Preoperative Pyuria Predicts for Intravesical Recurrence in Patients With Urothelial Carcinoma of the Upper Urinary Tract After Radical Nephroureterectomy Without a History of Bladder Cancer.

BACKGROUND: We assessed preoperative pyuria as a significant predictor of intravesical recurrence (IVR) in patients with upper urinary tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU). PATIENTS AND METHODS: We evaluated the data from 268 patients with UTUC without a history of bladder cancer who had undergone RNU from 2006 to 2016 at 4 academic institutions. The associations between the clinical variables and the presence of pyuria were evaluated by univariate analysis. IVR was assessed using the Kaplan-Meier method and Cox regression analysis. RESULTS: The median postoperative follow-up of patients with IVR-free survival was 29.1 months (interquartile range, 15.4-55.3 months). The rate of IVR was significantly greater in the patients with than in those without pyuria (P = .025). Multivariate analysis showed that preoperative pyuria (hazard ratio [HR], 1.70; P = .007), a ureteral tumor site (HR, 1.64; P = .012), and positive surgical margins (HR, 2.70; P = .013) were associated with a significantly increased risk of IVR. A postoperative risk stratification model using these factors showed significant differences among the 3 subgroups of patients with low, intermediate, and high risk. The 5-year IVR-free survival rates for the patients with low, intermediate, and high risk were 69.1%, 51.8%, and 18.8%, respectively (P = .004). CONCLUSION: Preoperative pyuria, a ureteral tumor site, and positive surgical margins were associated with a significantly increased risk of IVR. Although external validation is required, the presence of preoperative pyuria could be a significant predictor of IVR in patients with UTUC after RNU.

Prolactin Levels After Switching to Paliperidone Palmitate in Patients with Schizophrenia.

Objective: The aim of this study was to investigate the tolerability and efficacy of paliperidone palmitate and its effect on the levels of prolactin in patients with schizophrenia. Method: A prospective study was carried out in 22 Japanese middle-aged patients with schizophrenia who were switched from paliperidone-extended release or risperidone long-acting injectable to paliperidone palmitate for a minimum of 12 months. Psychotic symptoms using the 18-item Brief Psychiatric Rating Scale, extrapyramidal symptoms using 9-item Drug-induced Extrapyramidal Symptoms Scale, and plasma prolactin levels using fasting blood samples were assessed at Baseline, and one, three, six, and 12 months. Results: There were significant reductions in prolactin levels at one, three, and six months relative to baseline in the male subjects switched from risperidone long-acting injectable, while prolactin levels in male subjects switched from paliperidone-extended release and the female subjects switched from risperidone long-acting injectable or paliperidone-extended release were largely unchanged. No time-sequential changes were observed in total scores of Brief Psychiatric Rating Scale and Drug-induced Extrapyramidal Symptoms Scale, irrespective of previous antipsychotics treatment. Conclusion: Switching from paliperidone-extended release or risperidone long-acting injectable to paliperidone palmitate did not result in any observed time-sequential changes in psychotic symptoms in study subjects, and prolactin levels decreased in male subjects switched from risperidone long-acting injectable. As measurement of paliperidone concentrations is limited in routine practice, a fluctuation range of prolactin levels may be a useful marker for confirmation of safety maintenance treatment with long-acting injectables in clinical settings.

Culturally sensitive and universal measure of resilience for Japanese populations: Tachikawa Resilience Scale in comparison with Resilience Scale 14-item version.

