Altered brain morphology and functional connectivity in postmenopausal women: automatic segmentation of whole-brain and thalamic subnuclei and resting-state fMRI.

The transition to menopause is associated with various physiological changes, including alterations in brain structure and function. However, menopause-related structural and functional changes are poorly understood. The purpose of this study was not only to compare the brain volume changes between premenopausal and postmenopausal women, but also to evaluate the functional connectivity between the targeted brain regions associated with structural atrophy in postmenopausal women. Each 21 premenopausal and postmenopausal women underwent magnetic resonance imaging (MRI). T1-weighted MRI and resting-state functional MRI data were used to compare the brain volume and seed-based functional connectivity, respectively. In statistical analysis, multivariate analysis of variance, with age and whole brain volume as covariates, was used to evaluate surface areas and subcortical volumes between the two groups. Postmenopausal women showed significantly smaller cortical surface, especially in the left medial orbitofrontal cortex (mOFC), right superior temporal cortex, and right lateral orbitofrontal cortex, compared to premenopausal women (p < 0.05, Bonferroni-corrected) as well as significantly decreased functional connectivity between the left mOFC and the right thalamus was observed (p < 0.005, Monte-Carlo corrected). Although postmenopausal women did not show volume atrophy in the right thalamus, the volume of the right pulvinar anterior, which is one of the distinguished thalamic subnuclei, was significantly decreased (p < 0.05, Bonferroni-corrected). Taken together, our findings suggest that diminished brain volume and functional connectivity may be linked to menopause-related symptoms caused by the lower sex hormone levels.

Povidone-iodine rectal cleansing and targeted antimicrobial prophylaxis using rectal swab cultures in men undergoing transrectal ultrasound-guided prostate biopsy are associated with reduced incidence of postoperative infectious complications.

PURPOSE: The aim of this study was to evaluate the effect of povidone-iodine rectal disinfection and targeted antimicrobial prophylaxis in men undergoing transrectal ultrasound-guided prostate biopsy based on rectal swab culture results. METHODS: From January 2011 to December 2015, we studied differences in infectious complications in men who received povidone-iodine rectal disinfection with targeted antimicrobial prophylaxis and those who received empirical prophylaxis before transrectal ultrasound-guided prostate biopsy. Clinical variables including demographics, prior antibiotic, rectal swab culture results, povidone-iodine rectal cleansing, antibiotic prophylaxis, and infectious complications were evaluated. Patients were divided into three groups as follows: Group A received no povidone-iodine rectal cleansing but received empirical antimicrobial prophylaxis; group B received povidone-iodine rectal cleansing and empirical antimicrobial prophylaxis; and group C received povidone-iodine rectal cleansing and targeted antimicrobial prophylaxis. RESULTS: Patients were divided into group A (n = 192; 13.2 %), group B (n = 579; 39.9 %), or group C (n = 679; 46.8 %). In groups A and B, all patients received fluoroquinolone antimicrobial prophylaxis. Group C patients received targeted antimicrobial prophylaxis according to antibiotic resistance of rectal flora, and 71.1 % of these received fluoroquinolone antimicrobial prophylaxis. Infectious complication rates were 3.6, 2.9, and 1.3 % in group A, group B, and group C, respectively. Incidences of acute prostatitis and bacteremia were significantly lower in group C (p = 0.041 and p = 0.049, respectively) than in the other groups. CONCLUSIONS: In the era of quinolone resistance, the combination of povidone-iodine rectal cleansing and targeted antibiotic prophylaxis may reduce the rate of infectious complications.

Risk factors for and prophylactic effect of povidone-iodine rectal cleansing on infectious complications after prostate biopsy: a retrospective cohort study.

