Microbiological Features and Clinical Factors Associated with Empirical Antibiotic Resistance in Febrile Patients with Upper Urinary Tract Calculi.

BACKGROUND: To investigate the clinical and microbiological features of febrile patients with upper urinary tract calculi and factors that affect empirical antibiotic resistance. METHODS: A retrospective analysis was performed on 203 febrile patients hospitalized between January 2011 and December 2016 with antibiotic treatment for urinary tract infections and upper urinary tract calculi at three institutions. We collected and analyzed data, including patients' age, sex, body mass index, underlying diseases, stone-related factors, and the results of urine and blood culture examinations and antibiotic sensitivity tests. RESULTS: The male-to-female ratio was 1:2.3. Bacteria were identified in 152 of the 203 patients (74.9%). The most commonly cultured microorganisms included Escherichia coli (44.1%), followed by Enterococci spp. (11.8%), Proteus spp. (8.6%), Streptococcus agalactiae (6.6%), Klebsiella spp. (5.3%), Pseudomonas spp. (4.6%), coagulase-negative Staphylococcus (4.0%), Staphylococcus epidermidis (4.0%), Serratia spp. (2.6%), Enterobacter spp. (0.7%), Acinetobacter spp. (0.7%), and mixed infections (7.2%). Cultured bacterial species showed sex-specific differences. Multivariate analysis revealed that calculi's multiplicity was an independent predictive factor for quinolone resistance (P = 0.008). Recurrent infections were a significant predictor of cefotaxime resistance during multivariable analysis (P = 0.041). CONCLUSION: Based on the present study results, quinolone was not recommended as the empirical treatment in febrile patients with upper urinary tract calculi. Combination antibiotic therapy is recommended in cases of recurrent infections due to the possible occurrence of cefotaxime resistance.

Does mirabegron relieve ureteric stent-related discomfort? A prospective, randomized, multicentre study.

OBJECTIVES: To evaluate the effects of 50 mg mirabegron once daily for ureteric stent-related discomfort after ureteroscopic procedures by conducting a multicentre randomized study. PATIENTS AND METHODS: A total of 100 patients with indwelling ureteric stents after ureteroscopic stone removal or retrograde intrarenal surgery (RIRS) were randomized 1:1 to receive either no treatment or mirabegron during the stenting period. At the time of stent removal, the validated Ureteral Stent Symptom Questionnaire (USSQ), International Prostate Symptom Score (IPSS), total amount of analgesics administered, and post-voiding residual urine volume were reported for each patient. RESULTS: Overall, 96 patients were enrolled for analysis. The postoperative USSQ body pain score (21.96 vs 13.96; P = 0.007) and overall pain score (5.58 vs 2.83; P = 0.002) were lower in the mirabegron group than in the control group. The USSQ urinary symptom scores (32.58 vs 27.92; P = 0.582) and USSQ general health score (17.71 vs 14.00; P = 0.281) were also lower in the mirabegron group, but the difference was not significant. Postoperative IPSS total scores and quality-of-life scores were lower in the mirabegron group, but the difference was not significant. The change in IPSS storage symptom score, however, was lower in the mirabegron group than in the control group (3.58 ± 3.58 vs 1.83 ± 4.39; P = 0.035). Post-void residual urine volume did not differ between the two groups (P > 0.05). CONCLUSION: The use of 50 mg mirabegron once daily has the potential to reduce ureteric stent-related discomfort. Prospective larger-scale, placebo-controlled studies are warranted to further evaluate the beneficial effects of mirabegron on stent-related symptoms.

The effect of middle and lower trapezius strength exercises and levator scapulae and upper trapezius stretching exercises in upper crossed syndrome.

[Purpose] The purpose of this study was to determine the effectiveness of strength and stretching exercises on upper crossed syndrome. [Subjects and Methods] After measuring cervical alignment using the Global Posture System, 30 students with forward head posture were selected and divided into two groups. The experimental group (n=15) participated in strength and stretching exercises, three times per week for 4 weeks. The control group (n=15) did not participate in the exercises. The exercise program comprised middle and lower trapezius strength exercises and levator scapulae and upper trapezius stretching exercises. The temperature of the posterior neck was then measured using digital infrared thermographic imaging. [Results] There was a significant difference between the pretest and posttest results in the experimental group, and a significant difference in posterior neck temperature between the two groups. [Conclusion] This study showed that middle and lower trapezius strength exercises and levator scapulae and upper trapezius stretching exercises are more effective for upper crossed syndrome.

