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Objective: To demonstrate that hypolipidemia is a typical feature of the mouse model of amyotrophic lateral sclerosis (ALS) and to assess the association between hypolipidemia and disease stage, dietary intake, and sex. Methods: We compared daily dietary intake, body weight, and serumlipid and glucose levels in ALS mice and wild-type controls at different stages of the disease. Findings: Total cholesterol low-density lipoprotein (LDL) and LDL/high-density lipoprotein (HDL) ratio were significantly lower in ALS mice compared with controls. Subgroup analysis revealed that the incidence of hypolipidemia was significantly greater in male, but not female, ALS mice compared with control mice and that hypolipidemia was present at the presymptomatic stage of the disease. This hypolipidemia can be found without a decrease in the serum levels of other energy sources, such as glucose, in the presymptomatic stage. Conclusions: Hypolipidemia is present at the presymptomatic stage of the ALS mouse model in the absence of malnutrition, significant neuromuscular degeneration or regeneration, and respiratory difficulty. Our findings suggest that hypolipidemia might be associated with the pathomechanism of ALS and/or lipid-specific metabolism rather than simply an epiphenomenon of neuromuscular degeneration or energy imbalance. [ABSTRACT FROM AUTHOR]

Background: Patients with amyotrophic lateral sclerosis (ALS) suffer from hypoventilation, which can easily worsen during sleep. This study evaluated the efficacy of capnography monitoring in patients with ALS for assessing nocturnal hypoventilation and predicting good compliance with subsequent noninvasive ventilation (NIV) treatment. Methods: Nocturnal monitoring and brief wake screening by capnography/pulse oximetry, functional scores, and other respiratory signs were assessed in 26 patients with ALS. Twenty-one of these patients were treated with NIV and had their treatment compliance evaluated. Results: Nocturnal capnography values were reliable and strongly correlated with the patients' respiratory symptoms (R2 = 0.211-0.305, p = 0.004-0.021). The duration of nocturnal hypercapnea obtained by capnography exhibited a significant predictive power for good compliance with subsequent NIV treatment, with an area-under-the-curve value of 0.846 (p=0.018). In contrast, no significant predictive values for nocturnal pulse oximetry or functional scores for nocturnal hypoventilation were found. Brief waking supine capnography was also useful as a screening tool before routine nocturnal capnography monitoring. Conclusion: Capnography is an efficient tool for assessing nocturnal hypoventilation and predicting good compliance with subsequent NIV treatment of ALS patients, and may prove useful as an adjunctive tool for assessing the need for NIV treatment in these patients. [ABSTRACT FROM AUTHOR]

It has been suggested that oxidative stress is associated with the pathogenesis of osteoporosis. The objective of this study was to explore the association between a marker of oxidative stress and either bone turnover markers or bone mineral density (BMD) in postmenopausal women. In addition, the effects of oxidative stress on the formation of osteoclasts in human bone marrow cell culture were examined. We performed a cross-sectional analysis in healthy postmenopausal women aged 60–78 years ( n = 135, 68.2 ± 4.9). Oxidative stress was evaluated in the serum by measuring 8-hydroxy-2′-deoxyguanosine (8-OH-dG) levels. The biochemical markers of bone turnover and areal BMD were measured in all participants. Multivariate linear regression analysis revealed a negative association between 8-OH-dG levels and BMD of the lumbar spine, total hip, femoral neck, and trochanter and positive association with type I collagen C-telopeptide (ICTP) levels. The odds ratio of 8-OH-dG for osteoporosis was 1.54 (1.14–2.31, P = 0.003). In cultures of primary human marrow cells, HO caused concentration-dependent activation of TRAP-positive multinucleated giant cells. HO also increased the area of pits per osteoclast activity assay substrate. RT-PCR showed that HO stimulated the expression of M-CSF and RANKL and increased the RANKL/OPG ratio. The data support the view that oxidative stress is associated with increased bone resorption and low bone mass in otherwise healthy women. In addition, RANKL and M-CSF stimulation induced by oxidative stress may participate in osteoclastogenesis in human bone. [ABSTRACT FROM AUTHOR]

