Nine-year seroepidemiological study of severe fever with thrombocytopenia syndrome virus infection in feral horses in Cape Toi, Japan.

Severe fever with thrombocytopenia syndrome (SFTS) is a fatal zoonosis caused by ticks in East Asia. As SFTS virus (SFTSV) is maintained between wildlife and ticks, seroepidemiological studies in wildlife are important to understand the behavior of SFTSV in the environment. Miyazaki Prefecture, Japan, is an SFTS-endemic area, and approximately 100 feral horses, called Misaki horses (Equus caballus), inhabit Cape Toi in Miyazaki Prefecture. While these animals are managed in a wild-like manner, their ages are ascertainable due to individual identification. In the present study, we conducted a seroepidemiological survey of SFTSV in Misaki horses between 2015 and 2023. This study aimed to understand SFTSV infection in horses and its transmission to wildlife. A total of 707 samples from 180 feral horses were used to determine the seroprevalence of SFTSV using enzyme-linked immunosorbent assay (ELISA). Neutralization testing was performed on 118 samples. In addition, SFTS viral RNA was detected in ticks from Cape Toi and feral horses. The overall seroprevalence between 2015 and 2023 was 78.5% (555/707). The lowest seroprevalence was 55% (44/80) in 2016 and the highest was 92% (76/83) in 2018. Seroprevalence was significantly affected by age, with 11% (8/71) in those less than one year of age and 96.7% (435/450) in those four years of age and older (p < 0.0001). The concordance between ELISA and neutralization test results was 88.9% (105/118). SFTS viral RNA was not detected in ticks (n = 516) or feral horses. This study demonstrated that horses can be infected with SFTSV and that age is a significant factor in seroprevalence in wildlife. This study provides insights into SFTSV infection not only in horses but also in wildlife in SFTS-endemic areas.

Relationship between assistant's lens exposure and dose information during computed tomography examinations.

According to International Commission of Radiological Protection, the equivalent dose limit for the eye lens for occupational exposure is recommended to be 20 mSv yr-1, averaged over 5 years, with no single year above 50 mSv. Some studies reported the measurement of assistant's lens exposure in diagnostic computed tomography (CT) examinations, but further investigation is still required in the association between the lens dose for assistants and various dose parameters. Therefore, we measured the assistant's lens exposure using small optically stimulated luminescence dosimeters. The type of occupation, type of assistance, total scan time, total mAs, total scan length, and dose-length product (DLP) were recorded and analyzed in association with air kerma at the lens position. The assistance was classified into four types: 'assisted ventilation,' 'head holding,' 'body holding,' and 'raising patient's arm.' The air kerma of lens position was not significantly different for each assistance type (p< 0.05, Kruskal-Wallis test). Further, the lens doses for assistants correlated with DLP, but with various strengths of correlation with the assistance type and were influenced by the distance from the CT gantry. In conclusion, lens dose during assistance and DLP demonstrated the strongest correlation. 'Raising patient's arm' and 'head holding' exhibited stronger correlations, which required less table movement during the CT scan than 'assisted ventilation' and 'body holding'.

Revolutionizing Cow Welfare Monitoring: A Novel Top-View Perspective with Depth Camera-Based Lameness Classification.

This study innovates livestock health management, utilizing a top-view depth camera for accurate cow lameness detection, classification, and precise segmentation through integration with a 3D depth camera and deep learning, distinguishing it from 2D systems. It underscores the importance of early lameness detection in cattle and focuses on extracting depth data from the cow's body, with a specific emphasis on the back region's maximum value. Precise cow detection and tracking are achieved through the Detectron2 framework and Intersection Over Union (IOU) techniques. Across a three-day testing period, with observations conducted twice daily with varying cow populations (ranging from 56 to 64 cows per day), the study consistently achieves an impressive average detection accuracy of 99.94%. Tracking accuracy remains at 99.92% over the same observation period. Subsequently, the research extracts the cow's depth region using binary mask images derived from detection results and original depth images. Feature extraction generates a feature vector based on maximum height measurements from the cow's backbone area. This feature vector is utilized for classification, evaluating three classifiers: Random Forest (RF), K-Nearest Neighbor (KNN), and Decision Tree (DT). The study highlights the potential of top-view depth video cameras for accurate cow lameness detection and classification, with significant implications for livestock health management.

Customized Tracking Algorithm for Robust Cattle Detection and Tracking in Occlusion Environments.

