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Wakamiya T, Fujimoto T, Endo T, Nishioka S, Yokoyama N, Yamashita S, Kikkawa K, Hyodo Y, Ishimura T, Kohjimoto Y, Hara I, Fujisawa M. Myosteatosis as a novel predictor of new-onset diabetes mellitus after kidney transplantation. Int J Urol 2024; 31:39-44. [PMID: 37743534 DOI: 10.1111/iju.15304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 09/07/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVES We evaluate the effect of myosteatosis on new-onset diabetes mellitus after kidney transplantation. METHODS Consecutive patients who had renal transplant between 2006 and 2021 were reviewed, and 219 patients were finally included. Psoas muscle index was used to evaluate sarcopenia and average total psoas density (calculated by computed tomography before surgery) for myosteatosis. We used Cox proportional regression analyses in investigation of whether skeletal muscle depletion before surgery inclusive of sarcopenia and myosteatosis is a new additional predictor of new-onset diabetes mellitus. RESULTS Median recipient age and body mass index were 45 years and 21.1 kg/m2 , respectively, and 123 patients (56%) were male. Preoperative impaired glucose tolerance was present in 58 patients (27%) and new-onset diabetes mellitus in 30 patients (14%), with median psoas muscle index of 6 cm2 /m2 and average total psoas density of 41 Hounsfield Unit. In multivariate analysis, significant risk factors were body mass index ≥25 kg/m2 (p < 0.01), impaired glucose tolerance (p < 0.01), and average total psoas density < 41.9 Hounsfield Unit (p = 0.03). New-onset diabetes mellitus had incidence rates of 3.7% without risk factors, 10% with a single risk factor, 33% with two, and 60% with three. Patients with new-onset diabetes mellitus were effectively stratified by the number of risk factors (p < 0.01). CONCLUSIONS Myosteatosis could be a new risk factor used to predict new-onset diabetes mellitus.
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Affiliation(s)
- Takahito Wakamiya
- Department of Urology, Wakayama Medical University, Wakayama, Japan
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takuya Fujimoto
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takahito Endo
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Shun Nishioka
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Naoki Yokoyama
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | | | - Kazuro Kikkawa
- Department of Urology, Wakayama Medical University, Wakayama, Japan
| | - Yoji Hyodo
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takeshi Ishimura
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yasuo Kohjimoto
- Department of Urology, Wakayama Medical University, Wakayama, Japan
| | - Isao Hara
- Department of Urology, Wakayama Medical University, Wakayama, Japan
| | - Masato Fujisawa
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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Fujimoto T, Hyodo Y, Ishimura T, Tashiro Y, Endo T, Nisioka S, Yokoyama N, Yamamoto K, Yano I, Fujisawa M. Association of Alpha-Actinin-3 Polymorphism With Sarcopenia in Kidney Transplant Recipients. Transplant Proc 2023:S0041-1345(23)00150-1. [PMID: 37037724 DOI: 10.1016/j.transproceed.2023.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/13/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Sarcopenia is defined as the loss of skeletal muscle mass and function and is associated with increased mortality. Certain genetic polymorphisms represent risk factors used to assess the incidence of sarcopenia; however, few studies have evaluated the association between genetic polymorphisms and sarcopenia after kidney transplantation (KTx). We examined single-nucleotide polymorphisms (SNPs) in the genes involved in sarcopenia after KTx. METHODS Sixty-five patients who underwent KTx were enrolled in this study. We used the psoas mass index (PMI; the cross-sectional area of the bilateral psoas muscle/height) as a surrogate marker for assessing the extent of sarcopenia. We determined the PMI before KTx and 1 year after KTx, and we identified 5 SNPs in 5 genes associated with sarcopenia in the general population. Finally, the link between the changes in PMI 1 year after KTx and each SNP was examined. RESULTS The median PMI before KTx and 1 year after KTx was 7.4 (4.6-13.2) and 7.0 (3.6-13.6), respectively. The PMI decreased in 43 patients (66.2%). The alpha-actinin-3 rs1815739 genotype was associated with changes in PMI; the distribution of CT+TT genotypes in the PMI decrease group was significantly higher than that of the CC genotype (odds ratio, 4.23; 95% CI 0.05-0.97; P = 0.025). Moreover, the T allele frequency was significantly higher in the PMI decrease group than in the PMI increase group (odds ratio, 2.34; 95% CI 0.18-0.950; P = 0.025). CONCLUSION The alpha-actinin-3 rs1815739 genotype may represent a genetic risk factor for sarcopenia after KTx.
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Affiliation(s)
- Takuya Fujimoto
- Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoji Hyodo
- Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Takeshi Ishimura
- Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuki Tashiro
- Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahito Endo
- Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shun Nisioka
- Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naoki Yokoyama
- Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | | | - Ikuko Yano
- Department of Pharmacy, Kobe University Hospital, Kobe, Japan
| | - Masato Fujisawa
- Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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Endo T, Ishimura T, Nishioka S, Yokoyama N, Ogawa S, Fujisawa M. No Influence of Everolimus on Mycophenolic Acid Area Under the Concentration-Time Curve: Limited Sampling Strategy for Mycophenolic Acid in Japanese Kidney Transplant Recipients Treated With Tacrolimus, Mycophenolate Mofetil, Steroid, and Everolimus. Transplant Proc 2022; 54:286-292. [PMID: 35034789 DOI: 10.1016/j.transproceed.2021.08.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/26/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Despite a growing need for everolimus (EVR) to reduce calcineurin inhibitor toxicity in kidney transplantation (KTx), the influence of EVR on the pharmacokinetics of mycophenolic acid (MPA), a mycophenolate mofetil (MMF) active metabolite, is obscure, and no suitable limited sampling strategy (LSS) for MPA when EVR is concomitantly present exists. We aimed to investigate the influence of EVR on MPA pharmacokinetics in KTx. MATERIALS AND METHODS This study complied with all principles of the Declaration of Helsinki. Twenty patients were initially administered tacrolimus, MMF, and methylprednisolone and then received EVR 4 months after KTx. Approximately 4 weeks before and after EVR administration, the estimated value of the area under the concentration-time curve for MPA from 0 to 12 hours (MPA-AUC0-12) was calculated using MPA blood concentration just before and 1, 2, 4, and 6 hours after MMF administration. We compared several MPA pharmacokinetics parameters before and after EVR addition and determined the best estimation equation for LSS of MPA-AUC0-12. RESULTS Although MPA-C6 per dose (MPA-C6/D) significantly decreased after EVR addition (from 3.4 [±2.2] ng/mL/g to 2.5 [±0.9] ng/mL/g), MPA-C0/D, -C1/D, -C2/D, -C4/D, and MPA-AUC0-12/D showed no significant change. MPA-AUC0-12/D did not correlate with EVR-AUC0-12/D. The best estimation equation for LSS of MPA-AUC0-12 by 2 time points was [(2.94 × C2) + (5.09 × C4) + 5.32] (R2 = 0.73) and [(5.70 × C0) + (1.39 × C1) + 22.45] (R2 = 0.72) before and after EVR addition, respectively. CONCLUSIONS EVR can be safely combined with MMF after KTx once our results have been reevaluated.
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Affiliation(s)
- Takahito Endo
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeshi Ishimura
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Shun Nishioka
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naoki Yokoyama
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Satoshi Ogawa
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masato Fujisawa
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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Nishioka S, Ishimura T, Endo T, Yokoyama N, Ogawa S, Fujisawa M. Suppression of Allograft Fibrosis by Regulation of Mammalian Target of Rapamycin-Related Protein Expression in Kidney-Transplanted Recipients Treated with Everolimus and Reduced Tacrolimus. Ann Transplant 2021; 26:e926476. [PMID: 33431785 PMCID: PMC7812696 DOI: 10.12659/aot.926476] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Although renoprotective effects of everolimus (EVR) in kidney transplantation (KTx) have been widely reported, its pathophysiological mechanism remains unclear. Material/Methods We compared changes in eGFR (ΔGFR, ml/min/1.73 m2) and the ratio of the fibrotic area in biopsy specimens (ΔFI,%) from 3 months to 3 years after KTx between the EVR+ group (EVR addition and Tac reduction early after KTx, n=32), and the EVR− group (normal Tac without EVR, n=28). We also immunohistochemically evaluated mTOR-related protein expression. Results ΔGFR and ΔFI in the EVR+ vs. EVR− groups were −0.27±6.8 vs. −9.8±12.8 (p<0.001) and 2.4±4.9 vs. 9.5±10.5 (p<0.001), respectively. Phosphorylated mTOR and phosphorylated 4EBP1 expression at 3 years in the EVR+ group was significantly lower than that in the EVR− group. Moreover, in the subgroup analysis comparing ΔGFR and ΔFI among groups stratified by immunosuppressive regimen and mTOR signal enhancement, the ΔFI in patients with EVR+ with decreased mTOR signal enhancement was significantly milder than that in other patients. In addition, in the multivariate analysis, EVR addition was the only independent predictor for allograft fibrosis, whereas the Tac C0 concentration at neither 1 nor 3 years proved to be a risk factor. Conclusions These results suggested that EVR addition and Tac reduction may attenuate kidney allograft fibrosis, and that the suppression of mTOR signaling process may be involved in the anti-fibrotic effect of this immunosuppressive regimen. These results provide suggestions of how to utilize EVR for patients with KTx and improve graft function.
