Publications by authors named "Min Chul Cho"

136 Publications

Clinical utility of cerebrospinal fluid vitamin D-binding protein as a novel biomarker for the diagnosis of viral and bacterial CNS infections.

BMC Infect Dis 2021 Mar 5;21(1):240. Epub 2021 Mar 5.

Department of Laboratory Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea.

Background: Rapid and accurate diagnosis of central nervous system (CNS) infections is important, and laboratory tests help diagnose CNS infections. Even when the patient has symptoms, laboratory tests often do not reveal any specific findings. The potential of vitamin D-binding protein (VDBP) to be used as a biomarker for viral and bacterial CNS infections was studied.

Methods: A total of 302 subjects with suspected CNS infection who underwent lumbar puncture were included. Clinical and laboratory data were collected retrospectively. VDBP levels were measured in the cerebrospinal fluid (CSF) samples. Genotyping for the GC gene encoding VDBP was also performed. VDBP levels were analyzed and compared by CNS infection, pathogen, CSF opening pressure, and GC genotype.

Results: A CNS infection group (n = 90) and a non-CNS infection group (n = 212) were studied. In terms of its receiver operating characteristic, CSF VDBP showed an area under the curve of 0.726 for the diagnosis of CNS infection. CSF VDBP levels were significantly different between the CNS infection and non-infection groups. The CNS infection group with enterovirus showed a statistically lower distribution of CSF VDBP levels than the other virus groups. The group with CSF opening pressure > 25 cmHO showed higher CSF VDBP levels than the other groups. There was no significant difference in GC gene allele distribution between the CNS infection and non-infection groups.

Conclusions: CSF VDBP levels were increased in patients with CNS infection. The CSF VDBP showed potential as a new biomarker for viral and bacterial CNS infections.
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http://dx.doi.org/10.1186/s12879-021-05924-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7934275PMC
March 2021

Low Serum 25-Hydroxyvitamin D Level as a Potential Risk Factor of Erectile Dysfunction in Elderly Men with Moderate to Severe Lower Urinary Tract Symptoms.

World J Mens Health 2021 Feb 17. Epub 2021 Feb 17.

Department of Urology, Seoul Metropolitan Government-Seoul National University (SMG-SNU) Boramae Medical Center, Seoul, Korea.

Purpose: To evaluate the correlation between vitamin D level and erectile dysfunction (ED) in male lower urinary tract symptoms (LUTS) patients.

Materials And Methods: We analyzed data from 534 male patients who were tested for LUTS from 2014 to 2017. LUTS severity was classified into mild (≤7) or moderate to severe (≥8) based on total IPSS scores. Vitamin D deficiency was defined as a serum 25-hydroxyvitamin D [25(OH)D] level of less than 20 ng/mL. The severity of ED was dichotomized into mild (≥17 points) or moderate to severe (≤16 points) depending on total IIEF-5 scores. The association of the serum 25(OH)D level with moderate to severe ED was assessed using logistic regression analysis.

Results: In the entire cohort, moderate to severe ED was significantly associated with age ≥60 years (odds ratio [OR], 1.762; 95% confidence interval [CI], 1.011-3.073) and moderate to severe LUTS (OR, 2.075; 95% CI, 1.134-3.789), but not with serum 25(OH)D level (OR, 1.001; 95% CI, 0.979-1.023). Whereas, in the subgroup consisting of moderate to severe LUTS patients over 60 years (n=223), either low serum 25(OH)D level (OR, 0.944; 95% CI, 0.903-0.986) or vitamin D deficiency (OR, 2.949; 95% CI, 1.118-7.782) was the independent risk factor of moderate to severe ED as a result of each multivariate analysis.

Conclusions: Low vitamin D status closely correlated with moderate to severe ED in elderly men with moderate to severe LUTS.
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http://dx.doi.org/10.5534/wjmh.200176DOI Listing
February 2021

Serum 24,25-dihydroxyvitamin D level in general Korean population and its relationship with other vitamin D biomarkers.

PLoS One 2021 19;16(2):e0246541. Epub 2021 Feb 19.

Department of Laboratory Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea.

Background: Vitamin D status is presently assessed by measuring total serum concentration of 25-hydroxyvitamin D [25(OH)D]. However, 25(OH)D concentration alone might not accurately reflect vitamin D status owing to its weak relationship with various clinical indices and inconsistency across races. Recently, 24,25-dihydroxyvitamin D [24,25(OH)2D] and vitamin D metabolite ratio [VMR; ratio of 24,25(OH)2D to 25(OH)D] have emerged as vitamin D biomarkers. The present study aimed to determine the values of 24,25(OH)2D and VMR in healthy Koreans and compare them with other vitamin D biomarkers, including 25(OH)D and bioavailable 25(OH)D.

Methods: Serum samples and medical information were collected from 200 individuals (100 females and 100 males) who underwent general health checks without self-reported symptoms. We measured 24,25(OH)2D concentration using liquid chromatography-tandem mass spectrometry, and concentrations of 25(OH)D and vitamin D binding protein using immunoassays. VMR and bioavailable 25(OH)D concentration were calculated using the above data. Serum parathyroid hormone level, and bone mineral density (BMD) data were collected as clinical outcomes, and the effects of the vitamin D markers on them were tested using multiple linear regression models.

Results: The mean values of 25(OH)D, 24,25(OH)2D, VMR, and bioavailable 25(OH)D were 24.3 ± 8.5 ng/mL, 1.9 ± 1.1 ng/mL, 7.6 ± 2.5, and 3.2 ± 1.2 ng/mL, respectively. The concentration of 25(OH)D closely correlated with 24,25(OH)2D (R = 0.868, P < 0.001) and bioavailable 25(OH)D (R = 0.862, P < 0.001). No significant effects of 24,25(OH)2D, VMR, and bioavailable 25(OH)D were observed on the prediction of PTH and BMD in the multiple linear regression models.

Conclusion: Our study presents the distribution of 24,25(OH)2D concentration and VMR in Korean population for the first time. Overall, our data reaffirm that 25(OH)D is the primary marker for determining vitamin D status in the general population.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246541PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7894912PMC
February 2021

Rectification of cavernosal fibrosis and veno-occlusive dysfunction by administration of suberoylanilide hydroxamic acid in a rat model of cavernosal nerve injury: Comparison with a PDE5 inhibitor.

Andrology 2021 03 20;9(2):720-727. Epub 2020 Nov 20.

Department of Urology, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea.

Background: Cavernosal fibrosis, which is induced by cavernosal nerve (CN) injury and progresses with time, is the main cause of cavernosal veno-occlusive dysfunction (CVOD) after radical prostatectomy.

Objectives: To determine whether daily oral administration of suberoylanilide hydroxamic acid (SAHA; vorinostat) for 5-weeks from the immediate post-injury period after CN injury would rectify CVOD by suppressing cavernosal fibrosis and normalizing HDAC pathway in a rat model of CN crush injury (CNCI) and to compare the results with those obtained using chronic administration of PDE5-inhibitors (a positive control).

