Aspects of urinary tract infections and antimicrobial resistance in hospitalized urology patients in Asia: 10-Year results of the Global Prevalence Study of Infections in Urology (GPIU).

OBJECTIVES: To assess Asian data from Global Prevalence Study on Infections in Urology (GPIU study) which has been performed more than 10 years. METHODS: Seventeen Asian countries participated in the GPIU study between 2004 and 2013. Data for these countries were collected from the web-based GPIU database. The point prevalence of urinary tract infections (UTI) and antimicrobial susceptibility of representative pathogens were analysed for Asian geographic regions. RESULTS: A total of 6706 patients (5271 male, 1435 female) were assessed during the study period, and 659 patients were diagnosed with a UTI (9.8%). Of these UTI patients, 436 were male and 223 were female. Mean patient age was 54.9 ± 19.3 years. Pyelonephritis and cystitis were the most common clinical diagnoses, representing 30.7% and 29.9% of patients, respectively. Escherichia coli was the most frequently identified uropathogen (38.7%). For the patients with urinary tract infection, cephalosporins were the most frequently used antibiotics (34.4%), followed by fluoroquinolones (24.1%), aminoglycosides (16.8%). Fluoroquinolone resistance was relatively high (ciprofloxacin 54.9%, levofloxacin 39.0%), and cephalosporin resistance 42% (42.5-49.4%). Of the antibiotics evaluated, uropathogens had maintained the highest level of susceptibility to amikacin and imipenem (24.9% and 11.3% resistance rates, respectively). CONCLUSION: Uropathogens in many Asian countries had high resistance to broad-spectrum antibiotics. Knowledge of regional and local resistance data and prudent use of antibiotics are important for proper management of UTI in Asian countries.

Summary of the UAA-AAUS guidelines for urinary tract infections.

Urinary tract infections, genital tract infections and sexually transmitted infections are the most prevalent infectious diseases, and the establishment of locally optimized guidelines is critical to provide appropriate treatment. The Urological Association of Asia has planned to develop the Asian guidelines for all urological fields, and the present urinary tract infections, genital tract infections and sexually transmitted infections guideline was the second project of the Urological Association of Asia guideline development, which was carried out by the Asian Association of Urinary Tract Infection and Sexually Transmitted Infection. The members have meticulously reviewed relevant references, retrieved via the PubMed and MEDLINE databases, published between 2009 through 2015. The information identified through the literature review of other resources was supplemented by the author. Levels of evidence and grades of recommendation for each management were made according to the relevant strategy. If the judgment was made on the basis of insufficient or inadequate evidence, the grade of recommendation was determined on the basis of committee discussions and resultant consensus statements. Here, we present a short English version of the original guideline, and overview its key clinical issues.

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.

Microbiological and clinical characteristics in acute bacterial prostatitis according to lower urinary tract manipulation procedure.

We conducted a retrospective analysis of acute bacterial prostatitis (ABP) secondary to manipulation to document clinical features, management and microbiology based on the route of prior manipulation, which can be divided into two subgroups: transrectal and transurethral procedure. The medical records of 158 cases compatible with a confirmed diagnosis of ABP secondary to manipulation from 7 urological centers between 2001 and 2012 were reviewed. When subcategorized according to route of prior manipulation of the lower urinary tract, there were distinct differences between transrectal and transurethral manipulation group with regard to clinical and microbiological features. Escherichia coli was the most common causative bacterium in both groups, but Pseudomonas spp. were much more dominant pathogens in the group by transurethral manipulation than transrectal manipulation group. The susceptibilities to second-, third- and fourth-generation cephalosporins, amikacin, carbapenem and aztreonam were shown to be very low in the transurethral manipulation group. Therefore, it will take account the difference in antibiotic selection in the patients with ABP secondary to manipulation according to the manipulation route.

Treatment of paraffin-induced lipogranuloma of the penis by bipedicled scrotal flap with Y-V incision.

OBJECTIVES: The authors aimed to report 5 cases of patients with penile lipogranuloma-induced full necrosis of penile skin, wherein they obtained good results from simultaneous implementation of Y-V incision to prevent the shortening of penile length together with bipedicular scrotal flap. METHODS: The full excision of penile lipogranuloma and a bipedicled scrotal flap was performed. After finishing the scrotal flap, for extension in length, the authors performed the inverted V incision on the upper skin of followed by partial resection of suspensory ligament and sutured up to subcutaneous tissue in the inverted Y shape, extending the dorsal portion skin toward the penis. RESULTS: There was no shortening in length of the penis or reduction in girth and the resulting penis had no difference to normal skin of penis, with almost no contraction of the scrotum, and all patients were satisfied with the visual postoperative shape of the penis. CONCLUSIONS: The authors had performed a complete excision of paraffinoma in patients with penile paraffinoma with concurrent skin necrosis and obtained good outcomes of preventing the shortening of penile length by performing a bipedicled scrotal flap with Y-V incision using the scrotal skin.