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Affiliation(s)
- Shun Nishioka
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takeshi Ishimura
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takahito Endo
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Naoki Yokoyama
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Satoshi Ogawa
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Masato Fujisawa
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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Endo T, Fujimoto T, Nishioka S, Yokoyama N, Ogawa S, Ishimura T, Fujisawa M. Influence of everolimus on mycophenolate mofetil pharmacokinetics in kidney transplant patients. Korean Journal of Transplantation 2020. [DOI: 10.4285/atw2020.po-1062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Takahito Endo
- Department of Urology, Kobe University Hospital, Kobe, Japan
| | - Takuya Fujimoto
- Department of Urology, Kobe University Hospital, Kobe, Japan
| | - Shun Nishioka
- Department of Urology, Kobe University Hospital, Kobe, Japan
| | - Naoki Yokoyama
- Department of Urology, Kobe University Hospital, Kobe, Japan
| | - Satoshi Ogawa
- Department of Urology, Kobe University Hospital, Kobe, Japan
| | | | - Masato Fujisawa
- Department of Urology, Kobe University Hospital, Kobe, Japan
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Hinata N, Bando Y, Chiba K, Furukawa J, Harada K, Ishimura T, Nakano Y, Fujisawa M. Application of hyaluronic acid/carboxymethyl cellulose membrane for early continence after nerve-sparing robot-assisted radical prostatectomy. BMC Urol 2019; 19:25. [PMID: 31014320 PMCID: PMC6480847 DOI: 10.1186/s12894-019-0458-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 04/10/2019] [Indexed: 12/28/2022] Open
Abstract
Background To assess whether application of a hyaluronic acid-carboxymethyl cellulose membrane (HA/CMC) to the prostate bed and neurovascular plate facilitated early return of continence after nerve-sparing robot-assisted radical prostatectomy (RARP). Methods The subjects were 183 consecutive patients with organ-confined prostate cancer who underwent unilateral or bilateral nerve-sparing RARP. After vesicourethral anastomosis, HA/CMC was placed to cover Denonvilliers’ fascia (behind the anastomotic suture) and the preserved neurovascular plate. The time until complete continence after RARP and perioperative complications were compared between patients with or without HA/CMC. Results HA/CMC was applied in 13/46 patients (28.3%) receiving bilateral nerve-sparing surgery and 40/137 patients (29.2%) receiving unilateral nerve-sparing surgery. After bilateral nerve-sparing RARP, the median time until continence was significantly shorter in patients with HA/CMC than in those without HA/CMC (3.2 vs. 9.3 months, respectively, p < 0.01). After unilateral nerve-sparing RARP, the median time until continence was also significantly shorter in patients with HA/CMC than in those without HA/CMC (3.2 vs. 12.0 months, respectively, p < 0.01). Multivariate Cox proportional hazards regression analysis showed that an age < 70 years (hazard ratio [HR]: 1.74, 95% confidence interval [CI]: 1.12–2.80), institutional caseload > 200, (HR: 1.64, 95%CI: 1.10–2.47), and use of HA/CMC (HR: 1.84, 95%CI: 1.22–2.76) were independent predictors of early postoperative continence. Complication rates, including urinary leakage, did not differ significantly between patients with or without HA/CMC. Conclusion Application of HA/CMC to the prostate bed and neurovascular plate resulted in significantly faster postoperative return of continence after both unilateral and bilateral nerve-sparing RARP.
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Affiliation(s)
- Nobuyuki Hinata
- Department of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho Chuo-ku, Kobe, 650-0017, Japan. .,Training Center for Advanced Surgery and Endoscopy, Kobe University School of Medicine, Kobe, Japan.
| | - Yukari Bando
- Department of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho Chuo-ku, Kobe, 650-0017, Japan
| | - Koji Chiba
- Department of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho Chuo-ku, Kobe, 650-0017, Japan
| | - Junya Furukawa
- Department of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho Chuo-ku, Kobe, 650-0017, Japan
| | - Kenichi Harada
- Department of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho Chuo-ku, Kobe, 650-0017, Japan
| | - Takeshi Ishimura
- Department of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho Chuo-ku, Kobe, 650-0017, Japan
| | - Yuzo Nakano
- Department of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho Chuo-ku, Kobe, 650-0017, Japan
| | - Masato Fujisawa
- Department of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho Chuo-ku, Kobe, 650-0017, Japan
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Fujii H, Watanabe S, Kono K, Watanabe K, Goto S, Ishimura T, Fujisawa M, Nishi S. One-Year Impact of Kidney Transplantation on Cardiac Abnormalities and Blood Pressure in Hemodialysis Patients. Ther Apher Dial 2019; 23:529-533. [PMID: 30941871 DOI: 10.1111/1744-9987.12808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/25/2019] [Accepted: 04/01/2019] [Indexed: 11/29/2022]
Abstract
Cardiac abnormalities, including left ventricular hypertrophy and systolic dysfunction, are frequently observed among patients with CKD, including kidney transplant recipients; they are closely linked to cardiovascular disease and mortality. Although several studies have been performed for elucidating changes and mechanisms of cardiac abnormalities after kidney transplantation, details remain unclear. This study included 43 consecutive patients who underwent HD and received kidney transplantation between 2008 and 2012 at our institution. All subjects underwent echocardiography before and 1 year after kidney transplantation. One year after kidney transplantation, left ventricular mass index, cardiac chamber sizes, BP, and the number of antihypertensive agents were reduced. Although the percentage of patients with concentric hypertrophy did not change, the percentage of those with eccentric hypertrophy significantly decreased after kidney transplantation. Volume reduction due to the recovery of kidney function may be primarily attributed to the improvement of cardiac abnormalities, including left ventricular hypertrophy.
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Affiliation(s)
- Hideki Fujii
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shuhei Watanabe
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Keiji Kono
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kentaro Watanabe
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shunsuke Goto
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeshi Ishimura
- Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masato Fujisawa
- Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinichi Nishi
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
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Ogawa* S, Ishimura T, Nakano Y, Fujisawa M. MP70-15 CHANGE IN GLOMERULAR VOLUME AND ITS CLINICAL SIGNIFICANCE IN PROTOCOL BIOPSIES AFTER KIDNEY TRANSPLANTATION. J Urol 2019. [DOI: 10.1097/01.ju.0000557107.16114.bd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Yokoyama N, Ishimura T, Oda T, Ogawa S, Yamamoto K, Fujisawa M. Association of the PCK2 Gene Polymorphism With New-onset Glucose Intolerance in Japanese Kidney Transplant Recipients. Transplant Proc 2018; 50:1045-1049. [PMID: 29731064 DOI: 10.1016/j.transproceed.2018.01.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 01/22/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND New-onset diabetes mellitus after transplantation (NODAT) is a risk factor for both cardiovascular disease and poor graft survival after kidney transplantation (KTx). In this study, we identified single-nucleotide polymorphisms (SNPs) in genes involved in glucose metabolism and examined the correlation between these SNPs and glucose intolerance after KTx. METHODS Thirty-eight patients with normal glucose tolerance before KTx were included in this study. Patients with plasma glucose levels of >140 mg/dL at 120 minutes on the 75-g oral glucose tolerance test at 1 year after KTx were classified as having new-onset impaired glucose tolerance (NIGT). We identified 8 SNPs in 7 genes that are involved in glucose metabolism among the patients included in this study, and compared the prevalence rate of NIGT among SNPs in each gene. RESULTS Of the 38 patients, 11 (28.9%) were diagnosed with NIGT. For rs4982856 in the PCK2 gene, the distribution of genotypes among the total patient population was as follows: T/T, 12 (31.6%); T/C, 22 (57.9%); and C/C, 4 (10.5%). Seven of 11 patients with NIGT had the T/T genotype of rs4982856, whereas only 5 of 27 patients with normal glucose tolerance had this genotype. The T allele frequency of the rs4982856 was significantly higher in the NIGT group than in the normal group (81.8 vs 52.8%, respectively; P = .015). CONCLUSION Our study indicates that the T allele of the rs4982856 SNP in the PCK2 gene may be a risk factor for glucose intolerance after KTx.
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Affiliation(s)
- N Yokoyama
- Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - T Ishimura
- Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - T Oda
- Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - S Ogawa
- Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - K Yamamoto
- Department of Pharmacy, Kobe University Hospital, Kobe, Japan
| | - M Fujisawa
- Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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Harada K, Shiraishi Y, Suzuki K, Okamura Y, Bando Y, Hara T, Terakawa T, Furukawa J, Ishimura T, Shigemura K, Hinata N, Nakano Y, Fujisawa M. [EFFICACY AND SAFETY OF PAZOPANIB FOR ADVANCED OR METASTATIC RENAL CELL CARCINOMA: A SINGLE-INSTITUTION STUDY]. Nihon Hinyokika Gakkai Zasshi 2018; 109:216-219. [PMID: 31631085 DOI: 10.5980/jpnjurol.109.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
To investigate the efficacy and safety of first-line Pazopanib advanced or metastatic renal cell carcinoma (RCC): a single-institution study. (Patients and methods) We gathered 23 RCC patients treated between April 2014 and February 2018 in our institution and examined the treatments outcome and adverse events (AEs). (Results) Their risk criteria were categorized as follows: Favorable (n=2), Intermediate (n=12) and Poor (n=9) by International mRCC Database Consortion (IMDC). Median progression free survival (PFS) was 8.6 months and median overall survival (OS) was unreached. Best response (BR) of Pazopanib was partial response (PR): n=10, 50.0%, stable disease (SD): n=8, 40.0% and progression disease (PD): n=2, 10.0% (Three patients had no evaluable data,). AEs of Grade3 had liver dysfunction (n=3), thrombocytopenia (n=2), hand-foot syndrome (n=1), vomiting (n=1) and bowel bleeding (n=1). (Conclusion) The fist-line pazopanib demonstrated good clinical benefit with well-tolerance.
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Affiliation(s)
- Kenichi Harada
- Department of Urology, Kobe Uuiversity Graduate School of Medicine
| | - Yusuke Shiraishi
- Department of Urology, Kobe Uuiversity Graduate School of Medicine
| | - Kohtaro Suzuki
- Department of Urology, Kobe Uuiversity Graduate School of Medicine
| | | | - Yukari Bando
- Department of Urology, Kobe Uuiversity Graduate School of Medicine
| | - Takuto Hara
- Department of Urology, Kobe Uuiversity Graduate School of Medicine
| | - Tomoaki Terakawa
- Department of Urology, Kobe Uuiversity Graduate School of Medicine
| | - Junya Furukawa
- Department of Urology, Kobe Uuiversity Graduate School of Medicine
| | - Takeshi Ishimura
- Department of Urology, Kobe Uuiversity Graduate School of Medicine
| | | | - Nobuyuki Hinata
- Department of Urology, Kobe Uuiversity Graduate School of Medicine
| | - Yuzo Nakano
- Department of Urology, Kobe Uuiversity Graduate School of Medicine
| | - Masato Fujisawa
- Department of Urology, Kobe Uuiversity Graduate School of Medicine
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Oda T, Ishimura T, Yokoyama N, Ogawa S, Miyake H, Fujisaw M. Hypoxia-Inducible Factor-1α Expression in Kidney Transplant Biopsy Specimens After Reperfusion Is Associated With Early Recovery of Graft Function After Cadaveric Kidney Transplantation. Transplant Proc 2017; 49:68-72. [PMID: 28104162 DOI: 10.1016/j.transproceed.2016.10.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Ischemia/reperfusion injury during kidney transplantation (KTx) delays allograft recovery. Hypoxia-inducible factor-1α (HIF-1α) is the key regulator of the protective response to ischemia/reperfusion injury. We evaluated the impact of the HIF-1α signaling pathway on allograft recovery during cadaveric KTx. METHODS Between 1996 and 2015, 46 patients underwent cadaveric KTx. The expression levels of HIF-1α-related proteins, including phosphoinositide 3-kinase, phosphorylated (p)-Akt, p-mammalian target of rapamycin, p-Eukaryotic translation initiation factor 4E, p-S6 ribosomal protein, and HIF-1α, were immunohistochemically evaluated and semi-quantitatively scored in graft biopsy specimens after 1 hour of revascularization. Ten kidney biopsy specimens collected during donor nephrectomy for living KTx were used as controls. Delayed graft function (DGF) was defined as the need for dialysis within 1 week of KTx. We compared the staining scores of each protein and several clinical parameters between patients with and those without DGF. RESULTS Expression levels of all six proteins in specimens after revasculization were elevated compared with those in controls. Thirty-five patients had DGF. Expression levels of PI3K, p-AKT, p-mTOR, p-eIF4E, and HIF-1α were significantly higher in patients without DGF than in those with DGF. Univariate analysis identified expression levels of p-Akt, p-S6, and HIF-1α, in addition to donor type (heart beating/non-heart beating), cold ischemic time, and donor age as significant predictors of DGF. Of these, only expression levels of HIF-1α and donor type were independently associated with DGF in multivariate analysis. CONCLUSIONS Up-regulation of HIF-1α in allografts after reperfusion may be a predictor of early recovery after cadaveric KTx.
