A matched case-control study in Taiwan to evaluate potential risk factors for prostate cancer.

The rising incidence rate of prostate cancer (PCa) worldwide has become a public health concern. PCa has a multifactorial etiology, and the link between human papillomavirus (HPV) and PCa has been widely investigated by numerous case-control studies. This age-matched, case-control study included 143 PCa patients and 135 benign prostatic hyperplasia (BPH) patients, with prostatic specimens testing negative for malignancy, as control. Study participants were recruited from four major hospitals in Taoyuan City, Taiwan, period 2018-2020, looking into HPV infection and other PCa risk factors, including dietary habits, family history, personal lifestyle, and sexual behavior. Multiple logistic regression analysis and forward stepwise selection analysis were conducted to identify potential risk factors for PCa. HPV DNA was found in 10 of the 143 PCa cases (7%) and 2 of the 135 BPH controls (1.5%) (OR = 6.02, 95% CI = 1.03-30.3, p = 0.046). This association was slightly significant, and furthermore, high risk HPV was not found to be associated with PCa. Higher body mass index (BMI) (OR = 1.15, 95% CI = 1.05-1.27, p = 0.003), more total meat consumption (OR = 2.74, 95% CI = 1.26-5.94, p = 0.011), exhibited association to PCa. However, PCa family history only presented a statistically significant difference by forward stepwise analysis (OR = 3.91, 95% CI = 1.17-13.12, p = 0.027). While much focus has been on the association between HPV and PCa, the results of this study indicate that more efforts should be directed towards investigating dietary habits, personal lifestyle and family history as factors for PCa. These results could serve as a basis for designing PCa prevention strategies.

Probing penile hemodynamics by using photoplethysmography as objective indicators for male erection quality and sexual function.

Erectile dysfunction (ED) is mostly due to the lack of blood flow into the penis. In the past 20 years, near-infrared spectroscopy (NIRS) was used in measuring the concentrations and temporal dynamics of different hemoglobin types. However, the dynamics of the light absorption (photoplethysmography; PPG) have not been applied to survey penile hemodynamics and erection quality. This paper compared the use of photoplethysmography (PPG) to study vascular ED with standard penile Doppler ultrasonography. Men diagnosed with vascular ED for at least 6 months and nominated for penile ultrasonography were included. PPG signals were collected during the ultrasound examination. All beat-to-beat PPG waveforms were aligned with the peak and averaged to one representative template waveform for feature analysis, including amplitude differences (APD) index, reflection time index (RTI), augmentation index (AI), and perfusion index (PI). An inverse correlation was found between end-erection amplitude and both erection hardness score (EHS) and resistive index (RI). APD index and EHS as well as the international index of erectile function-5 (IIEF) and RI were positively correlated. RTI and AI were inversely correlated to IIEF and RI. PI was positively correlated to RI. PPG may therefore be useful as a noninvasive, convenient, technique for sexual function evaluation.

Validating METCAM/MUC18 as a Novel Biomarker to Predict the Malignant Potential of Prostate Cancer at an Early Stage by Using a Modified Gold Nanoparticles-Based Lateral Flow Immunoassay.

(1) Background: To further validate METCAM/MUC18 as a diagnostic biomarker for prostate cancer, a modified Lateral Flow Immune Assay (LFIA) with increased sensitivity and specificity was designed by taking advantage of the extremely high affinity between biotin and streptavidin and used. (2) Methods: The combination of a commercial biotinylated rabbit antibody (EPP11278), or the home-made biotinylated chicken antibody, and the nano-gold conjugated home-made chicken antibody or a commercial rabbit antibody (EPP11278), had the higher sensitivity and specificity in this modified LFIA to establish calibration curves from the two recombinant METCAM/MUC18 proteins and were used for determining METCAM/MUC18 concentrations in serum specimens from normal individuals, benign prostatic hyperplasia (BPH) patients, prostatic intraepithelial neoplasia (PIN) patients, prostate cancer patients with various Gleason scores, and treated patients. (3) Results: Data obtained by this modified LFIA were statistically better than traditional LFIA and prostate-specific antigen (PSA) test. Interestingly, serum METCAM/MUC18 concentrations were higher in pre-malignant PIN patients than prostate cancer patients and both were higher than normal individuals, BPH patients, and treated patients. Serum METCAM/MUC18 concentrations were directly proportional to most serum PSA. (4) Conclusions: Elevated serum METCAM/MUC18 concentrations may be used for predicting the malignant potential of prostate cancer at an early premalignant (PIN) stage, which is not achievable by the current PSA test.

