Asian guidelines for urinary tract infection in children.

The followings are the level of evidence (LE) and grade of recommendation (GR) on pediatric UTI in Asia. Classification according to the sites of infection (lower versus upper tract), the number of episode (first versus recurrent), the severity (simple versus severe), or the existence of complicating factor (uncomplicated versus complicated) is useful to differentiate children with UTI whether they are at risk of renal damage or not (LE: 2, GR: B). Diagnosis of UTI requires both urinalysis that suggests infection and positive urine culture (LE:3, GR B). For pre-toilet trained children, urine specimen for culture should be collected by urethral catheterization or suprapubic aspiration. For toilet trained children, midstream clean catch urine is reliable (LE: 3, GR: A). Urine culture is considered positive if it demonstrates growth of a single bacterium with the following colony counts: (1) any growth by suprapubic aspiration, (2) >5 × 104 CFU/ml by urethral catheterization, or (3) >100,000 CFU/ml by midstream clean catch (LE:3, GR: B). For children with febrile UTI, renal and bladder ultrasonography (RBUS) should be routinely performed as soon as possible (LE: 3, GR: C). RBUS should be followed up 6 months later in children with acute pyelonephritis and/or VUR (LE: 3, GR: C). Acute DMSA scan can be performed when severe acute pyelonephritis or congenital hypodysplasia is noted on RBUS or when the diagnosis of UTI is in doubt by the clinical presentation (LE: 3, GR: C). Late DMSA scan (>6 months after the febrile UTI) can be performed in children with severe acute pyelonephritis, high-grade VUR, recurrent febrile UTIs, or abnormal renal parenchyma on the follow-up RBUS (LE: 3, GR: C). Top-down or bottom-up approach for febrile UTI is suggested for the diagnosis of VUR. For top-down approach, VCUG should not be performed routinely for children after the first febrile UTI. VCUG is indicated when abnormalities are apparent on either RBUS or DMSA scan or both (LE: 2, GR: B). VCUG is also suggested after a repeat febrile UTI (LE:2, GR: B). Appropriate antibiotic should be given immediately after urine specimen for culture has been obtained (LE:2, GR: A). Initiating therapy with oral or parenteral antibiotics is equally efficacious for children (>3 months) with uncomplicated UTI (LE: 2: GR: A). The choice of empirical antibiotic agents is guided by the expected pathogen and the local resistance patterns (LE: 2, GR: A). For children with febrile UTI, the total course of antibiotic therapy should be 7-14 days (LE: 2, GR: B). Circumcision may, but not definitively, reduce the risk of febrile UTI in males and breakthrough febrile UTI in males with VUR. Circumcision should be offered to uncircumcised boys with febrile UTI and VUR in countries where circumcision is accepted by the general population (LE: 3, GR: B), while in countries where childhood circumcision is rarely performed, other measures for febrile UTI/VUR should be the preferred choice (LE: 4, GR: C). Bladder bowel dysfunction (BBD) is one of the key factors of progression of renal scarring (LE: 2). Early recognition and management of BBD are important in prevention of UTI recurrence (LE:2, GR: A). Antibiotic prophylaxis to prevent recurrent febrile UTI is indicated in children with moderate to high grade (III-V) VUR (LE: 1b, GR: A). Surgical intervention may be used to treat VUR in the setting of recurrent febrile UTI because it has been shown to decrease the incidence of recurrent pyelonephritis (LE: 2, GR: B).

An artificial neural-network approach to identify motor hotspot for upper-limb based on electroencephalography: a proof-of-concept study.

