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Abstract Purpose We want to investigate whether MR-US fusion can improve the detection rates of clinically significant prostate cancer in patients with prior negative prostate biopsy with PSA level <10 ng/mL. Methods Thirty nine patients who had previous a history of negative prostate biopsy and PSA levels <10 ng/mL were included in this study. MR was performed before the biopsy and graded using PIRADS V2. We labeled patients with index lesions with PIRADS scores of 3 or above as the MR-positive group, while patients with PIRADS scores of 1 or 2 were the MR-negative group. Two cores of added biopsy (AB) were performed per each index lesion under MR-US fusion. Twelve cores randomized systematic biopsy (SB) were followed. In MR negative group, two cores of AB were obtained in transition zone, followed by SB. Overall cancer and clinically significant cancer detection rates by patients and by cores were analyzed, and compared between MR-positive and negative group. Results The overall cancer detection rates were 51.3% by patient based and 13.8% by core based. While all of AB positive cancer patients were clinically significant cancer patients, five out of seven (71.4%) AB negative cancer patients were clinically insignificant cancer patients. AB results turned another four cancer patients from insignificant to significant cancer. The cancer detection rates between MR-positive and negative group were statistically significant. Conclusions Additional biopsy using MR–US fusion showed improved detection of clinically significant prostate cancer. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To investigate the efficacy of a u-healthcare service using Zigbee and mobile phone for elderly patients with diabetes mellitus or heart diseases. Materials and methods: From July to October, 2005, 29 patients were enrolled in our study. Two selected u-healthcare items, ECG and blood glucose measurement, were monitored. Twenty patients were provided with ZigBee built-in blood glucometer and mobile phones, and were instructed on using a web service where the measured blood glucose could be transmitted directly to the web and be administrated. Nine patients participated in ECG monitoring, by using a wireless, transmittable ECG recording instrument equipped with ZigBee protocol attached to their chest. Daily average transmission frequency, rate of transmission loss, and error reasons were analyzed. In addition, the patients were asked to score their degree of satisfaction about the sensors and u-healthcare services. Results: The mean transmission frequencies were 2.1 times/day in blood glucose monitoring and 6.1 times/day in ECG. The patients’ satisfaction scores of the blood glucometer and service used in this research were 8.59 and 9.01 of 10 points, respectively. The mean satisfaction scores about ECG sensor and ECG monitoring services were 5.79 and 7.29, respectively. Discussion: Despite the many problems still encountered such as technological problems related to sensors and some problems like battery replacement, we could transfer the data of glucometer and ECG sensors to web-server via ZigBee protocol. Authors think the ZigBee could be one of components of wireless u-healthcare systems in the future due to its advantages of lower power consumption. [Copyright &y& Elsevier]

MicroFlow Imaging (MFI) is a newer ultrasonography technique which enables to evaluate low velocity micro circulation such as organ perfusion or flow in small vascular beds. We tried to apply this technique in the evaluation of renal mass and compare ultrasonographic findings with CT enhancement. Between August 2018 to January 2019, fifty-four renal masses in forty-eight patients were retrospectively evaluated. All patients underwent MicroFlow Imaging (MFI) and color doppler imaging (CDI) using EPIQ 7 (Philips, the Netherlands) ultrasound machine and enhanced kidney CT scan including precontrast scan. The degree, distribution and shape of vascularity from MFI and CDI were analyzed. Degree of vascularity was ranged from 0 (absent) to 3 (profound). Distributions of vascularity were marked as peripheral, central and mixed. Shapes were marked as linear, branching and irregular. Incremental enhancement (IE) of CT was calculated by substraction of maximal measured Hounsfield unit (HU) from the HU of baseline precontrast scan. The degree of vascularity from MFI and CDI was correlated with IE of CT scan and mean IEs were compared among different group of the degree, distribution and shape of vascularity. The number of malignant lesions was thirty-two (30 renal cell carcinomas, 2 lymphomas) and the number of benign lesions was twelve (6 angiomyolipomas, 1 oncocytoma, 1 mixed epithelial and stromal tumor, 1 hemangioma, 3 simple cysts). All lesions were confirmed by histopathology (N= 35) or clinical follow-up over two years (N=7). Mean IE of benign solid (N=9) and malignant mass did not show statistical significance (p=0.412). Correlation coefficient (r) of IE between degree of vascularity from MFI and CDI were 0.6768 and 0.5164, respectively. Mean IEs according to different degree of vascularity from MFI and CDI were statistically significant (p < 0.05) by ANOVA, however F-ratio were 15.919 and 6.458, which meant that variability between group means was larger in MFI. For the distribution and shape of vascularity, only MFI showed statistically significant different IEs (p < 0.05). Comparing with CDI, MFI correlates better with contrast enhanced CT scan and predict tumor vascularity more sensitive and accurate. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To investigate the impact of the variations in the shape of the prostatic apex observed on preoperative magnetic resonance imaging (MRI) on patients’ status regarding urinary continence after undergoing radical retropubic prostatectomy, as well as the prevalence of such variations. Methods: We performed a retrospective analysis of 156 patients who had undergone preoperative MRI of the prostate and were followed up postoperatively by review of the records. For our analyses, patients were categorized into four different groups according to the shape of the prostatic apex shown on the midsagittal MRI scan. Patient status, including early (within 3 months after surgery) recovery of urinary continence, was also assessed. Results: Group 1 was the largest with 59 patients (37.8%), group 2 had 39 patients (25%), group 3 had 24 (15.3%), and group 4 had 34 patients (21.8%). Group 4 was composed of patients with the prostatic apex not overlapping with membranous urethra either anteriorly or posteriorly on MRI and had a significantly greater percentage (83.3% versus 66.7%) of patients with an early return of urinary continence after radical retropubic prostatectomy compared with the other groups (P = 0.014). On multivariate analysis of the predictive factor for the early return of urinary continence, anterior or posterior overlapping of the membranous urethra with the prostatic apex as shown on preoperative MRI was the only variable significantly associated with an early return of continence. Conclusions: The results of our study provide objective evidence that variations in the shape of the prostatic apex in relation to the membranous urethra may significantly affect early recovery of urinary continence after radical retropubic prostatectomy. [Copyright &y& Elsevier]

