Realizing the Potential of Social Determinants Data: A Scoping Review of Approaches for Screening, Linkage, Extraction, Analysis and Interventions.

Background: Social determinants of health (SDoH) like socioeconomics and neighborhoods strongly influence outcomes, yet standardized SDoH data is lacking in electronic health records (EHR), limiting research and care quality. Methods: We searched PubMed using keywords "SDOH" and "EHR", underwent title/abstract and full-text screening. Included records were analyzed under five domains: 1) SDoH screening and assessment approaches, 2) SDoH data collection and documentation, 3) Use of natural language processing (NLP) for extracting SDoH, 4) SDoH data and health outcomes, and 5) SDoH-driven interventions. Results: We identified 685 articles, of which 324 underwent full review. Key findings include tailored screening instruments implemented across settings, census and claims data linkage providing contextual SDoH profiles, rule-based and neural network systems extracting SDoH from notes using NLP, connections found between SDoH data and healthcare utilization/chronic disease control, and integrated care management programs executed. However, considerable variability persists across data sources, tools, and outcomes. Discussion: Despite progress identifying patient social needs, further development of standards, predictive models, and coordinated interventions is critical to fulfill the potential of SDoH-EHR integration. Additional database searches could strengthen this scoping review. Ultimately widespread capture, analysis, and translation of multidimensional SDoH data into clinical care is essential for promoting health equity.

Identifying important predictors of adolescent suicide ideation, planning, and attempt in low- and middle-income countries.

INTRODUCTION: Over 90% of all adolescent suicides occur in low- and middle-income countries (LMIC), yet the majority of suicide research has focused on primarily high-income countries (HIC). METHOD: Using nationally representative data on 82,494 adolescents from thirty-four LMIC, this research employed machine learning to compare the predictive effects of multiple determinants of suicidal behaviors previously identified in the literature. RESULTS: Results indicate that distinct predictors are present for suicidal ideation, suicidal planning, and suicide attempts in youth living in LMIC as well as shared predictors common to all three behaviors. CONCLUSION: These findings provide insights into the unique needs in global mental health policy and efforts within and across adolescents in LMIC.

Developing STEM Career Identities among Latinx Youths: Collaborative Design, Evaluations, and Adaptations during COVID-19.

In response to the low representation of Latinx adults in STEM occupations, this community-based participatory action research study aims to increase the number of middle school youths developing STEM career identities and entering high school with the intention to pursue STEM careers. The students were provided with summer and after-school activities focusing on network science and career development curricula. Using a quasi-experimental pretest-posttest design and career narratives, this study examined the changes in STEM and career self-efficacy, as well as career identity. The results show improvements in self-efficacy, an increased number of youths with intentions of pursuing future STEM career opportunities, and deeper reflections on their talents and skills after program participation. This paper also describes the program development and implementation in detail, as well as the adaptations that resulted from COVID-19, for scholars and educators designing similar programs. This study provides promising evidence for the quality of STEM and career development lessons in supporting the emergence of a STEM career identity and self-efficacy.

Predictors of suicide ideation among South Korean adolescents: A machine learning approach.

BACKGROUND: The current study developed a predictive model for suicide ideation among South Korean (Korean) adolescents using a comprehensive set of factors across demographic, physical and mental health, academic, social, and behavioral domains. The aim of this study was to address the pressing public health concerns of adolescent suicide in Korea and the methodological limitations of suicidal research. METHODS: This study used machine learning methods (decision tree, logistic regression, naive Bayes classifier) to improve the accuracy of predicting suicidal ideation and related factors among a nationally representative sample of Korean middle school students (N = 6666). RESULTS: Factors within all domains, including demographic characteristics, physical and mental health, and academic, social, and behavioral, were important in predicting suicidal thoughts among Korean adolescents, with mental health being the most important factor. LIMITATIONS: The predictive model of the current research does not infer causality, and there may have been some loss of information due to measurement issues. CONCLUSIONS: Study results provide insights for taking a multidimensional approach when identifying adolescents at risk of suicide, which may be used to further address their needs through intervention programs within the school setting. Considering the cultural stigma attached to disclosing suicidal ideation and behavior, the current study proposes the need for a preventive screening process based on the observation and assessment of adolescents' general characteristics and experiences in everyday life.

Impact of community well-being on individual well-being: A longitudinal multinational study with 155 countries.