BACKGROUND: To apply transcranial electrical stimulation (tES) to the motor cortex, motor hotspots are generally identified using motor evoked potentials by transcranial magnetic stimulation (TMS). The objective of this study is to validate the feasibility of a novel electroencephalography (EEG)-based motor-hotspot-identification approach using a machine learning technique as a potential alternative to TMS. METHODS: EEG data were measured using 63 channels from thirty subjects as they performed a simple finger tapping task. Power spectral densities of the EEG data were extracted from six frequency bands (delta, theta, alpha, beta, gamma, and full) and were independently used to train and test an artificial neural network for motor hotspot identification. The 3D coordinate information of individual motor hotspots identified by TMS were quantitatively compared with those estimated by our EEG-based motor-hotspot-identification approach to assess its feasibility. RESULTS: The minimum mean error distance between the motor hotspot locations identified by TMS and our proposed motor-hotspot-identification approach was 0.22 ± 0.03 cm, demonstrating the proof-of-concept of our proposed EEG-based approach. A mean error distance of 1.32 ± 0.15 cm was measured when using only nine channels attached to the middle of the motor cortex, showing the possibility of practically using the proposed motor-hotspot-identification approach based on a relatively small number of EEG channels. CONCLUSION: We demonstrated the feasibility of our novel EEG-based motor-hotspot-identification method. It is expected that our approach can be used as an alternative to TMS for motor hotspot identification. In particular, its usability would significantly increase when using a recently developed portable tES device integrated with an EEG device.

Design of Wearable EEG Devices Specialized for Passive Brain-Computer Interface Applications.

Owing to the increased public interest in passive brain-computer interface (pBCI) applications, many wearable devices for capturing electroencephalogram (EEG) signals in daily life have recently been released on the market. However, there exists no well-established criterion to determine the electrode configuration for such devices. Herein, an overall procedure is proposed to determine the optimal electrode configurations of wearable EEG devices that yield the optimal performance for intended pBCI applications. We utilized two EEG datasets recorded in different experiments designed to modulate emotional or attentional states. Emotion-specialized EEG headsets were designed to maximize the accuracy of classification of different emotional states using the emotion-associated EEG dataset, and attention-specialized EEG headsets were designed to maximize the temporal correlation between the EEG index and the behavioral attention index. General purpose electrode configurations were designed to maximize the overall performance in both applications for different numbers of electrodes (2, 4, 6, and 8). The performance was then compared with that of existing wearable EEG devices. Simulations indicated that the proposed electrode configurations allowed for more accurate estimation of the users' emotional and attentional states than the conventional electrode configurations, suggesting that wearable EEG devices should be designed according to the well-established EEG datasets associated with the target pBCI applications.

Prediction of Individual User's Dynamic Ranges of EEG Features from Resting-State EEG Data for Evaluating Their Suitability for Passive Brain-Computer Interface Applications.

With the recent development of low-cost wearable electroencephalogram (EEG) recording systems, passive brain-computer interface (pBCI) applications are being actively studied for a variety of application areas, such as education, entertainment, and healthcare. Various EEG features have been employed for the implementation of pBCI applications; however, it is frequently reported that some individuals have difficulty fully enjoying the pBCI applications because the dynamic ranges of their EEG features (i.e., its amplitude variability over time) were too small to be used in the practical applications. Conducting preliminary experiments to search for the individualized EEG features associated with different mental states can partly circumvent this issue; however, these time-consuming experiments were not necessary for the majority of users whose dynamic ranges of EEG features are large enough to be used for pBCI applications. In this study, we tried to predict an individual user's dynamic ranges of the EEG features that are most widely employed for pBCI applications from resting-state EEG (RS-EEG), with the ultimate goal of identifying individuals who might need additional calibration to become suitable for the pBCI applications. We employed a machine learning-based regression model to predict the dynamic ranges of three widely used EEG features known to be associated with the brain states of valence, relaxation, and concentration. Our results showed that the dynamic ranges of EEG features could be predicted with normalized root mean squared errors of 0.2323, 0.1820, and 0.1562, respectively, demonstrating the possibility of predicting the dynamic ranges of the EEG features for pBCI applications using short resting EEG data.

Development of a Brain-Computer Interface Toggle Switch with Low False-Positive Rate Using Respiration-Modulated Photoplethysmography.

