Risk of hepatic steatosis with the preoperative treatment of pancreatic cancer and the short-term postoperative outcomes.

PURPOSE: We investigated whether the preoperative treatment of patients with pancreatic cancer is a risk factor for hepatic steatosis (HS), and whether preoperative HS affects the short-term postoperative outcomes. METHODS: Patients who underwent radical surgery for pancreatic cancer between 2010 and 2023 were enrolled. The patients' medical records were reviewed. Albumin and carbohydrate antigen 19-9 were measured before and after chemotherapy in the patients who received preoperative chemotherapy. A logistic regression univariate analysis was performed to analyze the factors associated with new-onset HS. RESULTS: A total of 230 patients who underwent surgery were included. HS was observed on the date of surgery in 11 (10%) and two (2%) patients with and without preoperative chemotherapy, respectively. Female sex, initially borderline resectable or unresectable disease, history of cholangitis, presence of PEI, long-term (≥ 3 months) biliary drainage, preoperative chemotherapy, and serum albumin ≥ 3.9 mg/dl before chemotherapy were identified as risk factors for HS. The incidence of postoperative morbidity did not differ between the patients with and without preoperative steatosis. CONCLUSIONS: Preoperative chemotherapy, a history of cholangitis, the presence of PEI, and ≥ 3 months' duration of biliary drainage were risk factors for the development of HS before surgery for pancreatic cancer. However, preoperative HS did not affect the short-term postoperative outcomes.

Pancreatic cancer with liver metastasis maintaining complete response with gemcitabine monotherapy: A case report.

Pancreatic ductal adenocarcinoma (PDAC) is associated with a poor prognosis, and it has a recurrence rate of >70%, even in resectable cases. The treatment strategy for recurrent PDAC involves systemic chemotherapy, with gemcitabine (GEM) monotherapy historically serving as the standard of care. The present study describes the case of a patient with PDAC and postoperative liver metastases that maintained clinical complete remission (cCR) for >7 years following GEM monotherapy. A 63-year-old woman with upper abdominal pain was diagnosed with resectable PDAC and underwent pancreaticoduodenectomy. The patient was treated with GEM + S-1 as adjuvant chemotherapy for 6 months. Multiple liver metastases were detected 15 months post-operation and the patient was administered GEM alone. After 12 cycles, computed tomography showed cCR and GEM monotherapy was discontinued after 15 cycles. The patient has had no signs or symptoms of recurrence >7 years after the first recurrence. In addition, the present study analyzed PDAC resection specimens from four patients, including this case, to determine the expression levels of hENT1 protein in the tumor tissues. hENT1 is a transmembrane protein that acts as a nucleoside transporter and is a major mediator of GEM uptake into human cells. In the present case, hENT1 staining exhibited low frequency and weak positivity in the central region, whereas a strong positive reaction was observed in nearly all cell membranes at the invasive front of the cancer. The location, intensity, and frequency of hENT1 staining varied among cases. In conclusion, the efficacy of GEM may be predicted prior to treatment by evaluating hENT1 expression.

Multiple metastases of human epidermal growth factor receptor 2­positive, hormone receptor­positive, pT1a pN0 breast cancer within 1 year after surgery: A case report.

