Effects of Elastic Band Exercise on Functional Fitness and Blood Pressure Response in the Healthy Elderly.

Purpose: This study investigated the effects of 12 weeks of moderate intensity elastic band exercise (EBE) on functional fitness and blood pressure parameters in the elderly. Methods: 27 healthy older adults were randomly assigned to an exercise group (n = 15, age: 75.1 ± 1.4 years) and a control group (n = 12, age: 72.3 ± 1.4 years). Participants performed EBE for 60 min, three times a week, over the course of three months. The EBE consisted of incremental resistance and aerobic exercises designed to improve whole body fitness. Functional fitness and resting cardiovascular parameters were assessed before and after the exercise training program. Results: Grip strength, sit and reach, and one-leg stance improved significantly in the exercise group, while no significant improvements were found in chair stand and timed up and go (p < 0.05). Cardiovascular parameters including systolic blood pressure, diastolic blood pressure, mean arterial pressure, and pulse pressure significantly decreased in the exercise group relative to the control group (p < 0.05). Conclusions: Findings of the present study suggest that safe, inexpensive, and easily accessible EBE program with circuit training components play a significant role in improving upper and lower body fitness, as well as cardiovascular fitness, in the elderly.

Clinical Anatomy of the Puboprostatic Ligament for the Safe Guidance for the Prostate Surgery.

OBJECTIVE: To provide the anatomy of the puboprostatic ligament and related structures to save urogenital competence after prostatectomy. MATERIALS AND METHODS: Pelvic areas of 31 adult cadavers were dissected to figure out the shape, number, and location of the puboprostatic ligaments. RESULTS: The puboprostatic ligament was the most important support structure between the pubic bone and prostate gland. Puboprostatic ligaments were bilaterally single (61.3%), bilaterally double (19.4%), or mixed (19.4%). Ligaments were mostly I-shaped (53.8%). If ligaments had extra attachment to or from the arcuate line, the ligaments were λ-shaped (36.3%), or Y-shaped (8.8%). In one case, the ligament had a central fusion with an irregular shape. I-shaped puboprostatic ligaments were observed more frequently in specimens with double ligaments, while λ-shaped puboprostatic ligaments were observed more frequently in the cases with single ligaments. The average distance between both puboprostatic ligaments was 8.1 mm at the pubic site and 14.2 mm at the prostate site. The distance was narrower when the specimen had double puboprostatic ligaments on both sides. The neurovascular bundle ran beneath the puboprostatic ligament. If the ligament was the λ-shaped type, the neurovascular bundle frequently pierced the lateral band of the ligament. CONCLUSION: Puboprostatic ligaments hold and stabilize the prostate against the pubic bone. It is believed that a pelvis with bilateral, double puboprostatic ligaments would have advantages in urogenital competence. The morphologic data of the shape, multiplicity, and location of the PPLs would help to make a plan to approach the prostate.

The reproducibility and validity verification for body composition measuring devices using bioelectrical impedance analysis in Korean adults.

The purpose of this study is to examine the validity and reproducibility of impedance body fat measurement devices measuring the body composition of Korean male and female adults using three bioelectrical impedance analyzers. We compared two methods for evaluating body composition: dual energy X-ray absorptiometry (DEXA), and bioelectrical impedance analysis (BIA). Subjects were 200 healthy adult Korean males and females whose mean±standard deviation (range) age, standing height, body weight, and body mass index (BMI) were 44.1±14.5 years, 172.8±7.4 cm, 76.0±12.8 kg, and 25.4±3.3 kg/m2, and 44.5±14.7 years, 158.7±5.8 cm, 58.3±8.3 kg, and 23.2±3.0 kg/m2, respectively. As a result, first of all, the reproducibility of the bioelectrical impedance analyzer had very high coefficients at r=0.998, r=0.997 between men and women, respectively. The correlation coefficients among three comparisons for lean body mass (LBM) were provided the following coefficients: r=0.951 for DEXA vs. ACCUNIQ BC720, r=0.950 for DEXA vs. ACCUNIQ BC360, and r=0.946 for DEXA vs. ACCUNIQ BC380 in men. In the results for women, they also had the very high following coefficients: r=0.956 for DEXA vs. ACCUNIQ BC720, r=0.946 for DEXA vs. ACCUNIQ BC360, and r=0.957 for DEXA vs. ACCUNIQ BC380 in LBM. In conclusion, this research showed a higher correlation in terms of accuracy compared to existing BIA-based body composition measurement techniques, and the accuracy of LBM was improved with high correlation coefficients through the algorithm that was improved using the multifrequency BIA method in the ACCUNIQ BC products.

