Intraoperative Complications and Perioperative and Surgical Outcomes of Single-Port Robotics-Assisted Sacrocolpopexy.

INTRODUCTION AND HYPOTHESIS: The objective was to assess intraoperative and postoperative complication rates, along with perioperative and surgical outcomes, following single-port robotics-assisted sacrocolpopexy. METHODS: This retrospective case series included 200 patients who underwent single-port robotics-assisted sacrocolpopexy to treat Pelvic Organ Prolapse Quantification (POPQ) stage 2-4 symptomatic prolapse between April 2020 and August 2023 by a single surgeon. Intraoperative and postoperative complications and perioperative outcomes were evaluated for all the patients, whereas surgical outcomes for 74 patients were assessed at 1-year follow-up. Surgical failure was defined as the presence of any of the following: the presence of vaginal bulging symptoms, any prolapse beyond the hymen, or retreatment for prolapse. RESULTS: During the study period, 200 single-port robotics-assisted sacrocolpopexies were performed. The median age and body mass index were 65.0 years and 24.6 kg/m2 respectively. Most patients had POPQ stage 3 or 4 prolapse and underwent concomitant total hysterectomy. The median total operation time was 212.0 min, and none of the patients required conversion to laparoscopy or laparotomy. The intraoperative cystotomy rate was 2.5%, and one patient had a blood transfusion owing to presacral vessel injury. Postoperative complications of mesh exposure and wound hernia were 0.5% and 2.0% respectively. At 1 year postoperatively, the rate of composite surgical failure was 9.5%, with a 5.4% anatomical recurrence rate. None of the patients experienced apical prolapse recurrence, and one received anterior colporrhaphy for anterior compartment prolapse recurrence. CONCLUSIONS: Single-port robotics-assisted sacrocolpopexy is safe and effective, with low complication rates and favorable perioperative and surgical outcomes.

Changes in anti-Müllerian hormone values for ovarian reserve after minimally invasive benign ovarian cystectomy: comparison of the Da Vinci robotic systems (Xi and SP) and the laparoscopic system.

To investigate the impact on the ovarian reserve after minimally invasive ovarian cystectomy using two platforms, the Da Vinci robotic system (Xi and SP) and the laparoscopic system. Patients underwent laparoscopic or Da Vinci robotic (Xi or SP) ovarian cystectomy for benign ovarian cysts between January 1, 2018, and December 31, 2022 at Guro Hospital, Korea University Medical center. We measured the change of AMH values (%) = [(postAMH - preAMH)] × 100/preAMH. No significant differences in preoperative age, cyst size, estimated blood loss during surgery, hemoglobin drop, length of hospital stay, adhesion detachment rate and cyst rupture rate were observed. However, the operative time was significantly shorter in the laparoscopic group than that in the robotic group (67.78 ± 30.58 min vs. 105.17 ± 38.87 min, p < 0.001) The mean preAMH and postAMH were significantly higher with the Da Vinci robotic group than with the laparoscopic group (preAMH: 5.89 ± 4.81 ng/mL vs. 4.01 ± 3.59 ng/mL, p = 0.02, postAMH: 4.36 ± 3.31 ng/mL vs. 3.08 ± 2.60 ng/mL, p = 0.02). However, the mean ΔAMH was not significantly different between two groups. ΔAMH also did not demonstrate significant differences among the three groups; laparoscopic, Xi and SP robotic. Even in the patient groups with preAMH < 2 and diagnosed with endometriosis, the ΔAMH did not show significant differences between the laparoscopic and robotic groups. The Da Vinci robotic system is no inferior to conventional laparoscopic systems in preserving ovarian function.

Learning curves and perioperative outcomes of single-incision robotic sacrocolpopexy on two different da Vinci® surgical systems.

