Nocturia Potentially Influences Maintenance of Sexual Function in Elderly Men with Benign Prostatic Hyperplasia

Objective: This study examined the relationship between bothersome symptoms of nocturia and erectile function. Methods: Subjects comprised patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). Patients were prospectively followed on treatment with the alpha‐1 blocker naftopidil for 8 weeks. Patient backgrounds and efficacy of naftopidil associated with LUTS and sexual activity were evaluated. Results: The percentage of patients who identified nocturia as the most bothersome symptom was 30.2% (n = 135), representing the highest percentage among International Prostate Symptom Score (IPSS) items. The number of patients with nocturia as the most bothersome symptom plateaued at an IPSS for nocturia of two or three points. In contrast, the number of patients with slow stream as the most bothersome symptom increased with symptom severity according to IPSS for slow stream. Logistic regression analysis on association between nocturia and erectile function confirmed that the odds ratio was 1.41 (P < 0.05). Naftopidil showed excellent efficacy related to male LUTS, but International Index of Erectile Function 5 (IIEF5) total score was almost unchanged. Among patients with nocturia improved by naftopidil, IIEF5 total score was significantly changed in the group with IPSS nocturia score ≤1 as compared to the group with IPSS nocturia score ≥2 per night (P = 0.038). Conclusion: Nocturia the most bothersome symptom correlated with aging. Nocturia could associate erectile dysfunction, and keeping the frequency of nocturia at ≤1 episode might be meaningful for maintaining quality of life in elderly men.     

Screening of new bioactive metabolites for diabetes therapy

Microorganisms and plants produce bioactive metabolites that are potentially useful in the treatment of disease. We have designed and synthesized DHMEQ as a specific inhibitor of NF-κB based on the structure of epoxyquinomicin. It directly binds to NF-κB components to inhibit DNA-binding and was shown to be endowed with inhibiting activity in various inflammatory and cancer models in experimental animals. It was also effective to improve the success of islet transplantation especially when administered to donor mice. We have also isolated from the leaves of Ervatamia microphylla conophylline, a compound that induces differentiation of beta cells from the precursor cells and was recently found to suppress islet fibrosis in diabetes model rats.     

Primary hepatic mucosa-associated lymphoid tissue (MALT) lymphoma

Primary hepatic mucosa-associated lymphoid tissue (MALT) lymphoma is extremely rare, and the etiology of disease is not fully understood. We present herein the case of a primary hepatic MALT lymphoma with Helicobacter pylori and hepatitis C virus infection. A 71-year-old male was admitted to our institution to undergo a precise evaluation of a hepatic tumor incidentally detected during a computed tomography (CT) scan for chest examination. Dynamic CT showed faint enhancement during the arterial phase. The gadoxetate disodium-enhanced magnetic resonance imaging showed a hyper-intensity on the arterial phase and low intensity during the late and hepatocyte phases. Liver biopsy specimen showed small to intermediate size atypical lymphocytes with positive CD20 immunohistochemical staining. It was finally diagnosed as primary hepatic MALT lymphoma. FDG-PET/CT showed faintly increased uptake with a maximum standardized uptake value of 4.6, and did not show other pathological uptake. We present the rare case of primary hepatic MALT lymphoma and discussed the etiology of this disease.     

The influence of subclinical cardiovascular disease and related risk factors on cognition in type 2 diabetes mellitus: The DHS-Mind study

We hypothesized that measures of coronary artery calcified plaque (CAC) collected at baseline from the Diabetes Heart Study (DHS) would explain associations between cognition and diabetes collected at follow-up approximately 7 years later. The DHS is a sibling study of cardiovascular disease (CVD) in a cohort with a high prevalence of type 2 diabetes (~ 80%). Associations between baseline CAC and cognitive performance were tested using generalized estimating equations and mixed effects models to adjust for familial relationships. Diabetes status was associated (p < 0.05) with poorer performance on tests of verbal memory, processing speed, and semantic fluency adjusting for age, sex, education, and hypertension status. As hypothesized, including CAC in the statistical model attenuated this association. Additionally, CAC and fasting glucose predicted performance in tasks not associated with diabetes status in this study (Stroop Task, Phonemic Fluency). These results confirm work attributing the heterogeneity of cognitive outcomes in type 2 diabetes to subclinical risk factors that combine to affect different aspects of brain function. Importantly, these results imply that risk factor intervention should begin before comorbidities, particularly CVD, become clinically apparent.     

Validity of sheet-type portable monitoring device for screening obstructive sleep apnea syndrome

Purpose

The SD-101 is a non-restrictive sheet-like medical device that measures sleep-disordered breathing using pressure sensors that can detect the gravitational alterations in the body that accompany respiratory movement. One report has described that the screening specificity of the SD-101 for mild to moderate obstructive sleep apnea syndrome (OSAS) is relatively low. The present study examines whether the accuracy of the SD-101 for OSAS screening is improved by simultaneously measuring percutaneous oxygen saturation (SpO₂).

