Type D Personality Independently Predicts Erectile Dysfunction in Taiwanese Young Men.

BACKGROUND: Studies have demonstrated that erectile dysfunction has a well-established bidirectional relationship with depression and have indicated an independent association of type D personality (TDP) with depression. Nevertheless, the relationship of erectile dysfunction with TDP has not been sufficiently examined. AIM: To examine the associations among depression symptoms, TDP, and erectile dysfunction. METHODS: The cross-sectional study recruited 1740 sexually active Taiwanese men (age: 20-40 years) with erectile dysfunction. Participants completed an online questionnaire collecting general demographic information and containing the International Index of Erectile Function-5, Type D Scale-14, and Depression and Somatic Symptom Scale. Pearson's chi squared or Student's t'test was conducted for comparisons between participants with vs without TDP. We conducted multivariate and univariate logistic regression analysis to investigate the predictors of moderate/severe erectile dysfunction. OUTCOMES: The prevalence of TDP and moderate/severe erectile dysfunction, the associations between TDP and the severities of depression symptoms and erectile dysfunction, and independent risk factors for moderate/severe erectile dysfunction. RESULTS: A total of 360 (15.9%) and 941 (54.08%) men had moderate/severe erectile dysfunction and TDP, respectively. Men with TDP reported significantly higher total and subscale scores in the International Index of Erectile Function-5 and the Depression and Somatic Symptom Scale; this group also exhibited higher prevalence of moderate or severe erectile dysfunction. According to the univariate analysis, all variables significantly predicted moderate or severe erectile dysfunction except for age and body mass index. A multivariate analysis revealed TDP status and depression symptoms to be independent predictors of moderate or severe erectile dysfunction. With regard to subscales of the Type D Scale-14, we discovered that social inhibition had a greater influence on moderate or severe erectile dysfunction than had negative affectivity. A mediation analysis indicated that the relationship between TDP and erectile dysfunction was mediated by depressive symptoms. CLINICAL IMPLICATIONS: Research has suggested that compared with the general population, individuals with TDP are less willing to seek medical consultation, have lower medication adherence, and have heightened risk of depression; urologists should strive to identify patients with TDP. STRENGTHS & LIMITATIONS: This study is the first to investigate the association of TDP with erectile dysfunction in a large population of young men by using validated instruments. Conclusions on causality cannot be drawn due to the study's cross-sectional nature. CONCLUSION: This research revealed relationships among TDP, depression symptoms, and erectile dysfunction in Taiwanese young men. Fan Y-H, Liou Y-J, Cheng W-M. Type D Personality Independently Predicts Erectile Dysfunction in Taiwanese Young Men. J Sex Med 2022;19:1397-1403.

Can we treat bladder cancer with intravesical Bacillus Calmette-Guerin in patients with prior tuberculosis infection? A population-based cohort study.

BACKGROUND: Intravesical bacillus Calmette-Guerin (BCG) therapy is the treatment of choice for patients with T1 or high-grade superficial bladder cancer or those with carcinoma in situ after transurethral resection. A personal history of tuberculosis infection has been viewed as a relative contraindication for BCG therapy, because it may increase the risk of complications or decrease the treatment effectiveness. We determined the safety and efficacy of intravesical BCG treatment for patients with prior tuberculosis infection by analyzing the data obtained from the National Health Insurance Research Database in Taiwan. METHODS: We included patients who were newly diagnosed with bladder cancer from 2000 to 2009 and who received adjuvant intravesical BCG therapy within 3 months after the surgery. We excluded those who developed upper urinary tract cancer during the study period. Disease recurrence, disease progression, and major adverse effects were compared between patients with and without a prior diagnosis of tuberculosis infection until December 31, 2011. RESULTS: Among the 3915 patients included, 187 (4.8%) had been previously diagnosed with tuberculosis infection. The proportion of men (84.0% versus 76.9%) and older patients was higher in the group with a prior tuberculosis infection than in those without a prior tuberculosis infection. Significant differences in disease recurrence (20.3% versus 22.8%; hazard ratio [HR], 0.87; 95% confidence interval [CI], 0.63-1.21, p = 0.404) or disease progression (10.2% versus 12.8%, HR, 0.74; 95% CI, 0.46-1.17, p = 0.191) were not observed between the two groups. None of the patients with a prior tuberculosis infection had severe urinary tract infections, whereas four (0.1%) patients without such an infection developed severe urinary tract infections. CONCLUSION: A prior tuberculosis infection did not affect the treatment efficacy or safety of intravesical BCG treatment. The efficacy and safety of intravesical BCG therapy are comparable between bladder cancer patients with and without prior tuberculosis infections.