This study aimed to report a single surgeon's early experience and learning curves of single-incision robotic sacrocolpopexy on two different robotic surgical platforms, namely, the single-site approach on da Vinci Xi® and single-port approach on da Vinci SP® surgical systems. This retrospective study included 123 consecutive cases of robotic sacrocolpopexy performed between June 2017 and June 2021 for the patients with Pelvic Organ Prolapse Quantification stage 2-4 symptomatic prolapse. First consecutive 57 cases were performed under the da Vinci Xi® system applying the single-site manner, whereas the following 66 cases were done under the da Vinci SP® system. The primary outcome was intraoperative and perioperative complication rates, and the secondary outcome was learning curve of single-incision robotic sacrocolpopexy under the two different robotic surgical platforms. Learning curves based on the operation time were obtained through cumulative sum analysis. The mean age of each group was 65.6 ± 8.7 years for single-site robotic sacrocolpopexy and 63.7 ± 7.6 years for the single-port one (p = 0.202). More than 80% of patients for each group had advanced prolapse stages and underwent concomitant total hysterectomy. The overall baseline characteristics did not differ significantly between groups. The median operation time for each group were 201.0 and 201.5 min, respectively. Both groups showed comparable perioperative outcomes in terms of operation time, intraoperative blood loss, and length of hospital stay. Intraoperative cystostomy rates were 1.8% and 3.0%, respectively, and revealed no statistical difference (p = 0.736). The learning curves were comparable, and the surgeon required less than 15 cases for both single-site and single-port robotic sacrocolpopexies to stabilize operation time. Comparable learning curves and favorable intraoperative and perioperative outcomes of single-incision robotic sacrocolpopexy using two different robotic surgical systems show that both are feasible options for robotic sacrocolpopexy.

Leptin Stimulates Endometriosis Development in Mouse Models.

Endometriosis is a chronic inflammatory condition in women, and obesity leads to an inflammatory condition that is directly involved in the etiology of endometriosis. However, observational studies have shown an inverse correlation between endometriosis and a low body mass index (BMI). Obesity does not protect against endometriosis, and on the contrary, an increased BMI may lead to more severe forms of the disease. To determine the effect of obesity on endometriosis, diet-induced and genetically engineered obese mouse models were integrated with endometriosis mouse models with fluorescence-tagged ectopic lesions. High-fat diet-induced obese mice revealed a significant increase in endometriosis development compared with regular-diet control mice. However, obese recipient mice with leptin deficiency and leptin receptor deficiency showed suppressed endometriosis development compared with control mice. Furthermore, donor uterine tissues with leptin deficiency and leptin receptor deficiency suppressed endometriosis development compared with control donor in control recipient mice. Importantly, we revealed that aberrant high levels of leptin concentration significantly increased endometriosis development compared with vehicle treatment group in control mice with normal body weight. Our results suggest that leptin and its receptor are critical for endometriosis development.

Urinary Function of the Sasang Type and Cold-Heat Subgroup Using the Sasang Urination Inventory in Korean Hospital Patients.

INTRODUCTION: The Sasang type-specific pathophysiological symptom is pivotal for the Sasang type classification and pattern identification. The Sasang Urination and Defecation Inventory (SUDI) for urinary function analysis was developed; however, the clinical usefulness of urination-related subscales of SUDI in the Sasang type and Cold-Heat subgroup was not reported with acceptable validation analysis. METHODS: The clinical diagnosis of the Sasang type and Cold-Heat subgroup, responses to SUDI items, and weight and height of the 350 hospital patients were acquired retrospectively. The Sasang Urination Inventory (SUI) with SUI-CHR (problematic physical characteristics of urine), SUI-HSS (hypersensitivity of urinary urgency and high frequency), and SUI-DIS (urinary discomfort of hesitancy and residual urine sense) subscales using 12 items of SUDI were improvised. The item and construct validity of the SUI were examined using item response theory and confirmatory factor analysis, and the clinical usefulness of the SUI in Sasang type and Cold-Heat subgroup differentiation was attested. RESULTS: The SUI and its subscales showed acceptable structural validity and have clinical usefulness in the Tae-Eum type. The Tae-Eum type has a significantly higher SUI-CHR score than did the So-Yang type, and the Heat subgroup has a significantly higher SUI-HSS score than did the Cold subgroup in the Tae-Eum type. Discussion. The distinctive Sasang type- and Cold-Heat subscale-specific pathological symptoms in urinary function were revealed using the SUI. The SUI combined with objective Sasang typology measures might be useful for integrative precision medicine combining Eastern and Western practice and for evidence-based clinical education for medical professions.

