Objective:The aim of the present study was to investigate the relationship between diabetes mellitus (DM) and tumor features in patients with non-muscle invasive bladder cancer (NMIBC). Methods: Data from 251 patients who underwent transurethral resection (TUR) for NMIBC from January 2000 to June 2010 were analyzed retrospectively. Patients were divided into two groups: Group I, 159 patients (63%) who did not have DM at the time of surgery; and (ii) Group II, 92 patients (37%) who had DM at the time of surgery. Recurrence-and progression-free survival was assessed in both groups. Preoperative HbA1c levels, as parameter of glycemic control, were determined in Group II patients, with patients divided into two subgroups: (i) HbA1c Ն7.0%; and (ii) HbA1c <7.0%. The clinical features of the bladder tumor were compared in these two subgroups. Results: Compared with Group I, Group II patients were older and had a higher rate of hypertension, recurrence, and progression (P < 0.05). Univariate survival analysis showed that gender, DM, smoking, and serum creatinine were associated with recurrence-free survival (P < 0.05), whereas DM, stage, grade, intravesical instillation, and serum creatinine were associated with progression-free survival. In multivariate survival analysis, DM was found to be an independent factor for recurrence-(hazard ratio [HR] 2.11; 95% confidence interval [CI] 1.4-3.2; P = 0.001) and progression-free survival (HR 9.35; 95% CI 3.1-28.6; P = 0.001). Furthermore, patients with HbA1c Ն7.0% exhibited a significantly higher rate of multiplicity (P = 0.001), tumor grade (P = 0.03), and intravesical treatment (P = 0.04). Conclusions: In conclusion, DM seems to be an independent predictor of recurrence-and progression-free survival in NMIBC patients. Further prospective studies are needed to establish the prognostic significance of postoperative glycemic control in this patient population.

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PurposeTo evaluate the impact of nocturia on health-related quality of life and sleep in men.MethodsFrom January 2008 to December 2008, 284 patients with lower urinary tract symptoms were selected for this study. The participants completed a series of questionnaires on health-related quality of life (the overactive bladder questionnaire, or OAB-q), the Medical Outcomes Study (MOS) sleep scale, and the frequency volume chart.ResultsThe patient population had a mean age of 60.0±13.4 years (range, 40 to 79 years). The mean duration of symptoms was 28.8±34.6 months. The mean number of voiding episodes per night was measured as follows: 88 patients (31.0%) reported no nocturia, 60 patients (21.1%) reported 2>voids/night ≥1, 56 patients (19.7%) reported 3>voids/night ≥2, and 80 patients (28.2%) reported ≥3 voids/night. The mean number of nocturia episodes increased with age (P=0.001), and the number of nocturia episodes was significantly associated with the OAB-q symptom score (P=0.001) and symptom bother (P=0.001). Among the categories of the MOS sleep scale, sleep index I (P=0.020), sleep disturbance (P=0.010), adequacy of sleep (P=0.005), and somnolence (P=0.041) were significantly associated with an increased number of nocturia episodes.ConclusionsThe number of nocturia episodes increased with age in men. Nocturia appeared to be associated with further negative effects on sleep quality, health-related quality of life, and symptom bother.

Objective: Our intent was to investigate the impact of specific parameters-clinical status, performance status (Eastern Cooperative Oncology Group (ECOG)), C-reactive protein, serum albumin, and inflammation (Glasgow Prognostic Score)-on progression-free survival and overall survival in patients given systemic chemotherapy as the first-line treatment of advanced bladder cancer. Methods: A total of 67 patients treated for advanced bladder cancer in a 7-year period (2004-10) were reviewed. Prior to administration of first-line chemotherapy (gemcitabine plus cisplatin), baseline ECOG performance status, C-reactive protein, albumin, Glasgow Prognostic Score and clinical status were assessed. Patients with both elevated C-reactive protein (.1.0 mg/dl) and low albumin (,3.5 mg/dl) were assigned a Glasgow Prognostic Score of 2, while lesser scores were set when one (Glasgow Prognostic Score 1) or both levels (Glasgow Prognostic Score 0) were within the normal range. To evaluate relationships to progressionfree survival and overall survival, univariate and multivariate analyses were conducted. Results: By multivariate analysis, ECOG performance status (hazard ratio ¼ 3.48, 95% confidence interval 1.87 -6.45, P ¼ 0.001) and hypoalbuminemia (hazard ratio ¼ 2.04, 95% confidence interval 1.10 -3.78, P ¼ 0.023) were found to be factors independently associated with reduced progression-free survival. Factors independently associated with shortened overall survival were ECOG performance status (hazard ratio ¼ 5.32, 95% confidence interval 2.22 -12.71, P ¼ 0.001) and Glasgow Prognostic Score 2 (hazard ratio ¼ 7.00, 95% confidence interval 2.53-19.36, P ¼ 0.001). Conclusions: These outcomes indicate that a systemic inflammatory response coupled with hypoalbuminemia (Glasgow Prognostic Score 2) correlates significantly with shortened overall survival and may thus be useful as a prognostic index in this setting.

Introduction There have been extensive studies evaluating the functional neuroanatomy of the brain during visual sexual stimulation. However, little data exist concerning the role of olfactory stimulation in human sexuality. Aim This preliminary study intended to elucidate the brain areas responding to an olfactory sexual stimulus using functional magnetic resonance imaging (fMRI). Methods Eight healthy right-handed heterosexual male volunteers (20–35 years of age), having normal olfaction and no brain diseases, were recruited. During fMRI, a women's perfume was given as an olfactory sexual stimulant in an alternating block design with a 30-second stimulation period followed by a 30-second rest. After the fMRI sessions, the participants provided ratings for both the odorant's intensity and perceived arousal. Main Outcome Measures The study subjects rated the odorant stimulation and perceived sexual arousal response by Likert-type rating scales. Brain activation maps were made by blood oxygenation level-dependent (BOLD)-based fMRI with an echo-planar imaging pulse sequence. Results Two out of eight subjects experienced “strong” sexual arousal, and three subjects experienced “moderate” arousal during olfactory stimulation, resulting in a mean score of 2.25 on a 4-point scale. The common brain areas activated in response to the odor stimulus in all eight subjects included the insula, the inferior and middle frontal gyrus, and the hypothalamus. The median cingulate gyrus, thalamus, angular gyrus, lingual gyrus, and cerebellar cortex were activated in subjects who had moderate or strong sexual arousal response. Conclusion Olfactory stimulation with women's perfume produces the activation of specific brain areas in men. The brain areas activated differed according to the degree of perceived sexual arousal response. Further studies are needed to elucidate brain activation response according to the different kinds and intensities of olfactory stimulation.