研究者詳細 - 樋之津　史郎

論文 - 樋之津　史郎

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Estimation formulas for ionized magnesium in critically ill children.

Soichiro Tanimura, Hiroki Kato, Yurie Yamaga, Tomohiro Wakabayashi, Shiro Hinotsu, Norihiko Tsuboi, Shotaro Matsumoto, Satoshi Nakagawa

Clinical biochemistry 138 110962 - 110962 2025年08月 [国際誌]

INTRODUCTION: Clinically, ionized magnesium (iMg) measurement requires specialized equipment, leading many healthcare providers to rely on total magnesium (tMg) as a surrogate marker. However, accurately assessing magnesium homeostasis necessitates precise iMg measurement. Given this challenge, we conducted a study to develop predictive formulas for estimating iMg levels based on molecules involved in acid-base regulation. MATERIALS AND METHODS: This exploratory study was conducted prospectively with pediatric patients under 18 years of age admitted to the pediatric intensive care unit in a tertiary children's hospital in Japan between July and August 2024. We measured serum iMg levels using the Stat Profile Prime analyzer from Nova Biomedical. Concurrent blood samples were collected for ion analysis following the Stewart approach. Multiple regression analysis was utilized to develop an equation for estimating iMg levels. The accuracy of the developed equations was further assessed using Bland-Altman analysis and weighted κ coefficients. RESULTS: A total of 200 samples were analyzed. Spearman's rank correlation coefficient between iMg and tMg concentrations was 0.915, indicating a strong and statistically significant association in the simple regression analysis (β = 0.275, 95 % confidence interval 0.271-0.278). Three predictive equations were developed using multivariate analysis. These models were tested on another 86 additional samples. Bland-Altman analysis demonstrated minimal error between measured and estimated values, with κ coefficients indicating high concordance. CONCLUSIONS: We successfully developed an iMg estimation model using routinely measured clinical parameters.

Patient characteristics, treatment patterns, and survival outcomes in patients with castration-resistant prostate cancer: results from the J-CaP registry.

Mizuki Onozawa, Taketo Kawai, Shiro Hinotsu, Atsushi Saito, Takeshi Mitomi, Satoshi Uno, Haruki Kume

Japanese journal of clinical oncology 55 ( 7 ) 816 - 824 2025年07月 [国際誌]

BACKGROUND: The optimal treatment sequence of approved therapies for castration-resistant prostate cancer (PC) is unclear. This study assessed real-world patient characteristics, treatment patterns, and effectiveness in patients with castration-resistant PC in Japan. METHODS: Using data from the Japan Study Group of Prostate Cancer registry (2016-2018), this retrospective study included patients with ≥1 record of: primary androgen-deprivation therapy for hormone-sensitive PC and clinical progression to castration-resistant PC during primary androgen-deprivation therapy. The primary outcomes were patient characteristics, treatment patterns, and treatment duration. Other outcomes were overall survival (OS), cancer-specific survival (CSS), time to disease progression, and time to second disease progression. RESULTS: A total of 600 patients were included. The mean age was 75.3 (SD: 7.9) years at PC diagnosis. The median prostate-specific antigen level was 135.5 (IQR: 37.3-542.2) ng/mL. The most common first-line castration-resistant PC treatments were enzalutamide (30%), docetaxel (20%), abiraterone (18%), flutamide (12%), and bicalutamide (8.7%). The most common second-line treatments were enzalutamide (28.5%), abiraterone (21.9%), and docetaxel (16.6%). The median treatment duration for enzalutamide, docetaxel, abiraterone, and flutamide was 254.0, 176.0, 197.0, and 111.5 days, respectively. Across all treatments, the median OS, CSS, time to disease progression, and second disease progression was 1028.0, 1239.0, 616.0, and 887.0 days, respectively. CONCLUSION: Androgen receptor signaling inhibitors and docetaxel were the most common first- and second-line castration-resistant PC treatments. Enzalutamide was the preferred androgen receptor signaling inhibitor with the longest treatment duration.

Results of a Phase II Trial for Intermediate-Risk Rhabdomyosarcoma Treatment Protocol JRS-I: A Report From the Japan Rhabdomyosarcoma Study Group.

Atsushi Kikuta, Hidekazu Masaki, Hiroshi Hojo, Jun-Ichi Hata, Hajime Ohkita, Hajime Hosoi, Atsuko Nakazawa, Shiro Hinotsu, Hitoshi Ikeda, Seiji Kishimoto, Michio Kaneko, Akira Kawai, Junichi Hara, Tetsuya Takimoto, Miho Kato, Takashi Kaneko, Yoshiyuki Kosaka, Yasuhide Morikawa

Pediatric blood & cancer e31894 2025年07月 [国際誌]