Ensuring precise calving time prediction necessitates the adoption of an automatic and precisely accurate cattle tracking system. Nowadays, cattle tracking can be challenging due to the complexity of their environment and the potential for missed or false detections. Most existing deep-learning tracking algorithms face challenges when dealing with track-ID switch cases caused by cattle occlusion. To address these concerns, the proposed research endeavors to create an automatic cattle detection and tracking system by leveraging the remarkable capabilities of Detectron2 while embedding tailored modifications to make it even more effective and efficient for a variety of applications. Additionally, the study conducts a comprehensive comparison of eight distinct deep-learning tracking algorithms, with the objective of identifying the most optimal algorithm for achieving precise and efficient individual cattle tracking. This research focuses on tackling occlusion conditions and track-ID increment cases for miss detection. Through a comparison of various tracking algorithms, we discovered that Detectron2, coupled with our customized tracking algorithm (CTA), achieves 99% in detecting and tracking individual cows for handling occlusion challenges. Our algorithm stands out by successfully overcoming the challenges of miss detection and occlusion problems, making it highly reliable even during extended periods in a crowded calving pen.

Creation of synthetic contrast-enhanced computed tomography images using deep neural networks to screen for renal cell carcinoma.

In this study, we elucidate if synthetic contrast enhanced computed tomography images created from plain computed tomography images using deep neural networks could be used for screening, clinical diagnosis, and postoperative follow-up of small-diameter renal tumors. This retrospective, multicenter study included 155 patients (artificial intelligence training cohort [n = 99], validation cohort [n = 56]) who underwent surgery for small-diameter (≤40 mm) renal tumors, with the pathological diagnosis of renal cell carcinoma, during 2010-2020. We created a learned deep neural networks using pix2pix. We examined the quality of the synthetic enhanced computed tomography images created using this deep neural networks and compared them with real enhanced computed tomography images using the zero-mean normalized cross-correlation parameter. We assessed concordance rates between real and synthetic images and diagnoses according to 10 urologists by creating a receiver operating characteristic curve and calculating the area under the curve. The synthetic computed tomography images were highly concordant with the real computed tomography images, regardless of the existence or morphology of the renal tumor. Regarding the concordance rate, a greater area under the curve was obtained with synthetic computed tomography (area under the curve = 0.892) than with only computed tomography (area under the curve = 0.720; p < 0.001). In conclusions, this study is the first to use deep neural networks to create a high-quality synthetic computed tomography image that was highly concordant with a real computed tomography image. Our synthetic computed tomography images could be used for urological diagnoses and clinical screening.

Changes in population structure and genetic diversity of Misaki horses between 2015 and 2020.

For the preservation of Misaki horses, changes in the population structure and genetic diversity of the horses for 5 years were analyzed using population and genotype data from 2015-2020. The microsatellite genotyping was performed, and the average number of alleles (Na), expected heterozygosity (He), and observed value (Ho) were calculated. Moreover, the average generation length (GL) was estimated from the population management record. Then, no significant differences in Na, He, and Ho were found between 2015 and 2020, suggesting their genetic diversity had been maintained for 5 years. Moreover, the average GL was estimated as 4.6 years. Compared to other native horses, a short average GL suggesting a rapid generation renewing is a characteristic of the Misaki population.

Cow detection and tracking system utilizing multi-feature tracking algorithm.

In modern cattle farm management systems, video-based monitoring has become important in analyzing the high-level behavior of cattle for monitoring their health and predicting calving for providing timely assistance. Conventionally, sensors have been used for detecting and tracking their activities. As the body-attached sensors cause stress, video cameras can be used as an alternative. However, identifying and tracking individual cattle can be difficult, especially for black and brown varieties that are so similar in appearance. Therefore, we propose a new method of using video cameras for recognizing cattle and tracking their whereabouts. In our approach, we applied a combination of deep learning and image processing techniques to build a robust system. The proposed system processes images in separate stages, namely data pre-processing, cow detection, and cow tracking. Cow detection is performed using a popular instance segmentation network. In the cow tracking stage, for successively associating each cow with the corresponding one in the next frame, we employed the following three features: cow location, appearance features, as well as recent features of the cow region. In doing so, we simply exploited the distance between two gravity center locations of the cow regions. As color and texture suitably define the appearance of an object, we analyze the most appropriate color space to extract color moment features and use a Co-occurrence Matrix (CM) for textural representation. Deep features are extracted from recent cow images using a Convolutional Neural Network (CNN features) and are also jointly applied in the tracking process to boost system performance. We also proposed a robust Multiple Object Tracking (MOT) algorithm for cow tracking by employing multiple features from the cow region. The experimental results proved that our proposed system could handle the problems of MOT and produce reliable performance.