Adjuvant chemotherapy is usually not considered for pT1a pN0 human epidermal growth factor receptor 2 (HER2)-positive breast cancer due to its low recurrence rate. The present report describes a case of pT1a hormone receptor-positive HER2-positive breast cancer with multiple recurrences in the axillary lymph nodes and liver within 1 year after radical surgery. A 58-year-old woman underwent left total mastectomy and sentinel lymph node biopsy for left breast cancer with pathological stage IA (pT1a pN0). The subtype corresponded to luminal B-like breast cancer with a nuclear grade of 3 and a Ki-67 labeling index of 37%. An aromatase inhibitor (letrozole) was planned to be administered for 5 years after surgery, but the patient was diagnosed with multiple liver and axillary lymph node metastases 11 months after surgery. After 1 year of chemotherapy (paclitaxel) in combination with anti-HER2 therapy (pertuzumab and trastuzumab), liver metastases resolved. A complete response of the liver lesion has been maintained 4 years after the anti-HER2 therapy initiation. The present case exhibited two poor prognostic factors: High Ki-67 labeling index and nuclear grade 3. Based on the 'Predict' tool, the present case would be expected to have a cancer-related mortality rate of 6% 10 years after surgery with adjuvant endocrine therapy. Although this value may be controversial for postoperative anti-HER2 therapy, the present case should not be considered to be a low-risk case. When the identification of high-risk pT1a pN0 HER2-positive breast cancer is possible, postoperative anti-HER2 therapy plus chemotherapy would be effective in decreasing the rate of recurrence.

Preoperative CA19­9 level and dual time point FDG­PET/CT as strong biological indicators of borderline resectability in pancreatic cancer: A retrospective study.

Tumor resectability, which is increasingly determined based on preoperative chemotherapy, is critical in determining the best treatment for pancreatic cancers. The present study evaluated the usefulness of serum carbohydrate antigen 19-9 (CA19-9) and the preoperative 8F-fluorodeoxyglucose positron emission tomography/computed tomography standardized uptake value (SUV) percentage change (SUVmax%=[(SUVmax2-SUVmax1)/SUVmax1] ×100, where SUVmax1 and SUVmax2 represent the initial and delayed phases, respectively) as biological factors indicative of tumor resectability. The present study included patients with resectable pancreatic cancer who underwent complete surgical resection, for whom both CA19-9 and SUVmax% were documented using cut-off values of 500 U/ml and 24.25%, respectively. Patients were classified as follows: i) High CA19-9 and SUVmax%: both CA19-9 and SUVmax% were elevated; ii) high CA19-9 or SUVmax%: either CA19-9 or SUVmax% were elevated; or iii) low CA19-9 and SUVmax%: neither value met the cut-off. Relapse-free survival (RFS) and overall survival (OS) were calculated, for which univariate and multivariate analyses were performed. Of the 86 patients included, 39 were classified as high CA19-9 or SUVmax% and 12 as high CA19-9 and SUVmax%, with the former group having a significantly worse RFS (vs. low CA19-9 and SUVmax%; P<0.001; vs. high CA19-9 or SUVmax%; P=0.011) and OS (vs. low CA19-9 and SUVmax%, P=0.002; vs. high CA19-9 or SUVmax%, P<0.001). Therefore, high CA19-9 and SUVmax% was an independent predictor of worse RFS (P<0.001) and OS (P=0.003). In conclusion, CA19-9 and SUVmax% can be utilized as biological indicators of resectability.

Predictors of postoperative storage symptoms in male patients with lower urinary tract symptoms: A retrospective analysis of prostate surgery for benign prostatic enlargement.

OBJECTIVES: This study investigated the effects of prostate surgery on storage symptoms in male patients with lower urinary tract symptoms (LUTS) from benign prostatic enlargement (BPE). This study aimed to identify patient characteristics associated with improved, unchanged, and deteriorated post-surgical storage symptoms and to identify the risk factors for non-improvement or deterioration. METHODS: A retrospective analysis of 586 prostate surgeries performed between 2016 and 2022 at Yokosuka Kyosai Hospital was conducted on patients with LUTS and at least one storage symptom preoperatively. Patients with active urinary tract infection, prostate/bladder cancer, urethral strictures, or dementia were excluded. The study enrolled 230 patients and assessed storage symptoms using the International Prostate Symptom Score (IPSS). RESULTS: Overall, storage symptoms improved, remained unchanged, and deteriorated in 87.0%, 5.7%, and 7.4% of patients, respectively. The patients in the deteriorated group were significantly older, whereas those in the no-change group had smaller prostate volumes. Patient-reported outcome scores (IPSS, IPSS-QoL, and BII) were significantly higher in the improved group. The predictors of non-improvement included low IPSS storage score, cardiovascular disease, and diabetes mellitus. Predictors of deterioration included advanced age and low IPSS storage score. CONCLUSIONS: Patients with severe LUTS showed greater postoperative improvement in storage symptoms. A low IPSS storage score predicted non-improvement and deterioration. Advanced age, low IPSS storage score, and a history of cardiovascular disease and diabetes mellitus were identified as key predictors. Awareness of these factors may guide preoperative counseling and improve decision-making in prostate surgery, ensuring more personalized and effective treatment strategies.

