Search

This study aimed to compare the clinical outcomes of endoscopic spinal surgery (ESS) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for degenerative lumbar disease (DLD) through meta-analysis. The Medline (via PubMed), Cochrane, Scopus, and Embase databases were searched for studies that evaluated the outcomes of ESS and MIS-TLIF in DLD, including visual analog scale (VAS) score for low back pain, VAS score for leg pain, Oswestry Disability Index (ODI), and complications published between January 2000 and August 2020. Two authors extracted the data independently. Any discrepancies were resolved by a consensus. Four comparative studies were identified. No significant differences were found between the ESS and MIS-TLIF groups in terms of VAS score for back pain, VAS score for leg pain, and ODI, except for complication rate. The complication rate was higher in the ESS than in the MIS-TLIF group. A literature review identified four comparative studies reporting the clinical outcomes of ESS and MIS-TLIF for DLD. Despite the heterogeneity, a limited number of meta-analyses showed that the clinical outcomes between the two groups were not significantly different except for complication rate. Hence, further large-scale multicenter studies are required to validate our results.

Objectives This study aimed to compare the demographic characteristics, disease activity, functional status, and quality of life between patients with axial spondyloarthritis and fibromyalgia and patients with axial spondyloarthritis without fibromyalgia. Methods We searched MEDLINE via PubMed, Cochrane, Scopus, and Embase databases, from the earliest available indexing date to March 30, 2019, for comparative studies evaluating fibromyalgia in patients with axial spondyloarthritis. Two authors extracted data independently, and all discrepancies were resolved through consensus. Results Seven comparative studies were identified. No statistically significant differences were observed in terms of age, levels of inflammatory markers, and prevalence of extra-articular manifestations such as uveitis, psoriasis, and inflammatory bowel disease between patients with Axial spondyloarthritis fibromyalgia and those without it. Sex ratios (female to male) were approximately 3:2 and 1:3 in patients with and without fibromyalgia, respectively. The ratios concerning human leukocyte antigen B27-positive patients with and without fibromyalgia were 45.1% and 65.6%, respectively. Patients with fibromyalgia had significantly higher Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, and Ankylosing Spondylitis Quality of Life scores. Conclusions Our meta-analysis showed that patients with Axial spondyloarthritis fibromyalgia had considerably higher pain severity, disease activity, and worse quality of life than patients without fibromyalgia. The sex ratios (female to male) were approximately 3:2 and 1:3, and ratios for human leukocyte antigen B27-positive patients were 45.1% and 65.6% in patients with and without fibromyalgia, respectively. Further well-designed studies are needed to substantiate our results.

This study aimed to compare the results of gait analysis of adolescent idiopathic scoliosis (AIS) patients and healthy subjects through a meta-analysis of the existing research. The Medline (via PubMed), Cochrane, Scopus, and Embase databases were searched for studies that evaluated the findings of AIS, including spatiotemporal parameters (walking speed, step length, cadence, and stance phase duration), segmental kinematics (frontal, sagittal, and transverse pelvic motion), and electromyographic variables (electrical activity of the quadratus lumborum, erector spinae, and gluteus medius), and were published between January 2000 and May 2020. Two authors extracted the data independently, and any discrepancies regarding the eligibility of retrieved studies were resolved by a consensus. Six comparative studies were identified and subsequently analyzed. It was found that the stance phase and frontal pelvic motion were significantly reduced in AIS patients compared with healthy controls. No significant difference was observed for speed, step length, cadence, sagittal pelvic motion, and transverse pelvic motion. The electrical activity durations of the quadratus lumborum, erector spinae, and gluteus medius were significantly increased in the AIS group compared with healthy subjects. Despite the heterogeneity, a limited number of meta-analyses showed reduced stance phase and frontal pelvic motion with prolonged activation timing of the quadratus lumborum, erector spinae, and gluteus medius muscles. Hence, further large-scale, multicenter studies are required to validate our results.

OBJECTIVE The aim of this study was to investigate the relationship between neck pain and radiological findings in ankylosing spondylitis (AS) patients. METHODS The study groups comprised 257 AS and 50 normal patients. Of the AS patients, 91 had axial neck pain (group 1) and 166 did not (group 2). Full-length radiographs of the spine in the anteroposterior and lateral planes were taken. Radiographic parameters such as the chin brow vertical angle (CBVA), McGregor slope (McGS), slope of the Line of Sight (SLS), C2 slope, C2-C7 lordosis (CL), C2-C7 sagittal vertical axis (C2-C7 SVA), and T1 slope were measured. Statistical analysis was performed. RESULTS The AS and normal patients were found to have significantly different CBVA, McGS, C2 slope, C2-C7 SVA, and T1 slope. However, no significant difference was observed for SLS and CL. Between groups 1 and 2, there were significant differences in the McGS, CL, and T1 slope. However, no significant difference between these two groups was observed for CBVA, SLS, C2 slope, and C2-C7 SVA. Logistic regression analysis was performed to identify statistically significant predictors of neck pain in AS patients and it revealed that the T1 slope and McGS were two such predictors. The T1 slope showed superior discriminatory power to McGS and CL in the receiver operating characteristic curve analysis. CONCLUSIONS This study shows that a high T1 slope and McGS are independent radiological predictors of neck pain in AS. Further well-designed studies would be necessary to substantiate our results.