A new type of protective surface layer for high-capacity Ni-based cathode materials: nanoscaled surface pillaring layer.

A solid solution series of lithium nickel metal oxides, Li[Ni(1-x)M(x)]O2 (with M = Co, Mn, and Al) have been investigated intensively to enhance the inherent structural instability of LiNiO2. However, when a voltage range of Ni-based cathode materials was increased up to >4.5 V, phase transitions occurring above 4.3 V resulted in accelerated formation of the trigonal phase (P3m1) and NiO phases, leading to and pulverization of the cathode during cycling at 60 °C. In an attempt to overcome these problems, LiNi0.62Co0.14Mn0.24O2 cathode material with pillar layers in which Ni(2+) ions were resided in Li slabs near the surface having a thickness of ∼10 nm was prepared using a polyvinylpyrrolidone (PVP) functionalized Mn precursor coating on Ni0.7Co0.15Mn0.15(OH)2. We confirmed the formation of a pillar layer via various analysis methods (XPS, HRTEM, and STEM). This material showed excellent structural stability due to a pillar layer, corresponding to 85% capacity retention between 3.0 and 4.5 V at 60 °C after 100 cycles. In addition, the amount of heat generation was decreased by 40%, compared to LiNi0.70Co0.15Mn0.15O2.

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.

Risk factors for recurrent cystitis following acute cystitis in female patients.

We conducted a retrospective analysis of acute cystitis (AC) patients to evaluate the risk factors of recurrent cystitis (RC) patients following AC. The clinical records of 254 subjects with a confirmed diagnosis of AC and 90 healthy subjects who visited the Health Promotion Center between 2008 and 2012 were reviewed. A patient was diagnosed with RC if she was treated for three or more symptomatic episodes of cystitis over a 12-month period. Results were analyzed according to three groups: normal control (group A, n = 90), AC (group B, n = 121), and RC (group C, n = 133). Women in the cystitis groups (groups B and C) were more likely to have diabetes, be menopausal, have a history of catheterization or sexually transmitted infections (STI), have a low daily water intake, have frequent sexual intercourse, and to use contraception more frequently than the normal control group (P < 0.05). In groups B and C, Escherichia coli was the most common uropathogen, followed by Staphylococcus saprophyticus, Enterococcus species, and Klebsiella species. There were no differences between groups in the detection rates of these uropathogens. Factors that affected progression to RC were diabetes, catheterization history, STI history, sexual intercourse more than four times per month, sexual intercourse in the last month, and the use of contraceptives (P < 0.05). The identification of these factors may help develop preventive, diagnostic, and therapeutic strategies for treating RC that has progressed from AC.

Xanthogranulomatous pyelonephritis: clinical experience with 21 cases.

In this retrospective study, a review of the features of 21 recent cases of xanthogranulomatous pyelonephritis (XGP) is presented and compared with current published reports to improve the preoperative diagnosis. The clinical, laboratory, and radiological features, preoperative diagnoses, and operative methods of 21 patients with XGP were retrospectively reviewed. Mean age of the patients was 52.1 years; the female:male ratio was 2.5:1. All patients were symptomatic, and most common symptoms were flank pain and fever greater than 38 °C. The laboratory results showed anemia in 71.4% of cases, leukocytosis in 61.9%, and pyuria in 81.0%. In radiologic examinations, renal or ureter stone in 9 patients, hydronephrosis in 12 patients, a renal mass in 2 patients, and kidney enlargement in 9 patients were observed. For the patient who was suspected as having XGP before surgery, partial nephrectomy was performed; for 2 patients who were suspected as renal cell carcinoma, radical nephrectomy was performed; and for the remaining 18 patients, simple nephrectomy was performed. Among patients complaining of flank pain and fever, if the patients have a urinary tract infection and show the signs of anemia or leukocytosis and have staghorn calculi or a urinary tract obstruction and renal mass by radioactive examination, it is believed that the possibility of XGP should be considered.

Risk factors of infectious complication after ureteroscopic procedures of the upper urinary tract.