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Affiliation(s)
- T Oda
- Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - T Ishimura
- Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - N Yokoyama
- Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - S Ogawa
- Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - H Miyake
- Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - M Fujisaw
- Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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Yokoyama N, Oda T, Ogawa S, Ishimura T, Fujisawa M. MP74-13 ASSOCIATON OF PCK2 GENE POLYMORPHISM WITH IMPAIRED GLUCOSE TOLERANCE AFTER KIDNEY TRANSPLANTATION. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.2181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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13
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Nomura T, Sakakibara S, Moriwaki A, Kawamoto T, Suzuki S, Ishimura T, Hashikawa K, Terashi H. Low-Grade Myxofibrosarcoma of the Rectus Abdominus Muscle Infiltrating into Abdominal Cavity: A Case Report. Eplasty 2017; 17:e6. [PMID: 28293331 PMCID: PMC5329937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Objective: Myxofibrosarcoma (MFS) is a relatively rare tumor that is histologically characterized by myxoid stroma and spindle cell proliferation. This tumor most commonly arises as a slow growing, enlarging painless mass in the extremities of elderly patients. Methods: We report a case of a primary, low-grade MFS in the rectus abdominis muscle infiltrating the abdominal cavity of a 75-year-old man. Results: The patient underwent a wide excision of the right abdominal wall mass with a 3-cm surgical margin from the scar due to a biopsy. The tumor infiltrated the urinary bladder, peritoneum, and external iliac vessels. Twenty-six months after the initial operation, he had recurrences in his abdominal wall, urinary bladder, and right iliac vessels. Conclusions: To our knowledge, primary MFS of the muscle in the abdomen has not been documented previously. Although this case was histopathologically classified as a low-grade tumor, it infiltrated the abdominal cavity. The tumor is suspected to have penetrated the abdominal cavity below the linea arcuata, which lacks the posterior sheath of the rectus abdominis muscle; from there, it could easily spread without being blocked by any biological barriers.
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Affiliation(s)
- Tadashi Nomura
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Shunsuke Sakakibara
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Aya Moriwaki
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Teruya Kawamoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Satoshi Suzuki
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takeshi Ishimura
- Division of Urology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kazunobu Hashikawa
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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Ogawa S, Ishimura T, Miyake H, Fujisawa M. Expression profile of mammalian target of rapamycin-related proteins in graft biopsy specimens: Significance for predicting interstitial fibrosis after kidney transplantation. Int J Urol 2017; 24:223-229. [PMID: 28173612 DOI: 10.1111/iju.13287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 11/15/2016] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To investigate the influence of the expression profile of mammalian target of rapamycin-related proteins on the development of interstitial fibrosis after kidney transplantation. METHODS Immunohistochemical staining was carried out to evaluate the expression of five mammalian target of rapamycin-related proteins (phosphorylated-Akt, Ras homolog enriched in brain, phosphorylated-mammalian target of rapamycin, phosphorylated-p70 ribosomal S6 kinase and phosphorylated-4E binding protein 1) in graft biopsy specimens obtained from 77 patients at 3 months after kidney transplantation. The change of the estimated glomerular filtration rate and the change of the fibrosis index (defined as the change in the percent area of fibrosis on Masson's trichrome-stained sections of biopsy specimens) from 3 months to 3 years after kidney transplantation were determined. RESULTS There was a significant correlation between change of the estimated glomerular filtration and change of the fibrosis index in the 77 patients. Univariate analysis identified expression of phosphorylated-Akt, phosphorylated-mammalian target of rapamycin and phosphorylated-p70 ribosomal S6 kinase, as well as donor type and pre-transplant dialysis duration, as significant predictors of a change of the fibrosis index >10%. However, only phosphorylated-mammalian target of rapamycin expression, phosphorylated-p70 ribosomal S6 kinase expression and donor type were independently associated with a change of the fibrosis index >10% according to multivariate analysis. CONCLUSIONS These findings suggest that mammalian target of rapamycin-related proteins are involved in the development of interstitial fibrosis after kidney transplantation.
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Affiliation(s)
- Satoshi Ogawa
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeshi Ishimura
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hideaki Miyake
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masato Fujisawa
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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15
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Nakai K, Fujii H, Ishimura T, Fujisawa M, Nishi S. Incidence and Risk Factors of Persistent Hyperparathyroidism After Kidney Transplantation. Transplant Proc 2017; 49:53-56. [DOI: 10.1016/j.transproceed.2016.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Furukawa J, Nishikawa M, Terakawa T, Chiba K, Shigemura K, Harada KI, Hinata N, Ishimura T, Matsushita K, Nakano Y, Miyake H, Tanaka K, Fujisawa M. MP41-15 RENAL FUNCTION AND PERIOPERATIVE OUTCOMES OF SELECTIVE VERSUS COMPLETE RENAL ARTERIAL CLAMPING DURING ROBOT-ASSISTED PARTIAL NEPHRECTOMY USING CONSOLE-INTEGRATED REAL-TIME THREE-DIMENSIONAL IMAGE OVERLAY NAVIGATION. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Hara S, Ishimura T, Fujisawa M, Nishi S, Itoh T. Granular swollen epithelial cells in the kidney allograft: A clinicopathological study with special emphasis on possible marker for kidney allograft aging. Nephrology (Carlton) 2016; 21 Suppl 1:14-9. [PMID: 26969019 DOI: 10.1111/nep.12764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2016] [Indexed: 11/29/2022]
Abstract
AIM To elucidate the clinicopathological significance of granular swollen epithelial cells (GSECs), which provides histological evidence in the diagnosis of mitochondrial nephropathy, but incidentally observed in renal allografts, we evaluated GSECs as a surrogate histological marker for kidney allograft aging, as previously reported for p16, p21, and β-galactosidase. METHODS We retrospectively reviewed 426 kidney allograft biopsy specimens diagnosed at our university from January 2009 to April 2015. The prevalence and density of GSECs were compared with an age-matched control group of 508 native kidney biopsies. GSECs were defined as swollen (>2 times larger than normal renal tubular cells) epithelial cells best observed using Masson trichrome staining. Morphometric analyses were performed using digital microscopy software. RESULTS The prevalence of GSECs was 7.7% in allograft kidneys and 8.1% in native kidneys. GSECs in kidney allografts were predominantly detected in medullary renal tubules, but not in the Bowman's capsular epithelium or podocytes. GSECs were observed in the following cases; no remarkable changes, n = 11; interstitial fibrosis and tubular atrophy, n = 7; chronic calcineurin inhibitor toxicity, n = 5; antibody-mediated rejection, n = 3; T cell-mediated rejection grade IA, n = 1; and others, n = 6. Compared with control specimens, medullary density of GSECs in kidney allografts was significantly increased. The prevalence of GSECs slightly increased with post-transplant duration; however, this trend was not statistically significant. CONCLUSIONS The present study does not provide pathological significance of GSEC in kidney allografts in terms of allograft aging, and warrant the further research with molecular approach.
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Affiliation(s)
- Shigeo Hara
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeshi Ishimura
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masato Fujisawa
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinichi Nishi
- Department of Nephrology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoo Itoh
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
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18
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Kitamura K, Nakai K, Fujii H, Ishimura T, Fujisawa M, Nishi S. Pre-Transplant Erythropoiesis-Stimulating Agent Hypo-Responsiveness and Post-Transplant Anemia. Transplant Proc 2015; 47:1820-4. [PMID: 26293057 DOI: 10.1016/j.transproceed.2015.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 06/02/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND At the time of kidney transplantation (KT), almost all patients have anemia caused by low levels of endogenous erythropoietin (EPO), along with several other factors. After KT, anemia improves because of secretion of EPO from the allograft. But some recipients have persistent anemia. Whether or not erythropoiesis-stimulating agent (ESA) hypo-responsiveness before KT affects post-transplant anemia (PTA) remains unknown. METHODS Sixty-eight patients received KT between January 2007 and July 2012 through the Department of Urology at Kobe University Hospital, and 35 of these patients were enrolled. Exclusion criteria included age <18 years, unknown ESA dosage at transplantation, ESA start within 1 year after transplantation, and other criteria. We evaluated post-transplant hemoglobin (Hb) levels from the pre-transplant ESA responsive index (ERI): pre-transplant ESA dosage/Hb × body weight at 1 year after transplantation. RESULTS The mean (± SD) Hb of all patients rose from 11.3 ± 1.0 mg/dL to 12.7 ± 1.4 mg/dL at 1 year after transplantation (P < .01). The pre-transplant low ERI group (<10) showed significantly higher hemoglobin levels compared with the pre-transplant high ERI group (≥ 10; 12.9 ± 1.14 mg/dL versus 11.8 ± 1.76 mg/dL, respectively; P = .03). CONCLUSIONS ESA hypo-responsiveness before KT carried over after KT. Low pre-transplant ERI might be a sentinel marker for PTA.
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Affiliation(s)
- K Kitamura
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
| | - K Nakai
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
| | - H Fujii
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
| | - T Ishimura
- Division of Urology, Department of Surgery Related, Kobe University of Medicine, Kobe, Japan
| | - M Fujisawa
- Division of Urology, Department of Surgery Related, Kobe University of Medicine, Kobe, Japan
| | - S Nishi
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan.