Web- and Artificial Intelligence-Based Image Recognition For Sperm Motility Analysis: Verification Study.

BACKGROUND: Human sperm quality fluctuates over time. Therefore, it is crucial for couples preparing for natural pregnancy to monitor sperm motility. OBJECTIVE: This study verified the performance of an artificial intelligence-based image recognition and cloud computing sperm motility testing system (Bemaner, Createcare) composed of microscope and microfluidic modules and designed to adapt to different types of smartphones. METHODS: Sperm videos were captured and uploaded to the cloud with an app. Analysis of sperm motility was performed by an artificial intelligence-based image recognition algorithm then results were displayed. According to the number of motile sperm in the vision field, 47 (deidentified) videos of sperm were scored using 6 grades (0-5) by a male-fertility expert with 10 years of experience. Pearson product-moment correlation was calculated between the grades and the results (concentration of total sperm, concentration of motile sperm, and motility percentage) computed by the system. RESULTS: Good correlation was demonstrated between the grades and results computed by the system for concentration of total sperm (r=0.65, P<.001), concentration of motile sperm (r=0.84, P<.001), and motility percentage (r=0.90, P<.001). CONCLUSIONS: This smartphone-based sperm motility test (Bemaner) accurately measures motility-related parameters and could potentially be applied toward the following fields: male infertility detection, sperm quality test during preparation for pregnancy, and infertility treatment monitoring. With frequent at-home testing, more data can be collected to help make clinical decisions and to conduct epidemiological research.

METCAM/MUC18 is a new early diagnostic biomarker for the malignant potential of prostate cancer: Validation with Western blot method, enzyme-linked immunosorbent assay and lateral flow immunoassay.

BACKGROUND: METCAM/MUC18 expression was increased with the malignant progression of prostate cancer and also a bona fide metastatic gene, capable of initiating and driving the metastasis of a non-metastatic human prostate cancer cell line to multiple organs. OBJECTIVE: We explored if METCAM/MUC18 was detectable in human serum and a novel biomarker to predict malignant propensity of prostate cancer. MATERIALS AND METHODS: Two antibodies were identified by Western blot analysis having the highest sensitivity and specificity to establish calibration curves from the recombinant METCAM/MUC18 proteins. They were used in ELISA and LFIA to determine the METCAM/MUC18 concentrations in serum samples from 8 normal individuals, 4 BPH patients, 1 with PIN, 6 with high-grade prostate cancer, and 2 treated cancer patients. RESULTS: Serum METCAM/MUC18 concentrations were statistically significantly higher in the patients with PIN and prostate cancer than those with BPH, the treated patients and normal individuals. The LFIA results were statistically better than ELISA and Western blot methods. Serum METCAM/MUC18 concentrations were in direct proportional to most of serum PSA concentrations.

Factors associated with reoperation in hypospadias surgery - A nationwide, population-based study.

BACKGROUND/OBJECTIVE: To analyze the preoperative factors associated with the need for secondary surgery following primary urethroplasty. METHODS: This study utilized a subset of the National Health Insurance Research Database, which includes the data on all paid medical benefit claims from 1997 to 2007, for 1 million beneficiaries in 2005. We analyzed the claims data for all patients with hypospadias who had undergone primary urethroplasty. The characteristics of the patients, surgeons, and hospitals associated with surgical outcomes were analyzed to investigate possible associations with the need for secondary surgery. RESULTS: Among 52,705 live male newborn babies, 218 were diagnosed with hypospadias, of whom 89 received repair surgery. A total of 75 (84.3%) male newborn babies received single hypospadias surgery, and 14 (15.7%) underwent more than two surgical procedures. Univariate analysis demonstrated that the type of hypospadias and the surgeon caseload volume were significantly associated with the need for additional hypospadias surgery (p = 0.02 and p = 0.03, respectively). In multivariate analysis, the type of hypospadias (distal vs. proximal, odds ratio, 0.25; p = 0.03) and the surgeon caseload volume (high vs. low, odds ratio, 0.04; p = 0.05) were significantly correlated with secondary operation. CONCLUSION: The type of hypospadias and the surgeon caseload volume were significantly associated with the need for secondary hypospadias surgery. The findings of this study provide important information on the outcomes of hypospadias repair for parents and specialists.