Asynchronous brain-computer interfaces (BCIs) based on electroencephalography (EEG) generally suffer from poor performance in terms of classification accuracy and false-positive rate (FPR). Thus, BCI toggle switches based on electrooculogram (EOG) signals were developed to toggle on/off synchronous BCI systems. The conventional BCI toggle switches exhibit fast responses with high accuracy; however, they have a high FPR or cannot be applied to patients with oculomotor impairments. To circumvent these issues, we developed a novel BCI toggle switch that users can employ to toggle on or off synchronous BCIs by holding their breath for a few seconds. Two states-normal breath and breath holding-were classified using a linear discriminant analysis with features extracted from the respiration-modulated photoplethysmography (PPG) signals. A real-time BCI toggle switch was implemented with calibration data trained with only 1-min PPG data. We evaluated the performance of our PPG switch by combining it with a steady-state visual evoked potential-based BCI system that was designed to control four external devices, with regard to the true-positive rate and FPR. The parameters of the PPG switch were optimized through an offline experiment with five subjects, and the performance of the switch system was evaluated in an online experiment with seven subjects. All the participants successfully turned on the BCI by holding their breath for approximately 10 s (100% accuracy), and the switch system exhibited a very low FPR of 0.02 false operations per minute, which is the lowest FPR reported thus far. All participants could successfully control external devices in the synchronous BCI mode. Our results demonstrated that the proposed PPG-based BCI toggle switch can be used to implement practical BCIs.

Effects of a combination of herbal extracts (modified Ojayeonjonghwan (Wuzi Yanzong wan)) on partial urethral obstruction-induced detrusor overactivity in rats: impact on the nitric oxide pathway and oxidative stress.

BACKGROUND: We investigated the effects of a berry mixture formula (modified Ojayeonjonghwan (Wuzi Yanzong Wan, MO formula) on detrusor overactivity (DO). METHODS: The MO formula consisted of 5 seeds obtained from 5 types of berry plants. Twenty-four Sprague-Dawley rats were randomly assigned to four groups: sham-operated (control), partial urethral obstruction-induced DO (DO group), 0.03 mg/kg solifenacin-treated DO (solifenacin group) and 200 mg/kg MO formula -treated DO (berry mixture). The control and overactive groups were administered distilled water for 4 weeks, and the solifenacin and MO formula groups were treated with the respective medication for 4 weeks. After treatment, cystometrography was performed. At the endo of cystometrography, their bladder tissues were used for identifying the muscarinic receptors, endothelial nitric oxide synthase(eNOS), RhoA, Rock-I & II, 8-hydroxy-2' -deoxyguanosine(8-OHdG), superoxide dismutase(SOD), interleukin-6 &-8(IL-6, IL-8), and tumor necrosis factor-alpha(TNF-a). The tissues were stained and the muscle-to-collagen ratio was identified. RESULTS: The presence of the muscarinic receptors were not significantly different between the solifenacin and MO formula groups. However, significant differences were found between the solifenacin and MO formula groups in terms of eNOS, RhoA, Rock-I and -II levels. The muscle-to-collagen ratio was statistically lower in the DO and solifenacin groups; however, no significant difference was observed between the control and MO formula groups. Under oxidative stress, SOD showed a similar result as 8-OHgG. The MO formula group exhibited anti-inflammatory effects, showing that no significant difference was found between the control and MO formula groups regarding values of IL-6, IL-8, and TNF-a. However, the DO and solifenacin groups showed increased IL-6, IL-8, and TNF-a levels. Cystometrography showed that the OAB and solifenacin groups having a significantly lower value than the control and MO formula groups. The mean contraction interval was shorter in the DO, MO formula, and solifenacin groups and the highest in the control group. CONCLUSIONS: The MO formula exhibited a similar pharmacologic effect to that of solifenacin, with anti-inflammatory and antioxidant effects. Enhancement of the MO formula by the nitric oxide pathway affected DO including BPH-related DO. The MO formula may be one of the alternative choices of anticholinergics, a treatment for DO.

Electroencephalography-based endogenous brain-computer interface for online communication with a completely locked-in patient.

