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A 16-year-old male adolescent with a history of retractile testes fell in the bath and hit his scrotum against the bathtub. The following day, he presented to the primary care clinic with severe right testicular pain and nausea 2 hours after the onset. Physical examination showed a tender right

Hepatic encephalopathy caused by a large portosystemic shunt (PSS) can be treated by endovascular embolization of the shunt. The PSS diameter can be >20 mm; it occasionally poses technical difficulties. Here, a 72-year-old woman with liver cirrhosis, hyperammonemia, and large spleno-renal shunt underwent shunt embolization using an Amplatzer vascular plug 2 (AVP2) and metallic coils. The preloading coil in plug method (p-CIP), which facilitated embolization inside the AVP2 without cannulation from outside, was employed to overcome technical difficulties. We propose the use of p-CIP with an AVP2 as a tool for treatment of hepatic encephalopathy with PSS.

Introduction In Western countries, the risk of a testicular germ cell tumor in men with male factor infertility is greater than in the general population. However, Japanese data on this risk are lacking. Additionally, the clinical course for the pathogenesis involved has not been clearly characterized. Case presentation A 35‐year‐old Japanese male underwent a right orchiectomy because of a mass in his right scrotum. He had a previous history of microdissection testicular sperm extraction undertaken 6 years ago. The final diagnosis of the right scrotal mass was a stage I seminoma. However, a relapse occurred in the left inguinal lymph node 2 years after surgery and the patient was consequently treated with systemic chemotherapy. Pathological analysis of a microdissection testicular sperm extraction sample yielded a germ cell neoplasia in situ in the right testis. Conclusion In Japan, men who seek an evaluation for infertility might be more likely to develop testicular germ cell tumor.

Objective: Bacillus Calmette-Guerin (BCG) intravesical therapy is currently established using a low dose because of the high incidence of side-effects. Moreover, shortening the dwell time of BCG is conducted in some facilities owing to the complications associated with a long dwell time after injection. The method of BCG administration varies in each facility and even with each doctor. We evaluated whether the dwell-time and dose differences in patients who underwent intravesical BCG therapy is related to completion rates, adverse effects, and nonrecurrence rates. Methods: From November 2006 to April 2016, a total of 173 patients who received intravesical BCG therapy after transurethral resection of bladder tumor or transurethral biopsy were evaluated retrospectively. We allocated them into 4 groups based on the dose (40 or 80 mg BCG) and the dwell time (1 or 2 hours). Completion rate, side effects, and nonrecurrence rates were evaluated. Results: No significant improvement in the completion rate or reduction in side-effects was observed in any of the regimens. Although nonrecurrence rates for the 1-hour dwell time tended to be lower than the 2-hour dwell time, the difference was not significant. Conclusion: Our study suggests that reducing the BCG dose or shortening the dwell time does not reduce adverse effects or affect the nonrecurrence rate.

Background: Patients with metastatic urothelial carcinoma (mUC) have an uncertain prognosis. The aim of the current study was to evaluate the prognostic potential of a skeletal muscle mass reduction index measured by computed tomography (CT) for mUC patients undergoing second-line gemcitabine and docetaxel (GD) chemotherapy. Methods: We retrospectively reviewed 44 patients with mUC who received second-line GD chemotherapy between 2006 and 2015 in our hospital. Skeletal muscle area (SMA) at the third lumbar vertebra was measured using CT images obtained from medical records, and a skeletal muscle index (SMI) was calculated for each patient as: SMI = SMA / height2. Changes in SMI across timepoints (SMI inclination) were calculated as: SMI inclination = [( SMI/SMI)/duration of the interval between imaging visits]. Patients were then divided into two groups: a “steep” group (SMI inclination < -0.01) and a “gentle” group (SMI inclination ≥ -0.01). Kaplan-Meier curves and multivariate Cox proportional hazards regression models were used to evaluate the relationship between SMI inclination and overall survival (OS). Results: There were no differences in patient characteristics between the two groups with respect to median age, gender, Eastern Cooperative Oncology Group Performance Status (ECOG-PS), disease control rate or first-line treatment regimen. OS from the start of second-line GD therapy group was significantly shorter in the “steep” group relative to the “gentle” group. The multivariate analysis revealed that “steep” SMI inclination and presence of anemia were strong predictors of poor prognosis. Conclusion: Higher values of SMI inclination, indicating a faster rate of skeletal muscle mass reduction, may serve as a useful predictive marker for OS in mUC patients undergoing second-line GD chemotherapy.

Objective: In recent years, although reduced port surgeries (RPS) have been reported for many urological diseases, there have been no reports regarding simultaneous laparoscopic cystectomy and unilateral or bilateral nephroureterectomy with umbilical RPS. Therefore, the aim of this study was to evaluate outcomes and complications of simultaneous laparoscopic cystectomy and unilateral or bilateral nephroureterectomy with umbilical RPS. Methods: We performed a preliminary case series of 4 patients with synchronous upper urinary tract (UUT) tumor and invasive bladder cancer who underwent simultaneous laparoscopic cystectomy and unilateral or bilateral nephroureterectomy with umbilical RPS between 2014 and 2017 at our hospital. Demographic data, pathologic features, the surgical technique, and outcomes were retrospectively analyzed. Result: All 4 patients were men whose median age was 79 years (range 65-85 years) and median body mass index was 24.2 kg/m2 (range 21.5-27.3 kg/m2). The laparoscopic approach was technically successful in all 4 patients without the need for open conversion. The median total operative time was 434 minutes (range 372-481 minutes). The median estimated blood loss was 773 ml (range 153-923 ml), median interval to resuming oral intake was 2 days (range 1-7 days), and median hospital stay was 16 days (range 13-20 days). Conclusion: The reduced port approach is technically feasible in terms of many outcome measures, with significant cosmetic advantages. This method can be performed safely and recommended as a viable option for patients with concomitant UUT and bladder cancer.