Background:The association between autoimmune thyroiditis (AIT) and thyroid cancer is still not clear despite many previous reports. This study investigated whether serologic thyroid antibodies are predictive of thyroid cancer in patients with thyroid nodules.Method:We retrospectively reviewed records of patients with thyroid nodules evaluated by ultrasonography-guided fine-needle aspiration cytology at our institution between January 2006 and December 2008. Thyroid autoimmunity was assessed by measuring thyroglobulin antibody (TgAb) and thyroid peroxidase antibody (TPOAb). The final outcome deciding a benign or malignant status involved a combination of cytology and histology.Results:Of the 1638 patients, malignant nodules had a higher rate of positive TgAb (30.8% vs. 19.6%; p< 0.001) and elevated thyrotropin (TSH) levels (2.5 ± 2.8 mIU/L vs. 2.1 ± 2.0 mIU/L; p= 0.021) than benign nodules. The rate of positive TPOAb was not higher in malignant nodules, although both TPOAb and TgAb were well correlated with TSH levels and histological AIT. In the multivariate analysis, a positive TgAb was significantly associated with thyroid cancer (odds ratio [OR] = 1.61, 95% confidence interval [CI] 1.12–2.33) with upper tertile of normal range of TSH levels (OR = 1.72, 95% CI 1.12–2.63) and above normal range of TSH levels (OR = 1.98, 95% CI 1.06–3.70).Conclusion:We report for the first time that a positive serum TgAb test was an independent predictor for thyroid malignancy in thyroid nodules along with serum TSH levels regardless of the presence of AIT. Our results suggest that TgAb measurement could give additional information for predicting malignancy in cytologically indeterminate thyroid nodules in conjunction with clinical risk factors and TSH levels. [ABSTRACT FROM AUTHOR]

Longitudinally extensive transverse myelitis (LETM) is a syndrome with extensive spinal cord lesions spanning three or more vertebral segments on spinal cord MRI. Although many reports have indicated that LETM is a characteristic feature of neuoromyelitis optica (NMO) in Western countries, the clinical characteristics and risk for development of NMO in Korean patients with LETM is not clear. We retrospectively investigated the clinical, laboratory, radiological features, and prognosis of Korean patients with a first-ever episode of idiopathic LETM. Patients were classified into four subgroups, depending on their clinical course: monophasic LETM, recurrent LETM, NMO, and classic multiple sclerosis (MS). We compared various clinical, laboratory, and radiological features between groups. Of 20 patients with first-ever LETM, 15 (75%) were men, and 13 (65%) experienced clinical relapse over a mean follow-up period of 58 months. Three of 20 patients (two with NMO, one with recurrent myelitis) were seropositive for anti-AQP4 antibodies. The predominance of men in the monophasic and recurrent LETM groups compared to the NMO group was remarkable. In conclusion, Korean patients with LETM are predominantly male and have low seropositivity for anti-AQP4 antibody, which distinguishes them from LETM patients in Western countries. Patients with LETM and seropositivity for anti-AQP4 antibody have a high risk of relapse. The male predominance and the relatively low seropositive rate for anti-AQP4 suggests that rather than being a limited form of NMO, recurrent LETM is a new clinical entity in Koreans. [ABSTRACT FROM AUTHOR]

Hereditary spastic paraplegia with thin corpus callosum (HSP-TCC) is one of the most common complicated forms of autosomal recessive hereditary spastic paraplegia (HSP). Mutation in SPG11 gene, which is mapped to chromosome 15q21, was recently found to be a major cause of this variant form of HSP. The aim of this study is to investigate SPG11 mutations and clinical manifestations in two Korean families with HSP-TCC. Direct sequencing of the 40 coding exons and boundaries of exon–intron in SPG11 gene, and descriptions of clinical findings in two nonconsanguineous families with HSP-TCC are presented. Three novel and one known compound heterozygous mutations were found in two affected families, which were not found in controls, including one deletion in exon (c.5410_5411delTG), two insertions (c.1834_1835InsT and c.2163_2164InsT), and one missense mutation (c.3291+1G>T). Both of our patients had impairments in frontal lobe functions. We present the first SPG11 mutations in Korean families, three of which are novel. SPG11 mutation should be suspected in Korean patients having HSP with TCC and executive dysfunction. [ABSTRACT FROM AUTHOR]

