Peripheral neuropathy and nerve electrophysiological changes with enfortumab vedotin in patients with advanced urothelial carcinoma: a prospective multicenter cohort study

BACKGROUND

Enfortumab vedotin is a novel antibody-drug conjugate used as a third-line therapy for the treatment of urothelial cancer. We aimed to elucidate the effect of enfortumab vedotin-related peripheral neuropathy on its efficacy and whether enfortumab vedotin-induced early electrophysiological changes could be associated with peripheral neuropathy onset.

METHODS

Our prospective multicenter cohort study enrolled 34 patients with prior platinum-containing chemotherapy and programmed cell death protein 1/ligand 1 inhibitor-resistant advanced urothelial carcinoma and received enfortumab vedotin. The best overall response, progression-free survival, overall survival, and safety were assessed. Nerve conduction studies were also performed in 11 patients.

RESULTS

The confirmed overall response rate and disease control rate were 52.9% and 73.5%, respectively. The median overall progression-free survival and overall survival were 6.9 and 13.5 months, respectively, during a median follow-up of 8.6 months. The patients with disease control had significantly longer treatment continuation and overall survival than did those with uncontrolled disease. Peripheral neuropathy occurred in 12.5% of the patients. The overall response and disease control rates were 83.3% and 100%, respectively: higher than those in patients without peripheral neuropathy (p = 0.028 and p = 0.029, respectively). Nerve conduction studies indicated that enfortumab vedotin reduced nerve conduction velocity more markedly in sensory nerves than in motor nerves and the lower limbs than in the upper limbs, with the sural nerve being the most affected in the patients who developed peripheral neuropathy (p = 0.011).

CONCLUSION

Our results indicated the importance of focusing on enfortumab vedotin-induced neuropathy of the sural nerve to maximize efficacy and improve safety.

Impact of the coronavirus disease pandemic on robot-assisted radical prostatectomy and urologists' treatment behaviors: A single tertiary center retrospective study

OBJECTIVES

To assess whether the coronavirus disease (COVID-19) pandemic affected the outcomes of robot-assisted radical prostatectomy (RARP) and urologists' treatment behaviors.

METHODS

We retrospectively examined the medical records of 208 patients who had undergone RARP between August 2017 and December 2022. We compared the rate of preoperative androgen deprivation therapy (ADT), waiting period for RARP, patients' baseline characteristics and quality of life (QOL), proportion of adverse pathology on the RARP specimen, rate of Gleason grade group upgrading from biopsy to the RARP specimen, and prostate-specific antigen (PSA) recurrence-free survival between the pre-pandemic and pandemic groups.

RESULTS

The rate of preoperative ADT was significantly higher during than before the COVID-19 pandemic (13.7% vs. 1.9%; p = 0.002). The baseline physical and mental QOL scores did not differ significantly between the groups. The proportion of D'Amico low-risk patients was significantly lower (13.6% vs. 1.2%, p = 0.005) and waiting period for RARP was significantly shorter (median 3.5 months vs. 4.0 months, p = 0.016) in the pandemic group than in the pre-pandemic group. There was no significant difference in the proportion of adverse pathology between the groups (p = 0.104); however, the upgrading rate was significantly higher in the pre-pandemic group (p = 0.002). There was no significant difference in PSA recurrence-free survival between the groups (log-rank, p = 0.752).

CONCLUSIONS

The COVID-19 pandemic did not adversely affect the oncologic outcomes of RARP and QOL before RARP. However, it caused urologists to increase the use of preoperative ADT and to reserve RARP for higher-risk cases.

Usefulness of fluorescent ureteral catheter during laparoscopic residual ureterectomy

Introduction

There have been reports of surgery for residual ureteral tumors, most of them involved open surgeries. Herein, we report a case of retroperitoneal scopic left ureteral resection and partial cystectomy, performed by placing a fluorescent ureteral catheter in the residual ureter.

Case presentation

A 79-year-old man was admitted to our hospital with a chief complaint of gross hematuria. He had undergone transperitoneal left radical nephrectomy due to angiomyolipoma 20 years ago. Computed tomography and Magnetic resonance imaging revealed a solid tumor in the left residual ureter. Retroperitoneal scopic residual ureterectomy has been performed. During the operation, a fluorescent ureteral catheter proved to be very helpful in detecting the ureter.

Conclusion

A fluorescent ureteral catheter is considered to be a useful tool in laparoscopic surgery, especially in cases where identification of the ureter is expected to be difficult, such as the residual ureter in this case.

Impact of frailty on cancer-related fatigue and quality of life in outpatients with prostate cancer: a cross-sectional study of patient-reported outcomes

OBJECTIVE

To investigate the prevalence of frailty and its effects on cancer-related fatigue and quality of life among patients with prostate cancer.

METHODS

In this cross-sectional study, questionnaires were administered to 254 outpatients who visited the Department of Urology at Kagawa University Hospital for prostate cancer; finally, 108 outpatients were analyzed. Frailty, cancer-related fatigue and quality of life were assessed using the G8 screening tool, Japanese version of the Brief Fatigue Inventory and Japanese version of the Short Form 8 Health Survey, respectively. We defined frailty based on a score ≤14 points and divided the patients into frailty and no-frailty groups. We also compared the severity of cancer-related fatigue and quality of life between groups.

RESULTS

The prevalence of frailty among 108 outpatients was 63%. Older age correlated with frailty severity (P = 0.0007) but not cancer-related fatigue severity (P = 0.2391). The proportion of patients on treatment or with metastasis was not significantly different between groups. The frailty group had higher cancer-related fatigue severity (P = 0.004) and decreased levels of general activity, mood, walking ability, normal work and enjoyment of life, especially on the Brief Fatigue Inventory subscale. The frailty group had lower physical and mental quality of life than the no-frailty group or general population.

CONCLUSIONS

The frailty rate for these patients increased with age, exceeding 60% regardless of the treatment status, and was associated with worsened cancer-related fatigue severity and reduced quality of life. Our study highlights the importance of assessing frailty when selecting treatment, especially in older patients.

Real-world prostate-specific antigen response and progression to castration-resistant prostate cancer among men with metastatic castration-sensitive prostate cancer treated with apalutamide: a multi-institutional study in the Chu-shikoku Japan Urological Consortium

BACKGROUND

Japanese men receiving apalutamide often experience skin-adverse events (AEs), possibly requiring treatment interruption or dose reduction. However, concerns have arisen regarding the impact of these adjustments on the efficacy of apalutamide. Our study evaluated the efficacy, safety, and persistence of apalutamide in men with metastatic castration-sensitive prostate cancer (mCSPC).