The purpose of the current study is to evaluate the longitudinal relationship between subjective community well-being (CWB) (perception of freedom of choice and social support) and subjective individual well-being (IWB) (positive and negative affect). Using the World Happiness Report (2019), this study examined the subjective IWB and subjective CWB among 155 countries across an 8-year period. Using Latent Class Growth Analysis the results indicated that the 155 countries could be classified into three groups-countries reporting high freedom of choice and high social support, low freedom of choice and low social support, and low freedom of choice and high social support. From the results of both a multigroup Growth Mixed Model and a Growth Curve Model, the three groups were found to vary with respect to positive and negative affect with higher positive affect and lower negative affect reported in countries classified as high freedom of choice and high social support, lower positive affect and higher negative affect reported in countries classified as low freedom of choice and low social support, and lower positive and lower negative affect reported in countries classified as low freedom of choice and high social support. These results indicate that country's rated as allowing higher freedom of choice was associated with higher reported positive affect, and country's rated as having stronger social support systems was associated with lower ratings for negative affect.

A cross-national study of factors associated with perinatal mental health and wellbeing during the COVID-19 pandemic

BackgroundPregnant and postpartum women face unique challenges during the COVID-19 pandemic that may put them at elevated risk of mental health problems. However, few large-scale and no cross-national studies have been conducted to date that investigate modifiable pandemic-related behavioral or cognitive factors that may influence mental health in this vulnerable group. This international study sought to identify and measure the associations between pandemic-related information seeking, worries, and prevention behaviors on perinatal mental health during the COVID-19 pandemic. Methods and FindingsAn anonymous, online, cross-sectional survey of pregnant and postpartum women was conducted in 64 countries between May 26 2020 and June 13 2020. The survey, available in twelve languages, was hosted on the Pregistry platform for COVID-19 studies (https://corona.pregistry.com), and advertised predominantly in social media channels and online parenting forums. Participants completed measures on demographic characteristics, COVID-19 exposure and worries, media exposure, COVID-19 prevention behaviors, and mental health symptoms including posttraumatic stress symptoms via the IES-6, anxiety/depression via the PHQ-4, and loneliness via the UCLA-3. Of the 6,894 participants, substantial proportions of women scored at or above the cut-offs for elevated posttraumatic stress (2,979 [43%]), anxiety/depression (2,138 [31%], and loneliness (3,691 [53%]). Information seeking from any source (e.g., social media, news, talking to others) five or more times per day was associated with more than twice the odds of elevated posttraumatic stress and anxiety/depression, in adjusted models. A large majority of women (86%) reported being somewhat or very worried about COVID-19. The most commonly reported worries were related to pregnancy and delivery, including family being unable to visit after delivery (59%), the baby contracting COVID-19 (59%), lack of a support person during delivery (55%), and COVID-19 causing changes to the delivery plan (41%). Greater worries related to children (i.e. inadequate childcare, their infection risk) and missing medical appointments were associated with significantly higher odds of posttraumatic stress, anxiety/depression and loneliness. Engaging in hygiene-related COVID-19 prevention behaviors (face mask-wearing, washing hands, disinfecting surfaces) were not related to mental health symptoms or loneliness. ConclusionsClinically significant posttraumatic stress, anxiety/depression, and loneliness are highly prevalent in pregnant and postpartum women across 64 countries during the COVID-19 pandemic. Excessive information seeking and worries related to children and medical care are associated with clinically significant symptoms, whereas engaging in hygiene-related preventive measures were not. In addition to screening and monitoring mental health symptoms, reinforcing healthy information seeking, addressing worries about access to medical care and the well-being of their children, and strategies to target loneliness (e.g., online support groups) should be part of intervention efforts for perinatal women. Public and mental health interventions need to explicitly address the impact of COVID-19 on both physical and mental health in perinatal women, as prevention of viral exposure itself does not mitigate the mental health impact of the pandemic.

Comparison of Vendor-Provided Volumetry Software and NeuroQuant Using 3D T1-Weighted Images in Subjects with Cognitive Impairment: How Large is the Inter-Method Discrepancy?

