Combination of Muscle Quantity and Quality Is Useful to Assess the Necessity of Surveillance after a 5-Year Cancer-Free Period in Patients Who Undergo Radical Cystectomy: A Multi-Institutional Retrospective Study.

BACKGROUND: Although continuous surveillance after a 5-year cancer-free period in patients with bladder cancer (BC) who undergo radical cystectomy (RC) is recommended, optimal candidates for continuous surveillance remain unclear. Sarcopenia is associated with unfavorable prognosis in various malignancies. We aimed to investigate the impact of low muscle quantity and quality (defined as severe sarcopenia) on prognosis after a 5-year cancer-free period in patients who underwent RC. METHODS: We conducted a multi-institutional retrospective study assessing 166 patients who underwent RC and had five years or more of follow-up periods after a 5-year cancer-free period. Muscle quantity and quality were evaluated using the psoas muscle index (PMI) and intramuscular adipose tissue content (IMAC) using computed tomography images five years after RC. Patients with lower PMI and higher IMAC values than the cut-off values were diagnosed with severe sarcopenia. Univariable analyses were performed to assess the impact of severe sarcopenia on recurrence, adjusting for the competing risk of death using the Fine-Gray competing risk regression model. Moreover, the impact of severe sarcopenia on non-cancer-specific survival was evaluated using univariable and multivariable analyses. RESULTS: The median age and follow-up period after the 5-year cancer-free period were 73 years and 94 months, respectively. Of 166 patients, 32 were diagnosed with severe sarcopenia. The 10-year RFS rate was 94.4%. In the Fine-Gray competing risk regression model, severe sarcopenia did not show a significant higher probability of recurrence, with an adjusted subdistribution hazard ratio of 0.525 (p = 0.540), whereas severe sarcopenia was significantly associated with non-cancer-specific survival (hazard ratio 1.909, p = 0.047). These results indicate that patients with severe sarcopenia might not need continuous surveillance after a 5-year cancer-free period, considering the high non-cancer-specific mortality.

Effectiveness, Policy, and User Acceptance of COVID-19 Contact-Tracing Apps in the Post-COVID-19 Pandemic Era: Experience and Comparative Study.

BACKGROUND: In the post-COVID-19 pandemic era, many countries have launched apps to trace contacts of COVID-19 infections. Each contact-tracing app (CTA) faces a variety of issues owing to different national policies or technologies for tracing contacts. OBJECTIVE: In this study, we aimed to investigate all the CTAs used to trace contacts in various countries worldwide, including the technology used by each CTA, the availability of knowledge about the CTA from official websites, the interoperability of CTAs in various countries, and the infection detection rates and policies of the specific country that launched the CTA, and to summarize the current problems of the apps based on the information collected. METHODS: We investigated CTAs launched in all countries through Google, Google Scholar, and PubMed. We experimented with all apps that could be installed and compiled information about apps that could not be installed or used by consulting official websites and previous literature. We compared the information collected by us on CTAs with relevant previous literature to understand and analyze the data. RESULTS: After screening 166 COVID-19 apps developed in 197 countries worldwide, we selected 98 (59%) apps from 95 (48.2%) countries, of which 63 (66.3%) apps were usable. The methods of contact tracing are divided into 3 main categories: Bluetooth, geolocation, and QR codes. At the technical level, CTAs face 3 major problems. First, the distance and time for Bluetooth- and geolocation-based CTAs to record contact are generally set to 2 meters and 15 minutes; however, this distance should be lengthened, and the time should be shortened for more infectious variants. Second, Bluetooth- or geolocation-based CTAs also face the problem of lack of accuracy. For example, individuals in 2 adjacent vehicles during traffic jams may be at a distance of ≤2 meters to make the CTA trace contact, but the 2 users may actually be separated by car doors, which could prevent transmission and infection. In addition, we investigated infection detection rates in 33 countries, 16 (48.5%) of which had significantly low infection detection rates, wherein CTAs could have lacked effectiveness in reducing virus propagation. Regarding policy, CTAs in most countries can only be used in their own countries and lack interoperability among other countries. In addition, 7 countries have already discontinued CTAs, but we believe that it was too early to discontinue them. Regarding user acceptance, 28.6% (28/98) of CTAs had no official source of information that could reduce user acceptance. CONCLUSIONS: We surveyed all CTAs worldwide, identified their technological policy and acceptance issues, and provided solutions for each of the issues we identified. This study aimed to provide useful guidance and suggestions for updating the existing CTAs and the subsequent development of new CTAs.

Analysis on the Subdivision of Skilled Mowing Movements on Slopes.

Owing to the aging of the rural population in the hilly and mountainous areas of Japan, mowing on narrow ridges and steep slopes is done manually by the elderly-individuals over 65 years of age. Studies have shown that many accidents that occurred during mowing were caused by workers' unstable posture, especially when mowing on steep surfaces where there is a high risk of falling. It is necessary to analyze the body movements of mowing workers to elucidate the elements related to the risk of falls. Therefore, in this study, based on a high-precision motion-capture device and a series of experiments with elderly, skilled mowing workers, we focused on the movements of mowing. We sought to identify effective and safe mowing patterns and the factors that lead to the risk of falls. In various mowing styles, compared to the stride (S) and downward (D) mowing patterns, the basic (B) and moving (M) patterns were the most efficient; however, the risk of falls was also the highest among these patterns. While mowing, workers need to pay more attention to their arm strength and take appropriate measures to reduce the risk of falls according to their age and physique. The results can be used as data for the development of fall-detection systems and offer useful insights for the training of new mowing workers.