METHODS

We retrospectively reviewed the medical records of 108 men with mCSPC from 14 Japanese institutions. The primary outcomes were the efficacy of apalutamide: prostate-specific antigen (PSA) response (50%, 90% and < 0.2 decline) and progression to castration-resistant prostate cancer (CRPC). The secondary outcomes were the skin-AE and compliance of apalutamide.

RESULTS

PSA50%, PSA90% and PSA < 0.2 declines were observed in 89.8, 84.3 and 65.7%, and the median time to CRPC progression was not reached. PSA < 0.2 decline and an initial full dose of apalutamide were significantly associated with a longer time to CRPC. The most common AE was skin-AE (50.9%), and there was no association between the occurrence of skin-AE and the time to CRPC (P = 0.72). The median apalutamide persistence was 29 months, which was longer in the initial full dose recipients than in the reduced dose recipients. The dosage is reduced in about 60% of patients within the first year of treatment in the initial full dose recipients.

CONCLUSIONS

Our findings indicate the effectiveness of apalutamide in Japanese men with mCSPC, despite a substantial portion requiring dose reduction within a year among the initial full dose recipients.

Increasing age predicts adverse pathology including intraductal carcinoma of the prostate and cribriform patterns in deferred radical prostatectomy after upfront active surveillance for Gleason grade group 1 prostate cancer: analysis of prospective observational study cohort

BACKGROUND

In men undergoing upfront active surveillance, predictors of adverse pathology in radical prostatectomy specimens, including intraductal carcinoma of the prostate and cribriform patterns, remain unknown. Therefore, we aimed to examine whether adverse pathology in radical prostatectomy specimens could be predicted using preoperative patient characteristics.

METHODS

We re-reviewed available radical prostatectomy specimens from 1035 men prospectively enrolled in the PRIAS-JAPAN cohort between January 2010 and September 2020. We defined adverse pathology on radical prostatectomy specimens as Gleason grade group ≥3, pT stage ≥3, pN positivity or the presence of intraductal carcinoma of the prostate or cribriform patterns. We also examined the predictive factors associated with adverse pathology.

RESULTS

All men analyzed had Gleason grade group 1 specimens at active surveillance enrolment. The incidence of adverse pathologies was 48.9% (with intraductal carcinoma of the prostate or cribriform patterns, 33.6%; without them, 15.3%). The addition of intraductal carcinoma of the prostate or cribriform patterns to the definition of adverse pathology increased the incidence by 10.9%. Patients showing adverse pathology with intraductal carcinoma of the prostate or cribriform patterns had lower biochemical recurrence-free survival (log-rank P = 0.0166). Increasing age at active surveillance enrolment and before radical prostatectomy was the only predictive factor for adverse pathology (odds ratio: 1.1, 95% confidence interval: 1.02-1.19, P = 0.0178; odds ratio: 1.12, 95% confidence interval: 1.02-1.22, P = 0.0126).

CONCLUSIONS

Increasing age could be a predictive factor for adverse pathology. Our findings suggest that older men could potentially derive advantages from adhering to the examination schedule in active surveillance.

Oral 5-aminolevulinic acid administration before transurethral resection of bladder tumor induces perioperative nausea and vomiting

BACKGROUND

The efficacy of photodynamic diagnosis using 5-aminolevulinic acid during transurethral resection of bladder tumors has been demonstrated, albeit with limited information regarding its side effects. This study aimed to clarify the impact of oral 5-aminolevulinic acid on perioperative nausea and vomiting (NV) for the first time in a real-world clinical practice setting.

METHODS

Patients who underwent transurethral surgery at Kagawa University between April 2017 and March 2020 were included. Perioperative NV and antiemetic use status were prospectively assessed and compared between the patients who received oral 5-aminolevulinic acid and those who did not. Additionally, univariate and multivariate analyses were performed for predicting postoperative nausea and vomiting.

RESULTS

Of 214 patients, 74 (34.6%) received oral 5-aminolevulinic acid preoperatively. The proportions of preoperative NV and antiemetic use in the patients who received 5-aminolevulinic acid were 9.5% and 4.1%, respectively, and higher than in those who did not (0% and 0%; P < 0.01 and P = 0.04, respectively). Postoperative NV (25.7%) and antiemetics use (8.0%) ratios in the patients who received 5-aminolevulinic acid were significantly different from those in the non-users group (3.6% and 2.1%, P < 0.01 and P < 0.01, respectively). Although no differences in risk factors were found for postoperative NV between the two groups, multivariate analyses indicated 5-aminolevulinic acid use as an independent predictive factor for postoperative NV (odds ratio, 11.5; 95% confidence interval, 3.98-33.3; P < 0.01).

CONCLUSIONS

Our study clearly showed that oral administration of 5-aminolevulinic acid was associated with perioperative NV even without risk factors, highlighting the need for addressing its application.

A national questionnaire survey of Japanese urologists on treatment perspectives for elderly prostate cancer patients

OBJECTIVE

This study conducted a national questionnaire survey of Japanese urologists from a treatment perspective for older patients with prostate cancer.

METHODS

A questionnaire was distributed to 922 teaching hospitals of the Japanese Urological Association. Questionnaire items included years of urologist experience, gender, workplace, treatment equipment owned, daily specialty practice area, urological cancer specialty, treatment reference items for older adults, upper age limit for radical treatment, medication, and two hypothetical cases of Gleason grade group 2 prostate cancer with or without oligometastasis.

RESULTS

In total, 1732 questionnaires were analyzed, with responses evenly distributed across all age groups. Workplaces included general hospitals (49.4%), university hospitals (40.3%), and cancer centers (4.2%). Performance status was the most frequently mentioned treatment-related item, followed by comorbidities and cognitive function. In addition, geriatric assessment was used by only 13.3% of respondents. No upper age limit was found for total prostatectomy, brachytherapy, and external beam radiation. Anti-androgens, androgen receptor-axis-targeted agents, chemotherapy, poly ADP ribose polymerase inhibitors, and immune-checkpoint inhibitors were selected by 6.8%, 35.6%, 47.3%, 89%, 62.8%, 24.7%, 41.9%, and 41.7% of the respondents, respectively. Response rates for administration of hormone therapy for hypothetical cases of Gleason grade group 2 prostate cancer with or without oligometastases were 96.8% and 61.2%, respectively.