Background@#Determination of inter-method differences between clinically available volumetry methods are essential for the clinical application of brain volumetry in a wider context.Purpose: The purpose of this study was to examine the inter-method reliability and differences between the Siemens morphometry (SM) software and the NeuroQuant (NQ) software. @*Materials and Methods@#MR images of 86 subjects with subjective or objective cognitive impairment were included in this retrospective study. For this study, 3D T1 volume images were obtained in all subjects using a 3T MR scanner (Skyra 3T, Siemens). Volumetric analysis of the 3D T1 volume images was performed using SM and NQ. To analyze the inter-method difference, correlation, and reliability, we used the paired t-test, Bland-Altman plot, Pearson’s correlation coefficient, intraclass correlation coefficient (ICC), and effect size (ES) using the MedCalc and SPSS software. @*Results@#SM and NQ showed excellent reliability for cortical gray matter, cerebral white matter, and cerebrospinal fluid; and good reliability for intracranial volume, whole brain volume, both thalami, and both hippocampi. In contrast, poor reliability was observed for both basal ganglia including the caudate nucleus, putamen, and pallidum. Paired comparison revealed that while the mean volume of the right hippocampus was not different between the two software, the mean difference in the left hippocampus volume between the two methods was 0.17 ml (P < 0.001). The other brain regions showed significant differences in terms of measured volumes between the two software. @*Conclusion@#SM and NQ provided good-to-excellent reliability in evaluating most brain structures, except for the basal ganglia in patients with cognitive impairment.Researchers and clinicians should be aware of the potential differences in the measured volumes when using these two different software interchangeably.

Risk of injury after emergency department visit for acute peripheral vertigo: a matched-cohort study

Objective@#Peripheral vertigo is one of the most common causes of the emergency department (ED) visits. It can impair balance and might predispose patients to injuries after discharge. The purpose of this study was to determine whether peripheral vertigo is associated with an increased risk of trauma. @*Methods@#This matched-cohort study used the nationally representative dataset of de-identified claim information of 1 million randomly sampled individuals from a real Korean population, from 2002 to 2013. The exposure cohort included patients who visited EDs for new-onset peripheral vertigo without prior or concurrent injury. Each patient was randomly matched to five unexposed individuals (also without previous injury) by incidence density sampling. The primary outcome was a new injury within 1 year. The secondary outcomes were various injury subtypes. The time-dependent effect of the exposure was modeled using the extended Cox model. Age, sex, comorbidities, and household income level were included as covariates. @*Results@#A total of 776 and 3,880 individuals were included as the exposure and comparison cohorts, respectively. The risks of trunk injury and upper extremity injury were significantly higher in the exposure cohort. Extended Cox models with multivariable adjustment showed significantly increased risk for up to 1 year, with the first 1-month; 1 month to 3 months; and 3 months to 1 year hazard ratios of 5.23 (95% confidence interval [CI], 2.83–9.64); 1.50 (95% CI, 1.02–2.20); and 1.37 (95% CI, 1.11–1.68), respectively. @*Conclusion@#Patients visiting EDs for acute peripheral vertigo are at a higher risk of a new injury for up to a year.

Korean Guideline for the Prevention and Treatment of Glucocorticoid-induced Osteoporosis

OBJECTIVE: To develop guidelines and recommendations to prevent and treat glucocorticoid-induced osteoporosis (GIOP) in Korea. METHODS: The Korean Society for Bone and Mineral Research and the Korean College of Rheumatology developed this guideline based on Guidance for the Development of Clinical Practice Guidelines version 1.0 established by the National Evidence-Based Healthcare Collaborating Agency. This guideline was developed by adapting previously-published guidelines, and a systematic review and quality assessment were conducted. RESULTS: This guideline applies to adults aged 19 years or older who are using or plan to use glucocorticoids (GCs), but does not include children and adolescents. An initial assessment of fracture risk should be performed within 6 months of initial GC use. Fracture risk should be estimated using FRAX (Fracture Risk Assessment Tool) with adjustments for GC dose, previous osteoporotic fracture history, and bone mineral density (BMD) results. All patients taking more than 2.5 mg/day prednisolone or equivalent for more than 3 months are recommended to take adequate calcium and vitamin D. Patients at moderate to high fracture risk should be treated with additional osteoporosis medication. All patients continuing GC therapy should receive an annual BMD measurement, vertebral X-ray, and fracture risk assessment using FRAX. When a treatment failure is suspected, switching to another drug should be considered. CONCLUSION: This guideline is intended to provide guidance for clinicians in prevention and treatment of GIOP.