A novel physical vapor deposition method involving electromagnetic acceleration using a set of coaxial electrodes has been developed. In this study, the coaxial ion acceleration method is applied for a diamond-like carbon (DLC) thin film formation. In the developed method, the central electrode made of the deposition material is sputtered by the noble gas plasma current and accelerated toward the deposition chamber. Because the sputtered ions are accelerated by the Lorentz self-force, the ion injection energy can be controlled separately from the plasma temperature. In addition, the gaseous hydrocarbon, which is commonly used for DLC formation, is not required since a noble gas is used as the discharge gas.

Despite growing evidence suggesting that spinal microglia play an important role in the molecular mechanism underlying experimental neuropathic pain (NP) in male rodents, evidence regarding the sex-dependent role of these microglia in NP is insufficient. In this study, we evaluated the effects of microglial regulation on NP using Gi-designer receptors exclusively activated by designer drugs (Gi-DREADD) driven by the microglia-specific Cx3cr1 promoter. For the Cre-dependent expression of human Gi-coupled M4 muscarinic receptors (hM4Di) in CX3C chemokine receptor 1-expressing (CX3CR1+) cells, R26-LSL-hM4Di-DREADD mice were crossed with CX3CR1-Cre mice. Mouse models of NP were generated by partial sciatic nerve ligation (PSL) and treatment with anti-cancer agent paclitaxel (PTX) or oxaliplatin (OXA), and mechanical allodynia was evaluated using the von Frey test. Immunohistochemistry revealed that hM4Di was specifically expressed on Iba1+ microglia, but not on astrocytes or neurons in the spinal dorsal horn of CX3CR1-hM4Di mice. PSL-induced mechanical allodynia was significantly attenuated by systemic (intraperitoneal, i.p.) administration of 10 mg/kg of clozapine N-oxide (CNO), a hM4Di-selective ligand, in male CX3CR1-hM4Di mice. The mechanical threshold in naive CX3CR1-hM4Di mice was not altered by i.p. administration of CNO. Consistently, local (intrathecal, i.t.) administration of CNO (20 nmol) significantly relieved PSL-induced mechanical allodynia in male CX3CR1-hM4Di mice. However, neither i.p. nor i.t. administration of CNO affected PSL-induced mechanical allodynia in female CX3CR1-hM4Di mice. Both i.p. and i.t. administration of CNO relieved PTX-induced mechanical allodynia in male CX3CR1-hM4Di mice, and a limited effect of i.p. CNO was observed in female CX3CR1-hM4Di mice. Unlike PTX-induced allodynia, OXA-induced mechanical allodynia was slightly improved, but not significantly relieved, by i.p. administration of CNO in both male and female CX3CR1-hM4Di mice. These results suggest that spinal microglia can be regulated by Gi-DREADD and support the notion that CX3CR1+ spinal microglia play sex-dependent roles in nerve injury-induced NP; however, their roles may vary among different models of NP.

Peripheral nerve injury typically leads to chronic inflammation through recruitment of immune cells, which may induce neuropathic pain. We previously reported that M1-like macrophages at sites of peripheral nerve injury induced neuropathic pain; however, the involvement of other immune cells (e.g. M2-like macrophages) in the progression of neuropathic pain remains unclear. In addition, the immune responses that occur at sites of nerve injury have not been well characterized. In this study, we show that M2-like macrophages accumulate in injured nerves to participate in the clearance of dead or dying cells (i.e., efferocytosis). Because MerTK (a receptor of dead or dying cells) levels on the surface of macrophages are limited, it seems to induce the insufficient of efferocytosis, such that the levels of dead or dying cells cannot be controlled in injured nerves. Given that efferocytosis is pivotal for resolution of inflammation, our data suggest that insufficient efferocytosis is a contributing factor in the development of chronic inflammation in injured nerves.

Introduction: Cabazitaxel (CBZ) is used worldwide for castration-resistant prostate cancer after docetaxel treatment. In July 2014 the drug was approved in Japan with the same induction dose used for Caucasian patients. In this study, we examined and compared the results of an initial low-dose CBZ treatment in patients admitted to our hospital. Patients and Methods: Between July 2014 and August 2018, sixteen mCRPC patients were enrolled and underwent a low-dose CBZ treatment at our hospital. We compared the results with those of a Japanese metastatic docetaxel- and castration-resistant prostate cancer Phase I study. Results: The median patient age was 77 years (range, 53-84 years). Of the 16 patients, eight (50%) had a lymph node metastasis and 11 (68.8%) had a distant metastasis, 10 of whom had only a bone metastasis. The median dose of CBZ was 30 mg (range, 20-32 mg) and the median number of CBZ cycles was 2.5 (range, 1-18). The PSA level of 9 (56.3%) patients decreased after CBZ treatment, including 4 (25%) who showed a decrease to

