Hyeon Jeong

Ureteric stenting after ureteroscopy for ureteric stones: a prospective randomized study assessing symptoms and complications

To compare patients with and with no stenting after ureteroscopy for ureteric calculi, as placing such stents is routine, although many patients complain of pain and urinary symptoms.

Penile sensitivity in men with premature ejaculation

Premature ejaculation is the most prevalent form of male sexual dysfunction, but its cause has not been well established. Recent studies have indicated that in men with premature ejaculation, penile sensitivity is increased. To investigate whether penile hypersensitivity is a cause of premature ejaculation, we prospectively evaluated the penile sensitivity of 18 patients with a lifelong history of premature ejaculation from the first coital experience and 15 controls, both in the flaccid and erect state. We used an SMV-5 vibrometer (Suzuki-Matsuoka, Teknologue, Tokyo, Japan), which automatically controls stimulatory strength; its precision and reproducibility are thus higher than analogue-type biothesiometers. At the styloid process of the ulna and medial maleolus of the tibia, there was no significant statistical difference in vibratory threshold between the two groups (P>0.05). Also we did not find significant statistical differences in sensitivity of the glans penis, dorsum of the penile shaft, or frenulum of the penis between the two groups, in either the flaccid or erect state (P>0.05). According to our results, penile hypersensitivity, as measured by an SMV-5 vibrometer, does not appear to be a major factor contributing to premature ejaculation.

Cognitive Impairment in Age-related Macular Degeneration and Geographic Atrophy

PURPOSE To investigate cognitive function in patients with early and late age-related macular degeneration (AMD) compared with an elderly, community-dwelling Korean population without AMD. DESIGN Case-control study. PARTICIPANTS We enrolled 170 AMD patients and 190 non-AMD community-based controls. METHODS A comprehensive battery for cognitive function evaluation consisting of 15 psychological tests, including a depression evaluation test, was used. Cognitive function scores were adjusted for age, gender, education, and visual acuity (VA). We categorized AMD as early AMD, exudative AMD, or geographic atrophy. MAIN OUTCOME MEASURES The primary outcome measure was the degree of cognitive impairment, as assessed by the Korean versions of the Consortium to Establish a Registry for Alzheimers Disease Neuropsychological Assessment Battery, Benton Visual Retention Test, and Digit Span Test Forward and Backward. RESULTS Patients with AMD showed lower global cognition scores than did normal controls (mean Mini-Mental State Examination [MMSE] score, 24.97 vs 25.99; P<0.001). Among cognitive functions, visuospatial function, verbal memory, visual memory, and frontal function were impaired in AMD patients relative to normal controls. The rate of mild cognitive impairment (MCI) was higher in AMD patients than in controls (52.4% vs 26.8%; P<0.001), with an odds ratio (OR) of 3.127 (95% confidence interval, 1.855-5.271) after adjustment for age, education, and VA. Geographic atrophy was associated with the highest risk of MCI (OR, 4.431; 95% confidence interval, 1.413-13.898) and a clinically significant reduction in MMSE scores (23.42) relative to the controls. There was a trend of worsening cognitive function test scores from the controls to the early AMD, then the exudative AMD, and finally the geographic atrophy patients, after adjustment for covariates. AMD patients with poor VA (≤20/100) had 6 times the risk of MCI as AMD patients with good or moderate VA (>20/100). CONCLUSIONS Patients with AMD, especially those with the geographic atrophy subtype, are at greater risk for cognitive impairment than are non-AMD control subjects. In the visual rehabilitation of AMD patients, potential cognitive impairment should be taken into consideration.

Treatment for Chronic Prostatitis/ Chronic Pelvic Pain Syndrome: Levofloxacin, Doxazosin and Their Combination

Introduction: We performed a prospective, randomized study to examine the efficacies of levofloxacin and doxazosin alone and as a combination therapy in patients with National Institutes of Health (NIH) category III chronic prostatitis/chronic pelvic pain syndrome. Patients and Methods: Men with a NIH diagnosis of category III chronic prostatitis/chronic pelvic pain syndrome and who had experienced pelvic pain for more than 3 months during the last 6 months were enrolled. All patients underwent treatment for 6 weeks. The patients were assessed at baseline and after 2 and 6 weeks by using the NIH Chronic Prostatitis Symptom Index. Eighty-one men (average age 40.1 years) were randomized to either the levofloxacin group (n = 26), the doxazosin group (n = 26), or the combination group (n = 29). Results: The average baseline NIH Chronic Prostatitis Symptom Index total scores were 22.6, 22.4, and 24.1, respectively. At 6 weeks, the total scores were 11.2 (response rate 50.3%), 17.7 (response rate 21.1%), and 13.1 (response rate 45.6%), respectively. The levofloxacin group showed a higher response rate than the doxazosin group, not at 2 weeks but at 6 weeks (p < 0.001). Conclusions: For a 6-week short-term treatment levofloxacin is more effective than doxazosin for chronic prostatitis/chronic pelvic pain syndrome. In addition, levofloxacin monotherapy was also more effective when compared with the combination therapy.