Detection and phylogenetic analysis of Dabieshan tick virus and Okutama tick virus in ticks collected from Cape Toi, Japan.

New technologies have led to the discovery of novel tick-borne and tick-associated viruses. Dabieshan tick virus (DaTV) and Okutama tick virus (OkTV), which belong to the family Phenuiviridae, were discovered in ticks in China and Japan, respectively, in the 2010s. Although it is unknown whether these viruses cause disease in animals or humans, all tick-associated viruses have the potential to become etiological agents of infectious diseases through gene reassortment. Therefore, it is important to elucidate the ecology of these viruses, regardless of their pathogenicity. In this study, ticks were collected year-round in Cape Toi, Miyazaki Prefecture, Japan, and an epidemiological survey of tick-associated phenuiviruses was performed. A total of 516 ticks collected from the vegetation by dragging flannel sheets were used for analysis. Pan-phenuivirus reverse transcription PCR was performed on the tick samples, and DaTV and OkTV were detected. We found that 37.0% (85/230) and 23% (16/71) of nymphal and adult Haemaphysalis longicornis were infected with DaTV, respectively, and 10% (6/62) and 13% (1/8) of nymphal and adult Haemaphysalis flava were infected with OkTV, respectively. Phylogenetic analysis indicated that the DaTV identified in this study formed a unique clade that was distinct from the strains identified in China. The survey revealed that DaTV is distributed not only in China, but also in Japan. We believe that this study contributes to our understanding of the prevalence of tick-associated viruses.

Application of liquid scintillation light guide (LSLG) to scattered X-ray measurement from dental panoramic radiography system.

A 1.2 m flexible liquid scintillation light guide (LSLG) detector connected to a portable electric device was developed and applied to monitor X-rays scattered from a panoramic dental X-ray imaging apparatus. The X-ray absorption of the LSLG tube was simulated for 20 and 40 keV X-rays. The LSLG detector was calibrated by comparing doses measured by a 3-inch NaI(Tl) detector using Am-241 and Cs-137 sources. A linear relationship was obtained between dose rates (µSv/h) and count rates (cps). The elapsed time profile of scattered radiation from a panoramic dental X-ray imaging apparatus was determined. Local absorbed doses were measured with small OSL dosimeters on the LSLG tube suspended over the shoulder and the eyeglass. Behind the ears and neck (in the center of the LSLG tube) showed high doses. The LSLG detector was useful for real-time monitoring of scattered X-rays.

Impact of the coronavirus disease 2019 pandemic on the number of undergoing radical nephroureterectomy and postoperative adjuvant systematic therapy for upper tract urothelial carcinomas in Japan: A multicenter retrospective study.

OBJECTIVES: The coronavirus disease 2019 pandemic has affected cancer management worldwide. For upper tract urothelial carcinomas, delays in treatments are not recommended even during the pandemic. We investigated the impact of the pandemic on patients with these carcinomas who underwent radical nephroureterectomy (RNU) and adjuvant systematic therapy before and after COVID-19 spread in Japan. METHODS: This multicenter retrospective study included 304 patients who underwent RNU for upper tract urothelial carcinomas between May 1, 2019, and December 31, 2021, in Aichi, Japan. The patients were categorized into three groups based on whether they underwent surgery in the prepandemic (before infection spread in Japan), early pandemic (between confirmation of the first case and vaccination initiation), and late pandemic (after the start of vaccination in Japan) phases. The patient characteristics, diagnostic methods, pathological findings, and postoperative therapy were compared among the three phases. RESULTS: Overall, 74, 152, and 78 patients underwent RNU in the prepandemic, early pandemic, and late pandemic phases, respectively. The number of patients who underwent preoperative ureteroscopy decreased significantly from the prepandemic phase to the late pandemic phase due to pandemic-related restrictions (p = 0.016). There was no difference in the time to the first visit or pathological findings. Among patients classified as high-risk according to existing clinical trials, the proportion receiving adjuvant systematic therapy after RNU decreased significantly from 52.3% to 19% (p = 0.003). CONCLUSIONS: There was no difference in the pathological findings. The number of patients receiving appropriate adjuvant systematic therapy decreased during the pandemic.