Comparison of nivolumab plus ipilimumab with tyrosine kinase inhibitors as first-line therapies for metastatic renal-cell carcinoma: a multicenter retrospective study.

BACKGROUND: This study compared real-world outcomes of metastatic renal-cell carcinoma (mRCC) patients treated with tyrosine kinase inhibitors or nivolumab plus ipilimumab. METHODS: Using the International mRCC Database Consortium (IMDC), we retrospectively evaluated intermediate- and poor-risk mRCC patients who were treated with nivolumab plus ipilimumab (Nivo-Ipi), tyrosine kinase inhibitors (TKIs) as the first-line therapy between August 2015 and January 2020. We compared oncological outcomes between the Nivo-Ipi group and TKIs group using multivariate logistic regression analysis with the inverse probability of treatment weighting (IPTW) method. RESULTS: In this study 278 patients were included. There were 52 and 226 patients in the Nivo-Ipi and TKIs groups (sunitinib 97, axitinib 118, sorafenib 9, pazopanib 2), respectively. The median age in the Nivo-Ipi and TKIs groups were 69 and 67 years, respectively. There was no significant difference in age, performance status, history of nephrectomy, and the IMDC risk group distribution between the groups. The objective response rate was significantly higher in the Nivo-Ipi group (38%) than in the TKIs group (23%, P = 0.018). The IPTW-adjusted Cox regression analysis showed that a significantly longer progression-free survival (hazard ratio 0.60, P = 0.039) and overall survival (hazard ratio 0.51, P = 0.037) rates in the Nivo-Ipi group than those in the TKIs group. CONCLUSIONS: The oncological outcomes of patients receiving the first-line therapy of nivolumab plus ipilimumab in real-world practice were significantly improved in comparison with first-line TKIs therapy.

Training Physical and Geometrical Mid-Points for Multi-person Pose Estimation and Human Detection Under Congestion and Low Resolution.

This paper introduces the design and evaluation of NeoPose which is developed for multi-person pose estimation and human detection. The design of NeoPose is targeting the issue of human detection under congested situation and with low resolution in the image. Under such situations, we compared the performance of different versions of NeoPose as well as other existing algorithms in a human detection task. Throughout the task, the usefulness of two kinds of mid-point (physical and geometrical mid-points) and a deconvolution structure was discussed. Experiment results indicated that NeoPose which applied geometrical mid-points and deconvolution structure performed the best in terms of both precision and recall in the evaluation.

Renal cell carcinoma in a lumbar ectopic kidney.

INTRODUCTION: Lumbar ectopic kidney is a rare developmental renal anomaly. We report a case of renal cell carcinoma in lumbar ectopic kidney with an abnormality of the main renal artery piercing the renal parenchyma. CASE PRESENTATION: A 70-year-old female was referred to our division with an incidentally diagnosed ectopic kidney. Computed tomography angiography detected the right kidney at the lumbar (L3-L4) level with an early-enhanced 44-mm-diameter mass. The kidney had a laterally facing renal hilum and renal arteries piercing the renal parenchyma from the medial side. An open radical nephrectomy was performed using a peritoneal approach, and no perioperative complications were observed. The pathological diagnosis was clear cell carcinoma (pT1). CONCLUSION: This is the first case report of renal cell carcinoma in a lumbar ectopic kidney. It highlights the importance of preoperational imaging for aberrant artery and careful surgical management.

Analyzing the changes of health condition and social capital of elderly people using wearable devices.

PURPOSE: Rapid developments in information technology have enabled wearable devices to be applied in the health field. In elderly adults, wearable devices aid in data collection and exerts a positive effect on their social capital. This study evaluated the changes in these two parameters among elderly adults using wearable devices, and analyzed the effect of these devices on their daily lives. METHODS: We selected 18 elderly people using wearable devices, between February and May 2017. The data collected by the wearable devices included the number of steps taken, sleep duration, blood pressure, heart rate, respiratory rate, fatigue, and mood of the wearers. Using a questionnaire and the trajectory equifinality model, we interviewed and surveyed elderly adults in order to understand their health status and social capital. RESULTS: The health of the participants was generally good, and most were able to achieve > 8000 steps per day (p < 0.05). Mild and moderate fatigue symptoms were noted in elderly adults for 90% of the study period (p < 0.05). The number of steps, blood pressure, and heart rate changed significantly within a month. From the commencement of using the wearable devices, a steady increase was noted in the monthly number of steps. Interviews suggested that the elderly adults perceived wearable devices as having the potential to improve health and social capital. CONCLUSIONS: By using wearable devices, the participants had a better understanding of their own health, and were willing to take health-boosting measures. The participants were also more willing to increase their social capital and expand their social network.