies to demonstrate that within-item discriminations being similar in strength creates problems in estimation stability. The results suggest that a large sample could alleviate but not resolve the problems, at least when considering sample sizes up to 4,000. When the discriminations within items were made clearly different, the estimates of these discriminations were more consistent across the data replicates than that observed when the discriminations within the items were similar. The results also show that the similarity of an item's discriminatory magnitudes on different dimensions has direct implications on the sample size needed in order to consistently obtain accurate parameter estimates. Although our goal was to provide evidence of the empirical identification issue, the study further reveals that the extent of similarity of within-item discriminations, the magnitude of discriminations, and how well the items are targeted to the respondents also play factors in the estimation of the bifactor model's parameters.

Email me back: Examining provider biases through email return and responsiveness.

The majority of research on accessing and utilizing mental health services has focused on patient barriers to care. Few studies have explored possible provider biases that may impact client access at point of entry. Using the audit method, we conducted an email-based field experiment to investigate the responsiveness of psychotherapy providers to inquiries from simulated patients with different backgrounds (i.e., race, gender, diagnosis, and ability to pay). A total of 725 therapists (176 men, 549 women) practicing in Chicago, Illinois were identified from an online therapist directory and randomized to receive emails requesting therapy appointments. Overall, 21.7% of providers did not return prospective client email inquiries; 32.5% of providers were somewhat responsive in that they returned an email despite not being able to take on the client; and 45.7% were highly responsive in that they returned an email and offered an appointment or the opportunity to discuss the matter further. Male providers were less responsive to African American and Latinx simulated clients and most responsive to White clients, whereas female providers were more likely to respond similarly to all simulated clients. Moreover, regardless of the providers' gender, they were more responsive to simulated patients with depression than to simulated patients with schizophrenia or borderline personality disorder (BPD). Finally, providers were more responsive to those who could pay the full fee than to those who requested a sliding scale. Educating providers on these possible biases is important because it could help reduce biased behaviors and improve access to care for vulnerable populations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

[Functional Movement Disorders That Do Not Improve after Explaining the Diagnosis: Do Not Treat the Disease, Treat the Patient].

The most important factor in the treatment of functional movement disorders is the initial discussion between the doctor and the patient, wherein the doctor must inform the patient regarding their diagnosis and obtain their consent. To obtain consent, explanations must be tailored to the patient's knowledge. To do so, it is important to know the patient. In this process, psychological factors may be speculated. The rationale for the diagnosis, including test results, should be presented to the patient. Although the choice of future treatment should be left to the patient, the doctor must assure the patient of their continued support until they recover.

A Mixed Method Study of Teachers' Appraisals of Student Wellness Services and Supports During COVID-19.

BACKGROUND: Understanding teachers' appraisals of student wellness services and supports during COVID-19 is essential to strengthening services and improving student health outcomes. This mixed-method study aimed to examine US PK-12 teachers' appraisals of student wellness services and supports during COVID-19. METHODS: This study focuses on qualitative data from 291 teachers' open-ended responses to the question: "What do you wish your school leaders knew about this (wellness support) aspect of your work?" and whose responses described wellness services and supports. A qualitative content analysis was conducted by an interdisciplinary research team using open- and axial coding. RESULTS: Three main themes emerged. (1) insufficient access to mental health professionals and programming at schools, (2) concern about the quality of available services, and (3) a need for teacher professional development and support on student wellness. Statistically significant differences in teacher appraisals of insufficient access to mental health professionals and programming were found based on grade level taught and percentage of immigrant students in the school. CONCLUSION: With amplified student wellness needs, school personnel, including school leaders, must consider ways to allocate additional resources/staffing, assess the quality of services and supports, and design professional development opportunities to support teachers' involvement in supporting student wellness needs.

Organ-Specific and Mixed Responses to Pembrolizumab in Patients with Unresectable or Metastatic Urothelial Carcinoma: A Multicenter Retrospective Study.

