Vasitis: a rare diagnosis mimicking inguinal hernia: a case report.

BACKGROUND: Vasitis or inflammation of the vas deferens is a rare condition, and few case reports with computed tomography images have been published since 1980. CASE PRESENTATION: A 50-year-old man presented with severe right inguinal and lower abdominal pain. Initial diagnosis at the emergency department was incarcerated or strangulated inguinal hernia. The computed tomography scan revealed diffuse edematous changes of right spermatic cord and vas deferens with peripheral fat stranding. Correlating with his clinical symptoms, signs, and imaging findings, the diagnosis of vasitis was made. We report a case of acute vasitis about the cause, symptom, pathogen, differential diagnoses, image findings, and treatment. CONCLUSION: Although very rare, vasitis should be listed as one of the differential diagnosis for inguinal mass lesions. Cross-sectional imaging may be necessary to confirm the diagnosis and exclude differentials such as an inguinal hernia. Recognition of the characteristic image findings can help to make the correct diagnosis and avoid unnecessary surgery.

Vasitis: a clinical confusion diagnosis with inguinal hernia.

Vasitis or inflammation of the vas deferens is a rarely described condition categorized as ei-ther generally asymptomatic vasitis nodosa or the acutely painful infectious vasitis. Vasitis nodosa, the commonly described inflammation of the vas deferens, is benign and usually associated with a history of vasectomy. Clinically, patients present with a nodular mass and are often asymptomatic and require no specific treatment.

Hepatocyte Nuclear Factor-4α P2 Promoter Variants Are Associated With the Risk of Metabolic Syndrome and Testosterone Deficiency in Aging Taiwanese Men.

BACKGROUND: Hepatocyte nuclear factor-4α (HNF4A) can influence the risk of insulin resistance that is postulated to be an important link between metabolic syndrome (MetS) and testosterone deficiency (TD) in men. AIM: To investigate the relationship between single-nucleotide polymorphisms (SNPs) of HNF4A and the risk of developing MetS and TD in a population of aging Taiwanese men. METHODS: A free health screening of men over 40 years of age was conducted in a medical center in Kaohsiung City, Taiwan. All participants underwent a physical examination, answered a questionnaire on demographics and medical history, completed the Androgen Deficiency in The Aging Male questionnaire to assess clinical symptoms of TD, and provided 20-mL whole blood samples for biochemical, hormonal, and genetic evaluation. MAIN OUTCOME MEASURE: 3 common SNPs (rs11574736, rs1884613, and rs2144908) of HNF4A were selected and identified using a TaqMan 5' allelic discrimination assay. RESULTS: 559 men were enrolled for this study (mean age, 55.8± 4.9 years). Prevalence of TD was significantly higher (P = .031) in subjects with MetS (16.8%) than those without MetS (10.1%). In SNP rs1884613 of HNF4A, subjects with the C allele carried a 1.31- and 1.50-times higher risk of developing MetS and TD, respectively, compared to those with the G allele, after adjusting for potential covariates. In addition, subjects with the CC genotype were exposed to a 1.91- and 2.20-times higher risk of developing MetS and TD, respectively, compared to those with the GG genotype. CLINICAL IMPLICATIONS: Our findings may point to the importance of the role played by insulin resistance in the link between MetS and TD. STRENGTH & LIMITATIONS: Our current work is the first report with adequate sample size to evaluate the role of genetic variants of HNF4A on the risk of both MetS and TD in men. The limitations included subjects enrolled from a free health screening and single measurement of serum testosterone levels. CONCLUSION: The rs1884613 SNP marker of HNF4A is significantly associated with an increased risk for developing both MetS and TD in aging Taiwanese men. Further population-based studies utilizing larger samples of different ethnicities may be needed to confirm these preliminary results. Liu C-C, Lee Y-C, Hung S-P. Hepatocyte Nuclear Factor-4α P2 Promoter Variants Are Associated With the Risk of Metabolic Syndrome and Testosterone Deficiency in Aging Taiwanese Men. J Sex Med 2018;15:1527-1536.

