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Purpose To describe the optical coherence tomography features of pachyvitelliform maculopathy (PVM), an acquired vitelliform lesion (AVL) associated with pachychoroid disease. Methods This study was a retrospective, multicentre, observational analysis. Medical records and multimodal imaging were reviewed in all patients with pachychoroid disease and AVL. Visual acuity, central choroidal thickness (CCT), AVL dimensions, total choroidal area, luminal choroidal area, stromal choroidal area and choroidal vascular index were measured in all eyes with PVM and compared with normal age-matched control eyes. Results Mean age of the PVM group (17 eyes of 17 patients) was 71.41 years. Average follow-up was 33.15 months. Baseline VA was 20/40 in the PVM group and declined to 20/100 (p=0.006). AVLs were all detected overlying pachyvessels with optical coherence tomography and were all hyperautofluorescent with fundus autofluorescent imaging. Mean CCT in the PVM group was significantly greater (352.35 µm) than the CCT in the control group (226.88 µm, p<0.001). Retinal pigment epithelium (RPE) disruption was present in 64.71% of eyes with PVM at baseline and 41.18% developed macular atrophy at the end of follow-up. Conclusions PVM, defined by the presence of AVL associated with pachychoroid features, is a distinct novel entity of the pachychoroid disease spectrum. This study suggests a possible pathogenesis of RPE dysfunction secondary to a thick choroid, leading to accumulation of undigested photoreceptor outer segments and AVL. Clinicians should be aware of this common cause of vitelliform lesions and the poor visual prognosis due to the high risk of atrophy development. [ABSTRACT FROM AUTHOR]

Background: The Chinese visceral adiposity index (CVAI) and new visceral adiposity index (NVAI) are novel indices of visceral adiposity used to predict metabolic and cardiovascular diseases in Asian populations. However, the relationships of CVAI and NVAI with chronic kidney disease (CKD) have not been investigated. We aimed to characterize the relationships of CVAI and NVAI with the prevalence of CKD in Korean adults. Methods: A total of 14,068 participants in the 7th Korea National Health and Nutrition Examination Survey (6,182 men and 7,886 women) were included. Receiver operating characteristic (ROC) analyses were employed to compare the associations between indices of adiposity and CKD, and a logistic regression model was used to characterize the relationships of CVAI and NVAI with CKD prevalence. Results: The areas under the ROC curves for CVAI and NVAI were significantly larger than for the other indices, including the visceral adiposity index and lipid accumulation product, in both men and women (all P<0.001). In addition, high CVAI or NVAI was significantly associated with a high CKD prevalence in both men (odds ratio [OR], 2.14; 95% confidence interval [CI], 1.31 to 3.48 in CVAI and OR, 6.47; 95% CI, 2.91 to 14.38 in NVAI, P<0.05) and women (OR, 4.87; 95% CI, 1.85 to 12.79 in CVAI and OR, 3.03; 95% CI, 1.35 to 6.82 in NVAI, P<0.05); this association remained significant after adjustment for multiple confounding factors in men and women. Conclusion: CVAI and NVAI are positively associated with CKD prevalence in a Korean population. CVAI and NVAI may be useful for the identification of CKD in Asian populations, including in Korea. [ABSTRACT FROM AUTHOR]

Purpose: Several studies have shown that zinc has a significant influence on erectile function. However, no studies evaluating the cellular distribution of free zinc in penile erectile tissue have been performed. Therefore, this study aimed to test whether free zinc is present in penile tissue and whether it may be involved in the electrical stimulation (ES)-induced penile erection. Materials and Methods: The subjects for this study were 26 young (8-week-old) male C57BL/6J mice. After the cavernous nerve was exposed through a midline stomach incision, 14 mice received ES of the cavernous nerve (ES group), whereas 12 mice did not (control group). Intracavernous pressure (ICP) (consisting of 10 V at a duration of 1 min, frequency of 12 Hz and a pulse width of 1 m/s) was recorded during ES. Immediately after ICP was recorded, penile tissues were harvested for histological and biochemical analysis, including analysis of zinc transporter 3 (ZnT3) and intracellular free zinc levels. Results: The expression of neuronal nitric oxide synthase (nNOS) and endothelial NOS (eNOS) in penile tissue was significantly greater in the ES group than in the control group (p=0.036 and 0.016, respectively). And then, ZnT3 and intracellular free zinc were present in the penile tissue of both groups. However, ZnT3 immunofluorescence in the ES group was more intense in the dorsal nerve bundle (22% increase, p=0.032). The ES group also showed higher intensity N-(6-methoxy-8-quinolyl)-para-toluenesulfonamide (TSQ) fluorescence signals indicative of intracellular free zinc level in the penile tissue compared to the control group (49% increase in dorsal nerve bundle, p=0.001; 50% increase in corpus cavernosum, p=0.001). Conclusions: The results of the study supported the expression and distribution of free zinc in penile tissue and increased levels after penile erection. Therefore, this study provides anatomical evidence for the potential role of free zinc in penile erection. [ABSTRACT FROM AUTHOR]

Ultra-high molecular weight polypropylene (UHMWPP), with a molecular weight of more than 106 g/mol, is expected to have superior properties, such as high mechanical strength, high thermal properties, high chemical resistance and outstanding tribological properties. However, UHMWPP has a very poor processability due to its high melt viscosity. Therefore, we aimed to improve processability of UHMWPP by blending it with a low molecular weight polypropylene (LMWPP). We attempted to improve the interfacial miscibility and intermolecular entanglement of the UHMWPP/LMWPP system by using a kneader machine. The addition of LMWPP tended to change the mechanical, thermal, and rheological properties of the blend system. [ABSTRACT FROM AUTHOR]