The synergistic effects of a doxorubicin (Dox)-loaded microparticle-microbubble complex (DMMC) and focused ultrasound (FUS) with a short duty cycle (5%) were evaluated in a pancreatic cancer xenograft model established by inoculating immunodeficient mice with CFPAC-1 cells. The efficacy of the DMMC with FUS (study 1), the effect of conjugating the particles as opposed to mixing them (study 2) and the levels of tumor apoptosis and intracellular Dox (study 3) were evaluated. The DMMC with FUS exhibited the lowest tumor growth rate (30.8 mm3/wk) and the highest intracellular Dox uptake (8.8%) and tumor cell apoptosis rate (58.7%) among all treatments. DMMC had a significantly lower growth rate than the mixture of Dox-loaded microparticles and microbubbles (44.2 mm3/wk, p < 0.01) when they were combined with FUS. In conclusion, DMMC with short-duty-cycle FUS holds promise for tumor growth suppression, which may be attributed to high intracellular Dox uptake. [ABSTRACT FROM AUTHOR]

Objective To investigate the impact of prostatic apical shape from preoperative magnetic resonance imaging on early recovery of urinary continence after robot-assisted radical prostatectomy (RARP). Materials and Methods We reviewed the records of 1011 patients who underwent RARP at a tertiary center from October 2007 to March 2013. Patients were stratified into 4 different groups by prostatic apical shapes as shown on preoperative magnetic resonance imaging (groups A-D). The early recovery of urinary continence was defined as 0 or 1 security pad/d within 12 weeks after the surgery. The association between early recovery of continence and various factors was analyzed. Results Overall, 807 patients (79.8%) showed early recovery of urinary continence. The numbers of patients in groups A, B, C, and D were 88 (8.7%), 478 (47.3%), 167 (16.5%), and 278 (27.5%), respectively. There were no significant differences in the rates of early recovery of urinary continence between different groups ( P = .257). On multivariate analysis, the patient's age (odds ratio [OR], 0.960; P = .004), preoperative International Index of Erectile Function-5 score (OR, 1.029; P = .009), neurovascular bundle preservation (OR, 1.586; P = .013), and membranous urethral length (OR, 1.104; P = .001) were revealed as independent prognostic factors in the early recovery of urinary continence. Conclusion The results of our study showed that the prostatic apical shape does not influence the early recovery of urinary continence. We believe this is another strong point of RARP compared with conventional open surgery, particularly for patients with complex type of apical shape. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the relationship between prostate-specific antigen (PSA) and prostate volume in a histologically defined subset of Korean men confirmed to have benign prostatic hyperplasia (BPH) only from multicore biopsy of prostate. Methods: A total of 707 Korean men with a PSA level of 10 ng/mL or lower who were shown to have stromoglandular hyperplasia only from transrectal ultrasound (TRUS)-guided multicore biopsy of prostate were included in the study. We analyzed PSA and total prostate volume (TV) measured through TRUS by stratified age cohorts. We used Pearson correlation coefficient (r) and linear regression model to describe the relationship between variables. Results: Serum PSA level significantly correlated with TV in all stratified age cohorts, with r ranging from 0.29 to 0.47 (all P <0.001). Meanwhile, the degree of correlation appeared to increase with age. The slope of linear regression showing an association of PSA and TV was 3.68. The PSA increase per unit prostate volume decreased with the advancing cohort of age when we excluded subjects 70 years or older. Conclusions: Although PSA was significantly correlated with TV, the exact nature of the relationship between PSA and TV in Korean men with biopsy-proven BPH may be different from that in other races. Further basic research on the pathophysiology of BPH is needed to explain such a racial difference. [Copyright &y& Elsevier]