CONCLUSIONS

Less than 15% of urologists used geriatric assessments. Several responded that they would set age limits for highly invasive radical and systemic therapies.

A national questionnaire survey of Japanese urologists on active surveillance for low- and intermediate-risk prostate cancer

OBJECTIVE

To conduct a national questionnaire survey of Japanese urologists on active surveillance (AS) for low- and intermediate-risk prostate cancer (PCa).

METHODS

A questionnaire was sent to 922 Japanese Urological Association Teaching Base Hospitals. The items included were years of experience as a urologist, sex, workplace, treatment equipment owned, specialty area of daily practice, specialty area of urological cancer, and six hypothetical cases of AS. The cases were categorized by the following Gleason scores: 3 + 3 low risk of PCa, 3 + 4 intermediate risk, and 4 + 3 intermediate risk, with or without comorbidities for each case. Comorbidities were defined as cardiovascular diseases or illnesses warranting anticoagulant therapy.

RESULTS

Altogether, 1962 questionnaires were analyzed. Responses were almost equally distributed among all age groups. Workplaces included general hospitals (49.4%), university hospitals (40.3%), and cancer centers (4.2%). Percentages of proposed AS for low risk/no comorbidity, low risk/with comorbidity, intermediate-risk 3 + 4/no comorbidity, intermediate risk 3 + 4/with comorbidity, intermediate risk 4 + 3/no comorbidity, and intermediate risk 4 + 3/with comorbidity were 90.5%, 90%, 39.5%, 48.7%, 15%, and 22%, respectively. Analysis of the correspondents' backgrounds showed that the more the urologists' years of experience, the less they were to advise AS of low-risk patients. In the presence of comorbidities, urologists across all age groups tended to propose AS, even in the same Gleason grade group. Cancer center urologists recommended AS more often than their counterparts at general and university hospitals.

CONCLUSIONS

Approximately 40% of urologists proposed AS for intermediate-risk cases, confirming that AS for intermediate-risk patients is being considered in Japan.

A national questionnaire survey of Japanese urologists on the treatment perspective for elderly patients with prostate cancer

327

Background: Physicians' attitudes toward elderly prostate cancer patients in Japan remain unknown. So, we conduct a national questionnaire survey of Japanese urologists from a treatment perspective for elderly patients with prostate cancer. Methods: A questionnaire was sent to 922 Japanese urological association teaching base hospitals. The following items were included: years of experience as a urologist, gender, workplace, treatment equipment owned, specialty area of daily practice, specialty area of urological cancer, reference items for treatment of the elderly, upper age limit for radical treatment, medication, and two hypothetical cases of Gleason grade Group 2 prostate cancer with or without oligometastasis. For examined the correlation between experience for urological practice and the answer, “not considering the upper age limit”, Cochran-Armitage trend test was used. For comparison of the rate of answering with “not considering the upper age limit” between variables, z-tests were conducted repeatedly and Bonferroni adjustments were made. In this analysis, the statistical significance was set at a P-value <0.05. Results: Altogether, 1,732 questionnaires were analyzed. The responses were almost equally distributed among all age groups. Workplaces included general hospitals (49.4%), university hospitals (40.3%), and cancer centers (4.2%). Performance status was the most frequently referenced item in treating the elderly, followed by the presence of comorbidities and cognitive function. Furthermore, 13.3% of respondents used the geriatric assessment. There was no upper age limit for total prostatectomy, brachytherapy, and external radiation therapy. Antiandrogens, androgen receptor-axis-targeted agents, chemotherapy, PARP inhibitors, and immune-checkpoint inhibitors were selected by 6.8%, 35.6%, 47.3%, 89%, 62.8%, 24.7%, 41.9%, and 41.7% of the respondents, respectively. The answers for the administration of hormone therapy for hypothetical cases of Gleason grade Group 2 prostate cancer with or without oligometastasis were 96.8% and 61.2%, respectively. The answers for the administration of hormone therapy for hypothetical cases of Gleason grade Group 2 prostate cancer with or without oligometastasis were 96.8% and 61.2%, respectively. Conclusions: Fewer than 10% of urologists used geriatric assessments. Many urologists responded that they would set age limits for highly invasive radical and systemic therapies. [Table: see text]

Predictor of adverse pathology in patients who underwent deferred radical prostatectomy following active surveillance: Results from multi-institutional prospective observational cohort in the PRIAS-JAPAN

350

Background: Intraductal carcinoma of the prostate (IDC-P) and invasive cribriform are key prognostic pathologies among early stage prostate cancer patients; however, predictors of adverse pathology, including these types, remain unknown. In men who opted for active surveillance (AS), we aimed to examine the association between adverse pathology and patient characteristics, utilizing radical prostatectomy (RP) specimens. Methods: We re-reviewed available RP specimens from 1035 men prospectively enrolled in the PRIAS-JAPAN cohort between January 2010 and September 2020. We defined adverse pathology on RP specimen as Gleason grade group of ≥3, pT-stage≥T3, pN positivity, or the presence of IDC-P or invasive cribriform. And, we examined the predictive factors associated with adverse pathology, using factors at AS enrollment and before RP. Results: Out of 162 men underwent RP, available 137 RP specimens were analyzed. The percentage of adverse pathology was 48.9% (67 patients), including 8.8% in IDC-P and 29.9 % in invasive cribriform. Men with adverse pathology had lower prostate specific antigen recurrence-free survival than those without them (log rank P = 0.0189). On multivariate logistic regression analyses, increasing age at AS enrollment and before RP were the predictive factors for adverse pathology (Odds ratio [OR], 1.1; 95% confidence interval [CI]: 1.02-1.19, P = 0.0178, OR, 1.12; 95% CI: 1.02-1.22, P=0.0126), not magnetic resonance imaging findings. Conclusions: Aging is significantly associated with adverse pathology including IDC-P or cribriform. The results suggest that relaxing scheduled examinations during AS depending on age is not practical. Clinical trial information: UMIN000048095 .

Clinical outcomes of intraductal carcinoma or cribriform in radical prostatectomy specimens of men opting for active surveillance: data from the PRIAS-JAPAN study

BACKGROUND

Among early stage prostate cancer patients, intraductal carcinoma of the prostate (IDC-P) and invasive cribriform are key prognostic factors; however, their presence and clinical significance following active surveillance (AS) are unknown. In men who opted for AS, we aimed to examine the presence and impact of IDC-P or cribriform, utilizing radical prostatectomy (RP) specimens.

