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1.
J Infect Chemother ; 2024 Apr 06.
Article in English | MEDLINE | ID: mdl-38588797

ABSTRACT

INTRODUCTION: Antimicrobial susceptibility patterns of bacterial pathogens isolated from patients with complicated urinary tract infections were analyzed using the national surveillance data, comprising 793 bacterial strains from eight clinically relevant species. MATERIALS AND METHODS: Data were collected for the fourth national surveillance project from July 2020 to December 2021 by the Japanese Society of Chemotherapy, the Japanese Association for Infectious Disease, and the Japanese Society of Clinical Microbiology. Surveillance was supervised with the cooperation of 43 medical institutions throughout Japan. RESULTS: Fluoroquinolone required a minimum inhibitory concentration (MIC) of 2-64 mg/L to inhibit the 330 tested Escherichia coli strains. The proportion of levofloxacin-resistant E. coli strains increased from 28.6% in 2008 to 29.6% in 2011, 38.5% in 2015, and 44.5% in 2021. The proportion of levofloxacin-resistant strains of Pseudomonas aeruginosa also increased from previous survey results, showing a continuing downward trend. Conversely, the proportion of levofloxacin-resistant strains of Enterococcus faecalis decreased relative to previous reports. Neither multidrug-resistant P. aeruginosa nor carbapenem-resistant Enterobacteriaceae were detected. For methicillin-resistant Staphylococcus aureus (MRSA), the proportion of vancomycin-susceptible strains (MIC of 2 µg/mL) decreased from 14.7% to 7.7%. DISCUSSION: Bacterial strains that produced extended-spectrum ß-lactamase included E. coli (82/330 strains, 24.8%), Klebsiella pneumoniae (11/68 strains, 16.2%), and Proteus mirabilis (4/26 strains, 15.4%). As compared to previous surveillance reports, these strains showed an increase in proportion over the years.

2.
Clin Genitourin Cancer ; 22(3): 102075, 2024 Mar 21.
Article in English | MEDLINE | ID: mdl-38643665

ABSTRACT

BACKGROUND: The critical role of radiographic assessment at the time of castration-resistant prostate cancer (CRPC) diagnosis is underscored by this study. We performed a retrospective analysis of radiographic changes in metastasis from the time of diagnosis of metastatic hormone-sensitive prostate cancer (mHSPC) to CRPC diagnosis. We also explored its impact on prognosis post-CRPC. MATERIALS AND METHODS: We retrospectively analyzed 98 men who underwent radiographic examinations (bone scans and computed tomography [CT]) at the time of CRPC diagnosis. When radiographic studies demonstrated progression at CRPC diagnosis, patients were assigned to the radiographic progressive disease (rPD) group. The remaining patients were placed in the "non-rPD" group. The overall survival (OS) post-CRPC was compared between the 2 groups. RESULTS: The median OS post-CRPC was significantly shorter in the rPD group (n = 50) compared to the non-rPD group (n = 48) (32 months vs. not reached, P = .0124). Multivariate analysis showed that radiographic progression and shorter time to CRPC were associated with a shorter OS post-CRPC (hazard ratio [HR] = 3.14; 95% confidence interval [CI], 1.21-8.12, P = .019). CONCLUSION: Radiographic progression at the point of CRPC diagnosis independently predicts a shorter OS post-CRPC in patients with mHSPC. Therefore, assessing radiographic changes at the time of CRPC diagnosis could be instrumental in managing CRPC in patients with mHSPC.