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Miyake H, Ishimura T, Sakai I, Hara I, Eto H. Clinicopathological Features of Incidentally Detected Renal Cell Carcinoma in Japan. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/15610950310001630342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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20
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Yoshikawa M, Kitamura K, Ishimura T, Hara S, Fujisawa M, Nishi S. A suspected case of plasma cell-rich acute renal transplant rejection associated with de novo donor-specific antibody. Nephrology (Carlton) 2015; 20 Suppl 2:66-9. [PMID: 26031590 DOI: 10.1111/nep.12471] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2015] [Indexed: 11/28/2022]
Abstract
A kidney transplant case with de novo donor-specific antibody showed monoclonal plasma cell infiltration into the graft with ABO incompatibility. Three years after transplantation, the patient's graft function suddenly deteriorated. Interstitial edema and the predominant infiltration of inflammatory plasma cells with kappa chain monoclonality were observed in biopsy specimens. The in situ hybridization of Epstein-Barr virus was negative and post-transplant lymphoproliferative disorder was not evident from radiological examinations. On laboratory examination, the patient had de novo donor-specific antibody for HLA-DQ. We suspected plasma cell-rich acute rejection for which methylprednisolone pulse therapy, plasma exchange, rituximab, and 15-deoxyspergualin were given. In the ensuing biopsy, the degree of plasma cell infiltration was similar to the first biopsy; however, kappa chain monoclonality relatively weakened. Owing to resistance to these treatments, intravenous immunoglobulin (IVIG) (0.5 g/kg/day) was added. The serum creatinine level gradually declined to 3.1 mg/dL; however, it increased up to 3.6 mg/dL again. In the final biopsy, the infiltrated plasma cells disappeared but severe interstitial fibrosis developed. This case showed difficulty in the diagnosis and treatment of plasma cell-rich acute rejection. A detailed consideration of this case may be helpful in understanding the clinical features and pathogenesis of this condition.
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Affiliation(s)
- Mikiko Yoshikawa
- Division of Nephrology, Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken Kitamura
- Division of Nephrology, Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeshi Ishimura
- Division of Urology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shigeo Hara
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masato Fujisawa
- Division of Urology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinichi Nishi
- Division of Nephrology, Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
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Yokoyama N, Ishimura T. Usefulness of Three-Dimensional Computerized Tomographic Volumetry for Determining Split Renal Function in Donors for Living-Related Kidney Transplantation. Transplant Proc 2015; 47:588-90. [DOI: 10.1016/j.transproceed.2014.11.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 11/19/2014] [Indexed: 10/23/2022]
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22
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Nakai K, Fujii H, Yoshikawa M, Kono K, Yonekura Y, Goto S, Ishimura T, Takeda M, Fujisawa M, Nishi S. Effect of cinacalcet cessation on hyperparathyroidism in kidney transcaplant patients after long-term dialysis therapy. Clin Exp Nephrol 2015; 19:1184-8. [PMID: 25782729 DOI: 10.1007/s10157-015-1107-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cinacalcet is a promising therapy widely used in dialysis patients with hyperparathyroidism resistant to conventional therapy. However, reports regarding the influence of cinacalcet cessation after long-term use on kidney transplantation patients are few. METHODS This retrospective observational study included 40 dialysis patients who underwent kidney transplantation. Creatinine, corrected calcium, phosphorus, alkaline phosphatase, and intact parathyroid hormone levels were assessed before and after kidney transplantation according to pretransplant treatment of chronic kidney disease-mineral and bone disorder. RESULTS Ultrasonography revealed enlargement of the parathyroid in all patients treated with cinacalcet. Although the data at the time of kidney transplantation were comparable, the serum levels of calcium, alkaline phosphatase, and intact parathyroid hormone after kidney transplantation were higher in patients treated with cinacalcet than in those treated without. However, serum phosphate levels in the cinacalcet group were slightly higher at the time of kidney transplantation and significantly lower 3 months later. CONCLUSIONS Mineral abnormalities persisted in kidney transplant patients with enlarged parathyroid glands after discontinuation of cinacalcet treatment. Parathyroidectomy should be considered in kidney transplant candidates with the risk of developing refractory hyperparathyroidism after transplantation.
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Affiliation(s)
- Kentaro Nakai
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Hideki Fujii
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
| | - Mikiko Yoshikawa
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Keiji Kono
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Yuriko Yonekura
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Shunsuke Goto
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Takeshi Ishimura
- Division of Urology, Department of Organs Therapeutics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masashi Takeda
- Division of Urology, Department of Organs Therapeutics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masato Fujisawa
- Division of Urology, Department of Organs Therapeutics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinichi Nishi
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
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Tanaka K, Furukawa J, Shigemura K, Hinata N, Ishimura T, Muramaki M, Miyake H, Fujisawa M. Surgery-Related Outcomes and Postoperative Split Renal Function by Scintigraphy Evaluation in Robot-Assisted Partial Nephrectomy in Complex Renal Tumors: An Initial Case Series. J Endourol 2015; 29:29-34. [DOI: 10.1089/end.2014.0042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Kazushi Tanaka
- Division of Urology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Junya Furukawa
- Division of Urology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Katsumi Shigemura
- Division of Urology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nobuyuki Hinata
- Division of Urology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeshi Ishimura
- Division of Urology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mototsugu Muramaki
- Division of Urology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hideaki Miyake
- Division of Urology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masato Fujisawa
- Division of Urology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan
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Ishimura T, Muramaki M, Kishikawa H, Miyake H, Tanaka K, Nishimura K, Nojima M, Yamamoto S, Ichikawa Y, Fujisawa M. The Impact of Donor Factors on Early Graft Function in Kidney Transplantation From Donation After Cardiac Death. Transplant Proc 2014; 46:1064-6. [DOI: 10.1016/j.transproceed.2013.11.070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 11/22/2013] [Indexed: 10/25/2022]
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Hinata N, Miyake H, Kurahashi T, Ando M, Furukawa J, Ishimura T, Tanaka K, Fujisawa M. Novel telementoring system for robot-assisted radical prostatectomy: impact on the learning curve. Urology 2014; 83:1088-92. [PMID: 24642077 DOI: 10.1016/j.urology.2014.01.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 12/26/2013] [Accepted: 01/02/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To develop a Web-based audiovisual telementoring system for robot-assisted radical prostatectomy (RARP) and to assess the utility of this system. METHODS A telementoring system for RARP, consisting of a 3-dimensional high-definition view of the operating field, overview of the operating room, annotation function, and 2-channel audio feed with bidirectional connectivity between 2 institutions, was developed. The outcome of RARP performed for the initial 30 patients by 2 surgeons with telementoring was compared with that for 2 surgeons who received direct mentoring. RESULTS This system was shown to function properly with an acceptable latency. There were no significant differences in several parameters reflecting surgical outcomes, including the operating time, complication rate, early continence status, and positive margin rate between the telementoring and direct mentoring groups. CONCLUSION These findings suggest the usefulness of the telementoring system for promoting the spread of precise surgical techniques associated with RARP. To our knowledge, this is the first report concerning telementoring for robot-assisted surgery.
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Affiliation(s)
- Nobuyuki Hinata
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Hideaki Miyake
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | | | - Makoto Ando
- Division of Urology, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Junya Furukawa
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeshi Ishimura
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazushi Tanaka
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masato Fujisawa
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
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Tanaka K, Shigemura K, Ishimura T, Muramaki M, Miyake H, Fujisawa M. Evaluation of a 3D system based on a high-quality flat screen and polarized glasses for use by surgical assistants during robotic surgery. Indian J Urol 2014; 30:13-6. [PMID: 24497675 PMCID: PMC3897045 DOI: 10.4103/0970-1591.124199] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction: One of the main benefits of robotic surgery is the surgeon's three-dimensional (3D) vision system. The purpose of this study is to evaluate the efficacy of 3D vision using a flat screen and polarized glasses for surgical skills during robotic surgeries. Materials and Methods: In an experimental model, six surgeons performed three surgical tasks with laparoscopic devices using a standard 2D and a flat-screen 3D model with polarized glasses. Performance times were compared between two-dimensional (2D) and 3D vision for each task. The surgeons also graded the efficiency of the 3D system, on a subjective scale of 0-100. Results: Performance times for task 1 (seven holes) and 2 (elastic bands) were significantly reduced by 84% and 56% using 3D compared with a 2D system and experienced surgeons performed all three tasks faster in 3D than 2D. The surgeons reported the polarized glasses were comfortable to wear and direct vision was seldom affected. Conclusions: The use of 3D visualization seems to improve the efficiency of surgical skills during robotic surgery and reduce performance time for characteristic surgical procedure tasks.