Objectives: To investigate the association of prostate size with aggressiveness of prostate cancer in Korean men who received radical retropubic prostatectomy (RRP) for clinically localized prostate cancer. Methods: We evaluated the association of RRP specimen weight and prostate volume measured by transrectal ultrasound (TRUS) with pathologic tumor grade, extraprostatic extension of disease, surgical margin status, and seminal vesicle invasion by reviewing data of 346 consecutive patients who underwent RRP for clinically localized prostate cancer at our institution without receiving preoperative radiation or hormonal treatment. Results: A strong correlation was observed between RRP specimen weight and TRUS-measured prostate volume (Spearman r = 0.76; P <0.001). After adjustment for multiple variables including age, body mass index, and preoperative prostate-specific antigen level, RRP specimen weight was observed to be significantly associated with presence of Gleason pattern 4 or greater at RRP in an inverse fashion (P = 0.03). Regarding other adverse pathologic features, prostate weight was also significantly inversely associated with extraprostatic extension of prostate cancer (P = 0.04) and surgical margin positivity (P = 0.002). When TRUS-measured prostate volume was applied in place of RRP specimen weight, results were the same. Conclusions: Our data indicate that prostate size may be a useful predictor of tumor aggressiveness in Korean men with clinically localized prostate cancer. Further efforts should be made to elucidate actual mechanisms behind the association of prostate size and/or in vivo androgenicity with aggressiveness of prostate cancer. [Copyright &y& Elsevier]

Objectives: To investigate the impact of variations in bony pelvic dimensions observed from preoperative magnetic resonance imaging on operative time, intraoperative blood loss, and surgical margin status on performing open radical retropubic prostatectomy. Methods: A prospective study was undertaken in which preoperative magnetic resonance imaging was performed in 190 patients who were diagnosed with clinically localized prostate cancer before radical retropubic prostatectomy. Using the magnetic resonance image findings, various bony pelvic dimensions were measured. The associations of the measured pelvic dimensions and various clinicopathologic factors with the operative time, estimated blood loss, and surgical margin status were analyzed on multivariate analyses. Results: For operative time, none of the individual pelvic dimensions measured demonstrated significant associations on univariate analysis. In contrast, only the newly developed parameter, the pelvic dimension index, approached significance (P = 0.095). Only body mass index (BMI) proved to be independently associated with the operative time on multivariate analysis (P = 0.030). Also, only the prostate volume (P = 0.015) was independently associated with the estimated blood loss. For the surgical margin status, the preoperative PSA level (P = 0.041), pathologic Gleason score (P = 0.015), and BMI (P = 0.020), along with the pelvic dimension index (P = 0.048), demonstrated significant associations on univariate analyses. However, only the PSA level (P = 0.071) and BMI (P = 0.059) approached significance on multivariate analysis. Conclusions: Our results have demonstrated that variations in the bony pelvic dimensions might have some impact, but not significantly so, on open radical retropubic prostatectomy compared with other patient-related baseline factors such as the BMI or prostate volume. [Copyright &y& Elsevier]

Objectives: To investigate the significance of variations in neurovascular bundle (NVB) formation observed on preoperative magnetic resonance imaging (MRI) regarding postoperative potency after nerve-sparing radical retropubic prostatectomy (RRP). Methods: Preoperative MRI was performed in 93 patients who underwent bilateral nerve-sparing RRP for clinically localized prostate cancer and were followed up for at least 12 months after surgery. Judging from the MRI scans, patients were categorized into three groups: group 1, patients with no definite NVB observed on MRI, group 2, those with probable NVB formation observed on MRI but not definite, and group 3, those with NVB more definitely observed on MRI. Patients’ erectile function status was assessed preoperatively and postoperatively using the International Index Erectile Function 5-item (IIEF-5) questionnaire. Results: Of the 93 patients, 40.9% were in group 1, 21.5% in group 2, and 37.6% in group 3 according to the MRI findings. The patient characteristics, including age, serum prostate-specific antigen, pathologic Gleason score, and preoperative IIEF-5 scores, were not significantly different among the three groups. However, the changes in the IIEF-5 scores after bilateral nerve-sparing RRP demonstrated a significantly larger decrease for group 1 compared with groups 2 and 3. Similar trends were observed when patients 60 years old or younger and those older than 60 years were analyzed separately. Conclusions: In patients with no definite NVB formation observed on MRI, the nerves associated with erectile function may run along both sides of the prostate and spread more anteriorly than those with the NVB more definitely observed. Thus, to preserve the NVBs completely at all times, it would be important to widely dissect the lateral aspects of the prostate during nerve-sparing RRPs. [Copyright &y& Elsevier]

Publish consent withheld [ABSTRACT FROM AUTHOR]