To compare the serum levels of leptin and soluble leptin receptor (sOB-R) with adolescent idiopathic scoliosis (AIS) girls and controls through meta-analysis. The MEDLINE via PubMed, Cochrane, Scopus, and EMBASE database, from the earliest available date of indexing between January 2010 and January 2019, were searched for comparative studies evaluating serum levels of leptin and sOB-R in AIS girls. Two authors performed the data extraction independently. Any discrepancies were resolved by a consensus. Six comparative studies were identified. There was no statistically significant difference in terms of leptin between AIS girls and control [p = 0.19, WMD = -2.06 (-5.14, 1.03) ng/mL]. However, the sOB-R level was significantly higher [p 0.00001, WMD = 2.85 (1.81, 3.88) ng/mL] and the free leptin index was significantly lower [p = 0.0006, WMD = -0.12 (-0.19, -0.05)] in AIS girls than those of healthy control girls. The body mass index was significantly lower in AIS girls [p = 0.03, WMD = -1.53 (-2.95, -0.12) kg/m

Phosphodiesterase type 5 (PDE5) inhibitors are effective treatments for erectile dysfunction, and several recent studies have reported positive effects of PDE5 inhibitors on semen parameters as well. However, the data are still controversial. We investigated the effect of PDE5 inhibitors on sperm function by analyzing sperm motility and acrosome reaction.This study included young healthy men who underwent fertility evaluation; 32 cases were finally included. Men were excluded if they used a PDE5 inhibitor within 2 weeks or if they had insufficient semen volume (≤2 mL), leukocytospermia, or a genitourinary infection. Changes in sperm motility and acrosome reaction were determined afterMean age of the participants was 35.4±4.9 years, mean sperm concentration was 68.7±32.4 ×10⁶/mL, and mean sperm motility was 50.38%±8.41%. All three groups (control, sildenafil, tadalafil) experienced trends of decreased average sperm motility over time, but these changes were not significant. There were no significant differences between the three groups in the acrosome reaction after 120 minutes of drug exposure, either. The maximal semen concentration of oral intake of sildenafil (100 mg) or tadalafil (20 mg) did not substantially affect sperm motility or acrosome reaction.Our results suggest that on-demand use of a PDE5 inhibitor is safe and useful for the male partner of an infertile couple; however, further studies are warranted for daily PDE5 inhibitor use.

We aimed to evaluate the reliability and validity of the adapted Korean version of the Italian Spine Youth Quality of Life (ISYQOL) questionnaire. Translation/retranslation of the English version of ISYQOL was conducted, and all steps of the cross-cultural adaptation process were performed. The Korean version of the ISYQOL and the previously validated Scoliosis Research Society-22 (SRS-22) questionnaire were mailed to 120 consecutive idiopathic scoliosis patients wearing brace. Factor analysis and reliability assessment by kappa statistics of agreement for each item, the intraclass correlation coefficient (ICC) and Cronbach’s α were conducted. Construct validity was also evaluated by comparing the responses of ISYQOL with the responses of SRS-22 by using Pearson’s correlation coefficient. Factor analysis extracted 2 factors. All items had a kappa statistics of agreement greater than 0.6. The ISYQOL showed good test/re-test reliability (ICC = 0.812). Internal consistency of Cronbach’s α was found to be very good (α = 0.873). The Korean version of ISYQOL showed good significant correlation with SRS-22 total score and with single SRS-22 domains scores. The adapted Korean version of the ISYQOL was successfully translated and showed acceptable measurement properties, and as such, is considered suitable for outcome assessments in the Korean speaking patients with idiopathic scoliosis.

This study aimed to compare outcomes between ankylosing spondylitis (AS) treated with and without bisphosphonate (BP; non-BP) through a meta-analysis. The Medline (via PubMed), Cochrane, Scopus, and Embase databases were searched for studies that evaluated the outcomes of AS, including patient age, disease duration, disease activity, and bone mineral density (BMD), published between January 2000 and March 2020. Two authors extracted the data independently. Any discrepancies were resolved by a consensus. Six comparative studies were identified. No significant differences were found between the BP and non-BP groups in terms of demographic characteristics, disease activity, and BMD, except for follow-up erythrocyte sedimentation rate (ESR). The follow-up ESR was higher in the BP than in the non-BP group. A literature review identified six comparative studies reporting the outcomes of BP and non-BP treatments for AS. Despite the heterogeneity, a limited number of meta-analyses reported that BP treatment was not clearly better than non-BP treatment. Hence, further large-scale multicenter studies are required to validate our results.

Objective To compare outcomes of instrumented interbody fusion by the anterior approach (anterior lumbar interbody fusion [ALIF] with posterior pedicle screw fixation [PPF] or lateral lumbar interbody fusion [XLIF] with PPF) or the posterior approach (transforaminal lumbar interbody fusion [TLIF] or posterior lumbar interbody fusion [PLIF]) for spondylolisthesis through meta-analysis. Methods The MEDLINE via PubMed, Cochrane, Scopus, and Embase databases were searched for studies published between January 2010 and January 2019 evaluating outcomes including lumbar lordosis (LL), segmental lordosis (SL), slip rate, disc height (DH), back visual analogue scale (VAS), leg VAS, and Oswestry disability index (ODI) of ALIF with PPF or XLIF with PPF and TLIF or PLIF for spondylolisthesis. Two authors performed the data extraction independently. Any discrepancies were resolved by a consensus. Results Eight comparative studies were identified. There was no significant difference between the anterior approach and the posterior approach for preoperative LL, SL, and DH. In addition, postoperative back and leg VAS, and ODI between the 2 groups were not different. However, the anterior approach was more effective for restoration of postoperative LL, SL, and DH than the posterior approach. Conclusions A literature review identified 8 comparative studies reporting outcomes of the anterior approach and the posterior approach in instrumented interbody fusion for spondylolisthesis. Despite heterogeneity, a limited meta-analysis showed that the postoperative restoration of LL, SL, and DH was better in the anterior approach group. Further large multicenter studies would be necessary to substantiate our results.

Parkinson's disease (PD) is a neurodegenerative disorder characterized by progressive motor deficits and degeneration of dopaminergic neurons. Caused by a number of genetic and environmental factors, mitochondrial dysfunction and oxidative stress play a role in neurodegeneration in PD. By selectively knocking out mitochondrial transcription factor A (TFAM) in dopaminergic neurons, the transgenic MitoPark mice recapitulate many signature features of the disease, including progressive motor deficits, neuronal loss, and protein inclusions. In the present study, we evaluated the neuroprotective efficacy of a novel mitochondrially targeted antioxidant, Mito-apocynin, in MitoPark mice and cell culture models of neuroinflammation and mitochondrial dysfunction.Oral administration of Mito-apocynin (10 mg/kg, thrice a week) showed excellent central nervous system bioavailability and significantly improved locomotor activity and coordination in MitoPark mice. Importantly, Mito-apocynin also partially attenuated severe nigrostriatal degeneration in MitoPark mice. Mechanistic studies revealed that Mito-apo improves mitochondrial function and inhibits NOX2 activation, oxidative damage, and neuroinflammation.The properties of Mito-apocynin identified in the MitoPark transgenic mouse model strongly support potential clinical applications for Mito-apocynin as a viable neuroprotective and anti-neuroinflammatory drug for treating PD when compared to conventional therapeutic approaches.Collectively, our data demonstrate, for the first time, that a novel orally active apocynin derivative improves behavioral, inflammatory, and neurodegenerative processes in a severe progressive dopaminergic neurodegenerative model of PD. Antioxid. Redox Signal. 27, 1048-1066.

