Survival pattern of metastatic renal cell carcinoma patients according to WHO/ISUP grade: a long-term multi-institutional study.

The World Health Organization/International Society of Urological Pathology (WHO/ISUP) grading of renal cell carcinoma (RCC) is classified from grade 1-4, regardless of subtype. The National Comprehensive Cancer Network (NCCN) guidelines (2022) state that if there is an adverse pathological feature, such as grade 3 or higher RCC in stage 1 patients, more rigorous follow-up imaging is recommended. However, the RCC guidelines do not provide specific treatment or follow-up policies by tumor grade. Therefore, this study attempted to find out whether tumor grade affects survival rates in patients with metastatic RCC. The Korean Renal Cancer Study Group (KRoCS) database includes 3108 patients diagnosed with metastatic RCC between September 1992 and February 2017, with treatment methods, progression, and survival data collected from 11 tertiary hospitals. To obtain information on survival rates or causes of death, we utilized the Korea National Statistical Office database and institutional medical records. Data were accessed for research purpose on June, 2023. We then reviewed these sources to gather comprehensive and reliable data on the outcomes of our study cohort. This database was retrospectively analyzed, and out of 3108 metastatic RCC patients, 911 had been identified as WHO/ISUP grade. Grades were classified into either a low-grade (WHO/ISUP grade 1-2) or a high-grade group (WHO/ISUP grade 3-4). The patients were then analyzed related to progression and overall survival (OS). In metastatic clear cell RCC patients, the 1-year OS rate was 69.4% and the median OS was 17.0 months (15.5-18.5) followed up to 203.6 months. When comparing the patient groups, 119 low-grade and 873 high-grade cases were identified. No baseline difference was observed between the two groups, except that the high-grade group had a higher ECOG 1 ratio of 50.4% compared with 34.5% for the low-grade group (p = 0.009). There was a significant difference in OS between high-grade and low-grade groups. OS was 16.0 months (14.6-17.4) in the high-grade group and 28.0 months (21.1-34.9) in the low-grade group (p < 0.001). However, there was no difference in progression-free survival (PFS) rates with 9.0 months (8.0-10.0) for the high-grade group and 10.0 months (6.8-13.2) for the low-grade group (p = 0.377) in first-line treatment. In multivariable analysis, WHO/ISUP grade was a risk factor (HR = 1.511[1.135-2.013], p = 0.005) that influenced the OS. In conclusion, WHO/ISUP grade is a major data source that can be used as a ubiquitous marker of metastatic RCC in pre-IO era. Depending on whether the RCC is high or low grade, the follow-up schedule will need to be tailored according to grade, with higher-grade patients needing more active treatment as it can not only affect the OS in the previously known localized/locoregional recurrence but also the metastatic RCC patient.

Repetitive Transcranial Magnetic Stimulation for Wernicke-Korsakoff Syndrome: A Case Report.

A 57-year-old man who was diagnosed with Wernicke-Korsakoff syndrome showed severe impairment of cognitive function and a craving for alcohol, even after sufficient supplementation with thiamine. After completing 10 sessions of 10 Hz repetitive transcranial magnetic stimulation (rTMS) at 100% of the resting motor threshold over the left dorsolateral prefrontal cortex, dramatic improvement in cognitive function and a reduction in craving for alcohol were noted. This is the first case report of the efficacy of a high-frequency rTMS in the treatment of Wernicke-Korsakoff syndrome.

Evaluation of holmium laser for transurethral deroofing of severe and multiloculated prostatic abscesses.

PURPOSE: Our objective was to evaluate the use of a holmium laser for transurethral deroofing of a prostatic abscess in patients with severe and multiloculated prostatic abscesses. MATERIALS AND METHODS: From January 2011 to April 2014, eight patients who were diagnosed with prostatic abscesses and who underwent transurethral holmium laser deroofing at Pusan National University Hospital were retrospectively reviewed. RESULTS: Multiloculated or multifocal abscess cavities were found on the preoperative computed tomography (CT) scan in all eight patients. All patients who underwent transurethral holmium laser deroofing of a prostatic abscess had successful outcomes, without the need for secondary surgery. Of the eight patients, seven underwent holmium laser enucleation of the prostate (HoLEP) for the removal of residual adenoma. Markedly reduced multiloculated abscess cavities were found in the follow-up CT in all patients. No prostatic abscess recurrence was found. Transient stress urinary incontinence was observed in three patients. The stress urinary incontinence subsided within 3 weeks in two patients and improved with conservative management within 2 months in the remaining patient. CONCLUSIONS: Transurethral holmium laser deroofing of prostatic abscesses ensures successful drainage of the entire abscess cavity. Because we resolved the predisposing conditions of prostatic abscess, such as bladder outlet obstruction and prostatic calcification, by simultaneously conducting HoLEP, there was no recurrence of the prostatic abscesses after surgery. We recommend our method in patients requiring transurethral drainage.

Effect of topical steroid (0.05% clobetasol propionate) treatment in children with severe phimosis.

