A pilot clinical study to evaluate feasibility of using single patient classifier as a prognostic test in stage Ⅱ-Ⅲ gastric cancer patients

Objective:Precision medicine approaches emphasize the importance of reliable prognostic tools for guiding individualized therapy decisions.In this study,we evaluated the clinical feasibility of the single patient classifier(SPC)test,a new clinical-grade prognostic assay,in stageⅡ-Ⅲgastric cancer patients.Methods:A prospective multicenter study was conducted,involving 237 patients who underwent gastrectomy between September 2019 and August 2020 across nine hospitals.The SPC test was employed to stratify patients into risk groups,and its feasibility and performance were evaluated.The primary endpoint was the proportion of the cases in which the test results were timely delivered before selecting postoperative treatment.Furthermore,3-year disease-free survivals of risk groups were analyzed.Results:The SPC test met the primary endpoint criteria.The 99.5%of SPC tests were timely delivered to hospitals before the postoperative treatment started.In a clinical setting,the median time from the specimen transfer to laboratory to the result delivery to hospital was 4 d.Furthermore,3-year disease-free survivals were significantly different between risk groups classified with SPC tests.Conclusions:This study highlights the SPC test's feasibility in offering crucial information timely delivered for making informed decisions regarding postoperative treatment strategies.It also provides evidence to support the implementation of a future prospective clinical trial aimed at evaluating the clinical utility of the SPC test in guiding personalized treatment decisions for gastric cancer patients.

Validity of fatty liver prediction scores for diagnosis of fatty liver by Fibroscan

Background:The Korea National Health and Nutrition Examination Survey nonalcoholic fatty liver disease(K-NAFLD)score was recently developed with the intent to operationally define nonalcoholic fatty liver disease(NAFLD).However,there remained an external validation that confirmed its diagnostic performance,especially in patients with alcohol consumption or hepatitis virus infection.Methods:Diagnostic accuracy of the K-NAFLD score was evaluated in a hospital-based cohort consisting of 1388 participants who received Fibroscan®.Multivariate-adjusted logistic regression models and the contrast estimation of receiver operating characteristic curves were used for validation of the K-NAFLD score,fatty liver index(FLI),and hepatic steatosis index(HSI).Results:K-NAFLD-moderate[adjusted odds ratio(aOR)=2.53,95%confidence interval(CI):1.13-5.65]and K-NAFLD-high(aOR=4.14,95%CI:1.69-10.13)groups showed higher risks of fatty liver compared to the K-NAFLD-low group after adjustments for demographic and clinical characteristics,and FLI-moderate and FLI-high groups revealed aORs of 2.05(95%CI:1.22-3.43)and 1.51(95%CI:0.78-2.90),respectively.In addition,the HSI was less predictive for Fibroscan®-defined fatty liver.Both K-NAFLD and FLI also demonstrated high accuracy in the prediction of fatty liver in patients with alcohol consumption and chronic hepatitis virus infection,and the adjusted area under curve values were comparable between K-NAFLD and FLI.Conclusions:Externally validation of the K-NAFLD and FLI showed that these scores may be a useful,noninvasive,and non-imaging modality for the identification of fatty liver.In addition,these scores also predicted fatty liver in patients with alcohol consumption and chronic hepatitis virus infection.

Adult-onset hypophosphatemic osteomalacia as a cause of widespread musculoskeletal pain:A retrospective case series of single center experience

BACKGROUND Osteomalacia(OM)is frequently confused with various musculoskeletal or other rheumatic diseases,especially in patients with adult-onset widespread musculoskeletal pain because of its low prevalence and non-specific manifestations.AIM To facilitate the early diagnosis and etiology-specific treatment of adult-onset hypophosphatemic OM.METHODS A retrospective review of medical records was performed to screen adult patients who visited a physiatry locomotive medicine clinic(spine and musculoskeletal pain clinic)primarily presenting with widespread musculoskeletal pain at a single tertiary hospital between January 2011 and December 2019.We enrolled patients with hypophosphatemia,high serum bone-specific alkaline phosphatase levels,and at least one imaging finding suggestive of OM.RESULTS Eight patients with adult-onset hypophosphatemic OM were included.The back was the most common site of pain.Proximal dominant symmetric muscle weakness was observed in more than half of the patients.Bone scintigraphy was the most useful imaging modality for diagnosing OM because radiotracer uptake in OM showed characteristic patterns.Six patients were diagnosed with adefovir(ADV)-induced Fanconi syndrome,and the other two patients were diagnosed with tumor-induced OM and light-chain nephropathy,respectively.After phosphorus and vitamin D supplementation and treatment for the underlying etiologies,improvements in pain,muscle strength,and gait were observed in all patients.CONCLUSION Mechanical pain characteristics,hypophosphatemia,and distinctive bone scintigraphy patterns are the initial diagnostic indicators of adult-onset hypophosphatemic OM.ADV-induced Fanconi syndrome is the most common etiology of hypophosphatemic OM in hepatitis B virus-endemic countries.