Hydrogen sulfide (H(2)S) is a highly neurotoxic gas. It is the second most common cause of gas-induced deaths. Beyond mortality, surviving victims of acute exposure may suffer long-term neurological sequelae. There is a need to develop countermeasures against H(2)S poisoning. However, no translational animal model of H(2)S-induced neurological sequelae exists. Here, we describe a novel mouse model of H(2)S-induced neurotoxicity for translational research. In paradigm I, C57/BL6 mice were exposed to 765 ppm H(2)S for 40 min on day 1, followed by 15-min daily exposures for periods ranging from 1 to 6 days. In paradigm II, mice were exposed once to 1000 ppm H(2)S for 60 minutes. Mice were assessed for behavioral, neurochemical, biochemical, and histopathological changes. H(2)S intoxication caused seizures, dyspnea, respiratory depression, knockdowns, and death. H(2)S-exposed mice showed significant impairment in locomotor and coordinated motor movement activity compared with controls. Histopathology revealed neurodegenerative lesions in the collicular, thalamic, and cortical brain regions. H(2)S significantly increased dopamine and serotonin concentration in several brain regions and caused time-dependent decreases in GABA and glutamate concentrations. Furthermore, H(2)S significantly suppressed cytochrome c oxidase activity and caused significant loss in body weight. Overall, male mice were more sensitive than females. This novel translational mouse model of H(2)S-induced neurotoxicity is reliable, reproducible, and recapitulates acute H(2)S poisoning in humans.

Hydrogen sulfide (H2 S), the gas with the odor of rotten eggs, was formally discovered in 1777, over 239 years ago. For many years, it was considered an environmental pollutant and a health concern only in occupational settings. Recently, however, it was discovered that H2 S is produced endogenously and plays critical physiological roles as a gasotransmitter. Although at low physiological concentrations it is physiologically beneficial, exposure to high concentrations of H2 S is known to cause brain damage, leading to neurodegeneration and long-term neurological sequelae or death. Neurological sequelae include motor, behavioral, and cognitive deficits, which are incapacitating. Currently, there are concerns about accidental or malicious acute mass civilian exposure to H2 S. There is a major unmet need for an ideal neuroprotective treatment, for use in the field, in the event of mass civilian exposure to high H2 S concentrations. This review focuses on the neuropathology of high acute H2 S exposure, knowledge gaps, and the challenges associated with development of effective neuroprotective therapy to counteract H2 S-induced neurodegeneration.

Purpose Recently, cells deficient in O 6 -methylguanine–DNA methyltransferase (MGMT) were found to show increased sensitivity to temozolomide (TMZ). We evaluated whether hypermethylation of MGMT was associated with survival in patients with glioblastoma multiforme (GBM). Methods and Materials We retrospectively analyzed 93 patients with histologically confirmed GBM who received involved-field radiotherapy with TMZ from 2001 to 2008. The median age was 58 years (range, 24–78 years). Surgical resection was total in 39 patients (42%), subtotal in 30 patients (32%), and partial in 17 patients (18%); only a biopsy was performed in 7 patients (8%). Postoperative radiotherapy began within 3 weeks of surgery in 87% of the patients. Radiotherapy doses ranged from 50 to 74 Gy (median, 70 Gy). MGMT gene methylation was determined in 78 patients; MGMT was unmethylated in 43 patients (55%) and methylated in 35 patients (45%). The median follow-up period was 22 months (range, 3–88 months) for all patients. Results The median overall survival (OS) was 22 months, and progression-free survival (PFS) was 11 months. MGMT gene methylation was an independently significant prognostic factor for both OS ( p = 0.002) and PFS ( p = 0.008) in multivariate analysis. The median OS was 29 months for the methylated group and 20 months for the unmethylated group. In 35 patients with methylated MGMT genes, the 2-year and 5-year OS rates were 54% and 31%, respectively. Six patients with combined prognostic factors of methylated MGMT genes, age ≤50 years, and total/subtotal resections are all alive 38 to 77 months after operation, whereas the median OS in 8 patients with unmethylated MGMT genes, age >50 years, and less than subtotal resection was 13.2 months. Conclusion We confirmed that MGMT gene methylation is a potent prognostic factor in patients with GBM. Our results suggest that early postoperative radiotherapy and a high total/subtotal resection rate might further improve the outcome.

Introduction Accurate assessment of prediagnostic baseline erectile function (EF) is crucial when evaluating postoperative changes of EF in patients undergoing bilateral nerve sparing robot‐assisted laparoscopic radical prostatectomy (RLRP). Because score domains of the International Index of Erectile Function‐5 (IIEF‐5) can be affected by factors such as recall intervals and psychological stress or discomfort due to cancer diagnosis and treatment, it is important to assess the prediagnostic baseline EF at appropriate times. Aim To determine optimal timing to evaluate prediagnostic baseline EF in patients undergoing bilateral nerve sparing RLRP. Methods Between March 2009 and February 2010, 54 patients ranging in age from 48 to 74 years were asked to complete IIEF‐5 questionnaires before prostate biopsy, 1 day before RLRP, and 1 month after RLRP to assess preoperative baseline EF. Main Outcome Measures Differences in the mean scores of IIEF‐5 were analyzed using paired t ‐tests. The strengths of the linear relationships among the three IIEF‐5 scores were quantified using Pearson's correlation coefficient. An interrator agreement analysis in distribution was performed using the kappa statistic to determine the degree of agreement among the IIEF‐5 scores. Results The mean IIEF‐5 score before RLRP was significantly higher than the mean IIEF‐5 score before prostate biopsy ( P P = 0.931). Scores of the IIEF‐5 taken before prostate biopsy and 1 month following RLRP showed substantial agreement (kappa = 0.712), whereas scores of the IIEF‐5 taken before prostate biopsy and before RLRP showed lower agreement (kappa = 0.325). Conclusion To more accurately assess the prediagnostic baseline EF in patients with localized prostate cancer, the IIEF‐5 questionnaire should be administered before prostate biopsy rather than before RLRP as cancer diagnosis‐related symptoms and depression can affect IIEF‐5 scores. Kim DS, Chung YG, Kim DJ, Park KK, Chung MS, Lee DH, Lee SH, Mah SY, and Chung BH. Optimal timing to evaluate prediagnostic baseline erectile function in patients undergoing robot‐assisted radical prostatectomy. J Sex Med 2012;9:602–607.