Development and validation of Sasang Urination and Defecation Inventory (SUDI) for pathophysiological symptoms of Sasang typology.

BACKGROUND: The pathophysiological symptom of Sasang typology is essential for getting clinical diagnosis and analyzing treatment effects. The clinical index for examining urination and defecation related symptoms were developed and validated with established clinical measures. METHODS: Questionnaire items of six subscales of Sasang Urination and Defecation Inventory (SUDI) were developed based on previous systematic reviews, and its clinical validity was examined with clinical measures of Urogenital Distress Inventory-6 (UDI-6), Overactive Bladder Symptom Score (OBSS), and ROME 3 criteria for Irritable Bowel Syndrome (ROME3-IBS) and Functional Constipation (ROME3-FC) using 48 healthy participants. The internal consistency of six subscales of SUDI were examined with Cronbach alpha. The Pearson correlation was used to examine correlation between SUDI and Western clinical measures, and the ANOVA was adopted to investigate differences among Sasang type groups in clinical measures. RESULTS: The SUDI-UCHR (problematic characteristics of urine) and SUDI-ANMD (defecation anomaly discomfort) were found to represent unique concept of traditional Korean medicine, however SUDI-IRRB (irritability of bowel movement) and SUDI-FCON (functional constipation) were similar with functional gastrointestinal disease of western medicine. SUDI-URET (ability to retain urine), SUDI-UDIS (urinary discomfort) and SUDI-ANMD of So-Yang type (7.95 ± 2.16, 14.33 ± 2.01, and 13.10 ± 2.57) are significantly different from those of So-Eum type (9.94 ± 2.54, 12.18 ± 2.96, and 10.59 ± 3.47, respectively). CONCLUSION: The pathophysiological symptoms of urination and defecation in Sasang typology were systematically scrutinized, and summarized into six subscales of SUDI in this study. The SUDI would be useful for analyzing clinical symptoms of Sasang typology along with integrative collaboration of traditional Korean and Western medicine.

Biopsychological and pathophysiological features of Cold-Heat subgroup of Sasang typology with Sasang Digestive Function Inventory, Sasang Personality Questionnaire and Body Mass Index.

BACKGROUND: The Sasang typology is a traditional Korean personalized medicine and its Cold-Heat subgroup identification is essential for effective use of medical herbs and acupuncture. The purpose of this study was to discover differences between Cold-Heat subgroups with objective clinical measures and to examine its clinical usefulness. METHODS: The pathophysiological symptoms of the digestive system, temperament and body shape of 241 patients were measured using the Sasang Digestive Function Inventory (SDFI), Sasang Personality Questionnaire (SPQ) and Body Mass Index (BMI). The differences between Cold and Heat subgroups of each Sasang types were tested by Analysis of Covariance considering age and sex, while the associations of SDFI, SPQ and BMI with Cold-Heat subgroup were examined by logistic regression analysis. RESULTS: There were significant differences between Cold and Heat subgroups in SDFI, SPQ and BMI for the So-Yang, SDFI and BMI for the Tae-Eum type and SDFI-Digestion subscale for the So-Eum type. Moreover, the SDFI-Digestion was a substantial predictor for Cold-Heat subgroup identification in three Sasang types. The logistic regression model with SDFI, SPQ and BMI correctly predicted 81.9%, 77% and 75.5% of the Cold-Heat subgroups in So-Yang, Tae-Eum and So-Eum types, respectively. CONCLUSION: The results of the present study showed that the objective and validated clinical measures of SDFI, SPQ and BMI would be useful for differentiating Cold-Heat subgroups of Sasang typology. Further clinical studies on pathophysiological mechanisms in Cold-Heat subgroup are required to generalize these results.