Grape Seed Extract Supplementation Attenuates the Blood Pressure Response to Exercise in Prehypertensive Men.

We tested the hypothesis that exaggerated pressor responses observed in prehypertensive males (N = 9) during dynamic exercise are attenuated following acute dietary supplementation with grape seed extract (GSE) (i.e., a single dose). Effects of placebo and GSE (300 mg) on systolic blood pressure, diastolic blood pressure, mean arterial pressure (MAP), cardiac output (CO), stroke volume (SV), total vascular conductance (TVC), and rate × pressure product (RPP) in response to two submaximal cycling workloads (40% and 60% VO2peak) were compared 2 h after ingestion of GSE or placebo on different days, 1 week apart. Endothelial function was also evaluated using flow-mediated dilation (FMD). Placebo treatment had no effect on any of the variables. GSE supplementation attenuated MAP at both workloads (40% VO2peak: 115 ± 1 vs. 112 ± 2 mmHg; 60% VO2peak: 126 ± 2 vs. 123 ± 2 mmHg) and RPP at the lower workload. Conversely, SV, CO, and TVC were augmented during both workloads. FMD was augmented by GSE (18.9 ± 2.0 vs. 12.4% ± 2.0%). These findings indicate that in exercising prehypertensive males, a single dose of GSE reduces blood pressure, peripheral vasoconstriction, and work of the heart and enhances O2 delivery; effects that may be due, in part, to endothelium-dependent vasodilation. We propose that acute GSE treatment represents an intervention that may minimize potential increases in the risk of cardiovascular events during dynamic exercise in prehypertensives.

Urinary Incontinence Could Be Controlled by an Inflatable Penile Prosthesis.

PURPOSE: Due to the increasing numbers of radical prostatectomies (RP) performed for prostate cancer, a substantial and increasing number of patients suffer from postoperative urinary incontinence and erectile dysfunction (ED). The objective of our study was to see whether an inflatable penile prosthesis implantation could control urinary incontinence for patients with the dual problems of ED and incontinence. MATERIALS AND METHODS: From March 2010 through May 2015, 25 post-RP patients were referred to our clinic with ED or incontinence. The degree of incontinence was classified according to the International Consultation on Incontinence Questionnaire-Short Form. Inflatable penile prostheses were implanted in all 25 patients. RESULTS: For one month after implantation, partial or full inflation was performed progressively to control urine leakage. Of 18 patients, 13 patients were categorized with mild or moderate stress incontinence. All 13 patients obtained control of incontinence with partial inflation (30% to 60%) and all reported satisfactory outcomes. Five out of the 18 patients were categorized with severe total incontinence. Three of the 5 patients could tolerate incontinence with full inflation on and off. Thirteen patients out of the total of 18 (72.2%) had their incontinence controlled by an inflating penile prosthesis. CONCLUSIONS: An inflatable penile prosthesis is highly recommended as an initial procedure, especially in patients with the dual problems of ED and incontinence.

Histamine H2 receptor blockade augments blood pressure responses to acute submaximal exercise in males.