Changes of muscarinic receptors and connexin-43 expression as a mechanism of overactive bladder in ovariectomized rats.

PURPOSE: After menopause, the bladder is known to become overactive. To investigate the mechanisms involved in these changes, we examined the muscarinic receptors M2, M3 and gap junction protein connexin-43 in an ovariectomized rat bladder. METHODS: Twenty 10-week-old female SD rats were used. Ten rats were ovariectomized, (Ovx group) and 10 rats received a sham operation (Con group). Four weeks after the operation, urodynamic tests were performed to verify overactive bladder, and the animals were killed. The body, bladder and uterus weights were measured. The bladder specimens were prepared for immunohistochemical staining for muscarinic receptors M2, M3 and connexin-43. Western blotting was also used for the same protein measurement (M2, M3 and connexin-43). A t test with a p value of 0.05 was considered significant, and SPSS 12.0 for Windows was used to analyze the data. RESULTS: The mean body weight of the Ovx group (315.8 ± 18.1 g) was heavier than the Con group (270.0 ± 23.6 g) (p = 0.009). The mean uterus weight of the Ovx group (260.4 ± 186.8 g) was lighter than the Con group, (600.6 ± 175.9 g) (p = 0.028) and the mean bladder weight of the Ovx group (80.2 ± 15.9 g) was lighter than the Con group (97.4 ± 10.6 g) (p = 0.041). The mean bladder contraction of the Ovx group (5.5 ± 2.3/10 min) was more frequent than that of the Con group (3.2 ± 2.8) (p < 0.05). The expressions of M2 and M3 were not different between the Ovx and the Con group, but the expression of connexin-43 in the Ovx group was more intense than in the Con group in immunohistochemical staining. These findings were also confirmed by Western blotting results. CONCLUSIONS: Ovariectomized rats showed frequent bladder contraction and increased connexin-43 expression without changes in M2 and M3 receptor expression. These results imply that ovariectomy-induced overactive bladder may be due to an altered gap junction protein function rather than muscarinic receptor modification.

Origin and characterization of retrograde labeled neurons supplying the rat urethra using fiberoptic confocal fluorescent microscopy in vivo and immunohistochemistry.

PURPOSE: Autonomic innervation of urethral smooth muscle may influence urinary continence after prostatectomy. It is unclear whether the cavernous nerves carry fibers that influence continence. Using a retrograde axonal tracer combined with real-time in vivo imaging and ex vivo immunohistochemistry we determined the course and type of neurons supplying urethral smooth muscle distal to the prostate in the rat. MATERIALS AND METHODS: We injected the retrograde axonal tracers cholera toxin B fragment-Alexa Fluor 488 and Fast Blue in the distal urethral smooth muscle in 10 rats each. Five days later the cavernous nerves and pelvic ganglion were imaged using fiberoptic confocal fluorescence microscopy (cholera toxin B fragment-Alexa Fluor 488) or harvested for immunohistochemistry (Fast Blue). Dual immunofluorescence of Fast Blue neurons with tyrosine hydroxylase or neuronal nitric oxide synthase was done to characterize neurons as noradrenergic or nitrergic. To ascertain whether the cavernous nerves contain fibers to the urethra that originate in the pelvic ganglia we cut the cavernous nerves with their ancillary branches in 3 rats and imaged them for Fast Blue. RESULTS: Fluorescent neurons and axons were detected in cavernous nerves and the pelvic ganglion. Few neurons were seen in rats with cavernous nerve section. Of urethral neurons 53.1% showed neuronal nitric oxide synthase positivity while 40.6% were immunoreactive for tyrosine hydroxylase. About 6.2% of urethral neurons failed to show tyrosine hydroxylase or neuronal nitric oxide synthase immunoreactivity. CONCLUSIONS: Most of the autonomic innervation to the urethra beyond the prostatic apex travels in the cavernous nerves. Many nerves may be parasympathetic based on neuronal nitric oxide synthase immunoreactivity. Nerves supplying the urethra outside the cavernous nerves may course posterior to the prostate. Along with afferent fibers, tyrosine hydroxylase immunoreactivity expressing neuron fibers, ie noradrenergic nerves, traveling in the cavernous nerves may increase urethral resistance or regulate the reflex mechanisms controlling continence.