METHODS

We re-reviewed 137 RP specimens available in the PRIAS-JAPAN prospective cohort between January 2010 and September 2020. We assessed the presence of IDC-P or cribriform, and compared the patients' characteristics and prostate-specific antigen (PSA) recurrence-free survival after RP between groups with and without IDC-P or cribriform. In addition, we examined the predictive factors associated with IDC-P or cribriform.

RESULTS

The percentage of patients with IDC-P or cribriform presence was 34.3% (47 patients). IDC-P or cribriform pattern was more abundant in the higher Gleason grade group in RP specimens (P < 0.001). The rates of PSA recurrence-free survival were significantly lower in the IDC-P or cribriform groups than in those without them (log rank P = 0.0211). There was no association between IDC-P or cribriform on RP with the Prostate Imaging-Reporting and Data System (PI-RADS) 4,5 score on magnetic resonance imaging (MRI) before RP even with adjustments for other covariates (OR, 1.43; 95% confidence interval [CI] 0.511-3.980, P = 0.497).

CONCLUSIONS

IDC-P or cribriform comprised approximately one-third of all RP specimens in men who underwent RP following AS, confirming their prognostic significance.

Active surveillance in younger patients with prostate cancer: clinical characteristics including longitudinal patient-reported outcomes

OBJECTIVE

this study aimed to evaluate the active surveillance continuation period, treatment intervention rate and health-related quality of life in younger patients.

METHODS

we prospectively conducted a health-related quality of life survey of patients enrolled in the Prostate Cancer Research International: Active Surveillance-JAPAN study at Kagawa University between January 2010 and December 2020. Health-related quality of life was assessed by mail using a validated Japanese version of the Short-Form 8 Health Survey and Expanded Prostate Cancer Index at active surveillance enrolment and annually thereafter until discontinuation of active surveillance. We divided the patients into two groups, younger (aged <65 years) and older (aged ≥65 years), and compared the two groups.

RESULTS

of the 84 patients, 22 were in the younger group. The active surveillance continuation period was shorter in the younger group than in the older group. The 3-year treatment intervention rate was higher in the younger group than in the older group. The majority of the reasons for definitive treatment were related to the protocol, which was similar in both groups (80 versus 76%). The sexual summary scores at active surveillance enrolment were higher in the younger group than in the older group. During active surveillance, the younger group and the older group showed no deterioration in all health-related quality of life scores compared with the scores at the enrolment of active surveillance.

CONCLUSIONS

patient-reported health-related quality of life survey indicated that the health-related quality of life of younger Japanese patients was maintained over time during active surveillance, similar to that of older patients.

Effects of Arterial Stiffness on Cerebral WM Integrity in Older Adults: A Neurite Orientation Dispersion and Density Imaging and Magnetization Transfer Saturation Imaging Study

BACKGROUND AND PURPOSE

Arterial stiffness is reported to be able to cause axonal demyelination or degeneration. The present study aimed to use advanced MR imaging techniques to examine the effect of arterial stiffness on the WM microstructure among older adults.

MATERIALS AND METHODS

Arterial stiffness was measured using the cardio-ankle vascular elasticity index (CAVI). The high-CAVI (mean CAVI ≥ 9 points) and the low-CAVI groups (mean CAVI < 9 points) were created. The neuronal fiber integrity of the WM was evaluated by neurite orientation dispersion and density imaging and magnetization transfer saturation imaging. Tract-Based Spatial Statistics and the tracts-of-interest analysis were performed. Specific WM regions (corpus callosum, internal capsule, anterior thalamic radiation, corona radiata, superior longitudinal fasciculus, forceps minor, and inferior fronto-occipital fasciculus) were selected in the tracts-of-interest analysis.

RESULTS

In Tract-Based Spatial Statistics, the high-CAVI group showed a significantly lower myelin volume fraction value in the broad WM and significantly higher radial diffusivity and isotropic volume fraction values in the corpus callosum, forceps minor, inferior fronto-occipital fasciculus, internal capsule, corona radiata, and anterior thalamic radiation than the low-CAVI group. In tracts-of-interest analysis using multivariate linear regression, significant associations were found between the mean CAVI and radial diffusivity in the anterior thalamic radiation and the corona radiata; isotropic volume fraction in the anterior thalamic radiation and the corona radiata; and myelin volume fraction in the superior longitudinal fasciculus (P < .05). Additionally, partial correlation coefficients were observed for the significant associations of executive function with radial diffusivity and myelin volume fraction (P < .05).

CONCLUSIONS

Arterial stiffness could be associated with demyelination rather than axonal degeneration.

[Testicular Preservation in a Patient with a Testicular Epidermoid Cyst Achieved by Preoperative Diagnosis : A Case Report]

Testicular epidermoid cysts are relatively rare, accounting for about 1% of all testicular tumors, and are often treated by high orchiectomy. We describe here the case of a testicular epidermoid cyst treated by testicle-sparing surgery due to a preoperative diagnosis. A 23-year-old man complained of a painless mass in the right scrotum. Physical examination revealed a firm little fingertip-sized smooth-surfaced mass in the right testis. Ultrasonography showed a hypoechoic lesion with an echogenic rim in the right testis. A T2-weighted magnetic resonance image showed a well-demarcated mass with a low signal outline. On the basis of a preoperative diagnosis of epidermoid cyst, intraoperative testicular frozen section was performed, and the mass was resected surgically while preserving the testis.

The Impact of Histopathological Features of Prostate Cancerous Lesions on Multiparametric Magnetic Resonance Imaging Findings using PI-RADS Version 2

OBJECTIVES

To determine the square measure threshold of prostate cancer lesions in pathological specimens showing PI-RADS categories 3 to 5, and to identify the pathological characteristics of cancerous lesions over the threshold.

METHODS

Cancer foci detected in horizontal sections of specimens were defined as pathological cancerous lesions, in which square measure, lesion location (peripheral or transition zone), Gleason pattern (GP), GP4-5 component percentages, and GP 4 subtypes were assessed. A receiver operating characteristic curve was used to determine the threshold of the square measure of pathological specimens that distinguishes between lesions of PI-RADS categories 1 and 2 and those of 3 to 5. Univariable and multivariable analyses were performed to determine the histopathological features associated with PI-RADS categories 3 to 5.