AIM: Although scales specific to resilience are available and widely used, qualities of resilience could be culturally sensitive. This study aimed to develop a concise scale of resilience for Japanese populations, and compare its validity to that of the Resilience Scale 14-item version (RS-14), one of the most widely used scales for measuring resilience. METHODS: The Tachikawa Resilience Scale (TRS) was developed on the basis of data obtained from unstructured interviews with Japanese motor vehicle accident survivors without psychiatric disorder. The reliability and validity of the TRS and RS-14 were then examined in cross-sectional studies performed with 523 company workers and 140 psychiatric outpatients. RESULTS: The TRS and RS-14 were negatively correlated with depressive symptoms in company workers and psychiatric outpatients and with anxiety in psychiatric outpatients, and were positively correlated with social support in company workers. Internal consistency and test-retest reliability of the TRS were high. Construct validity of the TRS was equivalent to that of the RS-14 in company workers, and higher than that of the RS-14 in psychiatric outpatients. CONCLUSION: The reliability and validity of the TRS and RS-14 in Japanese company workers and patients with psychiatric disorders were acceptable. The validity of the TRS was equivalent to or better than that of the RS-14. Although the TRS cannot be regarded as an established scale due to a lack of theoretical rationale, the results of this study suggest that scales measuring resilience that cover cultural aspects might be more relevant in given populations.

The neurocognitive effects of aripiprazole compared with risperidone in the treatment of schizophrenia.

Aripiprazole is a D2 and D3 receptor partial agonist that is unlike other second generation antipsychotics. The effectiveness of aripiprazole with regard to neurocognitive function and its adverse effects is unclear. The present study evaluates the comparative efficacy, effects on neurocognitive function, and adverse effects of aripiprazole and risperidone in the treatment of hospitalized patients with schizophrenia. This double-blind, cross-over study included 23 patients with schizophrenia who were randomly assigned to be treated first with either aripiprazole or risperidone. After eight weeks on one medication, the patients were switched to the other medication for eight weeks. The patient assessment included the Positive and Negative Syndrome Scale (PANSS), neurocognitive assessments, and adverse events including extrapyramidal symptoms, vital signs, electrocardiogram, and clinical laboratory tests. The study findings indicated that psychopathology assessed with the PANSS, extrapyramidal symptoms and other adverse effects did not differ between aripiprazole and risperidone for the subjects remaining in treatment. In the neurocognitive assessments, the score for disinhibition with aripiprazole was significantly lower than with risperidone (p < 0.05). In addition, serum prolactin levels were significantly lower with aripiprazole (p < 0.001). The treatment drop-out rate was higher for patients receiving aripiprazole than risperidone. In comparing aripiprazole and risperidone, risperidone is better from the viewpoint of treatment continuation. On the other hand, some adverse effects, such as hyperprolactinemia and disinhibition, are less severe with aripiprazole. Thus, for certain applications, aripiprazole may be a beneficial new treatment option for schizophrenia.

[Occurrence and prognosis of hepatocellular carcinoma].

Tomiura, a rural area of Chiba Prefecture in which community-based HCV screening has been carried out since 1991, is known as a high-incidence area of HCV. This study was conducted to clarify the clinical characteristics of subjects with positive HCV antibody titer found on mass survey, in relation to the development and outcome of hepatocellular carcinoma. We analyzed clinical data of patients with positive HCV antibody test results followed up for 9 to 11 years after the mass survey examinations. Among 171 patients, we identified 23 cases (13.5%) of hepatocellular carcinoma in a 9-year period. Correlations have been identified between the occurrence of hepatocellular carcinoma and those factors including gender, aminotranseferase levels, platelet count and ultrasound findings at the time of the first health screening, as well as patterns of fluctuation in aminotranseferase levels during the follow-up period. Among those patients with hepatocellular carcinoma, 11 patients survived for more than 5 years. The survival period has been found to be related to AST level at the time of first health screening, the findings in ultrasound scanning when the carcinoma was initially identified, and patterns of fluctuation in aminotranseferase levels subsequent to the first diagnosis.

Intercellular communications within the rat anterior pituitary XII: immunohistochemical and physiological evidences for the gap junctional coupling of the folliculo-stellate cells in the rat anterior pituitary.