Cancer Stem Cell Gene Variants Predict Disease Recurrence in Patients Treated with Radical Prostatectomy for Prostate Cancer.

Background: Cancer stem cells (CSCs) are involved in tumor progression and drug resistance. We hypothesized that variants in CSC marker genes influence treatment outcomes in prostate cancer. Methods: Ten potentially functional single nucleotide polymorphisms (SNPs) in seven prostate CSC marker genes, TACSTD2, PROM1, ITGA2, POU5F1, EZH2, PSCA, and CD44, were selected for analysis of their association with disease recurrence by Kaplan-Meier analysis and Cox regression in a cohort of 320 patients with localized prostate cancer receiving radical prostatectomy. Results: We identified one independent SNP, rs2394882, in POU5F1 that was associated with prostate cancer recurrence (hazard ratio 0.32, 95% confidence interval 0.14-0.71, P = 0.005) after adjustment for known clinical predictors. Further in silico functional analyses revealed that rs2394882 affects POU5F1 expression, which in turn is significantly correlated with prostate cancer aggressiveness and patient prognosis. Conclusion: Our results suggest that rs2394882 is prognostically relevant in prostate cancer, possibly by modulating the expression of the CSC gene POU5F1.

Impact of metabolic syndrome and its components on kidney stone in aging Taiwanese males.

OBJECTIVES: Metabolic syndrome (MtS) and kidney stone are two common aging diseases with male dominant. This is the first study regarding the potential impact of MtS and its components on kidney stone in aging Chinese population. METHODS: A total of 694 males with a mean age of 55.6 years were enrolled. The definition of MtS was according to the modified criteria developed by the Bureau of Health Promotion in Taiwan. Subjects were classified as having a disease of kidney stones according to diagnosis by a physician with available medical records or evidence from ultrasonography judged by an investigator of urologist. RESULTS: Using age-adjusted multivariate logistic regression analysis, our results showed that subjects with kidney stone had significantly higher prevalence of MtS (p = 0.04, OR = 1.74, 95% CI: 1.0 1-3.00). The presence of MtS had significant correlation with kidney stone (p = 0.01, OR = 1.83, 95% CI: 1.1 4-2.93), which were associated with the increment of MtS components (p < 0.01). After adjusting for age and testosterone level, abnormal blood pressure (BP) was the most significantly independent component of MtS for kidney stone among the MtS components (p < 0.01, OR = 2.81, 95% CI: 1.46-5.39). CONCLUSIONS: In aging Taiwanese males, the presence of MtS and its components are strongly associated with kidney stone. Abnormal BP is the most significant risk component of MtS for kidney stone.

A comparison of S.T.O.N.E nephrolithometry scoring system, Guy's stone score, and Seoul National University Renal Stone Complexity (S-ReSC) in predicting mini-PCNL stone-free rate.

The main goal of the study is to evaluate the three stone scoring systems (S.T.O.N.E nephrolithometry scoring system (STONE), Guy's stone score (GSS) and Seoul National University Renal Stone Complexity (S-ReSC)) for the stone-free rate (SFR) of mini-PCNL. We retrospectively analyzed 72 patients who received mini-PCNL from February 2018 to October 2020. The SFR, complication rates, hospitalization days and recurrence rates were analyzed using three stone scoring systems. The result showed statistical significance in the association between scoring system and stone-free (STONE: OR 95%CI 0.409 (0.221-0.759), p = 0.0045; S-ReSC OR 95%CI 0.633 (0.401-0.999), p = 0.0497), but not GSS (OR 95%CI 0.776 (0.397-1.516), p = 0.4581). After adjusting the potential confounding factors, the area under curve (AUC) of STONE, GSS, and S-ReSC was 0.86, 0.78, and 0.81, respectively, and Akaike information criterion (AIC) of STONE, GSS, and S-ReSC was 64.65, 74.89, and 69.92, respectively. The accuracy rate of STONE, GSS, and S-ReSC was 0.81, 0.75, and 0.79, respectively. There was no statistically difference of predicting stone recurrence (p = 0.46, 0.53, 0.86), complications (p = 0.74, 0.51, 0.16) and hospitalization days (p = 0.77, 0.86, 0.87) in STONE, GSS, and S-ReSC, respectively. In conclusion, both the STONE and S-ReSC stone scoring systems are viable for predicting the SFR following mini-PCNL, especially after variable adjustment with the STONE system demonstrating superiority over S-ReSC.

