Remission Depth in Metastatic Hormone-Sensitive Prostate Cancer Is Associated With Prognosis in Patients With Initial Prostate-Specific Antigen Values Above 100 Ng/ML.

INTRODUCTION: Recently, new drugs have caused a paradigm shift in the treatment of metastatic hormone-sensitive prostate cancer (HSPC). Meanwhile, research has identified several prognostic factors of metastatic HSPC. OBJECTIVE: The present study focused on remission depth in metastatic HSPC and evaluated its association with remission depth. METHOD: We analyzed 427 patients diagnosed with metastatic HSPC with serum initial prostate-specific antigen (PSA) > 100 ng/ml. The nadir serum PSA value was used as a marker of remission depth for each duration to castration resistance by using receiver operating characteristic (ROC) curves. Cox proportional hazards regression was used to assess for any correlation of progression-free survival (PFS) and overall survival (OS) with the nadir PSA level. RESULTS: The cut-off value for the nadir PSA level per time to castration resistance (TTCR) at three, five, seven, and nine years was calculated. The nadir PSA value alone was able to predict prognosis because of its high sensitivity, high specificity, and high AUC in ROC analysis. The nadir PSA level can be an independent prognostic marker not only for TTCR but also for OS on multivariate analysis. CONCLUSION: We identified the cut-off value for nadir PSA per TTCR period in patients with metastatic HSPC. The nadir PSA value alone can predict prognosis; this demonstrates utility in routine clinical practice due to its simplicity and accuracy.

Utility of periodic medical questionnaires and examinations for immune-related adverse event screening: A prospective observational study.

BACKGROUND: Immune checkpoint inhibitors (ICIs) are associated with immune-related adverse events (irAEs) specific to the immunity-boosting activity of the drugs and may necessitate discontinuation of treatment depending on their severity. IrAEs may be difficult to diagnose in their early stages as they can occur in any organ. The present, prospective, observational study is the first to attempt to assess the utility of periodic medical questionnaires and laboratory, radiological, and physiological examinations in diagnosing irAEs. METHODS: We analyzed 51 patients who received immunotherapy for metastatic renal or urothelial carcinoma at Tokyo Metropolitan Tama Medical Center between 2016 and 2020. A medical questionnaire consisting of 41 questions and laboratory tests were administered to the patients on the day of each ICI administration and 1 week afterwards. A significant complaint was defined as a complaint not addressed in the questionnaire immediately prior to the first ICI administration. RESULTS: Fifty-one patients with metastatic renal or urothelial carcinoma were enrolled. The mean age was 72.1 years (range: 54-88 years). The male: female ratio was 32: 19. Of the total cohort, 26 (51%) patients had renal carcinoma, and 25 (49%) had urothelial carcinoma. The median follow-up time was 2.6 (range: 0.4-40.7) months. Thirty-three patients (65%) experienced irAEs. CONCLUSIONS: In our cohort, periodic medical questionnaires and examinations were effective for early diagnosis and prompt treatment of irAEs. Although periodic examinations led to a high irAE diagnosis rate, the attendant medical cost was high. Further study is needed to find ways of addressing this issue.

Safe administration of ipilimumab plus nivolumab to a dialysis patient with renal cell carcinoma.

INTRODUCTION: The combination of ipilimumab plus nivolumab has been used as first-line therapy for metastatic renal cell carcinoma. While it is well known that hemodialysis patients have a higher rate of renal cell carcinoma compared to the general population, no reports have described the safety of ipilimumab-nivolumab in metastatic renal cell carcinoma patients on hemodialysis. CASE PRESENTATION: A 73-year-old man with a 21-year history of dialysis was referred to our department in 2019 for bilateral renal tumors and multiple lung nodules. He had already been diagnosed with bilateral renal tumors in 2015, without undergoing surgery due to comorbidities. In May 2019, contrast-enhanced computed tomography revealed multiple lung metastases in addition to the existing renal tumors; consequently, he was treated with four doses of nivolumab-ipilimumab with no adverse events. CONCLUSION: The combination of ipilimumab plus nivolumab was safely used in a hemodialysis patient with metastatic renal cell carcinoma.