Idiopathic segmental ureteritis, misdiagnosed as ureteral cancer preoperatively: a case report with literature review.

A 53-year-old man presented with right flank pain for 6 days. Computerized tomography revealed a 3 cm long segment of ureteral narrowing with wall thickening and hydronephrosis, suspicious for ureteral cancer. Under the clinical diagnosis of ureteral carcinoma a right nephroureterectomy was performed. The wall of the distal ureter, 2.5 cm from the bladder cuff, had a luminal-narrowing, firm mass-forming lesion with abrupt transition from the adjacent ureter. Histologically, the resected ureteral mass showed transmural fibrosing, chronic inflammation with numerous plasma cells, epithelioid granulomas, and obliterative phlebitis. Histological findings were consistent with idiopathic segmental ureteritis (ISU) with differential diagnoses of IgG4-related sclerosing disease, including lymphoplasmacytic inflammatory pseudotumor (IPT) and idiopathic retroperitoneal fibrosis. IgG4 immunostaining in this case was barely positive, excluding the possibility of IgG4-related IPT. Although the majority of luminal obliterated segmental lesions of the ureter are neoplastic in nature, non-neoplastic inflammatory processes as seen in this case may occur in the ureter, causing diagnostic confusion with true neoplasms. Herein we report a rare case of ISU that was clinically misdiagnosed as malignancy preoperatively. ISU of the current case may be an IgG4-unrelated subtype of IPT.

Cyclosporin A Aggravates Calcification of Vascular Smooth Muscle Cells Under High-Glucose Conditions with a Calcifying Medium.

BACKGROUND Vascular calcification (VC) progresses substantially even after kidney transplantation, and is a predictor of morbidity and mortality. However, the effect of cyclosporin A (CsA) on VC has not been reported in diabetic kidney transplant patients. In this study, we evaluated the effect of CsA on the VC of mouse vascular smooth muscle cells (VSMCs) under high glucose (HG). MATERIAL AND METHODS To demonstrate the effect of CsA (1.0 µmol/L) and HG (30 mM) in the induction of the VC of the VSMCs, we determined alkaline phosphatase (ALP) activity, microscopic morphology of calcification, the expressions of the calcification and inflammation-related genes, and the intracellular calcium concentrations in VSMCs. RESULTS Calcification was observed 14 days after exposure to a calcifying medium (sodium phosphate monobasic and dibasic mixture). On microscopic morphology, CsA alone did not induce calcification under HG conditions, but clearly increased calcification under HG with a calcifying medium. ALP activity increased under HG with CsA or a calcifying medium compared to HG conditions alone. CsA increased ALP activity under low glucose (LG, 5.5 mM) with a calcifying medium, but markedly increased under HG with a calcifying medium. CsA significantly increased the mRNA expressions of the calcification markers (core binding factor-alpha 1, bone morphologic proteins 2) as well as those of the inflammatory marker (interleukin 6), under HG with a calcifying medium. Intracellular calcium concentrations were unchanged in CsA alone but significantly increased with the presence of a calcifying medium under both LG and HG conditions. CONCLUSIONS Considering the effect of CsA on VC, the vascular adverse effects of CsA need to be verified in diabetic transplant patients in the future.

Panax ginseng effects on DNA damage, CYP1A1 expression and histopathological changes in testes of rats exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin.

