The prevalence and topographic distribution of penile calcification in a large cohort: a retrospective cross-sectional study.

The prevalence of penile calcification in the population remains uncertain. This retrospective multicenter study aimed to determine the prevalence and characteristics of penile calcification in a large cohort of male patients undergoing non-contrast pelvic tomography. A total of 14 545 scans obtained from 19 participating centers between 2016 and 2022 were retrospectively analyzed within a 3-months period. Eligible scans (n = 12 709) were included in the analysis. Patient age, penile imaging status, presence of calcified plaque, and plaque measurements were recorded. Statistical analysis was performed to assess the relationships between calcified plaque, patient age, plaque characteristics, and plaque location. Among the analyzed scans, 767 (6.04%) patients were found to have at least one calcified plaque. Patients with calcified plaque had a significantly higher median age (64 years (IQR 56-72)) compared to those with normal penile evaluation (49 years (IQR 36-60) (p < 0.001). Of the patients with calcified plaque, 46.4% had only one plaque, while 53.6% had multiple plaques. There was a positive correlation between age and the number of plaques (r = 0.31, p < 0.001). The average dimensions of the calcified plaques were as follows: width: 3.9 ± 5 mm, length: 5.3 ± 5.2 mm, height: 3.5 ± 3.2 mm, with an average plaque area of 29 ± 165 mm² and mean plaque volume of 269 ± 3187 mm³. Plaques were predominantly located in the proximal and mid-penile regions (44.1% and 40.5%, respectively), with 77.7% located on the dorsal side of the penis. The hardness level of plaques, assessed by Hounsfield units, median of 362 (IQR 250-487) (range: 100-1400). Patients with multiple plaques had significantly higher Hounsfield unit values compared to those with a single plaque (p = 0.003). Our study revealed that patients with calcified plaques are older and have multiple plaques predominantly located on the dorsal and proximal side of the penis.

Surgery for an Isolated Adrenal Metastasis of Gastric Cancer.

Adrenal metastasis is considered a rare hematogenous metastasis that develops after gastric cancer surgery. The chances of curative surgery are very low. It is usually unresectable. We aim to present a case of isolated adrenal metastasis that developed in a patient, who underwent a total gastrectomy with the diagnosis of gastric cancer approximately 26 months back. Left adrenalectomy was planned with curative intent. R0 resection was performed. The patient was followed up for one year after surgery. The option of surgical treatment is recommended for isolated metachronous adrenal metastases. Curative surgical resection may positively impact the prognosis of patients in selected cases. Key Words: Gastric cancer, Adrenal metastasis, Surgical resection.

O Nível de Endocan Sérico pode ser Usado como Biomarcador para Prever Aterosclerose Subclínica em Pacientes Pré-Diabéticos? / Can the Serum Endocan Level Be Used as a Biomarker to Predict Subclinical Atherosclerosis in Patients with Prediabetes?

Resumo Fundamento Pacientes pré-diabéticos têm um risco aumentado de doença cardiovascular aterosclerótica, e, portanto, a detecção precoce é importante. Objetivo Nosso estudo teve o objetivo de revelar a usabilidade dos níveis de endocan sérico como biomarcador no diagnóstico de aterosclerose subclínica em pacientes pré-diabéticos, com base em medições de EIMC. Métodos Os participantes foram classificados de acordo com a presença (n=42) ou ausência (n=42) de pré-diabetes. Os valores de endocan sérico, glicemia em jejum, insulina em jejum e hemoglobina glicada (HbA1c) dos pacientes foram examinados e a EIMC foi medida. O nível de significância para a análise estatística foi 0,05. Resultados Apesar de se ter determinado que os níveis de endocan sérico são mais baixos em pacientes pré-diabéticos em comparação com o grupo de controle (p=0,042), determinou-se que os valores de EIMC são mais altos (p=0,046). A avaliação do endocan sérico por análise regressiva multivariada detectou que seu nível estava associado à EIMC, independentemente de outros parâmetros (p=0,007). Encontramos uma correlação negativa entre insulina plasmática em jejum e níveis de endocan (r=-0,320, p=0,001). Conclusões Este estudo demonstrou que a espessura íntima-média de carótida é mais alta e o nível de endocan sérico é mais baixo em pacientes pré-diabéticos. Os níveis de endocan sérico diminuídos em pacientes pré-diabéticos podem ser um fator que contribui para os mecanismos de formação de aterosclerose.