Methods: Fifty-six 12-week-old rats were randomized into the four groups: sham surgery (S), CNCI (I), and CNCI treated with daily administration of 25.0 mg/kg SAHA (V) or 20.0 mg/kg udenafil (P). Group-V and Group-P received the respective treatment for 5-weeks from the following day after CNCI. At 5 weeks after surgery, dynamic infusion cavernosometry (DIC), histological staining, and Western blot analysis were performed.

Results: Group-I had a significantly decreased papaverine response, higher maintenance rate or drop rate, lower smooth muscle (SM)/collagen ratio, decreased SM content, and increased protein expression of HDAC2, HDAC3, TGF-β1, and collagen-1, compared with Group-S. The three DIC parameters in Group-V and Group-P significantly improved compared to those in Group-I. Except for the maintenance rate, the improvement in papaverine response and drop rate in Group-V was not significantly different from that in Group-P. Group-V and Group-P showed the rectification of SM/collagen ratio and protein expression of TGF-β1 or collagen-1. SM content was improved in Group-P, but not in Group-V. Group-V showed the normalization of protein expression of both HDAC2 and HDAC3, whereas protein expression of only HDAC2 was partially restored in Group-P.

Discussion: Treatment strategies targeting the HDAC pathway might be helpful to alleviate CVOD induced by CN injury.

Conclusions: According to our data, chronic administration of SAHA improves post-injury CVOD by suppressing cavernosal fibrosis via rectifying the HDAC/TGF-β1 pathway in nerve-injured rats, comparable to that with PDE5 inhibitors.
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http://dx.doi.org/10.1111/andr.12922DOI Listing
March 2021

Vitamin D and endometriosis: Is there a correlation with disease severity?

Clin Exp Reprod Med 2020 Sep 25;47(3):235-236. Epub 2020 Aug 25.

Department of Obstetrics and Gynecology, Gyeongsang National University Hospital, Jinju, Korea.

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http://dx.doi.org/10.5653/cerm.2019.03342.r1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7482944PMC
September 2020

Restoration of Cavernous Veno-Occlusive Function through Chronic Administration of a Jun-Amino Terminal Kinase Inhibitor and a LIM-Kinase 2 Inhibitor by Suppressing Cavernous Apoptosis and Fibrosis in a Rat Model of Cavernous Nerve Injury: A Comparison with a Phosphodiesterase Type 5 Inhibitor.

World J Mens Health 2020 Jul 9. Epub 2020 Jul 9.

Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.

Purpose: To determine if chronic administration of Jun-amino terminal kinase (JNK)-inhibitors and LIM-kinase 2 (LIMK2)-inhibitors from the immediate post-injury period in a rat model of cavernous-nerve-crush-injury could normalize cavernous-veno-occlusive-function, and to compare it with phosphodiesterase type 5 (PDE5)-inhibitors.

Materials And Methods: A total of 75 12-week-old male Sprague-Dawley-rats were randomized into five groups: sham-surgery (S), cavernous-nerve-crush-injury (I), cavernous-nerve-crush-injury treated with 10.0 mg/kg LIMK2-inhibitor (L) or 10.0 mg/kg JNK-inhibitor and 10.0 mg/kg LIMK2-inhibitor (J+L) or 20.0 mg/kg udenafil (P) for five-weeks. Five-weeks after surgery, dynamic-infusion-cavernosometry, histological-studies, caspase-3-activity-assay, and Western-blot were investigated.

Results: Group-I had lower papaverine-response, higher maintenance-rate and higher drop-rate, compared to Group-S. Group-L, Group-J+L and Group-P showed improvement in the three dynamic-infusion-cavernosometry parameters. The papaverine-response and drop-rate in Group-J+L and Group-P recovered to sham-control level, but those in Group-L did not. Regarding apoptosis, Group-I had decreased content of α-smooth-muscle-actin, increased caspase-3 activity and increased cJun-phosphorylation. The cJun-phosphorylation improved only in Group-J+L. The α-smooth-muscle-actin content and caspase-3-activity in Group-J+L and Group-P improved, but those in Group-L were not. Regarding fibrosis, Group-I had decreased smooth muscle (SM)/collagen-ratio, increased protein-expression of fibronectin, and increased Cofilin-phosphorylation. Cofilin-phosphorylation was normalized in Group-L and Group-J+L, but not in Group-P. SM/collagen-ratio and protein-expression of fibronectin in Group-L, Group-J+L and Group-P improved.

Conclusions: Our data indicate that chronic inhibition of JNK and LIMK2 can restore cavernous-veno-occlusive-function by suppressing cavernous-apoptosis and cavernous-fibrosis, comparable to the results by PDE5-inhibitors. Chronic inhibition of JNK and LIMK2 might be a potential mechanism-specific targeted therapy for cavernous-veno-occlusive-dysfunction induced by cavernous nerve-injury.
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http://dx.doi.org/10.5534/wjmh.200085DOI Listing
July 2020

Bladder wall thickness and detrusor wall thickness can help to predict the bladder outlet obstruction in men over the age of 70 years with symptomatic benign prostatic hyperplasia.

Investig Clin Urol 2020 09 16;61(5):491-497. Epub 2020 Jul 16.

Department of Urology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.

Purpose: We investigated the possible association between preoperative bladder wall thickness (BWT) or detrusor wall thickness (DWT) and bladder outlet obstruction (BOO) based on urodynamic studies in men with symptomatic benign prostatic hyperplasia (BPH).

Materials And Methods: Data were prospectively collected from a BPH surgery database. A total of 196 men who underwent prostate vaporization for symptomatic BPH were included in this study. BWT and DWT were measured in the suprapubic area after uroflowmetry.

Results: No significant difference was noted in BWT and DWT in any patient according to the presence of BOO; however, subgroup analysis showed that BWT and DWT were significantly thicker in the obstruction group in men aged 70 years or older than in those under age 70 (BWT: 3.6+0.9 mm vs. 3.1+0.9 mm, p=0.022, DWT: 2.8±0.8 mm vs. 2.3±0.8 mm, p=0.007). In this older age group, the classification based on a BWT ≥4.0 mm showed 31% sensitivity, 87% specificity, and 65% diagnostic accuracy for the diagnosis of BOO, whereas DWT ≥3.0 mm showed 49% sensitivity, 82% specificity, and 69% diagnostic accuracy.

Conclusions: BWT and DWT were associated with BOO in men aged 70 years or older. Therefore, BWT and DWT will be a useful non-invasive parameter for deciding the management strategy for elderly men with symptomatic BPH. An appropriate measurement method should be established as soon as possible for further application of the relationship among BWT, DWT and BOO.
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http://dx.doi.org/10.4111/icu.20190376DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7458872PMC
September 2020

Differences in risk factors for biochemical recurrence after radical prostatectomy stratified by the degree of obesity: Focused on surgical methods.