Histamine is a potent vasodilator that has been found to increase during exercise. We tested the hypothesis that histamine would attenuate blood pressure (BP), cardiac output (CO), and vascular resistance responses to short-term, submaximal dynamic exercise during H2 receptor blockade. Fourteen healthy men (20-29 years of age) were studied. Systolic (SBP), diastolic (DBP), and mean arterial (MAP) BP and heart rate (HR) were assessed at rest and during the last minute of 10 min of submaximal cycling exercise (60% of peak oxygen consumption) in the absence and presence of histamine H2 receptor blockade (ranitidine, 300 mg). Stroke volume (SV) (impedance cardiography) and plasma norepinephrine (NE) were measured, and CO, rate × pressure product (RPP), and total peripheral resistance (TPR) were calculated. Plasma levels of histamine were also measured. H2 blockade had no effects on any variables at rest. During exercise, SBP (184 ± 3 mm Hg vs. 166 ± 2 mm Hg), MAP (121 ± 2 mm Hg vs. 112 ± 5 mm Hg), and RPP (25.9 ± 0.8 × 10(3) mm Hg·beats/min vs. 23.5 ± 0.8 × 10(3) mm Hg/beats·min) were greater during blocked conditions (P < 0.05), and an interaction was observed for TPR. SV, DBP, HR, and NE levels were unaffected by blockade. Plasma histamine increased from 1.83 ± 0.14 ng/mL at rest to 2.33 ± 0.23 ng/mL during exercise (P < 0.05) and was not affected by H2 blockade (1.56 ± 0.23 ng/mL vs. 1.70 ± 0.24 ng/mL). These findings suggest that, during submaximal exercise, histamine attenuates BP, vascular resistance, and the work of the heart via activation of H2 receptors and that these effects occurred primarily in the vasculature and not in the myocardium.

The role of metaboreceptor on exercise in hyperthermic environment with college basketball players.

The objective of this study is to review physiological differences of college basketball players cardiovascular responses and group IV metaboreceptor interactions appearing post muscular ischemia exercise (PEMI) caused by a static handgrip exercise (SHE). The subjects were placed in a temperature and moisture stabilized indoor environment for 2 h in order to measure blood pressure. For the SHE, maximal voluntary contraction of arms with a relative strength of 50 % of the maximum muscular strength was put into isometric training for 2 min. After completing the exercises, cuffs worn on the arms of the subjects were pressurized up to 200 mmHg by applying PEMI to block the artery and vein. In this way, the cardiovascular responses created by SHE and PEMI were measured. Blood samples of subjects were collected from the vein of each upper arm before SHE and after PEMI to measure the metabolite hormone and catecholamine in the blood. Results from the measurements showed a significant decrease of blood pressure under high temperature environments compared to normal temperature environments. With respect to PEMI, increases in blood pressure under the high temperature environment were significantly lower compared to the normal temperature environment. In conclusion, this study revealed that college basketball players with good physical strength had higher sensitivities of arterial baroreceptor. However, blood pressure was not increased accordingly because the increase of cutaneous vasoconstriction due to stimuli of the metaboreceptor under a high temperature environment could not be compensated by arterial baroreflex due to the increase of total vascular conductance.

Effects of chronic dietary nitrate supplementation on the hemodynamic response to dynamic exercise.

While acute treatment with beetroot juice (BRJ) containing nitrate (NO3 (-)) can lower systolic blood pressure (SBP), afterload, and myocardial O2 demand during submaximal exercise, effects of chronic supplementation with BRJ (containing a relatively low dose of NO3 (-), 400 mg) on cardiac output (CO), SBP, total peripheral resistance (TPR), and the work of the heart in response to dynamic exercise are not known. Thus, in 14 healthy males (22 ± 1 yr), we compared effects of 15 days of both BRJ and nitrate-depleted beetroot juice (NDBRJ) supplementation on plasma concentrations of NOx (NO3 (-)/NO2 (-)), SBP, diastolic blood pressure (DBP), mean arterial pressure (MAP), CO, TPR, and rate pressure product (RPP) at rest and during progressive cycling exercise. Endothelial function was also assessed via flow-mediated dilation (FMD). BRJ supplementation increased plasma NOx from 83.8 ± 13.8 to 167.6 ± 13.2 µM. Compared with NDBRJ, BRJ reduced SBP, DBP, MAP, and TPR at rest and during exercise (P < 0.05). In addition, RPP was decreased during exercise, while CO was increased, but only at rest and the 30% workload (P < 0.05). BRJ enhanced FMD-induced increases in brachial artery diameter (pre: 12.3 ± 1.6%; post: 17.8 ± 1.9%). We conclude that 1) chronic supplementation with BRJ lowers blood pressure and vascular resistance at rest and during exercise and attenuates RPP during exercise and 2) these effects may be due, in part, to enhanced endothelium-induced vasodilation in contracting skeletal muscle. Findings suggest that BRJ can act as a dietary nutraceutical capable of enhancing O2 delivery and reducing work of the heart, such that exercise can be performed at a given workload for a longer period of time before the onset of fatigue.