Regaining of morning erection and sexual confidence in patients with erectile dysfunction

Aim： To investigate how erectile dysfunction （ED） medications affect morning erection in patients with ED and how they respond to the return of morning erection. Methods： This study was conducted in 120 patients who experienced successful intercourse with either tadalafil or sildenafil. Using a random face-to-face interview and a questionnaire （about the quality and number of days getting morning erection after using the two medications）, the impact of the medications on the morning erections was investigated, and the participants were asked about their feelings on regaining morning erection. Results： Of the respondents, 81% （68% of those with sildenafil and 99% of those with tadalafil） experienced morning erections after taking an oral ED medication. The men who took tadalafil mainly for 2 days with one dose, while those who took sildenafil experienced morning erections mainly for 1 day. The major sentiment upon regaining a morning erection was, ＂having more confidence as a man＂ （74%）. Among the 96 respondents who experienced morning erections with tadalafil, 52% preferred tadalafil over sildenafil, not only because of freedom from concerns about a specific time to have relations, but also regaining morning erection. Conclusion： Regaining a morning erection affects the recovery of confidence as a man and influences the preference for tadalafil over sildenafil.

Efficacy of early treatment with infliximab in pediatric Crohn’s disease

AIM: To investigate the effectiveness of early infliximab use for induction and maintenance therapy in pediatric Crohn’s disease. METHODS: We performed a retrospective chart review of 36 patients with Crohn’s disease. Ten patients (group A) were treated with mesalamine after induction therapy with oral prednisolone, and 13 patients (group B) were treated with azathioprine after induction therapy with oral prednisolone. Thirteen patients (group C) received infliximab and azathioprine for induction and maintenance therapy for the first year, and were treated with azathioprine after 1 year. All patients were followed for at least 24 mo. Efficacy was determined by the relapse rate using the pediatric Crohn’s disease activity index score in each group at 12 and 24 mo. RESULTS: At the 1 year follow-up, the relapse ratee, Mi Jin Kim, Hae Jeong Lee, Yon Ho Choe (23.1%, 3 of 13 patients) in group C was lower than that (61.5%, 8 of 13 patients) in group B (P = 0.047). At the 2 years follow-up, the relapse rate (38.5%, 5 of 13 patients) in group C was lower than that (76.9%, 10 of 13 patients) in group B (P = 0.047). Adverse events in group C were fewer than in groups A and B. CONCLUSION: Early induction with infliximab at diagnosis, known as "top-down" therapy, was effective for reducing the relapse rate compared to conventional therapies for at least 2 years.

Advances in deep learning for computed tomography denoising

Computed tomography(CT)has seen a rapid increase in use in recent years.Radiation from CT accounts for a significant proportion of total medical radiation.However,given the known harmful impact of radiation exposure to the human body,the excessive use of CT in medical environments raises concerns.Concerns over increasing CT use and its associated radiation burden have prompted efforts to reduce radiation dose during the procedure.Therefore,low-dose CT has attracted major attention in the radiology,since CT-associated x-ray radiation carries health risks for patients.The reduction of the CT radiation dose,however,compromises the signal-to-noise ratio,which affects image quality and diagnostic performance.Therefore,several denoising methods have been developed and applied to image processing technologies with the goal of reducing image noise.Recently,deep learning applications that improve image quality by reducing the noise and artifacts have become commercially available for diagnostic imaging.Deep learning image reconstruction shows great potential as an advanced reconstruction method to improve the quality of clinical CT images.These improvements can provide significant benefit to patients regardless of their disease,and further advances are expected in the near future.