Recommended Initial Antimicrobial Therapy for Emphysematous Pyelonephritis: 51 Cases and 14-Year-Experience of a Tertiary Referral Center.

The aim of this study was to investigate the profiles of pathogens and patterns of antibiotic resistance of emphysematous pyelonephritis (EPN), offering recommendations for initial antibiotic treatment.Between January, 2001, and November, 2014, demographic data, presenting clinical features, management strategies, and treatment outcomes of 51 patients with EPN were retrospectively reviewed, analyzing microbiological characteristics of causative pathogens and patterns of antibiotic resistance.Overall survival rate was 90.2% (46/51). Pathogens isolated most frequently were Escherichia coli (49.0%), Klebsiella pneumoniae (19.6%), and Proteus mirabilis (17.7%). Approximately 24% of E coli isolates and 22% K pneumoniae isolates were resistant to fluoroquinolones. Improper empiric antibiotic use (P = 0.02) and third-generation cephalosporin-resistant pathogens (G3CRP) (P = 0.01) were significantly more common in cases of patient fatality. Prior hospitalization and antibiotic use within past year (P = 0.03), need for emergency hemodialysis (P = 0.03), and development of disseminated intravascular coagulation (DIC) (P = 0.03) were factors correlating significantly with microbial resistance to third-generation cephalosporins. The area under the receiver operating characteristic curve was 0.91. The cut-off point determined by the maximum Youden index for 2 of these 3 factors yielded a sensitivity of 0.8 and specificity of 0.93.Third-generation cephalosporins are recommended as initial treatment of EPN. In patients with histories of prior hospitalization and antibiotic use and in those needing emergency hemodialysis or developing DIC, carbapenem is the empiric antibiotic of choice. Patients presenting with 2 or more factors carry the highest risk of G3CRP involvement. Fluoroquinolone and gentamicin should be avoided.

The Biochemical and Pathological Correlates of Successful Semen Cryopreservation From Patients With Testicular Cancer: A Single Tertiary Center Experience.

OBJECTIVE: To determine the predictors for success with regard to semen cryopreservation and good semen quality of patients with testicular cancer. MATERIALS AND METHODS: A total of 50 men (aged 16-36 years) with testicular cancer, referred for semen cryopreservation prior to gonadotoxic treatment, were included. Age, alpha fetal protein (α-FP), beta human chorionic gonadotropin, lactate dehydrogenase, clinical staging, tumor volume, and pathological reports were evaluated as correlates of successful semen cryopreservation and good semen quality. RESULTS: The overall success rate was 52%. α-FP (4113.1 ng/mL vs 81.2 ng/mL) and tumor volume (77.7 mL vs 25.5 mL) were significantly higher in the failure group as compared to the success group. The seminoma to nonseminomatous germ cell tumor ratio was lower in the failure group as compared to the success group (9/17 vs 3/21). There was nearly a significant difference (P = .066). The optimal cutoff value for α-FP > 1000 ng/mL showed the highest Youden index (0.689) and resulted in a sensitivity of 0.625 and specificity of 1.0 for predicting poor outcome. In terms of multivariate analysis, the α-FP (P = .013), tumor volume (P = .047), and α-FP > 1000 ng/mL (P = .010) were significantly associated with poor semen quality and failure to preserve semen. Sperm quality was found to be higher in the seminoma versus the nonseminomatous germ cell tumor patients in: sperm concentration (21.5 million/mL vs 11.8 million/mL, P < .027). Furthermore, tumor volume is correlated to α-FP (P = .018) and is weakly correlated to lactate dehydrogenase (P = .067) CONCLUSION: Elevated α-FP and tumor volume are independently poor factors for semen quality and semen cryopreservation. In clinical use, α-FP is a noninvasive tool to predict the success of semen cryopreservation and patients with α-FP > 1000 ng/mL should be informed of the higher risk of poor semen quality and semen cryopreservation concerns.

Temporal trend of newly diagnosed incidence, medical utilization, and costs for pediatric urolithiasis, 1998-2007: a nationwide population-based study in Taiwan.

