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Purpose: To investigate the changes in intraocular cytokines after ranibizumab treatment in patients with polypoidal choroidal vasculopathy (PCV).Methods: This multicenter, prospective study enrolled patients with PCV treated with three monthly ranibizumab followed by a pro re nata regimen for 24 weeks. Best corrected visual acuity, slit lamp examination, fundus photography, and optical coherence tomography were performed every 4 weeks. Aqueous humor was collected to measure intraocular cytokines at baseline, week 8, and the time of recurrence or week 20. The association of changes in intraocular cytokines with visual acuity, central macular thickness, central choroidal thickness, area of abnormal vessels, and polyp closure was assessed.Results: This study included 25 eyes. The mean patient age was 70.3 ± 6.1 years. The vascular endothelial growth factor (VEGF) concentration decreased at week 8, but only interferon (IFN)-γ, tissue inhibitors of matrix metalloproteinases (TIMP)-2, and monocyte chemoattractant protein (MCP)-2 decreased at the time of recurrence. The recurrence interval was positively associated with the baseline epithelial-neutrophil activating peptide (ENA)-78, interleukin (IL)-17, leptin, and transforming growth factor-β1, and baseline central macular thickness was positively correlated with the baseline fibroblast growth factor-4 and IL-10. Thick central choroidal thickness was associated with a low basic fibroblast growth factor and high IFN-γ at baseline. The MCP-3 and Tie-2 levels decreased in two eyes with polyp closure.Conclusions: Ranibizumab significantly reduced intraocular VEGF concentrations and consequently improved PCV. However, the cytokines IFN-γ, TIMP-2, and MCP-2, rather than VEGF, were associated with PCV recurrence. Further studies of intraocular cytokines involved in neovascularization in PCV are needed.

Purpose: We report bilateral, diffuse, uveal melanocytic proliferation caused by a stomach adenocarcinoma.Case summary: A 78-year-old male complained of visual impairment 3 months in duration. He had diabetes and had undergone cataract surgery on both eyes 4 years prior. His best-corrected visual acuity was counting fingers in the right eye and 20/160 in the left eye. Both intraocular pressures were normal. The anterior segments yielded no specific findings. The maculae exhibited multiple, round, patchy, pigmented or depigmented lesions with exudative retinal detachment. Fluorescein angiography revealed multiple hyperfluorescent lesions. Optical coherence tomography revealed that the hyper-reflective exudates lay between the neurosensory retina and the retinal pigment epithelium. We diagnosed bilateral, diffuse, uveal melanocytic proliferation and performed a systemic evaluation. Computed tomography revealed several mass lesions in the lung, stomach, and lymph nodes; these appeared to be malignant. An esophagogastroduodenoscopic biopsy confirmed that the lesions were adenocarcinomas.Conclusions: A bilateral, diffuse, uveal melanocytic proliferation induced by a primary malignant tumor exhibited multiple, pigmented subretinal exudates associated with exudative macular retinal detachment. In patients with such findings, it is necessary to evaluate the malignant tumor status of remote organs.

Purpose: To report a case of Streptococcus infantarius endophthalmitis related to the use of a XEN® Gel Stent.Case summary: A 75-year-old male was referred to our practice with a diagnosis of endophthalmitis 55 days after XEN® Gel Stent implantation. He had primary open-angle glaucoma. Visual acuity was 20/50. Slit-lamp examination revealed conjunctival injection and anterior chamber inflammation with hypopyon. Fundus examination showed inflammatory cells with exudative materials in the vitreous. The aqueous sampling for culture of causative micro-organisms was followed by removal of the XEN® Gel Stent, along with anterior chamber irrigation and intracameral and intravitreal injection of antibiotics. Streptococcus infantarius was isolated after 5 days. Vitrectomy, anterior chamber lavage, and intravitreal injection of antibiotics were additionally performed to control the intraocular inflammation. Sixteen days after vitrectomy, the intraocular inflammation disappeared. The choroidal detachment was resolved 34 days after vitrectomy. Visual improvement was limited to 20/100 at 6 months.Conclusions: XEN® Gel Stent-related bacterial endophthalmitis was successfully treated by implant removal, vitrectomy, and proper intraocular antibiotic treatment.

Purpose: Here, we report a case of acute noninfectious endophthalmitis after removal of silicone oil (SO) and posterior capsulectomy in a patient with proliferative diabetic retinopathy.Case summary: SO removal and posterior capsulectomy were performed in a 61-year-old man who had undergone vitrectomy with combined cataract surgery, membrane peeling, laser photocoagulation, and SO injection to treat vitreous hemorrhage and tractional retinal detachment three months previously. The patient’s best-corrected visual acuity on the day after surgery was 20/50; it decreased to hand motion at five days after SO removal. Exudative membrane with hypopyon, anterior chamber cell (trace), and mild conjunctival injection were observed. The patient did not complain of ocular pain. Topical steroid was applied following a diagnosis of postoperative noninfectious endophthalmitis. The exudative membrane and hypopyon decreased after three days of treatment and had resolved completely after one month of treatment. The patient’s visual acuity improved to 20/50.Conclusions: Noninfectious endophthalmitis can develop after removal of SO and posterior capsulectomy. Topical steroid treatment is effective in such cases.