New infundibulopelvic angle measurement method can predict stone-free rates following retrograde intrarenal surgery.

To enhance the accuracy of predicting stone-free rates after retrograde intrarenal surgery, we devised a novel approach to assess the renal infundibulopelvic angle. We conducted a retrospective review of patient records for those who underwent retrograde intrarenal surgery for renal stones between April 2018 and August 2019. Patient demographics, stone characteristics, and perioperative data were recorded. Subsequently, we introduced a modified angle measurement called the pelvic stone angle and evaluated its predictive performance for stone-free rates by comparing it with the traditional method in scoring systems. A total of 43 individuals were included in this study. Notable differences in stone burden and Hounsfield unit measurements were found between stone-free and non-stone-free patients. The pelvic stone angle demonstrated a good model fit when used in scoring systems, performing equally well as the conventional approach. The area under the receiver operating characteristic curve for the R.I.R.S. scoring system using the pelvic stone angle and the conventional approach did not show a significant difference. In conclusion, the predictive ability of the pelvic stone angle for stone-free rates was comparable to the old measurement method. Moreover, scoring systems using the pelvic stone angle exhibited a better model fit than those using the conventional approach.

Pituitary apoplexy induced by Gonadotropin-releasing hormone agonists for treating prostate cancer-report of first Asian case.

We present the first Asian case of a 77-year-old man who developed pituitary apoplexy (PA) soon after gonadotropin-releasing hormone agonist (GnRHa) (leuprorelin) injection to treat prostate cancer. Headache, ophthalmoplegia, visual field deficit, nausea, and vomiting are the typical characteristics of pituitary apoplexy. Though the occurrence rate is rare, the consequence of this condition can vary from mild symptoms such as headache to life-threatening scenarios like conscious change. Magnetic resonance imaging is the best imaging modality to detect PA and sublabial trans-sphenoid pituitary tumor removal can resolve most of PA symptoms and is so far the best solution in consensus. We also review 11 previous reported cases receiving GnRHa for androgen deprivation therapy of prostate cancer, and hope to alert clinicians to use GnRHa with caution.

The influence of climatic factors in the seasonal fluctuation of urolithiasis and the trend of stone disease management in the southern Taiwan.

This study aims to analyze the effects of climate parameters on the number of urolithiasis treatments in our hospital and understand the effects of climate parameters on the prevalence of urolithiasis in southern Taiwan. We also look at trends associated with urolithiasis and treatments. Retrospectively reviewed the records of extracorporeal shockwave lithotripsy (ESWL), ureteroscopy (URS), retrograde intrarenal surgery (RIRS), and percutaneous nephrolithotripsy (PCNL) performed in our hospital from January 2012 to December 2018. Climate data for were collected from Central Weather Bureau. The monthly meteorological data included average temperatures, humidity, rainfall, sunshine hours, atmospheric pressure, and wind speed. Monthly numbers of patients undergoing stone management was positively correlated to average temperature (r = 0.657), relative humidity (r = 0.234), monthly rainfall (r = 0.261) and monthly sunshine hours (r = 0.348), while it was negatively correlated to atmospheric pressure (r = - 0.522). The multivariate linear regression model demonstrated temperature (ß = 10.682, 95% CI 6.178-14.646, p < 0.001) and Relative humidity (ß = - 95% CI - 5.233- - 1.216, p = 0.002) to be independently related to numbers of stone treatment. The data also revealed a rising prevalence of urolithiasis with an associated increase in the number of interventions, with fewer ESWL (74.0-49.4%). Temperature and relative humidity are associated with monthly numbers of stone treatment. Ambient temperature is the most critical climate factor affecting the prevalence of symptomatic urolithiasis and intention of active stone removal in southern Taiwan.