The fadBA operon in the fatty acid β-oxidation pathway of P. putida KCTC1639 was blocked to induce a metabolic flux of the intermediates to the biosynthesis of medium chain-length PHA (mcl-PHA). Succinate at 150 mg l−1 stimulated cell growth and also the biosynthesis of medium chain-length-polyhydroxyalkanoate. pH-stat fed-batch cultivation of the fadA knockout mutant P. putida KCTC1639 was carried out for 60 h, in which mcl-PHA reached 8 g l−1 with a cell dry weight of 10.3 g l−1. [ABSTRACT FROM AUTHOR]

Background: Papillary thyroid microcarcinoma (PTMC) detection has been increasing explosively with the recent improvement and application of new diagnostic tools. However, the associations between clinical, histopathological, and molecular findings are often not fully evaluated in reaching a decision for the treatment of PTMC. Objective: To retrospectively evaluate the patients diagnosed with PTMC in terms of the clinical and histopathological features and the immunohistochemical findings of specific molecular markers, and thereby provide an association with the disease prognosis for the Korean patients. Design: We have reviewed the clinical records of patients who underwent surgery for thyroid cancer (during January 2000 to August 2006 interval) at St. Mary''s Hospital, Seoul, Korea. The clinical and histopathological characteristics of 217 PTMCs were evaluated cross-sectionally after surgery, and immunohistochemical staining of p53, epidermal growth factor receptor (EGFR), Ki-67, and cyclooxygenase-2 (COX-2) for 87 isolated specimens was performed. Main outcome: The proportions of extrathyroid extension, lymphatic invasion, and lymph node metastasis cited were 31.9, 19.2, and 17.8, respectively. However, distant metastasis was not noted. Fifty-three (27.1) patients had multiplicity, and 39 patients (20.0) had bilateral disease. A primary tumor larger than 5 mm was significantly associated with extrathyroid extension, lymphatic invasion, and lymph node metastasis. The absence of EGFR expression shown by immunohistochemical analysis was closely correlated with extrathyroid extension and lymph node metastasis, while the absence of COX-2 expression was associated with multiplicity and bilaterality. Conclusion: Many patients with PTMC had clinical and histopathological poor prognostic factors. The expression of molecular markers, such as EGFR and COX-2, may have a role in the prognosis of PTMC. When considering all of the prognostic factors, a more tailored management approach appears to be necessary for patients with PTMC. [ABSTRACT FROM AUTHOR]

Objective:We analyzed the sonographic characteristics of thyroid nodules and assessed the diagnostic value of ultrasonography in order to distinguish between benign and malignant lesions in terms of the management of thyroid nodules. Design:We retrospectively analyzed the sonographic features of thyroid nodules in 580 patients who had been examined with fine-needle aspiration cytology or who underwent surgery for a thyroid nodule. The sonographic features that suggested malignancy include microcalcifications, an irregular or microlobulated margin, marked hypoechogenicity, and a shape that was taller than it was wide. The presence of one or more of these features indicated classification as category 3 (malignant). The absence of all of these features indicated classification as category 2 (benign). Presence of an anechogenic cystic nodule was classified as category 1 (benign). Main outcome:Of 124 lesions classified as category 3, 60 of the lesions were malignant. Of 418 lesions classified as category 1 or 2, 409 were benign. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy based on the sonographic classification method were 87.0, 86.5, 48.4, 97.8, and 86.5, respectively. Conclusions:Our results identified this sonographic classification as a useful tool in the differentiation of malignant nodules from benign nodules. In view of the high negative predictive value of sonographic classification, a more aggressive approach is recommended only for category 3 nodules. [ABSTRACT FROM AUTHOR]

Nerve Growth Factor (NGF) is a neurotrophic factor that prevents apoptosis in neuronal progenitor cells. In rat pheochromocytoma (PC12) cells, tyrosine kinase A receptor (TrkA) mediates neurotrophic or protective effects, while p75 neurotrophin receptor (p75NTR) functions as a death receptor. We have determined whether TrkA mediates any cytotoxic effect. Following serum deprivation, TrkA expression increased 2.2-fold and apoptosis began with expression of Bax proapoptotic protein. Application of NGF halved cell viability but this was reversed by K252a, the TrkA inhibitor. These results confirmed the paradoxical cytotoxic effect of neurotrophic NGF via TrkA in PC12 cells following serum deprivation. [ABSTRACT FROM AUTHOR]