PURPOSE: To evaluate the risk factors and efficacy of a povidone-iodine enema on infectious complications after transrectal ultrasound-guided prostate biopsy. METHODS: A total of 814 males who underwent transrectal ultrasound-guided prostate biopsy from January 2011 to December 2013 were evaluated retrospectively. Clinical variables, including demographics, prior antibiotic, or quinolone exposure, rectal swab culture results, povidone-iodine rectal cleansing, antibiotic prophylaxis, and infectious complications, were evaluated. RESULTS: Overall, 16 of 814 (2.0%) patients developed infectious complications after prostate biopsy. Of the patients with infectious complications, five had fever, two had urinary tract infections, and nine had bacteremia or sepsis. Infectious complication rates were not significantly different between povidone-iodine rectal cleansing (n = 613) and no cleansing (n = 201) groups (1.5 vs. 3.5%, p = 0.083). However, povidone-iodine rectal cleansing reduced severe infectious complications such as bacteremia and sepsis (0.3 vs. 3.5%, p = 0.001). A rectal swab culture was performed in 552 patients, and extended-spectrum ß-lactamase (ESBL)-producing and quinolone-resistant Escherichia coli were detected in 4.5 and 7.8% of cultures, respectively. Quinolone and antibiotic exposure within 6 months prior to prostate biopsy were associated with quinolone resistance and ESBL positivity of rectal flora and infectious complications. CONCLUSIONS: In the era of quinolone resistance, a povidone-iodine enema may reduce the infectious complication rate by reducing bacterial load. Quinolone exposure prior to prostate biopsy was a risk factor for antibiotic resistance to rectal flora and infectious complications.

The Effect of Korean Red Ginseng on Sexual Function in Premenopausal Women: Placebo-Controlled, Double-Blind, Crossover Clinical Trial.

This study investigated whether Korean red ginseng (KRG) extracts could improve sexual function in premenopausal women. Forty-one premenopausal women participated in this placebo-controlled, double-blind, and crossover clinical study with administration of either three ginseng capsules (1 g per capsule) or placebo daily. After 8 weeks of medication of KRG or placebo, medication was changed for the subjects to placebo or KRG after 2 weeks of washout period. The efficacy of KRG extracts was measured by using Female Sexual Function Index (FSFI). Results. Twenty-three women completed the study. Total FSFI scores increased after KRG treatment (from 20.13 ± 2.87 to 23.98 ± 4.10, p = 0.015) and placebo treatment (from 20.06 ± 2.64 to 23.78 ± 3.28, p = 0.003). However, this change was not significantly different between the two groups (p = 0.702). KRG treatment significantly improved sexual desire, arousal, orgasm, and satisfaction domains; however, there was no treatment effect compared with placebo. There was a case of gastric discomfort after taking KRG extracts. Oral administration of KRG extracts improved sexual function in premenopausal women; however, there were no statistical significant changes compared to placebo. It implies that KRG extracts have a substantial placebo effect in premenopausal women with sexual dysfunction.

Application of bone scans for prostate cancer staging: Which guideline shows better result?

INTRODUCTION: We evaluated the accuracy of current guidelines by analyzing bone scan results and clinical parameters of patients with prostate cancer to determine the optimal guideline for predicting bone metastasis. METHODS: We retrospectively analyzed patients who were diagnosed with prostate cancer and who underwent a bone scan. Bone metastasis was confirmed by bone scan results with clinical and radiological follow-up. Serum prostate-specific antigen, Gleason score, percent of positive biopsy core, clinical staging and bone scan results were analyzed. We analyzed diagnostic performance in predicting bone metastasis of the guidelines of the European Association of Urology (EAU), American Urological Association (AUA), and the National Comprehensive Cancer Network (NCCN) guidelines as well as Briganti's classification and regression tree (CART). We also compared the percent of positive biopsy core between patients with and without bone metastases. RESULTS: A total 167 of 806 patients had bone metastases. Receiver operating curve analysis revealed that the AUA and EAU guidelines were better for detecting bone metastases than were Briganti's CART and NCCN. No significant difference was observed between AUA and EAU guidelines. Patients with bone metastases had a higher percent positive core than did patients without metastasis (the cut-off value >55.6). CONCLUSION: The EAU and AUA guidelines showed better results than did Briganti's CART and NCCN for predicting bone metastasis in the enrolled patients. A bone scan is strongly recommended for patients who have a higher percent positive core and who meet the EAU and AUA guidelines.

What do most erectile dysfunction guidelines have in common? No evidence-based discussion or recommendation of heart-healthy lifestyle changes and/or Panax ginseng.