The effects of Panax ginseng extracts on DNA damage, expression of cytochrome P450 (CYP) 1A1 and reproductive toxicity were evaluated in the testis of rats exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxinthe (TCDD). Fifty rats were divided into five groups according to treatment with 2,3,7,8-TCDD and P. ginseng extracts. Single cell gel electrophoresis assays were performed to evaluate DNA damage that occurred in the lymphocytes of rats. Histological changes in the seminiferous tubules of the testis were determined using Johnsen's scoring system and Real Time-PCR was performed to evaluate the mRNA expression of CYP1A1. Significant pathological effects were observed in the 2,3,7,8-TCDD treated rats including a reduced seminiferous tubular diameter, an increased number of damaged tubules (maturation arrest, eosinophilic degeneration and spermatid giant cells) and increased Johnsen's score. DNA damage and the expression of CYP1A1 mRNA were significantly increased in rat testes. There were no significant differences between the control and animals treated with P. ginseng extracts. However, a significantly decreased level of DNA damage, decreased CYP1A1 expression and reduced pathological effects were observed in the 2,3,7,8-TCDD with P. ginseng extracts treated groups when compared with the TCDD treated group. In summary, our study demonstrates that 2,3,7,8-TCDD induces the pathological and genotoxical damage in rat testes, while P. ginseng extract treatment exhibits a therapeutic capacity to reduce these effects via reduction of CYP1A1 mRNA.

Does Systemic Disease Aggravate the Severity of Dry Mouth by Anticholinergics in Overactive Bladder Patients?

PURPOSE: In overactive bladder (OAB) patients with systemic diseases, dry mouth tends to be more prominent owing to the effects of systemic diseases or related medications. We evaluated how systemic diseases affect dry mouth before and after anticholinergic treatment. MATERIALS AND METHODS: OAB patients were enrolled in this study. The patients were divided according to the presence or absence of systemic diseases. Patients with systemic diseases were sub-grouped by the number of systemic diseases (only one or more than one disease). OAB symptoms score (OABSS), visual analogue scale (VAS) score for dry mouth, and body mass index (BMI) were measured. The statistical assessments were donewith independent T-tests and ANCOVAs. RESULTS: One hundred and four OAB patients were enrolled in this study. Seventy (67.3%) patients had systemic diseases and thirty-four (32.7%) patients did not. Age and BMI were higher in the systemic diseases group. The baseline VAS score of OAB in the systemic diseases group (15.9 ± 19.5) was higher than that in the OAB without systemic diseases group (4.1 ± 6.4) (P = .002). Even after age and BMI adjustment, the difference was significant. The follow-up VAS score was also different (P = .028), but the change in VAS score was not different (P = .280). In a sub-analysis, the change in VAS score in the group with two or more systemic diseases (23.6 ± 18.1) was higher than that in the group with only one systemic disease (12.5 ± 13.2) (P = .012). CONCLUSION: The severity of xerostomia after treatment with anticholinergics in OAB increases in patients with one systemic disease parallel to its severity before starting treatment. However, in patients with two or more systemic disease the magnitude of change in xedrostomia score is higher that we would expect in patients with no or one systemic diasese.

Chronic prostatitis/chronic pelvic pain syndrome in adolescents compared with that in young adults.

PURPOSE: Chronic prostatitis (CP)/chronic pelvic pain syndrome (CPPS) has been studied mainly in adults; reports in adolescents are rare. We compared the clinical characteristics of adolescent CP/CPPS patients with those of young adults. MATERIALS AND METHODS: We retrospectively analyzed 20 adolescents with CP/CPPS aged <20 years who visited our outpatient department from August 2005 to April 2012. The control group comprised 120 young adult CP/CPPS patients. A complete medical history, physical examination, the national institute of health-chronic prostatitis symptoms index (NIH-CPSI) questionnaire, urinalysis, expressed prostatic secretion (EPS) or semen analysis, transrectal prostate ultrasonography, and prostate-specific antigen (PSA) were performed. Based on the EPS or semen analysis, patients were divided into category III-A or III-B. RESULTS: The mean age was 16.5±2.0 and 32.8±5.0 years in the adolescent and control groups, respectively. A sexual activity history was seen in 2 patients; 9 and 11 patients were in category III-A and III-B, respectively. The PSA was 0.65±0.39 and 1.22±0.48 ng/mL in the adolescent and control groups, respectively. The prostate size was 12.4±4.4 and 21.0±4.9 g in the adolescent and control groups, respectively. The NIH-CPSI scores in the adolescent group were 9.2±5.2, 5.5±3.5, 7.5±3.2, and 22.2±8.1 for pain, voiding, quality of life (QoL) domains, and total scores, respectively. The adolescent group showed a tendency to exhibit high voiding symptom scores. CONCLUSIONS: CPPS has an equally severe impact on QoL in adults and adolescents. Apart from high voiding symptom scores in adolescents, no difference was found in terms of urologic clinical parameters.