BACKGROUND: Brain-computer interfaces (BCIs) have demonstrated the potential to provide paralyzed individuals with new means of communication, but an electroencephalography (EEG)-based endogenous BCI has never been successfully used for communication with a patient in a completely locked-in state (CLIS). METHODS: In this study, we investigated the possibility of using an EEG-based endogenous BCI paradigm for online binary communication by a patient in CLIS. A female patient in CLIS participated in this study. She had not communicated even with her family for more than one year with complete loss of motor function. Offline and online experiments were conducted to validate the feasibility of the proposed BCI system. In the offline experiment, we determined the best combination of mental tasks and the optimal classification strategy leading to the best performance. In the online experiment, we investigated whether our BCI system could be potentially used for real-time communication with the patient. RESULTS: An online classification accuracy of 87.5% was achieved when Riemannian geometry-based classification was applied to real-time EEG data recorded while the patient was performing one of two mental-imagery tasks for 5 s. CONCLUSIONS: Our results suggest that an EEG-based endogenous BCI has the potential to be used for online communication with a patient in CLIS.

Assessment of user voluntary engagement during neurorehabilitation using functional near-infrared spectroscopy: a preliminary study.

BACKGROUND: Functional near infrared spectroscopy (fNIRS) finds extended applications in a variety of neuroscience fields. We investigated the potential of fNIRS to monitor voluntary engagement of users during neurorehabilitation, especially during combinatory exercise (CE) that simultaneously uses both, passive and active exercises. Although the CE approach can enhance neurorehabilitation outcome, compared to the conventional passive or active exercise strategies, the active engagement of patients in active motor movements during CE is not known. METHODS: We determined hemodynamic responses induced by passive exercise and CE to evaluate the active involvement of users during CEs using fNIRS. In this preliminary study, hemodynamic responses of eight healthy subjects during three different tasks (passive exercise alone, passive exercise with motor imagery, and passive exercise with active motor execution) were recorded. On obtaining statistically significant differences, we classified the hemodynamic responses induced by passive exercise and CEs to determine the identification accuracy of the voluntary engagement of users using fNIRS. RESULTS: Stronger and broader activation around the sensorimotor cortex was observed during CEs, compared to that during passive exercise. Moreover, pattern classification results revealed more than 80% accuracy. CONCLUSIONS: Our preliminary study demonstrated that fNIRS can be potentially used to assess the engagement of users of the combinatory neurorehabilitation strategy.

On the Feasibility of Using an Ear-EEG to Develop an Endogenous Brain-Computer Interface.

Brain-computer interface (BCI) studies based on electroencephalography (EEG) measured around the ears (ear-EEGs) have mostly used exogenous paradigms involving brain activity evoked by external stimuli. The objective of this study is to investigate the feasibility of ear-EEGs for development of an endogenous BCI system that uses self-modulated brain activity. We performed preliminary and main experiments where EEGs were measured on the scalp and behind the ears to check the reliability of ear-EEGs as compared to scalp-EEGs. In the preliminary and main experiments, subjects performed eyes-open and eyes-closed tasks, and they performed mental arithmetic (MA) and light cognitive (LC) tasks, respectively. For data analysis, the brain area was divided into four regions of interest (ROIs) (i.e., frontal, central, occipital, and ear area). The preliminary experiment showed that the degree of alpha activity increase of the ear area with eyes closed is comparable to those of other ROIs (occipital > ear > central > frontal). In the main experiment, similar event-related (de)synchronization (ERD/ERS) patterns were observed between the four ROIs during MA and LC, and all ROIs showed the mean classification accuracies above 70% required for effective binary communication (MA vs. LC) (occipital = ear = central = frontal). From the results, we demonstrated that ear-EEG can be used to develop an endogenous BCI system based on cognitive tasks without external stimuli, which allows the usability of ear-EEGs to be extended.

Clinical efficacy of roxithromycin in men with chronic prostatitis/chronic pelvic pain syndrome in comparison with ciprofloxacin and aceclofenac: a prospective, randomized, multicenter pilot trial.