Purpose To compare the efficacy and safety of brolucizumab versus aflibercept in eyes with polypoidal choroidal vasculopathy (PCV) over 96 weeks in the HAWK study. Design HAWK was a global, 2-year, randomised, double-masked, multicentre phase III trial in participants with neovascular age-related macular degeneration. Methods Of the Japanese participants with PCV, 39 received brolucizumab 6 mg and 30 received aflibercept 2 mg. After 3 monthly loading doses, brolucizumab-treated eyes received an injection every 12 weeks (q12w) but were adjusted to q8w if disease activity was detected. Aflibercept-treated eyes received fixed q8w dosing. Mean change in best-corrected visual acuity (BCVA), the proportion of participants on q12w, retinal thickness, retinal fluid changes and safety were assessed to Week 96. Results Mean change in BCVA (early treatment diabetic retinopathy study (ETDRS) letters) from baseline to week 48/week 96 was+10.4/+11.4 for brolucizumab and +11.6/+11.1 for aflibercept. For brolucizumab-treated eyes, the probability of only q12w dosing after loading through week 48 was 76%, and 68% through week 96. Fluid resolution was greater with brolucizumab than aflibercept: respective proportions of eyes with intraretinal fluid and/or subretinal fluid were 7.7% and 30% at week 48% and 12.8% and 16.7% at week 96. Brolucizumab exhibited an overall well-tolerated safety profile despite a higher rate of intraocular inflammation compared with aflibercept. Conclusion In Japanese eyes with PCV, brolucizumab q12w/q8w monotherapy resulted in robust and consistent BCVA gains that were comparable to q8w aflibercept dosing. Anatomical outcomes favoured brolucizumab over aflibercept, with 76% of brolucizumab participants maintained on q12w dosing after loading to week 48. [ABSTRACT FROM AUTHOR]

Background/Aims To analyse the long-term anatomic and visual outcomes of patients with peripapillary pachychoroid syndrome (PPS), a recently described entity in the pachychoroid disease spectrum. Methods This study retrospectively included patients from several retina centres worldwide. Visual acuity (VA), retinal thickness and choroidal thickness at baseline, 6 months and final follow-up were assessed. Temporal trends in VA and anatomic characteristics were evaluated. Visual and anatomic outcomes in eyes that were observed versus those that were treated were analysed. Results Fifty-six eyes of 35 patients were included with mean follow-up of 27±17 months. Median VA was 20/36 at baseline and remained stable through follow-up (p=0.77). Retinal thickness significantly decreased subfoveally (p=0.012), 1.5 mm nasal to the fovea (p=0.002) and 3.0 mm nasal to the fovea (p=0.0035) corresponding to areas of increased thickening at baseline. Choroidal thickness significantly decreased subfoveally (p=0.0030) and 1.5 mm nasal to the fovea (p=0.0030). Forty-three eyes were treated with modalities including antivascular endothelial growth factor injection, photodynamic therapy, and others. VA remained stable in treated eyes over follow-up (p=0.67). An isolated peripapillary fluid pocket in the outer nuclear layer was characteristic of PPS. Conclusion Patients with PPS experienced decreased retinal oedema and decreased choroidal thickening throughout the course of disease. While some patients experienced visual decline, the overall visual outcome was relatively favourable and independent of trends in retinal or choroidal thickening. [ABSTRACT FROM AUTHOR]

It has been suggested that the coronavirus disease 2019 (COVID-19) pandemic has had a negative impact on glycemic control in patients with type 2 diabetes mellitus (T2DM). However, no study has examined yearly trends in glycated hemoglobin (HbA1c) levels after the start of the COVID-19 outbreak. Here, we performed a retrospective analysis of HbA1c concentrations during the early period of the COVID-19 outbreak (COVID-19 cohort) and then compared the yearly trend in the mean HbA1c level, along with fluctuations in HbA1c levels, with those during previous years (non-COVID-19 cohorts). We observed that the mean HbA1c level in patients with T2DM increased during the first 6 months of the COVID-19 outbreak. After 6 months, HbA1c levels in the COVID-19 cohort returned to levels seen in the non-COVID-19 cohorts. The data suggest that vulnerable patients with T2DM should be monitored closely during the early period of a pandemic to ensure they receive appropriate care. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the various patterns of subretinal fluid (SRF) in eyes with age-related macular degeneration (AMD) in the absence of macular neovascularisation (MNV) and to assess the long-term outcomes in these eyes. Methods This retrospective study included only eyes with non-neovascular AMD and associated SRF. Eyes with evidence of MNV were excluded. Spectral-domain optical coherence tomography (SD-OCT) was obtained at baseline and at follow-up, and qualitative and quantitative SD-OCT analysis of macular drusen including drusenoid pigment epithelial detachment (PED) and associated SRF was performed to determine anatomic outcomes. Results Forty-five eyes (45 patients) were included in this analysis. Mean duration of follow-up was 49.7 ±36.7 months. SRF exhibited three different morphologies: crest of fluid over the apex of the drusenoid PED, pocket of fluid at the angle of a large druse or in the crypt of confluent drusen or drape of lowlying fluid over confluent drusen. Twenty-seven (60%) of the 45 eyes with fluid displayed collapse of the associated druse or drusenoid PED and 24 (53%) of the 45 eyes developed evidence of complete or incomplete retinal pigment epithelial and outer retinal atrophy. Conclusion Non-neovascular AMD with SRF is an important clinical entity to recognise to avoid unnecessary anti-vascular endothelial growth factor therapy. Clinicians should be aware that SRF can be associated with drusen or drusenoid PED in the absence of MNV and may be the result of retinal pigment epithelial (RPE) decompensation and RPE pump failure. [ABSTRACT FROM AUTHOR]

Post-micturition dribble (PMD) is the involuntary loss of urine immediately after urination. It is classified as a post-micturition symptom and is more common in males. Traditionally, PMD has been considered to be part of the aging process, to have a low prevalence, and to be less bothersome than other lower urinary tract symptoms (LUTS). However, recent evidence suggests that PMD is not less common and does not elicit less discomfort compared with other LUTS in males. Also, PMD seems to commonly overlap with other LUTS and to be associated with erectile dysfunction. Although the etiology of PMD is not fully understood, a weakness or failure of the pelvic floor muscles is considered to be the most important factor. Although bulbar urethral massage and pelvic floor exercises are known to be effective in treating PMD, pharmacologic treatment has not yet been introduced. Recently, the possibility of treating PMD with phosphodiesterase-5 inhibitor has been suggested. [ABSTRACT FROM AUTHOR]