Background Neuro–immune interaction underlies chronic neuroinflammation and aberrant sensory processing resulting in neuropathic pain. Despite the pathological significance of both neuroinflammation-driven peripheral sensitization and spinal sensitization, the functional relationship between these two distinct events has not been understood. Methods In this study, we determined whether inhibition of inflammatory macrophages by administration of α4β2 nicotinic acetylcholine receptor (nAChR) agonists improves neuropathic pain and affects microglial activation in the spinal dorsal horn (SDH) in mice following partial sciatic nerve ligation (PSL). Expression levels of neuroinflammatory molecules were evaluated by RT-qPCR and immunohistochemistry, and PSL-induced mechanical allodynia was defined by the von Frey test. Results Flow cytometry revealed that CD11b+ F4/80+ macrophages were accumulated in the injured sciatic nerve (SCN) after PSL. TC-2559, a full agonist for α4β2 nAChR, suppressed the upregulation of interleukin-1β (IL-1β) in the injured SCN after PSL and attenuated lipopolysaccharide-induced upregulation of IL-1β in cultured macrophages. Systemic (subcutaneous, s.c.) administration of TC-2559 during either the early (days 0–3) or middle/late (days 7–10) phase of PSL improved mechanical allodynia. Moreover, local (perineural, p.n.) administration of TC-2559 and sazetidine A, a partial agonist for α4β2 nAChR, during either the early or middle phase of PSL improved mechanical allodynia. However, p.n. administration of sazetidine A during the late (days 21–24) phase did not show the attenuating effect, whereas p.n. administration of TC-2559 during this phase relieved mechanical allodynia. Most importantly, p.n. administration of TC-2559 significantly suppressed morphological activation of Iba1+ microglia and decreased the upregulation of inflammatory microglia-dominant molecules, such as CD68, interferon regulatory factor 5, and IL-1β in the SDH after PSL. Conclusion These findings support the notion that pharmacological inhibition of inflammatory macrophages using an α4β2 nAChR agonist exhibit a wide therapeutic window on neuropathic pain after nerve injury, and it could be nominated as a novel pharmacotherapy to relieve intractable pain. Electronic supplementary material The online version of this article (10.1186/s12974-018-1133-5) contains supplementary material, which is available to authorized users.

Objective: UroVysion (Abbott Molecular, Inc., Illinois, USA) is based on multicolor fluorescence in situ hybridization (FISH). It has been used successfully in the USA following its Food and Drug Administration approval in 2001. However, the technology was not approved for use in Japan until 2017. Cystoscopy and urine cytology are the most frequently used examinations to detect bladder cancer in Japan, and there are only a few reports regarding the performance of UroVysion. Therefore, the aim of this study is to examine the diagnostic accuracy of UroVysion FISH in Japanese patients whose tumors are detected by cystoscopy before transurethral resection of bladder tumor (TURBT). Methods: From April 2018 to July 2018, a total of 40 patients who were diagnosed as having bladder tumors by cystoscopy, and therefore underwent TURBT were registered in this study. One day before TURBT, urine cytology and UroVysion FISH were used in order to compare the accuracy with which they could detect bladder carcinoma, as confirmed by pathological results of TURBT. Results: The pathological results of TURBT showed urothelial carcinoma in 33 cases. Urine cytology showed positive results for 0 cases (0%), suspicious results for 10 cases (30.3%), and negative results for 23 cases (69.7%). On the other hand, UroVysion FISH indicated 9 positive cases (27.3%) and 24 negative cases (72.7%). There were 19 cases of urothelial carcinoma (57.6%) that were not detected by either method. Conclusion: We conclude that UroVysion FISH alone is insufficient to detect bladder cancer and that cystoscopy is essential for the optimum detection or follow up of bladder cancer cases in our hospital.

Introduction Creation of an ileal conduit is associated with complications. A few cases have been reported on tumor development in an ileal conduit; diffuse large B‐cell lymphoma originating from an ileal conduit is extremely rare. Case presentation A 62‐year‐old Japanese man who had undergone radical cystectomy and ileal conduit diversion 6 years previously presented with a whitish bulge that had developed on the surface of the ileal conduit during follow‐up visit. Mass biopsy was performed and the histological diagnosis was diffuse large B‐cell lymphoma. Positron emission tomography showed no metastatic lesions. We attempted chemotherapy because the tumor cells tested positive for CD20; after six courses of a regimen involving rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone; diffuse large B‐cell lymphoma of the ileal conduit resolved gradually. The patient is alive and remains free from the diagnosed diffuse large B‐cell lymphoma. Conclusion We reported an extremely rare case of diffuse large B‐cell lymphoma originating from the ileal conduit created after radical cystectomy.

