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Objectives: This study aims to evaluate the impact of anterior fibromuscular stroma preserved enucleation (AFSPE) of the prostate on serum testosterone levels in patients with benign prostatic obstruction (BPO) and to explore age‐related differences in postoperative testosterone elevation. Methods: In a retrospective analysis, 304 patients from a pool of 560 who underwent AFSPE at Linkou Chang Gung Memorial Hospital between January 2018 and December 2021 were evaluated. Patients were stratified based on preoperative testosterone levels into low (<3.5 ng/mL) and normal (≥3.5 ng/mL) groups. Serum testosterone levels were measured preoperatively, at 1.5 and 3–6 months postoperatively. Age and other demographic data were analyzed as potential factors influencing testosterone changes. Results: The low‐testosterone group (n = 90) showed significant testosterone increases, from an average of 2.61 ng/mL preoperatively to 3.3 ng/mL at 1.5 months and 3.59 ng/mL at 3–6 months postoperatively (p < 0.0001). The normal‐testosterone group (n = 214) maintained stable testosterone levels at 1.5 months but exhibited a significant rise to 6.06 ng/mL by 3–6 months (p = 0.0079). Older age was inversely associated with postoperative testosterone elevation in both groups. Improvements in nocturia were notable in both groups. Conclusions: AFSPE of the prostate significantly elevates serum testosterone levels in men with BPO, particularly benefiting those initially with low levels. Age is a crucial factor influencing postoperative testosterone changes, indicating that younger patients may benefit more from this intervention. AFSPE offers a promising approach for improving hormonal health in BPO patients, alongside alleviating urinary symptoms. [ABSTRACT FROM AUTHOR]

Microfluidics has enabled the miniaturization of fluidic systems for various biomedical and industrial applications, including small-scale robotic propulsion. One mechanism for generating propulsive force through microfluidics is by exploiting the solutal Marangoni effect via releasing surfactant on the air-water interface. Surfactants locally reduce the surface tension, which leads to a surface stress that can propel the floating robot, called Marangoni surfer. However, so far the release of the surfactant is not controllable. In this study, we combine microfluidics-based Marangoni propulsion with a novel untethered magnetic pumping mechanism to enhance its controllability. The proposed magnetic micropump capitalizes on the interaction force between two soft magnets, which can generate a pumping force of 4.64 mN to actuate a membrane, and achieve a deformation of 450 μm. Net flow is achieved using a nozzle/diffuser flow rectifier whose efficacy as a function of the channel geometry is numerically studied. We investigate the flow rate of the pump with regard to the actuation frequency. Finally, we demonstrate its ability to control the motion of the Marangoni surfer. [ABSTRACT FROM AUTHOR]

Natural products have attracted great interest in the development of tissue engineering. Recent studies have demonstrated that unsaturated fatty acids found in natural plant seed oil may exhibit positive osteogenic effects; however, few in vivo studies have focused on the use of plant seed oil for bone regeneration. The aim of this study is to investigate the effects of seed oil found in Sapindus mukorossi (S. mukorossi) on the osteogenic differentiation of mesenchymal stem cells and bone growth in artificial bone defects in vivo. In this study, Wharton-jelly-derived mesenchymal stem cells (WJMSCs) were co-cultured with S. mukorossi seed oil. Cellular osteogenic capacity was assessed using Alizarin Red S staining. Real-time PCR was carried out to evaluate ALP and OCN gene expression. The potential of S. mukorossi seed oil to enhance bone growth was assessed using an animal model. Four 6 mm circular defects were prepared at the parietal bone of New Zealand white rabbits. The defects were filled with hydrogel and hydrogel-S. mukorossi seed oil, respectively. Quantitative analysis of micro-computed tomography (Micro-CT) and histological images was conducted to compare differences in osteogenesis between oil-treated and untreated samples. Although our results showed no significant differences in viability between WJMSCs treated with and without S. mukorossi seed oil, under osteogenic conditions, S. mukorossi seed oil facilitated an increase in mineralized nodule secretion and upregulated the expression of ALP and OCN genes in the cells (p < 0.05). In the animal study, both micro-CT and histological evaluations revealed that new bone formation in artificial bone defects treated with S. mukorossi seed oil were nearly doubled compared to control defects (p < 0.05) after 4 weeks of healing. Based on these findings, it is reasonable to suggest that S. mukorossi seed oil holds promise as a potential candidate for enhancing bone healing efficiency in bone tissue engineering. [ABSTRACT FROM AUTHOR]

To understand if and why guardians access their adolescent child's electronic health record patient portal account. Guardians of transgender and gender-diverse adolescents completed a survey regarding patient portal use. Descriptive statistics were used to describe items related to guardian access to adolescent portal accounts. Of 82 respondents, 37.8% indicated they had used their child's login to access the patient portal. Most indicated they accessed their adolescent's account because their child asked them to do so. Other common reasons included being worried they might miss important health information and not realizing there was a difference between patient and proxy accounts. Results of this study provide a more detailed understanding regarding guardian access to adolescent patient portals. Findings can be used to inform adolescent patient portal design and enrollment practices that protect adolescent confidentiality. [ABSTRACT FROM AUTHOR]