RESULTS

A total of 100 consecutive patients underwent multiparametric magnetic resonance imaging before robotic-assisted laparoscopic prostatectomy. A total of 1366 pathological cancerous lesions were detected, 217 of which were classified as PI-RADS categories 3 to 5. A square measure of 40 mm² on pathological specimens was the threshold for PI-RADS categories 3 to 5. Of the 415 lesions that were over 40 mm², 211 lesions exhibited PI-RADS categories 1, 2 and 204 lesions exhibited PI-RADS categories 3 to 5. Multiple logistic regression analysis showed that square measure, fused glands, and cribriform glands were independently associated with PI-RADS categories 3 to 5.

CONCLUSION

Cancerous lesions over 40 mm² showing PI-RADS categories 3 to 5 are associated with square measure, fused glands, and cribriform glands.

Ureteroiliac artery fistula caused by full-length metallic ureteral stenting in a malignant ureteral obstruction: a case report

Background

The metallic stent is a new device for relieving the urinary tract in patients with malignant ureteral obstruction with short life expectancy and has been used frequently worldwide for its efficacy and safety. A ureteroarterial fistula with indwelling ureteral stent is rare but highly fatal, and there are several reports of ureteroarterial fistula treated by conventional polymer stents, although there are no reports on metallic stents. To our knowledge, this paper describes the first case of a ureteroiliac artery fistula caused by a full-length metallic ureteral stent in malignant ureteral obstruction.

Case presentation

Our patient was a 57-year-old Asian woman with a history of locally advanced cervical cancer who underwent abdominal total hysterectomy and chemoradiotherapy. She was diagnosed with right hydronephrosis and hydroureter secondary to upper ureteral obstruction because of retroperitoneal lymph node metastasis. A urinary tract obstruction after placement of 12 months of polymer stent followed by 18 months of metallic stent was relieved, consequently resulting in intermittent gross hematuria with bladder tamponade and anemia. Contrast-enhanced computed tomography could not reveal a ureteroarterial fistula; however, retrograde pyelography emphasized the existence of a ureteroiliac artery fistula. The patient underwent successful endovascular heparin-bonded stent graft placement, and her gross hematuria disappeared thereafter.

Conclusion

The metallic stent is a useful device for patients with malignant ureteral obstruction with a short life expectancy, although it may impose a higher pressure on the extraureteral tissue than conventional polymer stents due to its properties and may cause a ureteroarterial fistula. The narrowing of the external iliac artery diameter visualized by computed tomography may be helpful for predicting ureteroarterial fistulas.

Spontaneous lumbar artery rupture in a kidney transplant patient: A case report

We experienced a case of retroperitoneal hematoma secondary to spontaneous lumbar artery rupture in a kidney transplant patient. A 48-year-old woman underwent kidney transplantation for end-stage renal disease. Fifteen days after transplantation, the patient presented with strong abdominal and back pain on the right side, and blood examination showed severe anemia. Contrast-enhanced computed tomography and emergent angiography was performed, which showed extravasation from the lumbar artery. Selective angiographic embolization of the lumbar artery was performed, and the patient received a transfusion of red blood cells, following which, hemoglobin increased to 7.6 g/dl. Renal function then stabilized, and anemia improved.

Decrescent intensity training concurrently improves maximal anaerobic power, maximal accumulated oxygen deficit, and maximal oxygen uptake

This study aimed to investigate the effects of a gradually decreasing intensity training from that corresponding to maximal anaerobic power (MAnP) to that of near maximal oxygen uptake ([Formula: see text]) (decrescent intensity training) on MAnP, maximal accumulated oxygen deficit (MAOD), and [Formula: see text] in untrained young men. Seventeen untrained young men were randomly divided into either a training (TR; n = 9) group or a control (CON; n = 8) group. The TR group performed the decrescent intensity training, whereas the CON group did not perform any exercises. The mean training time per session throughout the training period was 275 ± 135 s. There was a Group × Time interaction for both absolute and relative (p < 0.01) values of [Formula: see text], MAOD, and MAnP. The TR group had significantly increased values for all variables after the 8-week training program, and the relative values of all variables were significantly higher in the TR group than in the CON group. Muscle thicknesses in the anterior and posterior aspects of the thigh and maximal isokinetic knee extension and flexion strengths improved only in the TR group (p < 0.05). A single-exercise training with gradually decreasing intensity from that corresponding to the MAnP to that of approximately 100% [Formula: see text] improves MAnP, MAOD, and [Formula: see text] concurrently, despite the short training time per session.

A phosphodiesterase 5 inhibitor, tadalafil, suppresses stromal predominance and inflammation in a rat model of nonbacterial prostatitis

BACKGROUND

Chronic inflammation is thought to be a major causative factor for the development of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS). Tadalafil, a phosphodiesterase type 5 inhibitor (PDE5-I), which has been used for the treatment of BPH-LUTS in daily practice, is known to act at several urinary organs. In this study, focused on the prostate, we examined the effect of tadalafil on the pathological changes and inflammatory factors in a rat nonbacterial prostatitis (NBP) model.

METHODS

Forty ten-month-old male Wistar rats were divided into nonbacterial prostatitis (NBP), NBP with tadalafil treatment (NBP-tadalafil), control, and control treated with tadalafil (control-tadalafil) groups (n = 10 per group). The NBP and NBP-tadalafil groups were castrated and then received daily subcutaneous 17β-estradiol for 30 days. The control-tadalafil and NBP-tadalafil groups were administered daily oral tadalafil for 30 days. All rats were then sacrificed and pathological changes and inflammatory factors were assessed in the prostatic tissues.

RESULTS

In the NBP group, the stroma-to-epithelium (S/E) ratio in the ventral prostate was significantly higher than in the control group (P < 0.001). In the NBP-tadalafil group, the S/E ratio was significantly lower than in the NBP group (P < 0.001). The macrophage levels and the extent of T-cell infiltration in the NBP-tadalafil group were significantly lower than in the NBP group (P < 0.005; P < 0.001, respectively). Compared with the NBP group, tissue concentrations of inflammatory cytokines, such as tumor necrosis factor-α, interleukin-8, and interleukin-1β, were significantly downregulated in the NBP-tadalafil group (P < 0.01; P < 0.05; P < 0.005, respectively).