Effects of social supports on burden in caregivers of people with dementia

BACKGROUND Social support programs for dementia caregivers were widely used in order to reduce care burden. We investigated which types of social supports can reduce psychological and non-psychological burdens of dementia caregivers, and explored the mechanism of those social supports. METHODS We evaluated 731 community-dwelling dementia patients and their caregivers from the National Survey of Dementia Care in South Korea. We investigated the five types of social supports (emotional support, informational support, tangible support, positive social interaction, affectionate support) using the Medical Outcomes Study Social Support Survey in each caregiver. The mechanisms of specific types of social support on psychological/non-psychological burden were examined using path analysis. RESULTS Positive social interaction and affectionate support reduced psychological burden via direct and indirect paths. Tangible support reduced the non-psychological burden via direct and indirect paths. Informational support and emotional support were not helpful for reducing psychological or non-psychological burden. A maximum of 20% of psychological burden could be relieved by positive social interaction and 10.3% of that could be reduced by affectionate support. Tangible support was associated with a 15.1% maximal improvement in non-psychological burden. CONCLUSIONS In order to reduce caregiver burden in dementia effectively, psychosocial interventions should be tailored to target type of caregiver burden.

Lymphovascular invasion as a prognostic factor in the upper urinary tract urothelial carcinoma: a systematic review and meta-analysis.

BACKGROUND The objective of the present study was to conduct a systematic review and meta-analysis of the published literature investigating lymphovascular invasion (LVI) and its effects on upper urinary tract urothelial carcinoma (UTUC) prognosis. METHODS To identify relevant studies, PubMed, Cochrane Library, OVID and SCOPUS database were searched from the inception until June 2012. RESULTS A total of 17 trials met the eligibility criteria for the meta-analysis. The total number of patients included was 4896, ranging from 60 to 2492 per study. None of the 17 included studies was based on the data of prospective analysis of survival. In 13 of 17 studies, patients had received adjuvant chemotherapy. Despite our attempts to limit the between-study heterogeneity through a strict inclusion criteria, there was a between-study heterogeneity in the effect of LVI on all of the meta-analyses, with a p value of <0.05 and I(2) generally greater than 50%. Thus, the hazard ratio (HR) was calculated using the random-effect model. The pooled HRs were statistically significant for disease-free survival (pooled HR, 1.91; 95% confidence interval [CI], 1.40-2.41), cancer-specific survival (CSS) (pooled HR, 1.72; 95% CI, 1.28-2.71) and overall survival (pooled HR, 4.05; 95% CI, -0.44-8.53). There was no clear evidence of funnel plot asymmetry, and thus, no evidence of publication bias was found. CONCLUSIONS Our meta-analysis showed that LVI is predictive of mortality in UTUC. However, these findings should be interpreted with caution due to the heterogeneity in the series. These results need to be further confirmed by an adequately designed prospective study to provide a better conclusion on the relationship between LVI and the outcome of patients with UTUC.

IgE-mediated occupational asthma induced by herbal medicine, Banha (Pinellia ternata)

There have been few reported cases of occupational asthma induced by Pinellia ternata (Banha), and the mechanism responsible for this type of asthma is still undetermined. We report a case of Banha‐induced occupational asthma with IgE‐mediated mechanism. The patient had positive skin responses to Banha extract and Banha‐specific bronchial challenge elicited an early asthmatic response. The serum‐specific IgE binding to Banha extract was detectable and completely inhibited with the additions of 0.1 µg/mL of Banha extract on ELISA inhibition. Seven IgE binding components to Banha extract (6.5, 22, 24, 32, 34, and 48 kDa) were detected using SDS–PAGE and immunoblot analysis. In conclusion, the results of this study suggest that P. ternata (Banha)‐derived allergens are able to cause IgE‐mediated bronchoconstriction in exposed workers.