Purpose: To report a case of acute stromal keratitis after vitrectomy for the treatment of myopic tractional maculopathy in a lupus patient.Case summary: A lupus patient who were treated with low dose steroid complained of decreased visual acuity due to myopic tractional maculopathy with fovea detachment. No evidence of intraocular inflammation was observed. The best-corrected visual acuity (BCVA) was 20/40. We performed the vitrectomy and removal of epiretinal membrane and internal limiting membrane. BCVA of 20/80 at day 1 decreased to hand motion at day 5. Severe corneal edema and superficial punctate keratitis that were observed did not improve three days after the anti-herpetic treatment. Based on this, we diagnosed her as immune-mediated acute stromal keratitis in lupus, and treated with oral methylprednisolone of 20 mg. The corneal edema improved rapidly following high dose systemic steroid. Myopic fovea detachment also improved. Improvement of BCVA was limited to 20/80 at six months, compared to the baseline one.Conclusions: We observed the development of acute stromal keratitis after vitrectomy for the myopic tractional maculopathy in the patient with lupus. High dose systemic steroid improved this corneal complication. Increased dose of systemic steroid should be considered before and after vitrectomy in lupus patients.

Purpose To describe the development of multiple retinal hemorrhages after uncomplicated macular hole (MH) surgery, and to determine the associated factors. Methods The medical records of 163 patients (167 eyes) diagnosed with idiopathic MHs and who underwent surgery at Pusan National University Hospital between March 2016 and July 2018 were retrospectively reviewed. The development of retinal hemorrhages was evaluated using ultra-widefield fundus photographs. Multiple retinal hemorrhages were defined as three or more dot or blot hemorrhages that had not been observed before and during the surgery. The patients were divided into two groups according to the presence of multiple retinal hemorrhages. The variable parameters were compared between the two groups to find the risk factors. The associated factors were evaluated further for the independent factor using multiple logistic regression analysis. Results Multiple retinal hemorrhages were observed in 31 eyes (18.6%) after MH surgery. The associated factors were the surgical induction of posterior vitreous detachment (PVD) (p = 0.003), use of the internal limiting membrane flap technique (p = 0.028), and staining with Brilliant Blue G (BBG) (p = 0.003). Retinal hemorrhages were exclusively observed in eyes in which BBG was used. Surgical PVD induction was the only independent risk factor (odds ratio, 13.099; p = 0.013). No statistically significant differences were observed between the two groups in the postoperative visual outcomes and MH closure rate. Additionally, patients who underwent surgery for idiopathic epiretinal membrane during the study period were reviewed to validate the above findings. Multiple retinal hemorrhages were noted in only one case (0.4%) in which BBG was used after surgical induction of PVD. Conclusions Multiple retinal hemorrhages after MH surgery appear to be related to the intravitreal use of BBG in eyes that sustained mechanical damage because of surgical induction of PVD; however, they did not affect surgical outcomes.

Background and objectives: Renal arteriovenous malformation (AVM) is a rare disease and is difficult to be diagnosed by conventional methods because of its rarity. In this study, we investigated the diagnostic clues, and made an algorithm for the better diagnosis of renal AVM. Materials and Methods: We reviewed 13 patients who were diagnosed with AVM by using renal angiography from 1986 to 2020 at our institutes. We evaluated clinical features, diagnostic tools, treatment modalities, and outcomes after the treatment of patients. Results: All patients were female, and the mean age was 36.9 years (range 19 to 54 years). Twelve (92.3%) patients complained of gross hematuria. Four (30.8%) patients showed symptoms in relation with pregnancy and delivery. Angiographic findings demonstrated cirsoid type in 10 patients and aneurysmal type in 3 patients. Among the 11 patients who underwent computed tomography, AVMs were detected in 3 (27.3%) patients. Renal duplex Doppler was performed in 6 patients, and all of these patients were diagnosed with AVM, demonstrating a vascular turbulence or blood-rich area. Twelve patients were initially treated with transarterial embolization. Nephrectomy was performed in two patients due to persistent bleeding with hypovolemic shock. Conclusions: We should consider possible AVMs in patients who were not detected by conventional work up for hematuria, especially in mid-aged, pregnant, or recently delivered women. Renal duplex Doppler might be the optimal diagnostic modality in these patients. Our diagnostic algorithm could be aid to diagnosis and treatment for renal AVM patients.