Purpose: Lower urinary tract symptoms (LUTS) are correlated with erectile dysfunction (ED), but research on whether postmicturition dribble (PMD) is related to ED is limited. We assessed the correlation between PMD and ED in middle-aged and older Korean men with LUTS. Materials and Methods: In our prospective, cross-sectional, observational, multicenter study, we enrolled 205 men (age >40 years) with LUTS. LUTS and ED were assessed using the International Prostate Symptom Score (IPSS) and International Index of Erectile Function-5 (IIEF-5), respectively. PMD was assessed using the Hallym PostMicturition Dribble Questionnaire, Question 1, and the PMD volume was calculated in a paper test. Age, prostate volume, serum prostate-specific antigen, maximum urinary flow rate, and postvoid residual urine were also evaluated. Results: There were significant differences in the total and voiding IPSS between men with and without ED (p=0.042 and 0.043, respectively). The Hallym PostMicturition Dribble Questionnaire 1 score was inversely well correlated with the IIEF-5 score (r =-0.388, p<0.001). Also, the PMD volume was inversely correlated with the IIEF-5 score (r =-0.138, p=0.042). ED prevalence increased as the Hallym PostMicturition Dribble Questionnaire 1 score increased (p=0.002). Further, incorporating the Hallym PostMicturition Dribble Questionnaire 1 into the IPSS tended to increase the predictive accuracy of LUTS by 4.2% in ED patients (p=0.082). Conclusions: PMD was significantly correlated with ED and reinforced the relationship between LUTS and ED in middleaged and older men. PMD might be an important component of the association between LUTS and ED. [ABSTRACT FROM AUTHOR]

There is no safe and effective standard method for glans penis augmentation. Furthermore, there has been scant research on glans penis augmentation due to a poor understanding of glans anatomy, technical difficulty, and a lack of suitable substances for augmentation. Cross-linked dextran gel is a newly developed filler for soft-tissue augmentation. We evaluated the efficacy and safety of using a novel technique to inject cross-linked dextran gel for glans penis augmentation during a 24-week follow-up study. This prospective, single-arm, multicenter study enrolled twenty healthy adult men who underwent glans penis augmentation between June and August 2013. Cross-linked dextran gel was injected into the glans penis using a simple and easy technique. The sizes of the glans penis and individual satisfaction were assessed. Any adverse event was also reported. A total of 18 individuals were analyzed; two of them were lost to follow-up. The mean procedure time and injected volume were about 30 min and 6.6 ± 0.9 ml, respectively. The mean surface areas of the glans at baseline and 24 weeks were 20.0 ± 3.5 cm2 and 33.6 ± 5.4 cm2, respectively, representing a mean increase of 68.7% ± 14.0% ( P < 0.001). Sixteen individuals (88.9%) were satisfied with the outcomes, and none were dissatisfied. There were no serious adverse events during the study. Cross-linked dextran gel injection for glans penis augmentation was easy and showed a significant augmentative effect on the glans penis, good durability, and was well tolerated without serious adverse events. Therefore, cross-linked dextran gel injection may be an effective, new technique for glans penis augmentation. [ABSTRACT FROM AUTHOR]

Purpose: The goal of this study was to investigate the long-term efficacy and safety of a mixture of polymethyl methacrylate (PMMA) and cross-linked dextran Lipen-10Ⓡ used for penile augmentation under the physical impact generated during sexual intercourse. Materials and Methods: From March 2010 to October 2011, a total of 20 patients with a mean age of 44 years (interquartile range, 20∼70 years) who requested penile augmentation participated in this study. Lipen-10Ⓡ filler is a mixture of 75% cross-linked dextran, 15% PMMA, and 10% hypromellose solution. With the patient in the supine position, Lipen-10Ⓡ was injected into the subcutaneous tissue between the dartos fascia and Buck's fascia of the penis using a fanning technique. Penile length and circumference were measured before the procedure and six, 12, and 18 months after the procedure. Values were compared using the Student's t-test and the paired t-test. Results: A total of 15 patients completed this study. The increases in circumference and length observed six months after the procedure were found to have been maintained without change at 12 and 18 months of follow-up. At 12 and 18 months of follow-up, no abnormal findings were observed. Pelvic magnetic resonance imaging conducted at 18 months of follow-up showed no trace of the injected filler having migrated to other sites, and the volume was well maintained. Conclusions: Lipen-10Ⓡ, a mixture of PMMA and cross-linked dextran, showed good durability and tolerability over 18 months of follow-up during which the participants were sexually active. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate risk factors for deterioration of lower urinary tract symptoms (LUTS) in elderly men in a communitybased, prospective longitudinal cohort study. Methods: In a suburban area in Korea, 1,514 subjects aged ≥45 years were randomly selected by systematic sampling. A total of 918 elderly subjects were enrolled in this in-depth clinical study in 2004. Of these, 547 participants were followed up for 3 years and the data was analyzed in 2014. Standard questionnaires were administered face-to-face by trained interviewers. After excluding women, 224 male participants with complete data including transrectal ultrasonography were included in the final analysis. LUTS were diagnosed using the International Prostate Symptom Score (IPSS) questionnaire. Symptom deterioration was defined as a score of ≥8 points during the 3-year follow-up period. Results: LUTS prevalence increased to 13.1% and the mean IPSS increased by 2.6 points during the 3-year period. After adjusting for confounders, a smoking history of ≥50 pack-years was an independent risk factor for deterioration of LUTS and storage subsymptoms compared with no history of smoking (3.1 and 5.1 odds, respectively). Physical activity had a protective effect on voiding subsymptoms. However, high protein diet and alcohol intake were not associated with LUTS deterioration. Conclusions: The LUTS prevalence among elderly men living in a suburban area increased to 13.1% and the IPSS increased by 2.6 points during the 3-year period. A history of heavy smoking, low physical activity, and high protein intake were associated with LUTS deterioration. However, there was no significant association between alcohol intake and LUTS deterioration. [ABSTRACT FROM AUTHOR]