Sexual health or erectile dysfunction (ED) state of the art guidelines provide a thorough overview of conventional prescription or other notable extrinsic treatment options. Yet, over the past 10-15 years, a plethora of international researchers have established that individual and comprehensive lifestyle changes can prevent and potentially improve ED. We review the lifestyle evidence that should equate to grade A or level 1 evidence recommendations for ED. We also review the evidence for Panax ginseng, an over-the-counter (OTC) dietary supplement with a 35-year history of laboratory investigations, multiple positive randomized trials over approximately 15 years and several independent meta-analyses and systematic reviews. Perhaps it is time to at least discuss and even emphasize lifestyle and other non-conventional interventions in ED guidelines so that patients can explore a diversity of potentially synergistic choices with their physicians and can improve their quality and quantity of life. Ignoring the consistent, positive data on lifestyle modifications in ED guidelines, for example, is tantamount to ignoring diet and lifestyle changes to reduce the risk of or ameliorate cardiovascular diseases.

Prostate cancer with solitary metastases to the bilateral testis.

We present the case of an 81-year-old patient with testicular metastasis from prostate carcinoma. After the initial diagnosis of prostate cancer, he had an 8-year course of hormonal therapy and showed no clinical evidence of metastasis to other organs. Asymptomatic metastasis of prostate carcinoma to the testis is a rare clinical condition. We diagnosed his condition, based on histopathology following a subcapsular orchiectomy and transurethral resection of the prostate.

Effects of Korean red ginseng on sexual arousal in menopausal women: placebo-controlled, double-blind crossover clinical study.

INTRODUCTION: Many menopausal women experience climacteric symptoms including impairment of sexual function. Recent reports have suggested that Korean red ginseng (KRG) has a relaxing effect on the clitoral cavernosal muscle and vaginal smooth muscle in rats. AIM: We assessed whether KRG extracts would improve sexual function in menopausal women. METHODS: Thirty-two menopausal women participated in a placebo-controlled, double-blind, crossover clinical study with administration of either three capsules of ginseng (1 g per capsule) or placebo daily. After completing the KRG or placebo arm, the participants were crossed over to the other arm after a 2-week washout period. The efficacy and safety of the KRG extracts were measured by using questionnaires. MAIN OUTCOME MEASURES: Female Sexual Function Index (FSFI) and Global Assessment Questionnaire (GAQ). RESULTS: Twenty-eight women completed the study. They were, on average, 51.2 + or - 4.1 years old, and their mean menopausal state was for a duration of 37.4 + or - 2.9 months. Few carryover effects were noted in either study arm. The ginseng extract significantly improved scores on the FSFI from 3.10 + or - 0.87 to 3.50 + or - 0.72 in the sexual arousal domain (P = 0.006). The GAQ was more significantly affected by ginseng extracts than by placebo (P = 0.046). There were no severe adverse events in the KRG group, although two cases of vaginal bleeding occurred during KRG treatment. CONCLUSIONS: Oral administration of KRG extracts improved sexual arousal in menopausal women. Red ginseng extracts might be used as an alternative medicine in menopausal women to improve their sexual life.

The effect of Korean red ginseng extract on the relaxation response in isolated rabbit vaginal tissue and its mechanism.

INTRODUCTION: Ginseng is an herbal medicine with a variety of biological activities. AIM: The purpose of this study was to investigate the effect of Korean red ginseng (KRG) extract on the relaxation response in isolated rabbit vaginal tissue and its mechanism as a potential therapeutic agent for female sexual dysfunction. METHOD: Strips of rabbit vagina were mounted in organ chambers to measure isometric tension. After the strips were precontracted with phenylephrine, the contractile responses to KRG extract (1-20 mg/mL), nitric oxide inhibitor (N[omega]-nitro-L-arginine methyl ester [L-NAME]), an inhibitor of soluble guanylate cyclase (methylene blue), an inhibitor of Ca(2+)-activated K(+) channels (tetraethylammonium [TEA]), and an adenosine triphosphate (ATP)-sensitive K(+) channel blocker (glybenclamide) were examined. MAIN OUTCOME MEASURES: The relaxation of the vaginal tissue strip was assessed after treating KRG extract or other chemicals. RESULTS: KRG (1-20 mg/mL) extract relaxed the vaginal tissue strip in a dose-dependent manner up to 85%. The relaxation effect was significantly inhibited by L-NAME (30 microM) and methylene blue (30 microM) (P < 0.05). In addition, KRG inhibited the contraction induced by depolarization with 10, 20, and 40 mM KCl. The KRG-induced relaxation effect was significantly inhibited by TEA (300 microM) (P < 0.05), and not by glybenclamide (30 microM). CONCLUSIONS: These data show that KRG extract has a relaxing effect on rabbit vaginal smooth muscle tissue. These effects might be mediated partly through the NO pathway and hyperpolarization via Ca(2+)-activated K(+) channels.