This Viewpoint discusses the challenges to implementing artificial intelligence–based translation in clinical settings and what health care organizations can do to mitigate these challenges. [ABSTRACT FROM AUTHOR]

The article discusses a study on urinary incontinence recovery following endoscopic enucleation of the prostate. The study analyzed the long-term effects of different surgical techniques on urinary incontinence symptoms in 316 patients. The results showed significant improvement in urinary incontinence symptoms by 6 months after surgery. The article also mentions other research on surgical treatments for benign prostatic hyperplasia that have observed similar trends in reducing urinary incontinence. The findings suggest that certain surgical approaches, such as preserving the anterior fibromuscular stroma, may enhance continence control and improve patient outcomes. [Extracted from the article]

This document is a letter to the editor discussing the use of pigtail suture stents (PSS) versus Double J stents in ureterorenoscopy (URS) procedures. The letter highlights studies that show PSS may result in fewer post-operative bladder irritative symptoms compared to Double J stents. However, the letter also raises concerns about the efficacy of PSS in managing conditions such as ureteral edema, trauma, or residual stone formations. It also discusses the potential benefits of PSS in preserving the competency of the ureterovesical junction (UVJ) and reducing upper tract damage. The letter emphasizes the need to find a balance between stent placement duration, managing obstruction and vesicoureteral reflux (VUR), and considering the role of ureteral external compression by tumors. The authors also mention the potential complications associated with indwelling ureteric stents. The letter concludes by stating that the insights from previous studies should be considered when inserting Double J stents. [Extracted from the article]

The study by Kato et al. explores the relationship between nocturnal polyuria (NP) and inadequate nighttime blood pressure reduction in men with lower urinary tract symptoms (LUTS). The findings suggest that men with NP have less reduction in systolic blood pressure during sleep compared to those without NP, indicating a potential therapeutic avenue of enhancing nocturnal blood pressure reduction to mitigate NP. The authors also propose a mechanism that explains the interconnection between disturbances in urine production at night, circadian rhythm disruptions, and hormonal regulation. They emphasize the importance of considering factors such as nocturia, NP, and testosterone levels in the management of LUTS. [Extracted from the article]

The article discusses the anterior prostatic urethral mucosa preservation (APUMP) technique and its effectiveness in reducing postoperative stress urinary incontinence during holmium laser enucleation of the prostate (HoLEP). The APUMP technique, similar to the AFS-preserved method, focuses on preserving critical anatomical structures to mitigate complications. The preservation of the anterior prostatic urethral mucosa is a consequential result of preserving the anterior fibromuscular stroma (AFS), which significantly reduces urinary incontinence rates. The article also highlights the importance of preserving the AFS in maintaining structural integrity and enhancing functional outcomes. Both the APUMP technique and the AFS-preserved technique contribute to improving patient outcomes in prostate surgeries. [Extracted from the article]

This article discusses the relationship between lower extremity muscle strength, area, specific force, and lower urinary tract symptoms (LUTS) in older men. The study, which analyzed data from the Baltimore Longitudinal Study of Aging, found a correlation between higher thigh muscle strength and specific force with milder LUTS in cross-sectional models. However, longitudinal analyses did not reveal a significant connection between baseline muscle measurements and changes in urinary symptoms over time. The article suggests that nocturia and testosterone levels may play a role in the relationship between muscle function and LUTS. It emphasizes the importance of managing nocturia to prevent the decline of testosterone and maintain muscle mass and strength. [Extracted from the article]

The article discusses the management of bladder-centric benign prostatic hyperplasia (BPH) after laser enucleation of the prostate. The authors explore the theory that symptoms like frequency, urgency, and urge incontinence indicate bladder distress, which can progress to more severe conditions if left untreated. They suggest that treatment should not only focus on relieving prostatic obstruction but also on managing the bladder's health. The findings highlight the potential benefits of early surgical intervention and the importance of timely management in patients with significant BPH symptoms. [Extracted from the article]

This article discusses the relationship between testosterone deficiency (TD) and nocturia, a condition characterized by frequent urination at night. While previous studies have focused on TD as a contributing factor to nocturia, this article proposes that nocturia may actually lead to TD by disrupting sleep and the circadian rhythm centered in the hypothalamus. The disruption of sleep patterns may also exacerbate metabolic syndromes and conditions like benign prostatic hyperplasia (BPH), intensifying nocturia symptoms. The article suggests that a holistic approach, addressing metabolic syndrome and its components, could potentially mitigate BPH progression and improve patient outcomes. Further research is needed to understand the bidirectional nature of TD and nocturia and develop therapeutic interventions. [Extracted from the article]