PURPOSE: To evaluate the safety and efficacy of multimodality treatment with vincristine, actinomycin D, and cyclophosphamide (VAC) therapy, surgery, and radiotherapy according to the US Intergroup Rhabdomyosarcoma Study IV (IRS-IV), and to establish a central review system and standard treatment for intermediate-risk pediatric rhabdomyosarcoma in Japan. PATIENTS AND METHODS: The Japan Rhabdomyosarcoma Study-I (JRS-I) was a single-arm, phase II trial for intermediate-risk rhabdomyosarcoma treatment with open enrollment from June 2004 to March 2009. Patients received 12 cycles of VAC every 3 weeks for 42 weeks, with local therapy beginning after Week 12. The endpoints were progression-free survival (PFS), overall survival (OS), and incidence of hepatic veno-occlusive disease (VOD). RESULTS: Thirty-one eligible patients were enrolled, and at a median follow-up of 5.2 years, the 3-year PFS and OS for patients were 74.2% ± 7.9% (95% confidence interval [CI] 55.0%-86.2%) and 90.3% ± 5.3% (95% CI 72.9%-96.8%), respectively. VOD occurred in 3 (8%) of the 40 evaluable patients, but all recovered, and there were no deaths. CONCLUSION: The VAC regimen for intermediate-risk rhabdomyosarcoma with the first central review system in Japan is safe and feasible, and these findings can be positioned as basic data for improving treatment outcomes in Japan.

Changes in the Use of Telephone Follow-ups among Patients with Urologic Malignancies in Japan.

Keiko Fujino, Naoya Masumori, Shiro Hinotsu

Annals of clinical epidemiology 7 ( 3 ) 80 - 89 2025年07月 [国内誌]

BACKGROUND: This study aimed to compare telephone follow-ups for patients with urologic malignancies in Japan before and during the COVID-19 pandemic. METHODS: Using the database of the Japan Medical Data Center Co., Ltd., we identified patients with urologic malignancies who underwent at least one telephone follow-up between April 2014 and March 2020.The self-controlled case series method was used to calculate the incidence rate ratio of telephone follow-up utilization for the pandemic using the pre-pandemic period as a reference. RESULTS: Of the 289 patients, 31 were women. Their median age was 80 years, and the median observation period was 28 months.The incidence rate ratio for telephone follow-up utilization during the pandemic was 17.8 compared to that of the pre-pandemic period. In an analysis stratified by type of carcinoma, the incidence rate ratios were higher in all strata than they were before the pandemic. However, among male patients with genital malignancies, particularly prostate cancers, the incidence rate ratio was lower than in other strata.According to analysis stratified by age, the usage of telephone follow-up for men in their 50s or younger was particularly low. Additionally, the interval between face-to-face visits increased in patients over 60 years-of-age. CONCLUSIONS: The telephone follow-up among patients with urologic malignancies in Japan increased significantly during the early phase of the COVID-19 pandemic. Our results indicate that telephone follow-up can potentially be a valuable patient-doctor communication tool.

Efficacy of nivolumab + ipilimumab ± chemotherapy versus pembrolizumab + chemotherapy in patients with PD-L1-negative non-small cell lung cancer (START001 PART-B): a multicenter retrospective observational study.

Yutaro Nagano, Mamoru Takahashi, Toshiyuki Sumi, Keiki Yokoo, Tatsuru Ishikawa, Osamu Honjo, Sayaka Kudo, Shun Kondo, Yusuke Tanaka, Makoto Shioya, Midori Hashimoto, Mitsuo Otsuka, Yuta Sudo, Masahiro Yanagi, Hayato Yabe, Hirotaka Nishikiori, Masami Yamazoe, Yuichiro Asai, Yasuko Fukataki, Shiro Hinotsu, Hirofumi Chiba

Japanese journal of clinical oncology 2025年05月 [国際誌]

BACKGROUND: Programmed death ligand 1 (PD-L1) serves as a crucial biomarker for predicting the efficacy of immune checkpoint inhibitors in patients with non-small cell lung cancer (NSCLC). This study aimed to identify the most suitable first-line treatment regimen for patients with PD-L1 expression <1% (PD-L1-negative) NSCLC by comparing nivolumab plus ipilimumab (NI), NI combined with chemotherapy (NICT), and pembrolizumab and chemotherapy (PCT). METHODS: We analyzed data from 141 patients with PD-L1-negative NSCLC treated with NI, NICT, or PCT at 14 Japanese institutions between December 2020 and November 2022. Propensity score analysis was employed to minimize selection bias, and Kaplan-Meier analysis and Cox proportional hazards regression were used to evaluate progression-free survival (PFS) and overall survival (OS). RESULTS: Neither NI nor NICT demonstrated superior PFS or OS than PCT. Subgroup analyses revealed no significant differences between treatment groups across age, histological subtypes, or clinical features. Results from propensity score matching and inverse probability of treatment weighting were consistent with those observed in the overall cohort. Moreover, safety profiles showed that PCT was associated with the lowest rates of treatment discontinuation and immune-related adverse events requiring systemic corticosteroid therapy. CONCLUSIONS: In patients with PD-L1-negative NSCLC, the efficacy of NI and NICT was not superior to that of PCT. Thus, we concluded that PCT could be a favorable treatment option for this patient population.

Summary of the clinical practice guideline for the management of urinary stones, third edition.