[Motivational interviewing and cognitive behavior therapy for smoking cessation].

The combination therapy of counseling and medication is very important in smoking cessation treatment. Motivational interviewing (MI) and cognitive behavior therapy (CBT) are interventions recommended in two well-recognized guidelines for smoking cessation in the United States. MI is effective for those who do not want to quit smoking; CBT for those who cannot but want to quit smoking, those who repeatedly quit and re-smoke, those who are depressed, and women who are concerned about their weight. However, neither MI nor CBT for smoking cessation is widely practiced in Japan. We describe the nature of, evidence for, and practice of MI and CBT in smoking cessation treatment, hopeful that clinicians and other healthcare staff learn and apply these techniques.

[Remarkable tumor response to cisplatin plus gemcitabine therapy in a patient with recurrent gallbladder cancer - a case report].

We report a case of recurrent gallbladder cancer in which the patient's tumor showed a remarkable response to gemcitabine( GEM)plus cisplatin(CDDP)therapy. In January 2007, the patient underwent curative resection for gallbladder cancer (T2N1M0, Stage III), and tegafur/uracil was administered for a year as adjuvant chemotherapy. In September 2009, elevated serum CA19-9 levels were observed, and para-aortic lymph node swelling was seen on CT scans. In addition to the indications reported by Valle et al, CDDP plus GEM therapy was initiated. After the first 2 courses of therapy, the para-aortic lymph nodes markedly decreased in size, and the serum CA19-9 levels normalized. Grade 4 neutropenia and grade 3 thrombocytopenia were observed after 3 courses of therapy. We decreased the drug doses because toxicities were observed. We hesitated to discontinue therapy because the indications for discontinuing chemotherapy while the patient showed a good response were not known. Finally, we discontinued therapy after 28 courses because recovery from the resultant toxicities became difficult in spite of decreasing the drug doses(CDDP 25 mg/body, GEM 600 mg/body), and because a good response to therapy was confirmed by CT. The patient is alive and has been disease-free for more than 2 years.

Reliability and validity of Kano Test for Social Nicotine Dependence (KTSND), and development of its revised scale assessing the psychosocial acceptability of smoking among university students.

PURPOSE: To examine reliability and validity of Kano Test for Social Nicotine Dependence (KTSND), a scale assessing the psychosocial acceptability of smoking, and to develop a new version when validity or reliability of KTSND was not acceptable. METHODS: We carried out a self-administered cross-sectional survey on undergraduate university students. The participants completed the KTSND, and supplemented three questions on the attitudes toward tobacco control policies and smoking states. Using daily smokers, we examined the relationship between the KTSND and Fagerström Test for Nicotine Dependence (FTND). In each study, we examined test-retest reliability and construct validity, discriminant and convergent validity, and factor validity. RESULTS: Although the KTSND had high internal consistency (Cronbach's a 0.82) and high test-retest reliability (r=0.72), the results of factor analysis were unacceptable; we expected three factors to be extracted, however, only two factors of "Overestimate of smoking usefulness" and "Allege smoking as a taste and/or culture" were extracted. Using the Kano's Test for Assessing Acceptability of Smoking (KTAAS), the new version of KTSND in which a question was replaced with another one, the third factor of "Neglect of harm of tobacco smoking" was extracted adding to the above-mentioned two. KTAAS had also both high internal consistency (Cronbach's alpha 0.82) and test-retest reliability (r=0.66). Overall, the KTSND and the KTAAS score differed according to smoking states, and the nonsmokers' scores were the lowest. CONCLUSION: The KTSND was a popular questionnaire in Japan, however, its validity assessed using factor analysis was not acceptable, while KTAAS had sufficient reliability and validity, and might assess the cognition and attitude affirming or accepting tobacco smoking among university students.