Background The applicability of the sphincter complex integral theory to robotic-assisted radical prostatectomy (RARP) is unclear, with little known about the long-term effect of sphincter complex integrity on continence. Objective To determine whether the preoperative anatomical and functional features of the sphincter complex and the degree of nerve-sparing affect long-term continence after RARP. Design, setting, and participants Prospective study of 529 patients who underwent RARP at a single tertiary center. Outcome measurements and statistical analysis Anatomical factors , including membranous urethral length (MUL) and pelvic diaphragm length (PDL) , were assessed using sagittal views of preoperative magnetic resonance imaging. MUL was defined as the distance from the posterior prostate apex to the urethra level at the penile bulb, and PDL was defined as the length of the urethra that met the planes created by the pelvic floor muscles. Functional parameters including maximum urethral closure pressure (MUCP) and functional urethral length were evaluated using preoperative measurements of the urethral pressure profiles. The degree of nerve-sparing was stratified as bilateral, unilateral, or none. Continence (pad-free status) was assessed according to anatomical and functional factors and nerve-sparing. We used binary logistic regression to assess factors predicting continence return 12 mo after RARP. Results and limitations Continence return rates 1, 3, 6, and 12 mo after RARP were 39.7%, 66.0%, 80.2%, and 87.0%, respectively. Continence return rates at 12 mo differed significantly in patients with MUL ≥11.7 mm (91.9%) and Conclusions The anatomical length and static pressure of the sphincter complex affected continence after RARP. Bilateral nerve-sparing was independently associated with long-term continence. Patient summary Predisposing length and static pressure of the urinary sphincter affect continence after robotic-assisted radical prostatectomy. Nerve bundle preservation during surgery enhances postoperative return of continence.

Background and objectives: To investigate the risk factors for emphysematous cystitis (EC) compared to those of acute cystitis (AC) to increase clinicians awareness of the possibility for the aggravation of patient status. Materials and methods: We retrospectively reviewed a total of 54 patients who were hospitalized with a diagnosis of EC by abdominal computed tomography (CT) scan from 2006 to 2020. The control group included 92 patients who were hospitalized for the treatment of AC in the same period. We sought to identify the clinical features and predisposing diseases, such as age, sex, diabetes mellitus (DM), hypertension (HTN), cerebrovascular accident (CVA), chronic kidney disease (CKD), neurogenic bladder (NB), history of urinary tract infection (UTI), and emphysematous pyelonephritis (EPN), that were associated with the development of EC. Results: The median (interquartile range (IQR)) age of the patients with EC was older than that of the patients with AC (78.5 (15.3) years (range: 52–100) vs. 70.0 (26.5) years (range: 28–97 years)). Sepsis and mortality occurred only in the EC group (48.1% and 11.1%, respectively). The univariate analysis of predisposing factors revealed that age, DM, HTN, CVA, CKD, and NB were significantly associated with EC. In the multivariate analysis, DM (OR, 6.251, 95% CI, 2.254–17.250, p &lt, 0.001), CKD (OR, 18.439, 95% CI, 3.421–99.404, p = 0.001), NB (OR, 7.374, 95% CI, 1.993–27.285, p = 0.003) were associated with EC. Conclusions: The results of this study revealed that DM, CKD, and NB were significant risk factors for EC. The tendency toward sepsis and high mortality underscore the need for careful observation while treating patients with EC with the risk noted above.

The objectives of this study were to investigate patients treated for scrotal trauma at our institute for the last three decades to describe our experience with an emphasis on the etiologies and ultrasonographic findings in these patients. We reviewed medical records of patients who underwent scrotal ultrasonography for evaluation of testicular trauma at our institutes from 1986 to 2015. Trends regarding the etiology of scrotal trauma were evaluated during each decade. The echo pattern and contour definition of the testicular parenchyma and the pattern of hematoma development were recorded to evaluate radiographic findings of testicular injury. The correlation between ultrasonographic and intraoperative findings was assessed. A total of 115 patients were analyzed. Most patients (92.2%) presented with blunt trauma. The most common etiology of testicular trauma was assault during the first and second decades, while injury related to a fall was most common during the third decade. Of the 77 patients (67.0%) who underwent urgent exploration, 46 patients (59.7%) had testicular rupture. Loss of contour definition, heterogeneous echo pattern of the testicular parenchyma, and testicular hematoma showed a moderate to strong degree of correlation with testicular rupture (Spearman correlation co-efficient: 0.5-0.8). Over the past 30 years, the etiology of testicular injury changed from assault to falls or athletic injury and the severity of injury has decreased. Our findings demonstrate the importance of ultrasonography for determining an appropriate management strategy in scrotal trauma. Surgical exploration should be considered in patients with abnormal ultrasonographic findings.

To evaluate the better risk stratification based on surgical pathology, and to predict oncologic outcomes after radical prostatectomy (RP) with a better scoring system in high-risk prostate cancer (PCa) patients. We evaluated high-risk PCa patients (PSA >20 ng/ml, ≥cT3a, or Gleason score 8–10) who underwent RP between 2007 and 2013 at our institute. We classified patients into three groups according to their pathologic outcomes: favorable (pT2, Gleason score ≤7, and node negative), intermediate (specimen-confined disease (pT2-3a, node negative PCa with negative surgical margins) but not in the favorable group), and unfavorable (the remaining patients). We developed a risk stratification scoring system to predict prognostic outcomes after RP and validated our scoring system to estimate its predictive accuracy. Among a total of 356 patients, 95 (26.7%), 115 (32.3%), and 146 (41%) were in the favorable, intermediate, and unfavorable prognostic groups, respectively. The 5-year biochemical recurrence-free survival rates of the patients in each group were 87.8, 64.6, and 41.4%, respectively. We developed a scoring system based on preoperative PSA, clinical stage, percentage of tumor positive core, and percentage of cores with a Gleason score 8–10. This demonstrated internally and externally validated concordance indices of 0.733 and 0.772, respectively. Using our scoring system, we can predict which patients with high-risk PCa would benefit more from RP. Thus, this system can be used in patient counseling to determine an optimal treatment strategy for high-risk PCa.