Simple Summary In cases of cancer metastasis, some tumor cells circulate in blood (CTCs) and function as a seed for metastasis. These cells are important for detailed study of the molecular basis of metastasis. However, their few numbers and difficult isolation hinder its analysis. Apheresis, a process used to isolate a specific component of blood, can efficiently separate peripheral blood monocyte (PBMC), whose density is closely like that of CTCs. In the present study we used the dogs as a precious model of human’s cancers to check the safety and feasibility of apheresis and to separate PBMC and infused MCF7 cells using Spectra Optia apheresis machine (Terumo). The process was performed safely to capture PBMC and MCF7. The captured MCF7 cells were regrown up in vitro and characterized. In conclusion, Spectra Optia apheresis machine (Terumo) can be used safely to isolate CTCs from dogs blood with precautions to keep hemodynamic stability. Abstract In patients with solid tumors, circulating tumor cells (CTCs) spread in their blood and function as a seed for metastases. However, the study of CTCs has been limited by their rarity, low frequency, and heterogeneity. The efficient collection of CTCs will contribute to further research of metastatic cancers. Apheresis is a process in which the whole blood of an individual is passed through a machine that isolates a particular constituent and returns the remainder to the circulation. In the present study, we investigated the safety and feasibility of apheresis to separate peripheral blood monocytes (PBMCs), whose density is closely similar to that of CTCs, and to capture intravenously administered human breast cancer cells, MCF7s, from the dogs. No life-threatening events were observed in dogs during the apheresis process. The changes in the hemogram were transient and recovered gradually within a few days after apheresis. During apheresis, 50 mL of PBMCs could be collected from each dog. Notably, a thrombus was formed along the circuit wall during apheresis, which decreased the blood collection pressure. MCF7 cells were successfully captured by the apheresis machine. The captured cells were regrown in vitro and characterized compared with the original cells. In conclusion, apheresis could be safely performed in dogs to isolate CTCs with precautions to maintain hemodynamic stability.

A 45-year-old Japanese man, who was undergoing HIV infection treatment, was aware that he had gross hematuria, and he was diagnosed as having a ureteral tumor by radiographic examination. Therefore, he was referred to our department for further examination and treatment. We considered that the ureteral tumor was a urothelial carcinoma (cT2N0M0) because of the left ureteral tumor and urine cytology results, and thus, laparoscopic ureteronephrectomy was performed. The pathological diagnosis was a solitary extramedullary plasmacytoma (EMP) of the ureter. Currently, he is alive and free of disease at 7 months postoperatively. EMP develops in the nasal cavity, paranasal cavity, gastrointestinal tract, lung, thyroid, eye socket, lymph node, and various organs, but the ureter is an extremely rare site of EMP. In addition, the patient had an HIV infection. To the best of our knowledge, this is the first case of EMP of the ureter in an HIV-positive patient.

Excess scar formation can occur after skin injurふy and lead to abnormal scar formation, such as keloids and hypertrophic scars, which are characterised by substantial deposition of extracellular matrix in the dermis. Periostin, an extracellular matrix protein that plays a crucial role in skin development and maintaining homeostasis, is also involved in skin disorders such as systemic/limited scleroderma, wound closure, and abnormal scar formation. However, the mechanism of periostin involvement in abnormal scar formation is not yet fully understood. In this study, we investigated the mechanism by which periostin is involved in abnormal scar formation. Treatment of human dermal fibroblasts (HDFs) with IL-4 and IL-13, which are cytokines of Th2 type immune responses that are up-regulated in abnormal scars, dramatically elevated the levels of periostin mRNA and protein, and also promoted the secretion of periostin by HDFs. Transforming growth factor-β1 (TGF-β1) had the same effect on HDFs as IL-4 and IL-13. Stimulation of HDFs with periostin promoted RhoA/ROCK pathway-mediated TGF-β1 secretion from HDFs. Our results suggest that IL-4 and IL-13 induce periostin expression and secretion, and in turn, secreted periostin induces RhoA/ROCK pathway-mediated TGF-β1 secretion. Secreted TGF-β1 then induces further periostin production and secretion, thereby promoting abnormal scar formation.

A 76-year-old Japanese man visited a nearby medical clinic complaining of abdominal distention. He had undergone extraperitoneal laparoscopic prostatectomy at our institution 5 months before the onset of abdominal distention. An imaging study revealed a large cystic lesion, and biochemical examination of a sample obtained via cyst puncture led to a diagnosis of lymphocele. As the lymphocele was resistant to puncture, drainage, and sclerotherapy with minomycin, laparoscopic fenestration was performed. Although the patient developed an adhesive ileus postoperatively, the cyst has not recurred. Fenestration surgery is a feasible option for lymphocele refractory to various conservative therapies.

Objective: There are few reports of the long-term outcomes of elderly patients with prostate cancer. We analyzed data from our institution from the past 12 years, including the patient history, treatment methods, and prognosis of patients with prostate cancer aged 80 years or more. Patients and Methods: A total of 179 cases of prostate cancer in patients aged 80 years or more were retrospectively evaluated. We divided them chronologically into groups A, B, C, and D: Group A included 40 cases from 2002–2004; Group B, 48 cases from 2005–2007; Group C, 46 cases from 2008–2010; and Group D, 45 cases from 2011–2013. Results: Sixty-one (30%) patients changed treatment course. Interestingly, no cancer deaths occurred in the patients who changed treatment course. Although 14 (7.8%) cancer deaths occurred (A: B: C: D = 4: 4: 6: 0, respectively), all occurred in 2011 or later. Conclusion: In our study, over 50 patients who underwent treatment survived for 5 years or more. By treating prostate cancer in elderly patients when appropriate, we can lower the mortality rate due to prostate cancer. Our results support the active treatment of prostate cancer in elderly patients.