CONCLUSIONS

Tadalafil suppressed stromal predominance and showed anti-inflammatory effects in a rat NBP model in association with downregulation of inflammatory cytokines.

Body Fat Area as a Predictive Marker of New-Onset Diabetes Mellitus After Kidney Transplantation

BACKGROUND

New-onset diabetes after kidney transplantation (NODAT) adversely affects patient survival. Excessive fat accumulation is generally considered a risk factor of NODAT. Body mass index (BMI) and abdominal circumference (AC) are frequently used to assess fat accumulation but cannot directly measure it. This study measured body fat area (BFA) via computed tomography and aimed to clarify whether preoperative BFA can predict the development of NODAT more accurately than BMI and AC.

METHODS

This retrospective study included 62 patients without diabetes mellitus who received living-donor kidney transplantation at our institute between July 2005 and April 2016. We investigated the association between preoperative BMI, AC, and BFA and the development of NODAT.

RESULTS

Eight patients (12.9%) developed NODAT during a mean follow-up period of 78.1 months. The preoperative BMI, AC, and BFA were markedly higher in NODAT patients than in patients without NODAT (P = .05, P = .02, P < .01, respectively). Correlation analyses revealed that BFA had a strong relationship with BMI (r = 0.68, P < .01) and AC (r = 0.77, P < .01). Receiver operating characteristic curve analyses demonstrated that BFA, compared to BMI and AC, had considerable predictive accuracy for the development of NODAT, with an area under the curve of 0.803 (sensitivity 75%, specificity 87%).

CONCLUSIONS

Preoperative BFA could be a predictive marker of NODAT in renal graft recipients. Our findings underline the importance of routine preoperative BFA measurements in clinical practice.

Energy expenditure, recovery oxygen consumption, and substrate oxidation during and after body weight resistance exercise with slow movement compared to treadmill walking

The benefit of body weight resistance exercise with slow movement (BWRE-slow) for muscle function is well-documented, but not for energy metabolism. We aimed to examine physiological responses [e.g., energy expenditure (EE), respiratory exchange ratio (RER), and blood lactate (La)] during and after BWRE-slow compared to EE-matched treadmill walking (TW). Eight healthy young men (23.4 ± 1.8 years old, 171.2 ± 6.2 cm, 63.0 ± 4.8 kg) performed squat, push-up, lunge, heel-raise, hip-lift, and crunch exercises with BWRE-slow modality. Both the concentric and eccentric phases were set to 3 s. A total of three sets (10 repetitions) with 30 s rest between sets were performed for each exercise (26.5 min). On another day, subjects walked on a treadmill for 26.5 min during which EE during exercise was matched to that of BWRE-slow with the researcher controlling the treadmill speed manually. The time course changes of EE and RER were measured. The EE during exercise for BWRE-slow (92.6 ± 16.0 kcal for 26.5 min) was not significantly different from the EE during exercise for TW (95.5 ± 14.1 kcal, p = 0.36). BWRE-slow elicited greater recovery EE (40.55 ± 3.88 kcal for 30 min) than TW (37.61 ± 3.19 kcal, p = 0.029). RER was significantly higher in BWRE-slow during and 0-5 min after exercise, but became significantly lower during 25-30 min after exercise, suggesting greater lipid oxidation was induced about 30 min after exercise in BWRE-slow compared to TW. We also indicated that BWRE-slow has 3.1 metabolic equivalents in average, which is categorized as moderate-intensity physical activity.

Regulation of Perfusion Pressure during Cardiopulmonary bypass using Sevoflurane

In hypothermic cardiopulmonary bypass (CPB), various vasodilators are used to control the perfusion pressure. These agents, however, often decrease the pressure excessively, and the low perfusion pressure may persist until the end of CPB. In this study we evaluate the safety and characteristics of the regulation of perfusion pressure during CPB using a volatile anesthetic, sevoflurane which has an extremely low partition coefficient. Twenty adult patients who underwent cardiac surgery were studied. Sevoflurane was applied by a vaporizer inserted into the oxygenator gas supply line. Pump flows were fixed at 2.4 L/min/m2 during the hypothermic period. Sevoflurane concentration was adjusted to keep mean arterial pressure (MAP) between 40 and 70 mmHg during CPB. Hemodynamic and metabolic parameters were measured and compared to the group we previously treated with chlorpromazine. In all cases, MAP could be maintained adequately. In the sevoflurane group, systemic vascular resistance indices (SVRI) during the rewarming period and at the end of CPB were higher, and doses of norepinephrine needed at the end of CPB were significantly lower than in the chlorpromazine group. The regulation of perfusion pressure during CPB using sevoflurane was safe and could easily maintain adequate SVRI.

Heat stress-induced phosphorylation of FoxO3a signalling in rat skeletal muscle

AIM

A recent study demonstrated that FoxO3a was directly induced by the overexpression of Hsp72 in rat soleus muscle. However, whether heat stress treatment induces FoxO3a phosphorylation in rat skeletal muscle remains unclear. This study examined the effects of heat stress on the regulation of the FoxO3a signalling pathway in rat skeletal muscle.

METHODS

Thirty-two male Wistar rats (15 weeks old) were randomly assigned into two groups; sedentary control group (Sed, n = 8) and experimental group (n = 24). After an overnight fast, one leg of each rat (HS leg) in the experimental group was immersed in hot water (43 °C) for 30 min, and the soleus and plantaris muscles in both legs were removed immediately (0 min), 30 min, 60 min, or 24 h after the heat stress (n = 6 each group). The contralateral, non-heated leg in the experimental group served as an internal control (CT leg).

RESULTS

Heat stress treatment resulted in a significant increase in FoxO3a phosphorylation (Ser253) in the soleus and plantaris muscles of heat-stressed legs after 24 h. Hsp72 expression in heat-stressed legs was significantly higher at 60 min and 24 h in these muscles. Activation of the PTEN/Akt and MEK/ERK pathways was also observed in these muscles immediately after stress, but not at 24 h. There were no differences in FoxO1 and AMPKα phosphorylation in either muscle.

CONCLUSION

Heat stress in rat skeletal muscle induces phosphorylation of FoxO3a signalling, and it may be related to Hsp72 upregulation, and the activation of the PTEN/Akt and MEK/ERK pathways.