[Clinical study of smoking cessation clinic subjects].

The Cigarette-associated diseases will be decreased only by stopping smoking. At a smoking cessation clinic, we evaluated 22 subjects for smoking cessation after a three-month smoking cessation program. The program was completed by 20 subjects, or 90%, of whom 15, or 68%, quit smoking. Varenicline tartrate was used to treat 90% of subject, of whom 8, or 40%, suffered nausea. This was treated using an anti-nausea agent, which relieved symptoms immediately.

Social nicotine dependence in Australian dental undergraduate students.

OBJECTIVES: This study aimed to investigate dental undergraduate students' tobacco usage and social nicotine dependence in Australia. A special interest was to identify the role of factors such as age, gender, year of dental education and cohabitants' smoking status for social nicotine dependence. MATERIALS AND METHODS: A sample of 252, first-to-fifth year undergraduate students in an Australian dental school was used. Each completed a self-administered questionnaire. RESULTS: The smoking rate was 4.8%. Current smokers displayed higher social nicotine dependence than those that had never smoked (t=3.1, df=244, P=0.002). Dental undergraduate students that showed higher social nicotine dependence (P=0.001, OR=1.3, 95% CI: 1.1-1.6), or that had smoking cohabitants (P=0.016, OR=4.8, 95% CI: 1.3-17.0), were more likely to smoke. Students' social nicotine dependence increased with year of dental study (P=0.043, ß=0.4, t=2.0). Social nicotine dependence enhanced tobacco usage among Year-1-to-4 students (P=0.005, OR=1.4, 95% CI: 1.1-1.7) but not Year-5 undergraduates (P=0.432). CONCLUSIONS: Social nicotine dependence has become a developing issue in dental education. Tobacco control should be highlighted in the dental curriculum. Future investigations into the effects of dental education on social nocotine dependence and tobacco usage are indicated.

[Questionnaire polls on health awareness of second-hand smoking exposure among non- and ex-smoker school teachers].

An accurate education of the harmful health effects of second-hand smoke on young people is important, and school teachers play a critical role. We polled school teachers about health awareness of second-hand smoking and the effectiveness of 4 methods of protecting against second-hand smoke. Self-reporting questionnaires were given to 452 non-smoker and ex-smoker subjects. To evaluate social nicotine dependence, we used the Kano Test for Social Nicotine Dependence (KTSND) questionnaire. Of 364 teachers (80.5%) who answered and were at risk of second-hand smoke exposure, 39.6% had respiratory symptoms, and 34.9% answered "ignore" or "slightly anxious" about second-hand smoking. The mean KTSND scores of those who answered "extremely anxious", "moderately anxious", "slightly anxious", and "ignore second-hand smoking" were 10.5 +/- 5.7, 12.3 +/- 6.0, 14.7 +/- 5.8, and 18.4 +/- 4.9, respectively. The KTSND scores of teachers who answered "ignore second-hand smoke" were higher than those of teachers who answered "anxious". The scores were also higher in subjects who believe second-hand smoke can be avoided by the recommended protective measures, than in subjects who know that avoidance is impossible, indicating that these teachers accepted smoking behavior. These results suggest that non-smoking and ex-smoking teachers with high KTSND scores might underestimate the health hazards of second-hand smoke, and overestimate the recommended protective measures. Therefore, re-education about awareness of the harmful effects of second-hand smoke should be given to them.

Validity and reliability of Kano Test for Social Nicotine Dependence.