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Affiliation(s)
- Kazushi Tanaka
- Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Katsumi Shigemura
- Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeshi Ishimura
- Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mototsugu Muramaki
- Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hideaki Miyake
- Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masato Fujisawa
- Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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Tanaka K, Shigemura K, Furukawa J, Ishimura T, Muramaki M, Miyake H, Fujisawa M. Comparison of the Transperitoneal and Retroperitoneal Approach in Robot-Assisted Partial Nephrectomy in an Initial Case Series in Japan. J Endourol 2013; 27:1384-8. [PMID: 24044768 DOI: 10.1089/end.2012.0641] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Kazushi Tanaka
- Division of Urology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Katsumi Shigemura
- Division of Urology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Junya Furukawa
- Division of Urology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeshi Ishimura
- Division of Urology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mototsugu Muramaki
- Division of Urology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hideaki Miyake
- Division of Urology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masato Fujisawa
- Division of Urology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan
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Yildirim T, Yilmaz R, Altindal M, Turkmen E, Arici M, Altun B, Erdem Y, Guliyev O, Erkmen Uyar M, Tutal E, Bal Z, Sezer S, Erkmen Uyar M, Bal U, Bal Z, Tutal E, Say n B, Guliyev O, Erdemir B, Sezer S, O'Rourke-Potowki A, Gauge N, Penny H, Cronin A, Frame S, Goldsmith DJ, Yagan JA, Chandraker A, Velickovic Radovanovic RM, Catic Djordjevic A, Mitic B, Stefanovic N, Cvetkovic T, Serpieri N, Grosjean F, Sileno G, Torreggiani M, Esposito V, Mangione F, Abelli M, Castoldi F, Catucci D, Esposito C, Dal Canton A, Vatazin AV, Zulkarnaev AB, Borst C, Liu Y, Thoning J, Tepel M, Libetta C, Margiotta E, Borettaz I, Canevari M, Martinelli C, Lainu E, Abelli M, Meloni F, Sepe V, Dal Canton A, Miguel Costa R, Vasquez Martul E, Reboredo J, Rivera C, Simonato F, Tognarelli G, Daidola G, Gallo E, Burdese M, Cantaluppi V, Biancone L, Segoloni GP, Burdese M, Priora M, Messina M, Tamagnone M, Daidola G, Linsalata A, Lavacca A, Biancone L, Segoloni G, Zuidema W, Erdman R, van de Wetering J, Dor F, Roodnat J, Massey E, Timmerman L, IJzermans J, Weimar W, Goldsmith DJ, Sibley-Allen C, Hilton R, Moghul M, Burnapp L, Blake G, Koo TY, Park JS, Park HC, Kim GH, Lee CH, Oh IH, Kang CM, Hwang JK, Park SC, Choi BS, Chun HJ, Kim JI, Yang CW, Moon IS, Van Laecke S, Van Biesen W, Nagler EV, Taes Y, Peeters P, Vanholder R, Pruthi R, Ravanan R, Casula A, Harber M, Roderick P, Fogarty D, Cho A, Shin JH, Jang HR, Lee JE, Huh W, Kim DJK, Oh HY, Kim YG, Sancho Calabuig A, Gavela Martinez E, Kanter Berga J, Beltran Catalan S, Avila Bernabeu AI, Pallardo Mateu LM, Gonzalez E, Polanco N, Molina M, Gutierrez E, Garcia Puente L, Sevillano A, Morales E, Praga M, Andres A, Banasik M, Boratynska M, Koscielska-Kasprzak K, Bartoszek D, Myszka M, Zmonarski S, Nowakowska B, Wawrzyniak E, Halon A, Chudoba P, Klinger M, Rojas-Rivera J, Gonzalez E, Polanco N, Morales E, Andres A, Morales JM, Egido J, Praga M, Kopecky CM, Haidinger M, Kaltenecker C, Antlanger M, Marsche G, Holzer M, Kovarik J, Werzowa J, Hecking M, Saemann MD, Hwang JK, Kim JM, Koh ES, Chung BH, Park SC, Choi BS, Kim JI, Yang CW, Kim YS, Moon IS, Banasik M, Boratynska M, Koscielska-Kasprzak K, Krajewska M, Mazanowska O, Kaminska D, Bartoszek D, Zabinska M, Halon A, Malkiewicz B, Patrzalek D, Klinger M, Sulowicz J, Szostek S, Wojas-Pelc A, Ignacak E, Sulowicz W, Bellizzi V, Calella P, Cupisti A, Capitanini A, D'Alessandro C, Giannese D, Camocardi A, Conte G, Barsotti M, Bilancio G, Luciani R, Locsey L, Seres I, Kovacs D, Asztalos L, Paragh G, Wohlfahrtova M, Balaz P, Rokosny S, Wohlfahrt P, Bartonova A, Viklicky O, Kers J, Geskus RB, Meijer LJ, Bemelman F, ten Berge IJM, Florquin S, Hwang JC, Jiang MY, Lu YH, Weng SF, Testa A, Porto G, Sanguedolce M, Spoto B, Parlongo R, Pisano A, Enia G, Tripepi G, Zoccali C, Zuidema W, Mamode N, Lennerling A, Citterio F, Massey E, Van Assche K, Sterckx S, Frunza M, Jung H, Pascalev A, Johnson R, Loven C, Weimar W, Dor F, Soleymanian T, Keyvani H, Jazayeri SM, Fazeli Z, Ghamari S, Mahabadi M, Chegeni V, Najafi I, Ganji MR, Meys KME, Groothoff JW, Jager K, Schaefer F, Tonshoff B, Mota C, Cransberg K, van Stralen K, Gurluler E, Gures N, Alim A, Gurkan A, Cakir U, Berber I, Van Laecke S, Caluwe R, Nagler E, Van Biesen W, Peeters P, Van Vlem B, Vanholder R, Sulowicz J, Wojas-Pelc A, Ignacak E, Betkowska-Prokop A, Kuzniewski M, Krzanowski M, Sulowicz W, Masson I, Flamant M, Maillard N, Cavalier E, Moranne O, Alamartine E, Mariat C, Delanaye P, Canas Sole LL, Iglesias Alvarez E, Pastor MCMC, Moreno Flores FF, Abujder VV, Graterol FF, Bonet Sol JJ, Lauzurica Valdemoros RR, Yoshikawa M, Kitamura K, Nakai K, Goto S, Fujii H, Ishimura T, Takeda M, Fujisawa M, Nishi S, Prasad N, Gurjer D, Bhadauria D, Gupta A, Sharma R, Kaul A, Cybulla M, West M, Nicholls K, Torras J, Sunder-Plassmann G, Feriozzi S, Lo S, Wong PYH, Ip D, Wong CK, Chow VCC, Mo SKL, Molnar M, Ujszaszi A, Czira ME, Novak M, Mucsi I, Cruzado JM, Coelho S, Porta N, Bestard O, Melilli E, Taco O, Rivas I, Grinyo J, Pouteau LM, N'Guyen JM, Hami A, Hourmant M, Ghahramani N, Karparvar Z, Shadrou S, Ghahramani M, Fauvel JP, Hadj-Aissa A, Buron F, Morelon E, Ducher M, Heine C, Glander P, Neumayer HH, Budde K, Liefeldt L, Montero N, Webster AC, Royuela A, Zamora J, Crespo M, Pascual J, Adema AY, van Dorp WTH, Mallat MJK, de Fijter HW, Kim YS, Hong YA, Chung BH, Park CW, Yang CW, Kim YS, Choi BS, Suleymanlar G, Uzundurukan Z, Kapuagas A, Sencan I, Akdag R, Pascual J, Torio A, Mas V, Perez-Saez MJ, Mir M, Faura A, Montes-Ares O, Checa MD, Crespo M, Sawinski D, Trofe-Clark J, Sparkes T, Patel P, Goral S, Bloom R, Kim HJ, Park SJ, Kim TH, Kim YW, Kim YH, Kang SW, Abdel Halim M, Gheith O, Al-Otaibi T, Mosaad A, Awadeen W, Said T, Nair P, Nampoory MRN. Transplantation: clinical studies - A. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Riegersperger M, Plischke M, Steiner-Boker S, Seidinger D, Winkelmayer W, Sunder-Plassmann G, Vlahovic P, Vlahovic P, Cvetkovic T, Djordjevic V, Velickovic-Radovanovic R, Stefanovic N, Ignjatovic A, Sladojevic N, Cademartori V, Massarino F, Parodi EL, Russo R, Sofia A, Fontana I, Viviani GL, Garibotto G, Mai M, Mai W, Taner B, Wadei H, Prendergast M, Gonwa T, Martin J, Martin J, Aurore S, Aline CS, Nicolas M, Manolie M, Catherine S, Eric A, Christophe M, Brakemeier S, Liefeldt L, Glander P, Waiser J, Lachmann N, Schonemann C, Zukunft B, Illigens P, Schmidt D, Wu K, Rudolph B, Neumayer HH, Budde K, Pallardo Mateu L, Gavela Martinez E, Sancho Calabuig A, Crespo Albiach J, Beltran Catalan S, Gavela Martinez E, Kanter Berga J, Kimura T, Yagisawa T, Ishikawa N, Sakuma Y, Hujiwara T, Nukui A, Yashi M, Duraes J, Malheiro J, Fonseca I, Rocha A, Martins LS, Almeida M, Dias L, Castro-Henriques A, Cabrita A, Mai M, Mai W, Wadei H, Prendergast M, Gonwa T, Volpe A, Quaglia M, Menegotto A, Fenoglio R, Izzo C, Airoldi A, Terrone C, Stratta P, Ahmed B, Mireille K, Nilufer B, Annick M, Karl Martin W, Anh-Dung H, Dimitri M, Philippe M, Judith R, Daniel A, Liefeldt L, Glander P, Glander P, Lan Y, Schmidt D, Heine C, Budde K, Neumayer HH, Schmidt D, Glander P, Glander P, Budde K, Neumayer HH, Liefeldt L, Quaglia M, Quaglia M, Capone V, Izzo C, Menegotto A, Fenoglio R, Airoldi A, Stratta P, Grace B, Clayton P, Cass A, Mcdonald S, Yagisawa T, Yagisawa T, Yashi M, Kimura T, Nukui A, Fujiwara T, Sakuma Y, Ishikawa N, Iwabuchi T, Muraishi O, Torregrosa V, Barros X, Martinez de Osaba MJ, Paschoalin R, Campistol JM, Hassan R, El-Hefnawy A, Soliman S, Shokeir A, Cobanoglu Kudu A, Gungor O, Kircelli F, Altinel E, Asci G, Ozbek SS, Toz H, Ok E, Sandrini S, Setti G, Valerio F, Possenti S, Torrisi I, Polanco N, Garcia-Puente L, Gonzalez Monte E, Morales E, Gutierrez E, Bengoa I, Hernandez A, Caballero J, Morales JM, Andres A, Sgarlato V, Sgarlato V, Comai G, La Manna G, Moretti I, Grandinetti V, Martelli D, Scolari MP, Stefoni S, Valentini C, Valentini C, Persici E, La Manna G, Cappuccilli ML, Sgarlato V, Liviano D'arcangelo G, Fabbrizio B, Carretta E, Mosconi G, Scolari MP, Feliciangeli G, Grigioni FW, Stefoni S, Apicella L, Guida B, Vitale S, Garofalo G, Russo L, Maresca I, Rossano R, Memoli B, Carrano R, Federico S, Sabbatini M, Carta P, Zanazzi M, DI Maria L, Caroti L, Miejshtri A, Tsalouchos A, Bertoni E, Sezer S, Erkmen Uyar M, Colak T, Bal Z, Tutal E, Kalaci G, Ozdemir Acar FN, Jacquelinet C, Bayat S, Pernin V, Portales P, Szwarc I, Garrigue V, Vetromile F, Delmas S, Eliaou JF, Mourad G, Huber L, Huber L, Slowinski T, Naik M, Glander P, Liefeldt L, Schmidt D, Neumayer HH, Budde K, Nakai K, Fujii H, Kono K, Goto S, Ishimura T, Takeda M, Fujisawa M, Nishi S, Pereira Paschoalin R, Paschoalin R, Torregrosa JV, Barros Freiria X, Duran Rebolledo CE, Sanchez Escuredo A, Sole M, Campistol JM, Youssouf S, Tabbasm F, Bell R, Al-Jayyousi R, Warwick G, Grall A, Treguer L, Essig M, Lecaque C, Noel N, Buchler M, Bertrand D, Rivalan J, Braun L, Villemain F, Hurault de Ligny B, Totet A, Pestourie N, Toubas D, Nevez G, Le Meur Y, Nour el Houda B, Mustapha H, Wafaa F, Inass L, Rambabova Bushljetikj I, Rambabova Bushljetikj I, Masin-Spasovska J, Spasovski G, Popov Z, Sikole A, Ivanovski N, Raimundo M, Guerra J, Teixeira C, Santana A, Silva S, Mil Homens C, Gomes Da Costa A, Loredo D, Cleres M, Gondolesi G, Gutierrez LM, Fortunato RM, Descalzi V, Raffaele P. Transplantation - clinical II. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ishimura T, Takeda M, Nakano Y, Miyake H, Tanaka K, Fujisawa M. MP-06.09 The Impact of Donor Factor on Graft Function in Kidney Transplantation from Diseased Donor After Cardiac Death. Urology 2011. [DOI: 10.1016/j.urology.2011.07.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Platou ES, Knutsen TM, Steen T, Kirkfeldt R, Johansen J, Nohr E, Moller M, Arnsbo P, Nielsen J, Pruiti GP, Conti S, Puzzangara E, Di Grazia A, Ussia GP, Tamburino C, Calvi V, Nielsen JC, Bloch Thomsen PE, Hojberg S, Moller M, Riahi S, Dalsgaard D, Mortensen LS, Andersen HR, Kolodzinska A, Kutarski A, Grabowski M, Malecka B, Jarzyna I, Opolski G, Mabo P, Solnon A, Tassin A, Martins R, Graindorge L, Cebron JP, Rodriguez-Diez G, Moreno I, Bello E, Olmedo F, Vargas E, Leal R, Ortiz M, Robledo-Nolasco R, Schau T, Seifert M, Meyhoefer J, Neuss M, Butter C, Miyamoto S, Ishimura T, Inoko M, Haruna T, Izumi T, Ueyama K, Fujita M, Nohara R. Hot topics in pacing therapy. Europace 2011. [DOI: 10.1093/europace/eur228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tanaka K, Matsumoto M, Yasufuku T, Shigemura K, Yamaguchi K, Terakawa T, Ishimura T, Muramaki M, Haraguchi T, Furukawa J, Nakano Y, Miyake H, Fujisawa M. 1497 THREE-DIMENSIONAL (3D) VISION: DOES IT IMPROVE ASSISTANT SKILLS DURING ROBOTIC SURGERY? AN ASSESSMENT OF A 3D SYSTEM USING A FLAT HIGH-QUALITY 3D SCREEN AND POLARIZED GLASSES. J Urol 2011. [DOI: 10.1016/j.juro.2011.02.1455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nakabeppu F, Ishimura T, Kumagai K, Fukui K. Development of the Very thin Microcrystalline N-Layer and its Application to the Stacked Solar Cell. ACTA ACUST UNITED AC 2011. [DOI: 10.1557/proc-164-389] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AbstractIn order to improve the efficiency of the amorphous silicon stacked solar cells, we have developed the preparation method of highly conductive very thin microcrystalline silicon n-layers. We have found that the addition of a small amount of Ar gas to deposition gases is effective to make microcrystallite size small. The obtained thin films were characterized by conductivity measurement, R-HEED observation and TEM observation.This newly developed thin microcrystalline n-layers have been applied to the stacked solar cells. Increase of Jsc by 5-6% has been achieved because of the reduction of light absorption loss in n-layer without decrease of Voc and FF.
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Fujioka H, Ishimura T, Sakai Y, Fujii T, Jo Y, Takenaka A, Fujisawa M. ERECTILE FUNCTION AFTER BRACHYTHERAPY WITH EXTERNAL BEAM RADIATION FOR PROSTATE CANCER. ACTA ACUST UNITED AC 2009; 50:295-301. [PMID: 15277008 DOI: 10.1080/01485010490448444] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The effect of therapeutic modalities on sexual potency is an important consideration for patients choosing a treatment for prostate cancer. We assessed erectile function after iridium-192 (1r-192) high-dose rate (HDR) brachytherapy with external beam radiation therapy (EBRT), and examined the efficacy of sildenafil after this treatment. Forty-two prostate cancer patients (T1c to T3bN0M0) were treated with 22Gy HDR brachytherapy with 36.8Gy EBRT without neoadjuvant hormone therapy. Erectile function was assessed using a 5-item version of the International Index of Erectile Function questionnaire (IIEF-5), pre, 3 and 12 months after treatment, Potency was defined as an IIEF-5 score > or = 11. Ten patients with potency before HDR brachytherapy with EBRT with or without neoadjuvant hormone therapy requested Sildenafil 3 months after treatment. The mean IIEF-5 score of all patients was 10.5 +/- 8.5, 4.5 +/- 5.3 (p < 0.001), and 3.8 +/- 4.7 (p < 0.001), pre, 3 and 12 months after treatment, respectively. Seventeen (40.4%) patients were potent before treatment. The mean IIEF-5 score of those patients was 15.8 +/- 3.2, 9.6 +/- 5.1 (p = 0.04), and 11.3 +/- 6.1 (p = 0.06), pre, 3 and 12 months after treatment, respectively. Ten of 17 (58.8%) patients maintained their potency 12 months after treatment. In 10 patients with potency before treatment who were treated with sildenafil, the mean IIEF-5 score increased from 6.2 +/- 3.5 at 3 months to 13.6 +/- 5.1 (p < 0.001) at 12 months after treatment. Eight of 10 (80%) patients treated with sildenafil had recovered 12 months after treatment. HDR brachytherapy with EBRT can be performed with favorable results for maintaining potency.
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Affiliation(s)
- H Fujioka
- Department of Urology Kawasaki Medical School, Kurashiki, Japan
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Abstract
OBJECTIVES To assess immunohistochemically 8-hydroxy-2'-deoxyguanosine (8-OHdG, a sensitive biological marker of oxidative damage and stress) in testicular tissue from patients with varicocele, to determine whether 8-OHdG is related to spermatogenesis, as oxidative stress in testicular DNA is associated with poor semen quality and reduced fertility. PATIENTS, SUBJECTS AND METHODS Testicular tissue samples were collected from the testes of 36 patients with varicocele and five normal volunteers. The mean (sd) age of the patients was 35.3 (5.4) years. The prevalence of immunostained germ cells among all the germ cells in >20 seminiferous tubules was calculated. RESULTS The mean (sd) sperm concentration and Johnsen's score in the varicocele group was lower than in the normal group, at 27.6 (11.8) vs 80.4 (21.7) million/mL (P < 0.001) and 7.6 (1.1) vs 9.0 (0.7), respectively (P < 0.05). In all patients, 8-OHdG was mainly expressed in the spermatogonia and spermatocytes in the seminiferous tubule. Immunostained germ cells correlated negatively with sperm concentration (r = -0.48, P = 0.01) and Johnsen's score (r = -0.46, P = 0.02), but not with follicle-stimulating hormone, luteinizing hormone or testosterone level. Immunostained germ cells were significantly more prevalent in the varicocele group, at 53.6 (5.7)%, than that in the normal group, at 14.3 (2.3)% (P < 0.001). The prevalence of immunostained germ cells and clinical grades were positively related; the ratio recorded for varicocele grades I, II and III was 38.0 (10.0)%, 41.0 (9.1)%, and 57.0 (9.3)%, respectively (grade I vs grade III, P < 0.05). CONCLUSIONS Increased 8-OHdG expression in the testis was associated with deficient spermatogenesis in infertile men with varicocele.
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Affiliation(s)
- Tomomoto Ishikawa
- Division of Urology, Department of Organ Therapeutics, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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Takenaka A, Hara R, Ishimura T, Fujii T, Jo Y, Nagai A, Fujisawa M. A prospective randomized comparison of diagnostic efficacy between transperineal and transrectal 12-core prostate biopsy. Prostate Cancer Prostatic Dis 2007; 11:134-8. [PMID: 17533394 DOI: 10.1038/sj.pcan.4500985] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The aim of this study is to elucidate the diagnostic efficacy between transperineal and transrectal 12-core prostate biopsy for prostate cancer. We prospectively randomized 200 consecutive men into two groups to undergo systematic prostate biopsy. Overall positivity for cancer was similar (47% by transperineal and 53% by transrectal; P=0.480). However, in case with 'gray zone' PSA (from 4.1 to 10.0 ng/ml), significantly more cores were positive when approach was transperineal, especially among transition zone cores. Therefore, urologist preferences are sufficient for choosing an approach, except for a possible small advantage of transperineal biopsy when PSA is in gray zone.
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Affiliation(s)
- A Takenaka
- Division of Urology, Department of Organ Therapeutics, Kobe University Graduate School of Medicine, Kobe, Japan.
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Ishikawa T, Fujioka H, Ishimura T, Takenaka A, Fujisawa M. 1864: Expression of Leptin and Leptin Receptor in the Testis of Fertile and Infertile Patients. J Urol 2007. [DOI: 10.1016/s0022-5347(18)32037-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
Ghrelin, which is the endogenous ligand for the growth hormone (GH) secretagogue receptor (GHS-R), has been primarily linked to the central neuroendocrine regulation of GH secretion and food intake, although additional peripheral actions of ghrelin have also been reported. Recent research has suggested that ghrelin also affects testosterone (T) secretion in vitro. To investigate the role of ghrelin in human testicular function, we examined the expression of ghrelin in testicular tissues by immunohistochemistry. Testicular tissue samples were collected from the testes of 5 fertile volunteers, 8 patients with obstructive azoospermia, and 36 oligospermic patients with varicocele testis. In the testicular tissues, ghrelin was stained using the antighrelin polyclonal antibody, and the Johnsen score was calculated. The concentrations of serum follicle-stimulating hormone (FSH), lutenizing hormone (LH), and T were determined by chemiluminescence assays. Immunostaining of ghrelin was detected in the interstitium and in Leydig cells. Ghrelin expression by Leydig cells was inversely correlated with the serum T concentration (r=-.50; P<.001), but was not directly related to spermatogenesis. We conclude that steroidogenic dysfunction is associated with increased ghrelin expression in human testes.
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Affiliation(s)
- Tomomoto Ishikawa
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.