3.
World J Urol ; 42(1): 147, 2024 Mar 13.
Article in English | MEDLINE | ID: mdl-38478082

ABSTRACT

OBJECTIVE: We aimed to assess the impact of the timing of urinary drainage on clinical outcomes in patients with obstructive pyelonephritis (OPN) associated with upper urinary tract (UUT) stones. METHODS: We retrospectively evaluated the multicenter dataset of 240 patients with OPN associated with UUT stones who underwent urinary drainage. We divided the patients into two groups depending on the timing of urinary drainage; emergency drainage, defined as within 12 h from admission, and delayed drainage, defined as between 12 and 48 h from admission. The outcomes were the length of hospital stay, time to leukocyte normalization, and time to body temperature normalization. One-to-two propensity score matching (PSM) was applied to minimize the effect of confounders between the two groups. Subsequently, predictive patient factors for emergency drainage were analyzed using the logistic regression model. RESULTS: Only the time from admission to normal body temperature was significantly shorter in the emergency drainage group when compared with the delayed drainage group (median: 2 vs. 3 days; p = 0.02), while there was no difference in time from drainage to body temperature normalization between the two groups. On multivariable analysis, high pretreatment C-reactive protein (CRP) was associated with implementing emergency drainage within 12 h. CONCLUSIONS: The timing of urinary drainage was only associated with the duration of high fever, but it did not affect the postdrainage course. Emergency urinary drainage is more likely to be performed in severe patients, such as high pretreatment CRP.


Subject(s)
Pyelonephritis , Urinary Calculi , Urinary Tract , Humans , Drainage , Propensity Score , Pyelonephritis/complications , Retrospective Studies , Urinary Calculi/complications , Multicenter Studies as Topic
4.
Cancer Immunol Immunother ; 73(2): 38, 2024 Jan 30.
Article in English | MEDLINE | ID: mdl-38289361

ABSTRACT

Immune checkpoint inhibitor (ICI)-based combination therapies are the recommended first-line treatment for metastatic renal cell carcinoma (mRCC). However, no head-to-head phase-3 randomized controlled trials (RCTs) have compared the efficacy of different ICI-based combination therapies. Here, we compared the efficacy of various first-line ICI-based combination therapies in patients with mRCC using updated survival data from phase-3 RCTs. Three databases were searched in June 2023 for RCTs that analyzed oncologic outcomes in mRCC patients treated with ICI-based combination therapies as first-line treatment. A network meta-analysis compared outcomes including overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and complete response (CR) rate. Subgroup analyses were based on the International mRCC Database Consortium risk classification. The treatment ranking analysis of the entire cohort showed that nivolumab + cabozantinib (81%) had the highest likelihood of improving OS, followed by nivolumab + ipilimumab (75%); pembrolizumab + lenvatinib had the highest likelihood of improving PFS (99%), ORR (97%), and CR (86%). These results remained valid even when the analysis was limited to patients with intermediate/poor risk, except that nivolumab + ipilimumab had the highest likelihood of achieving CR (100%). Further, OS benefits of ICI doublets were not inferior to those of ICI + tyrosine kinase inhibitor combinations. Recommendation of combination therapies with ICIs and/or tyrosine kinase inhibitors based on survival benefits and patient pretreatment risk classification will help advance personalized medicine for mRCC.


Subject(s)
Carcinoma, Renal Cell , Kidney Neoplasms , Humans , Carcinoma, Renal Cell/drug therapy , Follow-Up Studies , Ipilimumab , Network Meta-Analysis , Nivolumab , Pathologic Complete Response , Kidney Neoplasms/drug therapy
5.
Int J Urol ; 31(1): 25-31, 2024 Jan.
Article in English | MEDLINE | ID: mdl-37840031

ABSTRACT

Adjuvant immune checkpoint inhibitor therapies have radically altered the treatment landscape for renal cell carcinoma and urothelial carcinoma. However, studies have reported negative data regarding adjuvant immune checkpoint inhibitor therapies. Thus, this study aimed to assess the role of adjuvant immune checkpoint inhibitor therapy for both renal cell carcinoma and urothelial carcinoma. A systematic review and network meta-analysis were conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Multiple databases were searched for articles published as of February 2023. Studies were deemed eligible if they evaluated disease-free survival in patients with renal cell carcinoma and urothelial carcinoma receiving adjuvant immune checkpoint inhibitor therapy. Five studies met the inclusion criteria. In a network meta-analysis, pembrolizumab was shown to be the most effective regimen for patients with renal cell carcinoma, whereas nivolumab was found to be the most effective regimen for patients with urothelial carcinoma. Additionally, these results were consistently observed in a sub-analysis of the T stage. The present analysis provides findings that support the usefulness of adjuvant nivolumab therapy in urothelial carcinoma and adjuvant pembrolizumab therapy in renal cell carcinoma, in agreement with the currently available guidelines. However, the caveat is that the randomized controlled trials included in this analysis differed in important respects despite being similar in study design. Therefore, with these differences in mind, care needs to be taken when selecting patients for these immune checkpoint inhibitor therapies to maximize their benefits.