The safety of progestogen in the prevention of preterm birth: meta-analysis of neonatal mortality.

BACKGROUND: The safety of preventive progestogen therapy for preterm birth remains to be established. This meta-analysis aimed to evaluate the effects of preventive progestogen therapy on neonatal mortality. METHODS: Randomized controlled trials (RCTs) on the preventive use of progestogen therapy, published between October 1971 and November 2015, were identified by searching MEDLINE/PubMed, EMBASE, Scopus, ClinicalTrials.gov, Cochrane Library databases, CINAHL, POPLINE, and LILACS using "progesterone" and "preterm birth" as key terms. We conducted separate analyses according to the type of progestogen administered and plurality of the pregnancy. RESULTS: Twenty-two RCTs provided data on 11,188 neonates. Preventive progestogen treatment in women with a history of preterm birth or short cervical length was not associated with increased risk of neonatal death compared to placebo in all analyzed progestogen types and pregnancy conditions. The pooled relative risks (95% confidence interval) of neonatal mortality were 0.69 (0.31-1.54) for vaginal progestogen in singleton pregnancies, 0.6 (0.33-1.09) for intramuscular progestogen in singleton pregnancies, 0.96 (0.51-1.8) for vaginal progestogen in multiple pregnancies, and 0.96 (0.49-1.9) for intramuscular progestogen in multiple pregnancies. CONCLUSIONS: The results of this meta-analysis suggest that administration of preventive progestogen treatment to women at risk for preterm birth does not appear to negatively affect neonatal mortality in single or multiple pregnancies regardless of the route of administration.

Validation of the Sasang Personality Questionnaire in high school students.

BACKGROUND: The Sasang Personality Questionnaire (SPQ) is an objective measure of Yin-Yang temperament of Sasang typology with proven clinical and structural validity; however, it has not been validated in people younger than 20 years. The purpose of this study was to examine the biopsychological structure of the SPQ in high school students. METHODS: A total of 670 Korean high school students (365 boys and 305 girls) completed the SPQ, Junior version of Temperament and Character Inventory (JTCI), and weight and height measures. The correlation between the SPQ and JTCI subscales was investigated, and the differences of these subscales, body mass index, and Pondera Index between the high (30%), middle (40%), and low (30%) SPQ total score groups were examined with analysis of variance. The profile analysis was also performed to compare JTCI subscale profiles of the three SPQ total score groups. RESULTS: The SPQ total score significantly correlated positively with JTCI novelty seeking (r = 0.548 and r = 0.540) and negatively with JTCI harm avoidance (r = -0.393 and r = -0.395) in boys and girls, respectively. The JTCI novelty-seeking score is significantly higher in the high SPQ total score group (24.12 ± 5.27 and 24.15 ± 5.17 for boys and girls, respectively) than in the low SPQ total score group (16.49 ± 5.08 and 17.24 ± 4.83, respectively), and the JTCI harm-avoidance score is significantly higher in the low SPQ total score group (25.34 ± 6.08 and 26.64 ± 5.77 for boys and girls, respectively) than in the high SPQ total score group (19.27 ± 6.62 and 19.23 ± 6.00, respectively). The JTCI subscale profiles for the three SPQ total score groups were significantly different for boys (degrees of freedom = 3.416, F = 292.16, p < 0.001) and girls (degrees of freedom = 3.4, F = 230.51, p < 0.001). There were no significant correlations or differences in body mass index and Pondera Index among the SPQ total score groups. CONCLUSION: The results showed that the biopsychological structure of the SPQ in adolescents is robust, similar to that in the adult population. The SPQ might be useful for the application of Sasang typology in pediatrics.

Anti-apoptotic effect of modified Chunsimyeolda-tang, a traditional Korean herbal formula, on MPTP-induced neuronal cell death in a Parkinson's disease mouse model.