Efficacy of Whole Bowel Irrigation Using Solutions with or without Adsorbent in the Removal of Paraquat in Dogs

1 The efficacy of whole bowel irrigation with a solution containing either polyethylene glycol (PEG) with electrolyte or an adsorbent (Kayexalate™) with a cathartic (sorbitol) was investigated in 18 dogs who had been given 250 mg kg -1 paraquat dichloride via a jejunal tube to eliminate the influence of gastric absorption.

2 Plasma paraquat concentrations 2 and 3 h after the initiation of bowel irrigation and at the end of the study (5 h later) were significantly lower in the bowel irrigation groups than in the control (no bowel irrigation) group.

3 The total body clearances of paraquat in the bowel irrigation groups were significantly greater than in the control group.

4 There were no significant differences between the two different irrigation solution groups in plasma paraquat concentration, the area under the plasma concentration time curve and the total body clearance.

5 In the PEG with electrolyte group, about 70% of the administered dose of paraquat was removed by means of bowel irrigation (n=4).

6 The adjunction of the adsorbent had no beneficial effects.

7 Haemodynamic changes associated with whole bowel irrigation were unremarkable except that right atrial and pulmonary arterial pressures were elevated in the latter part of the study.

Traditional and ankle-specific vertical jumps as strength-power indicators for maximal sprint acceleration

AIM

This study aimed to determine the demand of strength-power capabilities represented by traditional and ankle-specific vertical jump modalities ‑ squat jump (SJ), counter-movement jump (CMJ), rebound-continuous jump (RJ), rebound-continuous ankle jump (AJ) ‑ relative to sprint acceleration ability during the entire acceleration phase of maximal sprint.

METHODS

Nineteen male sprinters performed a 60-m maximal sprint and various vertical jumps. Correlation coefficients among the vertical jump performances and between those and the 60-m sprint time and sprint acceleration at each step were calculated.

RESULTS

There were significant relationships between the 60-m sprint time and SJ height, CMJ height, AJ height, and AJ index. AJ height and index had no correlation with any other jump variables. Acceleration was significantly correlated with SJ height from the 6th to the 10th steps (r=0.48-0.51) and with CMJ height from the 5th to the 11th steps (r=0.46-0.54). Acceleration was also correlated with the AJ index from the 14th to the 19th steps (r=0.48-0.54). Acceleration had no correlation with the RJ index at any step.

CONCLUSION

The results suggest that the AJ allows assessment of different reactive strengths compared with traditional jump modalities. To accelerate effectively, the explosive strengths of the SJ and CMJ are important during the early stage of acceleration (from 6.6±0.4 to 17.5±0.8 m), and the reactive strength represented by the AJ is necessary during the later stage of acceleration (from 23.4±1.0 to 33.7±1.4 m). Sprinters and coaches should be aware of the different demands of strength-power capability for effective acceleration.

Effects of walking combined with restricted leg blood flow on mTOR and MAPK signalling in young men

Walking combined with blood flow reduction (BFR-walk) elicits muscle hypertrophy. However, the skeletal muscle intracellular signalling behind this response is currently unknown.

AIM

To investigate the effects of BFR-walk on mechanistic target of rapamycin (mTOR) and mitogen-activated protein kinase (MAPK) signalling pathways in young men.

METHODS

Six young men performed 20 min of treadmill walking at 55% of their predetermined maximum oxygen uptake. A pressure cuff belt was applied to the most proximal thigh of only one leg (BFR-Leg, external compression was 240 mmHg), whereas the other leg (CON-Leg) was without BFR during walking. Muscle biopsies were taken from the vastus lateralis of the CON-Leg before exercise and in both legs 3 h after exercise.

RESULTS

Erk1/2 phosphorylation levels were significantly (P < 0.05) increased after exercise in both legs; however, only the BFR-Leg saw an increased phosphorylation of p38. For mTOR signalling, there were no changes in Akt, mTOR or S6K1 phosphorylation levels before or after walking. However, eEF2 phosphorylation level was significantly (P < 0.05) lower for the BFR-Leg 3 h after walking compared with CON-Leg.

CONCLUSION

BFR-walk exercise may activate some intracellular signalling cascades that are associated with muscle hypertrophy in young men.

Association of acceleration with spatiotemporal variables in maximal sprinting

This study clarified the association between acceleration and the rates of changes in spatiotemporal variables on a step-to-step basis during the entire acceleration phase of maximal sprinting. 21 male sprinters performed a 60-m sprint, during which step-to-step acceleration and rates of changes in step length (RSL) and step frequency (RSF) were calculated. The coefficients of correlation between acceleration and other variables were tested at each step. There were positive correlations between acceleration and the RSF up to the second step. Acceleration was positively correlated with the RSL from the 5(th) to the 19(th) step. At the third and from the 16(th) to the 22(nd) step and from the 20(th) to the 21(st) step, there was no significant correlation, but weak relationships were found between acceleration and the RSF and RSL. The results suggest that the acceleration phase can be divided into 3 sections, and for sprinting to be effective, it is important to accelerate by increasing the step frequency to the third step, increasing the step length from the 5(th) to the 15(th) step, and increasing the step length or frequency (no systematic relative importance of step length or frequency) from the 16(th) step in the entire acceleration phase.

Effect of NS-018, a selective JAK2V617F inhibitor, in a murine model of myelofibrosis

A single somatic mutation, V617F, in Janus kinase 2 (JAK2) is one of the causes of myeloproliferative neoplasms (MPNs), including primary myelofibrosis, and the JAK2V617F mutant kinase is a therapeutic target in MPN. However, inhibition of wild-type (WT) JAK2 can decrease the erythrocyte or platelet (PLT) count. Our selective JAK2 inhibitor, NS-018, suppressed the growth of Ba/F3 cells harboring JAK2V617F more strongly than that of cells harboring WT JAK2. The 4.3-fold JAK2V617F selectivity of NS-018 is higher than the 1.0- to 2.9-fold selectivity of seven existing JAK2 inhibitors. NS-018 also inhibited erythroid colony formation in JAK2V617F transgenic mice at significantly lower concentrations than in WT mice. In keeping with the above results, in a JAK2V617F bone marrow transplantation mouse model with a myelofibrosis-like disease, NS-018 reduced leukocytosis and splenomegaly, improved bone marrow fibrosis and prolonged survival without decreasing the erythrocyte or PLT count in the peripheral blood. By exploring the X-ray co-crystal structure of NS-018 bound to JAK2, we identified unique hydrogen-bonding interactions between NS-018 and Gly993 as a plausible explanation for its JAK2V617F selectivity. These results suggest that NS-018 will have therapeutic benefit for MPN patients through both its efficacy and its reduced hematologic adverse effects.