Influence of Donor's Renal Function on the Outcome of Living Kidney Transplantation: 10-Year Follow-up

PURPOSE: With the improved surgical techniques and immunosuppression available today, conventional prognostic factors have taken on less significance. Accordingly, the native renal function of the donor is thought to be more important. Thus, we analyzed the prognostic significance of the donor's renal function as assessed by 24-hour urine creatinine clearance on kidney graft survival for 10 years after living kidney transplantation. MATERIALS AND METHODS: From January 1998 to July 2000, 71 living kidney transplantations were performed at a single institution. From among these, 68 recipients were followed for more than 6 months and were included in the present analysis. We analyzed kidney graft survival according to clinical parameters of the donor and the recipient. RESULTS: Mean follow-up duration of recipients after living kidney transplantation was 115.0+/-39.4 months (range, 10 to 157 months), and 31 recipients (45.6%) experienced kidney graft loss during this time period. Estimated mean kidney graft survival time was 131.8+/-6.2 months, and 5-year and 10-year kidney graft survival rates were estimated as 88.2% and 61.0%, respectively. Donor's mean 24-hour urine creatinine clearance (Ccr) before kidney transplantation was 122.8+/-21.2 ml/min/1.73 m2 (range, 70.1 to 186.6 ml/min/1.73 m2). The 10-year kidney graft survival rates for cases stratified by a donor's Ccr lower and higher than 120 ml/min/1.73 m2 were 39.0% and 67.2%, respectively (p=0.005). In univariate and multivariate analysis, donor's Ccr was retained as an independent prognostic factor of kidney graft survival (p=0.001 and 0.005, respectively). CONCLUSIONS: Donor's 24-hour urine Ccr before living kidney transplantation was an independent prognostic factor of kidney graft survival. Therefore, it should be considered before living kidney transplantation.

Effect of Desmopressin with Anticholinergics in Female Patients with Overactive Bladder

PURPOSE: The aim of this study was to evaluate the effect of desmopressin combined with anticholinergics on daytime frequency and urgency in female patients with overactive bladder (OAB). MATERIALS AND METHODS: We included 68 female patients with OAB. Patients were randomly assigned to receive 5 mg of solifenacin (group I) or 5 mg of solifenacin and 0.2 mg of desmopressin (group II) for 2 weeks. A pre/post-treatment 3-day voiding diary and the Urinary Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7) were used to assess changes in voiding symptoms and quality of life (QoL); results were compared between the two groups. RESULTS: Groups I and II included 31 and 37 patients, respectively. Time to first void was 12 min later in group II (105 min vs. 117 min), but this difference was not statistically significant. However, time to the second and third voids (203 min vs. 255 min, 312 min vs. 368 min) and the first urgency episode (212 min vs. 255 min) were significantly longer in group II. Compared with group I, patients in group II showed significant improvement in QoL scores. When improvement after treatment was defined as increase in time to first void of greater than 10% after 2 weeks of treatment, desmopressin with anticholinergics was more effective in patients over the age of 65 years and with more than 150 ml of voided volume. CONCLUSIONS: Desmopressin combined with anticholinergics was more effective than anticholinergics only in the treatment of female patients with OAB.

Efficacy and Safety of Tamsulosin for the Treatment of Non-neurogenic Voiding Dysfunction in Females: A 8-Week Prospective Study

We evaluated the therapeutic effects of tamsulosin for women with non-neurogenic voiding dysfunction. Women who had voiding dysfunctions for at least 3 months were included. Inclusion criteria were age > or =18 yr, International Prostate Symptom Score (IPSS) of > or =15, and maximum flow rate (Q(max)) of > or =12 mL/sec and/or postvoid residuals (PVR) of > or =150 mL. Patients with neurogenic voiding dysfunction or anatomical bladder outlet obstruction were excluded. All patients were classified according to the Blaivas-Groutz nomogram as having no or mild obstruction (group A) or moderate or severe obstruction (group B). After 8 weeks of treatment, treatment outcomes and adverse effects were evaluated. One hundred and six patients were evaluable (70 in group A, 36 in group B). After treatments, mean IPSS, bother scores, Q(max), PVR, diurnal and nocturnal micturition frequencies and scored form of the Bristol Female Lower Urinary Tract Symptoms questionnaire (BFLUTS-SF) were changed significantly. Eighty-nine patients (84%) reported that the treatment was beneficial. The proportion of patients reported that their bladder symptoms caused "moderate to many severe problems" were significantly decreased. No significant difference were observed between the groups in terms of IPSS, bother score, Q(max), PVR, micturition frequency, and BFLUTS-SF changes. Adverse effects related to medication were dizziness (n=3), de novo stress urinary incontinence (SUI) (n=3), aggravation of underlying SUI (n=1), fatigue (n=1). Tamsulosin was found to be effective in female patients with voiding dysfunction regardless of obstruction grade.

