How do we diagnose detrusor underactivity? Comparison of diagnostic criteria based on an urodynamic measure.

PURPOSE: To compare several contemporary urodynamic criteria for diagnosing detrusor underactivity (DU) and estimate how well they coincide with each other. MATERIALS AND METHODS: From our prospective urodynamic database we identified nonneurogenic lower urinary tract symptoms (LUTS) patients older than 60 years between 2003 and 2014. Patients were reclassified based on four and three contemporary criteria for DU among men and women. Each criterion was compared with the others using the McNemar test. RESULTS: Urodynamic data of 4,372 patients (3,357 men and 1,015 women) were analyzed. In men, the prevalence of DU was estimated to be 56%, 17%, 5%, and 10% based on bladder contractility index, Abrams-Griffith number, maximal detrusor pressure at maximal flow rate (PdetQmax) 30, and bladder voiding efficiency (BVE) criteria. In women, 14.9%, 9.6%, and 6.4% of patients were classified as having DU based on maximal flow rate/postvoid residual (Qmax/PVR), PdetQmax 30, and BVE criteria. For individual subjects, all 4 criteria for men were significantly different from each other, while PdetQmax 30 and BVE criteria for women did not differ significantly (p=0.065). Additionally, BVE criterion for men and PdetQmax 30 and BVE criteria for women could distinguish the differences of patient age, free Qmax and free PVR between patient with and without DU. CONCLUSIONS: Each urodynamic criterion for men does not coincide with each other in the diagnosis of DU within individual subjects. On the other hand, PdetQmax 30 criteria and BVE criteria for women could be appropriately applied to clinical practice when diagnosing DU in women with LUTS.

Visceral obesity in predicting oncologic outcomes of localized renal cell carcinoma.

PURPOSE: We investigate the clinicopathological features and prognostic significance of visceral obesity in patients with localized renal cell carcinoma. MATERIALS AND METHODS: This study included 706 patients with localized renal cell carcinoma who had undergone curative surgery between January 2003 and April 2012. Visceral, subcutaneous and total adipose tissue were measured based on preoperative computerized tomography of the umbilical region. Visceral adipose tissue percent was calculated using the formula, VAT% = [visceral adipose tissue/total adipose tissue] × 100. The association between clinicopathological factors and visceral obesity was examined. RESULTS: A higher VAT% at diagnosis was associated with older age at diagnosis, higher prevalence of diabetes and higher prevalence of former or current smoking status. The distribution of histological subtypes differed significantly among VAT% quartiles. The proportion of high grade tumors increased as VAT% increased (OR 1.023, 95% CI 1.000-1.126, p = 0.037). A U-shaped association between VAT% quartiles and the risk of disease recurrence was observed for all patients. Disease recurrence was significantly increased in the lowest (HR 3.198, 95% CI 1.765-10.040, p = 0.036) and highest (HR 4.760, 95% CI 2.937-13.210, p = 0.010) VAT% quartiles. CONCLUSIONS: Relative visceral obesity as assessed by VAT% was associated with clinicopathological characteristics of localized renal cell carcinoma. A U-shaped association between VAT% quartiles and risk of disease recurrence was observed among patients with localized renal cell carcinoma.

How to assess scapular dyskinesis precisely: 3-dimensional wing computer tomography--a new diagnostic modality.

BACKGROUND: Aberrations in scapular motion are believed to be associated with the presence of shoulder or elbow pathologies. There are many methods to evaluate scapular kinematics, but they have certain limitations. Nevertheless, it is believed that appropriate rehabilitation for each type of scapular dyskinesis is important. METHODS: Eighty-nine athletes were videotaped and seven blinded observers categorized scapular dyskinesis into 4 types, which was followed by 3-dimensional (3D) wing computer tomography (CT). Four blinded examiners evaluated 5 angles [upward rotation (UR), internal rotation (IR), anterior tilting (AT), superior translation (ST), and protraction (PRO)] on the 3D wing CT. Inter-rater reliability (IRR) was calculated for both the methods. CT scan measurements were compared with the 4 observational types to establish the validity. RESULTS: The IRR with observational assessment of scapular dyskinesis into 4 types was good, 0.780. The 3D wing CT analysis had a very high IRR, 0.972. There was a statistically significant correlation between observational assessment and 3D wing CT analysis. The UR angle, ST angle in type 3 scapular dyskinesis, and AT angle in type 1 scapular dyskinesis were increased as compared with those in the other types of scapular dyskinesis. All these measurements were made in the resting position of the scapula. CONCLUSION: The 3D wing CT analysis allows precise quantification of a position associated with scapular dyskinesis. Therefore, 3D wing CT can be considered as an alternative method for assessing scapular dyskinesis.

Proteasome inhibition promotes functional recovery after peripheral nerve reperfusion injury.

BACKGROUND: The proteasome degrades NF-kappaB blocking protein (I-kappaB) and activates NF-kappaB that plays as a key transcriptional factor to regulate inflammatory factors that are involved in the tissue reperfusion injury. This study was designed to assess whether the proteasome inhibitor can attenuate peripheral nerve ischemia/reperfusion (I/R) injury and consequently promote motor functional recovery after ischemic insult. METHODS: Rat sciatic nerves were exposed to 2 hour of ischemia followed by various periods of reperfusion. Rats were administered either proteasome inhibitor (bortezomib) or phosphate-buffered saline 30 minutes before reperfusion start. Results were evaluated using a walking track test, and an isolated muscle contraction test, and by muscle weight, and histology. RESULTS: Bortezomib treatment induced an earlier improvement in sciatic functional index and a more rapid restoration of contractile force and wet weight of extensor digitorum longus muscle. Bortezomib reduced early axonal degeneration and promoted regeneration. CONCLUSION: This study indicates that bortezomib; a proteasome inhibitor, is effective at promoting the functional recovery of reperfused peripheral nerve. The proteasome inhibition may play a role as one of the clinical strategy in the peripheral nervous system I/R injury with further understanding its mechanism of action.