Ureteroscopic procedures are being commonly performed in urology, but only a few clinical studies have been conducted on infectious complications after these procedures, and overall understanding on the preoperative use of prophylactic antibiotics is insufficient. This study examined the incidence rate of infectious complications and the risk factors affecting incidence after ureteroscopic procedures. We retrospectively reviewed the medical records of 531 patients who underwent ureteroscopy and ureteroscopic lithotripsy in our hospital, including age, sex, past history, comorbidity, urine analysis, urine culture, blood test, hydronephrosis, urethral catheter or ureteral stent, and percutaneous nephrostomy placement from January 2002 to December 2011. A total of 20 patients (3.8%) contracted infectious complications after various procedures in the upper urinary tract. Preoperative bacteriuria, hydronephrosis, and the placement of a urethral catheter or ureteral stent, and percutaneous nephrostomy are significant risk factors of infectious complication. No significant differences were shown in the types and start time of prophylactic antibiotics. Diagnostic ureteroscopy exhibited a higher incidence rate of infectious complications compared to ureteroscopic lithotripsy.

Evaluation of Seeplex® STD6 ACE Detection kit for the diagnosis of six bacterial sexually transmitted infections.

Traditionally, the diagnosis of bacterial sexually transmitted infection (STI) has been dependent on the isolation of the causative pathogens by culturing endocervical or urethral swab specimens on selective media. While such procedures typically provide excellent diagnostic accuracy, they are often time-consuming and expensive. A multiplex polymerase chain reaction (PCR) assay, based on a semi-automated detection system, was evaluated for the detection of six STI causative organisms. The Seeplex(®) STD6 ACE (auto-capillary electrophoresis) Detection assay employed six pairs of dual priming oligonucleotide (DPO™) primers specifically targeted to unique genes of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Ureaplasma urealyticum, Mycoplasma hominis, and Trichomonas vaginalis. A total of 739 specimens (304 cervical swabs and 435 urine samples) collected for 4 months were tested, and results were compared to those obtained with a combined monoplex PCR. The concordance between the multiplex PCR and monoplex PCR assay was 100% for both sensitivity and specificity. We also tested for the presence of two pathogenic bacteria (C. trachomatis and N. gonorrhoeae) and compared the results obtained with the multiplex PCR and BD ProbeTec duplex strand displacement amplification (SDA). The results of the multiplex PCR and duplex SDA were 99.7% concordant for C. trachomatis and 100% concordant for N. gonorrhoeae. The multiplex PCR assay using the Seeplex(®) STD6 ACE Detection kit proved to be a novel cost-effective and fast diagnostic tool with high sensitivity and specificity for the simultaneous detection of six STI pathogens.

Prevalence of sexually transmitted infections and sexual behavior of young adults and middle-aged people presenting to health examination centers in Korea.

Sexually transmitted infections lead to considerable costs and problems from a socioeconomic perspective, as well as in terms of patient health. In order to effectively manage sexually transmitted infections, it is necessary to establish basic epidemiologic data in this field. This study investigated prevalence rates of syphilis, gonorrhea, and chlamydia among 1612 persons aged 20-59 years among the general population who visited health examination centers in Korea, and examined the sexual behavior of young and middle-aged adults using a questionnaire survey. In total, 807 males and 805 females participated in this study, and among the 1612 subjects, 6, 7, and 90 were gave positive results in syphilis, gonorrhea, and chlamydia infection tests, respectively, indicating prevalence rates of 0.37, 0.43, and 5.58%. In the questionnaire survey, 85.8% of the respondents answered that they had not taken any test for a sexually transmitted infection, and chlamydia-positive respondents were observed to have had a significantly higher number of sexual partners. Among all of the respondents, 43.7% used a condom only sometimes during sexual intercourse, while 15% did not usually do so. Future studies to follow up the incidence and prevalence rates of sexually transmitted infections in detail in young adults and middle-aged people are necessary, and the results of this study will be utilized as basic data for them.

Preventive effect of selenium on chronic bacterial prostatitis.