Sci Rep 2020 06 23;10(1):10157. Epub 2020 Jun 23.

Department of Urology, Seoul National University College of Medicine, Seoul, South Korea.

This study aims to evaluate differences in the risk factors for biochemical recurrence (BCR) for radical prostatectomy stratified by degree of obesity, focusing on the surgical method used. All 3099 patients who underwent radical prostatectomy in two medical centres from January 2008 to March 2018 were retrospectively reviewed. Patients were divided into three groups based on body mass index: 'normal', 'overweight', and 'obese'. Risk factors associated with biochemical recurrence were compared between different degrees of obesity. We analysed the contributing risk factors of BCR-free survival using univariate and multivariable Cox hazard models. There were 378 (12.2%) and 1815 (58.6%) patients in the 'obese' and 'overweight' groups, respectively. Accordingly, 1324 patients underwent retropubic radical prostatectomy (RRP), and 1775 underwent robotic-assisted laparoscopic prostatectomy (RALP). Multivariable analysis showed that patients who underwent RALP had significantly lower BCR free survival in the 'overweight' and 'obese' groups than those who underwent RRP, with adjusted hazard ratios of 0.75 (95% CI 0.59-0.95, p-value = 0.01) and 0.55 (95% CI 0.33-0.90, p-value = 0.02), respectively. The degree of obesity was not directly associated with BCR-free survival. Robotic prostatectomy showed greater benefits in BCR-free survival than open prostatectomy in the 'overweight' and 'obese' groups.
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http://dx.doi.org/10.1038/s41598-020-67237-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7311457PMC
June 2020

Survival Benefits Based on the Number of Lymph Nodes Removed during Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: Systematic Review and Meta-Analysis.

J Clin Med 2020 Jun 21;9(6). Epub 2020 Jun 21.

Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Korea.

The role of lymph node dissection (LND) is still controversial for upper tract urothelial carcinoma (UTUC), and there are no guidelines regarding its use. This study was conducted to find a higher level of evidence for the survival benefits based on the number of LNs removed during radical nephroureterectomy (RNUx) through a systematic review and meta-analysis. We included studies comparing patients who underwent LND during RNUx for UTUC. We searched the major electronic databases (Pubmed, Embase, and Scopus) and conducted manual searches of the electronically available abstracts of the major international urology cancer meetings [American Society of Clinical Oncology (ASCO), American Urological Association (AUA), and Eropean Association of Urology (EAU)] prior to April 2019 using grouped terms of nephroureterectomy (nephroureterectom*) and lymph node excision (lymphadenectomy; lymph + node*; lymph* + metasta*) with variations in the terms. Study selection, data collection, and risk of bias assessment were performed by two independent authors (A and B). Six retrospective case-control studies included a total of 33,944 patients who underwent RNUx for UTUC, 5071 of whom underwent LND and were finally included in the meta-analysis. The pooled hazard ratio (HR) in these studies revealed that an increased number of LNs removed during RNUx was associated with improved cancer-specific survival (CSS) in patients with UTUC (HR = 0.95, 95% CI: 0.91-0.99; = 0.07). In addition, increased numbers of LNs removed were associated with improved overall survival (OS) in pN0 patients. However, in pN+ patients, the number of LNs removed showed no survival benefit on CSS, overall survival (OS), or progression-free survival (PFS). Higher numbers of LNs removed during RNUx were associated with improved survival outcomes in patients with UTUC. This study confirmed that LND also has oncological benefits in UTUC patients. Although still a controversial topic, meticulous LND must be considered, and efforts should be made to eliminate as many LNs as possible when administering RNUx for UTUC, especially in patients without clear evidence of LN metastasis.
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http://dx.doi.org/10.3390/jcm9061933DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7357082PMC
June 2020

Serum vitamin D binding protein level, but not serum total, bioavailable, free vitamin D, is higher in 30-days survivors than in nonsurvivors with sepsis.

Medicine (Baltimore) 2020 Jun;99(25):e20756

Department of Laboratory Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine.

The prognostic value of 3 types (total, bioavailable, and free) of 25-hydroxy vitamin D [25(OH)D] and vitamin D binding protein (VDBP) in patients with sepsis is unknown. The aim of this study was to evaluate the association of levels of those 3 types of 25(OH) D and VDBP with 30-day mortality in patients with sepsis. From March to December 2018, patients diagnosed with sepsis and admitted to the medical intensive care unit were enrolled, prospectively. We measured total 25(OH)D and VDBP levels, performed GC genotyping for the polymorphisms rs4588 and rs7041, and calculated bioavailable and free 25(OH)D levels. Total, bioavailable, and free 25(OH)D levels did not differ in 30-days nonsurvivors and survivors. Serum VDBP level was significantly higher in survivors than nonsurvivors (138.6 ug/mL vs 108.2 ug/mL, P = .023) and was associated with 30-day mortality in univariate but not multivariate analysis. VDBP polymorphisms and allele frequencies were not statistically different between the groups. Serum VDBP level was significantly higher in survivors than nonsurvivors over 30-days mortality in septic patients. However, 3 types (total, bioavailable, and free) of 25(OH)D levels did not differ between the survivors and nonsurvivors group.
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http://dx.doi.org/10.1097/MD.0000000000020756DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7310855PMC
June 2020

Development and validation of an explainable artificial intelligence-based decision-supporting tool for prostate biopsy.

BJU Int 2020 12 4;126(6):694-703. Epub 2020 Aug 4.

Department of Urology, Seoul National University College of Medicine, Seoul, South Korea.

Objectives: To develop and validate a risk calculator for prostate cancer (PCa) and clinically significant PCa (csPCa) using explainable artificial intelligence (XAI).

Patients And Methods: We used data of 3791 patients to develop and validate the risk calculator. We initially divided the data into development and validation sets. An extreme gradient-boosting algorithm was applied to the development calculator using five-fold cross-validation with hyperparameter tuning following feature selection in the development set. The model feature importance was determined based on the Shapley value. The area under the curve (AUC) of the receiver operating characteristic curve was analysed for each validation set of the calculator.

Results: Approximately 1216 (32.7%) and 562 (14.8%) patients were diagnosed with PCa and csPCa. The data of 2843 patients were used for development, whereas the data of 948 patients were used as a test set. We selected the variables for each PCa and csPCa risk calculation according to the least absolute shrinkage and selection operator regression. The AUC of the final PCa model was 0.869 (95% confidence interval [CI] 0.844-0.893), whereas that of the csPCa model was 0.945 (95% CI 0.927-0.963). The prostate-specific antigen (PSA) level, free PSA level, age, prostate volume (both the transitional zone and total), hypoechoic lesions on ultrasonography, and testosterone level were found to be important parameters in the PCa model. The number of previous biopsies was not associated with the risk of csPCa, but was negatively associated with the risk of PCa.