A Study of Minimal Change in Nocturia Affecting Quality of Life

PURPOSE: It is well known that nocturia is a bothersome symptom that affects the quality of life (QoL). However, it is not known how much of a decrease in nocturnal frequency is needed to improve the QoL. We determined the minimal change in nocturnal frequency affecting the QoL of patients with nocturia. MATERIALS AND METHODS: A total of 87 patients with BPH and nocturia were treated with alpha-blocker and desmopressin for 8 weeks. Considering that the minimal clinically important change (MCIC) is different according to the baseline value, we divided the patients into two groups (group I, II). Group I had mild to moderate nocturia with voiding or =4 times per night. Voiding diaries and King's Health Questionnaires (KHQs) were evaluated before and after treatment. To determine the minimal change in nocturia affecting the QoL, statistical analysis was performed by Student's t-test and ANOVA test with the change in KHQ score according to decreased numbers of nocturnal frequency. RESULTS: Groups I and II had 35 and 52 patients, respectively. The minimal decrease in nocturnal frequency associated with a statistically significant decrease in sleep/energy domain scores was 1 time in Group I and 2 times in Group II. CONCLUSIONS: These data show that decreases in nocturia of at least 1 time in patients with mild to moderate nocturia ( or =4 times/night) are needed to improve the QoL.

Expression Changes of the Phosphodiesterase 5 isoform in the Penis of Type 2 Diabetic Rat / 대한남성과학회지

PURPOSE: To investigate the tissue distribution of PDE5 isoforms in type 2 diabetic rat penile tissues. MATERIALS AND METHODS: We prepared ten male Otsuka Long-Evans Tokushima Fatty (OLETF) rats, which develop NIDDM naturally, and ten control male Long-Evans Tokushima Fatty (LETO) rats. An oral glucose tolerance test confirmed diabetes development in OLETF rats at 26 weeks. At 42 weeks, we checked serum glucose, testosterone, triglyceride, insulin, and adiponectin before sacrifice. We performed semi-quantitative multiplex RT-PCR for rat PDE5, PDE5A1, and PDE5A2. Immunohistochemistry was performed using mouse monoclonal anti-cGB-PDE5 and anti-smooth muscle alpha-actin. RESULTS: OLETF rats were significantly more hyperglycemic, hypogonadal, hyperinsulinemic, hypercholesterolemic, hypertriglycemic, and had lower adiponectin levels than LETO rats. Levels of PDE5 mRNA were decreased in OLETF rats, but there were no changes in PDE5A1 or PDE5A2 mRNA levels. CONCLUSION: Diabetes may contribute to decreased expression of PDE5 mRNA, but not PDE5A1 or PDE5A2, in rat penile tissue. Furthermore, serum free testosterone was decreased in diabetic rats. PDE5 has an important role in the development of diabetic erectile dysfunction, but it is not clear whether PDE5A1 and PDE5A2 gene have specific roles.

Expression Changes of the Phosphodiesterase 5 isoform in the Penis of Type 2 Diabetic Rat / 대한남성과학회지

PURPOSE: To investigate the tissue distribution of PDE5 isoforms in type 2 diabetic rat penile tissues. MATERIALS AND METHODS: We prepared ten male Otsuka Long-Evans Tokushima Fatty (OLETF) rats, which develop NIDDM naturally, and ten control male Long-Evans Tokushima Fatty (LETO) rats. An oral glucose tolerance test confirmed diabetes development in OLETF rats at 26 weeks. At 42 weeks, we checked serum glucose, testosterone, triglyceride, insulin, and adiponectin before sacrifice. We performed semi-quantitative multiplex RT-PCR for rat PDE5, PDE5A1, and PDE5A2. Immunohistochemistry was performed using mouse monoclonal anti-cGB-PDE5 and anti-smooth muscle alpha-actin. RESULTS: OLETF rats were significantly more hyperglycemic, hypogonadal, hyperinsulinemic, hypercholesterolemic, hypertriglycemic, and had lower adiponectin levels than LETO rats. Levels of PDE5 mRNA were decreased in OLETF rats, but there were no changes in PDE5A1 or PDE5A2 mRNA levels. CONCLUSION: Diabetes may contribute to decreased expression of PDE5 mRNA, but not PDE5A1 or PDE5A2, in rat penile tissue. Furthermore, serum free testosterone was decreased in diabetic rats. PDE5 has an important role in the development of diabetic erectile dysfunction, but it is not clear whether PDE5A1 and PDE5A2 gene have specific roles.