Introduction AMS 700CX/CXM inflatable penile prosthesis is increasingly applied for the treatment of erectile dysfunction (ED). However, there are a few long-term survival data of the inflatable penile prosthesis (IPP) over 10 years. Aim To determine the long-term mechanical reliability of AMS 700CX/CXM inflatable penile prosthesis in patients with ED. Methods A total of 438 consecutive patients with ED received implantation of an AMS 700CX/CXM penile prosthesis at our institution from January 1991 to April 2009. In 397 patients (90.7%), the medical records were available and current status of penile prosthesis could be obtained by a direct telephone interview. The overall and mechanical survival rates of penile prosthesis were evaluated using Kaplan–Meier method. Main Outcome Measures Assessing the mechanical and overall survival rates of the AMS 700CX/CXM penile prosthesis using Kaplan–Meier analysis, and looking for clinical factors related to survival of the CX/CXM using log-rank test. Results Mean age of 397 patients was 63.1 years (range, 24-93) and follow-up duration was 113 months (range 1-219). Eighty-two patients (20.6%) experienced mechanical failure at a median follow-up of 82 months. Mechanical survival rate of the penile prosthesis was 97.6%, 93.2% and 78.2% at 3, 5, and 10 years after implantation, respectively. 12 patients (3.0%) experienced nonmechanical failure including infections, tissue erosion resulting in cylinder protrusion at the meatus and chronic discomfort. Overall survival rate of the penile prosthesis was 95.0%, 91.0% and 75.5% at 3, 5, and 10 years after implantation, respectively. Patients with neurogenic cause for ED showed lower median overall survival of penile prosthesis compared with patients with non-neurogenic cause. Patient age, obesity, and diabetes mellitus had no association with overall survival of penile prosthesis after implantation. Conclusions The AMS 700CX/CXM could be accepted and applied in more patients as a reliable treatment alternative of ED. Kim DS, Yang KM, Chung HJ, Choi HM, Choi YD, and Choi HK. AMS 700CX/CXM inflatable penile prosthesis has high mechanical reliability at long-term follow-up.

Objectives We present a case of transumbilical laparoendoscopic single-site surgery (LESS) for partial nephrectomy in a child. Methods On May 22, 2009, we performed LESS partial nephrectomy on a 7-year-old girl with a 3.5-cm renal mass. The surgery was performed using a homemade single-port device inserted through a single 3-cm umbilical incision. LESS partial nephrectomy was performed with hilar clamping and suturing of the renal defect. Results The duration of the operation was 210 minutes, and the warm ischemic time was 42 minutes. The suturing required 35 minutes, and the estimated blood loss was 10 mL. Histopathological analysis revealed a 3.5-cm metanephric adenoma with a clean surgical margin. The patient was discharged without intraoperative or postoperative complications. On follow-up, Doppler ultrasound sonography showed the kidney was normal in appearance, size, and echogenicity. Split renal function was calculated to be 47.5% for the left kidney upon dimercaptosuccinic acid renal scintigraphy. Conclusions LESS partial nephrectomy was safe and feasible for removal of a renal mass in a child. Additional development of applicable instruments and refinement of the suturing technique are needed.

Objectives To investigate the prognostic significance of lymphovascular invasion (LVI) in patients with localized upper urinary tract transitional cell carcinoma (UUT-TCC) after radical nephroureterectomy. Methods The clinical records of 271 patients with UUT-TCC who underwent radical nephroureterectomy between 1986 and 2006 were reviewed. Patients with pT4 stage, lymph node involvement, or distant metastasis were excluded. A total of 238 patients with pTa-3N0M0 were eligible. The prognostic significance of various clinicopathologic factors was analyzed using univariate and multivariate analysis. The mean age was 64.1 years (range, 25-91 years) and the median follow-up duration was 53.4 months (range, 3-240 months). Results LVI was present in 31 patients (13%). LVI was related to higher pT stage, high tumor grade, sessile architecture, and squamous differentiation. On univariate analysis, tumor architecture, squamous differentiation, LVI, tumor grade, and pT stage influenced disease-specific survival. On multivariate analysis, LVI (hazards ratio [HR], 2.33; P = .014) and pT stage (HR, 2.07; P = .021) showed significantly different rates of disease-specific survival. Patients were classified according to pT stage and LVI. The high-risk group (pT3 and LVI+) showed significantly worse disease-specific survival than the low- (pT ≤ 2 and LVI−) or intermediate-risk groups (pT3 and LVI−, pT ≤ 2 and LVI+) ( P P = .032, respectively). Conclusions LVI and pT stage are significant prognostic factors for recurrence-free and cancer-specific survivals in patients with localized UUT-TCC. LVI and pT stage would be helpful for selecting patients who are appropriate for postoperative adjuvant chemotherapy.