Despite the requirement for effective medication against neuropathic pain associated with type 2 diabetes mellitus (T2DM), mechanism-based pharmacotherapy has yet to be established. Given that long-lasting neuroinflammation, driven by inflammatory macrophages in the peripheral nerves, plays a pivotal role in intractable pain, it is important to determine whether inflammatory macrophages contribute to neuropathic pain associated with T2DM. To generate an experimental model of T2DM, C57BL/6J mice were fed a high-fat diet (HFD) ad libitum. Compared with control diet feeding, obesity and hyperglycemia were observed after HFD feeding, and the mechanical pain threshold evaluated using the von Frey test was found to be decreased, indicating the development of mechanical allodynia. The expression of mRNA markers for macrophages, inflammatory cytokines, and chemokines were significantly upregulated in the sciatic nerve (SCN) after HFD feeding. Perineural administration of saporin-conjugated anti-Mac1 antibody (Mac1-Sap) improved HFD-induced mechanical allodynia. Moreover, treatment of Mac1-Sap decreased the accumulation of F4/80+ macrophages and the upregulation of inflammatory mediators in the SCN after HFD feeding. Inoculation of lipopolysaccharide-activated peritoneal macrophages in tissue surrounding the SCN elicited mechanical allodynia. Furthermore, pharmacological inhibition of inflammatory macrophages by either perineural or systemic administration of TC-2559 [4-(5-ethoxy-3-pyridinyl)-N-methyl-(3E)-3-buten-1-amine difumarate], a α4β2 nicotinic acetylcholine receptor-selective agonist, relieved HFD-induced mechanical allodynia. Taken together, inflammatory macrophages that accumulate in the SCN mediate the pathophysiology of neuropathic pain associated with T2DM. Inhibitory agents for macrophage-driven neuroinflammation could be potential candidates for novel pharmacotherapy against intractable neuropathic pain.

Objectives: Gauze remnants form gauzeomas after surgery, if infection has not occurred. We present a case of gauzeoma diagnosed after surgery. Patient: A 72-year-old man noticed a mass in his lower abdomen. He had undergone surgery for left inguinal hernia 21 years ago. A retroperitoneal mass was found on computed tomography (CT) and magnetic resonance imaging (MRI), and he was then referred to our hospital. A detailed abdominal ultrasonography, CT, and MRI revealed a cystic mass with a bulkhead-like structure near the bladder. These findings indicated the possibility of a malignant cyst; hence, an open surgery was performed to excise the mass. Macroscopically, the specimen was clearly bound, covered with a capsule, and filled with pus and had a gauze inside. Results: Based on the patient history and position of the mass, it was diagnosed as gauzeoma, which had strayed into the retroperitoneal cavity during the surgery for inguinal hernia. Conclusion: The imaging findings of gauzeoma are diverse; hence, it is often difficult to diagnose without surgery. However, gauzeoma can be lethal if the cystic mass is infected; thus, it is important to diagnose it correctly.

Neuropathic pain can have a major effect on quality of life but current therapies are often inadequate. Growing evidence suggests that neuropathic pain induced by nerve damage is caused by chronic inflammation. Upon nerve injury, damaged cells secrete pro-inflammatory molecules that activate cells in the surrounding tissue and recruit circulating leukocytes to the site of injury. Among these, the most abundant cell type is macrophages, which produce several key molecules involved in pain enhancement, including cytokines and chemokines. Given their central role in the regulation of peripheral sensitization, macrophage-derived cytokines and chemokines could be useful targets for the development of novel therapeutics. Inhibition of key pro-inflammatory cytokines and chemokines prevents neuroinflammation and neuropathic pain; moreover, recent studies have demonstrated the effectiveness of pharmacological inhibition of inflammatory (M1) macrophages. Nicotinic acetylcholine receptor ligands and T helper type 2 cytokines that reduce M1 macrophages are able to relieve neuropathic pain. Future translational studies in non-human primates will be crucial for determining the regulatory mechanisms underlying neuroinflammation-associated neuropathic pain. In turn, this knowledge will assist in the development of novel pharmacotherapies targeting macrophage-driven neuroinflammation for the treatment of intractable neuropathic pain.

Primitive neuroectodermal tumor (PNET) is a member of the Ewing's sarcoma family of tumors (ESFT). We report a case of PNET in a 66-year-old male who presented with a large solid tumor within the parenchyma of the middle pole of the left kidney with metastases to the left adrenal gland and right ischium. A fine-needle biopsy was performed and showed a small round cell tumor. Results of immunohistochemical staining suggested this tumor belonged to ESFT. Preoperative VDC-IE (combined vincristine, doxorubicin and cyclophosphamide followed by another combination of ifosfamide and etoposide) chemotherapy and left radical nephrectomy and adrenalectomy were performed. The histopathological findings of the resected tumor were similar to those in the biopsy specimen, but the results of AE1/AE3 were different. For the diagnosis, fluorescence in situ hybridization was performed. Split signals of the EWSR1 gene were detected, and transmission electron microscopy showed neuroendocrine granules and microtubules. The final diagnosis of this tumor was PNET of the kidney.