Methods

Sixty consecutive individuals with suspected OSAS consented to undergo overnight polysomnography (PSG) together with simultaneous measurements of SD-101 and SpO₂ at our laboratory.

Results

The apnea–hypopnea index (AHI) determined from PSG and the respiratory disturbance index determined from SD-101 measurements significantly correlated (SD-101 alone: r?=?0.871, p?<?0.0001; SD-101 with SpO₂: r?=?0.965, p?<?0.0001). Bland–Altman plots showed a smaller dispersion for the SD-101 with SpO₂ than for the SD-101 alone. The SD-101 with SpO₂ detected an AHI of >15 on PSG with a sensitivity and specificity of 96.9 and 90.5 % compared with 87.5 and of 85.7 %, respectively, of the SD-101 alone.

Conclusions

Simultaneously measuring SpO₂ improved the accuracy of the SD-101 for OSAS screening. Furthermore, this modality appears to offer high sensitivity and specificity for detecting even moderately severe OSAS.     

Clinical outcomes of two-field lymphadenectomy for patients with clinical stage IA carcinoma of the thoracic esophagus

Background

The optimal treatment for early stage carcinoma of the thoracic esophagus is undecided and remains debatable. This report documents the results of a series of patients with clinical stage IA carcinoma of the thoracic esophagus treated at our institute with esophagectomy and two-field lymphadenectomy (2FL).

Methods

We analyzed 70 patients with clinical stage IA carcinoma who underwent radical esophagectomy with 2FL.

Results

The overall 5-year survival rate of the 70 patients was 81 %. Seventeen of the 70 patients (24 %) had lymph node metastasis. The overall 5-year survival rate of the 53 patients with no metastatic nodes (87 %) was significantly better than that of the 17 patients with positive nodes (65 %; p = 0.022). The operative morbidity was 44 %. Recurrence was recognized in 17 patients (24 %). The median disease-free interval (DFI) until recurrence was 20.5 months. With respect to the initial tumor recurrence, among the 16 patients with a recurrence, there were 9 with a cervical lymph node recurrence, 3 with a hematogenous recurrence, 2 with a combined recurrence, 1 with an abdominal lymph node recurrence in the paraaortic site, and 1 in the anastomotic site. The median DFI and survival times of the patients with a cervical lymph node recurrence were 26 and 55 months, respectively. Of the 9 patients with a cervical lymph node recurrence, 3 disease-free patients survived: 2 received surgery and 1 received radiotherapy.

Conclusions

Two-field lymphadenectomy might be enough for patients with clinical stage IA carcinoma of the middle and lower thoracic esophagus in regard to prognosis, but close follow-up for lymph node recurrence, especially at the cervical site, should be conducted.     

One-stage radical operation of aortoesophageal fistula -combination of VATS esophagectomy and open aortic surgery: report of a case

Aortoesophageal fistula is a rare but fatal disease of thoracic surgery. We present a case of a 74-year-old male with aortoesophageal fistula. The patient underwent successful one-stage surgical treatment by video-assisted esophagectomy with esophageal reconstruction by gastric conduit and open aortic graft replacement subsequent to a temporary thoracic endovascular aortic repair.     

Removal of broad-based esophageal hemangioma using endoscopic submucosal dissection

Esophageal hemangiomas are rare, representing around 3 % of all benign esophageal tumors. Esophagectomy or tumor enucleation has been performed to treat esophageal hemangiomas, but recently the use of endoscopic therapy, such as endoscopic mucosal resection or endoscopic injection sclerotherapy, is increasing. We describe removal of a hemangioma using endoscopic submucosal dissection. We also briefly discuss the literature concerning clinicopathologic aspects and management of esophageal hemangioma.     

Transplanted Murine Long-term Repopulating Hematopoietic Cells Can Differentiate to Osteoblasts in the Marrow Stem Cell Niche

Bone marrow transplantation (BMT) can give rise to donor-derived osteopoiesis in mice and humans; however, the source of this activity, whether a primitive osteoprogenitor or a transplantable marrow cell with dual hematopoietic and osteogenic potential, has eluded detection. To address this issue, we fractionated whole BM from mice according to cell surface immunophenotype and assayed the hematopoietic and osteopoietic potentials of the transplanted cells. Here, we show that a donor marrow cell capable of robust osteopoiesis possesses a surface phenotype of c-Kit⁺ Lin⁻ Sca-1⁺ CD34^−/lo, identical to that of the long-term repopulating hematopoietic stem cell (LTR-HSC). Secondary BMT studies demonstrated that a single marrow cell able to contribute to hematopoietic reconstitution in primary recipients also drives robust osteopoiesis and LT hematopoiesis in secondary recipients. These findings indicate that LTR-HSC can give rise to progeny that differentiate to osteoblasts after BMT, suggesting a mechanism for prompt restoration of the osteoblastic HSC niche following BM injury, such as that induced by clinical BMT preparative regimens. An understanding of the mechanisms that regulate this differentiation potential may lead to novel treatments for disorders of bone as well as methods for preserving the integrity of endosteal hematopoietic niches.