Background Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by ossification of the enthesis. The diagnosis has been mainly based on the chest or whole spine lateral plain film. Recently, chest or thoracolumbar computed tomography (CT) has been reported to be more reliable for the diagnosis of DISH. The purposes of this study were to investigate the prevalence and location of DISH and evaluate the prevalence of comorbidities, such as ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF), using whole spine CT. Methods Whole spine CT scans of patients over 16 years of age who were examined at Cheju Halla General Hospital between February 2011 and December 2016 were reviewed for this study. The diagnosis of DISH was made according to the modified Resnick criteria. The prevalence of DISH in each age decade and its location were evaluated. Also, the prevalence of OPLL and OLF in DISH patients was investigated. Results The overall incidence of DISH was 24.4% (40 of 164 cases). There was no case of DISH in patients in their 40s and younger. The percentile incidences of DISH in patients in their fifth, sixth, seventh, eighth, and ninth decades were 20.0% (4 of 20 cases), 32.3% (10 of 31 cases), 40.0% (10 of 25 cases), 34.5% (10 of 29 cases), and 27.3% (6 of 22 cases), respectively. A strong positive correlation between the age decade and the incidence of DISH was noted (r = 0.853, p = 0.007). DISH patients had higher incidences of OLF (22.5%) and OPLL (37.5%). The most common location of DISH was the middle thoracic spine (90.0%) followed by the lower thoracic spine (87.5%). There was one case of DISH involving only the cervical spine. Conclusions The incidence of DISH diagnosed by CT was higher than we expected. Whole spine CT can be a valuable modality to evaluate the location of DISH in the cervical and lumbar spine and the comorbidity rates of OLF and OPLL.

Background Several previous studies reported on the impact of upright standing and chair sitting on the sagittal spinopelvic alignment. However, there are no studies on the impact of the two Asian (Korean and Japanese) style floor-sitting positions on the sagittal spinopelvic alignment. The purpose of this study was to evaluate the impact of four different body postures (standing, chair sitting, kneel sitting, and cross-legged sitting) on the sagittal spinopelvic alignment. Methods Sixteen selected healthy volunteers (10 males and six females) were subjects of this pilot study. In all subjects, radiographs were taken in comfortable standing and sitting positions. All spinal curvatures including lumbar lordotic angle (LLA), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI) were measured on the radiographs. Results In standing position, the average LLA, SS, PT, and PI were 37.1°, 35.3°, 15.7°, and 51.0°, respectively. In chair sitting, the average LLA, SS, PT, and PI were 17.9°, 20.3°, 28.2°, and 49.5°, respectively. In kneel sitting (Japanese style), the average LLA, SS, PT, and PI were 31.8°, 38.3°, 14.2°, and 52.5°, respectively. In cross-legged sitting (Korean style), the average LLA, SS, PT, and PI were 9.8°, 13.4°, 38.3°, and 51.7°, respectively. LLA in standing (37.1°) and kneel sitting (31.8°) were very similar. Remarkable reduction in LLA was observed in Korean-style cross-legged sitting (9.8°), and LLA in chair sitting (17.9°) was about half of that in standing. SS was similar in standing (35.3°) and kneel sitting (38.3°), and it was reduced remarkably in cross-legged sitting (13.4°). PT was largest in cross-legged sitting (38.3°), and it was similar between standing (15.7°) and kneel sitting (14.2°). PIs were similar in all positions. Conclusions The kneel sitting position did not show significant differences with the standing position when assessed using four parameters related to the sagittal spinopelvic alignment, whereas chair sitting and cross-legged sitting positions significantly altered the spinopelvic alignment compared to the standing position.

Control of blood pressure is important in old age for prevention of hypertension-associated complications. This study aimed to investigate the factors associated with control of hypertension in elderly people (or=60 years old) diagnosed with hypertension.The subjects were those who had a self-reported diagnosis of hypertension (532 men and 1078 women) from a stratified random cluster sample of 4201 people aged 60 years or older. Controlled hypertension was defined as a systolic blood pressure (SBP)140 mmHg and diastolic blood pressure (DBP)90 mmHg, and SBP130 mmHg and DBP80 mmHg for subjects with diabetes.The prevalence of controlled hypertension (25.9%) was low. In older women, the prevalence of isolated uncontrolled SBP was increased. After adjusting for other covariates, uncontrolled hypertension was positively associated with body mass index (BMIor=23 kg/m(2)), and negatively associated with balanced diet and a past history of cardiovascular disease in men, whereas in women it was positively associated with waist circumference (or=80 cm).In elderly people diagnosed with hypertension general obesity (high BMI) appears to have an important influence on uncontrolled hypertension in men, whereas abdominal obesity (high waist circumference) appears to be an important factor in women.

To implement the globally harmonized system of classification and labelling of chemicals (GHS) in Korea, an inter-ministerial GHS committee, involving 8 ministries and an expert working group composed of 9 experts from relevant organizations and one private consultant, have made some progress towards implementation by 2008. As such, the first revision of the official Korean translated version of the GHS in accordance with the GHS purple book revision 1 in 2005, including annexes, started in August, 2006, was completed in December, 2006. The Ministry of Labor also finally revised the Industrial Safety and Health Act (ISHA) relating to the GHS and the detailed notification was announced on Dec 12, 2006 and became effective immediately. The revised ISHA will allow continued use of the existing hazard communication system until Jun 30, 2008. Other revisions of chemical-related regulations will follow soon to facilitate the implementation of the GHS by 2008. Besides, inter-ministerial collaborative efforts on harmonizing regulations and disseminating the GHS in Korea will continue to avoid any confusion or duplication and for the effective use of resources.

Objectives To evaluate the sexual function and stress level during timed intercourse (TI) of male partners of infertile couples. Patients and Methods The study included 236 male partners of couples with >1 year of infertility who sought medical care or an evaluation of couple infertility. Besides infertility evaluation, all men were asked to complete the five-item version of the International Index of Erectile Function (IIEF-5) for evaluation of sexual function, and stresses related to infertility and TI were measured using 10-division visual analogue scales (VAS). Results Stress levels for sexual function were higher during fertile than non-fertile periods in109 of the 236 (46.2%) male partners, with 122 (51.7%) reporting no difference in stress during fertile and non-fertile periods. The mean (sd) VAS score of sexual relationship stress was significantly higher during fertile than non-fertile periods, at 3.4 (2.6) vs 2.1 (2.2) (P

Objective To investigate the therapeutic effectiveness of trigger point injection into the muscles around the groin in patients with clinically diagnosed chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Design Prospective, unicenter trial. Setting University rehabilitation hospital. Participants Patients (N=21) with clinically diagnosed CP/CPPS who are suspected of having myofascial pain syndrome. Intervention Ultrasound-guided trigger point injection. Main Outcome Measures Visual analog scale (VAS), National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) score, and injection-associated complications. Results Ultrasound (US)-guided trigger point injection of the iliopsoas, hip adductor, and lower abdominal muscles resulted in excellent outcomes. The mean values of the NIH-CPSI score decreased significantly from 20.2 pretreatment to 12.5 after the first treatment ( P P Conclusions In patients with CP/CPPS, US-guided trigger point injections of the iliopsoas, hip adductor, and abdominal muscles are safe and effective for both diagnosis and treatment when the cause of groin pain is suspected to originate from muscles. In particular, the iliopsoas muscle was affected in all patients in this study.