Background: This study aimed to identify the determinant factors for clinical outcomes and survival rates of patients with cardiac arrest (CA) concurrent with acute myocardial infarction (AMI) who underwent extracorporeal cardiopulmonary resuscitation (ECPR) using extracorporeal membrane oxygenation (ECMO). Methods: We retrospectively evaluated 37 patients admitted to our emergency department between January 2006 and August 2012 for AMI-induced CA treated with ECPR during ongoing continuous chest compressions. Results: Mean patient age was 61.4 ± 11.3 years, and 27 patients (73%) were men. Mean CPR time was 50.8 ± 35.4 min. Door-to-ECMO and door-to-balloon times were 84.4 ± 55.3 and 98.4 ± 56.8 min, respectively. Mean ECMO time was 106.4 ± 84.7 h; nine (24%) patients died within 24 h after ECMO initiation. Twelve (32%) patients were weaned off ECMO, seven (19%) of whom survived >30 days after ECMO removal; all except one had Cerebral Performance Category Grade 1. Of the patients who survived, 5 of them were able to be discharged. In multivariate analysis, statistical significance was only observed in door-to-ECMO time ≤60 min (OR, 6.0; 95% CI, 1,177–852.025; p = 0.033). Conclusion: We conclude that ECMO insertion within 60 min of the arrival of patients with AMI and CA at the ED appears to be a good option for maintaining myocardial and systemic perfusion, thereby increasing the survival rate of these patients. [ABSTRACT FROM AUTHOR]

Here we report two cases of retinal damage after exposure to a 510 nm laser diode during a laser show. The first patient was a 20-year-old female who presented with decreased visual acuity in her right eye after visiting a dance party with a diode laser show (wavelength 510 nm, power 2 mW), although she did not directly see the light. Retinal examination revealed a sub-internal limiting membrane hemorrhage and a small laser burn. The second patient was a 20-year-old female who visited for decreased vision in her left eye. She described similar events as the first patient. An exposure to green diode laser can result in retinal damage. It is strongly recommended that certified personnel operate laser devices used in indoor laser shows under strict regulation. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate how much the improvement of lower urinary tract symptoms (LUTS) affects sexual function and which storage symptoms or voiding symptoms have the greatest effect on sexual function. Materials and Methods: A total of 187 patients were enrolled in this study. Patients were randomly assigned to receive either tamsulosin 0.2 mg (group A) or tamsulosin 0.2 mg and solifenacin 5 mg (group B). At 4 weeks and 12 weeks, the LUTS and sexual function of the patients were evaluated by use of the International Index of Erectile Function-5 (IIEF5), International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS) questionnaire, uroflowmetry, and bladder scan. Results: Both groups A and B showed statistically significant improvements in IPSS, OABSS, and quality of life (QoL). Group A showed improved maximum flow rate, mean flow rate, and residual urine volume by time. Group B did not show an improvement in flow rate or residual urine volume but total voiding volume increased with time. The IIEF5 score was not improved in either group. In group A, the IIEF5 score dropped from 13.66±4.97 to 11.93±6.14 after 12 weeks (p=0.072). Group B showed a decline in the IIEF5 score from 13.19±5.91 to 12.45±6.38 (p=0.299). Although group B showed a relatively smaller decrease in the IIEF5 score, the difference between the two groups was not significant (p=0.696). Conclusions: Tamsulosin monotherapy and combination therapy with solifenacin did not improve erectile function despite improvements in voiding symptoms and QoL. The improvement in storage symptoms did not affect erectile function. [ABSTRACT FROM AUTHOR]

Background: We evaluated the efficacy of intravitreal bevacizumab on diabetic macular edema with subfoveal and perifoveal hard exudates. Materials and methods: Eleven eyes (11 patients) exhibiting diabetic macular edema with subfoveal and perifoveal hard exudates were included in this prospective, nonrandomized interventional pilot study. All patients were treated with monthly scheduled intravitreal bevacizumab injections for 6 months. Changes in the Early Treatment Diabetic Retinopathy Study best corrected visual acuity, amount of hard exudates on fundus photography, and macular edema detected by central subfield thickness on spectral domain optical coherence tomography after six serial injections, were assessed. The amount of hard exudates at each visit was evaluated as pixels in fundus photography, using an Adobe Photoshop program. Results: Ten of 11 patients completed follow-up. The mean Early Treatment Diabetic Retinopathy Study best corrected visual acuity was 59.9±5.7 letters (Snellen equivalent, 20/63) at baseline evaluation. The best corrected visual acuity exhibited no significant difference at month 6 compared with at baseline (57.9±6.0 letters or 20/70 at month 6; P=0.085). At month 6, mean central subfield thickness decreased from 370.4±56.5 to 334.6±65.0 μm (P=0.009). The mean amount of hard exudates increased from 4467.1±2736.1 to 6592.4±2498.3 pixels at month 6 (P=0.022). No serious adverse events occurred. Conclusion: Continuous intravitreal bevacizumab was found to have no benefit in visual acuity and amount of hard exudates, despite the improvement of macular edema at 6 months. [ABSTRACT FROM AUTHOR]