Subject(s)
Carcinoma, Renal Cell , Carcinoma, Transitional Cell , Kidney Neoplasms , Urinary Bladder Neoplasms , Humans , Carcinoma, Renal Cell/drug therapy , Carcinoma, Transitional Cell/drug therapy , Nivolumab/therapeutic use , Network Meta-Analysis , Immune Checkpoint Inhibitors/therapeutic use , Immunotherapy/methods , Adjuvants, Immunologic/therapeutic use , Kidney Neoplasms/drug therapy , Randomized Controlled Trials as Topic
6.
Int J Clin Oncol ; 29(2): 213-221, 2024 Feb.
Article in English | MEDLINE | ID: mdl-38103156

ABSTRACT

PURPOSE: The androgen receptor axis-targeted (ARAT) agents abiraterone and enzalutamide have been introduced against castration-resistant prostate cancer (CRPC). However, determining which of these agents should be used first is a clinical challenge. Therefore, in this study, we compared the efficacy of first-line abiraterone and enzalutamide treatments in chemotherapy-naïve patients with CRPC. METHODS: A total of 242 chemotherapy-naïve CRPC cases treated with first-line ARAT were analyzed. Outcome measures were PSA response, PSA progression-free survival (PSA-PFS), time to treatment failure (TTF), cancer specific survival (CSS), and overall survival (OS). RESULTS: Abiraterone (A) and enzalutamide (E) were administered to 61 and 181 patients, respectively. The median PSA response rate (- 65.4% [A] and - 78.8% [E], p = 0.0341), PSA decline ≥ 30% (55.7% [A] and 72.9% [E], p = 0.0183), PSA-PFS (median 4 months [A] and 8 months [E], p = 0.0126), TTF (median 6 months [A] and 14 months [E], p < 0.0001), CSS (median 45 months [A] and not reached [E], p < 0.0001), and OS (median 28 months [A] and 80 months [E], p < 0.001) were significantly better in the enzalutamide group. In the multivariate analyses for CSS and OS, ALP (p = 0.00376) and ARAT (p < 0.001) (CSS), evidence of metastasis (p = 0.0467), Hb (p = 0.00205), and ARAT (p = 0.00514) (OS) were significant factors, respectively. CONCLUSION: This study showed that PSA response, PSA-PFS, TTF, CSS, and OS were better with first-line enzalutamide administration. Direct inhibition of androgen receptor signaling by enzalutamide is associated with better clinical outcomes.


Subject(s)
Benzamides , Prostatic Neoplasms, Castration-Resistant , Receptors, Androgen , Male , Humans , Prostatic Neoplasms, Castration-Resistant/pathology , Prostate-Specific Antigen , Phenylthiohydantoin/therapeutic use , Nitriles , Treatment Outcome
7.
Transl Androl Urol ; 12(8): 1321-1325, 2023 Aug 31.
Article in English | MEDLINE | ID: mdl-37680224