Carbon monoxide-loaded cell therapy as an exercise mimetic for sarcopenia treatment.

Sarcopenia is characterized by loss of muscle strength and muscle mass with aging. The growing number of sarcopenia patients as a result of the aging population has no viable treatment. Exercise maintains muscle strength and mass by increasing peroxisome growth factor activating receptor γ-conjugating factor-1α (PGC-1α) and Akt signaling in skeletal muscle. The present study focused on the carbon monoxide (CO), endogenous activator of PGC-1α and Akt, and investigated the therapeutic potential of CO-loaded red blood cells (CO-RBCs), which is bioinspired from in vivo CO delivery system, as an exercise mimetic for the treatment of sarcopenia. Treatment of C2C12 myoblasts with the CO-donor increased the protein levels of PGC-1α which enhanced mitochondrial biogenesis and energy production. The CO-donor treatment also activated Akt, indicating that CO promotes muscle synthesis. CO levels were significantly elevated in the skeletal muscle of normal mice after intravenous administration of CO-RBCs. Furthermore, CO-RBCs restored the mRNA expression levels of PGC-1α in the skeletal muscle of two experimental sarcopenia mouse models, denervated (Den) and hindlimb unloading (HU) models. CO-RBCs also restored muscle mass in Den mice by activating Akt signaling and suppressing the muscle atrophy factors myostatin and atrogin-1, and oxidative stress. Treadmill tests further showed that the reduced running distance in HU mice was significantly restored by CO-RBC administration. These findings suggest that CO-RBCs have potential as an exercise mimetic for sarcopenia treatment.

[A Case of Testicular Torsion of Retractile Testis Requiring Orchidectomy].

We report a case of testicular torsion in an 8-year-old who was referred to our hospital for right groin pain. He was diagnosed with right retractile testis during a 12-month check-up. However, instead of performing orchiopexy, he was placed under observation until the age of 5, after which he did not seek medical attention. Physical examination revealed swelling and tenderness in the right inguinal region and no palpable testis in the right scrotum. Ultrasound and computed tomography revealed right testicular torsion, and emergency surgery was performed. Intraoperative findings revealed a dark and ischemic testis that was twisted at 180°in the right inguinal region. There was no improvement in blood flow even after the testicular torsion was released; therefore, right orchidectomy with left orchiopexy was performed. Although the incidence of testicular torsion is higher in patients with an undescended testis than in those with a normally positioned scrotal position testis, reports of testicular torsion associated with a retractile testis are rare.

First atroposelective Chan-Lam coupling for the synthesis of C-N linked biaryls.

The first atroposelective Chan-Lam coupling for the synthesis of C-N axial enantiomers is reported with good yields and ee. MnO2 additive is crucial for the success of the coupling. The longstanding problem of the lack of enantioselective synthesis to make chiral C-N linked atropisomers is solved.

Predicting Prostate Surgery Outcomes from Standard Clinical Assessments of Lower Urinary Tract Symptoms To Derive Prognostic Symptom and Flowmetry Criteria.