The enantioselective hydrolysis of insoluble (R,S)-ketoprofen ethyl ester to the optically active (S)-ketoprofen was carried out in a dispersed aqueous lipase reaction system induced by the inclusion of chiral cyclodextrins for complexation of the substrate. Hydroxypropyl-β-cyclodextrin was the most effective chiral selector and disperser giving an enantiomeric excess and conversion yield of 0.99 and 0.49, respectively. [ABSTRACT FROM AUTHOR]

Motor unit number estimations (MUNEs) can directly assess motor unit populations in muscle and quantify the degree of physiological or pathological motor unit degeneration. A high degree of reproducibility and reliability is required of any effective quantitative tool. MUNE is being increasingly applied clinically, and statistical MUNE has several advantages over alternative techniques. Nevertheless, the optimal method of applying statistical MUNE with respect to its reproducibility has not been established. We performed statistical MUNE by selecting the most compensated compound muscle action potential (CMAP) area as a test area and modified the results obtained by using the weighted mean surface-recorded motor unit potential (SMUP). MUNE measurements made in patients with amyotrophic lateral sclerosis (ALS) showed better reproducibility after incorporating the size-weighted modification. Therefore, we suggest that the size-weighted MUNE in combination with the selection of testing “neurogenically compensated” CMAP areas is a more reliable method of statistical MUNE analysis in ALS patients. Muscle Nerve 29: 211–217, 2004 [ABSTRACT FROM AUTHOR]

OBJECTIVE — The Internet is used worldwide as a communication tool. To improve the quality of diabetes control, we investigated the effectiveness of an Internet-based blood glucose monitoring system (IBGMS) on controlling the changes in HbA1c levels. RESEARCH DESIGN AND METHODS — We conducted a randomized clinical trial involving 110 patients who visited the outpatient clinic at the Kangnam St. Mary's Hospital for 3 months. The study subjects were treated with IBGMS for 12 weeks, and the control group received the usual outpatient management over the same period. HbA1c and other laboratory tests were performed twice, once at the beginning of the study and again at the end of the study. RESULTS — The test results from the beginning of the study established that there were no significant differences between the two groups with respect to age, sex, diabetes duration, BMI, blood pressure, HbA1c, and other laboratory data. On follow-up examination 12 weeks later, HbA1c levels were significantly decreased from 7.59 to 6.94% within the intervention group (P < 0.001). At the end of the study, HbA1c levels in the intervention group were significantly lower than in the control group after adjusting the baseline HbA1c (6.94 vs. 7.62%; P < 0.001, respectively). Among patients with baseline HbA1c <7.0%, the patients in the intervention group had lower HbA1c than those in the control group (6.38 vs. 6.99%; P < 0.05). Among the patients with a baseline HbA1c ≥7.0%, the difference between the two groups appeared more obvious: HbA1c levels at the end of the study were 8.12%. CONCLUSIONS — This new IBGMS resulted in a significant reduction of HbA1c during the study period. We propose that this IBGMS be used as a method for improving diabetes control. [ABSTRACT FROM AUTHOR]

Acute myelitis and optic neuritis are the main clinical features of patients with neuromyelitis optica (NMO), which usually appears as a relapsing-remitting course of disease that worsens over days and improves over weeks. We present a patient with chronic progressive myelitis over a 4-month period without remission as having a limited form of NMO that improved after plasmapheresis. Plasmapheresis may benefit patients with chronic progressive myelitis, which may be a manifestation of NMO, as well as those with a relapsing-remitting course of NMO. [ABSTRACT FROM AUTHOR]