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Abstract
The aim of our study was to investigate the relationships between the expression of leptin, leptin receptor in the testis and spermatogenesis, and testosterone (T) concentration in infertile men. Testicular tissue samples were collected from the testes of five fertile volunteers, eight patients with obstructive azoospermia (OA), six patients with Sertoli cell-only syndrome (SCO) and 32 oligospermic patients with varicocele testis. In testicular tissue, leptin and leptin receptor were identified by staining with polyclonal antibodies. Serum follicle stimulating hormone, lutenising hormone (LH), and T were determined by chemiluminescence assays. Leptin was expressed on germ cells, mainly on spermatocytes. The ratio of immunostained germ cells to total germ cells was inversely correlated with the concentration of T (r = -0.32, P = 0.01), sperm concentration (r = -0.51, P = 0.002) and Johnsen's score (r = -0.44,P = 0.005). In contrast, leptin receptor immunostained cells were found in the interstitium, primarily in Leydig cells. Leptin receptor expression on Leydig cells was inversely correlated with serum T concentration (r = -0.50, P < 0.001). The dysfunction of spermatogenesis is associated with an increase in leptin and leptin receptor expression in the testis.
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Affiliation(s)
- T Ishikawa
- Division of Urology, Department of Organs Therapeutics, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
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Ishimura T, Takenaka A, Sakai Y, Fujii T, Jo Y, Fujisawa M. Hydronephrosis caused by intra-abdominal abscess from cecal perforation by an ingested fish bone. Int J Urol 2006; 13:1350-1. [PMID: 17010018 DOI: 10.1111/j.1442-2042.2006.01552.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A patient was treated for hydronephrosis caused by an intra-abdominal abscess arising from cecal perforation by an ingested fish bone. To the authors' knowledge there is no previous report of such ureteral obstruction. Ureteral stenting, drainage of the abscess, and ileocecal resection were performed. Six months of stenting were required to attain ongoing ureteral patency following removal.
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Affiliation(s)
- Takeshi Ishimura
- Department of Urology, Kawasaki Medical School, Kurashiki, Okayama, Japan.
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Harada KI, Sakai I, Ishimura T, Inoue TA, Hara I, Miyake H. Clinical symptoms in localized renal cell carcinoma reflect its invasive potential: comparative study between incidentally detected and symptomatic diseases. Urol Oncol 2006; 24:201-6. [PMID: 16678049 DOI: 10.1016/j.urolonc.2005.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2005] [Revised: 07/06/2005] [Accepted: 07/07/2005] [Indexed: 12/12/2022]
Abstract
The objectives of this study were to analyze the association of clinical symptoms with several parameters in patients with organ-confined renal cell carcinoma (RCC), and investigate the difference in biologic characteristics between incidentally detected and symptomatic RCCs. This study included 132 patients who were pathologically diagnosed with organ-confined RCC after radical surgery, and their clinicopathologic features were compared to those in patients with incidentally detected and symptomatic diseases. In this series, 91 patients were incidentally diagnosed with RCC, while the remaining 41 had some clinical symptoms. The cause-specific survival in patients with incidental RCC was significantly higher than that in patients with symptomatic RCC, and the presence of clinical symptoms could be an independent predictor of cause-specific survival in these patients. Immunohistochemical staining of resected specimens from these patients were then performed with Ki-67, Bcl-2, matrix metalloproteinase (MMP)-2, MMP-9, and vascular endothelial growth factor antibodies. Despite the lack of differences in Ki-67, Bcl-2, and vascular endothelial growth factor expression between these 2 groups, significantly increased expressions of MMP-2 and MMP-9 in symptomatic RCCs were observed compared with those in incidental RCCs. Moreover, the presence of clinical symptoms in organ-confined RCC was significantly correlated with immunoreactivities of MMP-2 and MMP-9. These findings suggest that clinical symptoms have a significant impact on the prognosis of patients with organ-confined RCC and that the appearance of clinical symptoms may reflect the increased invasive potentials characterized by overexpression of MMPs.
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Affiliation(s)
- Ken-ichi Harada
- Department of Urology, Hyogo Medical Center for Adults, Akashi, Japan
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Takenaka A, Hara R, Hyodo Y, Ishimura T, Sakai Y, Fujioka H, Fujii T, Jo Y, Fujisawa M. Transperineal extended biopsy improves the clinically significant prostate cancer detection rate: A comparative study of 6 and 12 biopsy cores. Int J Urol 2006; 13:10-4. [PMID: 16448425 DOI: 10.1111/j.1442-2042.2006.01221.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND We evaluated the improvement in the rate of prostate cancer detection when using a 12-core transperineal biopsy protocol including transitional zone biopsy. METHODS Between April 2003 and November 2004, 247 consecutive men underwent transperineal systemic 12-core biopsy of the prostate. Six cores were obtained at the peripheral zone, four at the transitional zone and two at the apex. We examined the cancer detection rate in each of the 12 cores, and also determined the improvement of cancer detection resulting from the extensive 12-core versus standard 6-core biopsy. RESULTS Using the extensive 12-core biopsy, prostate cancer was detected in 98 cases (39.7%). Prostate-specific antigen (PSA), PSA density, the positive rate in digital rectal examination and transrectal ultrasound findings were significantly higher in the prostate cancer group than in the non-prostate cancer group, and prostate volume was larger in non-prostate cancer group. Every site showed almost the same positive rate, between 17.8 and 21.5%. There were 20 cases which were positive in the extended biopsy, but negative in the sextant. The detection improved significantly (20.4%). The improvement of cancer detection in extended biopsy was better in men with PSA levels of 10 ng/mL or less (28.9%), PSA density 0.3 or less (25.8%), negative digital rectal examination (23.3%), and negative transrectal ultrasound (21.6%). Of these twenty patients, no cases with insignificant tumor were detected in the six prostatectomy cases. In particular, three cases of the six were transitional-zone-only cancer. CONCLUSION Transperineal extended 12-core biopsy including 4 transitional zone cores is a more useful procedure than transperineal 6-core biopsy. Routine transitional zone biopsy, that is different from transrectal biopsy, might be useful for detecting biologically significant cancer.
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Affiliation(s)
- Atsushi Takenaka
- Department of Urology, Kawasaki Medical School, Kurashiki, Japan.
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Takeda M, Ishida T, Ishimura T, Fujisawa M. Correlation between endothelin expression in early post-transplant biopsy specimens and long-term allograft function in living-related renal transplantation. Clin Transplant 2006; 20:26-9. [PMID: 16556149 DOI: 10.1111/j.1399-0012.2005.00434.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We investigated whether degree of immunohistochemically evident endothelin (ET) expression in early post-transplant biopsy specimens could predict long-term allograft function in living-related renal transplantation. METHODS Allograft biopsy specimens obtained from 40 patients with living-related transplants were studied. Cases with episodes of acute rejection or calcineurin inhibitor toxicity were excluded. We immunostained graft biopsy specimens obtained at pre-transplantation (PRE) and at 3 months (3M) afterward with anti-ET antibody. The number of stained tubular epithelial cells per 1000 tubular cells was defined as the staining index (SI). In the 21 patients whom we could assess at 3 yr (3Y) after transplantation, the correlation between ET expression and long-term graft function was examined. RESULTS Anti-ET antibody staining was appreciable in tubular epithelium but not in glomeruli. Tubular SI at PRE and at 3M were 10.6 +/- 15.3 and 32.0 +/- 35.6 (mean +/- SD) respectively (p < 0.01). When patients were classified according to SI (group A, SI < 25; group B, SI > 25), declining ratio in creatinine clearance at 3Y after transplantation for groups A and B with respect was 21.8% +/- 15.4% and 41.9% +/- 21.6% (p < 0.05). CONCLUSION High ET expression in early post-transplantation, biopsy specimens was related to poor long-term allograft function following living-related renal transplantation.
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Affiliation(s)
- Masashi Takeda
- Department of Organs Therapeutics, Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
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Ishida T, Hyodo Y, Ishimura T, Takeda M, Hara I, Fujisawa M. Mast cell numbers and protease expression patterns in biopsy specimens following renal transplantation from living-related donors predict long-term graft function. Clin Transplant 2005; 19:817-24. [PMID: 16313331 DOI: 10.1111/j.1399-0012.2005.00427.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In human kidney transplantation the main cause of declining long-term graft function is chronic allograft nephropathy (CAN). Recent studies have implicated human mast cells (MC) in chronic inflammation and fibrosis, MC can be subtyped according to protease content: MC(T) containing tryptase only and MC(TC) containing both tryptase and chymase. We investigated immunohistochemically whether numbers and subtypes of MC in biopsy specimens 100 d after transplantation could predict subsequent fibrosis and graft dysfunction. The total number of MC/high-power field at 100 d after transplantation correlated significantly with change in creatinine clearance (DeltaCcr), defined as (Ccr at 100 d) - (Ccr at 3 yr) (R = 0.597, p = 0.0021); fibrosis index (FI) at 100 d (R = 0.583, p = 0.0066); and DeltaFI, defined as (FI at 3 yr) - (FI at 100 d) (R = 0.406, p < 0.05). The ratio of MC(TC) to total MC at 100 d also correlated with DeltaCcr (R = 0.491, p = 0.0148), FI at 100 d (R = 0.527, p = 0.0081), and DeltaFI (R = 0.417, p < 0.05). Thus, increases in number of total MC and the ratio of MC(TC) to total MC in early biopsy specimens were related to decline of long-term graft function and fibrosis.
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Affiliation(s)
- Toshiro Ishida
- Division of Urology, Department of Organs Therapeutics, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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Ishimura T, Sakai I, Harada KI, Hara I, Eto H, Miyake H. Clinicopathological features of recurrence after radical surgery for nonmetastatic renal cell carcinoma. Int J Clin Oncol 2004; 9:369-72. [PMID: 15549586 DOI: 10.1007/s10147-004-0409-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2003] [Accepted: 03/26/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND The objective of this study was to clarify the clinicopathological features of recurrent renal cell carcinoma (RCC) in patients who had undergone curative surgical resection of primary disease. METHODS The study included 171 patients treated by radical surgery for nonmetastatic RCC in our institution. Several clinicopathological factors were analyzed to determine differences between patients with and without disease recurrence. We further investigated predictive factors for disease recurrence, as well as prognostic factors after disease recurrence, using univariate and multivariate analyses. RESULTS Thirty-four of the 171 patients (19.9%) developed recurrence, and the median time from surgery to recurrence was 11 months (range, 1 to 146 months). The incidence of disease recurrence was significantly associated with sex, mode of detection, tumor size, pathological stage, tumor grade, and microvascular invasion (MVI). Univariate analysis showed that five factors--mode of detection, tumor size, pathological stage, tumor grade, and MVI--were found to be significant risk factors for recurrence after surgery, while only the pathological stage was an independent predictor of recurrence by multivariate analysis. After disease recurrence, the 1-, 3-, and 5-year cancer-specific survival rates were 66.3%, 45.9%, and 13.4%, respectively. Despite the absence of independent prognostic predictors after recurrence, recurrence more than 1 year after surgery and complete resection of recurrent lesions were shown to be significant prognostic factors by univariate analysis. CONCLUSION These findings suggest that careful follow-up should be performed for patients showing a high pathological stage after radical surgery for nonmetastatic RCC, because of the higher probability of disease recurrence, and that after recurrence, intensive treatment should be considered, particularly for patients with unresectable recurrent disease occurring within 1 year after initial radical surgery.