Retrospective analysis of extra-gastrointestinal stromal tumors

AIM:To investigate the clinicopathologic features of patients with extra-gastrointestinal stromal tumors(EGISTs)in South Korea.METHODS:A total of 51 patients with an EGIST were identified.The clinicopathologic features,including sex,age,location,tumor size,histology,mitotic rate,immunohistochemical features,genetic status and survival data,were analyzed.RESULTS:The median age was 55 years(range:29-80years),and male:female ratio was 1:1.04.The most common site was in the mesentery(n=15)followed by the retroperitoneum(n=13)and omentum(n=8).The median tumor size was 9.0 cm(range:2.6-30.0cm)and the median mitotic rate was 5.0/50HPF.(1/50-185/50).KIT was analyzed in 16,which revealed 10cases with wild-type KIT and 6 cases with an exon 11mutation.Among 51 patients,31 patients had undergone surgery,and 10 had unresectable disease and had taken palliative imatinib,which resulted in 22.7 mo of progression-free survival.Of the patients who had undergone surgery,18 did not take adjuvant imatinib,and 8 of these were categorized as"high risk"according to the risk criteria.However,the relapse-free survival was not different(P=0.157)between two groups.CONCLUSION:Because the biologic behaviors of GISTs differ according to the location of the tumor,a more stratified strategy is required for managing EGISTs including incorporation of molecular features.

Current approaches and future directions in the management of pterygium

Pterygium,a common ocular surface disorder,has a complex pathophysiology that may mimic tumorigenesis.There is altered expression of cell cycle/proliferation-related factors in pterygium tissues.Therefore,similar to cancer treatments,the management of pterygium ought to be multifactorial based on the patient’s condition.Current therapeutic methods for pterygium are focused on surgical resection in conjunction with antimetabolite use,in addition tissue graft is usually performed in the context of the avoidance of bare sclera.However,future directions in the management of pterygia will likely focus on genetic approaches.This perspective views the pathogenesis of pterygium,its existing therapies as well as current and future challenges in its treatment.

Iatrogenic colorectal perforation induced by anorectal manometry:Report of two cases after restorative proctectomy for distal rectal cancer

There are no reports regarding perforation of the colorectum induced by anorectal manometry. We report two cases of colorectal perforation that occurred during manometry in the patients undergoing restorative proctectomy for distal rectal cancer. In the first patient, computed tomography showed an extraperitoneal perforation in the pelvic cavity and a rupture of the rectal wall. A localized perforation into the retroperitoneum was managed conservatively. In the second patient, a 3 cm linear colon rupture was detected above the anastomotic site. A primary closure of the perforated colon and proximal ileostomy were conducted, but the patient died 2 wk later. We hypothesize that the perforation induced by anorectal manometry may be associated with the relative weakening of the proximal bowel wall due to anastomosis, decreased compliance, and abnormal rectal sensation. We suggest that measurement of the maximum tolerable volume should not be routinely performed alter restorative proctectomy for distal rectal cancer.

Weekly docetaxel and gemcitabine in previously treated metastatic esophageal squamous cell carcinoma

AIM: To assess the efficacy and safety of weekly docetaxel plus a fixed-dose rate(FDR) of gemcitabine in metastatic esophageal squamous cell carcinoma(SCC).METHODS: A multi-center, open-label, prospective phase Ⅱ study was designed.Thirty-three esophageal SCC patients with documented progression after fluoropyrimidine/platinum-based first-line chemotherapy were enrolled and treated with docetaxel 35 mg/m2 and gemcitabine 1000 mg/m2 iv at a FDR(10 mg/m2 per minute) on days 1 and 8.Treatment was repeatedevery twenty-one days until disease progression, unacceptable toxicity, or consent withdrawal.The primary endpoint was response rate(RR), and secondary endpoints were safety, progression-free survival(PFS) and overall survival(OS).RESULTS: Combination of weekly docetaxel and FDR gemcitabine was well tolerated: the most common treatment-related adverse events were anemia(97%), fatigue(64%) and neutropenia(55%).One patient with multiple lung and lymph node metastases died of respiratory failure after receiving four cycles of chemotherapy, and the possibility of drug-induced pneumonitis could not be completely excluded.Disease control(objective response plus stable disease) in the ITT population was achieved in 88% of patients, and the overall RR was 30%(95%CI: 15%-46%).The median PFS and OS were 4.0(95%CI: 3.4-4.6) and 8.8 mo(95%CI: 7.8-9.8 mo), respectively.CONCLUSION: A combination of weekly docetaxel and FDR gemcitabine showed promising antitumor activity and tolerability in previously treated, metastatic esophageal SCC.