Suppression of clusterin expression enhanced cisplatin-induced cytotoxicity on renal cell carcinoma cells

OBJECTIVES To evaluate whether antisense transfection targeted against clusterin enhances the chemosensitivity in renal cell carcinoma. METHODS Caki-1, a renal cell carcinoma cell line, and cisplatin were used as chemotherapeutic agents. Clusterin expression of Caki-1 cells after treatment with cisplatin was measured by Western blot analysis. After the construction of a clusterin suppression vector, clusterin expression was compared between Caki-1 cells transfected with the clusterin suppression vector (Caki-1/AS), Caki-1 cells transfected with control vector (Caki-1/VO), and parental Caki-1 cells. Tumor cell viability was measured with the MTT assay at 24 and 48 hours after cisplatin treatment. RESULTS The expression of clusterin increased gradually in Caki-1 cells, peaking at 24 hours, and was reduced to an almost undetectable level at 48 hours after cisplatin treatment. Clusterin expression was suppressed, and the percentage of viable tumor cells decreased significantly more in the Caki-1/AS than in the Caki-1/VO or parental Caki-1 cells at 24 hours after cisplatin treatment. The change in chemosensitivity of the Caki-1/AS cells lost its significance at 48 hours after cisplatin treatment. CONCLUSIONS Our results showed that clusterin expression increased transiently after treatment of cisplatin, and its suppression by antisense transfection enhanced the cisplatin-induced cytotoxicity of renal cell carcinoma cells. Clusterin suppression may be a useful modality in enhancing the effects of cytotoxic chemotherapy in renal cell carcinoma.

Suicidal behaviors in elderly Koreans: One-month-point prevalence and factors related to suicidality

BACKGROUND Suicide prevention in the elderly is a major public health priority worldwide and in Korea in particular. We investigated the one-month-point prevalence and factors related to suicidality for suicidal behaviors in elderly Koreans. METHODS A simple random sample (N=1588) was drawn from the residential roster of 14,051 Koreans aged 60 years or older who were residents of Osan in February 2010. All subjects were invited to participate in the survey through door-to-door home visits, and the response rate was 59.8%. RESULTS The age- and gender-standardized prevalence rates of lifetime suicide attempts, current suicidal ideation without a plan or attempt, and current suicidal ideation with a plan or attempt were estimated at 9.2%, 19.6%, and 2.24%. The prevalence of suicidal ideation without a plan or attempt was higher in women and less-educated individuals and increased with advancing age, whereas the prevalence of suicidal ideation with a plan or attempt was higher in more-educated individuals, was not differentiated by gender, increased until age 70, and then decreased thereafter. The factors related to suicidal ideation differed by the presence of a suicide plan or attempt. CONCLUSIONS Depressive elders in their 70s who have recently developed suicidal ideation would be a prime target for suicide intervention programs. LIMITATIONS The sample was regional, although the suicide rate in Osan was comparable to the average suicide rate in Korea.

The role of p53 on survival of upper urinary tract urothelial carcinoma: a systematic review and meta-analysis.

A systematic review and meta-analysis of the published literature that investigated the p53 expression and its effects on upper urinary tract urothelial carcinoma (UUTUC) prognosis was conducted. PubMed, Cochrane Library, OVID, and Scopus databases were searched for bibliographic information of articles about p53 expression evaluated by immunohistochemistry and survival in UUTUC from inception until June 2012. Seven articles met the eligibility criteria for this systematic review. The eligible studies included a total of 514 patients with a mean number of 73.4 patients per study (range, 42-154). None of the 7 included studies were based on the data of prospective analysis of survival. The threshold for dichotomizing the level of p53 also varied widely among studies, from 10% to 50%. When only unadjusted survival data were included, the pooled hazard ratio (HR) was statistically significant for disease-free (pooled HR, 1.70 [95% CI, 1.22-2.38), cancer-specific (pooled HR, 2.11 [95% CI, 1.13-3.93]), and overall survival (pooled HR, 1.55 [95% CI, 1.03-2.35]). There was no between-study heterogeneity in the effect of p53 status on all of the meta-analyses, with a P value >.05 and I(2) generally toward <50%. There was no clear evidence of funnel plot asymmetry, and no evidence of publication bias was found. Results of the meta-analysis suggest that p53 overexpression might be a prognostic factor for patients with UUTUC. These results need to be further confirmed by an adequately designed prospective study with larger populations.