Katsuhito Miyazawa, Satoshi Yamaguchi, Taro Iguchi, Ippei Chikazawa, Takahiro Yasui, Satoru Takahashi, Shiro Hinotsu, Koichiro Akakura, Shizuka Iida, Noritaka Ishito, Takaaki Inoue, Yasuo Kohjimoto, Shinichi Sakamoto, Yoshikazu Sato, Ryoji Takazawa, Tatsuya Takayama, Masao Tsujihata, Yukio Naya, Shuzo Hamamoto, Motoyuki Masai, Takuro Masaki, Junichi Matsuzaki, Soichi Mugiya

International journal of urology : official journal of the Japanese Urological Association 32 ( 5 ) 462 - 474 2025年05月 [国際誌]

This third edition of the Japanese Clinical Practice Guidelines for Urinary stones (2023) has been developed under the leadership of the Japanese Urological Association, the Japanese Society of Endourology and Robotics, and the Japanese Society on Urolithiasis Research. This revision adheres to the Minds Manual for Guideline Development (2017) and incorporates new findings from a nationwide survey conducted in 2015, which highlighted the epidemiological characteristics of urolithiasis in Japan since the previous guidelines were published in 2013. A significant advancement in this edition is the systematic review (SR) methodology applied to formulate recommendations for 12 clinical questions (CQs). Both quantitative and qualitative SRs were performed, leading to recommendations determined through consensus among 21 members of the guideline development group. Additionally, nine algorithms were created to support clinical decision-making based on these findings. Topics not addressed by the CQs, considered as foundational knowledge, are outlined in an "Explanation of Related Matters" section, which includes 26 items. This article provides an overview of these guidelines. This section ensures that practitioners have access to comprehensive information, covering aspects of urolithiasis management beyond the scope of the systematic reviews. This article provides an overview of the guidelines, emphasizing their relevance and importance in improving the management and treatment outcomes for patients with urinary stones. The guidelines are designed to be a practical resource for clinicians, facilitating evidence-based care in the evolving landscape of urolithiasis treatment.

Primary management of prostate cancer by universal health coverage effective coverage index.

Leandro Blas, Masaki Shiota, Mizuki Onozawa, Jae Young Joung, Kyo Chul Koo, Levent Türkeri, Bahadır Şahin, Jasmine Lim, Teng Aik Ong, Peter Ka-Fung Chiu, Chi-Fai Ng, Tong-Lin Wu, Vu Le Chuyen, Bannakij Lojanapiwat, Jason L Letran, Lukman Hakim, Edmund Chiong, Ghazi M Al-Edwan, Satoru Taguchi, Yoshiyuki Yamamoto, Shinichi Sakamoto, Taketo Kawai, Masatoshi Eto, Tohru Nakagawa, Shiro Hinotsu, Haruki Kume

World journal of urology 43 ( 1 ) 146 - 146 2025年03月 [国際誌]

PURPOSE: Prostate cancer is under-researched in many Asian countries because the paucity of comprehensive cancer registries has prevented large studies from comparing primary prostate cancer therapies. We aimed to provide further insights into recent trends in primary prostate cancer management across multiple Asian countries and regions according to universal health coverage. METHODS: This is part of the Asian Prostate Cancer (A-CaP), a prospective and multicenter study conducted in 12 Asian countries. The study cohort comprised patients newly diagnosed between January 2016 and December 2018. Patients were allocated to three categories according to the universal health coverage effective coverage index (Category 1 ≥ 80; Category 2, 70-79; and Category 3, < 70). We assessed primary management of prostate cancer according to these categories and by clinic pathological characteristics such as clinical stage, and D'Amico risk group. RESULTS: In total, 34,994 patients were included in the final analysis. Category 1 had the highest proportion of patients diagnosed at early stages and Category 3 had the highest proportion of patients diagnosed at advanced stages. Most patients in Category 1 had undergone computed tomography scans, magnetic resonance imaging, and bone scans. In contrast, only 1.7% and 5.4% of men in Categories 2 and 3, respectively, had undergone all three of these investigations. The proportion of patients who had undergone radiation and androgen deprivation therapy as primary treatment was highest in Category 1, whereas the rate of conservative management was highest in Category 2. More patients in Category 3 than in the other two categories had undergone radical prostatectomy, but fewer had been treated with radiation therapy. CONCLUSIONS: Our findings highlighted differences in patterns of treatment of newly diagnosed prostate cancer across 12 Asian countries and regions and suggest that, despite guidelines, health access affects treatment received.

Trends in uptake of cancer screening among people with severe mental illness before and after the COVID-19 pandemic in Japan: A repeated cross-sectional study.

Yuto Yamada, Masaki Fujiwara, Naoki Nakaya, Koji Otsuki, Taichi Shimazu, Maiko Fujimori, Shiro Hinotsu, Kiwamu Nagoshi, Yosuke Uchitomi, Masatoshi Inagaki

PCN reports : psychiatry and clinical neurosciences 4 ( 1 ) e70062 2025年03月 [国際誌]