Conclusion: We successfully developed and validated a decision-supporting tool using XAI for calculating the probability of PCa and csPCa prior to prostate biopsy.
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http://dx.doi.org/10.1111/bju.15122DOI Listing
December 2020

Can we improve the detection rate of prostate cancer using standard 12-core TRUS-guided prostate biopsy? Focused on the location of prostate biopsy.

Cancer Med 2020 06 12;9(11):3758-3764. Epub 2020 Apr 12.

Department of Urology, Seoul National University Boramae Medical Center, Seoul, Korea.

Background: We assessed the effect of biopsy location on the prostate cancer detection and clinically significant prostate cancer.

Methods: A total of 2774 patients with 12-core prostate transrectal ultrasound-guided prostate biopsy were included for per core analysis. Multivariate Cox regression analysis was performed to evaluate the effect of the location of biopsy on the prostate cancer and clinically significant prostate cancer detection.

Results: Prostate cancer was found in 775 patients (27.9%) and 576 prostate cancer patients (20.8%) were found to be clinically significant. The core length (P = .043), tumor length (P < .001), and % tumor length (P < .001) were significantly different according to the biopsy location. The detection rates for prostate cancer and clinically significant prostate cancer differed significantly according to the location of biopsy. Multivariate analysis revealed that the apical core was significantly related with increased detection of prostate cancer and clinically significant prostate cancer. The lateral core, in addition to apical core, was found to be significantly related with increased detection rates of prostate cancer and clinically significant prostate cancer in men with prostate-specific antigen <10 ng/mL.

Conclusions: More in-depth discussions on the location of standard 12-core prostate biopsy are considered necessary. Apical core and lateral core biopsies may be helpful, especially in patients with prostate-specific antigen ˂10 ng/mL if additional biopsies are planned following findings of no target lesions on imaging studies.
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http://dx.doi.org/10.1002/cam4.2990DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7286467PMC
June 2020

Novel Emerging Therapies for Erectile Dysfunction.

World J Mens Health 2021 Jan 16;39(1):48-64. Epub 2020 Mar 16.

Department of Urology, San Diego VA Health Care System & University of California, San Diego, CA, USA.

Currently, several treatments exist for the improvement of erectile dysfunction (ED). These include medical therapies such as phosphodiesterase type 5 inhibitors (PDE5-Is), invasive methods such as intracavernosal injection therapy of vaso-active substances, vacuum erection devices, and penile prosthesis implants. However, the percentage of patients that are unresponsive to available treatments and who drop out from treatments remains high. Current evidence reveals that the pathogenesis of ED is related to multiple factors including underlying comorbidities, previous surgery, and psychological factors. Diverse approaches using novel molecular pathways or new technologies have been tested as potential therapeutic options for difficultto-treat ED populations. Melanocortin receptor agonist, a centrally acting agent, showed promising results by initiating erection without sexual stimulation in non-responders to PDE5-Is. Recent clinical and pre-clinical studies using human tissues suggested that new peripherally acting agents including the Max-K channel activator, guanylate cyclase activator, and nitric oxide donor could be potential therapies either as a monotherapy or in combination with PDE5-Is in ED patients. According to several clinical trials, regeneration therapy using stem cells showed favorable data in men with diabetic or post-prostatectomy ED. Low-intensity shock wave therapy also demonstrated promising results in patients with vasculogenic ED. There are growing evidences which suggest the efficacy of these emerging therapies, though most of the therapies still need to be validated by well-designed clinical trials. It is expected that, should their long-term safety and efficacy be proven, the emerging treatments can meet the needs of patients hitherto unresponsive to or unsatisfied by current therapies for ED.
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http://dx.doi.org/10.5534/wjmh.200007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7752520PMC
January 2021

Optimal high-density lipoprotein cholesterol level for decreasing benign prostatic hyperplasia in men not taking statin medication: A historical cohort study.

Prostate 2020 05 20;80(7):570-576. Epub 2020 Mar 20.

Department of Urology, Seoul National University Boramae Medical Center, Seoul, Republic of Korea.

Background: We evaluated the optimal high-density lipoprotein cholesterol level for benign prostatic hyperplasia (BPH) prevention in men not taking statin medication using a large historical cohort.

Methods: We initially selected 130 454 men who underwent health checkups in 2009 from the National Health Information Database of the National Health Insurance Service. After excluding 36 854 men with BPH in 2009, and 45 061 men for statin use, 48 539 men were ultimately included in the analysis. A Kaplan-Meier analysis and multivariable Cox regression analysis was performed to assess the optimal high-density lipoprotein cholesterol level for preventing BPH.

Results: High-density lipoprotein cholesterol levels were less than 40 mg/dL in 7431 (15.3%) men, 40 to 49 in 15 861 (32.7%), 50 to 59 in 15 328 (27.5%), and greater than or equal to 60 in 11 919 (24.6%). The overall cumulative incidence of BPH was 4.4%, 8.7%, 13.0%, and 17.8% at the 1-, 2-, 3-, and 4-year follow-up periods, respectively. In multivariable analysis, high-density lipoprotein greater than or equal to 60 mg/dL were significantly associated with a decreased incidence of BPH, as were age, residence, income, body mass index, diabetes, hypertension, triglyceride, and increased annual clinic visits, especially in men in their 40s.

Conclusion: Elevated serum high-density lipoprotein cholesterol levels were negatively associated with BPH incidence. In addition, maintaining high-density lipoprotein greater than or equal to 60 mg/dL was associated with a decreased BPH incidence compared with high-density lipoprotein less than 40 mg/dL, especially in men in their 40s.
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http://dx.doi.org/10.1002/pros.23970DOI Listing
May 2020

Postoperative renal functional changes assessed by Tc-DTPA scintigraphy and predictive factors after miniaturized percutaneous nephrolithotomy and retrograde intrarenal surgery: An observational 1-year follow-up study.

Investig Clin Urol 2020 01 2;61(1):59-66. Epub 2020 Jan 2.

Department of Urology, Seoul National University Hospital, Seoul, Korea.

Purpose: We evaluated the comparative effect of miniaturized percutaneous nephrolithotomy (mini-PCNL) and retrograde intrarenal surgery (RIRS) on perioperative kidney function by use of diethylenetriamine penta-acetic acid (Tc-DTPA) scintigraphy and identified significant predictors associated with deterioration or amelioration of renal function after surgery.

Materials And Methods: All 70 patients who underwent mini-PCNL or RIRS between 2012 and 2016 were monitored by Tc-DTPA scintigraphy preoperatively. Patients with abnormal renal function were monitored from 3 to 12 months postoperatively. Logistic regression analyses were conducted to estimate the predictors of aggravated renal dysfunction and improvement.

Results: The difference in preoperative renal function between the contralateral and the operative side was >10% in 57 patients (81.4%). Among those in the group with abnormal renal function, 40 (70.2%), 10 (17.5%), and 7 (12.3%) patients showed stability, deterioration, and improvement in renal function at postoperative year 1, respectively. Functional changes did not differ according to the type of surgery. A high level of serum creatinine preoperatively (p=0.060) and a history of previous stone procedures (p=0.051) showed borderline significance for prediction of deterioration in renal function.