ABSTRACT

Background: Although current guidelines recommend administering adjuvant immunotherapy following resection of advanced primary renal cell carcinoma (RCC), the clinical benefit of presurgical immunotherapy for patients with RCC remains uncertain. Case Description: We conducted a retrospective analysis of five patients diagnosed with RCC who developed inferior vena cava (IVC) tumor thrombus and were treated with radical nephrectomy following combined immunotherapy with a tyrosine kinase inhibitor. The median follow-up after nephrectomy was 23 months (range, 19-30 months). In all cases, the size of the IVC tumor thrombus decreased, and three of the cases demonstrated a decrease in the tumor thrombus level. Surgical margins were negative in all cases, and none of the patients experienced any major intraoperative complications. However, adhesions were encountered at the operative sites during surgery in all cases. One patient required a lymphatic intervention due to abdominal lymphatic leakage (Clavien IIIa) within 90 days after operation. Our case series demonstrated a median progression-free survival (PFS) of 11 months [95% confidence interval (CI)]: 5.5-22.5 months). No patient died during the follow-up period. Conclusions: Presurgical therapy combined with immunotherapy and tyrosine kinase inhibitors warrants consideration. Nevertheless, surgeons should be mindful of the difficulties that may arise beyond the clinical stage.

8.
Anticancer Res ; 42(4): 2023-2028, 2022 Apr.
Article in English | MEDLINE | ID: mdl-35347024

ABSTRACT

BACKGROUND/AIM: Therapeutic strategies for prostate cancer are currently undergoing a paradigm shift due to the advent of next-generation androgen receptor inhibitors. Among these inhibitors, apalutamide is regarded as a key drug because of its effectiveness. However, risk factors for and the timing of the onset of apalutamide-related cutaneous adverse events remain unclear. Therefore, the present study investigated key risk factors for and timing of the onset of apalutamide-related cutaneous adverse events. PATIENTS AND METHODS: Sixty-two Japanese patients with non-metastatic castration-resistant prostate cancer treated with 240 mg/day of apalutamide were enrolled in the present study. RESULTS: Twenty-four patients (38.7%) developed cutaneous adverse events. Multivariable logistic regression analysis of age, height, and body weight identified body weight as a significant predictive factor for the incidence of cutaneous adverse events (p=0.019). When the mean body weight of patients (63.80 kg) was set as the cut-off value, the Kaplan-Meier analysis revealed that the risk of cutaneous adverse events was significantly increased in those with a body weight <63.8 kg (p=0.003, the log-rank test). The analysis also showed that cutaneous adverse events developed within the first 6 months regardless of body weight. CONCLUSION: A lower body weight is a significant risk factor for apalutamide-related cutaneous adverse events and their onset is within 6 months of initiation of therapy.


Subject(s)
Prostatic Neoplasms, Castration-Resistant , Body Weight , Humans , Male , Prostatic Neoplasms, Castration-Resistant/drug therapy , Prostatic Neoplasms, Castration-Resistant/pathology , Risk Factors , Thiohydantoins/adverse effects
9.
Jpn J Clin Oncol ; 51(11): 1665-1671, 2021 Nov 01.
Article in English | MEDLINE | ID: mdl-34296282

ABSTRACT

BACKGROUND: Randomized trials showed the survival benefits of the combined use of androgen receptor axis-targeted agents with androgen deprivation therapy in metastatic hormone-sensitive prostate cancer (mHSPC), regardless of the risk. However, treating patients with low-risk mHSPC with such intensive treatment is still debatable. METHODS: This retrospective study included 155 low-risk patients among 467 mHSPC patients treated in our affiliated institutions. The association between predictive factors and treatment outcomes was estimated using the Kaplan-Meier method and log-rank test. Predictive factors for castration resistant prostate cancer (CRPC)-free survival were investigated using Cox regression analyses. RESULTS: During the median follow-up of 39 months, 38.7% of patients developed CRPC and 14.2% died. In the multivariate analyses, a presence of Gleason pattern 5 (hazard ratio [HR] 2.04), high alkaline phosphatase (HR 1.007) and high lactate dehydrogenase (HR 1.009) were significant predictive factors for shorter CRPC-free survival. Finally, 155 patients were stratified into favorable- and unfavorable-risk groups based on the numbers of the predictive factors. The overall survival (OS) in the unfavorable-risk group (total scores: 2-3) was significantly worse than that of the favorable-risk group (total score: 0-1) (P = 0.02). This prognostic model was assessed with 50 low-risk mHSPC patients from the external validation dataset and found both the time to CRPC, and the OS in the unfavorable-risk group was significantly worse than that of the favorable-risk group (P < 0.01). CONCLUSIONS: The combination of Gleason pattern 5, high alkaline phosphatase and lactate dehydrogenase can predict those with worse OS in low-risk mHSPC patients.