Roxithromycin is effective in the treatment of intracellular organisms, including chlamydia and mycoplasma, and exhibits anti-inflammatory and immunomodulatory effects on respiratory diseases. To explore the potential therapeutic benefit of roxithromycin in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), this study compared the effect of roxithromycin with ciprofloxacin and aceclofenac. A total of 75 patients with CP/CPPS were randomized to three groups in open-label: group 1, ciprofloxacin; group 2, aceclofenac; and group 3, roxithromycin. The patients were treated for 4 weeks and were subsequently followed for 12 weeks. Changes from baseline in the total and domain scores of the NIH Chronic Prostatitis Symptom Index (NIH-CPSI) were evaluated. The NIH-CPSI score decreased in the roxithromycin, ciprofloxacin, and aceclofenac groups to a similar degree. The NIH-CPSI initial and 12-week total scores were 20.3 and 10.0, respectively, in group 1; 23.6 and 14.3, respectively, in group 2; and 21.1 and 9.8, respectively, in group 3. The three treatment arms did not differ significantly with respect to the efficiency of treatment (p > 0.05). Compared to patients in groups 1 and 2, group 3 patients with Category IIIb disease exhibited favorable results upon follow-up 12 weeks after treatment. The International Prostate Symptom Score (IPSS), uroflowmetry, and post-void residual volume were equivalent between the groups. Roxithromycin exhibits similar or favorable effects on the improvement of CP/CPPS compared to ciprofloxacin and aceclofenac. Roxithromycin could be used as a new therapeutic agent for CP/CPPS. Further study of the immunomodulatory action of roxithromycin in CP/CPPS is required.

Antimicrobial susceptibility pattern and epidemiology of female urinary tract infections in South Korea, 2010-2011.

This study aimed to (i) investigate the antimicrobial susceptibilities of bacteria that cause urinary tract infections (UTIs) in outpatient and inpatient settings and (ii) evaluate the risk factors for emerging antimicrobial drug resistance in UTIs in South Korea. In total, 3,023 samples without duplication were collected from females between 25 and 65 years of age who had been diagnosed with a urinary tract infection. Multicenter patient data were collected using a Web-based electronic system and then evaluated. The isolation rates of Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecium in the outpatient setting were 78.1, 4.7, and 1.3%, respectively; in the inpatient setting, the isolation rates of these microorganisms were 37.8, 9.9, and 14.8%, respectively. The susceptibilities of E. coli to amikacin, amoxicillin-clavulanic acid, cefotaxime, cefoxitin, ciprofloxacin, piperacillin-tazobactam, and imipenem in the outpatient setting were 99.4, 79.8, 89.4, 92.8, 69.8, 96.9, and 100.0%, respectively; in the inpatient setting, the susceptibilities to these antibiotics were 97.8, 73.9, 73.7, 82.1, 53.6, 93.2, and 100.0%, respectively. The most unique and common risk factor for emerging antimicrobial-resistant E. coli, K. pneumoniae, and E. faecium was previous exposure to antimicrobials. On the basis of these data, the use of fluoroquinolones should be reserved until culture data are available for the treatment of UTIs in South Korea. The present study will serve as a useful reference for Far Eastern Asia.

Comparison of intrarectal heated lidocaine gel and periprostatic nerve block for pain control in transrectal ultrasound-guided prostate biopsy: A randomized controlled non-inferiority trial.

Background: To investigate whether intrarectal local anesthesia with heated lidocaine gel (IRLAH) is non-inferior to periprostatic nerve block (PNB) for reducing pain in patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy. Methods: We performed a randomized controlled non-inferiority trial with 100 participants who underwent systematic TRUS-guided, 12-core prostate biopsy from August 2019 to July 2020. These participants were randomly assigned to a group receiving intrarectal local anesthesia with 20 mL of heated (40°C) 2% lidocaine gel (n = 50) or PNB (n = 50). The primary outcome was a pain score on a 0-10 visual analogue scale (VAS) at four time points with the non-inferiority margin of 1; VAS-1: during local anesthesia application; VAS-2: during probe insertion; VAS-3: during biopsy; VAS-4: 30 minutes after the procedure. The secondary outcome included complications during and after the procedure. Results: The IRLAH group (0.1) met non-inferiority as well as superiority criteria for mean VAS-1 score vs. the PNB group (2.33) (P < 0.001), as the difference (95% confidence interval [CI]) between the two groups was -2.23 (-2.66 to -1.79) and the upper bound of the 95% CI were both below the prespecified non-inferiority margin and below zero. For mean VAS-3 score, the difference (95% CI) was 0.3 (-0.38 to 0.98) and the upper bound of the 95% CI did not exceed the predefined non-inferiority margin indicating that IRLAH was non-inferior (IRLAH group, 3.44; PNB group, 3.14). Also, non-inferiority was shown for pain scores at VAS-2 and VAS-4. There were no significant differences in complications. Conclusion: IRLAH is a noninvasive and non-inferior alternative to PNB for pain control in TRUS-guided prostate biopsy without increased risk of complications.