Background Malaria that is caused by Plasmodium vivax is the most widely distributed human malaria. Its recent resurgence in many parts of the world, including the Republic of Korea (ROK), emphasizes the importance of improved access to the early and accurate detection of P. vivax to reduce disease burden. In this study, a rapid and efficient loop-mediated isothermal amplification (LAMP)-based method was developed and validated using blood samples from malaria-suspected patients. Method A LAMP assay targeting the α-tubulin gene for the detection of P. vivax was developed with six primers that recognize different regions of the target gene. The diagnostic performance of the α-tubulin LAMP assay was compared to three other tests: microscopic examinations, rapid diagnostic tests (RDTs), and nested polymerase chain reactions (PCRs) using 177 whole blood specimens obtained from ROK military personnel from May to December 2011. Results The α-tubulin LAMP assay was highly sensitive with a detection limit of 100 copies of P. vivax α-tubulin gene per reaction within 50 min. It specifically amplified the target gene only from P. vivax. Validation of the α-tubulin LAMP assay showed that the assay had the highest sensitivity (P < 0.001 versus microscopy; P = 0.0023 versus RDT) when nested PCR was used as the gold standard and better agreement (concordance: 94.9%, kappa value: 0.865) with nested PCR than RDT and microscopy. A Receiver Operation Characteristics analysis showed that the diagnostic accuracy of the α-tubulin LAMP assay for vivax malaria was higher (Area Under Curve = 0.908) than RDT and microscopy. Conclusion This study showed that the P. vivax α-tubulin LAMP assay, which can be used to diagnose early infections of vivax malaria, is an alternative molecular diagnostic tool and a point-of-care test that may help to prevent transmission in endemic areas. [ABSTRACT FROM AUTHOR]

Phosphodiesterase type 5 (PDE5) inhibitors are the most commonly used treatment for erectile dysfunction (ED). Since the launch of sildenafil, several drugs−including mirodenafil, sildenafil citrate (sildenafil), tadalafil, vardenafil HCL (vardenafil), udenafil, and avanafil−have become available. Mirodenafil is a newly developed pyrrolopyrimidinone compound, which is a potent, reversible, and selective oral PDE5 inhibitor. Mirodenafil was launched in Korea in 2007, and an orally disintegrating film of mirodenafil was developed in 2011 for benefitting patients having difficulty in swallowing tablets. This study aimed to review the pharmacokinetic characteristic profile of mirodenafil and report evidence on its efficacy in the case of ED. In addition, we reviewed randomized controlled studies of mirodenafil's daily administration and efficacy for lower urinary tract symptoms. [ABSTRACT FROM AUTHOR]

Purpose: According to previous studies, the prevalence of premature ejaculation (PE) in Korea ranges from 11.3% to 33%. However, the actual practice patterns in managing patients with PE is not well known. In this study, we have endeavored to determine how contemporary urologists in Korea manage patients with PE. Materials and Methods: The e-mailing list was obtained from the Korean Urological Association Registry of Physicians. A specifically designed questionnaire was e-mailed to the 2,421 urologists in Korea from May 2012 to August 2012. Results: Urologists in Korea diagnosed PE using various criteria: the definition of the International Society for Sexual Medicine (63.4%), Diagnostic and Statistical Manual of Mental Disorders (43.8%), International Statistical Classification of Disease, 10th edition (61.7%), or perceptional self-diagnosis by the patient himself (23.5%). A brief self-administered questionnaire, the Premature Ejaculation Diagnostic Tool, was used by only 42.5% of the urologists. Selective-serotonin reuptake inhibitor (SSRI) therapy was the main treatment modality (91.5%) for PE patients. 40.2% of the urologists used phosphodiesterase type 5 inhibitors, 47.6% behavior therapy, and 53.7% local anesthetics. Further, 286 (54.3%) urologists managed PE patients with a surgical modality such as selective dorsal neurotomy (SDN). Conclusions: A majority of Korean urologists diagnose PE by a multidimensional approach using various diagnostic tools. Most urologists believe that medical treatment with an SSRI is effective in the management of PE. At the same time, surgical treatment such as SDN also investigated as one of major treatment modality despite the lack of scientific evidence. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the present study was to evaluate the effects of low-dose tamsulosin on sexual function in patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia. Materials and Methods: A total of 138 male LUTS patients aged more than 50 years with an International Prostate Symptom Score (IPSS) ⩾8 were enrolled in this open-label, multicenter, prospective, noncomparative observational study. Clinical assessments included IPSS, quality of life (QoL) index, International Index of Erectile Function (IIEF), Danish Prostate Symptom Score (DAN-PSS), and an early morning erection questionnaire. The data were recorded at baseline and at 1 and 3 months after treatment with tamsulosin 0.2 mg/d. Adverse events were analyzed in all patients. Results: During the study period of 3 months, the IPSS and QoL index significantly improved from baseline by -11.40±9.40 and -1.11±1.36, respectively (p<0.001). However, there were no clinically relevant changes in total IIEF score (mean difference, 1.63±15.50; p=0.406) or the 5 subdomains (p>0.05). Furthermore, DAN-PSS weighted scores (A×B) showed no clinically relevant changes (mean difference on Q1, Q2, and Q3: -0.45±2.94, 0.27±2.50, and -1.27±2.27, p>0.05). In addition, there were no clinically significant changes in responses on the early morning erection questionnaire. Conclusions: Tamsulosin at the dose of 0.2 mg significantly improved the IPSS and the QoL index compared with baseline. However, tamsulosin did not exhibit any significant impact on sexual function or any negative impact on ejaculatory function. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed at investigating sexual behavior patterns of elderly residents of urban areas in South Korea and their correlation with lower urinary tract symptoms. Materials and Methods: From May, 2009 to October, 2009, 154 males and 299 females over 60 years old who visited senior welfare centers of Seoul were administered a questionnaire on sex life patterns and voiding symptoms. Results: Among the 154 males, 59 (38.3%) had sexual intercourse at least one time per month. The remaining 95 males (61.7%) did not have sexual intercourse, because of impotence for 52 males (52.6%), no sexual desire for 28 males (29.4%), and sex partner's problems for 15 males (15.7%). The higher International Prostate Symptom Score was, the lower International Index of Erectile Dysfunction-5 was (p=0.035). Among 299 females, 37 (12.4%) had sexual intercourse at least one time per month. The remaining 262 females (87.6%) did not have sexual intercourse, because of no spouse for 163 females (63.2%), no sexual desire for 48 females (18.6%), the spouse's impotence for 34 females (13.2%), and the spouse's bad health for 10 females (3.9%). It was found that self-diagnosis of overactive bladder affects sex life negatively. Conclusions: The sexual behaviors of the elderly included varying activity. Sexual intercourse were significantly associated with lower urinary tract symptoms. Our results suggest that the counseling with the elderly about sexual health is as important as it is with non-elderly individuals. [ABSTRACT FROM AUTHOR]