Metabolic dysfunction-associated fatty liver disease is an early predictor for testosterone deficiency in aging men without metabolic syndrome.

Background and aims: Metabolic dysfunction-associated fatty liver disease (MAFLD) has emerged as a valuable marker for identifying individuals at increased risk of metabolic dysfunction, liver-related complications, and cardiovascular disease. However, the association between MAFLD and testosterone deficiency (TD) in aging men remains poorly understood. This study aimed to investigate the association between MAFLD and the risk of TD in aging Taiwanese men, with a specific focus on those without metabolic syndrome (MetS). Methods: A free health screening program was conducted for Taiwanese men aged over 40 years in Kaohsiung, Taiwan. Participants underwent physical examinations, completed questionnaires regarding demographics, medical history, and clinical symptoms of TD, and provided 20-mL whole blood samples for biochemical, adipocytokine, and hormonal evaluations. Fatty liver index was used to evaluate the risk of fatty liver. Diagnostic criteria for MAFLD included fatty liver along with overweight/obesity, type 2 diabetes, or evidence of metabolic dysregulation. Results: A total of 631 men (mean age: 54.4 ± 8.4 years) were enrolled. The prevalence rates of TD and MetS were significantly higher in men with MAFLD compared to those without (both p < 0.001). Additionally, the presence of MAFLD showed a significant correlation with adipocytokines associated with insulin resistance, such as adiponectin, leptin, and retinol-binding protein-4 (RBP-4) levels (all p < 0.001). Among men without MetS, those with MAFLD had a 3.89- and 4.74-fold higher risk of total testosterone < 300 ng/dL and TD, respectively, after adjusting for potential covariates. Conclusion: MAFLD is associated with an elevated risk of TD in aging Taiwanese men, particularly in the absence of MetS. This finding suggests that MAFLD could serve as an early predictor of TD, facilitating the identification of high-risk individuals and enabling timely interventions. Further research is needed to validate these findings and explore the underlying mechanisms linking MAFLD, TD, and MetS in diverse populations.

Genetic Polymorphisms of MnSOD Modify the Impacts of Environmental Melamine on Oxidative Stress and Early Kidney Injury in Calcium Urolithiasis Patients.

Environmental melamine exposure increases the risks of oxidative stress and early kidney injury. Manganese superoxide dismutase (MnSOD), glutathione peroxidase, and catalase can protect the kidneys against oxidative stress and maintain normal function. We evaluated whether their single-nucleotide polymorphisms (SNPs) could modify melamine's effects. A total of 302 patients diagnosed with calcium urolithiasis were enrolled. All patients provided one-spot overnight urine samples to measure their melamine levels, urinary biomarkers of oxidative stress and renal tubular injury. Median values were used to dichotomize levels into high and low. Subjects carrying the T allele of rs4880 and high melamine levels had 3.60 times greater risk of high malondialdehyde levels than those carrying the C allele of rs4880 and low melamine levels after adjustment. Subjects carrying the G allele of rs5746136 and high melamine levels had 1.73 times greater risk of high N-Acetyl-ß-d-glucosaminidase levels than those carrying the A allele of rs5746136 and low melamine levels. In conclusion, the SNPs of MnSOD, rs4880 and rs5746136, influence the risk of oxidative stress and renal tubular injury, respectively, in calcium urolithiasis patients. In the context of high urinary melamine levels, their effects on oxidative stress and renal tubular injury were further increased.

Fatty liver index is associated with the risk of testosterone deficiency in aging men without metabolic syndrome.