Comparing State-of-the-Art Deep Learning Algorithms for the Automated Detection and Tracking of Black Cattle.

Effective livestock management is critical for cattle farms in today's competitive era of smart modern farming. To ensure farm management solutions are efficient, affordable, and scalable, the manual identification and detection of cattle are not feasible in today's farming systems. Fortunately, automatic tracking and identification systems have greatly improved in recent years. Moreover, correctly identifying individual cows is an integral part of predicting behavior during estrus. By doing so, we can monitor a cow's behavior, and pinpoint the right time for artificial insemination. However, most previous techniques have relied on direct observation, increasing the human workload. To overcome this problem, this paper proposes the use of state-of-the-art deep learning-based Multi-Object Tracking (MOT) algorithms for a complete system that can automatically and continuously detect and track cattle using an RGB camera. This study compares state-of-the-art MOTs, such as Deep-SORT, Strong-SORT, and customized light-weight tracking algorithms. To improve the tracking accuracy of these deep learning methods, this paper presents an enhanced re-identification approach for a black cattle dataset in Strong-SORT. For evaluating MOT by detection, the system used the YOLO v5 and v7, as a comparison with the instance segmentation model Detectron-2, to detect and classify the cattle. The high cattle-tracking accuracy with a Multi-Object Tracking Accuracy (MOTA) was 96.88%. Using these methods, the findings demonstrate a highly accurate and robust cattle tracking system, which can be applied to innovative monitoring systems for agricultural applications. The effectiveness and efficiency of the proposed system were demonstrated by analyzing a sample of video footage. The proposed method was developed to balance the trade-off between costs and management, thereby improving the productivity and profitability of dairy farms; however, this method can be adapted to other domestic species.

Inflammatory Changes and Composition of Collagen during Cervical Ripening in Cows.

Dystocia and stillbirths in cows pose a high risk of loss of both dams and fetuses, thereby resulting in high economic losses. One of the causes of these problems is birth canal abnormalities. Thus, to prevent these occurrences, it is necessary to understand the mechanisms underlying cervical ripening. Although physiological inflammatory responses and changes in collagen composition have been reported in humans and mice, related information is scarce for cows. We observed inflammatory changes and changes in the collagen composition in the cervix from late pregnancy to parturition to clarify some of the physiological changes associated with cervical ripening during normal calving in cows. Cervical mucus and tissue samples were collected from 41 Japanese Black cows at 200, 230, and 260 days of gestation and at 7-day intervals thereafter until parturition. The percentage of polymorphonuclear neutrophils (PMN%) in the mucus was calculated, and interleukin (IL)-8 concentration was determined by enzyme-linked immunosorbent assay. Blood samples were collected from the jugular vein, and leukocyte counts were determined. Picrosirius red-stained cervical tissue specimens were observed under a polarizing microscope, and the percentage of type I and type III collagen areas in the cervical tissue were calculated. The PMN% in cervical mucus was lowest at 200 days gestation (12−13 weeks before delivery), significantly increased 5 weeks before (21.7 ± 0.04), and was highest 1 week before calving (50.9 ± 0.04). IL-8 levels were increased at 295 days compared with those at 200 days of pregnancy (p < 0.05). No significant changes were observed in the white blood cell counts. The percentage of type I collagen in the cervical tissue reached a maximum (91.4 ± 0.02%) on day 200, significantly decreased after 274 days (3 weeks before calving), and continued to decrease thereafter until the week of parturition. There was no significant change in type III collagen levels. The results suggest that cervical ripening progresses when PMNs begin to infiltrate the cervix at around 260 days of gestation (5−4 weeks before parturition), IL-8, which increases at the end of pregnancy, mobilizes PMNs, and enhances inflammation, and that type I collagen changes are useful as an indicator of cervical ripening.

Impact of Histological Variants on Clinical Responses to Pembrolizumab in Patients With Metastatic Urothelial Cancer.