Heat stress activates the Akt/mTOR signalling pathway in rat skeletal muscle

AIM

It is well known that various stimuli, such as mechanical stress and nutrients, induce muscle hypertrophy thorough the Akt/mTOR signalling pathway, which is a key mediator of protein synthesis and hypertrophy in skeletal muscle. It was recently reported that heat stress also induces an increase in muscle weight and muscle protein content. In addition, heat stress enhances Akt/mTOR signalling after one bout of resistance exercise. However, it remains unclear whether increased temperature itself stimulates the Akt/mTOR signalling pathway.

METHODS

Forty-two male Wistar rats (279.5 ± 1.2 g) were divided into a control group (CON) or one of five thermal stress groups at 37, 38, 39, 40 or 41 °C (n = 7 each group). After overnight fasting, both legs were immersed in different temperatures of hot water for 30 min under sodium pentobarbital anaesthesia. The soleus and plantaris muscles were immediately removed from both legs after the thermal stress.

RESULTS

The phosphorylation of mTOR or 4E-BP1 and heat shock protein (HSP) expression levels were similar among groups in both the soleus and plantaris muscles. However, Akt and p70S6K phosphorylation significantly increased at 41 °C in the soleus and plantaris muscles. Moreover, we observed a temperature-dependent increase in Akt and p70S6K phosphorylation in both muscles.

CONCLUSION

Our data indicate that the altered temperature increased phosphorylation in a temperature-dependent manner in rat skeletal muscle and may itself be a key stimulator of Akt/mTOR signalling.

Effect of lidocaine on dynamic changes in cortical reduced nicotinamide adenine dinucleotide fluorescence during transient focal cerebral ischemia in rats

Rats were subjected to 90min of focal ischemia by occluding the left middle cerebral and both common carotid arteries. The dynamic changes in the formation of brain ischemic areas were analyzed by measuring the direct current (DC) potential and reduced nicotinamide adenine dinucleotide (NADH) fluorescence with ultraviolet irradiation. In the lidocaine group (n=10), 30min before ischemia, an intravenous bolus (1.5mg/kg) of lidocaine was administered, followed by a continuous infusion (2mg/kg/h) for 150min. In the control group (n=10), an equivalent amount of saline was administered. Following the initiation of ischemia, an area of high-intensity NADH fluorescence rapidly developed in the middle cerebral artery territory in both groups and the DC potential in this area showed ischemic depolarization. An increase in NADH fluorescence closely correlated with the DC depolarization. The blood flow in the marginal zone of both groups showed a similar decrease. Five minutes after the onset of ischemia, the area of high-intensity NADH fluorescence was significantly smaller in the lidocaine group (67% of the control; P=0.01). This was likely due to the suppression of ischemic depolarization by blockage of voltage-dependent sodium channels with lidocaine. Although lidocaine administration did not attenuate the number of peri-infarct depolarizations during ischemia, the high-intensity area and infarct volume were significantly smaller in the lidocaine group both at the end of ischemia (78% of the control; P=0.046) and 24h later (P=0.02). A logistic regression analysis demonstrated a relationship between the duration of ischemic depolarization and histologic damage and revealed that lidocaine administration did not attenuate neuronal damage when the duration of depolarization was identical. These findings indicate that the mechanism by which lidocaine decreases infarct volume is primarily through a reduction of the brain area undergoing NADH fluorescence increases which closely correlates with depolarization.

Detection of RB, p16/CDKN2 and p15(INK4B) gene alterations with immunohistochemical studies in human prostate carcinomas

To examine the status of cell cycle-inhibitory genes in human prostate carcinoma, we investigated alterations of RE (retinoblastoma), p16/CDKN2 and p15(INK4B) genes in 32 adenocarcinomas with immunohistochemistry. PCR-single-strand conformation polymorphism (SSCP) was used to examine all 27 exons of the RE gene, exons 1 to 3 of the p16/CDKN2 gene and exons 1 and 2 of the p15(INK4B) gene for mutations. Loss of heterozygosity (LOH) for the RE gene was probed by restriction fragment length polymorphism (RFLP) analysis. In addition, coordinate samples were subjected to immunohistochemical studies for reactivity to RE and p16 protein. The RE gene alterations were detected in 5 of the 32 tumors (16%); of these, only one mutation, a missense substitution, occurred within an exon. The remaining four single base insertions or deletions were found within introns of the RE gene and no mutational event was detected in its promoter region. LOH involving intron 17 of RB was detected in three cases of 10 informative tumors (30%). Intragenic mutations were also present in 3 of the 32 tumors in the p16/CDKN2 gene. In contrast, no mutational events were found in the p15(INK4B) gene in the tumors. Only one tumor had both a p16/CDKN2 mutation and LOH of the RE gene. Expression of pRB was absent or reduced in 16 cancers, while p16 expression was present in all cases to varying degrees. The results suggest that p16/CDKN2 gene mutations occur rarely and intragenic mutation, but not LOH,of the RE gene is not required in prostatic tumorigenesis.

Satellite cell pool enhancement in rat plantaris muscle by endurance training depends on intensity rather than duration

AIM

Increases in the number of satellite cells are necessary for the maintenance of normal muscle function. Endurance training enhances the satellite cell pool. However, it remains unclear whether exercise intensity or exercise duration is more important to enhance the satellite cell pool. This study examined the effects of different intensity and duration of endurance training on the satellite cell pool in rat skeletal muscle.

METHODS

Forty-one 17-week-old female Sprague-Dawley rats were assigned to control (n = 8), high intensity and high duration (n = 7), high intensity and low duration (n = 8), low intensity and high duration (n = 9) and low intensity and low duration (n = 9) groups. Training groups exercised 5 days per week on a motor driven treadmill for 10 weeks. After the training period, animals were anaesthetized and the plantaris muscles were removed, weighed and analysed for immunohistochemical and histochemical properties.

RESULTS

Although no significant differences were found in muscle mass, mean fibre area and myonuclei per muscle fibre between all groups, the percentage of satellite cells was significantly higher in the high-intensity groups than in the other groups (P < 0.05).

CONCLUSION

Increases in the satellite cell pool of skeletal muscle following endurance training depend on the intensity rather than duration of exercise.