Conclusions: RIRS and mini-PCNL had similar effects and favorable outcomes on renal function during a 1-year follow-up period. High baseline serum creatinine levels and a history of procedures warrant careful attention.
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http://dx.doi.org/10.4111/icu.2020.61.1.59DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6946815PMC
January 2020

Aqueous humor and serum 25-Hydroxyvitamin D levels in patients with cataracts.

BMC Ophthalmol 2020 Jan 6;20(1). Epub 2020 Jan 6.

Institute of Health Science, Gyeongsang National University, Jinju, South Korea.

Background: Serum 25-hydroxyvitamin D (25 (OH) D) levels are associated with various pathologic ocular conditions. Few studies have assessed 25 (OH) D concentrations in non-serum specimens, and none to date has assessed 25 (OH) D concentrations in human aqueous humor and their association with ocular diseases. This study investigated the possible correlations between 25 (OH) D concentrations in aqueous humor and serum and whether vitamin D concentrations in aqueous humor were associated with cataract.

Methods: This study prospectively enrolled 136 patients, including 87 with senile cataract and 49 with diabetic cataract, who underwent cataract surgery from January to November 2017. 25 (OH) D was measured in aqueous humor and serum specimens collected from all patients, and their correlation was analyzed statistically. Clinical and laboratory data, including the results of ophthalmologic examinations, were compared in the two groups of cataract patients.

Results: No correlation was observed between 25 (OH) D concentrations in aqueous humor and serum (P = 0.381). 25 (OH) D concentrations in aqueous humor were significantly higher in patients with diabetic than senile cataract (P = 0.006). Multivariate logistic regression analysis showed that the adjusted odds ratio for diabetic cataract for the highest compared with the lowest quartile of 25 (OH) D concentration in aqueous humor was 4.36 ng/ml (95% confidence interval [CI]: 1.33-14.34 ng/ml; P = 0.015). Multivariate linear regression analysis showed that 25(OH) D concentration in aqueous humor was 2.68 ng/ml (95% CI: 0.34-5.01 ng/ml; P = 0.025) higher in patients with diabetic than senile cataract.

Conclusions: 25(OH) D concentrations in aqueous humor and serum did not correlate with each other. Higher 25(OH) D level in aqueous humor was associated with diabetic cataract. These findings suggest that studies of vitamin D levels in patients with ocular conditions should include measurements of vitamin D levels in aqueous humor.
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http://dx.doi.org/10.1186/s12886-019-1293-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6945656PMC
January 2020

A Prospective, Multicenter, Open-Label Study of Dose Escalation Therapy in Male Patients With Nocturia Refractory to 0.2-mg Tamsulosin Monotherapy.

Int Neurourol J 2019 Dec 31;23(4):294-301. Epub 2019 Dec 31.

Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.

Purpose: To investigate the efficacy and safety of 0.4 mg of tamsulosin in patients with nocturia not responding to 0.2 mg.

Methods: Patients with intractable nocturia after treatment with 0.2 mg of tamsulosin for>1 month were included in a multicenter, prospective, observational, single-arm study. Patients were prescribed 0.4 mg of tamsulosin and followed up for 2 months to assess nocturnal voiding and nocturia-related bother. Changes in the mean number of nocturnal voids, the proportion of 50% responders, 3-day frequency-volume chart parameters, and questionnaire scores were assessed.

Results: Sixty-two patients were prescribed 0.2 mg of tamsulosin, of whom 56 were prescribed 0.4 mg of tamsulosin. Ten patients dropped out. A single case of orthostatic hypotension was reported. The mean age was 68 years. After 1 and 2 months of taking 0.4 mg of tamsulosin, 23.9% and 22.7% of patients demonstrated a>50% reduction of nocturia, and 16.1% and 19.4% of patients rated the treatment as "very effective," respectively. Dose escalation to 0.4 mg of tamsulosin, compared to 0.2 mg, did not show an additional effect on reducing nocturnal urine volume. Multivariate logistic regression analysis showed that lower serum sodium levels (odds ratio [OR], 0.41, P=0.037) and the presence of urge incontinence (OR, 7.08, P=0.036) were predictors of a significant improvement of nocturia in response to 0.4 mg of tamsulosin.

Conclusion: Dose escalation may yield a significant improvement of nocturia in>20% of patients, and may be especially helpful in patients with lower sodium levels and urge incontinence.
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http://dx.doi.org/10.5213/inj.1938076.038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6944788PMC
December 2019

Influence of anesthesia methods on surgical outcomes and renal function in retrograde intrarenal stone surgery: a prospective, randomized controlled study.

BMC Anesthesiol 2019 12 23;19(1):239. Epub 2019 Dec 23.

Department of Urology, Seoul National University Hospital, 101, Daehak-ro Jongno-gu, 03080, Seoul, Republic of Korea.

Background: We analyzed the influence of anesthesia methods on surgical outcomes and renal function in retrograde intrarenal surgery (RIRS) in a prospective, randomized controlled study.

Methods: Seventy patients who underwent RIRS from September 2015 to February 2017 were randomly allocated to general anesthesia (GA) or spinal anesthesia (SA) groups. Renal function was assessed using estimated glomerular filtration rate, and separate renal function was evaluated using nuclear medicine tests. Maneuverability and accessibility were evaluated after every surgery. All procedures were performed by a single experienced surgeon (SY Cho).

Results: Stone-free rate was higher in the GA (92.3%, 36 of 39) than the SA (71.0%, 22 of 31) (P = 0.019) group. Pain score was higher in the GA than in the SA group on the first postoperative morning (P = 0.025), but pain scores of the two groups were similar before discharge (P = 0.560). There were no differences in the changes of serum creatinine level (P = 0.792) and changes of estimated glomerular filtration rate (P = 0.807). Differences of separate renal function between operative and contralateral site increased significantly in patients under GA than under SA at postoperative 3 months (P = 0.014). Maneuverability and accessibility were better in SA with sedation than GA (P < 0.001).

Conclusions: RIRS under SA showed advantages in renal function change using renogram at postoperative 3 months and in lower pain score on the first postoperative morning. Performance of operator under SA was worse than that under GA and significantly improved with sedation. RIRS under SA showed advantages in lower pain score at postoperative first day.

Trial Registration: Clinicaltrials.gov ID is NCT03957109, and registration date is 17th May 2019. This study was retrospectively registered.
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http://dx.doi.org/10.1186/s12871-019-0901-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6927176PMC
December 2019

Comparison of antibiotic susceptibility of Escherichia coli between community-acquired and post-prostate biopsy acute bacterial prostatitis.

Arch Esp Urol 2019 Dec;72(10):1018-1025

Department of Urology. Dongguk University Ilsan Hospital. Gyeonggi-do. Republic of Korea.