BACKGROUND: Assessment of male lower urinary tract symptoms (LUTS) needs to identify predictors of symptom outcomes when interventional treatment is planned. OBJECTIVE: To develop a novel prediction model for prostate surgery outcomes and validate it using a separate patient cohort and derive thresholds for key clinical parameters. DESIGN, SETTING, AND PARTICIPANTS: From the UPSTREAM trial of 820 men seeking treatment for LUTS, analysis of bladder diary (BD), International Prostate Symptom Score (IPSS), IPSS-quality of life, and uroflowmetry data was performed for 176 participants who underwent prostate surgery and provided complete data. For external validation, data from a retrospective database of surgery outcomes in a Japanese urology department (n = 227) were used. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Symptom improvement was defined as a reduction in total IPSS of ≥3 points. Multiple logistic regression, classification tree analysis, and random forest models were generated, including versions with and without BD data. RESULTS AND LIMITATIONS: Multiple logistic regression without BD data identified age (p = 0.029), total IPSS (p = 0.0016), and maximum flow rate (Qmax; p = 0.066) as predictors of outcomes, with area under the receiver operating characteristic curve (AUC) of 77.1%. Classification tree analysis without BD data gave thresholds of IPSS <16 and Qmax ≥13 ml/s (AUC 75.0%). The random forest model, which included all clinical parameters except BD data, had an AUC of 94.7%. Internal validation using the bootstrap method showed reasonable AUCs (69.6-85.8%). Analyses using BD data marginally improved the model fits. External validation gave comparable AUCs for logistic regression, classification tree analysis, and random forest models (all without BD; 70.9%, 67.3%, and 68.5%, respectively). Limitations include the significant number of men with incomplete baseline data and limited assessments in the external validation cohort. CONCLUSIONS: Outcomes of prostate surgery can be predicted preoperatively using age, total IPSS, and uroflowmetry data, with prognostic thresholds of 16 for IPSS and 13 ml/s for Qmax. PATIENT SUMMARY: This study identified key preoperative factors that can predict outcomes of prostate surgery for bothersome urinary symptoms, including which patients are at risk of a poor outcome.

Influence of tract location on the outcomes of endoscopic combined intrarenal surgery: A retrospective analysis of 1000 cases.

OBJECTIVES: This study aimed to investigate the influence of tract location on surgical outcomes in endoscopic combined intrarenal surgery (ECIRS), considering the location of residual stones. METHODS: From January 2015 to December 2021, 1417 consecutive patients underwent ECIRS in three hospitals. After excluding patients with preoperative percutaneous nephrostomy, intended multi-stage procedures, those with a tract in the renal pelvis, and those with multiple tracts, 1000 patients were retrospectively analysed by comparing three groups based on tract location: group 1 (upper calyx), group 2 (middle calyx), and group 3 (lower calyx). A multivariate logistic regression model was implemented to assess whether the tract location independently affected the stone-free status. RESULTS: Patient characteristics were significantly different among the groups in terms of age, stone laterality, presence of calyceal stones, and hydronephrosis. There were no differences in stone-free rate (SFR) among the three groups. Multivariate analysis indicated that the tract location (group 1 or 2 compared with group 3) did not significantly affect the stone-free status (odds ratio = 1.4, 0.9-1.9, p = 0.066). Surgical duration significantly varied among the groups, with the shortest time observed in group 1. Organ injury was observed exclusively in group 1 (1.13%). Residual fragments were predominantly found in the lower calyx, with the calyx associated with the tract being the second most common location. CONCLUSIONS: Tract location does not significantly affect SFR. To improve the SFR, observation of the lower calyx and tract placement is important.

Models to predict the surgical outcome of mini-ECIRS (endoscopic combined intrarenal surgery) for renal and/or ureteral stones.