OBJECTIVES: Non-alcoholic fatty liver disease (NAFLD) is suggested to be a precursor of metabolic syndrome (MetS) and could influence the risk of testosterone deficiency (TD). Fatty liver index (FLI) is a simple and useful screening tool for NAFLD. We determined the association between the risk of NAFLD assessed by FLI and TD in aging Taiwanese men, especially those without MetS. MATERIALS AND METHODS: A free health screening program was conducted for men (age: >40 years) in a medical center in Kaohsiung, Taiwan. All participants underwent a physical examination; answered a questionnaire assessing demographics, medical history, and clinical symptoms of TD; and provided 20-mL whole blood samples for biochemical, adipocytokine, and hormonal evaluations. The risk of NAFLD was evaluated using FLI. The presence of NAFLD was ruled out if FLI value was <25 and ruled in if FLI value was ≥35. RESULTS: A total of 552 men (mean age: 54.7 ± 7.7 years) were enrolled. The prevalence rates of TD and MetS were significantly higher among men with NAFLD than those without NAFLD (both p < 0.001). FLI was significantly correlated with total testosterone (TT) and adipocytokines associated with insulin resistance, such as adiponectin, leptin, and retinol-binding protein-4 (RBP-4) levels, respectively (all p < 0.001). Among men without MetS, those at risk of and with NAFLD had a 3.82 and 8.50 times higher risk of TD, respectively, than those without NAFLD after adjusting for potential covariates. CONCLUSION: The FLI is associated with the risk of TD in aging Taiwanese men, especially in those without MetS. Our findings also suggest that insulin resistance may be an important link among the inter-relationships of NAFLD, MetS, and TD. Further population-based studies with larger sample sizes of different ethnicities are warranted to confirm these preliminary results.

Congenital bilateral absence of the vas deferens (CBAVD) with bilaterally present seminal vesicles.

Congenital bilateral absence of the vas deferens (CBAVD) is a rare obstructive anomaly contributing to male factor infertility. Various congenital anomalies associated with CBAVD involve the seminal vesicles and epididymis. Physical examinations are often not reliable. However, transrectal ultrasonography (TRUS) can distinguish seminal vesicle and epididymal anomalies. In this clinical report, a rare case of CBAVD without seminal vesical anomalies is presented. PE and TRUS revealed no remarkable findings. The patient underwent vaso-epididymal anastomosis for the seminal tract obstruction and was accidentally diagnosed with CBAVD. Although ultrasonography is a reliable approach, surgical methods are critical for the diagnosis of CBAVD.

Distal ureteral stone in an ileal conduit: A case treated by antegrade flexible ureteroscopic lithotripsy.

Antegrade flexible URSL is a minimal invasive option for treating distal ureteral stones in patient after urinary diversion.

Interrelationship of environmental melamine exposure, biomarkers of oxidative stress and early kidney injury.

Melamine contamination has remained pervasive in the environment even after the 2008 toxic milk scandal. Exposure to chronic low dosages of melamine is known to induce renal tubular damage, increasing the risk of stone formation and early kidney injury. This damage may come about via increased oxidative stress, but no studies of this possibility have been performed in humans. We conducted two human studies in 80 workers from melamine tableware factories (melamine workers) and 309 adult patients with calcium urolithiasis (stone patients) to evaluate the relationships between urinary melamine levels and two urinary biomarkers of oxidative stress, 8-oxo-2'-deoxyguanosine (8-OHdG) and malondialdehyde (MDA). Both human studies showed urinary melamine levels to be significantly and positively correlated with urinary 8-OHdG and MDA, indicating melamine exposure can increase oxidative stress. Additionally, we used structure equation modeling to evaluate relative contribution of type of melamine-induced oxidative stress on renal tubular injury and found that MDA mediated 36 %-53 % of the total effect of melamine on a biomarker of renal tubular injury, N-Acetyl-ß-d Glucosaminidase (NAG). In conclusion, our findings suggest exposure to low-dose melamine can increase oxidative stress and increase the risk of early damage to kidneys in humans.

Biomechanical Evaluation of Three-Dimensional Printed Dynamic Hand Device for Patients With Chronic Stroke.

