Bone scan index (BSI) scoring by using bone scintigraphy and circulating tumor cells (CTCs): predictive factors for enzalutamide effectiveness in patients with castration-resistant prostate cancer and bone metastases.

Reports of Bone Scan Index (BSI) calculations as imaging biomarkers to predict survival in patients with metastatic castration-resistant prostate cancer (mCRPC) have been mainly from retrospective studies. To evaluate the effectiveness of enzalutamide (ENZ) in Japanese patients with mCRPC and bone metastases using BSI (bone scintigraphy) and circulating tumor cell (CTC) analysis. Prospective, single-arm study at Juntendo University affiliated hospitals, Japan. Patients were administered 160 mg ENZ daily, with 3 monthly assessments: BSI, prostate specific antigen (PSA), CTC and androgen receptor splicing variant-7 (AR-V7) status. Primary endpoint: BSI-decreasing rate after ENZ treatment. Secondary endpoints: PSA-decreasing rate and progression free survival (PFS). Statistical analyses included the Wilcoxon t-test, Cox proportional hazard regression analysis, and log-rank test. Median observation period: 17.9 months, and median PFS: 13.8 (2.0-43.9) months (n = 90 patients). A decrease in BSI compared to baseline as best BSI change on ENZ treatment was evident in 69% patients at the end of the observation period (29% patients showed a complete response, BSI 0.00). At 3 months 67% patients showed a ≥ 50% PSA reduction, and 70% after ENZ treatment. PSA decline (3 months) significantly associated with a prolonged median PFS: 18.0 (estimated) versus 6.4 months (HR 2.977 [95% CI 1.53-5.78], p = 0.001). Best BSI decline response significantly associated with a prolonged PFS: 18.1(estimated) versus 7.8 months (HR 2.045 [95% CI: 1.07-3.90], p = 0.029). CTC negative status (n = 20) significantly associated with a prolonged PFS: 13.4 [estimated] vs 8.6 months (HR 2.366, 95% CI 0.97-5.71, p = 0.041). CTC positive/AR-V7 positive status significantly associated with a shorter PFS: 5.9 months (HR 8.56, 95% CI 2.40-30.43, p = 0.0087). -reduction (3 months) and BSI-reduction (on ENZ treatment) were significant response biomarkers, and a negative CTC status was a predictive factor for ENZ efficacy in patients with mCRPC.

Germ Cell Neoplasia in Situ Recognized Incidentally with Complaining of Discomfort in the Right Testis: A Case Report.

A 27-year-old man experienced discomfort in his right testis in early September, 2021, and visited the hospital five days later. Physical examination did not detect any abnormalities in the scrotum. However, an ultrasound revealed a tumor in the central part of the right testis, and a Magnetic Resonance Imaging (MRI) showed a tumor 2.7cm in diameter with clear boundaries and a marginally smooth surface. The level of alpha-fetoprotein, human chorionic gonadotropin, human chorionic gonadotropin-ß subunit, and lactate dehydrogenase were within normal limits. A Computed Tomography (CT) scan showed no abnormalities. We can't rule out the possibility of malignancy, right radical orchiectomy was performed with a diagnosis of right testicular tumor in mid-September 2021. The macroscopic lesion was 1.5×1.3 cm in size, and no viable tumorous cells were found pathologically. Atypical cells were observed in the seminiferous tubules from the spermatic cord, which were positively stained with immune-histochemical staining CD117 (c-kit), D2-40, and MIB-1 but negatively with alpha-fetoprotein, human chorionic gonadotropin, and human chorionic gonadotropin-ß subunit. The pathological diagnosis was germ cell neoplasia in situ, and no continuity was observed between these cells and bleeding necrosis. The patient has been followed up for 1 year and 4 months after surgery, with no recurrence or metastasis observed.

Acute urinary retention in a 23-year-old woman with mild encephalopathy with a reversible splenial lesion: a case report.

INTRODUCTION: Patients with clinically mild encephalitis/encephalopathy with a reversible splenial lesion present with relatively mild central nervous system disturbances. Although the exact etiology of the condition remains poorly understood, it is thought to be associated with infective agents. We present a case of a patient with mild encephalitis/encephalopathy with a reversible splenial lesion, who had the unusual feature of acute urinary retention. CASE PRESENTATION: A 23-year-old Japanese woman developed mild confusion, gait ataxia, and urinary retention seven days after onset of fever and headache. Magnetic resonance imaging demonstrated T2 prolongation in the splenium of the corpus callosum and bilateral cerebral white matter. These magnetic resonance imaging abnormalities disappeared two weeks later, and all of the symptoms resolved completely within four weeks. Except for the presence of acute urinary retention (due to underactive detrusor without hyper-reflexia), the clinical and radiologic features of our patient were consistent with those of previously reported patients with mild encephalitis/encephalopathy with a reversible splenial lesion. To the best of our knowledge, this is the first report of acute urinary retention recognized in a patient with mild encephalitis/encephalopathy with a reversible splenial lesion. CONCLUSION: Our findings suggest that mild encephalitis/encephalopathy with a reversible splenial lesion can be associated with impaired bladder function and indicate that acute urinary retention in this benign disorder should be treated immediately to avoid bladder injury.

CA19-9 as a serum marker for poor prognosis in urothelial carcinoma.

INTRODUCTION: To evaluate the role of serum carbohydrate antigen 19-9 (CA19-9) in the prognosis and follow-up evaluation of patients with urothelial carcinoma, the authors studied the association of the serum level and positive rate with clinical features such as infiltration and metastasis in 164 patients admitted to the authors' department. PATIENTS AND METHODS: This study included 164 cases of patients with urohelial carcinoma. The absolute value of the serum CA19-9 level and its positive rate were tested. Simple variant analysis and logistic regression analysis were used for estimation of statistical significance. Kaplan-Meier's test and Cox's proportional hazard model were used for analysis of survival. RESULTS: Significant differences in the serum CA19-9 levels were found with regard to the following parameters: the presence or absence of metastasis, clinical stage, depth of invasion, and degree of differentiation. The positive rate displayed a significant difference only for the presence or absence of metastasis. With regard to the presence of metastasis, serum CA19-9 was a significant risk factor along with depth of invasion in logistic regression analysis. Comparison of the survival rate indicated the prognosis to be significantly poor in the positive group and serum CA19-9 was regarded to be a prognostic risk factor in analysis via the regression model. CONCLUSIONS: Serum CA19-9 is thought to serve as a significant marker for advanced cancer and tumors with highly malignant potential and is useful for predicting prognosis of the disease.

Effects of hachimi-jio-gan (ba-wei-di-huang-wan) on blood flow in the human central retinal artery.

Hachimi-jio-gan (HJG), a Chinese herbal formula, and a placebo were given to 12 healthy adults, and the changes in blood flow in the central retinal artery were observed with the latest ultrasonic diagnosis device before and after administration. After administration of HJG, the systolic flow velocity, diastolic flow velocity and mean flow velocity in the central retinal artery showed significant increases. No change was observed in vascular resistance. The subjects deemed suitable for use of HJG showed remarkable increases in blood flow. No changes in blood flow velocities and vascular resistance were observed after administration of the placebo. HJG is frequently used in the aged, often with eye diseases such as cataract. It has been reported that a decrease of blood flow in the central retinal artery becomes more marked in proportion to the progress of various eye diseases. As increases in blood flow were obvious in the cases that were treated with HJG, it is suggested that increases in blood flow in the central retinal artery due to HJG give direct evidence supporting the positive effects of HJG on eye diseases.