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Affiliation(s)
- Takeshi Ishimura
- Department of Urology, Hyogo Medical Center for Adults, 13-70 Kitaohji-cho, Akashi 673-8558, Japan
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Abstract
BACKGROUND The objective of the present study was to investigate the significance of microscopic venous invasion (MVI) as a prognostic factor for patients with renal cell carcinoma (RCC) who underwent radical surgery. METHODS The study included a total of 157 consecutive patients with non-metastatic RCC who underwent radical surgery between January 1986 and December 2002. The median follow-up period was 45 months (range 6-162 months). Microscopic venous invasion was defined by the presence of a cancer cell in blood vessels based on the examination of hematoxylin-eosin stained specimens. Other prognostic variables were assessed by multivariate analysis to determine whether there was a significant impact on cancer-specific and recurrence-free survivals. RESULTS Microscopic venous invasion was found in 70 patients, and of this number, 17 (24.7%) developed a tumor recurrence and 12 (17.1%) died of cancer progression, while only six (6.9%) of the remaining 87 patients without MVI presented with disease-recurrence and three (3.5%) died of cancer. Among the factors examined, the presence of MVI was significantly associated with age, mode of detection, tumor size, pathological stage and tumor grade; however, only pathological stage was an independent predictor for disease-recurrence, and none of these factors were available to predict cancer-specific survival in multivariate analyses. In 120 patients with pT1 or pT2 disease, MVI was noted in 36 patients. In this subgroup, recurrence-free survival rates in patients with MVI were significantly lower than those in patients without MVI, and MVI was the only independent prognostic predictor for disease-recurrence in a multivariate analysis. CONCLUSION Microscopic venous invasion is not an independent prognostic factor in patients with non-metastatic RCC who underwent radical surgery; however, it could be the only independent predictor of disease-recurrence after radical surgery for patients with pT1 or pT2 disease.
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Affiliation(s)
- Takeshi Ishimura
- Department of Urology, Hyogo Medical Center for Adults, Akashi, Japan
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Ishimura T, Sakai I, Hara I, Eto H, Miyake H. Clinical outcome of transrectal ultrasound-guided prostate biopsy, targeting eight cores, for detecting prostate cancer in Japanese men. Int J Clin Oncol 2004; 9:47-50. [PMID: 15162826 DOI: 10.1007/s10147-003-0361-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The objective of this study was to evaluate the clinical usefulness of transrectal ultrasound (TRUS)-guided eight-core prostate biopsy for detecting prostate cancer in Japanese men. METHODS Between January 1998 and September 2002, a total of 628 consecutive patients underwent TRUS-guided biopsy of the prostate. As a rule, eight cores were taken from each patient; that is, standard sextant cores from the peripheral zone and two additional cores from the bilateral anterior lateral horns (ALHs). The present study included 428 patients who underwent an initial biopsy, whose age was between 50 and 79 years, and whose prostate-specific antigen (PSA) value was less than 20.0 ng/ml. The cancer detection rate was calculated according to age, PSA, digital rectal examination (DRE) and TRUS findings, prostate volume, and PSA density (PSAD). We also assessed whether the sampling of the two extra cores from the ALHs increased the cancer detection rate. RESULTS Of the 428 patients, 101 (23.6%) were diagnosed as having cancer by eight-core prostate biopsies. The cancer detection rate was significantly associated with the PSA value (ng/ml; < or =4 versus 4-10, versus 10-20), DRE findings (normal versus abnormal), TRUS findings (normal versus abnormal), and PSAD (ng/ml2; < or =0.15 versus >0.15). but not with age (years: < or =70 versus >70) on prostate volume (ml; < or =30 versus 30-50, versus >50). Of the 101 patients diagnosed as having prostate cancer, 11 had positive cores only in the ALH; that is, the increase in the cancer detection rate yielded by obtaining two extra cores from the ALHs was 10.9%. CONCLUSION Despite the reasonable strategy, systematic prostate biopsy targeting eight cores did not significantly improve the cancer detection rate compared with that of standard sextant biopsy in Japanese men. However, the increased cancer detection rate yielded by additional sampling from the ALHs was comparatively prominent in the subgroup whose PSA value was in the gray zone (4-10 ng/ml) or whose prostate volume was greater than 50 ml.
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Affiliation(s)
- Takeshi Ishimura
- Department of Urology, Hyogo Medical Center for Adults, 13-70 Kitaohji-cho, Akashi 673-8558, Japan
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Miyake H, Sakai I, Ishimura T, Hara I, Eto H. Significance of cancer detection in the anterior lateral horn on systematic prostate biopsy: the effect on pathological findings of radical prostatectomy specimens. BJU Int 2004; 93:57-9; discussion 59. [PMID: 14678368 DOI: 10.1111/j.1464-410x.2004.04555.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To clarify the significance of cancer detection in the anterior lateral horn (ALH) on systematic prostate biopsy in relation to its effect on the pathological findings from retropubic radical prostatectomy (RRP) specimens. PATIENTS AND METHODS The study included 84 consecutive patients who underwent RRP at our institution between January 1999 and December 2002, after being diagnosed as having prostate cancer, based on systematic prostate biopsies that included the areas taken by standard sextant biopsies and the bilateral ALHs. Several clinicopathological factors of these patients were analysed in relation to the presence or absence of cancer in the ALH on systematic biopsy. RESULTS Of the 84 patients, cancer was detected in the ALH in 44 (group A), but not in the remaining 40 (group B). There were no significant differences in age, preoperative serum prostate-specific antigen level, or prostate volume between the groups. However, the incidence of bilateral positive cores and the percentage of positive biopsy cores in group A were significantly higher than those in group B. Pathological examinations of RRP specimens showed no significant differences in the incidence of lymphatic invasion, vascular invasion and perineural invasion, or Gleason score between the groups, but group A had a significantly larger tumour volume and higher incidence of extraprostatic disease than group B. CONCLUSIONS Despite similar biological tumour characteristics and irrespective of the cancer location in the ALH, advanced and extensive disease frequently involves the ALH. Therefore, more aggressive treatment should be considered if cancer is detected in the ALH by systematic prostate biopsy.
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Affiliation(s)
- H Miyake
- Department of Urology, Hyogo Medical Center for Adults, Akashi, Japan.
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Abstract
Long-term renal allograft survival is limited mainly by the progressive process termed chronic allograft nephropathy (CAN) or chronic rejection. A pathological feature of CAN is characterized by progressive interstitial fibrosis. Transforming growth factor (TGF)-beta(1) plays an important role in fibrogenesis. We investigated whether the degree of TGF-beta(1) expression in early biopsy specimens routinely obtained from stable allografts at 100 days could predict fibrosis and graft dysfunction in the late phase by immunohistochemistry. Patients were children with a graft from related donors. We immunohistochemically determined intracellular and extracellular expression of TGF-beta(1) in the graft at 100 days using LC antibody (LC) for intracellular TGF-beta(1) and CC antibody (CC) for extracellular TGF-beta(1). We used the change in creatinine clearance between 100 days and 3 years after transplantation (Delta Ccr) as an index of long-term graft function. Image analysis was used to calculate the relative area involved by interstitial fibrosis in trichrome-stained sections of graft biopsy specimens at 100 days and 3 years, designating the change as Delta FI. Delta Ccr was - 4.2 +/- 9.4 mL/min in subjects with minimal early immunoreactivity for CC and - 20.5 +/- 5.9 mL/min in subjects with strong reactivity (p < 0.05). Delta Ccr was - 14.5 +/- 18.6 mL/min in subjects with minimal early immunoreactivity for LC and - 11.7 +/- 12.8 mL/min in those with strong reactivity. Delta FI in subjects with minimal CC reactivity (1.28 +/- 4.11 %) tended to be lower than in subjects with strong reactivity (8.45 +/- 15.47 %). Neither fibrosis at 100 days nor Delta FI differed between subjects with minimal and strong LC reactivity. Thus, extracellular TGF-beta(1) expression in grafts at 100 days after transplantation has an influence on long-term graft function and tends to be associated with increased graft fibrosis at 3 years.
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Affiliation(s)
- T Ishimura
- Department of Urology, Kawasaki Medical School, Matsushima, Kurashika, Japan
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Ishimura T, Fujisawa M, Isotani S, Iijima K, Yoshikawa N, Kamidono S. Endothelial nitric oxide synthase expression in ischemia-reperfusion injury after living related-donor renal transplantation. Transpl Int 2002; 15:635-40. [PMID: 12478411 DOI: 10.1007/s00147-002-0473-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2001] [Revised: 07/01/2002] [Accepted: 07/12/2002] [Indexed: 10/27/2022]
Abstract
Ischemia-reperfusion injury during renal transplantation has been linked to early graft dysfunction and late graft failure. Nitric oxide (NO), produced by NO synthase (NOS), participates in the recovery from ischemia. We correlated the intensity of graft immunoreactivity for the endothelial NOS isoform (eNOS) during early reperfusion with graft function in 25 children receiving grafts from related donors. Renal allograft biopsy specimens were obtained before transplantation, 1 h after renal artery reperfusion, and 1 year after transplantation. Immunohistochemical staining for eNOS occurred mainly within the endothelium of glomerular capillaries and peritubular capillaries as well as in tubule cells. The mean intensity score for eNOS staining (0-9) was 3.0+/-1.4 before transplantation, 4.5+/-1.9 at 1 h, and 3.3+/-1.9 at 1 year (baseline vs 1 h, P<0.05). Creatinine clearance (ml/min) in patients with a 1-h eNOS score of below 5 and of at least 5, respectively, was 77.1+/-28.4 vs 104.3+/-25.3 at 1 month, 78.7+/-33.4 vs 105.2+/-24.4 at 3 months, 64.7+/-30.1 vs 100.1+/-25.3 at 1 year, 58.2+/-31.3 vs 84.7+/-18.8 at 3 years, and 71.2+/-19.7 vs 78.3+/-23.1 at 5 years ( P<0.05 for 1 month, 1 year, and 3 years). We concluded that elevated eNOS expression after reperfusion in living related-donor renal transplantation enhances the recovery from renal ischemia and, consequently, reduces late graft deterioration.
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Affiliation(s)
- Takeshi Ishimura
- Division of Urology, Department of Organs Therapeutics, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
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