Control of Microstructure and Magnetic Properties of FePt Thin Films with TiN-MgO Intermediate Layer.

The effects of TiN-MgO intermediate layer on the microstructure and magnetic properties of FePt-SiNx-C films were investigated. With doping MgO into TiN, three components were formed, including titanium dioxide, titanium nitride and titanium oxynitride. This caused the decrease of the surface energy and the increase of the interface energy, and further induced the promotion of island growth of FePt, thus the improvement of the isolation and the decrease of FePt grains. On the other hand, the decrease of surface energy and the forming of some titanium dioxide with doping MgO would accompany the deterioration of epitaxial growth and thus the deterioration of the perpendicular magnetic anisotropy of FePt films in a certain degree. By optimizing the concentration of TiN and MgO, the FePt-SiNx-C films with small grain size of 5.86±1.03 nm and good perpendicular anisotropy would be obtained.

Cold hypersensitivity in the hands and feet is associated with erectile dysfunction in young Taiwanese men.

Cold hypersensitivity in the hands and feet (CHHF) is a protective or predisposing factor for many diseases; however, the relationship between CHHF and erectile dysfunction (ED) remains unclear. We aimed to investigate associations between CHHF and ED among young men of Southeast Asian origin. In this cross-sectional study, sexually active Taiwanese men aged 20-40 years were enrolled via an online questionnaire comprising general demographic information, comorbidities, subjective thermal sensations of their hands and feet in the past 6 months, and their erectile function using the International Index of Erectile Function-5 (IIEF-5). Participants who reported cold sensation of hands and feet were classified to have CHHF; those with IIEF-5 score ≤ 21 were considered to have ED. Total 54.2% and 27.9% of participants had ED and CHHF, respectively. Men with CHHF were significantly younger, had lower body mass index and IIEF-5 scores (p < 0.001), and a lower prevalence of diabetes mellitus (p = 0.033) along with higher prevalence of ED, psychiatric disorders, and insomnia (p < 0.001). After adjusting for predisposing factors of ED, CHHF (odds ratio 1.410, 95% confidence interval 1.159-1.714; p = 0.001) remained an independent predictor of ED. Thus, CHHF is independently associated with ED, affecting more than a quarter of young Taiwanese men. Autonomic dysregulation and subclinical endothelial dysfunction may be common pathophysiologies of CHHF and ED.

Self-Rectifying Memristors for Three-Dimensional In-Memory Computing.

Costly data movement in terms of time and energy in traditional von Neumann systems is exacerbated by emerging information technologies related to artificial intelligence. In-memory computing (IMC) architecture aims to address this problem. Although the IMC hardware prototype represented by a memristor is developed rapidly and performs well, the sneak path issue is a critical and unavoidable challenge prevalent in large-scale and high-density crossbar arrays, particularly in three-dimensional (3D) integration. As a perfect solution to the sneak-path issue, a self-rectifying memristor (SRM) is proposed for 3D integration because of its superior integration density. To date, SRMs have performed well in terms of power consumption (aJ level) and scalability (>102  Mbit). Moreover, SRM-configured 3D integration is considered an ideal hardware platform for 3D IMC. This review focuses on the progress in SRMs and their applications in 3D memory, IMC, neuromorphic computing, and hardware security. The advantages, disadvantages, and optimization strategies of SRMs in diverse application scenarios are illustrated. Challenges posed by physical mechanisms, fabrication processes, and peripheral circuits, as well as potential solutions at the device and system levels, are also discussed.

Lower urinary tract symptoms as an independent predictor of aortic regurgitation in women with cardiac symptoms.