Mechanisms Underlying Exaggerated Metaboreflex Activation in Prehypertensive Men.

PURPOSE: Previously, we found that the pressor response to muscle metaboreflex activation is enhanced in prehypertension and associated with peripheral vasoconstriction. However, mechanisms underlying this exaggerated response are not clear. Therefore, we tested the hypothesis that activation of this reflex is augmented owing to increased production of muscle metabolites (i.e., lactate, K, and H). METHODS: Twenty-two men (11 normotensive and 11 prehypertensive) were studied. Changes in cardiac output (Q˙), mean arterial pressure (MAP), and total peripheral resistance (TPR) were compared between the two groups during static exercise (SE) and postexercise muscular ischemia (PEMI). Subjects completed 2 min of SE at 50% of maximal voluntary contraction (MVC) followed by 2 min of PEMI. Venous blood samples for determination of metabolites and hormones (catecholamines, vasopressin, and plasma renin activity) were taken from the exercising and nonexercising arm, respectively. RESULTS: Mean arterial pressure responses to SE (39 ± 3 vs 31 ± 2 mm Hg) and PEMI (24 ± 3 vs 19 ± 3 mm Hg) were significantly higher in the prehypertensive group. Increases in lactate and decreases in pH during PEMI were seen in both groups. However, changes in these variables were greater in the prehypertensive group (lactate, 50.1 ± 6.2 vs 32.8 ± 7.6 mg·dL; pH, -0.06 ± 0.02 vs -0.01 ± 0.01) (P < 0.05). Postexercise muscular ischemia did not evoke increases in hormones in either group. CONCLUSIONS: Compared to the normotensive group, the augmented pressor response to the metaboreflex in the prehypertensive group was associated with greater production of muscle metabolites that activate its afferent arm. The augmented response was not associated with activation of the vasopressin and renin-angiotensin systems and greater activation of the sympathetic nervous system was not apparent. Consequently, additional factors specific to prehypertension, such as arterial stiffness, may have been involved.

Influence of Perilla frutescens var. acuta Water Extract on the Shelf Life and Physicochemical Qualities of Cooked Beef Patties.

This study investigated the effects of Perilla frutescens var. acuta water extract (WEP) on the shelf life and physicochemical qualities of cooked beef patties. The WEP contained phenolic compounds (80.65 mg gallic acid equivalents/g) and had half-maximal effective concentrations of 0.437 and 4.509 mg/mL for scavenging of DPPH and ABTS(+) radicals, respectively. Treatment with 0.6% WEP inhibited the growth of Escherichia coli O157:H7 (p<0.05). Based on the result of the antioxidative potential and antimicrobial potential of WEP, beef patties were prepared with three treatment groups: (1) beef patties without added antioxidant (control); (2) beef patties with 0.02% ʟ-ascorbic acid (BAA); and (3) beef patties with 0.6% WEP (BWEP). The pH and cooking loss of BWEP were lower and higher than those in the control, respectively (p<0.05). When cooked beef patties were stored for 21 d at 4℃, the total number of aerobic bacteria in BWEP was lower than those in the control on all days except day 14 (p<0.05). The TBARS values in BWEP were lower than those of controls on days 7, 14, and 21 (p<0.05). Compared to control and BAA, BWEP had lower L* and b* values and higher a* values throughout the storage period (p<0.05). Except on day 0, acceptability was higher in BWEP than in control and BAA (p<0.05). According to results, WEP can be used as a natural ingredient that improves the shelf life and sensorial qualities of meat products.

Augmentation of the exercise pressor reflex in prehypertension: roles of the muscle metaboreflex and mechanoreflex.