Provision of adequate task-oriented training can be difficult for stroke survivors with limited hand movement. The current passive devices are mainly intended for gross grasp and release training. Additional assistive devices are required to improve functional opposition. This paper investigated the functional recovery of chronic stroke patients after using a three-dimensional (3D) printed dynamic hand device (3D-DHD) as an adjunct to conducting a task-oriented approach (TOA). Ten participants were randomly assigned to either the 3D-DHD group (n = 5) or the control group (n = 5). The TOA was used for the 3D-DHD group by using the 3D-DHD twice a week for four weeks, followed by a two-week home program. Only the TOA was used for the control group. The outcome measures, including the box and blocks test (BBT) of manual dexterity and prehensile strength, were conducted at baseline and at follow-up at four and six weeks later. The 3D-DHD group exhibited significantly superior improvements to the control group in the BBT and the palmar pinch force test. Both the groups had significant within-group improvements in the BBT and in all strength measures compared with baseline measurements. The use of 3D-DHD could position stroke-affected hands in coordinated functional opposition and had the potential to facilitate manual dexterity and advanced prehensile movement.

Management of Large Proximal Ureteral Calculi: A Three-year Multicenter Experience of Simultaneous Supine Percutaneous Nephrolithotomy and Retrograde Ureterolithotripsy.

PURPOSE: To share our multicenter experience using a safe and effective method for treating large proximal ure-teral calculus by simultaneous supine percutaneous nephrolithotomy (sPCNL) and retrograde ureterolithotripsy (URSL) in the Galdakao-modified supine Valdivia position. MATERIALS AND METHODS: Between December 2014 and August 2017, all patients with large proximal ureteral stones (> 15 mm) who underwent simultaneous sPCNL and retrograde URSL at three medical centers were retro-spectively reported. The ureter stone was pushed back (retrograde) with the ureteroscope and was retrieved using forceps with a nephroscope through an Amplatz sheath. Surgical methods and outcomes were described to improve our experience and management of large proximal ureteral calculi. RESULTS: A total of 31 patients underwent simultaneous sPCNL and retrograde URSL. The mean patient age, stone size, operating time, and postoperative hospital stay were 57 years (range, 32-74 years), 20.1 mm (range, 15.0-37.9 mm), 81 minutes (range, 30-150), and 3.2 days (range, 2-7 days), respectively. There were 10 modified Clavien grade I and five grade II complications. No blood transfusions were necessary in this series. All patients were treated with double-J stents without a nephrostomy tube. Only one patient did not achieve stone-free status because of the strict stone impaction into the ureteral wall. This patient received auxiliary URSL after two months. Thereafter, the overall stone-clearance rate at three months was 100%. CONCLUSION: Our preliminary data showed that this modified method is safe and effective for treating large prox-imal ureteral stones.

Vitamin D receptor-binding site variants affect prostate cancer progression.

Vitamin D is an important modulator of cellular proliferation through the vitamin D receptor (VDR) that binds to DNA in the regulatory sequences of target genes. We hypothesized that single nucleotide polymorphisms (SNPs) in VDR-binding sites might affect target gene expression and influence the progression of prostate cancer. Using a genome-wide prediction database, 62 SNPs in VDR-binding sites were selected for genotyping in 515 prostate cancer patients and the findings were replicated in an independent cohort of 411 patients. Prognostic significance on prostate cancer progression was assessed by Kaplan-Meier analysis and the Cox regression model. According to multivariate analyses adjusted for known predictors, HFE rs9393682 was found to be associated with disease progression for localized prostate cancer, and TUSC3 rs1378033 was associated with progression for advanced prostate cancer in both cohorts. Vitamin D treatment inhibited HFE mRNA expression, and down-regulation of HFE by transfecting small interfering RNA suppressed PC-3 human prostate cancer cell proliferation and wound healing ability. In contrast, vitamin D treatment induced TUSC3 expression, and silencing TUSC3 promoted prostate cancer cell growth and migration. Further analysis of an independent microarray dataset confirmed that low TUSC3 expression correlated with poor patient prognosis. Our results warrant further studies using larger cohorts. This study identifies common variants in VDR-binding sites as prognostic markers of prostate cancer progression and HFE and TUSC3 as plausible susceptibility genes.