AIM: The aim of this study was to investigate trends in cancer screening participation among people with severe mental illness (PSMI) from periods before and after the COVID-19 pandemic. METHODS: In this repeated cross-sectional study, we used anonymized datasets on municipal cancer screening participation among PSMI in Okayama City. The data covered fiscal year (FY) 2018 to FY2022; we used the municipal cancer screening database and Medical Payment for Services and Supports for Persons with Disabilities. PSMI were defined as those with schizophrenia or related psychotic disorders (F20-29) or bipolar disorder (F30 or F31), identified using International Classification of Diseases, Tenth Revision, codes. The analysis included men and women aged 40-69 years for colorectal and lung cancer screening; men and women aged 50-69 years for gastric cancer screening; women aged 40-69 years for breast cancer screening; and women aged 20-69 years for cervical cancer screening. Municipal cancer screening rates among PSMI were calculated for each FY. RESULTS: For all cancer types, cancer screening rates for PSMI in FY2020 (colorectal: 9.0%; lung: 11.6%; gastric: 4.9%; breast: 6.2%; and cervical: 6.1%) were lower than the rates in FY2019 (11.5%, 14.0%, 6.5%, 9.3%, and 8.3%, respectively). In FY2022, the rates (9.9%, 12.9%; 5.3%; 8.0%, and 6.9%, respectively) recovered, but remained low. CONCLUSION: This study showed that cancer screening rates among PSMI were very low, both before and after the COVID-19 pandemic. Efforts to encourage participation in cancer screening in this population are urgently needed.

Pharmacotherapy for patients with calcium oxalate stones and abnormal urine chemistry: A systematic review and meta-analysis for the Japanese Clinical Practice Guidelines for the Management of Urinary Stones, Third Edition.

Yasuo Kohjimoto, Akinori Iba, Shimpei Yamashita, Masatoshi Higuchi, Ryusuke Deguchi, Ippei Chikazawa, Shiro Hinotsu, Satoshi Yamaguchi, Katsuhito Miyazawa, Isao Hara

International journal of urology : official journal of the Japanese Urological Association 32 ( 1 ) 16 - 28 2025年01月 [国際誌]

We performed a systematic review and meta-analysis to evaluate the benefits and harms of pharmacotherapies for patients with calcium oxalate stones and abnormal urine chemistry. This article is a modified and detailed version of the commentary on Clinical Question 10 described in the Japanese Clinical Practice Guidelines for the Management of Urinary Stones, Third Edition. PubMed and Ichushi Web were searched through August 2020 for articles on pharmacotherapies for calcium oxalate stones (thiazides, citrate preparations, uric acid production inhibitors, and magnesium preparations). Two reviewers independently selected randomized controlled trials reporting reduction of stone recurrence and adverse drug reactions as outcomes and performed data extraction and quality assessment. Meta-analyses with random effects models and rating of the strength of evidence were performed. Pharmacotherapies were shown to significantly reduce stone recurrence (risk ratio 0.47, 95% confidence interval 0.35-0.63). Meanwhile, the pharmacotherapies increased adverse drug reactions leading to study dropout (risk ratio 2.51, 95% confidence interval 1.09-5.75) and adverse drug reactions/adverse events (risk ratio 1.95, 95% confidence interval 1.07-3.56). The reported adverse drug reactions were, however, mainly minor and did not frequently require discontinuation of medication (2%-16%). The strengths of evidence for both outcomes were rated as moderate, because the risk of bias, indirectness, inconsistency, imprecision, and publication bias were all serious except for one item. The overall strength of evidence across outcomes was therefore determined to be moderate. These results support the conditional recommendation to initiate pharmacotherapies for patients with calcium oxalate stones and abnormal urine chemistry.

Maternal age and the rising incidence of hypertensive disorders of pregnancy: A comprehensive analysis of national claims data from Japan.

Naomi Maeda, Masayuki Koyama, Shintaro Takatsuka, Keisuke Oyatani, Nobuaki Himuro, Tasuku Mariya, Yoshika Kuno, Shiro Hinotsu, Tsuyoshi Saito, Hirofumi Ohnishi

PloS one 20 ( 2 ) e0319177 2025年 [国際誌]

BACKGROUND: Hypertensive disorders of pregnancy (HDP) significantly increase the risk of developing hypertension and cardiovascular disease (CVD) later in life and are a major cause of maternal mortality. However, little is known about the nationwide, long-term, all-inclusive status of HDP. OBJECTIVE: To estimate the incidence of HDP from 2011 to 2019 in Hokkaido, Japan, with a focus on age groups. METHODS: Using National Database (NDB) insurance medical data, a retrospective analysis was conducted. Due to the absence of direct pregnancy data, birth numbers were used as a surrogate for the number of pregnant women to calculate the incidence of HDP. RESULTS: The average incidence rate of HDP over 9 years was 6.37%. The incidence rate was lowest among women aged 25-29 years, at 5.58% (95% confidence interval [CI]: 5.43-5.73), and increased with age, peaking at 10.58% (95% CI: 10.10-11.09) among women over 40 years. Notably, the incidence rate for women under 20 years of age was 6.70% (95% CI: 5.97-7.51), which was higher than that for women in their 20s. A mean annual increase of 0.25% in age-adjusted incidence was observed during this period, which was statistically significant (R² = 0.87, p < 0.01). CONCLUSION: This study reveals that the risk of developing HDP is associated with both older childbearing and younger pregnancies and follows a J-curve, suggesting that factors other than maternal aging also contribute to the increased incidence of HDP and that further research on risk factors for HDP, which is on the rise worldwide, is urgently needed.

Japanese clinical practice guidelines for prostate cancer 2023.