Clear Cell Papillary Cystadenoma of the Epididymis Associated with Multiple Renal and Pancreatic Cysts / 대한남성과학회지

Papillary cystadenoma of the epididymis is a rare benign tumor that accounts for only 5% of all epididymal tumors. A case of epididymal cystadenoma was presented in a 25 year old man. The patient was hospitalized initially because of infertility and bilateral painless palpable scrotal masses. He had multiple renal cysts and pancreatic cysts. He had no renal, adrenal, cerebellar or retinal lesion as cardinal manifestation of the Von Hippel-Lindau Syndrome (VHL). The VHL gene mutation in this case was not identified. For evaluation and management, we planned left epididymovasostomy and left testicular biopsy. However, due to a cystic change on the left epididymis and left tunica albuginea, we instead performed a left partial epididymectomy for the cystic lesion, excision of the cystic mass from the left tunica albuginea, and diagnostic left testicular biopsy. The pathologic evaluation revealed a papillary cystadenoma of the epididymis and tunica albuginea, but with normal spermatogenesis.

The Meaning of Polysomnographic Indexes in Patients with Obstructive Sleep Apnea and Erectile Dysfunction / 대한남성과학회지

PURPOSE: The purpose of this study was to correlate erectile function with polysomnographic indexes of obstructive sleep apnea(OSA) and other associated factors. MATERIALS AND METHODS: Among the 42 patients who visited our sleep clinic, we enrolled 32 patients who scored lower than 22 on the IIEF-5(International Index of Erectile Function-5). Polysomnography(PSG) was performed for OSA evaluation. Apnea-hypopnea index(AHI), AHI during REM sleep, AHI during non-REM sleep, arousal index(AI), and sleep efficacy(SE) were used as PSG indexes. Obesity was quantified by body mass index(BMI). The patients were divided into 2 groups according to AHI: group A 10(n=19). BMI and erectile function scores were compared between the 2 groups. The correlations among erectile function scores, PSG indexes, and BMI were analyzed. RESULTS: IIEF-5 score was negatively correlated with AHI(r=-0.372, p <0.05) and AI(r=-0.472, p <0.05), and there was a positive correlation with SE(r=0.372, p <0.05) of PSG. Between the 2 AIH groups, the low AHI group had a statistically higher mean erectile function score, especially in the EF domain and in the total IIEF score compared to the high AHI group. CONCLUSIONS: Indexes for penile rigidity were negatively correlated with AHI and AI. These findings suggest that AHI, AI, and SE of PSG are meaningful indexes of erectile function and support the hypothesis that hypoxia induced by sleep apnea plays a role in poor rigidity. Further studies in larger groups, including analysis of PSG indexes and erectile function changes before and after the treatment of sleep apnea, would be necessary to confirm this hypothesis.

Sleep-Related Erections(SREs) in Chronic Vegetative State Patients / 대한남성과학회지

PURPOSE: To determine whether sleep-related erections(SREs) occur during chronic vegetative state and if so, to investigate what factors are involved. MATERIALS AND METHODS: Twenty-six men in a vegetative state aged 16~65 were selected. Exclusion criteria were the lack of informed consent, mean blood pressure under 90/60 mmHg during last 3 days, erectile dysfunction before brain injury, and a history of any anti-androgen treatment. Serum testosterone, albumin, sex hormone binding globulin(SHBG), and dehydroepiandrosterone sulfate(DHEAS) were assayed, and bioavailable testosterone(cBT) and free testosterone(cFT) were calculated. Nocturnal penile erections were counted and evaluated using the Rigiscan device for72 hours. Data on the number of erections, erection duration, minimal and maximal base tumescence, minimal and maximal tip tumescence, and base and tip rigidity were taken. RESULTS: SREs were noted in 25 patients. The mean erection number was 4.65+/-3.93(1~15), and the mean erection duration was 128.85+/-46.86 minutes(0~478.5). SREs were negatively correlated with age(r=-0.445, p<0.05), systolic BP(r=-0.394, p<0.05) and diastolic BP(r=-0.403, p<0.05), but positively correlated with DHEAS(r=0.395, p<0.05). SREs were not correlated with total testosterone, cBT or cFT. CONCLUSIONS: These preliminary findings suggest that SREs are a normal occurrence in vegetative patients. They contribute to penile blood perfusion if the supraspinal erection control center is intact and serum testosterone level is above the minimum required for SREs.