Objectives: To compare the antibiotic susceptibility of Escherichia coli (E. coli) between community- acquired acute bacterial prostatitis (CA-ABP) and ABP following transrectal ultrasound-guided prostate biopsy (Bx-ABP).

Methods: A total of 4,383 patients underwent prostate biopsy from January 2005 to June 2014. Among these patients, 34 had Bx-ABP; of which 22 patients had E. coli identified in their urine or blood culture. E. coli was also identified in 91 out of 209 patients with CA-ABP in urine or blood culture. We investigated patient and microbiological characteristics.

Results: The Bx-ABP (59.1%) group showed a higher bacteremia prevalence than the CA-ABP group (13.2%) (p<0.001). Significant differences in the antibiotic sensitivity to E. coli between the two groups were observed for fluoroquinolone, cephalothin, and gentamicin. The antibiotic sensitivity of fluoroquinolone in the Bx-ABP group was only 27.3%. Amikacin, imipenem, meropenem, amoxicillin/clavulanic acid, and piperacillin/ tazobactam showed more than 95% antibiotic sensitivity in both groups. Bx-ABP was an independent predictive factor for bacteremia by multivariate analysis.

Conclusions: E. coli in Bx-ABP showed a higher incidence of antibiotic resistance and bacteremia than those in CA-ABP. Carbapenem may be a treatment of choice for patients suspected of having sepsis. Considering the recent emergence of carbapenem-resistant bacteria, piperacillin/tazobactam or amikacin may be considered.
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December 2019

Publisher Correction: Quality of life after photo-selective vaporization and holmium-laser enucleation of the prostate: 5-year outcomes.

Sci Rep 2019 Nov 8;9(1):16722. Epub 2019 Nov 8.

Department of Urology, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, 07061, Republic of Korea.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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http://dx.doi.org/10.1038/s41598-019-53162-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6841686PMC
November 2019

Patients with Biopsy Gleason Score 3 + 4 Are Not Appropriate Candidates for Active Surveillance.

Urol Int 2020 6;104(3-4):199-204. Epub 2019 Nov 6.

Department of Urology, SMG-SNU Boramae Medical Center, College of Medicine, Seoul National University, Seoul, Republic of Korea,

Objective: The aim of this study was to evaluate the feasibility of including patients with biopsy Gleason score (bGS) 3 + 4 prostate cancer in an active surveillance (AS) protocol.

Methods: A total of 615 patients underwent a radical prostatectomy and satisfied the following requirements: prostate-specific antigen ≤10 ng/dL, clinical stage T1c or T2a, 2 or fewer positive biopsy cores, and bGS 6 or 3 + 4 prostate cancer. The patients were divided into two groups according to their bGS (bGS 6 group, n =534; bGS 3 + 4 group, n = 81).

Results: The adverse pathological features were significantly higher in the bGS 3 + 4 group (16.7 vs. 49.4%, p< 0.001). Biochemical recurrence (BCR)-free survival was also significantly lower in this group (p < 0.001). In a multivariate analysis, clinical stage (odds ratio [OR] 2.026, p =0.007), maximum percentage of biopsy core involvement (OR 1.015, p = 0.014), and bGS (OR 1.913, p = 0.030) were independent risk factors for adverse pathological features. However, the bGS was the only variable to forecast BCR (hazard ratio 3.567, p < 0.001).

Conclusions: A bGS 3 + 4 was the leading risk factor for a worse postoperative prognosis. Therefore, patients with a bGS 3 + 4 are not appropriate candidates for AS.
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http://dx.doi.org/10.1159/000503888DOI Listing
January 2021

Proportion of cores with the highest Gleason grade group among positive cores on prostate biopsy: does this affect the probability of upgrading or downgrading?

Scand J Urol 2019 Dec 1;53(6):372-377. Epub 2019 Nov 1.

Department of Urology, Seoul National University Boramae Medical Center, Seoul, Korea.

This study assessed the ability to predict the probability of pathologic upgrading or downgrading based on the proportion of cores with the highest Gleason grade on prostate biopsy. From 2002-2017, 494 patients with multiple positive cores on prostate biopsy who underwent radical prostatectomy were included for the analysis. The proportion of cores with the highest Gleason grade group among positive cores was calculated and patients were divided into three groups based on the proportion (≤33% vs >33% and ≤67% vs >67%). Tumor characteristics, including PSA level, biopsy Gleason grade, preoperative MR imaging, pathologic grade, pathologic stage and tumor volume, were worse in patients with a highest Gleason grade proportion, ≤33%. Upgrading (5.6% vs 15.0% vs 39.4%,  < 0.001) was more common in patients with a higher highest Gleason grade proportion, while downgrading (51.7% vs 35.3% vs 7.2,  < 0.001) was more common in patients with a lower highest Gleason grade proportion. On multivariate analysis, the highest Gleason grade proportion was a significant predictor for upgrading and downgrading in addition to other clinical variables. The areas under the curve for models predicting upgrading (0.784 vs 0.768,  = 0.009) and downgrading (0.746 vs 0.717,  = 0.017), which incorporating the highest Gleason grade proportion, were significantly higher than models without the highest Gleason grade proportion. The proportion of cores with the highest Gleason grade is a readily available novel parameter for calculating the probability of upgrading or downgrading.
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http://dx.doi.org/10.1080/21681805.2019.1681506DOI Listing
December 2019

Characteristics and Outcomes of Patients with Pulmonary Acute Respiratory Distress Syndrome Infected with Influenza versus Other Respiratory Viruses.

Tuberc Respir Dis (Seoul) 2019 Oct;82(4):328-334

Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea.

Background: Although the frequency of respiratory viral infection in patients with pulmonary acute respiratory distress syndrome (ARDS) is not uncommon, clinical significance of the condition remains to be further elucidated. The purpose of this study was to compare characteristics and outcomes of patients with pulmonary ARDS infected with influenza and other respiratory viruses.

Methods: Clinical data of patients with pulmonary ARDS infected with respiratory viruses January 2014-June 2018 were reviewed. Respiratory viral infection was identified by multiplex reverse transcription-polymerase chain reaction (RT-PCR).

Results: Among 126 patients who underwent multiplex RT-PCR, respiratory viral infection was identified in 46% (58/126): 28 patients with influenza and 30 patients with other respiratory viruses. There was no significant difference in baseline and clinical characteristics between patients with influenza and those with other respiratory viruses. The use of extracorporeal membrane oxygenation (ECMO) was more frequent in patients with influenza than in those with other respiratory viruses (32.1% vs 3.3%, p=0.006). Co-bacterial pathogens were more frequently isolated from respiratory samples of patients with pulmonary ARDS infected with influenza virus than those with other respiratory viruses. (53.6% vs 26.7%, p=0.036). There were no significant differences regarding clinical outcomes. In multivariate analysis, acute physiology and chronic health evaluation II was associated with 30-mortality (odds ratio, 1.158; 95% confidence interval, 1.022-1.312; p=0.022).