Peer-assisted learning to train high-school students to perform basic life-support

BACKGROUND: The inclusion of cardiopulmonary resuscitation(CPR) in formal education has been a useful approach to providing basic life support(BLS) services. However, because not all students have been able to learn directly from certified instructors, we studied the educational efficacy of the use of peer-assisted learning(PAL) to train high-school students to perform BLS services.METHODS: This study consisted of 187 high-school students: 68 participants served as a control group and received a 1-hour BLS training from a school nurse, and 119 were included in a PAL group and received a 1-hour CPR training from a PAL leader. Participants' BLS training was preceded by the completion of questionnaires regarding their background. Three months after the training, the participants were asked to respond to questionnaires about their willingness to perform CPR on bystander CPR and their retention of knowledge of BLS.RESULTS: We found no statistically significant difference between the control and PAL groups in their willingness to perform CPR on bystanders(control: 55.2%, PAL: 64.7%, P=0.202). The PAL group was not significantly different from the control group(control: 60.78±39.77, PAL: 61.76±17.80, P=0.848) in retention of knowledge about BLS services.CONCLUSION: In educating high school students about BLS, there was no significant difference between PAL and traditional education in increasing the willingness to provide CPR to bystanders or the ability to retain knowledge about BLS.

Relationship between insulin resistance, obesity and serum prostate-specific antigen levels in healthy men

The purpose of this study was to determine the relationship between insulin resistance, obesity and serum prostate-specific antigen （PSA） levels in healthy men with serum PSA level below 4 ng mL-1. The men included in the study cohort were 11 827 healthy male employees of the Korea Hydro and Nuclear Power Co., LTD who had undergone medical checkups including fasting glucose, fasting insulin and serum PSA between January 2003 and December 2008. Insulin resistance was calculated by homeostasis model assessment （HOMA [fasting glucose × fasting insulin]/22.5） and quantitative insulin sensitivity check index （QUICK/; 1/[log （fasting insulin） ＋ log （fasting glucose）]）. Age-adjusted body mass index （BMI） was significantly increased according to increasing quartile of insulin resistance as determined by HOMA and QUICKI, respectively, in analysis of variance （ANOVA） test and Duncan＇s multiple comparison test （P 〈 0.001）, but age-adjusted serum PSA concentration was significantly decreased according to increasing quartile of insulin resistance as determined by HOMA and QUICK/（P 〈 0.001）. Age, BMI, insulin resistance by HOMA or QUICK/were significantly independent variables to serum PSA level in a multivariate linear regression analysis （P 〈 0.001）. Insulin resistance was a significant independent variable to serum PSA level along with BMI. Insulin resistance and BMI were negatively correlated with serum PSA level in healthy men. Insulin resistance was positively correlated with BMI.

Percutaneous closure of congenital Gerbode defect using Nit-Occlud^®LêVSD coil

We present a case report about percutaneous closure of a congenital Gerbode defect using Nit-Occlud~? Lê VSD coil. The patient was referred to our hospital with a diagnosis of ventricular septal defect(VSD) and severe pulmonary arterial hypertension. But transthoracic echocardiography revealed a communication between the left ventricle(LV) and the right atrial(RA), called Gerbode defect. Catheterization confirmed the shunt from the LV to the RA. We successfully closed the defect with a VSD coil. After uneventful 6 mo follow-up, the patient was out of dyspnea, the symptom urged him to have medical attention. This case report is to discuss the diagnosis and percutaneous treatment approach for this rare congenital heart disease.