PURPOSE: "Social nicotine dependence" is a newly-coined phrase for describing a psychological and psychosocial state associated with smoking. That new dependence is defined as a misperception of smoking caused by smokers' attempts, for example, to deny the ill effects of tobacco and/or to justify themselves by regarding smoking as acceptable cultural and social behavior. It can be quantified by a 10-item questionnaire, the Kano Test for Social Nicotine Dependence (KTSND). We examined the internal consistency as well as the criterion-related and construct validity and factor structure of KTSND. METHODS: Self-administered questionnaires including the KTSND, smoking status, and stages in quitting smoking only for current smokers were collected from 666 industrial workers. RESULTS: The internal consistency of the KTSND assessed by Cronbach's alpha coefficient was 0.77. In addition, we found that an 8-item combination from among 10 items had a higher coefficient of 0.80. KTSND scores differed among three groups of smoking status as a criterion. Factor analysis clarified two potential factors: "an overestimation of smoking's effects to enhance physical and mental status" and "an insistence on smoking as acceptable cultural and social behavior." CONCLUSION: The KTSND proved to be valid in terms of the internal consistency and the inclusion of two key aspects of the misperception of smoking.

Innovative questionnaire examining psychological nicotine dependence, "The Kano Test for Social Nicotine Dependence (KTSND)".

A smoking habit is maintained by psychological and physical nicotine dependence. We thought up a new concept, "social nicotine dependence", which is a part of psychological dependence, and developed a new questionnaire, "The Kano Test for Social Nicotine Dependence (KTSND)" version 2. The KTSND has ten questions with a total score of 30. In order to investigate the validity of the KTSND, we applied it to the employees of 10 pharmaceutical companies and collected 344 respondents. The total KTSND scores of 18.4+/-5.2 (mean +/- SD, n = 105) for smokers were significantly higher than those of 14.2 +/- 6.1 (n= 88) for ex-smokers, and 12.1 +/- 5.6 (n = 151) for non-smokers. Each question produced significantly different scores among these groups. Smokers were subclassified by factors of physical nicotine dependence, namely, "number of cigarettes smoked per day" and "time until the first cigarette of the day". The total scores did not reflect these physical factors. On the other hand, the total KTSND scores reflected one of the psychological nicotine dependence factors, namely, "the stages for quitting smoking". The KTSND scores were significantly different among 4 groups: 22.4 +/- 6.3 for immotives, 19.0 +/- 3.9 for precontemplators, 16.1 +/- 3.8 for contemplators and 14.5 +/- 5.9 for preparers. These results showed that the KTSND reflected the smoking status and the stages for quitting smoking. We consider that the KTSND is a useful method to evaluate psychological aspects of smoking.

Paratracheal lymph node metastasis is associated with cervical lymph node metastasis in patients with thoracic esophageal squamous cell carcinoma.

BACKGROUND: We determined which lymph node metastases were associated with cervical lymph node metastases of thoracic esophageal squamous cell carcinoma. METHODS: A total of 6464 lymph nodes derived from 155 consecutive patients with thoracic esophageal squamous cell carcinoma were stained by immunohistochemistry (antibody: AE1/AE3). Lymph node metastases were mapped according to the mapping scheme of the American Thoracic Society, as modified by Casson et al. (Ann Thorac Surg 1994;58:1569-70). Patients were divided into two groups: those with and without cervical lymph node metastasis (CLNM). Mapping data were examined by uni- and multivariate analysis. RESULTS: Hematoxylin and eosin-positive and AE1/AE3-positive lymph node metastases were found in 59% and 77% of patients, respectively. Twenty-one (55%) of 38 patients in the CLNM(+) group and 30 (26%) of 117 patients in the CLNM(-) group had AE1/AE3-positive lymph node metastasis in the thoracic paratracheal lymph node. Paratracheal lymph node metastasis is only one independent factor for (CLNM), whereas upper thoracic paraesophageal lymph node and pulmonal hilar lymph node status were also significant in univariate analysis. Three (43%) of seven patients with cervical jumping metastasis from the thoracic esophagus had micrometastasis in the paratracheal lymph node. CONCLUSIONS: The paratracheal lymph node is most associated with (CLNM) of thoracic esophageal squamous cell carcinoma.