Subject(s)
Prostatic Neoplasms, Castration-Resistant , Prostatic Neoplasms , Alkaline Phosphatase , Androgen Antagonists/therapeutic use , Hormones , Humans , L-Lactate Dehydrogenase , Male , Prognosis , Prostatic Neoplasms/drug therapy , Prostatic Neoplasms, Castration-Resistant/drug therapy , Retrospective Studies
11.
Hinyokika Kiyo ; 67(12): 521-524, 2021 Dec.
Article in Japanese | MEDLINE | ID: mdl-34991291

ABSTRACT

We compared brain metastasis of renal cell carcinoma (RCC) in patients who received tyrosine kinase inhibitors (TKIs) ; 17 received local therapy, while 16 did not. The median survival rate was 19 months in the local therapy group and 11 months in the tyrosine kinase inhibitor alone group, showing no significant difference (p=0.52). Symptoms such as paralysis, headache, and dysarthria occurred due to brain metastasis. These symptoms improved in 8 out of 10 patients in the local therapy group. There were no cases of grade 3 or higher complications due to local therapy. Although local therapy did not prolong the overall survival, an improvement in symptoms was observed, suggesting that it is acceptable as palliative treatment.


Subject(s)
Brain Neoplasms , Carcinoma, Renal Cell , Kidney Neoplasms , Brain Neoplasms/drug therapy , Carcinoma, Renal Cell/drug therapy , Humans , Kidney Neoplasms/drug therapy , Neoplasm Metastasis , Protein Kinase Inhibitors , Retrospective Studies , Survival Rate
13.
Cancer Sci ; 111(7): 2460-2471, 2020 Jul.
Article in English | MEDLINE | ID: mdl-32402135

ABSTRACT

The present study aimed to evaluate the efficacy of the real-world use of axitinib and to develop a prognostic model for stratifying patients who could derive long-term benefit from axitinib. This was a retrospective, descriptive study evaluating the efficacy of axitinib in patients with metastatic renal cell carcinoma that had been treated with 1 or 2 systemic antiangiogenic therapy regimens at 1 of 36 hospitals belonging to the Japan Urologic Oncology Group between January 2012 and February 2019. The primary outcome was overall survival (OS). Using a split-sample method, candidate variables that exhibited significant relationships with OS were chosen to create a model. The new model was validated using the rest of the cohort. In total, 485 patients were enrolled. The median OS was 34 months in the entire study population, whereas it was not reached, 27 months, and 14 months in the favorable, intermediate, and poor risk groups, respectively, according to the new risk classification model. The following 4 variables were included in the final risk model: the disease stage at diagnosis, number of metastatic sites at the start of axitinib therapy, serum albumin level, and neutrophil : lymphocyte ratio. The adjusted area under the curve values of the new model at 12, 36, and 60 months were 0.77, 0.82, and 0.82, respectively. The efficacy of axitinib in routine practice is comparable or even superior to that reported previously. The patients in the new model's favorable risk group might derive a long-term survival benefit from axitinib treatment.


Subject(s)
Antineoplastic Agents/therapeutic use , Axitinib/therapeutic use , Carcinoma, Renal Cell/drug therapy , Carcinoma, Renal Cell/pathology , Kidney Neoplasms/drug therapy , Kidney Neoplasms/pathology , Protein Kinase Inhibitors/therapeutic use , Aged , Antineoplastic Agents/administration & dosage , Antineoplastic Agents/adverse effects , Axitinib/administration & dosage , Axitinib/adverse effects , Carcinoma, Renal Cell/mortality , Female , Humans , Kaplan-Meier Estimate , Kidney Neoplasms/mortality , Male , Middle Aged , Neoplasm Metastasis , Neoplasm Staging , Prognosis , Protein Kinase Inhibitors/administration & dosage , Protein Kinase Inhibitors/adverse effects , ROC Curve , Retreatment , Treatment Outcome
14.
Int Urol Nephrol ; 50(12): 2167-2172, 2018 Dec.
Article in English | MEDLINE | ID: mdl-30276602