To investigate the organ-specific response and clinical outcomes of mixed responses (MRs) to immune checkpoint inhibitors (ICIs) for unresectable or metastatic urothelial carcinoma (ur/mUC), we retrospectively analyzed 136 patients who received pembrolizumab. The total objective response rate (ORR) and organ-specific ORR were determined for each lesion according to the Response Evaluation Criteria in Solid Tumors version 1.1 as follows: (i) complete response (CR), (ii) partial response (PR), (iii) stable disease (SD), and (iv) progressive disease (PD). Most of the organ-specific ORR was 30−40%, but bone metastasis was only 5%. There was a significant difference in overall survival (OS) between responders and non-responders with locally advanced lesions and lymph node, lung, or liver metastases (HR 9.02 (3.63−22.4) p < 0.0001; HR 3.63 (1.97−6.69), p < 0.0001; HR 2.75 (1.35−5.59), p = 0.0053; and HR 3.17 (1.00−10.0), p = 0.049, respectively). MR was defined as occurring when PD happened in one lesion plus either CR or PR occurred in another lesion simultaneously, and 12 cases were applicable. MR was significantly associated with a poorer prognosis than that of the responder group (CR or PR; HR 0.09 (0.02−0.35), p = 0.004). Patients with bone metastases benefitted less. Care may be needed to treat patients with MR as well as patients with pure PD. Further studies should be conducted in the future.

Radiocesium in Japan Sea associated with sinking particles from Fukushima Dai-ichi Nuclear Power Plant accident.

This study examined the temporal variations in radiocesium concentration associated with sinking particles in the northeastern Japan Sea between September 2010 and July 2012. We analyzed sediment trap samples from this period after the Fukushima Dai-ichi Nuclear Power Plant (FDNPP) accident in March 2011. Cesium-134 was detected in samples collected between May and July 2011 at a depth of 1100 m (4.2-11 mBq g-dry-1) but not in other periods at 1100 m or deeper (3100 and 3500 m). These results confirmed the deposition of FDNPP-derived radiocesium on the surface water in the late April 2011, which rapidly sank with sinking particles to a depth of at least 1100 m, in the northeastern Japan Sea, about 40 days after the deposition in the North Pacific. If FDNPP-derived 137Cs was excluded, no seasonal changes were detected in the 137Cs activity concentration of the sinking particles, and the 137Cs activity concentration of the particles increased with increasing depth. Judging from the concentration of 137Cs of sinking particle and seasonal variation of total mass flux and organic matter content, the lithogenic particle seems to be important for radiocesium associated with sinking particles. These data also strongly suggest a difference in sinking features of particles between 2010-2011 and 2011-2012 deployments. Due to the existence of benthic front, shallow water (1100 m) and deep water (3500 m) are separated during 2010-2011 deployment, but in the winter of 2011-2012, this front disappeared and the particles in surface water seem to have sunk to the depth of 3100 m. The sinking velocity of the particles at 1100 m was estimated to be 33-62 m day-1, with a mean sinking velocity of 43 m day-1. These values were comparable to those estimated at depths shallower than 1000 m in the North Pacific after the FDNPP accident, or in the Mediterranean, North, and Black Seas after the Chernobyl accident.

A General Bayesian Multidimensional Item Response Theory Model for Small and Large Samples.

Although item response theory (IRT) models such as the bifactor, two-tier, and between-item-dimensionality IRT models have been devised to confirm complex dimensional structures in educational and psychological data, they can be challenging to use in practice. The reason is that these models are multidimensional IRT (MIRT) models and thus are highly parameterized, making them only suitable for data provided by large samples. Unfortunately, many educational and psychological studies are conducted on a small scale, leaving the researchers without the necessary MIRT models to confirm the hypothesized structures in their data. To address the lack of modeling options for these researchers, we present a general Bayesian MIRT model based on adaptive informative priors. Simulations demonstrated that our MIRT model could be used to confirm a two-tier structure (with two general and six specific dimensions), a bifactor structure (with one general and six specific dimensions), and a between-item six-dimensional structure in rating scale data representing sample sizes as small as 100. Although our goal was to provide a general MIRT model suitable for smaller samples, the simulations further revealed that our model was applicable to larger samples. We also analyzed real data from 121 individuals to illustrate that the findings of our simulations are relevant to real situations.

A study of psychological pain in substance use disorder and its relationship to treatment outcome.