Abstract Background Patients with prediabetes have an increased risk of atherosclerotic cardiovascular disease; therefore, early detection is important. Objective The present study aimed to reveal the usability of serum endocan levels as a biomarker in the diagnosis of subclinical atherosclerosis in patients with prediabetes, based on CIMT measurements. Methods Participants were classified according to the presence (n=42) or absence (n=42) of prediabetes. Serum endocan, fasting blood sugar, fasting insulin, and glycated hemoglobin (HbA1c) values of patients were examined, and CIMT was measured. The level of significance for statistical analysis was 0.05. Results While serum endocan levels were found to be lower in patients with prediabetes, when compared to the control group (p=0.042), CIMT values were found to be higher (p=0.046). When evaluated by multivariate regression analysis, the serum endocan level was found to be associated with CIMT, regardless of other parameters (p=0.007). A negative correlation was found between plasma fasting insulin and endocan levels (r=-0.320, p=0.001). Conclusions Carotid intima media thickness was found to be high and the serum endocan level was low in patients with prediabetes. Decreased serum endocan levels in patients with prediabetes may be a contributing factor to atherosclerosis formation mechanisms.

Can the Serum Endocan Level Be Used as a Biomarker to Predict Subclinical Atherosclerosis in Patients with Prediabetes? / O Nível de Endocan Sérico pode ser Usado como Biomarcador para Prever Aterosclerose Subclínica em Pacientes Pré-Diabéticos?

BACKGROUND: Patients with prediabetes have an increased risk of atherosclerotic cardiovascular disease; therefore, early detection is important. OBJECTIVE: The present study aimed to reveal the usability of serum endocan levels as a biomarker in the diagnosis of subclinical atherosclerosis in patients with prediabetes, based on CIMT measurements. METHODS: Participants were classified according to the presence (n=42) or absence (n=42) of prediabetes. Serum endocan, fasting blood sugar, fasting insulin, and glycated hemoglobin (HbA1c) values of patients were examined, and CIMT was measured. The level of significance for statistical analysis was 0.05. RESULTS: While serum endocan levels were found to be lower in patients with prediabetes, when compared to the control group (p=0.042), CIMT values were found to be higher (p=0.046). When evaluated by multivariate regression analysis, the serum endocan level was found to be associated with CIMT, regardless of other parameters (p=0.007). A negative correlation was found between plasma fasting insulin and endocan levels (r=-0.320, p=0.001). CONCLUSIONS: Carotid intima media thickness was found to be high and the serum endocan level was low in patients with prediabetes. Decreased serum endocan levels in patients with prediabetes may be a contributing factor to atherosclerosis formation mechanisms.

FUNDAMENTO: Pacientes pré-diabéticos têm um risco aumentado de doença cardiovascular aterosclerótica, e, portanto, a detecção precoce é importante. OBJETIVO: Nosso estudo teve o objetivo de revelar a usabilidade dos níveis de endocan sérico como biomarcador no diagnóstico de aterosclerose subclínica em pacientes pré-diabéticos, com base em medições de EIMC. MÉTODOS: Os participantes foram classificados de acordo com a presença (n=42) ou ausência (n=42) de pré-diabetes. Os valores de endocan sérico, glicemia em jejum, insulina em jejum e hemoglobina glicada (HbA1c) dos pacientes foram examinados e a EIMC foi medida. O nível de significância para a análise estatística foi 0,05. RESULTADOS: Apesar de se ter determinado que os níveis de endocan sérico são mais baixos em pacientes pré-diabéticos em comparação com o grupo de controle (p=0,042), determinou-se que os valores de EIMC são mais altos (p=0,046). A avaliação do endocan sérico por análise regressiva multivariada detectou que seu nível estava associado à EIMC, independentemente de outros parâmetros (p=0,007). Encontramos uma correlação negativa entre insulina plasmática em jejum e níveis de endocan (r=-0,320, p=0,001). CONCLUSÕES: Este estudo demonstrou que a espessura íntima-média de carótida é mais alta e o nível de endocan sérico é mais baixo em pacientes pré-diabéticos. Os níveis de endocan sérico diminuídos em pacientes pré-diabéticos podem ser um fator que contribui para os mecanismos de formação de aterosclerose.

Is high levels of vitamin D a new risk factor for Peyronie's disease?