This study aimed to compare refractive deviations between in-the-bag insertion, trans-scleral ciliary sulcus fixation, ciliary sulcus insertion, and ciliary sulcus insertion with optic capture after phacovitrectomy. Single-unit, single-surgeon, retrospective study. Consecutive patients who underwent phacovitrectomy and intraocular lens (IOL) out-of-the-bag insertion simultaneously were retrospectively reviewed. Patients who underwent phacovitrectomy with IOL in-the-bag insertion were also included for comparison with those who underwent phacovitrectomy with out-of-the-bag insertion. Patients were classified into four groups based on the IOL insertion method. The average difference from the target spherical equivalent (SE) to postoperative SE was defined as the refractive deviation. Refractive deviations of the groups were compared. The refractive deviation for the in-the-bag insertion (43 eyes) was −0.18 ± 0.50 Df, −0.84 ± 0.81 D for the trans-scleral ciliary sulcus fixation (43 eyes), −0.93 ± 0.68 D for the ciliary sulcus insertion (25 eyes), and −0.27 ± 0.50 D for the ciliary sulcus insertion with optic capture group (24 eyes). The trans-scleral ciliary sulcus fixation and ciliary sulcus insertion groups had significantly different deviations than the in-the-bag group (p

We analyzed the pathological and oncologic characteristics of anteriorly located prostate cancer and assessed the usefulness of magnetic resonance imaging to detect anterior prostate cancer.We analyzed the records of 728 consecutive patients treated with radical prostatectomy. Patients were categorized with anterior or prostate cancer or tumors involving the anterior and posterior prostate according to the dominant tumor location on whole mount section.The anterior and posterior prostate cancer groups and the group with cancer at both locations represented 31.0%, 46.7% and 22.3% of the total number of patients, respectively. Anterior prostate cancer was less commonly palpable (p 0.001) and needed more frequent repeat biopsy (p = 0.012) than posterior prostate cancer. Moreover, the anterior group had fewer positive cores than the posterior group (p0.001) despite comparable tumor volumes. Gleason score upgrading was more frequently observed in anterior than in posterior prostate cancer (p = 0.003). However, final pathological features did not significantly differ. Only the seminal vesicle involvement rate was lower in anterior than in posterior prostate cancer (p0.001). Estimated 5-year biochemical recurrence-free survival in patients with anterior prostate cancer was 87.5%, significantly higher than in patients with posterior prostate cancer (77.4%, p = 0.001) and patients with anterior plus posterior involvement (74.4%, p0.001). Multivariate analysis revealed that anterior location was an independent prognostic factor for biochemical recurrence (HR 0.403) along with other well-known prognostic factors. To detect anterior prostate tumors the sensitivity and specificity of magnetic resonance imaging were 78.1% and 58.2%, respectively.Anterior prostate cancer had pathological features and favorable oncologic outcomes comparable to those of posterior prostate cancer but also more frequent Gleason score upgrading. Magnetic resonance imaging had moderate diagnostic performance for detecting lesions in the anterior prostate.

This paper proposes a hierarchical routing algorithm for enhancing survivability of sensor nodes on WSAN. Proposed algorithm has two important parts. The first is a clustering algorithm that uses distance between sensor and actor, and remaining energy of sensor nodes for selecting cluster head. It will induce uniform energy consumption, and this has a beneficial effect on network lifetime. The second is an enhanced routing algorithm that uses the shortest path tree. The energy efficient routing is very important in WSAN which has energy limitation. As a result, proposed algorithm extends network and nodes lifetime through consuming energy efficiently. Simulation results show that the proposed clustering algorithm outperforms conventional routing algorithms such as VDSPT in terms of node and network life time, delay, fairness, and data transmission ratio to BS.