BACKGROUND: Very few studies have focused on the correlation between structural heart disease and lower urinary tract symptoms. In this study, we applied echocardiography to explore the correlation between lower urinary tract symptoms and structural heart disease. METHODS: In this single-center, prospective, cross-sectional study, we enrolled adult women undergoing echocardiography for suspected cardiac abnormalities causing cardiac symptoms between February 1, 2021, and March 31, 2021. All participants completed a questionnaire regarding demographic information and lower urinary tract symptoms, which were assessed according to the International Prostate Symptom Score. RESULTS: A total of 165 women aged 69.96 ± 10.20 years were enrolled. The prevalence of moderate-to-severe aortic regurgitation in patients with moderate-to-severe lower urinary tract symptoms was significantly higher than that in patients with mild lower urinary tract symptoms (33.3% vs 13.6%, p = 0.008). The prevalence of other echocardiographic abnormalities was not associated with severity of lower urinary tract symptoms. Multivariable logistic regression analyses revealed that moderate-to-severe lower urinary tract symptoms predicted moderate-to-severe aortic regurgitation ( p = 0.007; odds ratio: 3.560; 95% confidence interval: 1.409-8.993). Furthermore, the International Prostate Symptom Score storage subscore ( p = 0.001; odds ratio: 1.285; 95% confidence interval: 1.111-1.486), except the voiding subscore, was an independent predictor of moderate-to-severe aortic regurgitation. CONCLUSION: Moderate-to-severe lower urinary tract symptoms, especially storage symptoms, are an independent predictor of the co-existence of moderate-to-severe aortic regurgitation in women with cardiac symptoms. Early cardiological referral of patients with moderate-to-severe lower urinary tract symptoms and cardiac symptoms may improve their general health.

Factors influencing satisfaction with male circumcision in Taiwan.

We aimed to investigate patient satisfaction with male circumcision in Taiwan. An online, questionnaire-based, cross-sectional study involving 376 circumcised men 20 to 40 years of age in Taiwan was conducted. Circumcision-related satisfaction was defined as a visual analogue scale score ≥ 6 (range, 1-10). Pearson's chi-square test was performed to compare differences between satisfied and unsatisfied participants. Factors predictive of participant satisfaction were analysed using multivariate logistic regression. Statistical significance was set at P < 0.05. Among 376 circumcised men, 249 (66.2%) reported satisfaction with circumcision. Satisfied participants had higher levels of education, underwent circumcision for phimosis or balanitis, underwent circumcision during adulthood, reported a larger penile size, and had fewer long-term complaints. Furthermore, 89.4% had various long-term complaints, including skin colour mismatch, changes in masturbation methods, hypertrophic scarring, excessive shortening of the prepuce, and redundant prepuce. Multivariate analysis revealed that adult circumcision and the absence of long-term conditions were predictive of satisfaction. Two-thirds of participants were satisfied with their circumcision outcome, especially those who underwent circumcision for phimosis or balanitis during adulthood. Proper preoperative patient selection and postoperative symptom prevention would improve patient satisfaction.

Impact of type D personality and depressive symptoms on premature ejaculation in young adult males.

Background: Premature ejaculation (PE) is one of the most common male sexual dysfunctions with prominent psychological consequences. Type D personality (TDP) is also associated with multiple psychological disorders, such as depression and anxiety. However, the correlation between PE and TDP remains unknown. Aim: The study sought to investigate the relationships between depressive symptoms, TDP, and PE. Methods: Adult males in Taiwan who were 20 to 40 years of age and who had sexual intercourse in the past 6 months were recruited to complete online questionnaires composed of general demographics, the Premature Ejaculation Diagnostic Tool (PEDT), 5-item International Index of Erectile Function (IIEF-5), Type D Scale-14, and Depression and Somatic Symptom Scale (DSSS). Chi-square test and independent Student's t test were used to compare the parameters between the TDP and non-TDP groups. Univariate and multivariate logistic regression analyses were conducted to evaluate factors related to PE. Outcomes: Outcomes were the prevalence of PE and TDP in young Taiwanese men, the associations between depressive symptoms and PE and TDP, and the predictive factors of PE. Results: In total, 2558 men with a mean age of 31.3 ± 5.3 years were included in the present study. Among them, 315 (12.3%) and 767 (30.1%) participants were classified as having PE and moderate-to-severe erectile dysfunction (ED), respectively. In total, 1249 (48.8%) participants met the criteria for TDP. The PEDT, IIEF-5, and DSSS, including the total scores and depression and somatic subscales, were significantly higher in men with TDP (all P < .001). PE prevalence was significantly greater in men with TDP than in those without TDP (16.2% vs 8.6%; P < .001). Most parameters, including age, moderate-to-severe ED, the Type D Scale-14 subscales, and the DSSS somatic and depressive subscales, were significantly associated with PE in the univariate analysis. Only the depressive subscale of the DSSS and moderate-to-severe ED (IIEF-5 ≤16) were the independent predictors of PE in the multivariate analysis. Clinical Implications: The results suggest that it is important to consider the psychological effects of PE in young men, and the study has provided a biopsychosocial aspect to manage patients with PE. Strengths and Limitations: This is the first study to evaluate the association between PE, TDP, and depression in a large population of young adult males. However, the cross-sectional design may have limited the investigation of causality, and selection bias may be present. Conclusion: Men with TDP tended to have higher PEDT scores and a prevalence of PE and ED. Moderate-to-severe ED and depressive symptoms are the independent predictive factors of PE.