Substance Use Disorder (SUD) is a major public health concern affecting an estimated 22.5 million individuals in the United States. The primary aim of this study was to characterize psychological pain in a cohort of patients participating in outpatient treatment for SUD. A secondary aim was to determine the relationships between pre-treatment assessments of psychological pain, depression, anxiety and hopelessness with treatment retention time and completion rates. Data was analyzed from 289 patients enrolled in an outpatient community drug treatment clinic in Southern California, U.S. A previously determined threshold score on the Mee-Bunney Psychological Pain Assessment Scale (MBP) was utilized to group patients into high and low-moderate scoring subgroups. The higher pain group scored higher on measures of anxiety, hopelessness and depression compared to those in the low-moderate pain group. Additionally, patients scoring in the higher psychological pain group exhibited reduced retention times in treatment and more than two-fold increased odds of dropout relative to patients with lower pre-treatment levels of psychological pain. Among all assessments, the correlation between psychological pain and treatment retention time was strongest. To our knowledge, this is the first study to demonstrate that psychological pain is an important construct which correlates with relevant clinical outcomes in SUD. Furthermore, pre-treatment screening for psychological pain may help target higher-risk patients for clinical interventions aimed at improving treatment retention and completion rates.

The Bayesian Multilevel Trifactor Item Response Theory Model.

Advancements in item response theory (IRT) have led to models for dual dependence, which control for cluster and method effects during a psychometric analysis. Currently, however, this class of models does not include one that controls for when the method effects stem from two method sources in which one source functions differently across the aspects of another source (i.e., a nested method-source interaction). For this study, then, a Bayesian IRT model is proposed, one that accounts for such interaction among method sources while controlling for the clustering of individuals within the sample. The proposed model accomplishes these tasks by specifying a multilevel trifactor structure for the latent trait space. Details of simulations are also reported. These simulations demonstrate that this model can identify when item response data represent a multilevel trifactor structure, and it does so in data from samples as small as 250 cases nested within 50 clusters. Additionally, the simulations show that misleading estimates for the item discriminations could arise when the trifactor structure reflected in the data is not correctly accounted for. The utility of the model is also illustrated through the analysis of empirical data.

Postural Abnormality in Parkinson's Disease: A Large Comparative Study With General Population.

BACKGROUND: Postural abnormalities in Parkinson's disease (PD) patients and unimpaired elderly are not well differentiated. Factors related to postural abnormality associated with PD are controversial. OBJECTIVE: We assessed differences in postural change between PD patients and unimpaired elderly and elucidated factors related to abnormal posture in PD patients. METHODS: We measured the dropped head angle (DHA), anterior flexion angle (AFA), and lateral flexion angle (LFA) of the thoracolumbar spine of an unprecedented 1,117 PD patients and 2,732 general population participants (GPPs) using digital photographs. Two statistical analyses were used for elucidating factors related to these angles. RESULTS: In GPPs, age was correlated with DHA, AFA, and LFA. DHAs, AFAs, and LFAs of PD patients and age-matched GPPs were 21.70° ± 14.40° and 13.13° ± 10.79°, 5.98° ± 12.67,°and - 3.82° ± 4.04°, and 0.86° ± 4.25° and 1.33° ± 2.16°, respectively. In PD patients, factors related to DHA were age, male sex, and H & Y stage during ON time. Factors related to AFA were age, duration of disease, H & Y stage during ON and OFF times, pain, vertebral disease, and bending to the right. A factor related to LFA was AFA. CONCLUSIONS: DHA and AFA of GGPs correlated with age and were larger in PD patients than those with in GPPs. Some PD patients showed angles far beyond the normal distribution. Thus, factors associated with disease aggravation affected postural abnormality in PD patients.

GCH1 mutations in dopa-responsive dystonia and Parkinson's disease.