ABSTRACT

OBJECTIVE: The purpose of the study was to report the outcomes of our modified techniques of laparoscopic urachal resection, followed by novel umbilical-plasty using dermal regenerative grafts for symptomatic urachal remnants. METHODS: Between March 2014 and December 2016, laparoscopic urachal resection was carried out on 45 patients with complaints of urachal remnants. After extraction of the specimen and closure of the fascia at the umbilical site, a 1-cm square section of dermal regeneration sheet (TERUDERMIS®, Olympus) was suture retained between the fascia and the skin. Patient satisfaction with cosmesis was scored prospectively using the visual analogue scale (VAS). Perioperative records were reviewed to assess surgical outcomes. RESULTS: Laparoscopic urachal resection was successfully conducted via the transperitoneal approach. Postoperative bleeding was experienced in one patient (2.2%), which was subsequently controlled laparoscopically. Infection subsided with symptomatic relief in all patients. No symptomatic recurrences were encountered. Over 80% of patients (37/45) rated the cosmetic outcome of the plasty as good to excellent, with the median scores of 8 (range 5-10). CONCLUSIONS: Laparoscopic urachal resection is safe and curative with reasonable risk of complications. Novel umbilicoplasty using dermal regenerative graft is very simple technique and offers satisfactory cosmetic outcomes. Further follow-up and cosmesis evaluation are required.


Subject(s)
Abscess/surgery , Laparoscopy/methods , Plastic Surgery Procedures/methods , Umbilicus/surgery , Urachus/surgery , Adolescent , Adult , Female , Humans , Laparoscopy/adverse effects , Male , Middle Aged , Patient Satisfaction , Plastic Surgery Procedures/adverse effects , Young Adult
15.
J Infect Chemother ; 24(12): 954-957, 2018 Dec.
Article in English | MEDLINE | ID: mdl-30193786

ABSTRACT

We aimed to clarify prophylactic antimicrobial effects of single-dose piperacillin (PIPC) for perioperative infections in the transurethral resection of bladder tumor (TURBT) in comparison with those of single-dose tazobactam/piperacillin (TAZ/PIPC) through a retrospective analysis. We analyzed data from 192 TURBT patients treated with single-dose (4 g) intravenous PIPC (P group) between April 2015 and April 2017. For comparison, we analyzed data from 50 TURBT patients treated with single-dose (4.5 g) intravenous TAZ/PIPC (T/P group) between June 2013 and April 2014. We compared the perioperative incidences of fever (≥38 °C) and bacteriuria in the two groups. The number of febrile patients was four (2.1%) in the P group and one (2.0%) in the T/P group, without significant difference (p = 0.970). Among these febrile patients, urine and blood samples of two patients in the P group tested positive for bacterial cultures of Citrobacter koseri and Enterococcus faecalis, respectively. None of the patients in the T/P group tested positive for urine culture, postoperatively. However, 22 patients (18.2%) in the P group tested positive for urine culture, and Staphylococcus epidermidis (six patients), E. faecalis (three patients), Escherichia coli (three patients), Streptococcus agalactiae (two patients), Staphylococcus aureus (two patients), and C. koseri (one patient) were isolated. There was no significant difference in the incidence of bacteriuria in these two groups (p = 0.055). Based on these results, single-dose PIPC administration for the prevention of perioperative infections in TURBT was as effective as TAZ/PIPC.