Combining prostate health index and multiparametric magnetic resonance imaging may better predict extraprostatic extension after radical prostatectomy.

BACKGROUND: In patients undergoing radical prostatectomy (RP) for prostate cancer (PCa), preoperative prediction of extraprostatic extension (EPE) can facilitate patient selection for nerve-sparing procedures. Since both multiparametric magnetic resonance imaging (mpMRI) and prostate health index (PHI) have shown promise for the diagnosis and prognostication of PCa, we investigated whether a combination of mpMRI and PHI evaluations can improve the prediction of EPE after RP. METHODS: Patients diagnosed with PCa and treated with RP were prospectively enrolled between February 2017 and July 2019. Preoperative blood samples were analyzed for PHI (defined as [p2PSA/fPSA] × âˆštPSA), and mpMRI examinations were performed and interpreted by a single experienced uroradiologist retrospectively. The area under the receiver operating characteristic curve (ROC) was used to determine the performance of mpMRI, PHI, and their combination in predicting EPE after RP. RESULTS: A total of 163 patients were included for analysis. The pathological T stage was T3a or more in 59.5%. Overall staging accuracy of mpMRI for EPE was 72.4% (sensitivity and specificity: 73.2% and 71.2%, respectively). The area under the ROC of the combination of mpMRI and PHI in predicting EPE (0.785) was higher than those of mpMRI alone (0.717; p = 0.0007) and PHI alone (0.722; p = 0.0236). mpMRI showed false-negative non-EPE results in 26 patients (16%), and a PHI threshold of >40 could avoid undiagnosed EPE before RP in 21 of these 26 patients. CONCLUSION: The combination of PHI and mpMRI may better predict the EPE preoperatively, facilitating preoperative counseling and tailoring the need for nerve-sparing RP.

Type D Personality Is an Independent Predictor of Lower Urinary Tract Symptoms in Young Men.

This cross-sectional study, which included men aged 20-40 years, aimed to determine the relationships among type D personality, depressive symptoms and lower urinary tract symptoms in young men. An internet-based questionnaire was administered, and General demographics, International Prostate Symptom Scores, Type D Scale-14 scores, and Depression and Somatic Symptom Scale scores were analyzed. A total of 3,127 men were included; of these, 762 (24.4%) reported moderate/severe lower urinary tract symptoms, and 1,565 (50.05%) met the criteria for type D personality. Men with type D personality had significantly higher body mass index and total and sub-scores for the International Prostate Symptom Score and Depression and Somatic Symptom Scale. Furthermore, the type D personality group had a higher prevalence of lower urinary tract symptoms, particularly voiding symptoms. Univariate analysis revealed that all parameters, except for body mass index, were significant predictors of moderate/severe lower urinary tract symptoms. Multivariate analysis showed that age >30 years, type D personality, and depressive and somatic Depression and Somatic Symptom Scale sub-scores were independent predictors of moderate/severe lower urinary tract symptoms. Regarding Type D Scale-14 subscales, social inhibition, rather than negative affectivity, impacted moderate/severe lower urinary tract symptoms. Mediation analysis revealed that depressive symptoms mediated the relationship between type D personality and lower urinary tract symptoms. This study established correlations between type D personality, depressive symptoms, and lower urinary tract symptoms. As previous studies suggested that patients with type D personality are less likely to consult and adhere to treatment, and are at higher risk for depression, urologists should therefore actively recognize patients with TDP.