Aims To identify ophthalmological factors influencing asthenopia as a result of viewing three-dimensional (3D) displays. Methods Thirty adult subjects without ophthalmological abnormality watched the same 3D displays for 30 min. Each subject's near point of accommodation (NPA) and convergence (NPC), amplitude of fusional convergence and divergence, stereopsis, tear break-up time and temperature of ocular surface, and angle of phoric deviation were measured before and after viewing the 3D displays. In addition, a survey for subjective symptoms was conducted immediately following the viewing of the 3D displays. The above mentioned experiments were performed equally with two-dimensional (2D) displays in the same 30 subjects for detection of innate influence of 3D displays. Results The NPA and NPC in the subjects were significantly altered after watching the 3D displays (p<0.05) as compared with 2D displays. In addition, all of the 10 subjective symptoms measured were significantly increased after watching 3D displays (p<0.05). Conclusions Accommodation and binocular vergence are predominant ophthalmological factors that may influence asthenopia significantly following the viewing of 3D displays. Subjective visual discomfort also significantly increased following the viewing of 3D displays. And there is the need for more detailed evaluation for detecting the practically related factors with asthenopia. [ABSTRACT FROM AUTHOR]

Glioblastoma multiforme is one of the most common and aggressive tumors in central nervous system. It often possesses characteristic necrotic lesions with hemorrhages, which increase the chances of exposure to thrombin. Thrombin has been known as a regulator of MMP-9 expression and cancer cell migration. However, the effects of thrombin on glioma cells have not been clearly understood. In the present study, influences of thrombin on glioma cell migration were examined using Boyden chamber migration assay and thrombin-induced changes in MMP-9 expression were measured using zymography, semi-quantitative RT-PCR, and Western blotting. Furthermore, underlying signaling pathways by which thrombin induces MMP-9 expression were examined. Thrombin-induced migration and MMP-9 expression were significantly potentiated in the presence of wortmannin, a PI3K inhibitor, whereas MAPK inhibitors suppressed thrombin-induced migration and MMP-9 expression in C6 glioma cells. The present data strongly demonstrate that MAPK and PI3K pathways evidently regulate thrombin-induced migration and MMP-9 expression of C6 glioma cells. Therefore, the control of these pathways might be a beneficial therapeutic strategy for treatment of invasive glioblastoma multiforme. [ABSTRACT FROM AUTHOR]

To determine the association of vesico-urethral anastomosis location (VUAL) with early recovery of urinary continence (UC) after radical prostatectomy (RP). A retrospective analysis of 678 patients who underwent RP was carried out. Patients were divided into three groups based on the VUAL as determined by postoperative cystography: group I - VUAL above the upper margin of the symphysis pubis (SP), group II - between the upper margin and the middle of the SP, and group III - below the middle of the SP. Early recovery of UC was defined as using no pads or an occasional security pad within 3 months. Recovery rates were compared between the groups and factors predicting an early recovery of UC were investigated. Among all patients, 62.2% achieved an early recovery of UC. Patients in group I were younger, with a longer membranous urethra, greater percent of nerve sparing and shorter time to continence than those in groups II or III. Early recovery rates were 89.5%, 69.8% and 40.7% in group I, II and III, respectively ( P < 0.001). VUAL remained an independent predictor of early recovery of UC (OR 3.2 for group I vs II and 10.8 for group I vs III [ P < 0.001]) when adjusted for age, operative time, membranous urethral length and operation by surgeon with high surgical volume. VUAL represents an independent predictor of recovery of UC after RP. A higher VUAL is associated with a higher rate of early recovery of UC. [ABSTRACT FROM AUTHOR]

OBJECTIVE: • To investigate the impact of increased body mass index (BMI) on pathological features after radical prostatectomy (RP) in Korean patients. PATIENTS AND METHODS: • We reviewed the records of 1000 Korean patients who underwent RP for prostate cancer and assessed the differences in pathological outcomes and biochemical recurrence-free survival after RP according to BMI of subjects via univariate and multivariate analyses. • A multivariate logistics regression model, the performance of which was analysed from a receiver operator characteristics curve, was applied to assess the predictive capacity of variables shown to be significant predictors of adverse pathological outcome. RESULTS: #x2022; Among our subjects, only 17 (1.7%) men had BMI ≥ 30 kg/m 2. After adjusting for various clinical variables, BMI (highest quartile vs others) was shown to be significantly associated with extracapsular extension of tumour ( P = 0.014) and positive surgical margin ( P = 0.019), but not with high pathological Gleason score ( P = 0.912) and seminal vesicle invasion ( P = 0.191). • Meanwhile, the addition of BMI to a multivariate model devised for preoperatively predicting extracapsular extension of tumour did not significantly increase predictive accuracy of the model ( P = 0.319). On multivariate analysis, BMI was not shown to be a significant predictor of biochemical recurrence-free survival ( P = 0.201). CONCLUSION: • Although higher BMI was significantly associated with extracapsular extension of tumour, BMI did not significantly enhance the ability to preoperatively predict extra capsular extension of tumour and was not significantly associated with PSA outcome or with other objective pathological outcomes in Korean men undergoing RP, who are generally leaner than their western counterparts. [ABSTRACT FROM AUTHOR]