To increase the rate of living kidney donation, the long-term safety of nephrectomy must be demonstrated to potential donors. We analyzed long-term donor outcomes and evaluated the standardization of surgical technique. We evaluated 615 donors who underwent Video-assisted minilaparotomy living donor nephrectomy (VLDN) at Yonsei Severance Hospital between 2003 and 2009. Perioperative data and predictors of outcomes were prospectively analyzed. The mean operative time and mean warm ischemia time were 192.7 and 2.2 min, respectively. Mean estimated blood loss was 195.3 ml. The mean post-transplant serum creatinine levels and Modification of Diet in Renal Disease study equation for estimating glomerular filtration rate were 1.1 mg/dl and 68 ml/min/1.73 m(2) , respectively at 5 years after VLDN. The intra-operative and postoperative complication rate were 3.1% and 6.3%, respectively. Delayed renal function, 5-year graft survival, and complication rates of recipients were 1.1%, 98.4%, and 0.4%, respectively. Predictors of operative time were medical history, vessel anomaly, and surgeon experience (50 cases). The single predictor of intra-operative complications was vessel anomaly. Standardized VLDN is feasible and safe. Our data on long-term outcomes can assist in demonstrating the long-term safety of donor nephrectomy to potential donors. To compare VLDN to other types of donor nephrectomy, a prospective multicenter study must be performed.

The present study was aimed to assess the prevalence, awareness, treatment, control of hypertension, and the related risk factors in a Korean population. A cross-sectional study was conducted in a rural area of South Korea from 2005 to 2006. Subjects (n = 6388) were selected from individuals aged 40 years or older by stratified random cluster sampling. The age-adjusted prevalence of hypertension was 43.8 % (43.1 % in men, 44.9 % in women). The awareness, treatment, and control of hypertension were 60.1%, 91.7%, and 27.2%, respectively. In men, old age (> or = 60 years old) and low waist circumference (< 90 cm) were positively associated with higher awareness and treatment, whereas body mass index (BMI) was negatively associated with blood pressure (BP) control. Women aged 60 years or older were more aware of their condition, more treated, and more in control of their BP as well. In women, high BMI and a family history of diabetes mellitus were positively associated with higher awareness and treatment, whereas low waist circumference (< 80 cm) was negatively associated with BP control. Our findings indicate that appropriate health care should be given to hypertensive subjects on the basis of these risk factors and according to their sex.

OBJECTIVES To describe our experience with robot-assisted laparoendoscopic single-site surgery (LESS) to perform partial nephrectomy and evaluate a hybrid homemade port system as an effective access technique. METHODS From December 2008 to September 2009, robot-assisted LESS to perform partial nephrectomy through a hybrid homemade port was performed to treat 14 cases of renal cell carcinoma. The data, including patient characteristics, operative records, complications, and pathologic results, were analyzed. RESULTS The mean tumor size was 3.2 cm, the mean ischemic time was 30 minutes, and the mean operative time was 233 minutes. We used the hybrid homemade port technique in 10 cases. All surgical margins after partial nephrectomy were negative for malignancy. No port-related complications were reported. Two cases required conversion to mini-incisional partial nephrectomy. CONCLUSIONS Robot-assisted LESS for performing partial nephrectomy using a hybrid homemade port system is a safe and feasible treatment technique. It provided access for meticulous suturing on the renal parenchyma using articulating robot arms and ready access to the surgical field for the assistant.

Background Despite tremendous progress in understanding the mechanisms of constitutive and alternative splicing, an important and widespread step along the gene expression pathway, our ability to deliberately regulate gene expression at this step remains rudimentary. The present study was performed to investigate whether a theophylline-dependent "splice switch" that sequesters the branchpoint sequence (BPS) within RNA-theophylline complex can regulate alternative splicing. Results We constructed a series of pre-mRNAs in which the BPS was inserted within theophylline aptamer. We show that theophylline-induced sequestering of BPS inhibits pre-mRNA splicing both in vitro and in vivo in a dose-dependent manner. Several lines of evidence suggest that theophylline-dependent inhibition of splicing is highly specific, and thermodynamic stability of RNA-theophylline complex as well as the location of BPS within this complex affects the efficiency of splicing inhibition. Finally, we have constructed an alternative splicing model pre-mRNA substrate in which theophylline caused exon skipping both in vitro and in vivo, suggesting that a small molecule-RNA interaction can modulate alternative splicing. Conclusion These findings provide the ability to control splicing pattern at will and should have important implications for basic, biotechnological, and biomedical research.

Purpose: To compare the efficacy of corpus callosotomy and vagus nerve stimulation (VNS) for long-term adjunctive therapy in children with Lennox–Gastaut syndrome (LGS). Method: Fourteen patients underwent a total corpus callosotomy and 10 patients received VNS implantation. The patients were monitored for more than 12 months after treatment, and seizure rates and complications were retrospectively evaluated. Results: Seizure types among the 24 patients included atonic or tonic seizures with head-drops in 17 patients, generalized tonic seizures in two patients, atypical absence seizures in one patient, generalized tonic–clonic seizures in one patient, and myoclonic seizures in three patients. Of the 14 patients who underwent a corpus callosotomy, nine (64.3%) had a greater than 50% reduction in seizure frequency and five (35.7%) had a greater than 75% reduction. Of the 10 patients who underwent VNS implantation, seven (70.0%) had a greater than 50% reduction in seizure frequency and two (20.0%) had a greater than 75% reduction. There was no significant difference between the two procedures in terms of final efficacy. Complications of corpus callosotomy included aphasia in one patient, ataxia in another, and paresis in a third. Among patients receiving VNS, one patient experienced dyspnea while sleeping and one patient suffered from drooling. These complications were transient and tolerable, and were controlled by simple adjustments of VNS treatment parameters. Conclusion: The efficacy and safety of corpus callosotomy and VNS were comparable in children with LGS.