To establish a safer and more efficient treatment strategy with mini-endoscopic combined intrarenal surgery (ECIRS), the present study aimed to develop models to predict the outcomes of mini-ECIRS in patients with renal and/or ureteral stones. We retrospectively analysed consecutive patients with renal and/or ureteral stones who underwent mini-ECIRS at three Japanese tertiary institutions. Final treatment outcome was evaluated by CT imaging at 1 month postoperatively and stone free (SF) was defined as completely no residual stone or residual stone fragments ≤ 2 mm. Three prognostic models (multiple logistic regression, classification tree analysis, and machine learning-based random forest) were developed to predict surgical outcomes using preoperative clinical factors. Clinical data from 1432 ECIRS were pooled from a database registered at three institutions, and 996 single sessions of mini-ECIRS were analysed in this study. The overall SF rate was 62.3%. The multiple logistic regression model consisted of stone burden (P < 0.001), number of involved calyces (P < 0.001), nephrostomy prior to mini-ECIRS (P = 0.091), and ECOG-PS (P = 0.110), wherein the area under the curve (AUC) was 70.7%. The classification tree analysis consisted of the number of involved calyces with an AUC of 61.7%. The random forest model showed that the top predictive variable was the number of calyces involved, with an AUC of 91.9%. Internal validation revealed that the AUCs for the multiple logistic regression model, classification tree analysis and random forest models were 70.4, 69.6 and 85.9%, respectively. The number of involved calyces, and a smaller stone burden implied a SF outcome. The machine learning-based model showed remarkably high accuracy and may be a promising tool for physicians and patients to obtain proper consent, avoid inefficient surgery, and decide preoperatively on the most efficient treatment strategies, including staged mini-ECIRS.

Facile preparation of polycyclic halogen-substituted 1,2,3-triazoles by using intramolecular Huisgen cycloaddition.

When 1-(ω-azidoalkyl)-2-(2,2-dihalovinyl)arenes were heated in DMF, the intramolecular Huisgen cycloaddition of an azido group with a 1,1-dihalovinyl group afforded 5-halo-1,2,3-triazole-fused tricyclic benzo compounds. Based on the remaining bromo groups, carbon elongation by the Mizoroki-Heck or Suzuki-Miyaura coupling reactions, followed by an intramolecular Friedel-Crafts reaction, afforded polycyclic compounds with fused triazole rings. Thereafter, the bromo groups were converted into 2-nitrophenyl groups via the Suzuki-Miyaura coupling reaction, which was followed by the Cadogan reaction; a fluorescent pentacyclic compound was obtained.

Carbon Monoxide-Loaded Red Blood Cell Prevents the Onset of Cisplatin-Induced Acute Kidney Injury.

Cisplatin-induced acute kidney injury (AKI) is an important factor that limits the clinical use of this drug for the treatment of malignancies. Oxidative stress and inflammation are considered to be the main causes of not only cisplatin-induced death of cancer cells but also cisplatin-induced AKI. Therefore, developing agents that exert antioxidant and anti-inflammatory effects without weakening the anti-tumor effects of cisplatin is highly desirable. Carbon monoxide (CO) has recently attracted interest due to its antioxidant, anti-inflammatory, and anti-tumor properties. Herein, we report that CO-loaded red blood cell (CO-RBC) exerts renoprotective effects on cisplatin-induced AKI. Cisplatin treatment was found to reduce cell viability in proximal tubular cells via oxidative stress and inflammation. Cisplatin-induced cytotoxicity, however, was suppressed by the CO-RBC treatment. The intraperitoneal administration of cisplatin caused an elevation in the blood urea nitrogen and serum creatinine levels. The administration of CO-RBC significantly suppressed these elevations. Furthermore, the administration of CO-RBC also reduced the deterioration of renal histology and tubular cell injury through its antioxidant and anti-inflammatory effects in cisplatin-induced AKI mice. Thus, our data suggest that CO-RBC has the potential to substantially prevent the onset of cisplatin-induced AKI, which, in turn, may improve the usefulness of cisplatin-based chemotherapy.

Time-Resolved Structural Analysis of Fast-Photoresponsive Surfactant Micelles by Stroboscopic Small-Angle Neutron Scattering.