Purpose To investigate the changes in corneal higher-order aberration (HOA) during amblyopia treatment and the correlation between HOA and astigmatism in hyperopic amblyopia children. Methods In this retrospective study, a total of 72 eyes from 72 patients ranging in age from 38 to 161 months were included. Patients were divided into two groups based on the degree of astigmatism. Corneal HOA was measured using a KR-1W aberrometer at the initial visit and at 3-, 6-, and 12-month follow-ups. Correlation analysis was performed to assess the association between HOA and astigmatism. Results A total of 72 patients were enrolled in this study, 37 of which were classified as belonging to the higher astigmatism group, while 35 were assigned to the lower astigmatism group. There was a statistically significant difference in success rate between the higher and lower astigmatism groups. In both groups, all corneal HOAs were significantly reduced during amblyopia treatment. When comparing the two groups, a significant difference in coma HOA at the 12-month follow-up was detected (p = 0.043). In the Pearson correlation test, coma HOA at the 12-month follow-up demonstrated a statistically significant correlation with astigmatism and a stronger correlation with astigmatism in the higher astigmatism group than in the lower astigmatism group (coefficient values, 0.383 and 0.284 as well as p = 0.021 and p = 0.038, respectively). Conclusions HOA, particularly coma HOA, correlated with astigmatism and could exert effects in cases involving hyperopic amblyopia.

To investigate whether preoperative urodynamic detrusor overactivity (DO) contributes to post-prostatectomy incontinence (PPI). We systematically searched the online PubMed, Embase, and Cochrane Library databases spanning the period of January 1989 to December 2014. A total of nine articles met the eligibility criteria for this systematic review. The eligible studies included a total of 457 patients with a median number of 58 patients per study (range 17–92). Of the nine studies, five conducted open retropubic radical prostatectomy (RRP), two performed robot-assisted laparoscopic prostatectomy (RALP), and two others utilized multiple modalities. PPI was more likely to occur in patients with preoperative DO [pooled odds ratio (OR) 2.30; 95 % confidence interval (CI) 1.39–3.82; studies 9; participants 419], as compared to patients who were DO negative. Sensitivity analysis using the subgroups of RRP (OR 2.32; 95 % CI 1.11–4.85), RALP (OR 3.41; 95 % CI 1.55–7.47), DO defined as any amplitude of involuntary contraction (OR 2.32; 95 % CI 1.11–4.85), no postoperative intervention (OR 2.32; 95 % CI 1.11–4.85), and outcome evaluation after 6 months (OR 2.32; 95 % CI 1.11–4.85) demonstrated consistent results. Although some comparisons showed inter-study heterogeneity, there was no clear evidence of publication bias in this meta-analysis. Our meta-analysis results suggest that preoperative DO is another possible underlying mechanism for PPI.

We investigated the expression status of vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF)-B and their receptors in organ-confined clear cell renal cell carcinoma (ccRCC) to evaluate their prognostic significance after radical surgery. In 758 consecutive patients diagnosed with pT1-2N0 ccRCC between 2007 and 2012, we prospectively investigated the expression levels of VEGF, PDGF-B, VEGF receptor (VEGFR) and PDGF receptor (PDGFR)-β via immunohistochemistry. Clinicopathologic parameters and expression of the angiogenic factors were analyzed with respect to recurrence-free survival (RFS) after nephrectomy. The median follow-up was 29.5 months (IQR 21.5, 39.6) after surgery. Partial nephrectomy had been performed in 48.5 % of the patients, and tumors were staged as pT1a in 514 (67.8 %), pT1b in 192 (25.3 %) and pT2 in 52 (6.9 %). VEGF, PDGF and their receptors were identified in the cytoplasm and membranes of the tumor cells. Expression level of VEGFR inversely correlated with both tumor size (r = −0.076, p = 0.014) and nuclear grade (r = −0.297, p = 0.004). As for PDGF-B, the expression level showed an inverse correlation with tumor size (r = −0.216, p

Purpose: The aim of our study was to evaluate the association of several factors with spontaneous stone expulsion, including ureteral stone characteristics (size, location, hydronephrosis, perinephric stranding), types of medications prescribed (α-blocker, lowdose steroid), and other possible demographic and health-history factors (gender, age, serum creatinine, underlying diabetes mellitus [DM], and hypertension). Materials and Methods: A total of 366 patients with ureteral stones were enrolled. All patients underwent watchful waiting without any invasive procedures. Initial diagnoses of ureteral stones were confirmed by computed tomography scans, which were taken at approximately 1-month intervals to check for stone expulsion. Univariate and multivariate analyses were conducted to identify significant factors that contributed to stone expulsion. Results: Among 366 patients, 335 patients (91.5%) experienced spontaneous stone passage during a mean follow-up period of 2.95±2.62 weeks. The patients were divided into two groups depending on the success of spontaneous stone passage. Univariate analyses revealed that stone location (p=0.003), stone size (p=0.021), and underlying DM (p

Recently, wireless sensor network(WSN) have been used in various fields to implement ubiquitous computing environment. WSN uses small, low cost and low power sensors in order to collect information from the sensor field. This paper proposes a clustering algorithm for energy efficiency of sensor nodes. The proposed algorithm is based on conventional LEACH, the representative clustering protocol for WSN and it prolongs network and nodes life time using sleep technique and changable transmission mode. The nodes of the proposed algorithm first calculate their clustering participation value based on the distance to the neighbor nodes. The nodes located in high density area will have clustering participation value and it ∙제1저자 : 김선철 ∙교신저자 : 조용환 ∙투고일 : 2014. 12. 19, 심사일 : 2015. 1. 13, 게재확정일 : 2015. 3. 25. * 충북대학교 컴퓨터공학과(Dept. of Computer Engineering, Chungbuk National University) ※ 이 논문은 2013년도 충북대학교 학술연구지원사업의 연구비 지원에 의하여 연구되었음 (This paper was supported by the research grant of the Chungbuk National University in 2013) 78 Journal of The Korea Society of Computer and Information April 2015 can turn to sleep mode. Besides, proposed algorithm can change transmission method from conventional single-hop transmission to multi-hop transmission according to the energy level of cluster head. Simulation results show that the proposed clustering algorithm outperforms conventional LEACH, especially non-uniformly deployed network. ▸