Riboswitches, as previously reported, are natural RNA aptamers that regulate the expression of numerous bacterial metabolic genes in response to small molecule ligands. It has recently been shown that these RNA genetic elements are also present near the splice site junctions of plant and fungal introns, thus raising the possibility of their involvement in regulating mRNA splicing. Here it is shown for the first time that a riboswitch can be engineered to regulate pre-mRNA splicing in vitro. We show that insertion of a high-affinity theophylline binding aptamer into the 3′ splice site (3′ ss) region of a model pre-mRNA (AdML-Theo29AG) enables its splicing to be repressed by the addition theophylline. Our results indicate that the location of 3′ ss AG within the aptamer plays a crucial role in conferring theophylline-dependent control of pre-mRNA splicing. We also show that theophylline-mediated control of pre-mRNA splicing is highly specific by first demonstrating that a small molecule ligand similar in shape and size to theophylline had no effect on the splicing of AdML-Theo29AG pre-mRNA. Second, theophylline failed to exert any influence on the splicing of a pre-mRNA that does not contain its binding site. Third, theophylline specifically blocks the step II of the splicing reaction. Finally, we provide evidence that theophylline-dependent control of pre-mRNA splicing is functionally relevant.

Purpose: We evaluated the collagen-to-smooth muscle tissue matrix ratio and percentage of elastin in the renal pelvis, ureteropelvic junction (UPJ) and ureter, and compared these findings with the degree of obstruction, patient age and post-pyeloplasty renal recovery. Materials and Methods: We analyzed histological sections from 75 patients with UPJ obstruction. Nine patients were excluded owing to bilateral UPJ obstruction and an improper specimen. We divided the specimen obtained from pyeloplasty into 3 parts, namely the renal pelvis above the obstruction, the obstructed UPJ portion and the ureter below the obstruction. To examine the collagen and smooth muscle, sections were stained using Masson's trichrome, and elastic van Giesson stain was used for elastin, smooth muscle and collagen. Collagen, smooth muscle and elastin populations were identified, and the tissue matrix ratio and percentage of elastin were calculated by color image analysis. Results: In patients with lower ratios of collagen-to-smooth muscle in the UPJ proper hydronephrosis was more improved postoperatively (p = 0.049). In patients with a lower percentage of elastin in the renal pelvis, UPJ and ureter hydronephrosis was more improved postoperatively (p Conclusions: Because the UPJ portion was resected during pyeloplasty, the renal pelvis and the ureter remaining after pyeloplasty are likely to be related to improved hydronephrosis. A higher percentage of elastin in the renal pelvis and ureter contributes to inelasticity and low compliance, and results in a slower recovery from hydronephrosis after pyeloplasty.

Objectives To evaluate the significance of vesicoureteral reflux (VUR) in adult women with uncomplicated acute pyelonephritis. Methods Eighty-six adult women with uncomplicated acute pyelonephritis were studied from April 1998 to October 2003. They showed no structural urinary tract abnormalities. The mean age of patients was 36.2 years (range, 19 to 54 years). We divided these patients into two groups. In group I (31 patients), we performed a voiding cystourethrogram (VCUG) on the third day of treatment to demonstrate possible transient low-grade VUR during the acute infectious phase. In group II (the remaining 55 patients), we performed VCUG after the seventh day of treatment. Results There were only 2 (2.3%) cases of VUR among 86 patients with uncomplicated acute pyelonephritis. No VUR was found in group I, and grade II reflux was found in 2 patients of group II. Conclusions These results indicate that, unlike in children, VUR is not a significant factor causing ascending infection leading to the development of acute pyelonephritis in adult women. Further research is warranted regarding the pathophysiology of ascending infection in the adult population.

To make clear the uncertainty of the clinical outcome of extramammary Paget's disease (EMPD). Penile and scrotal involvement of EMPD is exceedingly rare, and only small series or case reports have been reported.From 1995 to 2003, 36 patients with penile and scrotal EMPD were treated and followed up. Local wide excision was done in all patients with or without intraoperative frozen biopsy analysis.Of the 36 patients, 13 (36.1%) underwent intraoperative frozen biopsy analysis and only 1 patient (7.7%) had a positive surgical margin. However, 23 (63.9%) underwent local wide excision with excessive surgical margins of up to 1 to 2 cm only by gross examination, but 17 (73.9%) of them had positive surgical margins (P0.01). Of the 17 patients with positive surgical margins, 8 developed local recurrence at a median of 8 months of follow-up (P0.05). One patient who had invasion to the subcutaneous tissue died of metastatic EMPD and internal malignancy (renal cell carcinoma) at 17 months after the initial operation. No patient had underlying adnexal carcinoma.The results of our study indicate that local wide excision with intraoperative frozen biopsy analysis is essential to the complete treatment of EMPD.

Perivascular epithelioid cells (PEC) in angiomyolipoma (AML) were recently proposed to be its most common progenitor cells. Histologically, triphasic components were present in various proportions, but were overwhelmingly myogenic in epithelioid variants of AML. Despite histological discrimination, the immunophenotypic profiles between triphasic and epithelioid AML have never been compared. The aim of the present study was to clarify the identity of PEC by using immunoreactivity to estrogen receptor (ER), progesterone receptor (PR), bcl-2 and placenta alkaline phosphatase (PLAP), and to use this information to compare triphasic and epithelioid AML. A total of 33 out of 67 cases of renal angiomyolipoma that underwent surgery were reviewed over the period 1998-2003. Two cases were associated with tuberous sclerosis. Ten patients had other malignant tumors, and three patients had a nodal extension. Immunohistochemistry showed that bcl-2 (59.4%), PLAP (46.9%), HMB-45 (100%) was predominantly localized around vessels. The stem cell markers were absolutely negative in all AML types. The estrogen receptors were positive in 14 cases (42.4%) and the progesterone receptors were positive in five cases. Bcl-2 and both female sex hormone receptors were significantly more frequent in the epithelioid variant of AML than in the triphasic type. Perivascular epithelioid cells express bcl-2, ER, PR and PLAP, and ER could be partly associated with myogenic proliferation.