BACKGROUND: The efficacy of anti-programmed celldeath protein 1 treatment in patients with urothelial carcinoma (UC) with molecular subtypes of histological variants has not been investigated. This study aimed to examine the impact of histological variants classified according to molecular subtypes on clinical outcomes in patients with platinum-resistant metastatic UC treated with pembrolizumab. PATIENTS AND METHODS: Data of 168 patients with metastatic UC who received intravenous pembrolizumab after platinum-based chemotherapy between December 2017 and November 2020 were retrospectively reviewed. Relationships between histological variant type (basal or luminal molecular subtypes) and survival outcome and response to immunotherapy were examined. Clinicopathological factors were analyzed using the Cox proportional hazards model. RESULTS: UC with histological variants was identified in 19 (11.3%) cases (basal subtype in 12; luminal subtype in 7). The median age of the patients was 72.5 years (range=40-89 years). The performance status was 0-1 in 151 (89.9%) patients. Liver metastasis was detected in 44 (26.2%) patients. The median progression-free survival was 3.5 months (range=0.5-34.3 months). Treatment with immune checkpoint inhibitors resulted in an overall mean survival (from the start of treatment) of 8.1 months (range=1.2-34.3 months). Patients with basal-type UC had significantly shorter progression-free survival and cancer-specific survival than those with pure UC (p=0.010 and p=0.035, respectively). A complete response was observed in eight patients (seven with pure UC, one with basal type). CONCLUSION: The basal histological variant might be a potential prognostic indicator in patients with platinum-resistant metastatic UC treated with pembrolizumab.

Usefulness of a lead-acrylic shield for reducing lens dose of assistant in x-ray CT examination.

In computed tomography (CT) examinations, the usefulness of protective glasses for reducing lens exposure to assistants has been reported. The present study aimed to compare the dose reduction effect for assistants with lead-acrylic shields and protective glasses (0.07 mm Pb, 0.5 mm Pb) during CT examination. The air dose distribution in a CT examination room with and without a lead-acrylic shield was compared. It was found that the amount of scattered radiation was significantly reduced by installing a lead-acrylic shield at the CT gantry aperture. Moreover, the reduction rate of air kerma at the assistant's lens was higher using the lead acrylic shield than with the protective glasses-95.7% during head holding and 76.1% during assisted ventilation.

Interferon gamma, lipopolysaccharide, and modified-live viral vaccines stimulation alter the mRNA expression of tumor necrosis factor α, inducible nitric oxide synthase, and interferon ß in bovine alveolar macrophages.

To understand the pathogenesis of bovine respiratory disease (BRD), it is necessary to elucidate the mechanisms of alveolar macrophage regulation by cytokines and pathogen-associated molecular patterns (PAMPs). Moreover, "non-specific effects (NSEs)" an innate immune regulatory mechanism in response to vaccines containing PAMPs, has recently attracted attention. It may be applied to BRD control, but there is limited knowledge in bovine. To investigate this, we stimulated alveolar macrophages in vitro with lipopolysaccharide (LPS), polyinosinic-polycytidylic acid sodium salt (Poly I:C), interferon gamma (IFN-γ), and modified-live viral (MLV) vaccines, respectively, and analyzed changes in tumor necrosis factor alpha (TNF-α), inducible nitric oxide synthase (iNOS), and interferon beta (IFN-ß) mRNA expression levels. mRNA expression levels of TNF-α, iNOS, and IFN-ß were significantly increased in bovine alveolar macrophages stimulated by IFN-γ and MLV vaccine; LPS, IFN-γ, and MLV vaccine; and MLV vaccine only, respectively. Additionally, all MLV vaccine-stimulated mRNA expression increases were observed in a concentration-dependent manner. These results revealed in part, the mechanism of bovine alveolar macrophage regulation by cytokines and PAMPs. Understanding the regulatory mechanisms of alveolar macrophages will contribute to understanding the pathogenesis of BRD and preventive and therapeutic BRD management based on NSEs.

Antibiotic-resistant Escherichia coli isolated from dairy cows and their surrounding environment on a livestock farm practicing prudent antimicrobial use.

On a livestock farm where antimicrobial administration and its history had been managed for prudent use of antimicrobials, we surveyed antibiotic-resistant Escherichia coli strains isolated from cow feces and the surrounding environment (i.e., rat and crow feces, and water samples from a drainage pit and wastewater processing tank) every month for 1 year. Two strains (1.7%) in cow feces were resistant to tetracycline, whereas all other strains were susceptible to all other antimicrobials. Among 136 strains isolated from cows and wild animals, only one ampicillin-resistant strain was identified. The antibiotic resistance rate in the drainage from the barn was 8.3% (10/120), and all strains showed susceptibility for 8 months of the year. Tetracycline resistance was common in all resistant strains isolated from animal feces and water samples; all tetracycline-resistant strains carried tetA. These results strongly support the proper use and management of antibiotics on farms to minimize the outbreak and spread of antibiotic-resistant bacteria.