Purpose: To investigate urine microbiome differences among healthy women, women with recurrent uncomplicated cystitis (rUC), and those with sporadic/single uncomplicated cystitis (sUC) to challenge traditional beliefs about origins of these infections. Materials and Methods: Patients who underwent both conventional urine culture and next-generation sequencing (NGS) of urine were retrospectively reviewed. Symptom-free women with normal urinalysis results as a control group were also studied. Samples were collected via transurethral catheterization. Results: In the control group, urine microbiome was detected on NGS in 83.3%, with Lactobacillus and Prevotella being the most abundant genera. The sensitivity of urine NGS was significantly higher than that of conventional urine culture in both the sUC group (91.2% vs. 32.4%) and the rUC group (82.4% vs. 16.4%). In urine NGS results, Enterobacterales, Prevotella, and Escherichia/Shigella were additionally found in the sUC group, while the recurrent urinary tract infection (rUTI)/rUC group exhibited the presence of Lactobacillus, Prevotella, Enterobacterales, Escherichia/Shigella, and Propionibacterium. Moreover, distinct patterns of urine NGS were observed based on menopausal status and ingestion of antibiotics or probiotics prior to NGS test sampling. Conclusions: Urine microbiomes in control, sUC, and rUTI/rUC groups exhibited distinct characteristics. Notably, sUC and rUC might represent entirely separate pathological processes, given their distinct urine microbiomes. Consequently, the use of urine NGS might be essential to enhancing sensitivity compared to conventional urine culture in both sUC and rUTI/rUC groups.

The article discusses the case of a 19-year-old male patient with facioscapulohumeral muscular dystrophy (FSHD). Topics covered include the results of his neurological examination, the distinctive features of neuralgic amyotrophy which was the first impression on the patient and the atypical manifestations of FSHD such as foot drop and proximal leg weakness.

Purpose: To evaluate the success rate and patient satisfaction with the readjustable midurethral sling (REMEEX system) for the treatment of stress urinary incontinence (SUI) with intrinsic sphincter deficiency (ISD) or recurrent SUI in obese and non-obese women. Materials and Methods: Between August 2009 and August 2015, 70 patients who treated with the REMEEX system were stratified into normal, overweight and obesity groups according to body mass index. Objective surgical outcomes were evaluated using a 1-hour pad test that was performed 3 months after surgery. The subjective outcomes and degree of patient satisfaction were evaluated 3 months and 1 year after surgery. Results: Twenty-six normal weight, 31 overweight, and 13 obese women were included in the study. The objective cure rate determined using the 1-hour pad test revealed that 11 women (42.3%) were cured and 15 (57.7%) had improved in the normal weight group, respectively, compared with 16 (51.6%) and 15 (48.4%) in the overweight group and 6 (46.2%) and 7 (53.8%) in the obese group, respectively (p=0.78). One year after surgery, the subjective success rate was 91.5% in the normal weight group, 93.5% in the overweight group and 92.3% in the obese group. A total of 84.7%, 77.4%, and 77.0% of normal weight, overweight and obese women were very satisfied or satisfied 1 year after surgery, respectively. All groups showed similar success rates and satisfaction. Conclusions: The REMEEX procedure is equally effective in obese and normal weight women with ISD-type SUI or recurrent SUI. [ABSTRACT FROM AUTHOR]

The article presents a case study of a girl who was diagnosed with motor neuron disease. The patient was diagnosed of beta-hexosaminidase A and B activity deficiency and Sandhoff disease was confirmed positive. She was assumed to have inherited 619A-G mutation from her mother. The article discusses Sandhoff disease, an autosomal recessive disease characterized by inability to create beta-hexosaminidase A and B enzyme involved in hydrolysis.

Since the identification of the human urinary microbiome, numerous studies have characterized this microbial community and improved our knowledge of its association with urinary diseases. This association between urinary diseases and microbiota is not confined to the urinary microbiota; it is interconnected with the microbiota of other organs. The gastrointestinal, vaginal, kidney, and bladder microbiota all affect urinary diseases because they work with their respective organs to control the growth and operation of the immune, metabolic, and nervous systems through dynamic bidirectional communication along the bladder-centered axis. Therefore, disturbances in the microbial communities may result in the emergence of urinary diseases. In this review, we describe the increasing and intriguing evidence of complicated and critical relationships that may contribute to the development and progression of urinary diseases through disruption of the microbiota in various organs.