The incidence of low-stage renal cell carcinoma is rising and is observed to demonstrate excellent prognosis following surgical treatment irrespective of method. However, several epidemiologic observational and population-based studies suggest that radical nephrectomy is associated with increased adverse renal outcomes such as chronic kidney disease (CKD) compared with partial nephrectomy. This is suggested in turn to lead to increased mortality via an increase in cardiovascular complications and mortality. Prospective data are scarce, and there are conflicting data as well on whether surgically induced CKD is as debilitating as medically induced CKD. Further research is needed to assess the presence and the extent of the relationship between nephrectomy, CKD, and noncancer mortality.

Recently, wireless sensor networks(WSNs) are widely used for intrusion detection and ecology, environment, atmosphere, industry, traffic, fire monitoring. In this paper, an energy efficient clustering algorithm is proposed. The proposed algorithm forms clusters uniformly by selecting cluster head that optimally located based on receiving power. Besides, proposed algorithm can induce uniform energy consumption regardless of location of nodes by multi-hop transmission and MST formation with limited maximum depth. Through the above, proposed algorithm elongates ∙제1저자 : 나성원 ∙교신저자 : 조용환 ∙투고일 : 2014. 4. 16, 심사일 : 2014. 4. 25, 게재확정일 : 2014. 5. 21. * 충북대학교 컴퓨터공학과(Dept. of Computer Engineering, Chungbuk National University) ※ 이 논문은 2012년도 충북대학교 학술연구지원사업의 연구비 지원에 의하여 연구되었음 (This paper was supported by the research grant of the Chungbuk National University in 2012) 50 Journal of The Korea Society of Computer and Information June 2014 network life time, reduces energy consumption of nodes and induces fair energy consumption compared to conventional LEACH and HEED. The results of simulation show that the proposed clustering algorithm elongates network life time through fair energy consumption. ▸

The prognostic value of the expression of vascular endothelial growth factor (VEGF), VEGF receptor 2 (VEGFR2), platelet-derived growth factor (PDGF)-β, and PDGF receptor (PDGFR)-β in papillary renal cell carcinoma (pRCC) is unknown. A total of 145 patients, who were confirmed to have pRCC, were analyzed. Expression levels of molecular markers were assessed via immunohistochemistry. The median follow-up period for all patients was 52.0 (interquartile range, 34.5-90.5) months. Among the cohort of 145 patients, high VEGF expression was observed in 100 (69.0%) patients, whereas high expression of VEGFR2, PDGF-β, and PDGFR-β was observed in 64 (44.1%), 42 (29.0%), and 30 (20.7%) patients, respectively. Only patients with high VEGFR2 expression exhibited improved 10-year recurrence-free survival (85.3% versus 58.1%; P=.005) and cancer-specific survival (86.4% versus 70.1%; P=.014) rates compared with individuals who exhibited low expression. Multivariate analysis revealed that high VEGFR2 expression was an independent prognostic factor for recurrence (hazard ratio, 0.326; P=.006) and cancer-specific mortality (hazard ratio, 0.334; P=.046). During follow-up, 17 patients received targeted drug therapy. Patients with high VEGFR2 expression showed a better initial response (partial response, 40%; stable disease, 20%; progressive disease, 40%) than patients with low expression did (partial response, 0%; stable disease, 58.3%; progressive disease, 41.7%; P=.052). pRCC with high VEGFR2 expression seems to be associated with a better initial response to targeted drug therapy and a better prognostic outcome.

INTRODUCTION AND OBJECTIVES: The predictive value of membranous urethral length (MUL) and shape of the prostatic apex (PA) for early recovery of urinary continence after radical prostatectomy (RP) were evaluated by preoperative magnetic resonance imaging (MRI). METHODS: Three-hundred three patients who underwent RP at our institute were prospectively analyzed. The MUL and shape of PA were measured by preoperative MRI. The urethral pressure profiles (UPP) were assessed preoperatively in all patients. The preand postoperative UPP were measured in a subgroup of 100 patients to assess the effect of change in UPP on early recovery of continence. Continence, defined pad-free state with no leakage of urine, was assessed at 3 months and 1 year after surgery. RESULTS: Of 303 patients, 213 patients (70.3%) initially achieved urinary continence 3moths after surgery, and a total of 251 (82.8%) patients achieved urinary continence 1 year after surgery. The MUL was longer in the continent group than in the incontinent group (11.2 mm vs. 12.4 mm, p1⁄40.001). Patients with the PA covering the membranous urethra on the anterior side (type 1 PA) showed worse urinary continence rates than those without (type 2 PA) (57.9% vs. 89.2%, p 12 mm and type 2 PA, showed a markedly increased probability of continence recovery compared to patients with a MUL 1⁄412 mm and type 1 PA (odds ratio 27.430, p