Detection of Stage I nasopharyngeal carcinoma by serologic screening and clinical examination.

In a prospective study, 42 048 adults residing in Zhongshan City, Guangdong, China, were followed for 16 years, and 171 of them developed nasopharyngeal carcinoma (NPC). Although Epstein-Barr virus (EBV) antibody levels of the cohort fluctuated, the antibody levels of 93% of the patients with NPC were raised and maintained at high levels for up to 10 years prior to diagnosis. This suggests that the serologic window affords an opportunity to monitor tumor progression during the preclinical stage of NPC development, facilitating early NPC detection. We reviewed the clinical records of the 171 patients with NPC in the prospective study to assess the efficacy of early NPC detection by serologic screening and clinical examination. Of the 171 patients, 51 had Stage I tumor (44 were among the 73 patients detected by clinical examination and 7 were among the 98 patients presented to outpatient department). Initial serologic screening predicted 58 (95.1%) of the 61 patients detected within 2 years. The risk of the screened population (58/3093) raised 13 times relative to cohort (61/42 048) during this period. Clinical examination detected all the 58 predicted cases, and 35 (60.3%) of which were diagnosed with Stage I tumor. The serologic prediction rate fell to 33.6% (37/110) 2 to 16 years after screening. The proportion of cases detected by clinical examination fell to 40.5% (15/37). The proportion of Stage I tumors among the cases detected by clinical examination during both periods remained at about 60%. We concluded that early detection of NPC can be accomplished by repeated serologic screening to maintain high prediction rates and by promptly examining screened subjects to detect tumors before the symptoms develop.

Predictive factors for disease recurrence in patients with locally advanced renal cell carcinoma treated with curative surgery.

BACKGROUND: Few prognostic factors have been proposed for patients with locally advanced renal cell carcinoma (RCC). This study aimed to investigate the possible predictive factors for disease-free survival (DFS) after curative surgery for RCC stage T3 or higher. METHODS: Patients with locally advanced RCC who underwent cure-intended partial or radical nephrectomy, with or without tumor thrombectomy, at our institution from April 1, 2005 to October 31, 2013 were retrospectively reviewed. Those undergoing cytoreductive nephrectomy were excluded. Preoperative data, including surgical and pathologic characteristics, were assessed for correlation with DFS. Chi-square tests, univariate and multivariate Cox regression analysis, and Kaplan-Meier survival curve analyses were performed to determine potential predictive factors. A p value less than 0.05 was considered statistically significant. RESULTS: A total of 159 patients were included for analysis. The mean duration of follow-up was 37.9 months, and 119 (74.8%) patients remained disease-free during follow-up. Disease recurrence was found in 40 (25.2%) patients, and pathologic T stage, capsule penetration, Fuhrman grade, thrombocytosis, renal vein thrombosis, and elevated serum alkaline phosphatase, platelet/lymphocyte ratio, and γ-glutamyl transpeptidase levels were significantly associated with disease recurrence on univariate analysis. On multivariate analysis, Fuhrman grade 3 or 4 (HR = 5.70, p = 0.0003, 95% CI = 2.23-14.56) showed significant associations with DFS. CONCLUSION: In patients with locally advanced RCC, Fuhrman grade was associated with worse DFS after curative surgery. Urologists should closely monitor patients with high Fuhrman grades.

The Prostate Health Index aids multi-parametric MRI in diagnosing significant prostate cancer.