ETHNOPHARMACOLOGICAL RELEVANCE: The modified-Chungsimyeolda-tang (DG) is an important traditional Korean herbal formula used in traditional oriental medicine for treatment of cerebrovascular disorders, including stroke. The formula is based on the book "Dongui Sasang Shinpyun". AIM OF THE STUDY: In the previous studies, the neuroprotective effect of DG is demonstrated in an in vitro Parkinson's disease (PD) model, and in this study, the 1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) animal model of PD is used to evaluate the behavioral effect of DG and possible mechanism through anti-apoptosis of DG. 6-Hydroxydopamine (6-OHDA) also is used to evaluate the anti-apoptosis effect of DG in SH-SY5Y cells. MATERIALS AND METHODS: MPTP was used to evaluate the behavioral damage and neurotoxicity in mice. The bradykinesia symptom was measured by a Pole test and a Rota-rod test in mice. Also the loss of tyrosine hydroxylase (TH)-positive neurons induced by MPTP was examined by an immunohistochemical assay. The DG-mediated anti-apoptosis effect was measured using an immunoblotting assay with apoptosis-related markers such as Bax and cleaved caspase-3. DG and 1-methyl-4-phenylpyridinium (MPP(+)) were co-treated with primary dopaminergic neurons to evaluate the protective effect of DG. The expression of caspase-3 and PARP was measured to detect the protective effect of DG from the damage by 6-OHDA. RESULTS AND CONCLUSIONS: The treatment with DG resulted in prophylactic effects on MPTP-induced Parkinsonian bradykinesia and the immunohistochemical analysis showed that DG provided the neuroprotection against the MPP(+)-induced dopaminergic neurons loss through the anti-apoptosis effect. The present results suggested that it might be possible to use DG for the prevention of substantia nigra pars compacta (SNpc) degeneration induced by exposure to the toxic substances, such as MPTP/MPP(+), in PD mouse model.

Neuroprotective effect of modified Chungsimyeolda-tang, a traditional Korean herbal formula, via autophagy induction in models of Parkinson's disease.

AIM OF THE STUDY: Previous studies in our laboratory revealed the neuroprotective effect of modified Yeoldahanso-tang (MYH) in models of Parkinson׳s disease (PD). In this study, we investigated another traditional Korean herbal formula, modified Chungsimyeolda-tang (termed DG), as a potential treatment for PD. Chungsimyeolda-tang has been used in Korea to treat cerebrovascular diseases, such as stroke. Here, we verify the neuroprotective and autophagy-inducing effects of DG to evaluate any potential anti-parkinsonian properties. MATERIALS AND METHODS: 1-Methyl-4-phenylpyridinium (MPP(+)) and rotenone were used to induce cytotoxicity in nerve growth factor (NGF)-differentiated rat pheochromocytoma (PC12) cells. Cell viability was measured using an MTT assay. Induction of autophagy by DG in NGF-differentiated PC12 cells was measured using an immunoblotting assay with an LC3 antibody. The proteasomal inhibitor lactacystin was used to induce ubiquitin-proteasome system (UPS) dysfunction in NGF-differentiated PC12 cells. DG-mediated clearance of aggregated proteins was measured using an immunoblotting assay with a ubiquitin antibody. RESULTS AND CONCLUSIONS: Our findings indicate that DG robustly protects NGF-differentiated PC12 cells against the neurotoxic effects of MPP(+) and rotenone in an in vitro model. Furthermore, DG protects NGF-differentiated PC12 cells against lactacystin-induced cell death. This effect is partially mediated by an increased autophagy associated with the enhanced degradation of aggregated proteins. This study suggests that DG is an attractive candidate drug for inducing autophagy and, therefore, may represent a promising strategy to prevent diseases associated with misfolded/aggregated proteins in various neurodegenerative disorders, including Parkinson׳s disease.

Factors associated with adherence to fecal occult blood testing for colorectal cancer screening among adults in the Republic of Korea.