Background: Intensive insulin treatment in type2 diabetes can improve β-cell function. The rapid insulin analogs(lispro) used as prandial and the long acting insulin analogs (glargine)used as basal can simulate physiological insulin profile more closely. Subjects and Method: Type2 diabetic patients(18 males and 24 females) were hospitalized and treated with multiple split insulin injection (lispro + glargine). We performed oral glucose tolerance test on subjects and HbA1C, blood glucose, insulin, C-peptide and other indexes were measered before and after MSII. Result: Total patient insulin requirement is 40.97±14.04 IU(0.65±0.26IU per kg) and basal insulin(Glargine) requirement is 16.29±5.76 IU.(39.7% of total amount). According to DM duration, we divided these patients into 2 groups, drug naive group, secondary failure to sulfonylurea. After MSII, the AIR of naive group was significantly higher than before treatment.(0.07±0.05 vs 0.61 ±0.72 pmol/L/min, p<0.05) The HOMA-β and AUCi/AUCg were also elevated significantly.(HOMA-β 8.03 vs 195.20; AUCi/AUCg 0.02±0.01 vs 0.38±0.38, p<0.05). But WBISI(whole body insulin sensitivity index) increase from 7.66± 4.69 to 2.79±1.75 (p<0.05). Conclusion: HOMA-β, AIR, AUCi/AUCg were used for evaluating β cell function. These indexes were markedly improved after MSII. Our results showed that strict correction of hyperglycemia could greatly improve β cell function, especially in drug naive patients. [ABSTRACT FROM AUTHOR]

Objectives: This study was performed to compare which is better predict cardiovascular event between Metabolically obese but normal weight (MONW) and Metabolically health but obese (MHO). Subjects and methods: We analyzed the data from total 7,007 Korean subjects (2,843 men and 4,164 women) from population based cross-sectional study and their mean age was 62.0±10.5 years. We defined the highest quartile of HOMA-IR as "metabolically obese (highly insulin resistant)" group and the lowest quartile as "metabolically healthy (very insulin sensitive)" group. Furthermore, subjects with their BMI ≥ 25 kg/m² were defined as "obese" group and 18.5 ≤ BMI < 23 kg/m² was defined as "normal weight" group according to Asian-Pacific region criteria for obesity. Results: Waist circumference, diastolic blood pressure, non HDL cholesterol, total cholesterol/HDL cholesterol ratio of MOH were significantly higher than those of MONW. However, fasting glucose and insulin level was significantly higher in MONW than MOH. Among MOH, prevalences of the metabolic syndrome defined by both NCEP and IDF criteria were significantly higher that of MONW (44.6% vs 35.8% in NCEP, 40.7% vs 17.2% in IDF) whereas prevalences of type 2 diabetes mellitus (T2DM) and impaired fasting glucose (IFG) in MONW were significantly higher than MOH (27.2% vs 7.5% in T2DM, 8.8% vs 3.3% in IFG). Furthermore, estimated 10 year CHD risk using Framingham risk score in MONW was significantly higher than MOH (12.1±11.5 vs. 8.9±7.1). Conclusions: Our study results suggested that highly insulin resistant subjects with normal weight might have higher risk for T2DM and CV event compared with obese, but very insulin sensitive subjects. [ABSTRACT FROM AUTHOR]

Background: Ubiquitin-specific protease 11 (USP11), one of the principal phosphatase and tensin homolog (PTEN) deubiquitinases, can reserve PTEN polyubiquitination to maintain PTEN protein integrity and inhibit PI3K/AKT pathway activation. The aim of the current study was to investigate the associations between immunohistochemical USP11 staining intensities and prognostic indicators in individuals with prostate cancer. Methods: Tissue microarrays (TMAs) were performed for human prostate cancer and normal tissue (control) samples. Data on patient’s age, Gleason score, plasma prostate-specific antigen (PSA) titer, disease stage, and presence of seminal vesicles, lymph nodes, and surgical margin involvement were collected. A pathologist who was blinded to the clinical outcome data scored the TMA for USP11 staining intensity as either positive or negative. Results: Cancerous tissues exhibited lower USP11 staining intensity, whereas the neighboring benign peri-tumoral tissues showed higher USP11 staining intensity. The degree of USP11 staining intensity was lower in patients with a higher PSA titer, higher Gleason score, or more advanced disease stage. Patients who showed positive USP11 staining were more likely to have more optimal clinical and biochemical recurrence-free survival statistics. Conclusions: USP11 staining intensity in patients with prostate cancer is negatively associated with several prognostic factors such as an elevated PSA titer and a high Gleason score. It also reflects both biochemical and clinical recurrence-free survival in such patients. Thus, USP11 staining is a valuable prognostic factor in patients with prostate cancer.