To evaluate the performance of the Prostate Health Index (PHI) in magnetic resonance imaging-transrectal ultrasound (MRI-TRUS) fusion prostate biopsy for the detection of clinically significant prostate cancer (csPCa). We prospectively enrolled 164 patients with at least one Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) ≥ 3 lesions who underwent MRI-TRUS fusion prostate biopsy. Of the PSA-derived biomarkers, the PHI had the best performance in predicting csPCa (AUC 0.792, CI 0.707-0.877) in patients with PI-RADS 4/5 lesions. Furthermore, the predictive power of PHI was even higher in the patients with PI-RADS 3 lesions (AUC 0.884, CI 0.792-0.976). To minimize missing csPCa, we used a PHI cutoff of 27 and 7.4% of patients with PI-RADS 4/5 lesions could have avoided a biopsy. At this level, 2.0% of cases with csPCa would have been missed, with sensitivity and NPV rates of 98.0% and 87.5%, respectively. However, the subgroup of PI-RADS 3 was too small to define the optimal PHI cutoff. PHI was the best PSA-derived biomarker to predict csPCa in MRI-TRUS fusion prostate biopsies in men with PI-RADS ≥ 3 lesions, especially for the patients with PI-RADS 3 lesions who gained the most value.

Better sleep quality could reinforce the relationship between sleep posture and kidney stone laterality in obstructive sleep apnea patients.

Urolithiasis is a common urologic problem among adults worldwide. It is interesting that urinary stones tend to recur on the same side and the pathophysiology of unilateral stone formation is not clearly understood. Researchers found that sleep posture could alter renal perfusion, and subsequent vascular injury may lead to urolithiasis formation. The aim of this study is to retrospectively evaluate the correlations between the specific sleep postures recorded in polysomnography (PSG) and the stone laterality in unilateral urinary stone formers with obstructive sleep apnea (OSA). We retrospectively reviewed patients receiving PSG for the diagnosis of OSA in our institutes between January 1st 2002 and September 30th 2016. Those had a history of unilateral urinary stones which surgical intervention was warranted were included. Supine, prone, right decubitus, and left decubitus sleep postures were determined as patients remained specific postures for more than 50% of their sleep time. The laterality of stones with sleep posture was analyzed with Chi-square test. A student t test was used to assess factors that influenced the ipsilateral stone formation. IBM SPSS Statistics 21 software was adopted to analyze the data, and p value less than 0.05 was considered statistically significant. 117 patients were enrolled in this study, among which 105 (89.7%) were male and 12 were female. The mean age at PSG examination was 53.5 ± 11.5 years. 66 patients were diagnosed as left-side urolithiasis, and 51 patients had urinary stones at right side. 58 (49.6%) patients slept predominantly in supine posture, while 53 (45.3%) patients, in decubitus posture, and no patient, in prone posture. A total of 51 patients' stones appeared at the same side as their decubitus posture (p < 0.0001). Shorter sleep stage I ratio (24.3 ± 15.5% versus 52.4 ± 24.7%, p = 0.017), longer sleep stage II + III + IV ratio (66.2 ± 21.9% versus 30.9 ± 2.8, p = 0.049), and less sleep stage change (176.6 ± 69.6 times versus 282.5 ± 91.2 times, p = 0.041) were correlated with stone formation on the same side. Age, gender, body mass index, and other polysomnographic parameters failed to demonstrate associations between the sides of urinary calculi and sleep postures. We discovered that sleep posture is associated with unilateral urolithiasis formation. Favorable sleep quality and less sleep stage changes could consolidate the correlations. Further prospective study is warranted to evaluate the effect of sleep posture and quality on non-OSA patients as well as the preventive effect of sleep posture modification on repeated unilateral stone formers.

Prostate health index density predicts aggressive pathological outcomes after radical prostatectomy in Taiwanese patients.