This study investigated the hemodynamic mechanisms underlying the exaggerated blood pressure response to muscle contraction in prehypertensive humans and the potential role of skeletal muscle metabo- and mechanoreceptors in this response. To accomplish this, changes in peak mean arterial blood pressure (ΔMAP), cardiac output, and total peripheral resistance (ΔTPR) were compared between prehypertensive (n = 23) and normotensive (n = 19) male subjects during 2 min of static contraction (at 50% of maximal tension), 2 min of postexercise muscle ischemia (metaboreflex), and 1 min of passive dorsiflexion of the foot (tendon stretch, mechanoreceptor reflex). These variables were assessed before and during the interventions. Percentage increases from baseline in MAP and TPR in response to the exercise pressor reflex were augmented in the prehypertensives, compared with the normotensives (44% ± 5% vs. 33% ± 4% and 34% ± 15% vs. 2% ± 8%, respectively) (p < 0.05). Metaboreflex-induced increases in MAP and TPR were also augmented in the prehypertensives (28% ± 5% vs. 14% ± 4% and 36% ± 12% vs. 14% ± 9%, respectively) (p < 0.05). In response to the mechanoreflex, no differences in the percentage increase in MAP or TPR were seen between groups. The results indicate that the reflex pressor response to static contraction is augmented in prehypertension and suggest that this phenomenon is due, at least in part, to enhanced activation of metaboreceptors.

Effects of Ovarian Cycle on Hemodynamic Responses during Dynamic Exercise in Sedentary Women.

This study tested the hypothesis that effects of the menstrual cycle on resting blood pressure carry over to dynamic exercise. Eleven healthy females were studied during the early (EP; low estrogen, low progesterone) and late follicular (LP; high estrogen, low progesterone) menstrual phases. Stroke volume (SV), heart rate (HR), cardiac output (CO), systolic blood pressure (SBP), diastolic blood pressure (DBP), and total vascular conductance (TVC) were assessed at rest and in response to mild and moderate cycling exercise during EP and LP. During EP, compared to LP, baseline SBP (111±1 vs. 103±2 mmHg), DBP (71±2 vs. 65±2 mmHg) and mean arterial pressure (MAP) (84±2 vs. 78±1 mmHg) were higher and TVC (47.0±1.5 vs. 54.9±4.2 ml/min/mmHg) was lower (p<0.05). During exercise, absolute values of SBP (Mild: 142±4 vs. 127±5 mmHg; Moderate: 157±4 vs. 144±5 mmHg) and MAP (Mild: 100±3 vs. 91±3 mmHg; Moderate: 110±3 vs. 101±3 mmHg) were also higher, while TVC was lower (Mild: 90.9±5.1 vs. 105.4±5.2 ml/min/mmHg; Moderate: 105.4±5.3 vs. 123.9±8.1 ml/min/mmHg) during EP (p<0.05). However, exercise-induced increases in SBP, MAP and TVC at both work intensities were similar between the two menstrual phases, even though norepinephrine concentrations were higher during LP. Results indicate that blood pressure during dynamic exercise fluctuates during the menstrual cycle. It is higher during EP than LP and appears to be due to additive effects of simultaneous increases in baseline blood pressure and reductions in baseline TVC.

Skeletal muscle metaboreflex is enhanced in postmenopausal women.

This study determined whether an elevated muscle metaboreflex contributes to the excessive blood pressure response to exercise in postmenopausal women. Thirty healthy female volunteers were studied (15 postmenopausal and 15 premenopausal). Stroke volume, heart rate, cardiac output (CO), systolic blood pressure, diastolic blood pressure, and total vascular conductance (TVC) were continuously assessed throughout the experiment. To activate the muscle metaboreflex, occlusion of the vasculature was induced via inflation of a blood pressure cuff (2 min) on the upper arm following static handgrip exercise. Muscle metaboreflex activation increased mean arterial pressure (MAP) in both groups. However, this pressor response was greater in the postmenopausal women (ΔMAP: 21.4 ± 3 vs. 14.5 ± 2 mmHg) (P < 0.05) even though the corresponding increase in CO was less (ΔCO: 0.0 ± 0.2 vs. 0.3 ± 0.2 l/min) (P < 0.05). TVC decreased in both the groups but was more pronounced in the postmenopausal group (ΔTVC: -10.7 ± 2.6 vs. -17.1 ± 3.6 ml/min/mmHg) (P < 0.05). In conclusion, the exaggerated blood pressure response to exercise in postmenopausal women is mediated, in part, by an overactive metaboreflex that is associated with enhanced peripheral vasoconstriction.

Increase in maximal oxygen uptake following 2-week walk training with blood flow occlusion in athletes.