Safety and efficacy of transradial coronary angiography and intervention in patients older than 80 years： from the Korean Transradial Intervention Prospective Registry

Background Radial artery access for coronary procedures is a safe and beneficial technique. However, elderly patients have been considered as a higher risk group of access site related complications compared to younger patients. This study was conducted to investigate the feasibility and safety oftransradial coronary angiography or intervention in the elderly. Methods A total of 6132 patients from Korean Transradial Intervention Prospective Registry at 20 centers were analyzed. Patients were divided into the non-elderly group （n = 5667） and the elderly （_〉 80 years） group （n = 465）. Using propensity score matching, the elderly group （n = 465） was compared with one-to-one matched the non-elderly group （n = 465）. Results After propensity score matching, mean age was 64.3 ＋ 10.3 years in the non-elderly group and 83.5 -4- 3.3 years in the elderly group. There was no difference of procedural characteristics, procedural and fluoroscopic times. Access site cross-over rate was not different between the non-elderly group and elderly group （7.5% vs. 6.2%, P = 0.074）. Bleeding compli- cations occurred similarly in two groups （2.6% of the non-elderly group vs. 1.9% of the elderly group, P -~ 0.660）. Access site complications were 1.9% of the non-elderly group and 0.9% of the elderly group （P = 0.263）. Both of in hospital death and cardiovascular death for one year were also similar between two groups. Conclusions Transradial angiography or intervention was safe and feasible in elderly patients. Complication rates and clinical outcomes in elderly patients were comparable with those in non-elderly patients.

Reconstruction of Rabbit Corneal Layer Composed of Corneal Fibroblasts and Corneal Epithelium on the Lyophilized Amniotic Membrane

Many researchers have employed the cryopreserved amniotic membrane（CAM） and corneal epithelial cells in the treatment of a severely damaged burned cornea, with corneal epithelial cells cultured on an amniotic membrane （AM）. The lyophilized amniotic membrane（LAM） has a higher graft take and a longer shelf life; it is easier to store and safer because of gamma irradiation. Two Teflon rings（ Ahn＇s supporter） were made for culturing the cells on the LAM, and were then used to support the LAM. To reconstruct a corneal layer composed of corneal fibroblasts and epithelium, the corneal fibroblasts were first cultivated on the stromal side of LAM for five days, foUowed by epithelial cells culture on the epithelial side, by using the air-liquid interface culture. The reconstructed corneal layer composed of corneal fibroblasts and corneal epithelial cells has a much healthier basal layer of corneal epithelium than the reconstructed corneal epithelium, which was got by using only corneal epithelial cells, and resembles the epithelium of normal corneas, without the horny layer. Thus, the reconstruction of the corneal layer by using a LAM is considered to be a good in vitro model, not only for its application in toxicological test kits, but also for transplantation in patients with a severely damaged cornea.

Efficacy and safety of oral SK3530 for the treatment of erectile dysfunction in Korean men： a multicenter, randomized, doubleblind, placebo-controlled, fixed dose, parallel group clinical trial

Aim： To evaluate the efficacy and safety of SK3530, a newly developed type 5 phosphodiesterase inhibitor （PDE5I）, in Korean men with erectile dysfunction （ED）. Methods： A total of 119 patients were randomized at 10 centers in Korea to receive either SK3530 （50, 100, or 150 mg; n = 89） or placebo （n = 30） taken 1 h before anticipated sexual activity for an 8-week period. The patients were evaluated at baseline and 4 and 8 weeks after beginning therapy. Efficacy was assessed using the International Index of Erectile Function （IIEF）, Sexual Encounter Profile （SEP）, and the Global Assessment Question （GAQ）. Safety was analyzed by adverse events, laboratory values and vital signs. Results： At the end of the study, all the primary and secondary efficacy end-points were statistically significantly improved by SK3530 compared with placebo （P 〈 0.05）. Of the 89 patients in the treatment arm, 36 （42.3 %） achieved normal erectile function after treatment, including six patients with severe ED. Treatment-related adverse events occurred in 32 patients. The most common adverse events were flushing, headache, dizziness and eye redness （10.9%, 7.6%, 2.5% and 2.5%, respectively）, and most were mild. Only two patients discontinued treatment during the study period because of adverse events. Conclusion： The results of our phase Ⅱ study have confirmed the efficacy and safety of SK3530 in a broad population of men with ED of various etiologies and severity. The optimal doses in terms of efficacy and safety were determined to be 50 mg and 100 mg, respectively.