Yasuo Kohjimoto, Hiroji Uemura, Masahiro Yoshida, Shiro Hinotsu, Satoru Takahashi, Tsutomu Takeuchi, Kazuhiro Suzuki, Hiroshi Shinmoto, Tsutomu Tamada, Takahiro Inoue, Mikio Sugimoto, Atsushi Takenaka, Tomonori Habuchi, Hitoshi Ishikawa, Takashi Mizowaki, Shiro Saito, Hideaki Miyake, Nobuaki Matsubara, Norio Nonomura, Hideki Sakai, Akihiro Ito, Osamu Ukimura, Hideyasu Matsuyama, Isao Hara

International journal of urology : official journal of the Japanese Urological Association 31 ( 11 ) 1180 - 1222 2024年11月 [国際誌]

This fourth edition of the Japanese Clinical Practice Guidelines for Prostate Cancer 2023 is compiled. It was revised under the leadership of the Japanese Urological Association, with members selected from multiple academic societies and related organizations (Japan Radiological Society, Japanese Society for Radiation Oncology, the Department of EBM and guidelines, Japan Council for Quality Health Care (Minds), Japanese Society of Pathology, and the patient group (NPO Prostate Cancer Patients Association)), in accordance with the Minds Manual for Guideline Development (2020 ver. 3.0). The most important feature of this revision is the adoption of systematic reviews (SRs) in determining recommendations for 14 clinical questions (CQs). Qualitative SRs for these questions were conducted, and the final recommendations were made based on the results through the votes of 24 members of the guideline development group. Five algorithms based on these results were also created. Contents not covered by the SRs, which are considered textbook material, have been described in the general statement. In the general statement, a literature search for 14 areas was conducted; then, based on the general statement and CQs of the Japanese Clinical Practice Guidelines for Prostate Cancer 2016, the findings revealed after the 2016 guidelines were mainly described. This article provides an overview of these guidelines.

Significance of androgen-deprivation therapy for intermediate- and high-risk prostate cancer treated with high-dose radiotherapy: A literature review.

Rihito Aizawa, Hitoshi Ishikawa, Manabu Kato, Shosei Shimizu, Takashi Mizowaki, Yasuo Kohjimoto, Shiro Hinotsu, Isao Hara

International journal of urology : official journal of the Japanese Urological Association 31 ( 10 ) 1068 - 1079 2024年10月 [国際誌]

The real-world benefits of adding androgen-deprivation therapy (ADT) and its optimal duration when combined with current standard high-dose radiation therapy (RT) remain unknown. We aimed to assess the efficacy of and toxicities associated with ADT in the setting of combination with high-dose RT for intermediate-risk (IR) and high-risk (HR) prostate cancer (PCa). This article is a modified and detailed version of the commentary on Clinical Question 8 described in the Japanese Clinical Practice Guidelines for Prostate Cancer (ver. 2023). A qualitative systematic review was performed according to the Minds Guide. All relevant published studies between September 2010 and August 2020, which assessed the outcomes of IR or HR PCa treated with high-dose RT, were screened using two databases (PubMed and ICHUSHI). A total of 41 studies were included in this systematic review, mostly consisting of retrospective studies (N = 34). The evidence basically supports the benefit of adding ADT to high-dose RT to improve tumor control. Regarding IR populations, many studies suggested the existence of a subgroup for which adding ADT had no impact on either overall survival or the BF-free duration. On the other hand, regarding HR populations, several studies suggested the positive impact of adding ADT for ≥1 year on overall survival. Adding ADT increases not only the risk of sexual dysfunction but also that of cardiovascular toxicities or bone fracture. Although the benefit of adding ADT was basically suggested for both IR and HR populations, further investigations are warranted to identify subgroups of patients for whom ADT has no benefit, as well as the appropriate duration of ADT for those who do derive benefit.

Changes in the trends of initial treatment for newly diagnosed prostate cancer in Japan: a nationwide multi-institutional study.

Taketo Kawai, Mizuki Onozawa, Satoru Taguchi, Masaki Shiota, Shinichi Sakamoto, Yoshiyuki Yamamoto, Yasuhide Kitagawa, Tohru Nakagawa, Shiro Hinotsu, Haruki Kume

Japanese journal of clinical oncology 54 ( 9 ) 1045 - 1051 2024年09月 [国際誌]

BACKGROUND: In previous large-scale studies conducted through 2010, androgen deprivation therapy (ADT) was the most common initial treatment for prostate cancer patients in Japan. However, recent advancements in treatment technologies have significantly affected the management of prostate cancer in Japan. This study analyzed the trends in initial treatments for prostate cancer based on two nationwide surveys. METHODS: Two Japan-wide multi-institutional surveys, J-CaP2010 and J-CaP2016, were conducted to enroll patients newly histologically diagnosed with prostate cancer in 2010 and 2016-18, respectively. Both surveys included age at diagnosis, initial PSA level, ISUP Grade Group, TNM classification, and initial treatment for prostate cancer. RESULTS: J-CaP2010 included data from 8192 patients across 140 institutions, whereas J-CaP2016 included data from 21 841 patients across 186 institutions. In J-CaP2016, the proportion of radical prostatectomy (RP) and radiation therapy (RT) in the initial treatment increased (from 32% to 36% and 21% to 26%, respectively), whereas the proportion of ADT decreased (from 40% to 29%) compared with those in J-CaP2010. The increase in RP or RT was noticeable in patients aged 75 years and older (from 20% to 38%) and those with high-risk localized cancer (from 58% to 74%) or locally advanced cancer (from 38% to 56%). The proportion of active surveillance or watchful waiting increased in patients with low-risk localized cancer (from 21% to 41%). The proportion of robot-assisted RP within all RPs and the proportion of intensity-modulated RT within all RTs increased remarkably (from 2.3% to 78% and 20% to 50%, respectively). CONCLUSIONS: In Japan, RP and RT have increased as initial treatments for prostate cancer, whereas ADT has decreased. Consequently, RP has emerged as the most commonly selected initial treatment, replacing ADT.