Subject(s)
Antibiotic Prophylaxis/methods , Piperacillin, Tazobactam Drug Combination/administration & dosage , Piperacillin/administration & dosage , Preoperative Period , Tazobactam/administration & dosage , Urinary Bladder Neoplasms/drug therapy , Administration, Intravenous , Aged , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Bacteriuria/blood , Bacteriuria/microbiology , Bacteriuria/urine , Female , Fever/blood , Fever/microbiology , Fever/urine , Humans , Male , Piperacillin/therapeutic use , Piperacillin, Tazobactam Drug Combination/therapeutic use , Retrospective Studies , Tazobactam/therapeutic use , Urinary Bladder Neoplasms/surgery
16.
Hinyokika Kiyo ; 64(5): 231-234, 2018 May.
Article in Japanese | MEDLINE | ID: mdl-30064163

ABSTRACT

Advances and improvements in the early detection, diagnosis, and treatment modalities have increased the opportunities to treat multiple primary malignancies. Herein, we report a male patient with five metachronous cancers. The patient had initially undergone partial tongue resection for tongue cancer in 2003 at the age of 57 years and was subsequently diagnosed with acute promyelocytic leukemia, duodenal cancer, prostate cancer, and bladder cancer, over a period of 13 years. The patient underwent androgen deprivation therapy and palliative radiation therapy for the management of metastatic prostate cancer in 2016. The poor prognosis of the patient was thought to be related to be the prostate cancer because the other cancers were either in remission or localized. The occurrence of five metachronous cancers is extremely rare, and this is the fourth case to be reported in the Japanese literature.


Subject(s)
Neoplasms, Multiple Primary , Prostatic Neoplasms , Urinary Bladder Neoplasms , Duodenal Neoplasms/diagnosis , Duodenal Neoplasms/therapy , Humans , Leukemia, Promyelocytic, Acute/diagnosis , Leukemia, Promyelocytic, Acute/therapy , Male , Middle Aged , Neoplasms, Multiple Primary/diagnosis , Neoplasms, Multiple Primary/therapy , Palliative Care , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/therapy , Urinary Bladder Neoplasms/diagnosis , Urinary Bladder Neoplasms/therapy
17.
Sensors (Basel) ; 18(4)2018 Apr 08.
Article in English | MEDLINE | ID: mdl-29642483

ABSTRACT

Virtualization of wireless sensor networks (WSN) is widely considered as a foundational block of edge/fog computing, which is a key technology that can help realize next-generation Internet of things (IoT) networks. In such scenarios, multiple IoT devices and service modules will be virtually deployed and interconnected over the Internet. Moreover, application services are expected to be more sophisticated and complex, thereby increasing the number of modifications required for the construction of network topologies. Therefore, it is imperative to establish a method for constructing a virtualized WSN (VWSN) topology that achieves low latency on information transmission and high resilience against network failures, while keeping the topological construction cost low. In this study, we draw inspiration from inter-modular connectivity in human brain networks, which achieves high performance when dealing with large-scale networks composed of a large number of modules (i.e., regions) and nodes (i.e., neurons). We propose a method for assigning inter-modular links based on a connectivity model observed in the cerebral cortex of the brain, known as the exponential distance rule (EDR) model. We then choose endpoint nodes of these links by controlling inter-modular assortativity, which characterizes the topological connectivity of brain networks. We test our proposed methods using simulation experiments. The results show that the proposed method based on the EDR model can construct a VWSN topology with an optimal combination of communication efficiency, robustness, and construction cost. Regarding the selection of endpoint nodes for the inter-modular links, the results also show that high assortativity enhances the robustness and communication efficiency because of the existence of inter-modular links of two high-degree nodes.


Subject(s)
Brain , Communication , Computer Communication Networks , Humans , Internet
18.
Appl Netw Sci ; 2(1): 6, 2017.
Article in English | MEDLINE | ID: mdl-30533514

ABSTRACT

In this study, the effect of assortativity on the robustness and efficiency of interconnected networks was investigated. This involved constructing a network that possessed the desired degree of assortativity. Additionally, an interconnected network was constructed wherein the assortativity between component networks possessed the desired value. With respect to single networks, the results indicated that a decrease in assortativity provided low hop length, high information diffusion efficiency, and distribution of communication load on edges. The study also revealed that excessive assortativity led to poor network performance. In the study, the assortativity between networks was defined and the following results were demonstrated: assortative connections between networks lowered the average hop length and enhanced information diffusion efficiency, whereas disassortative connections between networks distributed the communication loads of internetwork links and enhanced robustness. Furthermore, it is necessary to carefully adjust assortativity based on the node degree distribution of networks. Finally, the application of the results to the design of robust and efficient information networks was discussed.