BACKGROUND: There are models to predict pathological outcomes based on established clinical and prostate-specific antigen (PSA)-derived parameters; however, they are not satisfactory. p2PSA and its derived biomarkers have shown promise for the diagnosis and prognosis of prostate cancer (PCa). The aim of this study was to investigate whether p2PSA-derived biomarkers can assist in the prediction of aggressive pathological outcomes after radical prostatectomy (RP). METHODS: We prospectively enrolled patients who were diagnosed with PCa and treated with RP between February 2017 and December 2018. Preoperative blood samples were analyzed for tPSA, free PSA (fPSA), percentage of fPSA (%fPSA), [-2]proPSA (p2PSA), and percentage of p2PSA (%p2PSA). Prostate health index (PHI) was calculated as (p2PSA/fPSA) × âˆštPSA. Prostate volume was determined by transrectal ultrasound using the ellipsoid formula, and PHI density was calculated as PHI/prostate volume. The areas under the receiver operating characteristic curve were estimated for various PSA/p2PSA derivatives. Aggressive pathological outcomes measured after RP were defined as pathological T3 or a Gleason score (GS) >6 as determined in RP specimens. RESULTS: One hundred and forty-four patients were included for analysis. Postoperative GS was >6 in 86.1% of the patients, and pT stage was T3a or more in 54.2%. Among all PSA- and p2PSA-derived biomarkers, PHI density was the best biomarker to predict aggressive pathological outcomes after RP. The odds ratio of having an aggressive pathological outcome of RP was 8.796 (p = 0.001). In multivariate analysis, adding %fPSA to base model did not improve the accuracy (area under curve), but adding PHI and PHI density to base model improved the accuracy by 2% and 16%, respectively, in predicting pT3 stage or GS ≥ 7. The risk of pT3 stage or GS ≥ 7 was 20.8% for PHI density <1.125, and 64.6% for PHI density >1.125 (sensitivity: 74.6% and specificity: 88.9%). CONCLUSION: PHI density may further aid in predicting aggressive pathological outcomes after RP. This biomarker may be useful in preoperative counseling and may have potential in decision making when choosing between definitive treatment and active surveillance of newly diagnosed PCa.

Urodynamic characteristics might be variable in bladder pain syndrome/interstitial cystitis patients with different non-bladder co-morbid conditions.

BACKGROUND: The aim of the study was to identify the impact of non-bladder co-morbid conditions on the urodynamic characteristics of patients with bladder pain syndrome/interstitial cystitis. METHODS: Patients with bladder pain syndrome/interstitial cystitis completed the screening questionnaires for chronic fatigue syndrome, irritable bowel syndrome, fibromyalgia, temporo-mandibular disorders, multiple chemical sensitivities, tension/migraine headache, and localized myofascial pain disorder. They underwent either conventional pressure-flow urodynamic studies or video-urodynamic studies. Urodynamic variables were compared between patients with and those without co-morbid conditions. RESULTS: Of 111 patients (16 males and 95 females) with bladder pain syndrome/interstitial cystitis, 87 (78.4%) had at least one co-morbid condition (62% males vs 82% females, p = 0.005). Those with concomitant irritable bowel syndrome were younger and had urodynamic characteristics of smaller catheter-free voided volume, lower catheter-free average flow rate, smaller bladder volume on the first desire to void, and more prevalent dysfunctional voiding than those without irritable bowel syndrome. Patients with concomitant localized myofascial pain disorder also had larger bladder volume at the first desire to void and lower pressure at maximum flow than those without co-morbid myofascial pain disorder. There were no significant differences in urodynamic parameters between bladder pain syndrome/interstitial cystitis patients with and those without other co-morbidities. CONCLUSION: Bladder pain syndrome/interstitial cystitis patients, especially females, are more likely to have non-bladder co-morbidities, especially tension/migraine headache and localized myofascial pain. Bladder pain syndrome/interstitial cystitis Patients with co-morbid irritable bowel syndrome are younger and more likely to have abnormal urodynamic findings.

Determination of five components in Ixeris sonchifolia by high performance liquid chromatography.

A high performance liquid chromatography (HPLC) method was developed for the simultaneous quantification of five major active ingredients (markers) in Ixeris sonchifolia (Bge.) Hance, namely chlorogenic acid, caffeic acid, luteolin-7-O-beta-D-glucuronide, luteolin-7-O-beta-D-glucoside and luteolin. Samples were extracted with 70% methanol. The chromatographic separation was performed on a Hypersil ODS(2) column (250 mm x 4.6 mm i.d.; 5 microm) with a gradient of acetonitrile and 0.5% (v/v) aqueous acetic acid, at a flow rate of 1.0 ml/min, detected at 335 nm. Five regression equations showed good linear relationships (r(2)>0.999) between the peak area of each marker and concentration. The assay was reproducible with overall intra- and inter-day variation of less than 3.2%. The recoveries, measured at three concentration levels, varied from 94.1% to 100.7%. This assay was successfully applied to the determination of the 5 bioactive compounds in 18 samples. The results indicated that the developed assay method was rapid, accurate, reliable and could be readily utilized as a quality control method for I. sonchifolia (Bge.) Hance.