ABSTRACT Glucose can activate the carbohydrate response element binding protein (ChREBP) transcription factor to control gene expressions in the metabolic pathways. The way of ChREBP involvement in human prostate cancer development remains undetermined. This study examined the interactions between prostate fibroblasts and cancer cells under the influences of ChREBP. Results showed that high glucose (30 mM) increased the phosphorylation of AKT at S473 and AMP‐activated protein kinase (AMPK) at S485 in human prostate fibroblast (HPrF) cells and prostate cancer PC‐3 cells. High glucose enhanced the expression of ChREBP, which increased the expressions of fibronectin, alpha‐smooth muscle actin (α‐SMA), and WNT1 inducible signaling pathway protein 1 (WISP1), magnifying the cell growth and contraction in HPrF cells in vitro. The cell proliferation, invasion, and tumor growth in prostate cancer PC‐3 cells were enhanced by inducing the expressions of ChREBP, mucosa‐associated lymphoid tissue 1 (MALT1), and epithelial‐mesenchymal transition markers with high glucose treatment. Moreover, ectopic ChREBP overexpression induced NF‐κB signaling activities via upregulating MALT1 expression in PC‐3 cells. Our findings illustrated that ChREBP is an oncogene in the human prostate. High glucose condition induces a glucose/ChREBP/MALT1/NF‐κB axis which links the glucose metabolism to the NF‐κB activation in prostate cancer cells, and a glucose/ChREBP/WISP1 axis mediating autocrine and paracrine signaling between fibroblasts and cancer cells to promote cell migration, contraction, growth, and invasion of the human prostate. [ABSTRACT FROM AUTHOR]

A study conducted in South Korea suggests that prolonged antibiotic usage, particularly exceeding 180 days or using four or more antibiotic types, may be associated with a heightened risk of prostate cancer. Antibiotics are commonly prescribed for upper respiratory tract infections (URIs) and urinary tract infections (UTIs), which are prevalent in older males with comorbidities such as prostate cancer and benign prostatic hyperplasia (BPH). The study also highlights the possibility of incidental prostate cancer detection during routine tests for URIs. However, an alternative perspective proposes that chronic nocturia, a common issue in BPH patients, could lead to disruptions in circadian rhythm, alterations in gut microbiota, and exacerbation of metabolic syndrome, all of which are linked to cancer development. The findings emphasize the importance of judicious antibiotic prescription, particularly in patients with BPH. [Extracted from the article]

Purpose: To investigate the relationship between prostatic urethral angle (PUA) and the development of surgical capsule calculi (SCC) within the prostate, and to examine the presence and impact of intravesical prostatic protrusion (IPP)., Materials and Methods: A retrospective analysis was conducted on 90 patients who underwent radical prostatectomy, with preoperative assessments using both transrectal ultrasound of the prostate (TRUS) and magnetic resonance imaging. Patients were divided into groups with and without SCC and further categorized into type 1 and type 2 stones based on the location and severity of the calculi. Statistical analysis included chi-square and independent sample t-tests, with p<0.05 considered significant., Results: Of the patients, 82.2% were diagnosed with SCC. No significant difference in PUA was found between patients with and without SCC. However, a notable disparity in IPP presence was observed, suggesting an inverse correlation with SCC development. Additionally, no significant differences were identified when comparing the two types of SCC based on PUA and IPP measurements., Conclusions: The presence of IPP exhibited an inverse relationship with SCC, suggesting diminished urine flow pressure over the prostatic urethra may reduce the likelihood of SCC formation. However, no direct association between PUA and the presence or severity of SCC was identified. These findings highlight the complexity of factors contributing to prostatic calculi development and the potential role of IPP in this context., Competing Interests: The authors have nothing to disclose., (© The Korean Urological Association.)

Background:  The Accreditation Council for Graduate Medical Education suggests that Clinical Informatics (CI) fellowship programs foster broad skills, which include collaboration and project management. However, they do not dictate how to best accomplish these learning objectives., Objectives:  This study aimed to describe a standard approach to project-based learning for CI, to share its implementation, and to discuss lessons learned., Methods:  We created a standard approach to project-based learning based on concepts from adult learning theory, the project life cycle framework, the Toyota Production System, and Improvement Science., Results:  With this standard approach in place, we learned how best to support fellows in its use. In addition to this approach to supporting needs assessment, risk/change management, implementation, and evaluation/improvement skills, we found the need to develop fellow skills in collaboration, leadership, and time management/managing up. Supported by project-based learning using this standard approach, and with targeted project selection to meet topic-based learning objectives, fellows reached the ability to practice independently in 15 to 21 months., Discussion:  Fellows are uniquely positioned to ensure the success of projects due to their increased availability and protected time compared with attendings. They are readily available for project teams to draw upon their expertise with clinical workflows and understanding of technological solutions. Project-based learning addressing organizational priorities complements fellow project management coursework and improves fellows' ability to function successfully in large, complex, and dynamic organizations. Exposing fellows to contemporary problems, then addressing them through projects, provides fellows with up-to-date applied informatics knowledge., Conclusion:  Project-based learning can ensure that many general CI learning objectives are supported inherently. It reinforces project management teachings, while providing fellows with a marketable project portfolio to aid with future job applications. Having projects tightly aligned with organizational priorities supports ongoing investment in fellowship programs., Competing Interests: None declared., (Thieme. All rights reserved.)