19.
Jpn J Clin Oncol ; 45(3): 274-80, 2015 Mar.
Article in English | MEDLINE | ID: mdl-25420693

ABSTRACT

OBJECTIVE: Result of clinical trial for registration purpose is often difficult to generalize because of its limited population in number and inclusion criteria. METHODS: To understand the efficacy of sorafenib under daily medical practice, we retrospectively investigated therapeutic outcomes of 175 Japanese patients with advanced renal cell carcinoma treated with sorafenib at 15 centers. RESULTS: The objective response rate and disease control rate were 15.4 and 77.1%, respectively, being similar to those in the Phase II study in Japanese patients (19.4 and 73.6 months). Any tumor shrinkage was observed with 53% of patients, while tumor control without growth was in 61%. Lung lesions were more sensitive to sorafenib than other lesions, in terms of any tumor shrinkage (54%) and the extent of maximal shrinkage, while tumor control was better in lymph node metastases (77%) than in lung (69%). Liver was worse in any tumor shrinkage (35%), tumor control (55%) and the extent of tumor growth. Slightly, shorter median overall survival of 21.1 months compared with Phase II clinical trial (25.3 months) is likely to be attributable to different patient population, because median overall survival was improved to 26.4 months when the population was matched to that in Phase II trial. Univariate and multivariate analyses identified prognostic factors for worse overall survival, including intermediate and poor Memorial Sloan-Kettering Cancer Center risk, Eastern Cooperative Oncology Group performance status ≥1, the presence of non-clear cell component and the presence of liver metastasis. CONCLUSIONS: In conclusion, the present study confirmed the efficacy of sorafenib in the real-world setting on advanced renal cell carcinoma.


Subject(s)
Antineoplastic Agents/administration & dosage , Carcinoma, Renal Cell/drug therapy , Kidney Neoplasms/drug therapy , Niacinamide/analogs & derivatives , Phenylurea Compounds/administration & dosage , Administration, Oral , Adult , Aged , Aged, 80 and over , Carcinoma, Renal Cell/pathology , Disease-Free Survival , Drug Administration Schedule , Female , Humans , Kidney Neoplasms/pathology , Liver Neoplasms/drug therapy , Liver Neoplasms/secondary , Lung Neoplasms/drug therapy , Lung Neoplasms/secondary , Male , Middle Aged , Niacinamide/administration & dosage , Retrospective Studies , Sorafenib , Treatment Outcome
20.
Hinyokika Kiyo ; 60(9): 427-30, 2014 Sep.
Article in Japanese | MEDLINE | ID: mdl-25293795

ABSTRACT

We treated 6 patients with renal collecting duct carcinoma (CDC) in our hospital from December 2004 to December 2011. We compared clinico-pathological findings among all patients. The median age was 58 years (range, 37-77 years). Hematuria, back pain, and fatigue were observed in 5 patients with CDC. Five patients were pathologically diagnosed by radical nephrectomy while a patient was diagnosed by percutaneous renal biopsy without radical nephrectomy. Lymph node metastasis and distant metastasis were observed at diagnosis in 3 and 2 patients, respectively. Five of the 6 patients received systemic therapy after surgery, cytokine therapy in 2 patients, systemic chemotherapy in a patient, and molecular-targeting therapy in 2 patients, respectively. The median overall survival was 15 months (range, 1-44 months). Overall, the 1- and 3-year survival rates were 67 and 33%, respectively. Most of the patients had symptomatic advanced disease at diagnosis. Even though nephrectomy was performed, systemic treatment was not effective in such patients.


Subject(s)
Carcinoma, Renal Cell/therapy , Kidney Neoplasms/therapy , Adult , Aged , Female , Humans , Kidney Neoplasms/pathology , Lymphatic Metastasis , Male , Middle Aged , Neoplasm Staging
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