Guanosine triphosphate cyclohydrolase I (GCH1) mutations are associated with increased risk for dopa-responsive dystonia (DRD) and Parkinson's disease (PD). Herein, we investigated the frequency of GCH1 mutations and clinical symptoms in patients with clinically diagnosed PD and DRD. We used the Sanger method to screen entire exons in 268 patients with PD and 26 patients with DRD, with the examinations of brain magnetic resonance imaging scans, striatal dopamine transporter scans, and [123I] metaiodobenzylguanidine (MIBG) myocardiac scintigraphy scans. We identified 15 patients with heterozygous GCH1 mutations from seven probands and five sporadic cases. The prevalence of GCH1 mutations in probands was different between PD [1.9% (5/268)] and DRD [26.9% (7/26)] (p value < 0.0001). The onset age tends to be different between PD and DRD patients: 35.4 ± 25.3 and 16.5 ± 13.6, respectively (average ± SD; p = 0.08). Most of the patients were women (14/15). Dystonia was common symptom, and dysautonomia and cognitive decline were uncommon in our PD and DRD. All patients presented mild parkinsonism or dystonia with excellent response to levodopa. Seven of seven DRD and three of five PD presented normal heart-to-mediastinum ratio on MIBG myocardial scintigraphy. Five of six DRD and three of four PD demonstrated normal densities of dopamine transporter. Our findings elucidated the clinical characteristics of PD and DRD patients due to GCH1 mutations. PD patients with GCH1 mutations also had different symptoms from those seen in typical PD. The patients with GCH1 mutations had heterogeneous clinical symptoms.

A general Bayesian multilevel multidimensional IRT model for locally dependent data.

Many item response theory (IRT) models take a multidimensional perspective to deal with sources that induce local item dependence (LID), with these models often making an orthogonal assumption about the dimensional structure of the data. One reason for this assumption is because of the indeterminacy issue in estimating the correlations among the dimensions in structures often specified to deal with sources of LID (e.g., bifactor and two-tier structures), and the assumption usually goes untested. Unfortunately, the mere fact that assessing these correlations is a challenge for some estimation methods does not mean that data seen in practice support such orthogonal structure. In this paper, a Bayesian multilevel multidimensional IRT model for locally dependent data is presented. This model can test whether item response data violate the orthogonal assumption that many IRT models make about the dimensional structure of the data when addressing sources of LID, and this test is carried out at the dimensional level while accounting for sampling clusters. Simulations show that the model presented is effective at carrying out this task. The utility of the model is also illustrated on an empirical data set.

Vertical profiles of Fukushima Dai-ichi NPP-derived radiocesium concentrations in the waters of the southwestern Okhotsk Sea (2011-2017).

We examined the vertical 134Cs and 137Cs concentration profiles in the southwestern Okhotsk Sea in 2011, 2013, and 2017. In June 2011, atmospheric deposition-derived 134Cs from the Fukushima Dai-ichi Nuclear Power Plant (FDNPP) was detected at depths of 0-200 m (0.06-0.6 mBq/L). In July 2013, 134Cs detected at depths of 100-200 m (∼0.05 mBq/L) was ascribed to the transport of low-level 134Cs-contaminated water and/or the convection of radioactive depositions (<0.03 mBq/L at depths of 0-50 m). In July 2017, 134Cs was detected in water samples at depths above 300 m (0.03-0.05 mBq/L), and the inventory, decay-corrected to the FDNPP accident date, exhibited its maximum value (85 Bq/m2) during this period. Combining temperature-salinity data with the concentrations of global fallout-derived 137Cs led to a plausible explanation for this observation, which is a consequence of re-entry of FDNPP-derived radiocesium through the Kuril Strait from the northwestern North Pacific Ocean to the Okhotsk Sea and subsequent mixing with the south Okhotsk subsurface layer until 2017.

Assessment of psychological pain in suicidal veterans.