Trends of genital wart in Korea according to treatment method classification: Big data analysis of health care in 2010-2019.

PURPOSE: The purpose of this study is to investigate disease trend of genital wart through changes in each treatment method over the past 10 years in Korea. MATERIALS AND METHODS: From 2010 to 2019, surgical treatment including cauterization, excision, cryotherapy, and laser therapy, non-surgical treatment such as podophyllin, and surgical treatment for anorectal lesion were extracted and analyzed from 2010 to 2019. For each treatment method, characteristics such as sex, age, region, medical cost and average number of procedures were analyzed. RESULTS: The number of patients following all treatment modalities increased every year. Surgical treatment of genital wart and anorectal wart showed a significant increase in male patients. Number of non-surgical treatment decreased in males but increased in females. Surgical removal of the anorectal wart increased more than 250% in over 10 years, and males underwent surgery 4 times more than females. In both surgery and non-surgery, the mean session was higher in males. Most of them were carried out in primary medical institutions. In Seoul and Gyeonggi-do, the largest number of patients received treatment regardless of treatment method. CONCLUSIONS: Treatment for genital warts has increased rapidly over the past 10 years, and the increase in males is remarkable. The main treatment was surgery, and males mainly received surgical treatment, and females mainly received drug treatment. The primary medical institution was in charge of the most treatment. As the number of patients and related medical expenses are increasing rapidly, more attention and response to diseases are needed.

PAIP 2020: Microsatellite instability prediction in colorectal cancer.

Microsatellite instability (MSI) refers to alterations in the length of simple repetitive genomic sequences. MSI status serves as a prognostic and predictive factor in colorectal cancer. The MSI-high status is a good prognostic factor in stage II/III cancer, and predicts a lack of benefit to adjuvant fluorouracil chemotherapy in stage II cancer but a good response to immunotherapy in stage IV cancer. Therefore, determining MSI status in patients with colorectal cancer is important for identifying the appropriate treatment protocol. In the Pathology Artificial Intelligence Platform (PAIP) 2020 challenge, artificial intelligence researchers were invited to predict MSI status based on colorectal cancer slide images. Participants were required to perform two tasks. The primary task was to classify a given slide image as belonging to either the MSI-high or the microsatellite-stable group. The second task was tumor area segmentation to avoid ties with the main task. A total of 210 of the 495 participants enrolled in the challenge downloaded the images, and 23 teams submitted their final results. Seven teams from the top 10 participants agreed to disclose their algorithms, most of which were convolutional neural network-based deep learning models, such as EfficientNet and UNet. The top-ranked system achieved the highest F1 score (0.9231). This paper summarizes the various methods used in the PAIP 2020 challenge. This paper supports the effectiveness of digital pathology for identifying the relationship between colorectal cancer and the MSI characteristics.

Molecular cloning of prophenoloxidase and the effects of dietary ß-glucan and rutin on immune response in hemocytes of the fleshy shrimp, Fenneropenaeus chinensis.

To investigate the effects of dietary ß-glucan (0.5 or 1 g kg⁻¹ diet: 0.5-BG, 1-BG) and rutin (0.5 or 1 g kg⁻¹ diet: 0.5-RT, 1-RT) after 10 days in the absence of pathogen challenge on the immune response of Fenneropenaeus chinensis, we determined total hemocyte count (THC) and the expression of four immune-related genes in hemocytes: those for prophenoloxidase (proPO), peroxinectin (PX), lipopolysaccharide and/or ß-glucan binding protein (LGBP), and c-type lectin (CL). As a prerequisite for subsequent experiments, cDNA encoding proPO of the fleshy shrimp, Fenneropenaeus chinensis (f-proPO) was obtained from hemocytes; it had a full length of 3023 bp, with an open reading frame (ORF) of 2061bp, a 105-bp 5'-untranslated region, and a 906-bp 3'-untranslated region containing the poly A signal. The THCs of shrimp fed ß-glucan of 1 g kg⁻¹ diet, and rutin of 1 g kg⁻¹ diet were significantly higher than that of the control (P < 0.05). The expression of proPO mRNA was slightly downregulated and that of LGBP mRNA was upregulated (except in 1-RT). PX and CL mRNA remained constitutively expressed in all groups. Our results reveal that ß-glucan and rutin dietary supplements have minimal effect on immune response in the absence of pathogen challenge.