The antibiotic treatment rate of chronic bacterial prostatitis (CBP) is low, and long-term administration can result in adverse events and bacterial resistance. For these reasons, a new preventive modality, which can replace traditional antibiotic therapy, is required. To evaluate the preventive effect of selenium on CBP, the pre-treatments were divided into four groups, administered for 4 weeks, as follows: (1) control, (2) ciprofloxacin, (3) selenium, and (4) ciprofloxacin and selenium. Then, drip infusion of a bacterial suspension (Escherichia coli Z17, O2:K1; H-) into the prostatic urethra of Wistar rats was conducted to induce CBP. In 4 weeks, the results of microbiological culture of prostate and urine samples as well as histological findings of the prostate in each group were analyzed. Selenium decreased bacterial infection significantly; the decrease in infiltration rate of inflammatory cells into prostate tissues in the selenium group was similar to that in the control group. The effect of hindering bacterial infection on prostate tissue was greater in the group administered both selenium and an antibiotic than in other groups given only one of the agents. Although the findings of this study suggest that selenium can have a preventive effect against the occurrence of CBP, methods to prevent CBP are still controversial.

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.

Intensity Modulated High Dose Rate (HDR) Brachytherapy Using Patient Specific 3D Metal Printed Applicators: Proof of Concept.

Purpose: In high-dose-rate (HDR) brachytherapy, an anisotropic dose distribution may be desirable for achieving a higher therapeutic index, particularly when the anatomy imposes challenges. Several methods to deliver intensity-modulated brachytherapy (IMBT) have been proposed in the literature, however practical implementation is lacking due to issues of increased delivery times and complicated delivery mechanisms. This study presents the novel approach of designing a patient-specific inner shape of an applicator with 3D metal printing for IMBT using an inverse plan optimization model. Methods: The 3D printed patient-specific HDR applicator has an external shape that resembles the conventional brachytherapy applicator. However, at each dwell position of the HDR source, the shielding walls in the interior are divided into six equiangular sections with varying thicknesses. We developed a mathematical model to simultaneously optimize the shielding thicknesses and dwell times according to the patient's anatomical information to achieve the best possible target coverage. The model, which is a bi-convex optimization problem, is solved using alternating minimization. Finally, the applicator design parameters were input into 3D modeling software and saved in a 3D printable file. The applicator has been tested with both a digital phantom and a simulated clinical cervical cancer patient. Results: The proposed approach showed substantial improvements in the target coverage over the conventional method. For the phantom case, 99.18% of the target was covered by the prescribed dose using the proposed method, compared to only 58.32% coverage achieved by the conventional method. For the clinical case, the proposed method increased the coverage of the target from 56.21% to 99.92%. In each case, both methods satisfied the treatment constraints for neighboring OARs. Conclusion: The study simulates the concept of the IMBT with inverse planning using the 3D printed applicator design. The non-isotropic dose map can be produced with optimized shielding patterns and tailored to individual patient's anatomy, to plan a more conformal plan.

Hemodynamic protective effects of epinephrine containing saline irrigation in biportal endoscopic lumbar surgery.

During endoscopic orthopedic surgery, epinephrine mixed with irrigation saline is frequently used to improve visualization. By monitoring hemodynamic parameters throughout the procedure, we intended to discover the hemodynamic effect of epinephrine between the normal saline irrigation fluid without epinephrine group (NS) and normal saline irrigation fluid with epinephrine group (EPI). Patients who underwent 1-level lumbar decompression or discectomy surgery without fusion between August 2019 and July 2020 were reviewed retrospectively. The hemodynamic parameters were compared between the NS group and EPI group. As a second endpoint, the incidence of hypotension and hypertension events, expected blood loss, postoperative nausea and vomiting and postoperative epidural hematoma were compared between the 2 groups. The 2 groups were homogeneous in terms of age, sex, weight, height, body mass index (BMI), ASA physical status (ASA PS), and diagnosis. The incidence of hypotension events (67.2 % in the NS group, 45.7 % in the EPI group, P =.015) and severe hypotension events (51.7 % in the NS group, 28.6 % in the EPI group, P = .015) were less frequent in the EPI group. Only epinephrine had a significant protective effect through a multivariable analysis (P = .027, OR = 2.361) and in severe hypotension events, only epinephrine had a significant protective effect through a multivariable analysis (P = .011, OR = 2.818), and EBL was the risk factor through a multivariable analysis (P = .016, OR = 1.002) We believe that the addition of epinephrine to irrigation saline has hemodynamic protective effects in patients who underwent endoscopic lumbar surgery.

Electronic Medical Record-Based Machine Learning Approach to Predict the Risk of 30-Day Adverse Cardiac Events After Invasive Coronary Treatment: Machine Learning Model Development and Validation.