Psychological pain is a relatively understudied and potentially important construct in the evaluation of suicidal risk. Psychological pain also referred to as 'mental pain' or 'psychache' can be defined as an adverse emotional reaction to a severe trauma (e.g., the loss of a child) or may be associated with an illness such as depression. When psychological pain levels reach intolerable levels, some individuals may view suicide as the only and final means of escape. To better understand psychological pain, we previously developed and validated a brief self-rating 10-item scale, Mee-Bunney Psychological Pain Assessment Scale [MBP] in depressed patients and non-psychiatric controls. Our results showed a significant increase in psychological pain in the depressed patients compared to controls. We also observed a significant linear correlation between psychological pain and suicidality in the depressed patient cohort. The current investigation extends our study of psychological pain to a diagnostically heterogeneous population of 57 US Veterans enrolled in a suicide prevention program. In addition to the MBP, we administered the Columbia Suicide Severity Rating Scale (C-SSRS), Beck Depression Inventory (BDI-II), Beck Hopelessness Scale (BHS), and the Barratt Impulsiveness Scale (BIS-11). Suicidal patients scoring above a predetermined threshold for high psychological pain also had significantly elevated scores on all the other assessments. Among all of the evaluations, psychological pain accounted for the most shared variance for suicidality (C-SSRS). Stepwise regression analyses showed that impulsiveness (BIS) and psychological pain (MBP) contributed more to suicidality than any of the other combined assessments. We followed patients for 15 months and identified a subgroup (24/57) with serious suicide events. Within this subgroup, 29% (7/24) had a serious suicidal event (determined by the lethality subscale of the C-SSRS), including one completed suicide. Our results build upon our earlier findings and recent literature supporting psychological pain as a potentially important construct. Systematically evaluating psychological pain along with additional measures of suicidality could improve risk assessment and more effectively guide clinical resource allocation toward prevention.

Persistent Expression of Dopamine-Synthesizing Enzymes 15 Years After Gene Transfer in a Primate Model of Parkinson's Disease.

Restoring dopamine production in the putamen through gene therapy is a straightforward strategy for ameliorating motor symptoms for Parkinson's disease (PD). In a 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) toxicity-based primate model of PD, we previously showed the safety and efficacy of adeno-associated viral (AAV) vector-mediated gene delivery to the putamen of three dopamine-synthesizing enzymes (tyrosine hydroxylase [TH], aromatic l-amino acid decarboxylase [AADC], and guanosine triphosphate cyclohydrolase I [GCH]) up to 10 months postprocedure. Although three of four monkeys in this study have previously undergone postmortem analysis, one monkey was kept alive for 15 years after gene therapy to evaluate long-term effects. Here, we report that this monkey showed behavioral recovery in the right-side limb that remained unchanged for 15 years, at which time euthanasia was carried out owing to onset of senility. Immunohistochemistry of the postmortem brain from this monkey revealed persistent expression of TH, AADC, and GCH genes in the lesioned putamen. Transduced neurons were broadly distributed, with the estimated transduction region occupying 91% of the left postcommissural putamen. No signs of cytotoxicity or Lewy body pathology were observed in the AAV vector-injected putamen. This study provides evidence of long-term safety and efficacy of the triple-transduction method as a gene therapy for PD.

Prevention Technique of Postoperative Inguinal Hernia in Patients Undergoing Radical Prostatectomy for Localized Prostate Cancer.

To prevent inguinal hernia after retropubic radical prostatectomy, many urologists have utilized a prevention technique of inguinal hernia at the same time as retropubic radical prostatectomy. Here, we report the clinical benefit of the prevention technique of inguinal hernia as well as risk factors for the incidence of inguinal hernia. We investigated the medical records of 223 men who underwent retropubic radical prostatectomy for clinically localized prostate cancer between January 2007 and March 2013 at our medical center. We assessed the association between the postoperative inguinal hernia and variables such as age, body mass index, and previous abdominal surgery. Inguinal hernia-free survival was analyzed to verify risk factors of postoperative inguinal hernia. Of 223 patients, 67 (30 %) received prevention of inguinal hernia and 156 (70 %) did not. The median follow-up period after retropubic radical prostatectomy was 36 months (range, 3-58 months). Thirty one (14 %) patients developed unilateral or bilateral inguinal hernia after retropubic radical prostatectomy. The rate of postoperative inguinal hernia in prevented and non-prevented group was 3 % (2 of 67) and 19 % (29 of 156), respectively (P < 0.01, Mann-Whitney U test). Moreover, postoperative inguinal hernia-free survival in the prevention group was significantly longer than that in the non-prevented group (P < 0.01, log-rank test). In the prevention group, 1-, 2-, and 3-year inguinal hernia-free survival rates were 100 %, 96 %, and 96 %, respectively. Other clinical factors including age, body mass index, previous abdominal surgery, and previous inguinal hernia were not associated with the incidence of inguinal hernia in our cohort. The prevention technique was simple and safe to perform, and it could increase inguinal hernia-free survival rates after retropubic radical prostatectomy.