Photoresponsive materials are garnering attention because of their applications toward building a sustainable society. A recently developed fast-photoresponsive amphiphilic lophine dimer (3TEG-LPD) responds rapidly to light, making it a promising candidate for drug-delivery systems. In this study, the mechanism of structural changes induced by ultraviolet (UV) irradiation in 3TEG-LPD micelles in an aqueous solution was investigated via an in situ time-resolved small-angle neutron scattering (SANS) technique. Since subsecond resolution was necessary to observe the structural changes in the 3TEG-LPD micelles, stroboscopic SANS analysis was employed to obtain scattering profiles with a time width of 0.5 s. The structural parameters were quantitatively determined by performing a model-fitting analysis of the SANS results. The stroboscopic SANS results showed that upon UV irradiation, the axial ratio and pseudo-aggregation number of the 3TEG-LPD micelles increased by 1.8 and 1.6 times, respectively, whereas the number of water molecules per surfactant molecule decreased. This finding suggested that the change in the shape of the micelles from spherical to ellipsoidal shape was accompanied by dehydration. Under the present UV irradiation conditions, this structural change of the micelle occurred rapidly during the first 30 s after the start of UV irradiation. Each structural parameter recovered exponentially and reversibly during the recovery process after the cessation of UV irradiation. The changes in these parameters were analyzed in terms of kinetics by comparing them with the changes in the molecular structure. We found that the change of the micelles proceeds approximately twice as fast as the association of the molecule. Furthermore, from the perspective of the critical packing parameter consideration, the SANS analysis revealed that the UV-induced changes in 3TEG-LPD micelles are dominated by the enthalpy contribution. This finding is expected to be useful for developing new materials for various applications.

Splenic Infarction Associated With Epstein-Barr Virus in an Adult With an Anatomic Anomaly: A Case Report.

Splenic infarction (SI) is often associated with circulatory and hematological diseases and infections. Here, we report a rare case of SI in an adult with infectious mononucleosis (IM) caused by the Epstein-Barr (EB) virus. A 31-year-old male with an unremarkable medical history presented with abdominal pain and fever. Contrast-enhanced computed tomography revealed focal SI. The splenic artery branching from the superior mesenteric artery was <5 mm in diameter. The diagnosis of EB virus infection was made based on physical examination and blood test results. As no evidence of cardiogenic disease, malignant lymphoma, or other infections were present, a diagnosis of SI associated with IM was made. A symptomatic treatment was administered, and the splenomegaly and SI improved two weeks after discharge. IM was assumed as the cause of the focal SI.

Predictive factors for the success of trial without catheter for men with urinary retention.

OBJECTIVE: To investigate the trial of spontaneous urination without catheter (TWOC) outcomes for men with acute urinary retention, determine successful TWOC predictors, and evaluate the impact of add-on medication therapy on TWOC. METHODS: This retrospective study included men with acute urinary retention and post-void residual (PVR) >250 mL who underwent TWOC between July 2009 and July 2019. Patients were divided into a medicated group who received alpha1 blocker on urinary retention diagnosis and a naïve group who did not. The trial was defined as unsuccessful if the PVR was >150 mL or if the patient experienced difficulty emptying their bladder with abdominal discomfort or pain, and a transurethral catheter was reinserted. RESULTS: Among 576 men with urinary retention, 269 (46.7%) constituted the medicated group and 307 (53.3%) the naïve. The naïve group comprised more elderly patients (P = 0.010) with higher Eastern Cooperative Oncology Group performance status (PS) (P = 0.001) and smaller prostate volume (P = 0.028) than the other. In the medicated group, 153 men received additional oral medication before TWOC to increase the success rate. There were significant age differences (P = 0.041) in the medicated group and significant median PS differences (P = 0.010) in the naïve group between the successful and unsuccessful outcomes of TWOC. The multivariate logistic regression model demonstrated that age <80 years in medicated patients (P = 0.042, odds ratio [OR] 1.701) and PS <2 in naïve patients (P = 0.001, OR 2.710) were significant independent predictors of successful TWOC outcomes. CONCLUSIONS: This is the first study classifying patients with urinary retention according to medication status. Both medicated and naïve groups had different patient backgrounds and TWOC outcome predictors, suggesting a discrepant etiology behind urinary retention. Hence, acute urinary retention management in men should vary based on medication status for male lower urinary tract symptoms when urinary retention is diagnosed.