Walk training with blood flow occlusion (OCC-walk) leads to muscle hypertrophy; however, cardiorespiratory endurance in response to OCC-walk is unknown. Ischemia enhances the adaptation to endurance training such as increased maximal oxygen uptake (VO2(max)) and muscle glycogen content. Thus, we investigated the effects of an OCC-walk on cardiorespiratory endurance, anaerobic power, and muscle strength in elite athletes. College basketball players participated in walk training with (n = 7) and without (n = 5) blood flow occlusion. Five sets of a 3-min walk (4-6 km/h at 5% grade) and a 1-min rest between the walks were performed twice a day, 6 days a week for 2 weeks. Two-way ANOVA with repeated measures (groups x time) was utilized (P < 0.05). Interactions were found in VO2(max) (P = 0.011) and maximal minute ventilation (VE(max); P = 0.019). VO2(max) (11.6%) and VE(max) (10.6%) were increased following the OCC-walk. For the cardiovascular adaptations of the OCC-walk, hemodynamic parameters such as stroke volume (SV) and heart rate (HR) at rest and during OCC-walk were compared between the first and the last OCC-walk sessions. Although no change in hemodynamics was found at rest, during the last OCC-walk session SV was increased in all five sets (21.4%) and HR was decreased in the third (12.3%) and fifth (15.0%) sets. With anaerobic power an interaction was found in anaerobic capacity (P = 0.038) but not in peak power. Anaerobic capacity (2.5%) was increased following the OCC-walk. No interaction was found in muscle strength. In conclusion, the 2-week OCC-walk significantly increases VO2(max) and VE(max) in athletes. The OCC-walk training might be used in the rehabilitation for athletes who intend to maintain or improve endurance.

AMS 700CX/CXM inflatable penile prosthesis has high mechanical reliability at long-term follow-up.

INTRODUCTION: AMS 700CX/CXM inflatable penile prosthesis is increasingly applied for the treatment of erectile dysfunction (ED). However, there are a few long-term survival data of the inflatable penile prosthesis (IPP) over 10 years. AIM: To determine the long-term mechanical reliability of AMS 700CX/CXM inflatable penile prosthesis in patients with ED. METHODS: A total of 438 consecutive patients with ED received implantation of an AMS 700CX/CXM penile prosthesis at our institution from January 1991 to April 2009. In 397 patients (90.7%), the medical records were available and current status of penile prosthesis could be obtained by a direct telephone interview. The overall and mechanical survival rates of penile prosthesis were evaluated using Kaplan-Meier method. MAIN OUTCOME MEASURES: Assessing the mechanical and overall survival rates of the AMS 700CX/CXM penile prosthesis using Kaplan-Meier analysis, and looking for clinical factors related to survival of the CX/CXM using log-rank test. RESULTS: Mean age of 397 patients was 63.1 years (range, 24-93) and follow-up duration was 113 months (range 1-219). Eighty-two patients (20.6%) experienced mechanical failure at a median follow-up of 82 months. Mechanical survival rate of the penile prosthesis was 97.6%, 93.2% and 78.2% at 3, 5, and 10 years after implantation, respectively. 12 patients (3.0%) experienced nonmechanical failure including infections, tissue erosion resulting in cylinder protrusion at the meatus and chronic discomfort. Overall survival rate of the penile prosthesis was 95.0%, 91.0% and 75.5% at 3, 5, and 10 years after implantation, respectively. Patients with neurogenic cause for ED showed lower median overall survival of penile prosthesis compared with patients with non-neurogenic cause. Patient age, obesity, and diabetes mellitus had no association with overall survival of penile prosthesis after implantation. CONCLUSIONS: The AMS 700CX/CXM could be accepted and applied in more patients as a reliable treatment alternative of ED.

Clinical significance of lymph node dissection in patients with muscle-invasive upper urinary tract transitional cell carcinoma treated with nephroureterectomy.