The aim of this study is to investigate whether serum vitamin D level predicts the risk of Peyronie's disease. Calcium and inflammatory cytokines play an important role during fibrocalcification of the plaques in Peyronie's Disease. TGF-ß1 is one of the most fibrogenic cytokines. Increasing serum vitamin D levels is considered that induce expression of TGF-ß1. Serum vitamin D levels and TGF-ß1 are related with calcifications of some soft tissues in previous studies. One hundred and three Peyronie patients and 162 healthy volunteers were included in the study. In both groups, demographic data, medical history, physical examination and erectile capacity were recorded. Serum 25-hydroxyvitamin D, total cholesterol, low-density lipoprotein, high-density lipoprotein, triglyceride and testosterone levels were measured. The mean level of serum 25 (OH) D was significantly higher in men with Peyronie's disease compared with the controls (32.6 ± 7.9 ng/ml vs. 18.5 ± 6.6 ng/ml respectively. p < 0.001). There is a relationship between Peyronie's disease and high serum vitamin D levels. Also, increased low-density lipoprotein and total cholesterol levels, diabetes mellitus, and cardiovascular diseases were associated with Peyronie's disease.

Stone volume measuring methods: should the ct based threedimensional-reconstructed algorithm be proposed as the gold standard? what did the three-dimensional printed models show us? / Métodos de medida del volumen del cálculo: ¿Debería proponerse el algoritmo de reconstrucción 3D basado en TAC como el patrón de referencia? ¿Qué nos han enseñado los modelos de impresión 3D?

Objectives: We researched to detect the optimal method for evaluating stone volume, by comparing the ellipsoid formula and 3D reconstructed volume to gold standard of water displacement volume using 3D printed models. Methods: We retrospectively analyzed out patient database and evaluated 27 patients who had percutaneous nephrolithotripsy. From the DICOM data of patient’s preoperative CT images, stone structures were obtained using an image identification system. All DICOM files were saved in the stereolithography file format and a 3D printed model was created. True stone volume was found by water displacement method using this model and this volume compared with ellipsoid formula and 3D-reconstructed volume. Results: Stone volume on water displacement ranged from 0.38-29.8cm3 with a median of 17.5cm3, stone volume on ellipsoid formula ranged from 0.46-34.7cm3 with a median of 19.6cm3 and stone volume on CT based 3D-reconstructed ranged from 0.48-31.8cm3 with a median of 18.9cm3. There was a significant difference between ellipsoid formula and water displacement (p < 0.0001); however, there was no difference between 3D-reconstructed volume and water displacement (p = 0.051). Conclusion: Stone volume calculation using CT based 3D-reconstructed algorithm improves the accuracy of stone volume estimation and this measurement is superior to ellipsoid formula

Objetivos: Realizamos una investigación para detectar el método óptimo de evaluación del volumen del cálculo comparando la fórmula del elipsoide y la reconstrucción 3D del volumen con el patrón de referencia, el volumen de agua desplazado utilizando modelos de impresión 3D. Métodos: Analizamos retrospectivamente la base de datos de pacientes y evaluamos 27 que fueron sometidos a nefrolitotricia percutánea. Desde los datos del DICOM de las imágenes del TAC preoperatorio se obtuvieron las estructuras de los cálculos utilizando un sistema de identificación de imagen. Todos los archivos DICOM fueron guardados en un formato estereolitográfico y se creó un modelo 3D impreso. El volumen verdadero de la litiasis fue hallado mediante el método del desplazamiento de agua utilizando este modelo y se comparó con la fórmula del elipsoide y el volumen de reconstrucción 3D. Resultados: El volumen del cálculo con el desplazamiento de agua osciló entre 0,38-29,8 cm3 con una mediana de 17,5 cm3. Con la fórmula del elipsoide, el volumen tenía un rango entre 0,46-34,7 cm3 con una mediana de 19,6 cm3 y con la reconstrucción 3D basada en TAC el rango fue de 0,48-31,8 cm3 con una mediana de 19,6 cm3. Había una diferencia significativa entre la fórmula del elipsoide y el desplazamiento de agua ( p < 0,0001 ); sin embargo, no había diferencias entre el volumen por reconstrucción 3D y el desplazamiento de agua ( p = 0,051 ). Conclusion: El cálculo del volumen de la litiasis utilizando algoritmos de reconstrucción 3D basada en TAC mejora la precisión de la estimación del volumen de la litiasis y esta medida es superior a la fórmula del elipsoide

Stone volume measuring methods: Should the CT based three-dimensional-reconstructed algorithm be proposed as the gold standard? What did the three-dimensional printed models show us? / Métodos de medida del volumen del cálculo: ¿Debería proponerse el algoritmo de reconstrucción 3D basado en TAC como el patrón de referencia? ¿Qué nos han enseñado los modelos de impresión 3D?