Comparison of the short-term efficacy and safety of bipolar transurethral electro vaporization and holmium laser enucleation of the prostate for moderate and large benign prostatic enlargement.

BACKGROUND: To compare the efficacy and safety of bipolar transurethral vaporization of the prostate (B-TUVP) with holmium laser enucleation of the prostate (HoLEP) for moderate [prostate volume (PV) 30-80 ml] and large (≥ 80 ml) benign prostatic enlargement (BPE). MATERIALS AND METHODS: Male patients with lower urinary tract symptom (LUTS) or urinary retention who underwent B-TUVP or HoLEP treatment in two regional centers were respectively enrolled. Patient characteristics and treatment outcomes were retrospectively compared between B-TUVP and HoLEP. RESULTS: In patients with moderate and large prostate volume,B-TUVP showed shorter operative time (P < 0.001) and less hemoglobin decrease (P < 0.001) than in HoLEP. In uncatheterised patients, voiding symptoms and patients' quality of life improved after B-TUVP and HoLEP, but these improvement rates were consistently bigger in HoLEP than in B-TUVP. In catheterised patients, the rate of achieving catheter-free status after surgery was higher in HoLEP than in B-TUVP for patients with PV > 80 ml.(P < 0.001) The incidence of postoperative fever was higher in B-TUVP than in HoLEP for patients with PV 30-80 ml (P < 0.001) but not for those with PV > 80 ml.(P=0.08) The Incidence of postoperative stress incontinence(SUI) was higher in HoLEP than in B-TUVP for patients with moderate and large prostate volume. CONCLUSIONS: There are few studies that investigated the short-term efficacy and safety of second-generation B-TUVP in comparison with HoLEP for moderate and large BPE. Improvement in LUTS and achievement of catheter-free status were predominant in HoLEP, and these outcomes were more prominent in patients with large BPE of PV > 80 ml. However, B-TUVP resulted in less blood loss, shorter operative duration, and less SUI suggesting that B-TUVP is also well-tolerated surgical modality.

Prognosis of Pancreatic Cancer Based on Resectability: A Single Center Experience.

Although conversion surgery has increasingly been performed for initially unresectable advanced pancreatic ductal adenocarcinoma (PDAC), the rate of conversion, including that for patients who do not undergo resection, remains unclear. Patients with PDAC who were treated between January 2013 and December 2018 were classified into three groups: resectable (R), borderline resectable (BR), and unresectable (UR). We analyzed patient outcomes, including the rate of surgical resection and survival, in each of these groups. In total, 211 patients (R, 118; BR, 22; UR, 81) were selected. Among them, 117 (99%), 18 (82%), and 15 (19%) patients in the R, BR, and UR groups, respectively, underwent surgical resection. R0 resection rates were 88, 78, and 67%, whereas median overall survival (OS) from treatment initiation were 31, 18, and 11 months (p < 0.0001) in the R, BR, and UR groups, respectively. In patients who underwent surgical resection, relapse-free survival (RFS) and OS were similar among the three groups (R vs. BR vs. UR; median RFS (months), 17 vs. 13 vs. 11, p = 0.249; median OS (months), 31 vs. 26 vs. 32, p = 0.742). Lymph node metastases and incomplete adjuvant chemotherapy were identified as independent prognostic factors for OS. Although the surgical resection rate was low, particularly in the BR and UR groups, the prognosis of patients who underwent surgical resection was similar irrespective of the initial resectability status.

Clinical Factors to Predict Difficult Ureter during Ureteroscopic Lithotripsy.