Acute bacterial prostatitis: how to prevent and manage chronic infection?

We conducted a retrospective analysis of acute bacterial prostatitis (ABP) to evaluate the factors of progressing to chronic infection and chronic pelvic pain syndrome IIIa (CPPS IIIa) from ABP. The clinical records of 480 cases compatible with a confirmed diagnosis of ABP from five urological centers between 2001 and 2010 were reviewed. We defined chronic infection (CI) as a progression to chronic bacterial prostatitis (II), epididymo-orchitis, and showing persistent pyuria and bacteriuria after treatment of ABP in admission periods when followed up at 3 months or more. Results were analyzed according to two categories: category I, developed to CI (group A, n = 49) versus recovered without CI or CPPS IIIa (group C, n = 385); and category II, developed to CPPS IIIa (group B, n = 46) versus recovered without CI or CPPS IIIa (group C, n = 385). Of the 480 ABP patients, 10.2% (49/480) progressed to CI and 9.6% (46/480) progressed to CPPS IIIa. The frequency of CI was 11.3% (49/434) and that of CPPS IIIa was 10.7% (46/431). The factors that affected progression to CI were diabetes, prior manipulation, not doing cystostomy, and urethral catheterization (P < 0.05). The factors that affected progression to CPPS IIIa were the same as CI, but prostate volume was included in the CPPS IIIa group (P < 0.05). The identification and characterization of these factors may accelerate the development of preventive, diagnostic, and therapeutic strategies for the treatment of CI and CPPS IIIa from ABP.

Preventive effect of ginsenoid on chronic bacterial prostatitis.

Empirical antibiotic therapy is the preferred primary treatment modality for chronic bacterial prostatitis (CBP). However, this method of treatment has a low success rate and long-term therapy may result in complications and the appearance of resistant strains. Therefore a new alternative method for the prevention of CBP is necessary. There are several reports that ginsenoid has a preventive effect on urinary tract infection (UTI). To evaluate the preventive effect of ginsenoid on CBP compared to conventional antibiotics, we carried out an experiment in a rat model of the disease. Four groups of adult male Wistar rats were treated with the following medications: (1) control (no medication), (2) ciprofloxacin, (3) ginsenoid, and (4) ciprofloxacin/ginsenoid. All medications were given for 4 weeks, and then we created a CBP model in the animals by injecting an Escherichia coli Z17 (O2:K1;H(-)) suspension into the prostatic urethra. After 4 weeks, results of microbiological cultures of prostate and urine samples, as well as histological findings of the prostate in each group were analyzed. The microbiological cultures of the prostate samples demonstrated reduced bacterial growth in all experimental groups compared with the control group. Histopathological examination showed a significantly decreased rate of infiltration of inflammatory cells into prostatic tissue and decreased interstitial fibrosis in the ginsenoid group compared with the control group. Inhibition of prostate infection was greater in the group receiving both ginsenoid and antibiotic than in the single-medication groups. Although the findings of this study suggest a preventive effect of ginsenoid, preventive methods for CBP are still controversial.

The change of antibiotic susceptibility in febrile urinary tract infection in childhood and adolescence during the last decade.