OBJECTIVES: We researched to detect the optimal method for evaluating stone volume, by comparing the ellipsoid formula and 3D reconstructed volume to gold standard of water displacement volume using 3D printed models. METHODS: We retrospectively analyzed out patient database and evaluated 27 patients who had percutaneous nephrolithotripsy. From the DICOM data of patient's preoperative CT images, stone structures were obtained using an image identification system. All DICOM files were saved in the stereolithography file format and a 3D printed model was created. True stone volume was found by water displacement method using this model and this volume compared with ellipsoid formula and 3D-reconstructed volume. RESULTS: Stone volume on water displacement ranged from 0.38-29.8cm3 with a median of 17.5cm3, stone volume on ellipsoid formula ranged from 0.46-34.7cm3 with a median of 19.6cm3 and stone volume on CT based 3D-reconstructed ranged from 0.48-31.8cm3 with a median of 18.9cm3. There was a significant difference between ellipsoid formula and water displacement ( p <   0.0001 ); however, there was no difference between 3D-reconstructed volume and water displacement ( p = 0.051 ). CONCLUSION: Stone volume calculation using CT based 3D-reconstructed algorithm improves the accuracy of stone volume estimation and this measurement is superior to ellipsoid formula.

OBJETIVOS: Realizamos una investigación para detectar el método óptimo de evaluación del volumen del cálculo comparando la fórmula del elipsoide y la reconstrucción 3D del volumen con el patrón de referencia, el volumen de agua desplazado utilizando modelos de impresión 3D. MÉTODOS: Analizamos retrospectivamente la base de datos de pacientes y evaluamos 27 que fueron sometidos a nefrolitotricia percutánea. Desde los datos del DICOM de las imágenes del TAC preoperatorio se obtuvieron las estructuras de los cálculos utilizando un sistema de identificación de imagen. Todos los archivos DICOM fueron guardados en un formato estereolitográfico y se creó un modelo 3D impreso. El volumen verdadero de la litiasis fue hallado mediante el método del desplazamiento de agua utilizando este modelo y se comparó con la fórmula del elipsoide y el volumen de reconstrucción 3D. RESULTADOS: El volumen del cálculo con el desplazamiento de agua osciló entre 0,38-29,8 cm3 con una mediana de 17,5 cm3. Con la fórmula del elipsoide, el volumen tenía un rango entre 0,46-34,7 cm3 con una mediana de 19,6 cm3 y con la reconstrucción 3D basada en TAC el rango fue de 0,48-31,8 cm3 con una mediana de 19,6 cm3. Había una diferencia significativa entre la fórmula del elipsoide y el desplazamiento de agua ( p < 0,0001 ); sin embargo, no había diferencias entre el volumen por reconstrucción 3D y el desplazamiento de agua ( p = 0,051 ). CONCLUSION: El cálculo del volumen de la litiasis utilizando algoritmos de reconstrucción 3D basada en TAC mejora la precisión de la estimación del volumen de la litiasis y esta medida es superior a la fórmula del elipsoide.

Are There Differences in Brain Morphology in Patients with Lifelong Premature Ejaculation?