Which characteristics are associated with changes in medication status for lower urinary tract symptoms among patients with prostate cancer receiving external beam radiotherapy?

Yuki Kyoda, Kohei Hashimoto, Atsushi Takahashi, Takeshi Maehana, Kimihito Tachikawa, Takashi Muranaka, Shuichi Kato, Tomoyo Kurisu, Fumimasa Fukuta, Takahiro Kirisawa, Manabu Okada, Ko Kobayashi, Toshiaki Tanaka, Shiro Hinotsu, Naoya Masumori

Current urology 18 ( 2 ) 122 - 127 2024年06月 [国際誌]

BACKGROUND: We clarified the predictive factors for changes in the status of medications for lower urinary tract symptoms (LUTS) 2 years after local radiotherapy for nonmetastatic prostate cancer. MATERIALS AND METHODS: We retrospectively included patients who underwent local external radiotherapy for nonmetastatic prostate cancer in 8 institutions between April 2001 and March 2016. Patients were divided into the medication and no-medication group based on the use of drugs for LUTS before radiotherapy. We defined improvement of LUTS as when the patient did not require medication for LUTS at 24 months after radiotherapy in the medication group and as deterioration when medication was required in the no-medication group. Logistic regression analysis was used to evaluate predictive factors for changes in medication status. RESULTS: Altogether, 505 patients were divided into a no-medication group (n = 352) and a medication group (n = 153). The number of patients with deterioration and improvement in LUTS was 49 (14%) and 36 (23%), respectively. In the multivariate analysis, the predictive variables for deterioration were the International Prostate Symptom Score (≥8; odds ratio [OR], 2.21; p = 0.014) and the biopsy Gleason score (≤3 + 4 = 7; OR, 2.430; p = 0.008) in the no-medication group, whereas those for improvement were age (<75 years old; OR, 5.81; p = 0.002), the quality of life score (<3; OR, 3.15; p = 0.028), and a positive biopsy core rate (≥50%; OR, 2.530; p = 0.027) in the medication group. CONCLUSIONS: These predictive factors for changes in the status of medications for LUTS at 2 years after external radiotherapy may help determine the definitive therapy for nonmetastatic prostate cancer.

Early recovery of urinary continence after robot-assisted radical prostatectomy is associated with membranous urethra and neurovascular bundle preservation.

Satoshi Ando, Toru Sugihara, Shiro Hinotsu, Hiroto Kishino, Daichi Hirata, Risako Watanabe, Atsushi Yanase, Hirotaka Yokoyama, Hayato Hoshina, Kaori Endo, Jun Kamei, Eiichiro Takaoka, Tetsuya Fujimura

International journal of urology : official journal of the Japanese Urological Association 31 ( 5 ) 492 - 499 2024年05月 [国際誌]

OBJECTIVES: We investigated the correlation between surgical outcomes and postoperative urinary continence recovery in robot-assisted radical prostatectomy (RARP). METHODS: Patients who underwent RARP in our institution (n = 195) were included in this study. Preserved urethral length (PUL) was assessed during the procedure. Other outcomes of the surgical procedure were collected from operative records. Kaplan-Meier analysis with log-rank test was used to compare urinary continence recovery rate with the PUL, sparing of the neurovascular bundle (NVB), and other surgical procedures. Univariate and multivariate analyses were performed using Cox proportional hazards model, and p-values of <0.05 were considered significant. RESULTS: Patients with a PUL ≥26 mm had 10.0%, 24.7%, 36.6%, and 89.0% continence recovery rates at 30, 60, 90, and 365 days after surgery, respectively, while patients with a PUL <26 mm had 0%, 17.8%, 26.1%, and 80.9% recovery rates, respectively. Kaplan-Meier curves showed significantly better postoperative urinary continence recovery at 30 days after RARP in patients with a PUL ≥26 mm than those with a PUL <26 mm (p = 0.0028) and in patients with NVB preservation than those with no NVB preservation (p = 0.014). Urinary continence recovery within 30, 60, and 90 days after surgery was 90.6% for patients with a PUL of ≥26 mm and NVB preservation, while only 82.3% for patients with a PUL of <26 mm or no NVB preservation. CONCLUSION: Our results suggest that a PUL ≥26 mm and NVB preservation after RARP correlate with a significantly higher postoperative rate of recovery of urinary continence.

Summary of the Clinical Practice Guidelines for Upper Tract Urothelial Carcinoma 2023 by the Japanese Urological Association.