PURPOSE: We report our experience with the use of a topical steroid, 0.05% clobetasol propionate, for the treatment of phimosis with clinical complications. MATERIALS AND METHODS: This was a retrospective analysis of the clinical outcomes of all patients presenting with phimosis to a single institution during the time period from October 2008 to May 2012. A total of 88 patients who had a Kikiros retractability grade of 4 or 5 and phimosis-associated clinical complications, such as ballooning of the prepuce, balanoposthitis, or a history of urinary tract infection (UTI), were instructed to apply 0.05% clobetasol propionate cream to the slightly retracted foreskin and to massage gently while retracting the foreskin. The efficacy of treatment was evaluated at 4 weeks from the initiation of therapy. RESULTS: A total of 60 of the 88 patients (68.2%) showed a complete response (i.e., full retraction of the foreskin) to the therapy. The phimotic ring disappeared in 25 of the 88 patients (28.4%) after treatment. Patients who had a history of balanoposthitis, smegma, ballooning of the prepuce, or UTI showed significantly poorer improvement in preputial retraction (p<0.001, p<0.001, p<0.001, and p=0.02, respectively) and phimotic ring disappearance (p<0.001, p=0.001, p<0.001, and p=0.001, respectively) after treatment. No significant local or systemic side effects were associated with the administration of topical steroids. CONCLUSIONS: Topical application of 0.05% clobetasol propionate cream and skin stretching is a safe, simple, and effective procedure with no significant side effects for severe phimosis in prepubertal boys.

Protective effect of Aloe vera on polymicrobial sepsis in mice.

Sepsis is an acute life-threatening clinical condition and remains the major cause of death in intensive care units. The primary pathophysiologic event central to the septic response is an overwhelming activation of the inflammatory system and countervailing response from the anti-inflammatory system. However, the cause of this perturbation has yet to be elucidated. In this study, we report that Aloe vera therapeutically reverses the lethality induced by cecal ligation and puncture (CLP), a clinically relevant model of sepsis. The administration of Aloe vera ameliorated the multiple organ dysfunction syndrome, as evidenced by the serum levels of biochemical parameters and histological changes. In order to investigate the pharmacological mechanism of Aloe vera, the levels of the cytokines, tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, and IL-6 were determined by ELISA at various time points. The increases in the levels of TNF-alpha, IL-1beta, and IL-6 were attenuated by Aloe vera.In vivo administration of Aloe vera also markedly enhanced bacterial clearance. Our findings suggest that Aloe vera could be a potential therapeutic agent for the clinical treatment of sepsis.

Effect of SA1, a herbal formulation, on sexual behavior and penile erection.

SA1 is a mixture of 9 Oriental herbs (Korean red ginseng, fermented soybean, Tribulus terrestris, Fructus Rubi, Fructus Lycii, Semen Cuscutae, Dioscorea Rhizome, Fructus Corni and Fructus Crataegi) that are widely used as energizers and vitalizers in the indigenous system of medicine and have been alleged to improve the sexual functions in men. This study evaluated SA1 using both in vitro and in vivo experiments on laboratory animals in order to determine its effect on the sexual behavior and penile erection. The male rats used to examine the copulatory behavior were administered either the vehicle or SA1 (30, 100, 300, 600 mg/kg) orally for 2 weeks. The intracavernous pressure and systemic blood pressure were recorded in anesthetized rats. The responses to acetylcholine and SA1 of rabbit corpus cavernosum strips were also examined. There was an overall increase in the copulatory behavior parameters in the SA1-treated rats, which was reflected by a decrease in the mount and intromission latencies and an increase in the ejaculation latency and mount frequency. SA1 significantly increased the ratio of the intracavernous pressure to mean arterial pressure. In vitro, SA1 significantly enhanced the relaxation responses to acetylcholine. These results suggest that SA1 improves the sexual activity and erectile function.

Aspergillus oryzae GB-107 fermentation improves nutritional quality of food soybeans and feed soybean meals.

This study evaluated the effect of fermentation on the nutritional quality of food-grade soybeans and feed-grade soybean meals. Soybeans and soybean meals were fermented by Aspergillus oryzae GB-107 in a bed-packed solid fermentor for 48 hours. After fermentation, their nutrient contents as well as trypsin inhibitor were measured and compared with those of raw soybeans and soybean meals. Proteins were extracted from fermented and non-fermented soybeans and soybean meals, and the peptide characteristics were evaluated after electrophoresis. Fermented soybeans and fermented soybean meals contained 10% more (P < .05) crude protein than raw soybeans and soybean meals. The essential amino acid profile was unchanged after fermentation. Fermentation eliminated (P < .05) most of the trypsin inhibitor from both soybeans and soybean meals. Fermentation increased the amount of small-size peptides (<20 kDa) (P < .05) compared with raw soybeans, while significantly decreasing large-size peptides (>60 kDa) (P < .05). Fermented soybean meal contained more (P < .01) small-size peptides (<20 kDa) than soybean meal. Fermented soybean meal did not contain large-size peptides (>60 kDa), whereas 22.1% of peptides in soybean meal were large-size (>60 kDa). Collectively, fermentation increased protein content, eliminated trypsin inhibitors, and reduced peptide size in soybeans and soybean meals. These effects of fermentation might make soy foods more useful in human diets as a functional food and benefit livestock as a novel feed ingredient.