Objectives: Due to lack of tactile feedback, dissection of surgical planes during delicate procedures of nerve-sparing robot-assisted laparoscopic radical prostatectomy (RALRP) can be hampered more by postbiopsy hematomas or adhesions compared with open surgery. Thus, we investigated association between extent of postbiopsy hemorrhage observed via preoperative magnetic resonance (MR) imaging with surgical difficulty of RALRP. Methods: We reviewed records of 154 men who received prostate biopsy, MR imaging, and subsequently, nerve-sparing RALRP for clinically localized prostate cancer within 2 weeks of MR imaging. We scored degree of postbiopsy hemorrhage as shown on T1-weighted MR imaging (hemorrhage score) and analyzed potential association of hemorrhage score with variables representative of surgical difficulty (operative time, estimated blood loss, and margin positivity) and functional outcomes (urinary continence and erectile function). Results: Among our subjects, total hemorrhage score demonstrated no significant associations with interval from biopsy to MR imaging ( p = 0.210). In multivariate analyses, prostate volume and total hemorrhage score were observed to be significantly associated with operative time ( p = 0.004 and 0.039, respectively) and estimated blood loss ( p = 0.009 and 0.023, respectively). Patients' age and total hemorrhage score was observed to be independent predictor of the return of erectile function sufficient for vaginal intercourse at 6 months following RALRP ( p = 0.003 and 0.036, respectively). Conclusions: Degree of postbiopsy hemorrhage observed in preoperative MR imaging may be predictive of surgical difficulty for RALRP. Such findings provide concrete evidences that aftereffects of prostate biopsy have significant impact on performing RALRP. [ABSTRACT FROM AUTHOR]

To analyze the characteristics and the prognostic significance of chromophobe renal cell carcinomas (chRCC). Data about 2981 patients with non-metastatic renal cell carcinomas (RCC) at the time of surgery were retrospectively collected from 26 institutions between 1998 and 2008. All patients had undergone partial or radical nephrectomies. Of the 2981 patients, 2602 patients with conventional RCC (cRCC) and 148 with chRCC were studied. Clinical and pathological parameters were determined in all patients. Recurrence-free survival (RFS) and cancer-specific survival (CSS) were assessed. Patients with chRCC differed significantly from those with cRCC on the following parameters: younger age ( P = 0.026), greater female ratio ( P < 0.001), and larger tumor diameter ( P < 0.001). Both groups were alike with respect to body mass index ( P = 0.943), Eastern Cooperative Oncology Group performance status ( P = 0.163), T stage ( P = 0.375), and Fuhrman's grade ( P = 0.134). The 5-year RFS rates in patients with chRCC and cRCC were 82.7% and 83.3%, respectively ( P = 0.762). The 5-year CSS rates in patients with chRCC and cRCC were 88.8% and 92.2%, respectively ( P = 0.980). Both groups showed equivalent oncological outcomes in terms of RFS and CSS for cases stratified by T stage and Fuhrman's grade. In multivariate analysis, the histological subtype was not retained as an independent prognostic variable (RFS: P = 0.893; CSS: P = 0.729). Despite being significantly different from cRCC in terms of several clinical and pathological parameters, chRCC shows equivalent oncological outcomes. [ABSTRACT FROM AUTHOR]

The Al(OH)3/acrylic copolymer latexes were synthesized through the emulsion polymerization of acrylic monomers, butyl acrylate and 2-ethylhexyl acrylate in the presence of surface-functionalized Al(OH)3 filler particles. The polymerization was stabilized by polyoxyethylene (50) nonyl phenyl ether (NP-1050, nonionic surfactant) and ammonium (POE) alkyl aryl ether sulfate (EU-S133D, anionic surfactant) to produce stable composite latexes. The improved compatibility of Al(OH)3 surface with acrylic monomers was achieved by the modification with 3-(trimethoxysilyl) propyl methacrylate (γ-MPS). Transmission electron microscopy showed that nano-sized Al(OH)3 particles were slightly agglomerated in the copolymer latex. When pristine Al(OH)3 was used as a filler or γ-MPS-modified Al(OH)3 particles were added above 30 wt% with respect to monomers, unstable latexes were obtained, which were partially precipitated out on standing for prolonged time. The flame retardation effect was not apparent with the incorporation of Al(OH)3 in the latexes by 30 wt% as shown by LOI test. [ABSTRACT FROM AUTHOR]

We investigated the difference between tumor sizes measured via preoperative computed tomography (CT) images and in surgical specimens during pathologic examinations in a contemporary cohort of patients who received extirpative surgery for renal tumors. We reviewed records of 467 patients who received radical or partial nephrectomy for renal lesions suspicious for malignancy. For our study, only patients who underwent preoperative CT within 4 weeks of surgery were included. In all patients, radiographic tumor size, defined as the largest diameter of tumor measured via CT images, and pathologic tumor size, the largest diameter of tumor measured in surgical specimen, were compared and analyzed by various factors. Among total subjects, mean radiographic and pathologic tumor size were 4.56 ± 2.99 and 4.49 ± 3.23 cm, respectively ( P = 0.399). When subjects were categorized according to radiographic tumor size (1-cm range), statistically significant difference (average of 2 mm) between radiographic and pathologic tumor size was observed only in the 4 to <5 cm range ( P = 0.046). Among those with clear cell renal cell carcinoma, mean radiographic tumor size was significantly larger than pathologic size, but by only 1.4 mm ( P = 0.012). Factors such as age, gender, body mass index, tumor stage, tumor grade, and tumor location were observed to have no significant impact on differences observed between radiographic and pathologic tumor size. Although actual size of renal mass can be generally overestimated by CT images, difference may be minimal and clinically insignificant in most cases. [ABSTRACT FROM AUTHOR]

Organic-inorganic composites composed of electrically conducting poly(3,4-ethylenedioxythiophene)/multi-walled carbon nanotube (PEDOT/MWNT) were prepared by in-situ oxidative polymerization of ethylenedioxythiophene (EDOT) in the presence of MWNTs in supercritical carbon dioxide. Prior to the polymerization, MWNTs were surface modified with 3-(trimethoxysilyl) propyl methacrylate in order to improve the dispersibility in CO2. This approach provides a facile way to develop solvent free composites with nanostructures and uniformity. The resulting composites were analyzed by FT-IR, transmission electron microscopy, field emission scanning electron microscopy, thermogravimetric analysis, X-ray diffraction and UV-visible spectroscopy. In addition, the effect of the ratio of the MWNT to PEDOT on the polymerization was investigated. [ABSTRACT FROM AUTHOR]