Standardized report for early complications of radical prostatectomy.

BACKGROUND: Radical prostatectomy (RP) is one of the curative treatment options for patients with prostate cancer to achieve long-term survival, but it is accompanied by potential complications. The Martin criteria used as a format for reporting complications has become standard in recent years. However, it has not been applied in RP in Asian countries. In the present study, we investigated the early complications of RP developing within 90 days in our institute according to the Martin criteria. METHODS: Between January 2003 and November 2011, patients with organ-confined adenocarcinoma of the prostate who received RP in our institute were retrospectively reviewed. The operation was done as open RP, or minimally invasive RP, including laparoscopic RP and robot-assisted laparoscopic RP (RaLP). The preoperative, operative, postoperative, and pathological parameters were recorded for analysis. Definitions of complications were adopted from previous reports. Surgical and medical complications developed within 90 days postoperatively were identified respectively; severity of each complication was classified according to Clavien-Dindo classification. Clavien-Dindo classification grade III or higher complications were viewed as major complications. RESULTS: A total of 359 patients were included; 280 (78%) underwent open RP, 45 (12.5%) received laparoscopic RP, and 34 (9.5%) had RaLP. The overall complication rate was 40.1%, and the major complication rate was 13.1%. There was no surgical mortality. Diarrhea requiring conservative treatment (13.6%), minor urine leakage (9.5%), and gout attack (4.2%) were the leading complications. Minimally invasive RP had higher rates of lymph leakage (p = 0.015) and upper-extremity neuropathy (p = 0.048). Body mass index >25 kg/m(2) and use of neoadjuvant hormone therapy were predictors for overall and major complications, whereas diabetes mellitus also predicted the development of major complications. Besides lower case volume and learning curve for RaLP, patients' higher age at surgery and higher risk for disease progression compared to the Western series may be responsible for the higher complication rates. CONCLUSION: The early complication rates of RP in our patients were slightly high compared to the Western series. By standardized report, being overweight, diabetes mellitus, and use of neoadjuvant hormone therapy were identified as predictors of early complications in our series.

A nationwide population study of trazodone use in urology patients.

BACKGROUND: Erectile dysfunction (ED) has been a prevalent disease worldwide. The mainstay of treatment for ED focused on oral medications such as phosphodiesterase-5 (PDE-5) inhibitors or other medical aids with variable acceptance. Trazodone is a second-generation antidepressant approved by the U.S. Food and Drug Administration in 1981. Some evidence has suggested that trazodone may be helpful in improving ED, especially for problems dealing with male arousal. Although controversial, trazodone can sometimes be used for ED as an off-label medication for urological patients. By using a nationwide health insurance database, we attempted to estimate and thereafter analyze the existence and extent of off-label use of trazodone for ED in Taiwan. METHODS: The 1/500 randomly sampled outpatient visits dataset and the 1/1 million randomly selected dataset issued in 2000 in the National Health Insurance Research Database were used to estimate the total number of visits and the urological visits involving trazodone prescriptions. The refill rate, patient age at first prescription, and the diagnoses assigned to the prescription visits were also gathered and analyzed. RESULTS: The prescription visits in urological clinics consisted exclusively of male patients (99.0 ± 1.3%, p < 0.001). The use of trazodone was more prevalent and regular among the elderly (p < 0.001), which happens to parallel the trend of incidence rates of ED. Starting in 1998, the prescription rate for trazodone increased rapidly, but then slowed, equalized, and topped out in 2003. One of the reasons for this marked change in prescriptions rates in Taiwan may be the increased awareness of ED as a treatable disease under the promotion and marketing of three PDE-5 inhibitors. ED-related diagnoses assigned to the prescription visits accounted for 55% of total visits, whereas anxiety/depression-associated diagnoses were the bases of less than 13%, and those attributed to insomnia accounted for 2.3% of visits. CONCLUSION: Despite the fact that trazodone was not officially approved for patients with urological conditions, this medication has been used as an ED treatment in Taiwan at least since 1997; the prescriptions of trazodone were more prevalent among the elderly, and this trend increased, then evened out, and eventually reached its maximum point in 2003, correlating with the introduction of PDE-5 inhibitors.