Kazuyuki Mori, Shingo Hatakeyama, Hideki Enokida, Hideaki Miyake, Eiji Kikuchi, Hiroyuki Nishiyama, Tomohiko Ichikawa, Takao Kamai, Yasushi Kaji, Haruki Kume, Tsunenori Kondo, Hideyasu Matsuyama, Naoya Masumori, Akihiro Kawauchi, Atsushi Takenaka, Hirotsugu Uemura, Masatoshi Eto, Norio Nonomura, Yasuhisa Fujii, Shiro Hinotsu, Chikara Ohyama

International journal of urology : official journal of the Japanese Urological Association 31 ( 3 ) 194 - 207 2024年03月 [国際誌]

This article is an English translation of the Clinical Practice Guidelines for Upper Tract Urothelial Carcinoma (2nd edition) published in June 2023. The Japanese Urological Association's (JUA) Guidelines Committee on Upper Tract Urothelial Carcinoma (UTUC) created a 2023 update guideline to support clinicians' current evidence-based management of UTUC and to incorporate its recommendations into clinical practice. The new guideline adhered as closely as possible to the Minds Manual for Guideline Development 2020 ver. 3.0. Findings related to epidemiological, pathological, diagnosis, treatment, and follow-up were reviewed. In addition, seven clinical questions (CQs) were set to determine the grade of recommendation and level of evidence. Preconceptions and biases were removed from the preparation process, the overall evidence was evaluated appropriately, and recommendations were made after fully considering the balance between benefits and harms. Although the evidence is still insufficient to be taken up as a CQ, the latest important information is described in seven columns, and clinical issues that should be resolved in the future related to the CQ are described as recommendations for tomorrow. We hope that these guidelines will help medical professionals, patients, and their families involved in the treatment of UTUC in their decision-making, and hope that a critical review of these guidelines will lead to further refinements in the next edition.

The effect of lemborexant on insomnia in patients with psychiatric disorders: Detailed evaluation using the Athens Insomnia Scale.

Tomonori Murayama, Yuji Ito, Kenji Narita, Tetsuro Ishida, Shiro Hinotsu, Masahiko Fujita

PCN reports : psychiatry and clinical neurosciences 3 ( 1 ) e165 2024年03月 [国際誌]

AIM: Chronic insomnia disorder is common and associated with reduced quality of life. Benzodiazepine hypnotics are commonly prescribed for insomnia, but have potential side effects such as concentration impairment, somnolence, and dependence. Lemborexant (LEM) is an orexin receptor antagonist considered to have fewer side effects than benzodiazepine hypnotics. This study evaluated the effect of LEM on sleep in detail and examined whether benzodiazepine hypnotics can be gradually tapered by adding LEM. METHODS: We retrospectively examined the effectiveness of LEM in 28 outpatients with insomnia. Insomnia symptoms were assessed using the Athens Insomnia Scale (AIS) before and after LEM administration. We also attempted to taper benzodiazepine hypnotics and assessed benzodiazepine dose using diazepam equivalents for some patients taking benzodiazepine hypnotics. Wilcoxon's signed-rank test was used for statistical analysis. RESULTS: The mean AIS score was significantly improved after LEM treatment (8.7 ± 5.2 vs. 3.8 ± 3.3; P < 0.01). Among the AIS subitems, significant improvement was observed for six items: sleep induction, awakenings during the night, sleep quality, well-being, functioning capacity, and sleepiness during the day. The mean benzodiazepine dose was significantly lower after LEM treatment (4.6 ± 5.0 mg vs. 2.1 ± 3.3 mg; P < 0.01). CONCLUSIONS: This study indicated the potential of LEM for improving insomnia and reducing benzodiazepine dose.

A feasibility study of provider-level implementation strategies to improve access to colorectal cancer screening for patients with schizophrenia: ACCESS2 (N-EQUITY 2104) trial.

Masaki Fujiwara, Yuto Yamada, Tsuyoshi Etoh, Taichi Shimazu, Masafumi Kodama, Norihito Yamada, Takahiro Asada, Shigeo Horii, Takafumi Kobayashi, Teruo Hayashi, Yoshitaka Ehara, Kenji Fukuda, Keita Harada, Maiko Fujimori, Miyuki Odawara, Hirokazu Takahashi, Shiro Hinotsu, Naoki Nakaya, Yosuke Uchitomi, Masatoshi Inagaki

Implementation science communications 5 ( 1 ) 2 - 2 2024年01月 [査読有り] [国際誌]