On the basis of the stereocomplex formation between poly(L-lactide) (PLLA) and poly(D-lactide) (PDLA), the stereocomplexation-induced surface properties of enantimeric polylactide blends were inverstigated by electron spectrometer for chemical analysis (ESCA) and contact angle measurements as a function of a degree of complexation. The complexation of blends was controlled by using the stereochemical polylactides (stPLAs) with percent D repeat unit contents (optical purity) of 100, 98, 95, 90, and 85%. The PLLA-b-poly(dimethyl siloxane) (PDMS)-b-PLLA triblock copolymer, instead of PLLA was used as a surface probe material because of the high surface segregation of PDMS blocks. From ESCA measurements, the surface segregation of PDMS of PLLA-b-PDMS-b-PLLA/stPLA blends with ≤10% optical impurity was rapidly decreased with a degree of complexation. However, the uncomplexed blends >10% optical impurity showed that the surface segregation of PDMS was nearly that of PLLA-b-PDMS-b-PLLA. Similar behaviors were observed in the contact angle measurements. These results indicate that 10% optical impurity is a critical value at which the complex formation and the surface properties of the PLLA-b-PDMS-b-PLLA/stPLA blends can be controlled. [ABSTRACT FROM AUTHOR]

Three series of waterborne polyurethane (WBPU)/carbon nanotube (CNT) nanocomposites were prepared, and their morphology and properties with various 2,2-dimethylol propionic acid (DMPA) and CNT contents were investigated. The CNTs were homogeneously dispersed up to the optimum content in WBPU/CNT nanocomposite films. The degree of homogeneous CNT dispersion increased with increasing DMPA content in WBPU/CNT nanocomposite films. The optimum CNT content showed maximum tensile strength, Young's modulus and adhesive strength of WBPU/CNT nanocomposite film. The optimum CNT contents for WBPU/CNT nanocomposite samples containing 3.61, 5.16 and 5.86 wt% DMPA were about 0.50, 1.00 and 1.50 wt%, respectively. The WBPU/CNT nanocomposite adhesive showed higher adhesive strength at moderately high temperatures (40/60/80/100°C) compared to conventional WBPU. The highest adhesive strength at moderately high temperatures was found with 5.86 wt% DMPA and 1.5 wt% CNT content. [ABSTRACT FROM AUTHOR]

A series of waterborne polyurethane (WBPU) adhesives were prepared with various ratios of polyol, poly(tetramethylene oxide glycol) (PTMG), and chain extender, ethylene diamine (EDA), at a fixed content of diisocyanate, 4,4-dicyclohexylmethane diisocyanate (H12MDI) and hydrophilic agent, 2,2-dimethylol propionic acid (DMPA). WBPU adhesives were characterized by IR and 1H-NMR spectroscopies, X-ray diffraction (XRD) and gel permeation chromatography (GPC). It was found that the extent of hydrogen bonds between hard–hard segment (i.e., hydrogen bonds between the NH and carbonyl groups) increased with increasing chain extender content (decreasing polyol content). Moreover, the disordered hydrogen bond of carbonyl group (hydrogen bond of urethane groups in the interfacial region) increased with increasing chain extender content (decreasing polyol content). The cyclic urea and allophanate group, which are attributed to the side reaction and cross-linking reaction, respectively, were found above a molar ratio 0.17 of chain extender to diisocyanate. The adhesive strength was maximum with 0.95 wt% and 63.10 wt% chain extender and soft segment (PTMG), respectively (H2 sample) at room temperature for the WBPU adhesive. However, with increasing application temperature the adhesive strength decreased for all samples. [ABSTRACT FROM AUTHOR]

This study investigated the stereocomplex-induced surface structure of enantiomeric poly(lactide) (PLA) blend films by differential scanning calorimeter, electron spectrometer for chemical analysis, and contact angle measurements. The design of the blend systems is based on principles of surface segregation of a modified component with a low surface energy, fluorocarbons (F), as an end group. The two blend systems, uncomplexed (F-l-PLA/l-PLA) and complexed (F-l-PLA/d-PLA), showed quite different surface structures: the surface segregation of fluorocarbon groups in the (F-l-PLA/l-PLA) blend film was observed while the surface structure of the (F-l-PLA/d-PLA) blend film was similar to its bulk one. This indicates that the interchain interaction to form stereocomplexes between l- and d-PLA is strong enough to overcome the driving force of fluorocarbon groups toward the surface. [ABSTRACT FROM AUTHOR]

Abstract Purpose  In Korean patients, to subdivide the neovascular forms of age-related macular degeneration (AMD) associated with large retinal pigment epithelial detachment (PED), according to the indocyanine green angiographic features. Methods  Indocyanine green angiograms (ICGA) of 67 elderly patients (72 eyes) who presented with a PED of at least 1 disc diameter were evaluated retrospectively. Results  Polypoidal choroidal vasculopathy (PCV) and typical choroidal neovascularization (CNV)-associated PEDs were identified in 18 eyes (25%) and 19 eyes (26%), respectively. In ten eyes (13.9%), the exact type of neovascularization, whether PCV or CNV, could not be determined. Pure serous PEDs were identified in seven eyes (10%). The remaining 18 eyes (25%) were classified as having retinal angiomatous proliferation (RAP)-associated PED based upon the angiographic findings of vascular connections between the retinal vasculature and the neovascular complex. Conclusions  Three subset groups of PCV, CNV, and RAP were present with similar frequency in neovascularized AMD with a large PED in these Korean patients. In particular, RAP, previously thought to be rare in Asian patients, was found to be present with considerable frequency. Jpn J Ophthalmol 2007;51:216–223 Japanese Ophthalmological Society 2007 [ABSTRACT FROM AUTHOR]