Conclusion: Respiratory viral infection was not uncommon in patients with pulmonary ARDS. Influenza virus was most commonly identified and was associated with more co-bacterial infection and ECMO therapy.
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http://dx.doi.org/10.4046/trd.2019.0017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6778745PMC
October 2019

Analysis of vitamin D-binding protein (VDBP) gene polymorphisms in Korean women with and without endometriosis.

Clin Exp Reprod Med 2019 Sep 13;46(3):132-139. Epub 2019 Aug 13.

Institute of Health Sciences, Gyeongsang National University, Jinju, Korea.

Objective: Vitamin D-binding protein (VDBP) mediates various biological processes in humans. The goal of this study was to investigate whether VDBP gene polymorphisms could predispose Korean women to endometriosis.

Methods: We prospectively enrolled women with endometriosis (n = 16) and healthy controls (n = 16). Total serum 25-hydroxyl vitamin D (25(OH)D) concentrations were measured using an Elecsys vitamin D total kit. Levels of bioavailable and free 25(OH)D were calculated. Concentrations of VDBP were measured using a vitamin D BP Quantikine ELISA kit. DNA was extracted using a DNeasy blood & tissue kit. Two singlenucleotide polymorphisms (SNPs; rs4588 and rs7041) in GC, the gene that codes for VDBP, were analyzed using a TaqMan SNP genotyping assay kit. The functional variant of VDBP was determined based on the results of the two SNPs.

Results: Gravidity and parity were significantly lower in the endometriosis patients than in the control group, but serum CA-125 levels and the erythrocyte sedimentation rate were significantly higher. Total serum 25(OH)D levels in the endometriosis patients were significantly lower than in the control group. However, serum bioavailable 25(OH)D, free 25(OH)D, and VDBP levels did not differ significantly between the endometriosis and control groups. The genotypes and allele frequencies of GC were similar in both groups.

Conclusion: Korean women with endometriosis had lower total serum 25(OH)D concentrations than controls. Neither serum VDBP concentrations nor polymorphisms in the gene coding for VDBP were associated with endometriosis. Further studies are needed to investigate the pathophysiology and clinical implications of 25(OH)D and VDBP in endometriosis.
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http://dx.doi.org/10.5653/cerm.2019.00122DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6736509PMC
September 2019

Differences in 25-hydroxy vitamin D and vitamin D-binding protein concentrations according to the severity of endometriosis.

Clin Exp Reprod Med 2019 Sep 1;46(3):125-131. Epub 2019 Aug 1.

Department of Obstetrics and Gynecology, Gyeongsang National University Hospital, Jinju, Korea.

Objective: To investigate serum 25-hydroxyl vitamin D (25(OH)D) and vitamin D-binding protein (VDBP) concentrations in women with endometriosis according to the severity of disease.

Methods: Women with mild endometriosis (n = 9) and advanced endometriosis (n = 7), as well as healthy controls (n = 16), were enrolled in this observational study. Serum total 25(OH)D concentrations were analyzed using the Elecsys vitamin D total kit with the Cobas e602 module. Concentrations of bioavailable and free 25(OH)D were calculated. Concentrations of VDBP were measured using the Human Vitamin D BP Quantikine ELISA kit. Variables were tested for normality and homoscedasticity using the Shapiro-Wilk test and Leven F test, respectively. Correlation analysis was used to identify the variables related to total 25(OH)D and VDBP levels. To assess the effects of total 25(OH)D and VDBP levels in the three groups, multivariate generalized additive modeling (GAM) was performed.

Results: Gravidity and parity were significantly different across the three groups. Erythrocyte sedimentation rate (ESR) and CA-125 levels increased as a function of endometriosis severity, respectively (p= 0.051, p= 0.004). The correlation analysis showed that total 25(OH)D levels were positively correlated with gravidity (r = 0.59, p< 0.001) and parity (r = 0.51, p< 0.003). Multivariate GAM showed no significant relationship of total 25(OH)D levels with EMT severity after adjusting for gravidity and ESR. However, the coefficient of total 25(OH)D levels with gravidity was significant (1.87; 95% confidence interval, 0.12-3.63; p= 0.040).

Conclusion: These results indicate that vitamin D and VDBP levels were not associated with the severity of endometriosis.
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http://dx.doi.org/10.5653/cerm.2018.00416DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6736508PMC
September 2019

Combination of LIM-kinase 2 and Jun Amino-terminal Kinase Inhibitors Improves Erectile Function in a Rat Model of Cavernous Nerve Injury.

Urology 2019 Sep 13;131:136-143. Epub 2019 Jun 13.

Department of Urology, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea. Electronic address:

Objective: To determine if combined administration of LIMK2 and JNK inhibitors in a rat model of erectile dysfunction induced by cavernosal nerve (CN) injury could restore erectile function by suppressing both cavernosal apoptosis and fibrosis via rectification of molecular pathways related to the structural alterations.

Methods: Sixty 12-week-old male Sprague-Dawley rats were categorized into 4 groups: (1) Sham-surgery (Sham) group, (2) CN-crush-injury (CNCI), (3) CNCI group (CNCI+L+1.0J) treated with a combination of 10.0 mg/kg LIMK2-inhibitors and low-dose (1.0 mg/kg) JNK-inhibitors, and (4) CNCI group (CNCI+L+10.0J) treated with a combination of 10.0 mg/kg LIMK2-inhibitors and a high dose (10.0 mg/kg) of JNK-inhibitors. Ten days after surgery, erectile response, histological-studies, and Western-blot was investigated.

Results: The CNCI group showed a reduced maximal ICP/MAP or AUC/MAP, decreased immunohistochemical-staining of α-SMA, decreased SM/collagen ratio, increased phospho-cJun-positive apoptotic cells, increased phospho-LIMK2-positive fibroblasts, increased cJun-phosphorylation, increased LIMK2/Cofilin-phosphorylation, decreased Bcl-2/Bax ratio, and increased protein-expression of fibronectin, compared to the Sham group. Both the CNCI+L+1.0J and CNCI+L+10.0J groups showed improvements in erectile-responses, content of cavernosal α-SMA, number of phospho-cJun-positive apoptotic cells, Bcl-2/Bax ratio and cJun phosphorylation. Their improvements in the CNCI+L+10.0J group showed a tendency to be greater than those in the CNCI+L+1.0J group. Also, in the 2 treatment groups, rectification of SM/collagen ratio, number of phospho-LIMK2-positive fibroblasts, LIMK2/Cofilin-phosphorylation, and protein-expression of fibronectin was observed.

Conclusion: This study suggests that combined inhibition of JNK and LIMK2 may improve erectile function by suppressing cavernosal apoptosis and fibrosis via restoration of cJun/Bcl-2/Bax and LIMK2/Cofilin pathways at 10 days after CN injury.
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http://dx.doi.org/10.1016/j.urology.2019.06.005DOI Listing
September 2019

Quality of life after photo-selective vaporization and holmium-laser enucleation of the prostate: 5-year outcomes.