Monitoring and Protection against Radiation Dose to Eyes of Operators Performing Neuroendovascular Procedures: A Nationwide Study in Japan.

Objective: To meet the new standard of the annual dose limit for the eye lens recommended by the International Commission on Radiation Protection, radiation doses of neuroendovascular procedures in Japanese institutions were investigated. Methods: Radiation doses to operators involved in 304 neuroendovascular procedures at 30 Japanese institutions were prospectively surveyed. The institutions recruited at an annual meeting of the Japanese Society for Neuroendovascular Therapy participated voluntarily. A maximum of 10 wireless dosimeters were attached to the radiation protection (RP) goggles, the ceiling-mounted RP shielding screen, and the operators' forehead and neck over the protective clothing. Doses recorded inside the goggles were defined as eye lens doses for operators who wore RP goggles, while doses to the forehead were defined as eye lens doses for those who did not. The shielding effect rates of the protection devices were calculated, and statistical analysis was performed for the comparison of radiation doses. Results: From 296 analyzed cases, mean eye lens radiation doses per procedure were 0.088 mGy for the left eye and 0.041 mGy for the right eye. For the left eye, that dose without RP equipment was 0.176 mGy and that with RP goggles plus an RP shielding screen was 0.034 mGy. Four parameters, including left eye dose, air kerma at the patient entrance reference point, fluoroscopic time, and the total number of frames, were assessed for five types of neurovascular procedures. Of them, transarterial embolization for dural arteriovenous fistula was associated with the highest eye lens dose at 0.138 mGy. The shielding effect rates of protection goggles were 60% for the left and 55% for the right RP goggle. The mean doses to the inner and outer surfaces of the RP shielding screen were 0.831 mGy and 0.040 mGy, respectively, amounting to a shielding effect rate of 95%. Conclusion: To meet the new standard, both RP goggles and RP shielding screens are strongly recommended to be used effectively. Without proper use of radiological protection devices, the number of neuroendovascular procedures that one operator performs per year will be limited under the new guideline.

An Absorbing Markov Chain Model to Predict Dairy Cow Calving Time.

Abnormal behavioral changes in the regular daily mobility routine of a pregnant dairy cow can be an indicator or early sign to recognize when a calving event is imminent. Image processing technology and statistical approaches can be effectively used to achieve a more accurate result in predicting the time of calving. We hypothesize that data collected using a 360-degree camera to monitor cows before and during calving can be used to establish the daily activities of individual pregnant cows and to detect changes in their routine. In this study, we develop an augmented Markov chain model to predict calving time and better understand associated behavior. The objective of this study is to determine the feasibility of this calving time prediction system by adapting a simple Markov model for use on a typical dairy cow dataset. This augmented absorbing Markov chain model is based on a behavior embedded transient Markov chain model for characterizing cow behavior patterns during the 48 h before calving and to predict the expected time of calving. In developing the model, we started with an embedded four-state Markov chain model, and then augmented that model by adding calving as both a transient state, and an absorbing state. Then, using this model, we derive (1) the probability of calving at 2 h intervals after a reference point, and (2) the expected time of calving, using their motions between the different transient states. Finally, we present some experimental results for the performance of this model on the dairy farm compared with other machine learning techniques, showing that the proposed method is promising.

Safety of adjuvant gemcitabine plus cisplatin chemotherapy in a patient with bilateral ureteral cancer undergoing hemodialysis.

An 80 year old Japanese man with bilateral ureteral cancer underwent laparoscopic bilateral nephroureterectomy and lymph-node dissection. The pathological stage of the left and right ureteral tumors was pT3pN0M0. He received two courses of adjuvant gemcitabine and cisplatin chemotherapy while undergoing hemodialysis. The standard dose of gemcitabine and 50% of the standard dose of cisplatin were administered on the same day. Hemodialysis was started 6 h after gemcitabine administration and 1 h after cisplatin administration. The side effects were evaluated according to the Common Terminology Criteria for Adverse Events v4.0. In the first course, Grade 4 side effects including leukopenia, neutropenia, and thrombocytopenia were observed. He was treated with granulocyte colony-stimulating factor and platelet transfusion. Because the second course was administered without reducing the doses, granulocyte colony-stimulating factor was administered prophylactically, and Grade 4 side effects were reduced to Grade 3. Gemcitabine plus cisplatin chemotherapy can be administered safely in a patient with advanced ureteral cancer undergoing hemodialysis by adequately managing adverse events.