PURPOSE: The purpose of this study was to clarify the pattern of antibiotic resistance in pediatric urinary tract infections (UTIs). MATERIALS AND METHODS: We analyzed the data of entire urine culture tests and antibiotic susceptibility tests performed on hospitalized patients for febrile UTI at the Uijeongbu St. Mary's Hospital during 2010-2020. A retrospective analysis was performed using medical records of urine culture results and antibiotic susceptibility results in patients with UTIs. RESULTS: We performed urine cultures from 2,491 patients, and identified bacterial types in 1,651 cases. We found that the resistance rates to ampicillin, ampicillin/sulbactam, cefazolin, gentamicin, piperacillin, tobramycin, and trimethoprim/sulfamethoxazole were already over 20% in 2010. The resistance rates to many other antibiotics also steadily increased over time. Among the antibiotics tested in 2020, only amikacin, cefoxitin, imipenem, piperacillin/tazobactam, and tigecycline showed the resistance rates below 20%. Noticeably, ciprofloxacin also showed an increase in the resistance rate from 7.3% in 2010 (S 139 vs. R 11) to 27.78% in 2019 (S 104 vs. R 40) and even over 30% (33.96%) in 2020 (S 35 vs. R 18). CONCLUSIONS: Antibiotic resistance is a serious problem in pediatric UTIs. In the treatment of pediatric UTIs, more caution is needed in the use of antibiotics. It may be necessary to apply appropriate antibiotic management programs such as antibiotics steward program for pediatric patients. Failure of a proper response strategy coping with antibiotic resistance may accelerate the resistance crisis.

Clinical Efficacy of Multi-Focal Low-Intensity Extracorporeal Shockwave Therapy in the Treatment of Chronic Prostatitis/Chronic Pelvic Pain Syndrome: Prospective-Randomized, Double Blind, Placebo-Controlled Study.

PURPOSE: To assess the safety and effect of the multifocal low-intensity extracorporeal shockwave therapy (MESWT) in the treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). MATERIALS AND METHODS: We randomly separated 30 patients with CP/CPPS into a MESWT and placebo group of same number using prospective-randomized, double-blind design. The participants' National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) total and subdomain scores, International Prostate Symptom Score (IPSS), International Index of Erectile Function-5 (IIEF-5), and visual analogue scale (VAS) were assessed and compared at baseline and at finishing immediately and 4 weeks after procedure and also were compared between MESWT and placebo group. RESULTS: A total of 30 participants were randomized a MESWT or placebo group. Twenty of thirty participants completed this trial. NIH-CPSI total and subdomain scores, IPSS, IIEF-5, and VAS had significantly ameliorated compared with baseline in the MESWT group at 4 weeks assessment. Furthermore, comparison of the results from MESWT and placebo groups represented statistically significant differences in NIH-CPSI total and subdomain scores, IPSS, IIEF-5, and VAS. No side effects or events were occurred in both groups of the participants during study periods. CONCLUSIONS: MESWT can be an effective treatment modality in patients with CP/CPPS as it improves pain and QoL.

Proteomic analysis of placentas from cloned cat embryos identifies a set of differentially expressed proteins related to oxidative damage, senescence and apoptosis.

Production of cloned mammals by somatic cell nuclear transfer is associated with functional and structural abnormalities of placentation and with abnormal fetal development. A proteomic analysis was performed in domestic cats (Felis catus) to compare cloned term placentas (CTP) obtained from cesarean section (CS) to control placentas obtained from CS or vaginal delivery. The expression of 20 proteins was altered in CTP (p<0.05) compared to control placentas. The two control groups showed that the method of delivery, vaginal delivery or CS, did not affect protein expression (p>0.05). A total of 13 proteins were up-regulated in CTP, including apoptosis-related cathepsin D (CD), annexin A1 and heat shock protein 27 (HSP 27), and seven proteins were down-regulated in CTP, including prohibitin (PHB). The expression of PHB and CD was confirmed by Western blotting and immunofluorescence staining. The abnormal expression of PHB and CD correlated with the generation of reactive oxygen species, leading to decreased mitochondrial membrane potential and telomeric DNA, which are associated with cellular senescence and apoptosis. In summary, a specific pattern of abnormal protein expression is associated with the impaired development and functions of cloned placentas and hence with decreased fetal viability. Strategies aimed at restoring normal placental protein expression may increase the efficiency of somatic cell nuclear transfer and transgenic cat production and help restore endangered species.