The neutrophil-to-lymphocyte ratio (NLR), a measure of systemic inflammation, has been reported to be a predictive parameter of patient prognosis. We speculated that the NLR is decreased in renal cell carcinoma (RCC) patients in whom interleukin (IL)-2 is effective. In this study, we retrospectively examined the usefulness of the NLR as a prognostic factor using three cases of RCC treated with long-term IL-2. In all three cases, the NLR remained less than 2.7 during IL-2 treatment, suggesting its effectiveness as a marker. During interferon-α or molecular targeted drug therapy, the NLR was unstable, regardless of treatment effectiveness, but a sudden rise in the NLR tended to suggest massive radiographic progression and worse prognosis. The results suggested that the NLR might serve as a useful marker for therapies when determining prognosis.

Malignant bowel obstruction (MBO), an occasional complication in patients with advanced urological cancer, causes gastrointestinal symptoms such as nausea and vomiting leading to suffering which severely impairs quality of life (QOL) . Drug therapy, especially octreotide, a synthetic analog of somatostatin, is reportedly effective in controlling the symptoms of MBO. In the present study, we administered octreotide to urological cancer patients with MBO and evaluated the improvement of subjective symptoms, oral intake, and nasogastric intubation. Fourteen terminally ill urological cancer patients suffering with MBO were included (age range 55-92, 10 male, 4 female). Octreotide was administered at 300µg/day to those patients subcutaneously as a continuous injection. Significant improvements in subjective symptoms were observed in thirteen patients (92.8%), and ten patients (71.4%) were able to resume oral intake. Four patients required nasogastric drainage before the administration of octreotide, but nasogastric intubation was discontinued in all these cases after the use of octreotide. Early initiation of octreotide resulted in better improvement of MBO symptoms, and no adverse event was observed in any of the patients. These results revealed that 300µg/day dose of octreotide is safe and effective for managing gastrointestinal symptoms of terminally ill urological cancer patients with MBO. We also recommend starting the treatment with ocreotide as soon as MBO is diagnosed.

BACKGROUND Bone metastasis is a serious problem for individuals with prostate cancer, and the effects of the anticancer drug docetaxel (DTX) are insufficient. We therefore examined the therapeutic potential of magnetic cationic liposomes (MCL) in a novel rat model that allows the evaluation of tumor immunity. The effects of MCL thermotherapy were compared with those of DTX as a conventional therapy for the treatment of bone metastatic prostate cancer. METHODS Prostate tumor tissues were transplanted into the femurs of model rats divided into four groups: control, MCL, DTX, and MCL + DTX. Tumors were injected with MCL, and alternating magnetic field (AMF) irradiation was performed three times a week. Tumor proliferation and bone destruction were evaluated by proliferating cell nuclear antigen positivity, computed tomography, and CD68-positive cell number, while tumor immunity was evaluated by heat shock protein (HSP) 70 expression and CD8-positive lymphocyte number. RESULTS We successfully established a novel femur metastasis model of prostate cancer, and demonstrated that tumor proliferation and bone destruction in the MCL and MCL + DTX groups were significantly suppressed compared with control and DTX groups. MCL thermotherapy concurrently induced necrosis and apoptosis. The expression of HSP70 in the MCL and MCL + DTX groups was also significantly increased, and tumor immunity was enhanced through the induction of CD8-positive lymphocytes. CONCLUSION MCL thermotherapy was clearly more effective than DTX in treating bone metastatic prostate cancer. A combination of MCL thermotherapy and DTX therefore deserves consideration as a novel treatment for this disease. Prostate 73: 913–922, 2013. © 2013 Wiley Periodicals, Inc.

INTRODUCTION AND OBJECTIVES: The UCiTrainer is a low cost, portable laparoscopic trainer that utilizes an electronic tablet for video and optics; it can be printed with a consumer-level three-dimensional (3D) printer. We report our initial experience on the feasibility of using 3D printing technology as a novel method of manufacturing and distribution for low cost, surgical education tools on a global on demand basis. METHODS: We created computer-aided designs (CAD) using Solidworks Software (Dassault Systemes Solidworks Corp., Velizy-Villacoublay, France) for nine separate components which could then be assembled into a laparoscopic training device including an instrument port mold. These files were provided to two remote institutions to 3D print and assemble the trainer. The CAD files were uploaded to Makerware software (MakerBot Industries, New York City, NY) to be sliced into layers and prepared for printing. All pieces were printed using a Flashforge Creator 3D printer (Flashforge, Jinhua, China) in five separate prints. The following printer settings were used: raft layer, 15% infill, 2 shells, 0.10 mm layer height, 230 ? C extruder, 110 ? C build plate, 90 mm/s extrusion and 150 mm/s travel. In this process, successive layers of a heated, acrylonitrile butadiene styrene filament were extruded and laid on top of one another in both the horizontal and vertical axis. The printed mold was used to create two instrument ports using a liquid silicone rubber. Both remote institutions were provided oral and written instructions for assembly of the components. RESULTS: Initial attempts of 3D printing of the larger pieces (Figure 1b) were not successful due to deformation of the plastic. Additionally, initial calibration and leveling of the 3D printer were challenging to novices. Accordingly, the build plate was increased to 120 ? C and a full enclosure was made for the 3D printer to retain heat during the printing process. With these adjustments, successful printing of the components was accomplished. Both institutions were subsequently able to completely assemble and use the training device using only the oral and written instructions provided. CONCLUSIONS: 3D printing technology can be used successfully to disseminate a training device for use in surgical education. The device is inexpensive and can be made on an as-needed basis.