Urachal adenocarcinoma is rare, accounting for only 10% of adenocarcinomas of the bladder and the prognosis of urachal adenocarcinomas is poor since most cases are detected late. Since urachal adenocarcinoma is a rare disease, no effective standard treatment has yet been established. However, in recent studies, resection of carcinoma is considered the only treatment considered for non-metastatic cases. Although for large sized urachal adenocarcinoma, open surgery or laparoscopic surgery is usually considered, we have recently experienced huge urachal carcinoma by robotic surgery. We used cystoscopy and the robot to assess the cancer margins and safely perform the operation. A 71-year-old man with a medical history of hypertension and arrhythmia visited our urology department with urachal cancer detected by computed tomography (CT). CT showed a lobulated low-density mass, most likely urachal carcinoma, abutting the anterior dome of the bladder and anterior abdominal wall. We performed preoperative cystoscopy to assess the extent of the protrusion of the urachal cancer into the bladder wall and the area requiring resection during surgery. We confirmed the size and extent of the mass protruding into the anterior wall of the urinary bladder and Robot-assisted laparoscopic intracorporeal urachal mass resection and partial cystectomy using cystoscopy together was performed. After one month, the patient has no complications and no complaining symptoms complaints without any abnormal finding of follow up imaging test. Although more procedures must be performed to ensure the safety of robotic surgery as a treatment strategy for large urachal carcinomas, we confirm that robotic surgery can replace open or laparoscopic surgery for such tumors.

Due to the rapid development of next-generation sequencing, it has become possible to obtain information on the sequences of all genes in a specific microbiome. The detection of bacteria in patients with no urinary tract infections indicated that the dogma that “urine is sterile” was false, leading to active research regarding the roles of the urinary microbiome in the human urinary tract. Here, we present a review of the current literature regarding the role of the microbiome in urology.

Our knowledge that “urine is sterile” is no longer accepted after the development of a next-generation sequencing (NGS) test. Using NGS, microbiota in the human body were discovered, and it is expected that this will improve our understanding of human diseases. However, the mechanism involved in the effect of the microbiome on diseases is still poorly understood. Associations of gut microbiome with diseases have been recently reported. Based on such associations, bladder–gut–brain axis, gut–bladder axis, gut–vagina–bladder axis, and gut–kidney axis as novel mechanisms of action of the microbiome have been suggested. Each axis can influence the development and progression of disease through interactions. In these interactions, metabolites of the microbiome including short-chain fatty acids (SCFA) and the inflammasome play an important role. Inflammasomes are multiprotein oligomers that can initiate inflammatory responses. Inflammasomes can trigger inflammation and pyroptosis and ultimately contribute to disease development. SCFAs play an important role in immune cell migration, cytokine production, and maintenance of cellular homeostasis. Associations of inflammasomes with systemic diseases such as obesity and insulin resistance have been reported. The roles of inflammasomes and SCFAs in kidney, bladder, and prostate diseases have also been revealed recently.

Objective: To compare the therapeutic efficacy after suburethral adjustable sling (Remeex system) for female stress urinary incontinence (SUI) between pure intrinsic s phincter deficiency (ISD) and ISD with overactive bladder (OAB) group. Methods: The study subjects were 86 female patients with ISD who underwent Remeex system to treat female SUI and who were available for 12 months follow-up. We retrospectively studied both patients who underwent Remeex system due to pure ISD (group I) and those who underwent Remeex system due to ISD with OAB (group II). Improvement in objective and subjective symptoms were retrospectively evaluated using a 1hr pad weight test, global response assessment (GRA) and overactive bladder symptom score (OABSS). Results: Group I included 43 patients and group II included 43 patients of mean ages 56.8 ± 7.5 and 57.4 ± 6.6 years, respectively. Use of 1 hr pad weight test showed that incontinence decreased after the procedures in both groups, and that of group I patients was significantly lower than that of group II patients. The mean GRA score was significant a higher score in group I. The OABSS of patients in group II were 8.2 ± 1.1 and 7.2 ± 1.1, respectively, before and at 12 months after operation, did differ significantly. The mean change of OABSS of group II patients was significantly more decreased than that of group I patients. Conclusions: The Remeex system showed a greater patient satisfaction and a higher cure rate in pure ISD than ISD with OAB in female patients with urinary incontinence.