OBJECTIVE: To investigate the trends of newly diagnosed incidence, medical utilization, and medical costs for pediatric urolithiasis in Taiwan. MATERIALS AND METHODS: The present study uses the National Health Insurance Research Database, which contains the data of all medical benefit claims from the individuals enrolled in the national and single-payer insurance program in Taiwan. The National Health Insurance covered 22,717,053 enrollees, nearly 99% of Taiwan's population. Our analysis includes all subjects aged <18 years with a primary diagnosis of urolithiasis. We analyzed the temporal trend for annual newly diagnosed incidence, medical care visits, and medical costs for pediatric urolithiasis from 1998 to 2007. RESULTS: A total of 1474 patients aged <18 years with newly diagnosed urolithiasis were identified, including 719 (48.8%) boys and 755 (51.2%) girls. The overall newly diagnosed rate of urolithiasis in pediatric population was 0.038% in 2007. The peak age stratum of urolithiasis occurrence in 2007 was 15-18 years. The trend of annual newly diagnosed incidences for boys, girls, and all children declined from 1998 to 2007. Furthermore, there were declining trends both in medical costs and annual medical care visits during the study period. CONCLUSION: This is the first nationwide population-based study to indicate the declining trends in newly diagnosed rate, medical care visits, and medical costs for pediatric urolithiasis. These findings help to quantify and establish the burden of pediatric urolithiasis. These findings help to quantify and establish the burden of medical care for pediatric urolithiasis and to further refine the medical policy.

Predictors of failure of conservative treatment among patients with emphysematous pyelonephritis.

BACKGROUND: Emphysematous pyelonephritis (EPN) is a severe necrotizing infection of the renal parenchyma and perirenal tissues that is caused by gas-producing bacterial pathogens. Percutaneous drainage is now the gold standard of definitive management. The aim of this study is to analyze the predictors associated with failure of conservative treatment among patients with EPN and offer the recommendation of appropriate empirical antibiotic regimen. METHODS: From January 2001 to December 2013, 44 consecutive patients were diagnosed with EPN. The demographic characteristics, clinical presentations, management strategies, and final outcomes were analyzed retrospectively. RESULTS: The overall survival rate was 88.6% (39/44). Need for emergency hemodialysis, shock on initial presentation, altered mental status, severe hypoalbuminemia, inappropriate empirical antibiotic treatment and polymicrobial infections were significantly more common in the patients who died compared with the survivors. The overall failure rate of conservative treatment was 32.6% (14/43). Severe hypoalbuminemia (p = 0.003), need for emergency hemodialysis (p = 0.03), and polymicrobial infections (p = 0.04) were significantly associated with failure of conservative treatment. Severe hypoalbuminemia was independently associated with conservative management failure (p = 0.02). Even in the patients treated with percutaneous drainage plus effective antibiotics, failure was still associated with severe hypoalbuminemia (p = 0.01). According to the in vitro susceptibility data, third-generation cephalosporins is recommended as the empirical antibiotic regimen. CONCLUSIONS: Both appropriate empirical antibiotic and percutaneous drainage were essential for patients with EPN. Patients with severe hypoalbuminemia had a higher risk of conservative treatment failure, and additional management may be required.

Emphysematous pyelonephritis: clinical characteristics and prognostic factors.

OBJECTIVES: Emphysematous pyelonephritis is a severe necrotizing infection of the renal parenchyma and perirenal tissues that is caused by gas-producing bacterial pathogens. The aim of the present study was to determine the clinical characteristics and prognostic factors of patients with emphysematous pyelonephritis. METHODS: We retrospectively analyzed the clinical and laboratory data, imaging findings, and outcomes of 32 patients with emphysematous pyelonephritis. Receiver operating characteristic curve analysis was carried out on variables that were significantly associated with patient mortality. RESULTS: The overall survival rate was 87.5% (28/32). Escherichia coli (43.6%) was the most common organism cultured from urine and blood specimens. Hypoalbuminemia, shock as the presenting feature, bacteremia, need for hemodialysis and polymicrobial infection were significantly more common in cases resulting in death. The area under the receiver operating characteristic curve was 0.96. The cut-off point determined by the maximum Youden index (0.93) for three of these five factors yielded a sensitivity of 1.00 and specificity of 0.93. Shock as an initial presentation (P = 0.039) and polymicrobial infection (P = 0.010) were significantly associated with poor outcome. There were no significant differences in the clinical or laboratory features of the patients who did or did not undergo nephrectomy. CONCLUSION: Hypoalbuminemia, shock as an initial presentation, bacteremia, indications for hemodialysis and polymicrobial infection represent prognostic factors for mortality in patients with emphysematous pyelonephritis. Patients presenting with more than two of these prognostic factors carry the highest risk of mortality, and they require timely diagnosis and aggressive management.