Background To explore the safety, efficacy, and oncological outcome of 3-port laparoscopic radical cystectomy (LRC) compared to open radical cystectomy (ORC) in patients older than 75 years. Materials and methods From June 2010 to July 2014, we analyzed 16 radical cystectomies in patients older than 75 years (LRC group=8; ORC group=8). Demographic parameters, operative variables, and perioperative outcome in the 2 groups were retrospectively collected, analyzed, and compared. Results Patients in both groups had comparable preoperative characteristics. A significantly longer operating time (476 vs. 303 min, P=0.0002) and less estimated blood loss (627 vs. 2,106 mL, P=0.021) were observed in the LRC group compared to the ORC group. Infection and ileus were the most common early complications after surgery. Patients who underwent ORC suffered from more postoperative infection (22.2% vs. 0.0%, P=0.054) and ileus (25.0% vs. 12.5%, P=0.521) than the LRC group, but the difference was not significant. Conclusions Judging from this initial trial, 3-port LRC can be safely carried out in elderly patients. We suggest 3-port LRC as the primary intervention to treat muscle-invasive or high-risk nonmuscle-invasive bladder cancer in elderly patients with an otherwise relatively long life expectancy.

Recently, doubly fed induction generators (DFIG) and synchronous generators have been applied mostly to wind power generation, and variable speed control and power factor control have been implemented for high efficiency of wind energy capture and for high quality of power system voltage. In variable speed control, the wind speed or generator speed is used for maximum power point tracking. However, the properties of wind generation power fluctuations due to wind speed variation have not yet been investigated for those forms of control. The authors discuss power smoothing by these forms of control for DFIG interconnected to a 6.6-kV distribution line. The performance is verified by means of the power PSCAD/EMTDC system simulation software for actual wind speed data and is investigated by using an approximate equation for wind generation power fluctuations as a result of wind speed variation. © 2011 Wiley Periodicals, Inc. Electr Eng Jpn, 177(2): 10–18, 2011; Published online in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/eej.20958

Recently, doubly fed induction generator (DFIG) and synchronous generator are mostly applied for wind power generation, and variable speed control and power factor control are executed for high efficiently for wind energy capture and high quality for power system voltage. In variable speed control, a wind speed or a generator speed is used for maximum power point tracking. However, performances of a wind generation power fluctuation due to wind speed variation have not yet investigated for those controls.The authors discuss power smoothing by those controls for the DFIG inter-connected to 6.6kV distribution line. The performances are verified using power system simulation software PSCAD/EMTDC for actual wind speed data and are examined from an approximate equation of wind generation power fluctuation for wind speed variation.

INTRODUCTION AND OBJECTIVES: Lysine-specific demethylase 1 (LSD1), the first histone demethylase discovered, is a novel target for prostate cancer therapy. NCL1, a selective cell-active inhibitor of LSD1, was discovered at our university. We verified the mechanism of prostate cancer growth and examined the anticancer effects of NCL1. METHODS: Various tests were used to confirm the mechanism of prostate cancer growth, as well as the anticancer effects of NCLI. Cell viability was assessed by a WST assay with standard vehicle or NCL1. Chromatin immunoprecipitation (ChIP)wasused to incubateLNCaPcells with and without NCL1. Real-time polymerase chain reaction and ChIP were used to confirm the methylation status. Flow cytometry was performed on LNCaP cells treated with NCL1. For autophagy analysis, LNCaP cells were incubated with and without chloroquine (CQ), and with and without NCL1. We subsequently performed transmission electron microscopy (TEM), fluorescent immunocytochemistry, and aWSTassay. The effect on xenograft tumors was measured by subcutaneously injecting nude mice with PCai1 cells. Then, mice were injected intraperitoneallywith a vehicle orNCL1at doses of 0.5mg/kgor 1.0mg/kg. Lastly, tissue microarrays were prepared from prostate cancer specimens. RESULTS: The WST assay revealed that the number of viable cells was reduced after NCL1 treatment in all cell lines. ChIP showed NCL1-induced H3K9me2 accumulation at the ELK4 and KLK2 promoters. Flow cytometry showed that NCL1 dose-dependently induced apoptosis and cell cycle arrest in the G1 phase.,@Using TEM analysis, autophagosomes were observed in LNCaP cells treated with NCL1. The expression level of LC3-II was significantly increased in cells treated with NCL1 and CQ. The WST assay further revealed that a combination of NCL1 and CQ significantly decreased cell growth. When NCL1-treated mice were compared with controls, the xenograft tumor volume was reduced with no adverse effects. Tissue microarray analysis revealed that LSD1 expression in human cancer prostatectomy specimens was higher than that in normal glands. CONCLUSIONS: Prostate cancer growth was effectively suppressed with NCL1 both in vitro and in vivo without adverse events via regulation of apoptosis and autophagy, indicating the inhibitor,fs potential as a therapeutic agent for prostate cancer.