PURPOSE: Repeated participation in fecal occult blood testing (FOBT) is one of the major factors affecting the long-term success of population-based colorectal cancer screening programs. The aim of this study is to explore strong factors linked to repeated participation in FOBT in the prior decade (2002-2011) among adults using the Health Belief Model (HBM) after controlling for other covariates. METHODS: Data were obtained from South Korean adults, aged 50 years and over, who visited a national health screening center within a magnet hospital (N = 237). A pilot test was conducted to investigate the internal consistency of the HBM instruments and the clarity of survey questions. Sample characteristics and rates of adherence to FOBT screening were examined using means and frequencies. Important factors associated with adherence to FOBT were examined using multivariate logistic regression analysis. RESULTS: About 44% of the respondents were adherent to FOBT screening over the prior decade. Four out of the six HBM-driven factors (perceived susceptibility, severity, and barriers, and health motivation) were statistically significant. Those with greater levels of susceptibility and health motivation and lower levels of severity and barriers were more likely to adhere to FOBT. CONCLUSIONS: Health professionals should focus more on the four modifiable HBM-related factors to encourage adults to adhere to FOBT. Intervention programs, which lower perceived severity and barriers and increase susceptibility and health motivation, should be developed and implemented.

The neuroprotective effect of modified Yeoldahanso-tang via autophagy enhancement in models of Parkinson's disease.

AIM OF STUDY: Modified Yeoldahanso-tang (MYH) is a Korean herbal formula, containing 10 herbs: Pueraria lobata (Willd.) Ohwi, Angelica tenuissima Nakai, Scutellaria baicalensis Georgi, Platycodon grandiflorum (Jacq), Angelicae Dahurica, Cimicifuga heracleifolia Kom, Raphanus sativa L., Polygala tenuifolia (Willd.), Acorus gramineus Soland. and Dimocarpus longan Lour. The constitutive ratio of the ten herbs is at 6:4:2:1:2:2:2:4:6:6 in dry weight. MYH has been used to treat amnesia, hypochondria and dementia in Korea. In this study, we explored the possibility of using MYH in the prevention and treatment of Parkinson's disease (PD). Specifically, we made an effort to demonstrate the neuroprotective effects of MYH using experimental methods similar to those used in a recent study of PD. MATERIALS AND METHODS: 1-Methyl-4-phenylpyridinium (MPP+) (400µM) was used to induce cytotoxicity in NGF (nerve growth factor)-differentiated PC12 cells. Cell viability was measured using a MTT assay. Induction of autophagy by MYH in NGF-differentiated PC12 cells was measured using an immunoblotting assay with LC3 and beclin 1 antibodies. The proteasomal inhibitor lactacystin (10µM) was used to cause UPS dysfunction in NGF-differentiated PC12 cells. Clearance of aggregated proteins by MYH was measured using an immunoblotting assay with an ubiquitin antibody. 1-Methyl-4-phenyl-1,2,3,6-tetrahydrophenylpyridine (MPTP) (20mg/kg, 4 times i.p.) caused substantia nigra injuries in C57BL/6 mice. Dopamine (DA) neurons were identified using a tyrosine hydroxylase-immunohistochemistry (TH-IHC) assay with a rabbit anti-TH antibody. RESULTS: Our findings indicate that MYH provides protection against MPP+-induced injury in NGF-differentiated PC12 cell. And MYH provides neuroprotection against lactacystin-induced NGF-differentiated PC12 cell death, which effect is partially mediated by autophagy enhancement through enhanced degradation of aggregated proteins. Additionally, in a C57BL/6 mice model with MPTP-induced substantia nigra injuries, MYH inhibits both the loss of TH-positive neurons in the substantia nigra pars compacta (SNpc) and the reduction of the optical density of TH-IR fibers in the striatum (ST). CONCLUSIONS: All of our results indicate that MYH treatment has neuroprotective effects that are partially mediated by autophagy enhancement. MYH may be a promising herbal formula for the prevention and treatment of neurodegenerative diseases, especially PD.