BACKGROUND: People with schizophrenia have a lower colorectal screening rate than the general population. A previous study reported an intervention using case management to encourage colorectal cancer screening for patients with schizophrenia in psychiatric outpatient settings. In this feasibility study, we developed provider-level implementation strategies and evaluated the feasibility of conducting a definitive trial in terms of the penetration of the intervention assessed at the patient level. Additionally, we examined the fidelity of strategies to implement the intervention at the provider level in a routine clinical psychiatric setting. METHODS: This was a multicenter, single-arm feasibility study with medical staff at psychiatric hospitals in Japan. The provider-level implementation strategies developed in this study included three key elements (organizing an implementation team appointed by the facility director, interactive assistance using a clear guide that outlines who in the hospital should do what, and developing accessible educational materials) to overcome major barriers to implementation of the intervention and four additional elements (progress monitoring, joint meetings and information sharing among participating sites, adaptation of encouragement methods to specific contexts, and education of on-site staff), with reference to the elements identified in the Expert Recommendations for Implementing Change (ERIC). The feasibility of the strategies was evaluated by the proportion of patients who were eligible for encouragement (patients with schizophrenia aged 40, 50, or 60) who received encouragement. We set the goal of providing encouragement to at least 40% of eligible patients at each site. RESULTS: Two public and four private psychiatric hospitals in Okayama and Shimane prefectures participated in this study. Regarding fidelity, all elements of the strategies were conducted as planned. Following the procedures in the guide, each team prepared and provided encouragement according to their own facility and region. Penetration, defined as the proportion of eligible patients who received encouragement, ranged from 33.3 to 100%; five of the six facilities achieved the target proportion. CONCLUSIONS: The provider-level implementation strategies to implement encouragement were feasible in terms of penetration of the intervention assessed at the patient level. The results support the feasibility of proceeding with a future definitive trial of these strategies. TRIAL REGISTRATION: jRCT, jRCT1060220026 . Registered on 06/04/2022.

The impact of respiratory reactance in oscillometry on survival in patients with idiopathic pulmonary fibrosis.

Tatsuru Ishikawa, Hirotaka Nishikiori, Yuki Mori, Keiko Fujino, Atsushi Saito, Mamoru Takahashi, Koji Kuronuma, Shiro Hinotsu, Hirofumi Chiba

BMC pulmonary medicine 24 ( 1 ) 10 - 10 2024年01月 [国際誌]

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a progressive disease with a poor prognosis. Pulmonary function tests (PFTs) aid in evaluating the disease status of IPF. The clinical significance of oscillometry measurements in interstitial lung diseases has recently been reported. Our previous study showed that respiratory reactance (Xrs) measured by oscillometry reflected disease severity and predicted subsequent lung capacity decline in patients with IPF. However, the direct impact of Xrs on survival needs to be determined, and there are currently no reference values in oscillometry to predict prognosis. Therefore, this study aimed to investigate the association between oscillometry measurements, particularly Xrs, and survival in patients with IPF and to determine the cutoff values of Xrs that predict 3-year survival. METHODS: We analyzed the relationship between the measured values of PFT and oscillometry derived from 178 patients with IPF. Univariate and multivariate Cox proportional hazards analyses were performed to investigate the relationships between clinical indices at the time of the first oscillometry and survival. We performed the time-dependent receiver operating characteristic (ROC) curve analysis to set the optimized cutoff values of Xrs for 3-year survival prediction. We examined the discriminating power of cutoff values of Xrs on survival using the Kaplan-Meier method and the log-rank test. RESULTS: Xrs components, especially in the inspiratory phase (In), significantly correlated with the PFT values. In the multivariate analyses, Xrs (all of reactance at 5 Hz [X5], resonant frequency [Fres], and low-frequency reactance area [ALX] in the inspiratory phase) had a significant impact on survival (X5, p = 0.003; Fres, p = 0.016; ALX, p = 0.003) independent of age, sex, and other prognostic factors derived from the univariate analysis. The area under the ROC curve was 0.765, 0.759, and 0.766 for X5 In, Fres In, and ALX In, with cutoff values determined at - 0.98, 10.67, and 5.32, respectively. We found significant differences in survival after dividing patients using each of the cutoff values of Xrs. CONCLUSIONS: In patients with IPF, Xrs measured by oscillometry significantly impacted survival. We also determined the cutoff values of Xrs to discriminate patients with poor prognoses.

A Safer Method for Disinfection of Bacillus Calmette-Guerin-Containing Urine: A Prospective, Randomized Study.

Tomohiro Kameda, Yoshimasa Kondo, Yasuko Fukataki, Shiro Hinotsu, Tetsuya Fujimura, Tatsuya Takayama

Urologia internationalis 108 ( 5 ) 377 - 382 2024年 [国際誌]

INTRODUCTION: The aim of the study was to examine whether disinfection of bacillus Calmette-Guerin-containing urine with etaprocohol® (ethanol 76.9-81.4 vol % and isopropanol as an additive) is safer than disinfection with sodium hypochlorite. METHOD: In prospective research, safety and efficacy was analyzed in 5 patients in the etaprocohol® disinfection group and 5 patients in the sodium hypochlorite disinfection group. The primary endpoint was the temperature change after disinfection and the secondary endpoint was the unpleasantness of the odor caused by disinfection. Additionally, concentration of gas produced was also examined. Sensory tests were taken from staff who performed urine disinfection and the odor generated by disinfection was evaluated. As a safety protocol, post-BCG-treated urine is cultured to verify the negativity for mycobacteria. RESULTS: Mycobacteria were disinfected in all cases. The temperature rise following disinfection was significantly higher in the sodium hypochlorite group. The sensory test outcomes were significantly worse in the group disinfected with sodium hypochlorite. The concentration of gas generated immediately after disinfection in both groups reached the maximum value and declined quickly. CONCLUSIONS: Disinfection of bacillus Calmette-Guerin-containing urine with etaprocohol® was safer than disinfection with sodium hypochlorite, and an equivalent disinfection effect was achieved.

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