Brain activation areas of sexual arousal with olfactory stimulation in men: a preliminary study using functional MRI.

INTRODUCTION: There have been extensive studies evaluating the functional neuroanatomy of the brain during visual sexual stimulation. However, little data exist concerning the role of olfactory stimulation in human sexuality. AIM: This preliminary study intended to elucidate the brain areas responding to an olfactory sexual stimulus using functional magnetic resonance imaging (fMRI). METHODS: Eight healthy right-handed heterosexual male volunteers (20-35 years of age), having normal olfaction and no brain diseases, were recruited. During fMRI, a women's perfume was given as an olfactory sexual stimulant in an alternating block design with a 30-second stimulation period followed by a 30-second rest. After the fMRI sessions, the participants provided ratings for both the odorant's intensity and perceived arousal. MAIN OUTCOME MEASURES: The study subjects rated the odorant stimulation and perceived sexual arousal response by Likert-type rating scales. Brain activation maps were made by blood oxygenation level-dependent (BOLD)-based fMRI with an echo-planar imaging pulse sequence. RESULTS: Two out of eight subjects experienced "strong" sexual arousal, and three subjects experienced "moderate" arousal during olfactory stimulation, resulting in a mean score of 2.25 on a 4-point scale. The common brain areas activated in response to the odor stimulus in all eight subjects included the insula, the inferior and middle frontal gyrus, and the hypothalamus. The median cingulate gyrus, thalamus, angular gyrus, lingual gyrus, and cerebellar cortex were activated in subjects who had moderate or strong sexual arousal response. CONCLUSION: Olfactory stimulation with women's perfume produces the activation of specific brain areas in men. The brain areas activated differed according to the degree of perceived sexual arousal response. Further studies are needed to elucidate brain activation response according to the different kinds and intensities of olfactory stimulation.

Subcutaneous metallic mercury injection for penile augmentation.

Mercury intoxication is rare. Most often it is associated with occupational exposure or suicide attempts. We present the case of a 72-year-old patient who received a subcutaneous injection of metallic mercury into his penis for the purpose of penile aesthetic augmentation. Total phallectomy and perineal urethrostomy was performed, followed by chelation therapy. To our knowledge, this is the first report of penile subcutaneous mercury injection for aesthetic augmentation.

Efficacy of virtual glasses in audio-visual sexual stimulation during penile color duplex Doppler ultrasonography.

OBJECTIVE: To examine whether audio-visual sexual stimulation (AVSS) with virtual glasses is effective in improving the recording of penile hemodynamics during penile color duplex Doppler ultrasonography. PATIENTS AND METHODS: A total of 64 consecutive patients with erectile dysfunction underwent penile color duplex Doppler ultrasonography after intracavernosal injection of 10-20 microg prostaglandin El and subsequent genital stimulation. AVSS with virtual glasses and earphones was applied when peak systolic velocities (PSV) were less than 35 cm/s or end diastolic velocities (EDV) were more than 5 cm/s. PSV, EDV and the resistive index of both cavernosal arteries were continuously monitored. Clinical erectile response was assessed with visual inspection and manual palpation. RESULTS: AVSS with virtual glasses was performed on 40 of 64 patients. AVSS improved the clinical erectile response in 26 (65%) of 40 patients. Doppler ultrasonography without AVSS identified 11 (27.5%), 5 (12.5%), and 24 (60%) patients with arteriogenic, veno-occlusive, and mixed-type impotence, respectively. However, after real-time AVSS 15 (37.5%), 7 (17.5%), 8 (20%), and 10 (25%) patients demonstrated non-vasculogenic, arteriogenic, veno-occlusive, and mixed-type impotence, respectively. Real-time AVSS improved the Doppler wave forms in 65% of cases. CONCLUSION: AVSS with virtual glasses improves the recording of physiologic erectile response and may be used as a valuable tool during penile color duplex Doppler ultrasonography.