Long-term antibiotic use and risk of hepatocellular carcinoma later in life: a nationwide cohort study of 9.8 million participants

Dear Editor,Antibiotics are considered indispensable in numerous treatments against infectious diseases.However,their over-prescription and widespread use are emerging as important global issues,as they lead to resistant bacteria,reducing the efficacy of antibiotics[1].The defined daily doses per 1,000 habitants per day for antibiotics in South Korea is 28,which is much higher than the average of Organization for Economic Co-operation and Development countries[1].In animal studies,antibiotic tigecycline was found to inhibit the proliferation and induce apoptosis of hepatocellular carcinoma(HCC)cells[2].In addition,isoprenoid antibiotic was found to suppress the growth and invasion of HCC by targeting the signal transducer and activator of the transcription 3 signaling cascade[3].Despite evidence of the beneficial effects of antibiotics against HCC,evidence regarding their effects on the longterm development of HCC is limited.Introduction regarding the incidence of HCC is provided in the Supplementary file.

Association between cytochrome CYP17A1, CYP3A4, and CYP3A43 polymorphisms and prostate cancer risk and aggressiveness in a Korean study population

In this study, we evaluated genetic variants of the androgen metabolism genes CYP17A1, CYP3A4, and CYP3A43 to determine whether they play a role in the development of prostate cancer （PCa） in Korean men. The study population included 240 pathologically diagnosed cases of PCa and 223 age-matched controls. Among the 789 singie-nucleotide polymorphism （SNP） database variants detected, 129 were reported in two Asian groups （Han Chinese and Japanese） in the HapMap database. Only 21 polymorphisms of CYP17A1, CYP3A4, and CYP3A43 were selected based on linkage disequilibrium in Asians （d = 1）, locations （SNPs in exons were preferred）, and amino acid changes and were assessed. In addition, we performed haplotype analysis for the 21 SNPs in CYP17A1, CYP3A4, and CYP3A43 genes. To determine the association between genotype and haplotype distributions of patients and controls, logistic analyses were carried out, controlling for age. Twelve sequence variants and five major haplotypes were identified in CYP17A1. Five sequence variants and two major haplotypes were identified in CYP3A4. Four sequence variants and four major haplotypes were observed in CYP3A43. CYP17A1 haplotype-2 （Ht-2） （odds ratio [OR], 1.51; 95% confidence interval [Cl], 1.04-2,18） was associated with PCa susceptibility. CYP3A4 Ht-2 （OR. 1.87; 95% CI. 1.02-3.43） was associated with PCa metastatic potential according to tumor stage, rs17115149 （OR： 1.96; 95% Ch 1.04-3.68） and CYP17A1 Ht-4 （OR： 2.01; 95% Ch 1.07-4.11） showed a significant association with histologic aggressiveness according to Gleason score. Genetic variants of CYP17A1 and CYP3A4 may play a role in the development of PCa in Korean men.

Does intraoperative frozen section really predict significant positive surgical margins after robot-assisted laparoscopic prostatectomy?A retrospective study

We investigated the relationship between positive surgical margin(PSM)-related factors and biochemical recurrence(BCR)and the ability of intraoperative frozen sections to predict significant PSM in patients with prostate cancer.The study included 271 patients who underwent robot-assisted laparoscopic prostatectomy with bilateral nerve sparing and maximal urethral preservation.Intraoperative frozen sections of the periurethra,dorsal vein,and bladder neck were analyzed.The ability of PSM-related factors to predict BCR and significant PSM was assessed by logistic regression.Of 271 patients,108(39.9%)had PSM and 163(60.1%)had negative margins.Pathologic Gleason score^8(18.9%vs 7.5%,P=0.015)and T stage≥T3a(51.9%vs 24.6%,P<0.001)were significantly more frequent in the PSM group.Multivariate analysis showed that Gleason pattern≥4(vs<4;hazard ratio:4.386;P=0.0004)was the only significant predictor of BCR in the PSM cohort.Periurethral frozen sections had a sensitivity of 83.3%and a specificity of 84.2%in detecting PSM with Gleason pattern≥4.Multivariate analysis showed that membranous urethra length(odds ratio[OR]:0.79,P=0.0376)and extracapsular extension of the apex(OR:4.58,P=0.0226)on magnetic resonance imaging(MRI)and positive periurethral tissue(OR:17.85,P<0.0001)were associated with PSM of the apex.PSM with Gleason pattern≥4 is significantly predictive of BCR.Intraoperative frozen sections of periurethral tissue can independently predict PSM,whereas sections of the bladder neck and dorsal vein could not.Pathologic examination of these samples may help predict significant PSM in patients undergoing robot-assisted laparoscopic prostatectomy with preservation of functional outcomes.