Since Farquhar [1957. "Corticotrophs" of the rat adenohypophysis as revealed by electron microscopy. Anat. Rec. 127, 291] was the first to report the presence of agranular folliculo-stellate cells as corticotrophs in the anterior pituitary gland, there were no reports about electro-physiological characteristics of the folliculo-stellate cells because of its no hormonal activity and the chaotic distribution of the parenchyma cells. Male Wistar rats, aged 7 weeks with weighing 250--300 g, were separated into two groups. One group was used for immunohistochemical and light microscopical studies to detect S-100 protein and connexin 43. The other group was used for the electro-physiological study and then for the electron microscopical study to know the fine structural character of folliculo-stellate cells after the electro-physiological experiment. Clusters of S-100 protein cells (agranulated folliculo-stellate cells) and numerous connexin 43 positive sites on S-100 protein cells were clear in the "transitional zone" at which the pituitary tissue made the transition from the pars tuberalis to the proximal part of the anterior lobe. Penetration of electrodes to the cells distributed in the transitional zone showed stable membrane potential ranged between--27 and--67mV with no spontaneous activity. Random penetration of electrode showed that larger populations of cell ( approximately 80%) had membrane potentials with -55.6+/-5.1 mV, and less than 20% of cells had the resting membrane potential with -36.0+/-4.4 mV. There were two types of cell couplings; one major group for the recordings from cells with similar deep resting membrane potentials and the other for the recordings from cells with different resting membrane potentials. The former indicated that two cells were electrically coupled while the latter no electrical couples were observed. Carbenoxolone depolarized the membrane by 12.3+/-5.5 mV and reduced the amplitude of electrotonic potentials, and the response recovered by removal of carbenoxolone by the superfusate. The transitional zones of the pituitary glands examined the electrical coupling were observed by an electron microscopy. Almost cytological profiles were observed as intact. The results clearly indicated that the folliculo-stellate cell system deeply participated in the regulation of the anterior pituitary parallel with the portal vessel system, which was the main regulatory system for pituitary hormone secretion.

Intercellular communications within the rat anterior pituitary XI: an immunohistochemical study of distributions of S-100 positive cells in the anterior pituitary of the rat.

The distribution of the S-100 protein cell (folliculo-stellate cell) is very important to our understanding of the regulation of the anterior pituitary. In this study, 10 intact 60-day-old male Wistar-Imamichi rats, were separated equally into two groups. One was used for immunohistochemical study, and the other for electron microscopic analysis. Immunostained pituitary sections with S-100 protein antibody were photographed using a CCD camera equipped with a computer. The S-100 protein cells were then measured using NIH image software, and the three-dimensional distribution of the cells was analyzed. The distribution of the cells observed in each serial section showed that S-100 protein cells were dense at the basal zone of the gland and at the "transitional zone" where the pars tuberalis adjoined the anterior and intermediate lobes, where they represented over 50% of the total cell population. They then decreased in number with distance from this region to mid-way towards the sagittal axis before increasing again in the tail of the gland. The population of cells also decreased with increasing distance from the "transitional zone" to the wing and with distance from the basal zone. Portal vessels entered the anterior lobe through the "transitional zone" as thick capillaries, ran through the basal surface and penetrated into the central area of the anterior lobe. In all planes, S-100 protein cells encircled the capillaries. Ultrastructural observations confirmed the light microscopic findings indicating that clusters of agranular cells were densely located at the "transitional zone" and in the pars tuberalis. The distribution pattern of the folliculo-stellate cells and the capillaries showed good agreement and the spatial relationship between these two is detailed so as to better understand hypophyseal histophysiology.

Hemodynamic response of the left gastric vein to glucagon in patients with portal hypertension and esophageal varices.

Flow direction and flow velocity of the left gastric vein (LGV) and the portal vein (PV) were examined by a Doppler sonographic machine in 33 patients with esophageal varices, before and after venous injection of glucagon (1 mg). In two patients with hepatopetal blood flow in the LGV, the flow direction changed to hepatofugal after injection of glucagon. In 31 patients with hepatofugal blood flow in the LGV, a significant increase of flow velocity was observed in the LGV in 18 patients (58.1%) and the changes (26.4 +/- 24.6%) were significantly larger than those in the PV (7.9 +/- 16.0%). The changes in flow velocity decreased in the LGV as the diameter of the LGV and the size of varices increased. In conclusion, glucagon increased collateral blood flow in the LGV in portal hypertension. However, the grade of the response decreased as the grade of portal hypertension increased.