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Introduction: There are various doses, durations, and strains of bacillus Calmette-Guérin (BCG) intravesical instillation therapy, but optimal treatment has not yet been established. We retrospectively investigated the efficacy and safety of low-dose BCG therapy for non-muscle-invasive bladder cancer (NMIBC) and carcinoma in situ (CIS) in a multicenter study., Methods: From 1991 to 2019, 323 patients who received BCG therapy to prevent recurrence of NMIBC were analyzed as group A. Similarly, 147 patients who received BCG therapy for the treatment of CIS were analyzed as group B. Patients received low- or full-dose Tokyo-172 strain or full-dose Connaught strain, and the three strains were compared. Survival curves were estimated by the Kaplan-Meier method, and independent risk factors for intravesical recurrence were examined by multivariate logistic regression., Results: Recurrence-free survival (RFS) in group A was significantly better for the Connaught strain than the low-dose Tokyo-172 strain (p = 0.026), but not between the low- and full-dose Tokyo-172 strains (p = 0.443). RFS of group B, cancer-specific survival, and progression-free survival in both groups did not show statistically significant differences. Logistic analysis of group A showed that for intravesical recurrence, only pT1 was a significant risk factor, and there were no differences between the BCG strain and dose and no significant factors in group B. There were also no differences in the completion rate in both groups, but adverse events such as urinary frequency and feeling of residual urine were significantly lower with the low-dose Tokyo-172 strain., Conclusion: There was no difference in efficacy between the low- and full-dose Tokyo-172 strains, but to minimize adverse events, the low-dose Tokyo-172 strain may be worth considering., (© 2023 The Author(s). Published by S. Karger AG, Basel.)

Study Objective: To examine the short term effects of raised concentrations of air pollutants on myocardial infarction deaths, the authors measured if incidence rate ratios increased after the concentration of suspended particulate matter (SPM) reached various critical values and were sustained for various periods of time., Design: Retrospective analysis of a database, which contained hourly SPM concentrations and myocardial infarction deaths., Methods: The rate of death (events/1000 hours) attributable to myocardial infarction was compared among SPM categories. SPM categories were classified by five different critical values that measured high SPM levels, and by the hours of exposure (exposure window) after reaching the critical SPM level., Main Outcome Measures: The adjusted incidence rate ratios in the various SPM categories were compared with the reference category (0-99 microg/m(3)) to determine the incidence rate ratio., Setting: Tokyo Metropolitan area, Japan. Patients/, Participants: 14,950 people who died of myocardial infarction in the Tokyo Metropolitan area from 1990 to 1994., Main Results: When the exposure window was one hour, the adjusted incidence rate ratio in each category were 1.13 (95% CI: 1.07 to 1.20) in the 100-149 microg/m(3) category, 1.17-1.24 in the intermediate categories, and 1.40 (1.00 to 1.97) in the highest (300 microg/m(3) over) category. When the exposure window was one to six hours, increased rate ratios were seen in the highest category (1.17 (four hours) to 1.40 (one hour)). Gradual increases in the incidence rate ratio were seen as the SPM category increased when the exposure window was less than six hours., Conclusion: An increased rate ratio of myocardial infarction deaths was seen within a few hours after reaching a high concentration of SPM. When the exposure window was less than six hours, there was a gradual increase in the incidence rate ratio as the SPM concentration increased.

Objective: The purpose of this study was to survey the clinical characteristics, complications, and therapeutic outcome in patients with acromegaly., Patients and Methods: The clinical features of 65 patients with acromegaly (31 males, 34 females; mean age: 50+/-2 yr.) who were admitted to Tokyo Women's Medical University between 1990 and 1999 were analyzed retrospectively from medical records., Results: The retrospective analysis revealed that the diagnosis of acromegaly was preceded by approximately 8.1+/-1.1 years of signs and symptoms of the disease. Forty-six of the 65 patients (71%) had macroadenomas, 16 (25%) had microadenomas, and the remaining three had empty sella. The rate of biochemical cure or remission was 81% for microadenoma (13/16), 64% for macroadenoma without extrasellar extension (9/14), and 13% for macroadenoma with cavernous sinus extension (2/15). Eighteen (28%) patients had impaired glucose tolerance (IGT) and 32 (49%) had diabetes mellitus (DM). After treatment for acromegaly, glucose metabolism was analyzed again in 38 patients, and it improved in 26 patients with IGT or DM. Twenty-five of 65 patients (38%) had hypertension. Of 26 patients who underwent barium enema or colonoscopy, 10 had colonic polyps and 4 had colon cancer., Conclusion: This study suggests that long-term excessive growth hormone (GH) secretion causes many complications. Therefore, awareness of the early symptoms and signs of acromegaly and long-term careful management of complications, along with therapy to reduce serum GH/insulin-like growth factor (IGF)-I levels, are important for patients with acromegaly.