INTRODUCTION AND OBJECTIVES: Lysine-specific demethylase 1 (LSD1), the first discovered histone demethylase, is a novel target for prostate cancer therapy. LSD1 expression positively correlates with prostate tumor malignancy. NCL1, a selective cell-active inhibitor of LSD1, was discovered at our university. Here, we verified the mechanism of prostate cancer growth and examined the anti-cancer effect of NCL1 using an animal model. METHODS: We used the prostate cancer cell lines LNCaP, PCai1, and PC3. LSD1 expression was examined by western blotting in LNCaP, PCai1, and PC3 cells. Cell viability was assessed by a WST-1 assay in LNCaP, PCai1, and PC3 cells treated for 48 h with vehicle or 1e100 mM NCL1. LNCaP cells were incubated with or without 30 mM NCL1 for 210 min. Chromatin was collected, and ChIP and real-time polymerase chain reaction were used to confirm the methylation status of the promoter regions of certain genes. Nude mice were subcutaneously injected with 3 106 PCai1 cells. Four days later, mice were injected intraperitoneally with NCL1 at doses of 0.5 mg/kg or 1.0 mg/kg. Mice were treated twice a week for 8 weeks. RESULTS: LSD1 was expressed in all cell lines. The number of viable cells were reduced after NCL1 treatment in all cell lines in a dose-dependent manner. On ChIP analysis, NCL1 treatment induced H3K9me2 accumulation at the androgen response element 1/2 (ARE1/2) and at ELK4 and KLK2 promoter regions. Tumor volume was significantly lower in mice treated with 1.0 mg/kg NCL1 than in controls. Mice that received 1.0 mg/kg NCL1 showed vacuolar degeneration, low Ki67 positivity, and high TUNEL intensity. There were no adverse effects in terms of body weight, relative organ weight, histological findings, and blood biochemical examination results. CONCLUSIONS: LSD1 is involved in prostate cancer cell proliferation via H3K9me2 demethylation at ARE1/2 and ELK4 and KLK2 promoter regions. NCL1 is safe and effective in vivo and induces an anti-cancer effect through apoptosis induction. NCL1 is promising for the development of therapeutics for prostate cancer.

Xenograft tumors with enhanced expression of miR124 showed significant reduced levels of both full-length AR and AR-V7, resulting in reduced tumor growth (P 0.001). CONCLUSIONS: Our study demonstrated, in the pre-clinical setting, the novel finding that miR124 significantly suppresses the full length AR expression and its alternative spliced variants, AR-V7 and AR-V3 and their downstream targets. Thus, miR124 is a potential therapeutic opportunity to delay the development of CRPC in patients treated with Enzalutamide. We have shown that miRNA 124 can be delivered systematically, a prerequisite for its clinical use.

A 71-year-old man was referred to our hospital because of intermittent urine stream and postmicturition dribbling. Magnetic resonance imaging (MRI) results suggested the mass to be a malignant mesenchymal tumor arising from the left lobe of the prostate, on the basis of the presence of a beak sign. Radical prostatectomy and partial rectal excision with subsequent colostomy were performed. Contrary to preoperative MRI, no prostate involvement was found on histologic examination. Histopathologic and immunohistochemical findings showed typical characteristics of solitary fibrous tumors. The patient's postoperative course was uneventful. He showed no signs of recurrence and metastasis at 2-year follow-up.

OBJECTIVES To establish a novel and simple method of preventing post-retropubic prostatectomy (RRP) inguinal hernia. Inguinal hernias occur in 8%-22% of men within 1-2 years of RRP. Although manipulation during RRP might weaken the normal fascia structure at the internal inguinal ring with the vas deferens, the exact mechanism of post-RRP inguinal hernia remains unknown. METHODS Several surgeons performed RRP at our hospital on 271 patients between April 2004 and September 2009. Among these patients, post-RRP measures to prevent inguinal hernia were applied to 101 patients (group A) and not applied to 170 patients (group B). We released the bilateral spermatic cord from the peritoneum before suturing the wound, which should prevent the intestinal tract coated with the peritoneum from pushing through the internal inguinal tract. We compared the incidence of postoperative inguinal hernia between the 2 groups. RESULTS The patients were followed up for an average of 11.6 (range: 2-22 months) and 23.9 (range: 23-24 months) months in groups A and B, respectively. Inguinal hernia developed in no patients in group A and in 20 (11.8%) in group B. The hernia-free rate was significantly lower in group B than group A. All postoperative inguinal hernias were indirect. The median interval between surgery and hernia diagnosis was 10.6 months (range, 2-24), and 16 patients (80%) were diagnosed within 12 months. CONCLUSIONS We developed a simple method of preventing inguinal hernia after RRP. Our technique is simple enough to complete within a few minutes, and the outcome is excellent.

Background Magnetite used in an 8-MHz radiofrequency (RF) capacitive heating device can increase the temperature of a specific site up to 45°C. When treating a metastatic lesion around large abdominal vessels via hyperthermia with magnetite, heating-induced adverse effects on these vessels need to be considered. Therefore, this study examined hyperthermia-induced damage to blood vessel walls in vitro. Methods A large agar phantom with a circulatory system consisting of a swine artery and vein connected to a peristaltic pump was prepared. The blood vessels were placed on the magnetite-containing agar piece. Heating was continued for 30 min at 45°C. After heating, a histological study for injury to the blood vessels was performed. Results The inner membrane temperature did not reach 45°C due to the cooling effect of the blood flow. In the heated vessels, vascular wall collagen degenerated and smooth muscle cells were narrowed; however, no serious changes were noted in the vascular endothelial cells or vascular wall elastic fibers. The heated vessel wall was not severely damaged; this was attributed to cooling by the blood flow. Conclusions Our findings indicate that RF capacitive heating therapy with magnetite may be used for metastatic lesions without injuring the surrounding large abdominal vessels.