The Comparison of the Abdominal Leak Point Pressure and the 1-Hour Pad Test in Patients with Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: The aim of this study was to determine whether or not the 1-hour pad test demonstrates the objective severity of female stress urinary incontinence. MATERIALS AND METHODS: One hundred eighteen female patients with stress urinary incontinence symptom were prospectively evaluated with a 1-hour pad test as recommended by the International Continent Society and they also underwent videourodynamics to determine the ALPP. The patients were divided into 2 groups by the ALPP: group A (n=94) was the low leak point pressure group (ALPP100cmH2O or no leakage). A pad gain < or=2g was considered a negative pad test. Student's t-test was done to evaluate the difference of urine leakage between the two groups. RESULTS: The mean amount of urine leakage measured by the 1-hour pad test for groups A and B were 53.4+/-47.2 and 50.9+/-53.9g, respectively, and there was no statistically significant differences between two groups (p=0.839). Eighteen (15.2%) women did not leak during the ALPP measurement and 6 (5.1%) women had a negative pad test. Among the 18 women with no leakage on the ALPP, 15 had a positive pad test and 3 had a negative pad test. Among the 6 women with a negative pad test, 3 had leakage and 3 had no leakage during the ALPP measurement. One hundred fifteen patients received an operation for stress urinary incontinence. The three patients who had no leak on the ALPP and who also had a negative pad test did not receive the operation. CONCLUSIONS: These data suggest that the 1-hour pad test did not demonstrate the objective severity of stress urinary incontinence. However, the 1-hour pad test was more sensitive to demonstrate leakage than the ALPP; therefore, in the case of no leakage during the ALPP measurement, the 1-hour pad test is needed to check the leakage.

Expression of Hypoxia-inducible Factor-1alpha and Vascular Endothelial Growth Factor in Corpus Cavernosum of the Type 2 Diabetes Mellitus Rat / 대한남성과학회지

PURPOSE: The expression of hypoxia-inducible factor-1alpha(HIF-1alpha) and vascular endothelial growth factor(VEGF) has been known as important factor of vascular complications in diabetes mellitus. The penile tumescence has variable degree according to vascularity. The aims of this study were to investigate erectile function and cavernosal expression of HIF-1alpha and VEGF in Otsuka Long-Evans Tokushima Fatty(OLETF) rats, which develop NIDDM naturally. MATERIALS AND METHODS: Ten male OLETF rats and ten control male Long-Evans Tokushima Fatty(LETO) rats were included in this study. The development of diabetes mellitus for OLETF were defined by glucose tolerance test at 26 weeks. After 72 weeks, OLETF rats, LETO rats and ten twenty-week male Sprague-Dawley rats were studied. Intracavernosal pressure were measured after cavernous nerve stimulation. Immunohistochemical stain and Western blot analysis were done for HIF-1alpha and VEGF in corpus cavernosum. RESULTS: Cavernous nerve stimulation-induced mean intracavernosal pressure(mmHg) was significantly decreased in the OLETF group(21.6+/-6.7 mmHg) compared to LETO(32.8+/-16.0 mmHg) group and in the LETO group compared to Sprague-Dawley group(47.2+/-11.7 mmHg)(p <0.05). With Western blot analysis, HIF-1alpha and VEGF expressions were higher in the OLETF group compared to other groups. With immunohistochemical stain, HIF-1alpha and VEGF were mainly expressed in corpus cavernosum and endothelium. CONCLUSIONS: We propose that increased HIF-1alpha and VEGF expressions in OLETF rat penile tissue can be found at microvascular injury in corpus cavernosum and are presumed to be associated with vasculogenic erectile dysfunction.