Sunchang CountyAbstract To investigate the effects of soybean germination time on the quality of cheonggukjang, the physicochemicalcharacteristics and enzyme activities of cheonggukjang during fermentation were compared. B. subtilis SCD 115035 strainisolated from traditional cheonggukjang was selected for making cheonggukjang. Germinated (12-h) soybean-cheonggukjang produced the highest amount of viscous substance (13.22%) after 48 h of fermentation, and the contentswere inversely proportional to the germination time of the soybeans. The acidic- and neutral-protease activities ofungerminated soybean-cheonggukjang were higher than those of germinated soybean-cheonggukjang. The amino nitrogencontent of ungerminated soybean-cheonggukjang was the highest (436.93 mg%) at 48 h of fermentation, and its contentwas similar to that of 12-h germinated soybean-cheonggukjang. However, the total isoflavone content of 36-h germinatedsoybean-cheonggukjang was the highest after 72 h of fermentation, and its content was higher than those of cheonggukjangmade from soybeans germinated for 0, 12, and 24 h.Keywords: cheonggukjang, soybean, germination, enzyme activity, isoflavone

This paper reports a new mechanism for congestion controls. The proposed congestion detection algorithm can be provided with delay and unnecessary energy consumption. Conventional congestion control methods decide congestion by queue occupancy or mean packet arrival rate of MAC layer only, however, our method can perform precise detection by considering queue occupancy and mean packet arrival rate. In addition, the congestion avoiding method according to congestion degree and scheduling method using priority for real time packets are proposed. Finally, simulation results show that proposed congestion detection and control methods outperforms conventional scheduling schemes for wireless sensor network.

This paper proposes and efficient routing scheme named MP-DD(MultiPath-Direct Diffusion) which are simple enough to be applicable to the wireless sensor networks. Conventional DD(Direct Diffusion) uses only one optimal path, therefore it consumes more energy of specific nodes. MP-DD uses multiple path and has a information of hop upstream node in the direction of the base-station. Simulation results show that the proposed scheme can increase network survivability compared to conventional DD and EAR(Energy Aware Routing) schemes.

Background: The presence of lymph nodes (LN) within the prostatic anterior fat pad (PAFP) has been reported in several recent reports. These PAFP LNs rarely harbor metastatic disease, and the characteristics of patients with PAFP LN metastasis are not well-described in the literature. Our previous study suggested that metastatic disease to the PAFP LN was associated with less severe oncologic outcomes than those that involve the pelvic lymph node (PLN). Therefore, the objective of this study is to assess the oncologic outcome of prostate cancer (PCa) patients with PAFP LN metastasis in a larger patient population. Methods: Data were analyzed on 8800 patients from eleven international centers in three countries. Eighty-eight patients were found to have metastatic disease to the PAFP LNs (PAFP+) and 206 men had isolated metastasis to the pelvic LNs (PLN+). Clinicopathologic features were compared using ANOVA and Chi square tests. The Kaplan-Meier method was used to calculate the time to biochemical recurrence (BCR). Results: Of the eighty-eight patients with PAFP LN metastasis, sixty-three (71.6 %) were up-staged based on the pathologic analysis of PAFP and eight (9.1 %) had a low-risk disease. Patients with LNs present in the PAFP had a higher incidence of biopsy Gleason score (GS) 8–10, pathologic N1 disease, and positive surgical margin in prostatectomy specimens than those with no LNs detected in the PAFP. Men who were PAFP+ with or without PLN involvement had more aggressive pathologic features than those with PLN disease only. However, there was no significant difference in BCR-free survival regardless of adjuvant therapy. In 300 patients who underwent PAFP LN mapping, 65 LNs were detected. It was also found that 44 out of 65 (67.7 %) nodes were located in the middle portion of the PAFP. Conclusions: There was no significant difference in the rate of BCR between the PAFP LN+ and PLN+ groups. The PAFP likely represents a landing zone that is different from the PLNs for PCa metastasis. Therefore, the removal and pathologic analysis of PAFP should be adopted as a standard procedure in all patients undergoing radical prostatectomy.