Objective: To identify risk factors for difficult ureters during ureteroscopic lithotripsy and to determine the appropriate indications for preoperative stenting. Methods: We retrospectively analyzed 156 ureteroscopic procedures for upper urinary tract stones after excluding those with preoperative stenting or percutaneous nephrostomy. Traceability of the ureter was assessed by two urologists. Traceability was defined as positive if either or both urologists discerned the ureter in all slices on preoperative plain computed tomography. Patients' backgrounds were compared between the nondifficult ureter and difficult ureter groups. A multivariate logistic regression model was used to evaluate the relationships between difficult ureters and other clinical factors. Results: Of 156 patients, 31 (19.9%) were classified into the difficult ureter group. The positive traceability was higher in the nondifficult ureter group (48.3% vs. 83.2%, P < 0.001). The major axis was smaller in the difficult ureter group than in the nondifficult ureter group (8.8 ± 3.9 mm vs. 10.9 ± 4.5 mm, P < 0.018). A major axis <8 mm (odds ratio: 4.495, 95% confidence interval: 1.791-11.278, and P=0.001), negative traceability (odds ratio: 7.565, 95% confidence interval: 2.693-21.248, and P < 0.001), smoking status (odds ratio: 3.196, 95% confidence interval: 1.164-8.773, and P=0.024), and absence of diabetes mellitus (odds ratio: 5.813, 95% confidence interval: 1.121-30.142, and P=0.036) were identified as independent predictors of difficult ureters on multivariate logistic regression analysis. Conclusion: Patients with smaller stones, negative traceability, ongoing tobacco consumption, and absence of diabetes mellitus were at higher risk of difficult ureters. In these patients, preoperative stenting may be considered.

Predictive factors for the success of trial catheter removal for women with urinary retention.

OBJECTIVE: To investigate the outcome, determine the predictors for the success of, and evaluate the efficacy of pharmacokinetic therapy on trial catheter removal for women with urinary retention. METHODS: Inclusion criteria were female patients with acute urinary retention defined as painful, palpable, or percussive bladder, when the patient is unable to pass any urine, accompanied by postvoid residual (PVR) > 250 ml, and who underwent trial catheter removal between July 2009 and July 2019. Before trial catheter removal, alpha-blockers alone or alpha-blockers and parasympathomimetics (bethanechol or distigmine bromide) were used to facilitate spontaneous voiding in some cases. RESULTS: Fifty-nine of 104 (56.7%) women with urinary retention were catheter-free post trial. There was no significant difference between successful and non-successful trials in average age (p = .392), median ECOG (Eastern Cooperative Oncology Group) performance status (p = .374), diabetes mellitus (p = .842), dementia (p = .801), previous history of cerebrovascular events (p = .592), or intrapelvic surgery (p = .800). Oral medications were administered for 39/59 (66.1%) in the success group and 30/45 (66.7%) patients in the non-success groups (p = .598). Serum albumin (3.2 ± 0.7 g/dl and 2.8 ± 0.8 g/dl, p = .039) and total protein values (6.5 ± 0.8 g/dl and 6.0 ± 1.0 g/dl, p = .038) at diagnosis of urinary retention were higher in the success group than the non-success group, respectively. Multivariate logistic regression found that a serum albumin >3 g/dl was an independent predictor of successful trial catheter removal for women with urinary retention (p = .030, odds ratio [OR] 3.3, 95% confidence interval [CI] of OR 1.1-9.9). Age < 70 years old was a likely predictor of successful trial catheter removal (p = .066, OR 4.8, 95% CI of OR 0.9-25.0). CONCLUSIONS: This is the first retrospective study to investigate the predictive factors for successful trial catheter removal in women with urinary retention. A serum albumin value >3 mg/dl at diagnosis of urinary retention was a significant independent predictor of catheter-free status after trial catheter removal, and age < 70 years-old was a possible contributor. There was no evidence that oral medication contributed to catheter-free status.