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BACKGROUND: With advances in surgical technology, thoracic surgeons have widely adopted minimally invasive limited-resection techniques to preserve normal tissues. However, it remains difficult to achieve in situ localization of invisible pulmonary nodules during surgery. Therefore, we proposed an in situ ultra-low-dose X-ray imaging device for intraoperative pulmonary nodule localization during minimally invasive surgeries. METHODS: The proposed device features a hand-held type and consists of a carbon nanotube-based X-ray source and an intraoral dental sensor. In a preclinical study, we created pseudo pulmonary nodules using ex vivo pig lungs. Subsequently, its clinical feasibility was evaluated using ex vivo lung cancer specimens from patients with cancer who had undergone minimally invasive surgery. RESULTS: Using the proposed device, we successfully differentiated normal and abnormal tissues from X-ray images of resected lung specimens. In addition, our proposed device only yielded an average radiation dose of 90.9 nGy for a single acquisition of X-ray images and demonstrated excellent temperature stability under consecutive X-ray irradiations. The radiation exposure of our proposed device (0.1±0.0006 µSv/h) was significantly lower than that of conventional C-arm fluoroscopy (41.5±51.8 µSv/h). In both preclinical and clinical studies, the margin of nodule shadows was clearly visualized using the proposed device. CONCLUSIONS: The proposed device substantially reduced radiation exposure to staff and patients and may allow in situ localization of pulmonary nodules. Our proposed device clearly revealed the margins of lung nodules with radiocontrast injection and showed the potential to identify solid nodules without the use of radiocontrast agents.

Purpose The aim of this study was to compare the body images of patients who underwent radical cystectomy with an orthotopic ileal neobladder or an ileal conduit. Materials and Methods A total of 114 adult patients who underwent radical cystectomy between March 2006 and December 2012 at a single institution, Ewha Womans University Mokdong Hospital in Korea, were evaluated in this retrospective chart-review study. Forty-two patients (29 orthotopic ileal neobladder and 13 ileal conduit) who completed questionnaires were included in the final analysis; the remaining patients were excluded. The patients were assessed with two questionnaires: the Korean version of the Body Image Scale (K-BIS) and the self-designed questionnaire. Results The results did not differ significantly by age at surgery, time from surgery to survey, pathologic stage, grade, histologic subtype, education, residency, or Eastern Cooperative Oncology Group performance status, but did differ significantly by age at survey and sex. The mean summary score for K-BIS showed significant differences between the two groups (p=0.001). We found that patients who underwent an orthotopic ileal neobladder had a significantly better body image. The self-designed questionnaire score was not significantly different between the two groups (p=0.572). Conclusions In our retrospective analysis, patients who underwent orthotopic ileal neobladder had a superior body image compared with those who underwent an ileal conduit.

Purpose: We investigated the efficacy and safety of propiverine chloride (BUP-4) flexible dose in female patient with mixed urinary incontinence. Methods: The participants were women with mixed incontinence, including urgency (grade 3 or more, one or more episodes per day) or mild stress incontinence (grade I) or both. The subjects were received 4 weeks of treatment with propiverine 20 mg once daily. If the response of the 4 week treatment was insufficient, the dose was increased to 30 mg/day. The patient who satisfied with initial treatment sustained propiverine 20 mg for next 8 weeks. The efficacy of treatment was assessed base on the response of Benefit, Satisfaction and Willingness to Continue questionnaire (BSW questionnaire). Change of Overactive Bladder Symptom Score (OABSS), micturition diary parameters was assessed. Adverse events were evaluated throughout the study. Results: A total of 86 patients with mixed incontinence were enrolled, 76 patients completed the 3 month study. 29 patients (33.7%) responded as “dissatisfied” with the treatment at week 4 and treated with escalated dose to 30 mg propiverine next 8 weeks. (20 mg group; 48 subjects, 30 mg group; 28 subjects) 90% of patients in 30 mg group satisfied with their treatment at final follow-up on week 12. Three patients still dissatisfied with 30 mg propiverine treatment in spite of escalating the dose. The change in OABSS score were significantly improved after 12 week propiverine treatment at both groups. Most clinical parameters showed much more improvement in 20 mg group than 30 mg group. Most common adverse event was dry mouth and constipation. Two patients complained dry mouth, one patient had constipation and two patients had dyspepsia. Conclusions: Propiverine 30 mg could be an effective treatment of mixed incontinence without increasing the incidence of side effect compared to propiverine 20 mg. It could be considered to propiverine 30 mg as a starting dose.