INTRODUCTION AND OBJECTIVES: In prostate-specific antigen(PSA) era, late detection of prostate cancer still exists when the tumor arised from anterior portion of prostate. We analyzed the characteristics of anterior predominant prostate cancer, and assess the usefulness of MRI to detect the tumor preoperatively. METHODS: We evaluated clinicopathological data and radiologic findings of 660 patients treated with radical prostatectomy between July, 2007 and June, 2012. All patients underwent MRI with diffusion-weighted imaging, and ADC mapping. When the lesion was larger than 8mm in diameter, showed low signal intensity on T2weighted image, restricted diffusion on diffusion-weighted images and ADC maps, it was considered presence of tumor. RESULTS: Anterior predominant prostate cancer constituted 26.8% of total patients. Index tumor in anterior peripheral zone, anterior fibromuscular stroma, and transition zone were 27.7%, 3.4%, and 69.0% respectively. Age, BMI, PSA, prostate volume, and PSA density in anterior predominant prostate cancer were not different from posterior prostate cancer. Diagnosis with repeated biopsy was more frequent in anterior predominant cancer, and clinical T stage (p 0.001), pathologic T stage (p 0.001), pathologic GS (p 0.040) were lower. In D’Amico low-risk patients, anterior predominant cancer presented in 40.1%, and upgrading was more frequently observed than posterior predominant cancer (65.1% vs 49.5%, p 0.027). In anterior predominant cancer, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MRI were 64.2%, 83.0%, 63.8%, 83.2%, and 77.0%, respectively. CONCLUSIONS: Anterior predominant cancer had favorable pathologic features compared with posterior dominant cancer. However, more frequent upgrading was noted. MRI was useful to detect the hidden anterior predominant cancer.

Objective To evaluate whether anticholinergic medication contributes to early recovery of continence and improvement of other voiding symptoms after radical prostatectomy (RP). Patients and Methods A total of 78 patients with clinically localized prostate cancer who had incontinence at 1 week after RP were enrolled prospectively. The patients were allocated to one of the 2 groups: group 1 (α-adrenergic agonist [midodrine] plus an anticholinergic [solifenacin]) or group 2 (α-adrenergic agonist only). A urodynamic study and the International Continence Society male Short Form questionnaire were completed preoperatively and 4 months after RP. One-hour pad test and 3-day frequency volume chart at 1 and 4 months after medication were also analyzed. Results The rate of continence, defined as being pad free, did not differ between the groups at 4 months (both 71.8%; P >.05). However, the decreased value of mean weight of daily pads worn by groups 1 and 2 were 51.5 vs 11.7 g, respectively ( P = .005). The incontinence ( P = .008) and quality of life ( P = .044) subscale scores significantly worsened in group 2, whereas they remained unchanged in group 1. Maximal detrusor pressure and maximal urethral closure pressure significantly decreased in both groups, whereas maximal cystometric capacity increased significantly in group 1 only (290.8-332.0 cm H 2 O; P Conclusion Anticholinergics may facilitate early recovery from incontinence and prevent worsening of quality of life, which might be attributed to increased cystometric capacity after their use.

Objective To investigate the prevalence of high-grade or insignificant prostate cancer in Korean men with prostate-specific antigen (PSA) levels of 3.0-4.0 ng/mL. Methods The medical records of 4233 consecutive men with PSA levels of 3.0-10.0 ng/mL, who underwent prostate biopsy between 2007 and 2012 at our institute, were reviewed. The clinicopathologic characteristics were compared between patients with a PSA level of 3.0-4.0 ng/mL and those with a PSA level of 4.0-10.0 ng/mL. Predictive factors for high-grade (Gleason score ≥7) or insignificant cancer (defined according to the Epstein criteria) in men with a PSA level of 3.0-4.0 ng/mL were assessed. Results The high-grade disease rates were similar between men with a PSA level of 3.0-4.0 ng/mL and those with a PSA level of 4.0-10.0 ng/mL (50.5% and 53.1%, respectively). The rates of clinically insignificant cancer were higher in men with a PSA level of 3.0-4.0 ng/mL than in those with a PSA level of 4.0-10.0 ng/mL (28.4% vs 12.5%; P

We investigated the prognostic significance of tumor location at the renal hilum near the sinus structure on the recurrence in T1 renal cell carcinoma (RCC).A total of 1,818 T1 RCC patients who underwent radical (RN) or partial nephrectomy (PN) from 1997 to 2011 were retrospectively reviewed. A hilar tumor was defined as a tumor abutting the main renal artery and/or vein or its segmental branches, without invasion. We compared the recurrence-free survival (RFS) rates between hilar and nonhilar T1 RCC and analyzed predictors of RFS after nephrectomy.Patients with hilar tumors showed a poorer 5-year RFS compared with nonhilar tumors both in T1a (89.7 vs. 98.5 %, p0.001) and T1b (81.6 vs. 95.1 %, p0.001) RCCs. Among patients who underwent RN and PN, hilar tumors were associated with lower 5-year RFS (87.6 vs. 97.2 % for RN, 78.1 vs. 98.2 % for PN, both p0.001). In T1a hilar tumor, PN was associated with poorer 5-year RFS than RN (79.5 vs. 93.0 %, p0.001). In multivariate analysis, a hilar location remained as an independent predictor of recurrence in both T1a and T1b tumors (both p = 0.001).Hilar tumors show a higher recurrence rate than nonhilar counterparts in T1 RCC. In T1a hilar tumors, PN demonstrated poorer RFS than RN. Potential intrinsic renal anatomical or lymphovascular structural differences as well as differences in cancer characteristics need further investigations.