We examined whether the presence and severity of preoperative hydronephrosis have prognostic significance in patients who underwent radical cystectomy for transitional cell carcinoma of the bladder. The medical records of 457 patients who underwent radical cystectomy for bladder cancer between 1986 and 2005 were retrospectively reviewed. Following the Society for Fetal Urology grading system, patients were divided into low-, and high-grade hydronephrosis groups. Clinicopathologic factors associated with preoperative hydronephrosis and survival were evaluated. Of a total of 406 patients, unilateral hydronephrosis was found in 74 (18.2%), bilateral hydronephrosis in 11 (2.7%), and no hydronephoris in 321 (79.1%). Low-grade hydronephrosis was found in 57 (12.2%) patients and high-grade hydronephrosis in 28 (6%). Preoperative hydronephrosis was related to higher pT stage and lymph node invasion. In univariate analysis, the presence of hydronephrosis, hydronephrosis grade, age, pT and pN stage, tumor grade, surgical margin, number of retrieved nodes, carcinoma in situ, and lymphovascular invasion were significant prognostic factors for cancer-specific survival. In multivariate analysis, bilateral hydronephrosis and high-grade hydronephrosis remained significant predictors for decreased survival. The presence of preoperative hydronephrosis, and high-grade hydronephrosis are significant prognostic factors in patients with bladder cancer after radical cystectomy.

We evaluated the long-term outcome of vagus nerve stimulation (VNS) in 28 children with refractory epilepsy. Of these 28 children, 15 (53.6%) showed a >50% reduction in seizure frequency and 9 (32.1%) had a >75% reduction. When we compared seizure reduction rates according to seizure types (generalized vs. partial) and etiologies (symptomatic vs. cryptogenic), we found no significant differences. In addition, there was no correlation between the length of the stimulation period and treatment effect. The seizure reduction rate, however, tended to be inversely related to the seizure duration before VNS implantation and age at the time of VNS therapy. VNS also improved quality of life in this group of patients, including improved memory in 9 (32.1%), improved mood in 12 (42.9%), improved behavior in 11 (39.3%), improved altertness in 12 (42.9%), improved achievement in 6 (21.4%), and improved verbal skills in 8 (28.6%). Adverse events included hoarseness in 7 patients, dyspnea at sleep in 2 patients, and wound infection in 1 patient, but all were transient and successfully managed by careful follow-up and adjustment of parameters. These results indicate that VNS is a safe and effective alternative therapy for pediatric refractory epilepsy, without significant adverse events.

Background : To evaluate the prevalence and clinical characteristics of metabolic syndrome as defined by the NCEP-ATP III criteria in middle aged Korean rural people. Methods : Cross-sectional study including 5330 participants (2197 males, 3133 females), over the age 40. Metabolic syndrome according to NCEP-ATP III criteria was defined if three or more of the following criteria were satisfied: 1) Abdominal obesity: Waist circumference (WC) in men > 102 cm and in women > 88 cm. 2) Hypertriglyccridcmia: 150 mg/dL. 3) Low HDL cholesterol: 130/85 mmHg. 5) High fasting glucose: 110 mg/dL. We also applied WHO-APR (Asian Pacific Region) criteria for abdominal obesity (WC in men > 90 cm and in women > 80 cm) instead of NCEP-ATP III criteria. Insulin resistance was analysed by HOMA-IR. Results : Age-adjusted overall prevalence of metabolic syndrome by NCEP-ATP III criteria was 24.8% (17.6% in men, 30.0% in women). The prevalence of metabolic syndrome for each age group in men was as follows: age 40 through 49 (18.8%), 50 through 59 (17.4%), 60 through 69 (18.3%), and over 70 (14.5%). In women: age 40 through 49 (22.3%), 50 through 59 (32.7%), 60 through 69 (39.9%), and over 70 (39.3%). In men, the prevalence decreased with aging, but not in women with consistent increment. Age-adjusted prevalence of abdominal obesity was 1.6% (men) & 25.3% (women) by NCEP-ATP III criteria, but 22.5% (men) & 55.6% (women) by WHO-APR criteria. Among various components of metabolic syndrome, the prevalence of hypertriglyceridemia was well correlated with the changing pattern of the prevalence of metabolic syndrome. Relative risk of metabolic syndrome increased as HOMA-IR & fasting insulin levels did. Conclusion : In middle aged Korean adults, metabolic syndrome defined as NCEP-ATP III criteria was strongly correlated to the degree of insulin resistance. The peak age of metabolic syndrome in men was age 40 through 49, and the prevalence decreased with aging. Therefore, early intervention for risk factors of metabolic syndrome might be required in men. On the other hand, prevention for cardiovascular disease will be needed for perimenopausal women due to considerably increased prevalence in the age 50 through 59.

Purpose The aim of this study is to investigate seizure outcomes following epilepsy surgery in non-lesional neocortical pediatric epilepsy. Methods We performed a retrospective study on 27 patients with intractable childhood epilepsy who received epilepsy surgery between 1999 and 2006 at Sang-gye Paik Hospital and Severance Children's Hospital. None of the patients had any detectable lesions on MRI. Surgical outcome was assessed at least 2 years postoperatively; clinical characteristics, surgical outcome, pathologic findings, types of surgery, localizing features on SPECT, FDG-PET, and long-term video-EEG were reviewed. Results Eighteen patients (67%) demonstrated an Engel class I outcome postoperatively. The mean follow-up duration was 4.3 years (range, 2.2–9 years). Eighteen out of 27 cases (67%) showed focal localizing features on ictal SPECT, and 21 of 27 cases (78%) showed abnormal findings on PET. Single lobectomy was the most common procedure, and was performed in 20 patients (74%). Multilobar resection was performed in seven patients (26%). Cortical dysplasia was the most common finding during pathological examination, and was observed in 15 (56%) cases. In addition, gliosis was found in two patients (7%) and non-specific pathological findings were described in 10 patients (37%). Conclusions In children with intractable epilepsy and a MRI demonstrating no abnormal lesions, epileptic surgery should be strongly considered when cortical pathology can be identified from other studies.