BACKGROUND: Although there is a growing interest in prediction models based on electronic medical records (EMRs) to identify patients at risk of adverse cardiac events following invasive coronary treatment, robust models fully utilizing EMR data are limited. OBJECTIVE: We aimed to develop and validate machine learning (ML) models by using diverse fields of EMR to predict the risk of 30-day adverse cardiac events after percutaneous intervention or bypass surgery. METHODS: EMR data of 5,184,565 records of 16,793 patients at a quaternary hospital between 2006 and 2016 were categorized into static basic (eg, demographics), dynamic time-series (eg, laboratory values), and cardiac-specific data (eg, coronary angiography). The data were randomly split into training, tuning, and testing sets in a ratio of 3:1:1. Each model was evaluated with 5-fold cross-validation and with an external EMR-based cohort at a tertiary hospital. Logistic regression (LR), random forest (RF), gradient boosting machine (GBM), and feedforward neural network (FNN) algorithms were applied. The primary outcome was 30-day mortality following invasive treatment. RESULTS: GBM showed the best performance with area under the receiver operating characteristic curve (AUROC) of 0.99; RF had a similar AUROC of 0.98. AUROCs of FNN and LR were 0.96 and 0.93, respectively. GBM had the highest area under the precision-recall curve (AUPRC) of 0.80, and the AUPRCs of RF, LR, and FNN were 0.73, 0.68, and 0.63, respectively. All models showed low Brier scores of <0.1 as well as highly fitted calibration plots, indicating a good fit of the ML-based models. On external validation, the GBM model demonstrated maximal performance with an AUROC of 0.90, while FNN had an AUROC of 0.85. The AUROCs of LR and RF were slightly lower at 0.80 and 0.79, respectively. The AUPRCs of GBM, LR, and FNN were similar at 0.47, 0.43, and 0.41, respectively, while that of RF was lower at 0.33. Among the categories in the GBM model, time-series dynamic data demonstrated a high AUROC of >0.95, contributing majorly to the excellent results. CONCLUSIONS: Exploiting the diverse fields of the EMR data set, the ML-based 30-day adverse cardiac event prediction models demonstrated outstanding results, and the applied framework could be generalized for various health care prediction models.

Epidemiological characteristics of genital herpes and condyloma acuminata in patients presenting to urologic and gynecologic clinics in Korea.

As viral sexually transmitted infections (STIs) are hard to cure completely and because they recur frequently, the management of patients and the prevention of the spread of viral STIs are important, rather than focusing on their treatment, unlike the focus for bacterial STIs. Thus, their prevalence and epidemiological characteristics should be investigated first. This study examined the prevalence of genital herpes and condyloma acuminata in patients visiting urologic and gynecologic clinics and evaluated the epidemiological characteristics of these diseases through questionnaire surveys. Out of 167,767 patients, 1,585 were reported to have genital herpes and condyloma acuminata, and the prevalences of the two diseases were 0.58 and 0.37%, respectively. The percentage of patients with viral STIs as a proportion of the total number of patients with STIs including bacterial STIs, was 35.6%. While the prevalence of genital herpes was relatively higher in middle-aged patients, that of condyloma acuminata was observed to be higher in relatively young patients. Among the patients participating in the questionnaire survey, 39.5 and 21.0% responded that they had experienced recurrence of genital herpes and condyloma acuminata, respectively. In conclusion, because the prevalences of genital herpes and condyloma acuminata as viral STIs were not trivial compared to that of bacterial STIs, and because of their frequent recurrence, policies adjusted to the characteristics of these viral STIs and more studies on the management of recurrence are necessary.

Prevalence of sexually transmitted infections and the sexual behavior of elderly people presenting to health examination centers in Korea.

Sexually transmitted infections are diseases provoking a great social and economic burden as well as health-related problems, and with the aging of society and the extension of life expectancy sexually transmitted infections in the elderly have drawn more attention these days. For the management of sexually transmitted infections in this population, basic epidemiological data need to be established. In this study, 1,804 persons from the general population aged over 60 years visiting health examination centers were tested for syphilis, gonorrhea, and chlamydia, and interviewed about the patterns of sexual behavior of elderly people through questionnaires. The prevalence rates of syphilis, gonorrhea, and chlamydia recorded were 0.222% (4/1804), 0 (none), and 0.776% (14/1804), respectively. The results of the survey showed that the sexual life of the elderly people was currently active, and the sexual behavior of chlamydia patients was distinguished in some characteristics from that of the general participants. Political management to prevent sexually transmitted infections needs to be continued in elderly people as it is in other age groups. More detailed follow-up studies are necessary to determine the incidence and prevalence rates of the diseases in the elderly population in future, and the results of this study are considered to be useful as basic data for such studies.