We investigated the value of lymph node dissection in patients with cN0 muscle-invasive transitional cell carcinoma of the upper urinary tract (UUT-TCC). Medical records of 152 patients with cN0 muscle-invasive UUT-TCC, who underwent nephroureterectomy between 1986 and 2005, were reviewed. Sixty-three patients (41.4%) underwent lymph node dissection. The median number of lymph nodes harvested was 6 (range, 1 to 35), and from these, lymph node involvement was confirmed in 9 patients (14.3%). Locoregional recurrence (LR) and disease-recurrence (DR) occurred in 29 patients and 63 patients, respectively. Fifty-five patients (36.2%) had died of cancer at the last follow-up. The number of lymph nodes harvested was associated with the reduction of LR (chi(2)(trend)=6.755, P=0.009), but was not associated with DR (chi(2)(trend)=1.558, P=0.212). In the survival analysis, N stage (P=0.0251) and lymph node dissection (P=0.0073) had significant influence on LR, but not on DR or disease-specific survival. However, the number of lymph nodes harvested did not affect LR-free, DR-free, or disease-specific survival. We conclude that lymph node dissection may improve the control of locoregional cancer, as well as staging accuracy, in cN0 muscle-invasive UUT-TCC, but that it does not clearly influence survival.

Cardiac metastasis from colorectal cancer: a case report.

The heart is an unusual site of metastasis from any malignancy. We report a case of cardiac metastasis from colorectal cancer. A 70-year-old woman was referred with a presumptive diagnosis of sigmoid colon cancer with cardiac myxoma. Two-dimensional echocardiography showed a 4 cm x 4.5 cm mobile mass on the lateral right atrial wall, and computed tomography revealed a low attenuated lobulating mass in the right atrium. The patient underwent anterior resection for sigmoid colon cancer (T4N2). Thereafter, she experienced progressive shortness of breath. Therefore, a cardiac operation was performed 2 wk after the colorectal operation. Histological examination revealed adenocarcinoma, which was identical to the primary lesion. Although two-dimensional echocardiography has become the diagnostic test of choice for detecting cardiac tumors, in patients with colorectal cancer showing a cardiac mass, further diagnostic evaluation such as a magnetic resonance imaging might be necessary.

Toxicity evaluation of complex metal mixtures using reduced metal concentrations: application to iron oxidation by Acidithiobacillus ferrooxidans.

In this study, we investigated the inhibition effects of single and mixed heavy metal ions (Zn2+, Ni2+, Cu2+, and Cd2+) on iron oxidation by Acidithiobacillus ferrooxidans. Effects of metals on the iron oxidation activity of A. ferrooxidans are categorized into four types of patterns according to its oxidation behavior. The results indicated that the inhibition effects of the metals on the iron oxidation activity were noncompetitive inhibitions. We proposed a reduced inhibition model, along with the reduced inhibition constant (alpha i), which was derived from the inhibition constant (KI) of individual metals and represented the tolerance of a given inhibitor relative to that of a reference inhibitor. This model was used to evaluate the toxicity effect (inhibition effect) of metals on the iron oxidation activity of A. ferrooxidans. The model revealed that the iron oxidation behavior of the metals, regardless of metal systems (single, binary, ternary, or quaternary), is closely matched to that of any reference inhibitor at the same reduced inhibition concentration, [I]reduced, which defines the ratio of the inhibitor concentration to the reduced inhibition constant. The model demonstrated that single metal systems and mixed metal systems with the same reduced inhibitor concentrations have similar toxic effects on microbial activity.

Robot-assisted laparoscopic radical cystoprostatectomy with ileal conduit urinary diversion: initial experience in Korea.

In this paper, we report our initial experience of robot-assisted laparoscopic radical cystoprostatectomy (RLRC) with an ileal conduit urinary diversion (ICUD). Our patient was a 59-year-old man presenting with a clinical T4 invasive transitional cell carcinoma of the bladder and prostate. A RLRC was performed with the da Vinci() robot system (Intuitive Surgical, Mountain View, CA), which has a total of seven degrees of motion (six degrees of freedom and grip), and EndoWrist (Intuitive Surgical) instrumentation. The specimen was extracted through the 8-cm-sized incision in the umbilical trocar site. The ICUD was achieved through a removal site of a specimen by an extracorporeal technique. The total operative time was 340 minutes and the estimated blood loss was 600 mL. The pathologic examination showed a stage T4a, with negative surgical margins. A RLRC can be an alternative to the open technique. We are the first group to perform RLRC in Korea and to report on our technique and outcome.