INTRODUCTION: Even though lifelong premature ejaculation (PE) is highly prevalent, few studies have investigated the neural mechanisms underlying PE. AIM: This study aimed to investigate whether patients with lifelong PE exhibit macrostructural or microstructural alterations of the parts of the brain involved in the male sexual response. MATERIALS AND METHODS: We enrolled 42 healthy participants and 54 lifelong PE patients. Lifelong PE was diagnosed according to the Premature Ejaculation Diagnostic Tool (PEDT) and intravaginal ejaculation latency time (IELT). We compared measures of cortical morphology, such as volumes of gray matter, white matter, cerebellum volumes, and subcortical structures (ie, amygdala, caudate, hippocampus, globus pallidus, putamen, and thalamus) between the groups using a voxel-based morphometry method from whole-brain T1-weighted magnetic resonance imaging. Moreover, we evaluated the relationships between the relevant cerebral alterations and the severity of symptoms obtained from participants via self-reported questionnaires. MAIN OUTCOME MEASURES: Cerebral macrostructural and microstructural alterations were assessed in PE patients and controls, along with the correlation of caudate nucleus changes in PE patients with clinical data (including the PEDT and the IELT). RESULTS: The mean volume of the caudate nucleus was significantly larger in the lifelong PE patients compared with healthy controls (P = .048). Moreover, caudate nucleus volume was positively correlated with PEDT score (r = 0.621; P = .0179) and negatively correlated with the IELT (r = -0.592; P = .0101). However, cortex morphology and the other subcortical volumes were not significantly different between the 2 groups (P > .05). CLINICAL IMPLICATIONS: Microstructural alterations in deep gray matter nuclei might be a useful parameter for studying the mechanism of the neurobiology underlying PE. STRENGTHS AND LIMITATIONS: There are few studies examining microstructural changes in PE patients. This study furthers our understanding of the etiology of PE. Limitations include the small sample, which limits our ability to make an absolute determination as to whether such subcortical changes are the cause or the consequence of lifelong PE. CONCLUSIONS: We found a significant difference in caudate nucleus volume between patients with PE and healthy controls. In addition, the caudate nucleus volume was positively associated with the severity of PE symptoms. More extensive and possibly longitudinal studies are needed to improve our understanding of the mechanism of the neurobiology underlying PE. Atalay HA, Sonkaya AR, Ozbir S, et al. Are There Differences in Brain Morphology in Patients with Lifelong Premature Ejaculation? J Sex Med 2019;16:992-998.

Evaluation of stone volume distribution in renal collecting system as a predictor of stone-free rate after percutaneous nephrolithotomy: a retrospective single-center study.

We analyzed our stone-free rates of PNL with regard to stone burden and its ratio to the renal collecting system volume. Data of 164 patients who underwent PNL were analyzed retrospectively. Volume segmentation of renal collecting system and stones were done using 3D segmentation software with the images obtained from CT data. Analyzed stone volume (ASV) and renal collecting system volume (RCSV) were measured and the ASV-to-RCSV ratio was calculated after the creation of a 3D surface volume rendering of renal stones and the collecting system. Univariate and multivariate statistical analyses were performed to determine factors affecting stone-free rates; also we assessed the predictive accuracy of the ASV-to-RCSV ratio using the receiving operating curve (ROC) and AUC. The stone-free rate of PNL monotherapy was 53% (164 procedures).The ASV-to-RCSV ratio and calyx number with stones were the most influential predictors of stone-free status (OR 4.15, 95% CI 2.24-7.24, <0.001, OR 2.62, 95% CI 1.38-4.97, p < 0.001, respectively). Other factors associated with the stone-free rate were maximum stone size (p < 0.029), stone surface area (p < 0.010), and stone burden volume (p < 0.001). Predictive accuracy of the ASV-to-RCSV ratio was AUC 0.76. Stone burden volume distribution in the renal collecting system, which is calculated using the 3D volume segmentation method, is a significant determinant of the stone-free rate before PCNL surgery. It could be used as a single guide variable by the clinician before renal stone surgery to predict extra requirements for stone clearance.

Metabolic syndrome in collection and disposal of solid waste sector.

OBJECTIVES: This study aims to assess the frequency and factors relevant to metabolic syndrome in workers employed in the collection and disposal of solid waste sector. MATERIALS AND METHODS: This cross-sectional study was conducted in the major solid waste collecting and disposal company named ISTAÇ AS (Istanbul Environmental Protection and Waste Processing Corporation) in Istanbul, Turkey. All 715 male employees of the company were included in the study without sampling. The study was completed with 619 subjects. Since it was a small group, female workers were not taken into account in the study. Metabolic syndrome frequency was investigated according to the NCEP-ATP III criteria including the levels of systolic and diastolic blood pressure, waist perimeter, HDL, triglyceride, fasting blood glucose values. RESULTS: Metabolic syndrome was present in 40.9% of participating employees. Metabolic syndrome was more common in those working in the excavation field (54.0%), such as caterpillar operators (56.5%), and less common in employees working in administrative offices, such as office staff or managers, who were under 35 years old and who had been working for less than 10 years (p < 0.05). Employees working in work stations other than administrative offices had a 2.60 times higher risk compared to those working in administrative offices. CONCLUSIONS: Metabolic syndrome may be related to work station, job, age and period worked by the subjects.