Sci Rep 2019 06 4;9(1):8261. Epub 2019 Jun 4.

Department of Urology, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, 07061, Republic of Korea.

This study was aimed to compare serial long-term postoperative changes in quality-of-life (QoL) between photoselective-vaporization (PVP) using 120W-High-Performance-System and holmium-laser-enucleation (HoLEP) in benign-prostatic-hyperplasia (BPH) patients and to identify factors influencing the QoL improvement at the short-term, mid-term and long-term follow-up visits after surgery. We analyzed 1,193 patients with a baseline QoL-index ≥2 who underwent PVP (n = 439) or HoLEP (n = 754). Surgical outcomes were serially compared between the two groups at up to 60-months using the International-Prostatic-Symptom-Score (I-PSS), uroflowmetry, and serum PSA. We used logistic regression analysis to identify predictors of QoL improvement (a reduction in the QoL-index ≥50% compared with baseline) at the short-term (12-months), mid-term (36-months), and long term (60-months) follow-up after surgery. In both groups, the QoL-index was decreased throughout the entire follow-up period compared with that at baseline. There were no significant differences in postoperative changes from the baseline QoL-index between the two groups during the 48-month follow-up, except at 60-months. The degree of improvement in QoL at 60-months after HoLEP was greater than that after PVP. A lower baseline storage-symptom-subscore and a higher bladder-outlet-obstruction-index (BOOI) were independent factors influencing QoL improvement at the short-term. No independent factor influences QoL improvement at the mid- or long-term.
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http://dx.doi.org/10.1038/s41598-019-44686-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6547661PMC
June 2019

Author Correction: Changes in separate renal function in patients who underwent minimally invasive renal stone surgery according to the preoperative functional deterioration.

Sci Rep 2019 May 28;9(1):8119. Epub 2019 May 28.

Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Korea.

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has been fixed in the paper.
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http://dx.doi.org/10.1038/s41598-019-44432-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6536677PMC
May 2019

Cerebrospinal fluid vitamin D-binding protein as a new biomarker for the diagnosis of meningitis.

Neurol Sci 2019 Aug 13;40(8):1597-1605. Epub 2019 Apr 13.

Department of Laboratory Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Gangnam-ro, Jinju-si, Gyeongsangnam-do, 52727, Republic of Korea.

Background: Meningitis is an inflammatory process involving meninges. It is difficult to diagnose because of the absence of a diagnostic biomarker. We first report here the possibility of cerebrospinal fluid (CSF) vitamin D-binding protein (VDBP) as a new biomarker for the diagnosis of meningitis.

Methods: This prospective study enrolled a total of 102 subjects (58 patients with non-neurologic disease, 17 patients with meningitis, and 27 patients with other neurologic diseases) from 2017 to 2018. CSF and blood samples were collected in pairs. Total 25(OH)D in CSF and serum and VDBP levels in serum were measured. GC genotyping was also performed to determine polymorphisms of rs4588 and rs7041. CSF total 25(OH)D and VDBP levels were compared with serum total 25(OH)D and VDBP levels according to disease (meningitis vs. non-meningitis). Receiver operating characteristic (ROC) analysis for the diagnosis of meningitis using CSF VDBP level was performed.

Results: Mean CSF VDBP and serum VDBP levels of all patients were 1.48 ± 1.32 and 181.28 ± 56.90 μg/mL, respectively. CSF VDBP level in the meningitis disease group (3.20 ± 1.49 μg/mL) was significantly (P < 0.001) higher than that in other disease groups. According to ROC curve analysis, the appropriate cut-off value for CSF VDBP was 1.96 μg/mL, showing sensitivity of 82.4% and specificity of 85.9%. AUC of CSF VDBP was 0.879 (95% CI: 0.789-0.962).

Conclusions: CSF VDBP level showed very good diagnostic performance. It could be used as a potential biomarker for the diagnosis of meningitis.
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http://dx.doi.org/10.1007/s10072-019-03873-9DOI Listing
August 2019

Ten-Year Interval Changes in the Prevalence of Self-Identified Premature Ejaculation and Premature Ejaculation Based on an Estimated Intravaginal Ejaculation Latency Time of <3 Minutes in the General Population: The Korean Internet Sexuality Survey (KISS) 2016.

J Sex Med 2019 04;16(4):512-521

Department of Urology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea; College of Medicine, Seoul National University, Seoul, Republic of Korea. Electronic address:

Introduction: Because the prevalence of premature ejaculation (PE) may change with time, few studies have been conducted over a 10-year time interval.

Aim: A 10-year time interval survey to determine whether there was a change in the prevalence of self-identified PE and PE defined on the basis of an estimated intravaginal ejaculation latency time of <3 minutes in adult Korean men, even after adjusting for various sociocultural factors.

Methods: We sent an e-mail to the panels registered in the same Internet survey agency in 2006, asking them to participate in a questionnaire-based survey of the same study design. 1,401 participants were enrolled in the 2016 study that included 800 subjects in their 20s-50s. The PE prevalence adjusted for age was evaluated because the proportion of participants per age was different between the 2 surveys. The age-adjusted prevalence of self-identified PE and PE with an estimated intravaginal ejaculation latency time of 3 minutes, which meets the diagnostic criteria for PE set by the International Society for Sexual Medicine (PE), was evaluated.

Main Outcome Measures: Changes in the overall prevalence of self-identified PE and PE in over a decade were evaluated.

Results: The overall age-adjusted prevalence of self-identified PE increased from 19.0% in 2006 to 21.6% in 2016; however, the result was not statistically significant (P = .244). The overall age-adjusted prevalence of PE increased from 1.8-4.0% in 2006 and 2016, respectively (P = .012). The risk factors of self-identified PE were few intercourses per month, masturbation, and self-identified erectile dysfunction. In addition, the risk factors of PE were aging, high body mass index, few intercourses per month, and masturbation.

Clinical Implication: The prevalence of PE has increased over 10 years. However, this increase may be due to sociocultural changes and should be more concerned with these factors.

Strength & Limitations: This study was the first to conduct a 10-year interval Web-based survey on the prevalence and risk factors of PE. However, this was not a cohort study with the same participants.

Conclusion: The overall age-adjusted prevalence of PE increased significantly over a decade, and sociocultural factors such as lifestyle were associated with the difference of PE prevalence for 10 years. However, more research is needed to determine how these sociocultural changes affect PE prevalence. Song WH, Yoo S, Oh S, et al. Ten-Year Interval Changes in the Prevalence of Self-Identified Premature Ejaculation and Premature Ejaculation Based on an Estimated Intravaginal Ejaculation Latency Time of <3 Minutes in the General Population: The Korean Internet Sexuality Survey (KISS) 2016. J Sex Med 2019;16:512-521.
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http://dx.doi.org/10.1016/j.jsxm.2019.02.003DOI Listing
April 2019