Purpose We examined the effect of stress on the pathophysiology of bladder stability in terms of enzyme levels, Rho-kinase, and bladder relaxation. Materials and Methods A total of 48 female Sprague-Dawley rats were studied in scheduled stress environments for 7, 14, and 28 days; 24 rats were in the control group and 24 rats were in the test (stressed) group. Results Estrogen decreased significantly whereas testosterone and dopamine increased significantly in the stress group (p

Clinically, botulinum toxin A blocks the cholinergic innervation of the target tissue. Recently, it has been proved effective not only at a neuromuscular junction but also within parasympathetic or sympathetic neural synapses. Seven women with pain on genitalia that could not be controlled with conventional pain managements were enrolled in this study. Twenty to 40 U of botulinum toxin A were used in each injection. Injection sites were the vestibule, levator ani muscle or the perineal body. Repeat injections were administered every 2 weeks if the patient's symptoms had not fully subsided. In all patients, pain had disappeared with botulinum toxin A injections. Five patients needed to be injected twice; the other two patients needed only one injection. We did not observe complications related to botulinum toxin A injections, such as pain, hemorrhage, infection, muscle paralysis or other complications. The subjective pain score improved from 8.3 to 1.4, and no one has experienced a recurrence (the follow-up period was four to 24 months, with a mean follow-up of 11.6 months). Botulinum toxin A is effective in blocking nociception. Even though further investigation and well-controlled study will be necessary, we suggest that the botulinum toxin therapy would be useful and safe in managing vulvodynia of muscular or neuroinflammatory origins.

INTRODUCTION AND OBJECTIVES: We have previously demonstrated in animal models that priapism is associated with upregulated expression of the opiorphin gene in corporal smooth muscle (CSM) tissue. In this study we have examined if hypoxia is a determining factor for up-regulated opiorphin expression in CSM, and if the up-regulation of opiorphin regulates other pathways associated with development of priapism. The hypothesis that vascular occlusion and ischemia is a mechanism for the development of vascular diseases associated with sickle cell disease dates back to 1948, although most recent studies have considered priapism to be a result from an imbalance between the “relaxant” and “constrictor” pathways causing heightened relaxation of CSM. METHODS: We have used an in vitro model of hypoxia to determine the genes expression in rat CSM of the rat opiorphin homologue (sialorphin, encoded by the vcsa1 gene) and two other genes associated with the development of priapism (adenosine 2 binding receptor, a2br, and hypoxia induced factor 1a, hif1a). We have looked at the expression of these genes in the CSM from a pre-priapic and priapic sickle cell mouse model. RESULTS: We demonstrate that hypoxia causes up-regulated expression of vcsa1, a2br and hif1a in CSM cells. However, when these cells are pretreated with siRNA against vcsa1 then hypoxia-induced upregulation of a2br and hif1a expression is prevented, suggesting that vcsa1 is important in the regulation of these genes. In the CSM of sickle cell mice the mouse opiorphin homologue is up-regulated in a pre-priapic life stage. The early up-regulation of the mouse opiorphin suggests that this is a response to the hypoxic conditions resulting from sickle cell disease rather than a response to priapism. CONCLUSIONS: Overall our results suggest that sickle cell disease causes hypoxia/ischemia in CSM tissue, resulting in increased opiorphin expression. Opiorphin then acts as a master regulator of compensatory smooth muscle “relaxant” pathways. It is the excessive activation of these “relaxant” pathways that results in priapism. In many aspects this hypothesis connects the 60 year old hypothesis that ischemia associated with sickle cell disease is a mechanism for the development of vascular diseases to the more recent studies where activation of relaxant pathways in corporal tissue are considered a primary mechanism for the development of priapism.

Factors related to sexual arousal are different in men and women. The conditions for women to become aroused are more complex. However, the conventional audio-visual stimulation (AVS) materials used to evaluate sexual arousal are universal. In the present study, we investigated sexual differences in the response to different types of AVS by studying activated areas of the brain using functional magnetic resonance imaging (fMRI). fMRI was performed during two types of AVS in 20 healthy heterosexual volunteers (aged 20-28 years, 10 men and 10 women). The two AVS types were: (1) mood type, erotic video clips with a concrete story and (2) physical type, directly exposing sexual intercourse and genitalia. fMRI images were analyzed and compared for each stimulation with a Mann-Whitney U test, with statistical significance set at P

This study was undertaken to investigate whether prolonged stress interferes with sexual behavior and changes biochemical and physiologic mechanisms. Experiments were repeated three times with different rats in each period. In all, 63 female Sprague–Dawley rats were employed, with 21 rats in each period, and the control group was maintained at room temperature with free access to food and water. The stress group was maintained under a scheduled stress condition for 10 days, and seven rats from the group were randomly selected and exposed to the control environment for 10 days as the recovery group. Sexual behavior, hormonal values, and neuronal and endothelial nitric oxide synthase (nNOS and eNOS) expressions of vaginal tissue were analyzed and compared. Serum testosterone levels were significantly elevated in the stress and recovery groups (P

Purpose：Biothesiometer is a device for quantitatively measuring vibratory thresholds in a noninvasive manner. It has been utilized for evaluating variety of neurological diseases for decades. We aimed to investigate difference of vibratory thresholds according to presence of specific lower urinary tract symptoms(LUTS). Materials and Methods：173 female patients were included in this study. We investigated medical history, and performed physical examination, cystoscopy, and biothesiometry. Biothesiometry were recorded on clitoris, vestibules, and both labia minora. Relationship between age, LUTS, serum triglyceride(TG) and cholesterol(Chol) level, and vibratory thresholds were also analyzed. Results：Mean age of patients was 51.8±9.4 years. LUTS consisted of stress urinary incontinence(SUI)(87.4%), urgency or urge incontinence(UUI)(77.1%), and frequency(66%). Age was closely related with vibratory thresholds. Correlation coefficient was 0.394, 0.343, 0.332, 0.294, 0.279 for clitoris, both labia, and anterior and posterior vestibules, respectively(p