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Early detection of primary bladder cancer (BCa) is vital, because stage and grade have been generally accepted not only as categorical but also as prognostic factors in patients with BCa. The widely accepted screening methods for BCa, cystoscopy and urine cytology, have unsatisfactory diagnostic accuracy, with high rates of false negatives, especially for flat-type BCa with cystoscopy and for low-risk disease with urine cytology. Currently, liquid biopsy has attracted much attention as being compensatory for that limited diagnostic power. In this review, we survey the literature on liquid biopsy for the detection of BCa, focusing on circulating tumor cells (CTCs), urinary cell-free DNA (ucfDNA), and urinary microRNA (umiRNA). In diagnostic terms, CTCs and umiRNA are determined by quantitative analysis, and ucfDNA relies on finding genetic and epigenetic changes. The ideal biomarkers should be highly sensitive in detecting BCa. Currently, CTCs produce an unfavorable result; however, umiRNA and ucfDNA, especially when analyzed using a panel of genes, produce promising results. However, given the small cohort size in most studies, no conclusions can yet be drawn about liquid biopsy’s immediate application to clinical practice. Further large studies to validate the diagnostic value of liquid biopsy for clinical use are mandatory.

To investigate the association between the onset, severity, and type of immune‐related adverse events (irAEs) and the efficacy of pembrolizumab in patients with platinum‐pretreated advanced urothelial carcinoma (UC), we retrospectively collected clinical datasets of 755 patients and conducted landmark analysis. Patients who survived for fewer than 3 months were excluded from the evaluation to reduce the immortal time bias. In total, 620 patients were evaluated, of whom 220 patients (35.5%) experienced grade ≥2 irAEs, including 134 patients with grade 2 irAEs and 86 with grade ≥3 irAEs. Propensity score matching extracted 198 patients with and without grade ≥2 irAEs. The onset of grade ≥2 irAEs was associated with longer median progression‐free survival (PFS) (8.3 months vs. 4.5 months, p = 0.003) and overall survival (OS) (20.4 months vs. 14.3 months, p = 0.031) and a higher objective response rate (ORR) (44.8% vs. 30.2%, p = 0.004). Patients with grade 2 irAEs had significantly better oncological outcomes (PFS, OS, and ORR) than grade ≤1 and ≥3 irAEs. Patients with grade ≥3 irAEs had worse outcomes than grade 2 irAEs. Endocrine and skin irAEs were related with better survival outcomes, and the rate of severities was lower in these categories. In conclusion, the occurrence of irAEs, particularly low‐grade irAEs, was predictive of pembrolizumab efficacy in patients with platinum‐pretreated advanced UC. Kaplan‐Meier plots analysis showing OS for 396 patients with grade ≥2 irAEs and with grade 1 or no irAEs who survived longer than 3 months after propensity score matching. The onset of grade ≥2 irAEs was associated with longer median OS (20.4 months vs. 14.3 months, p = 0.031).

In natural gravel-bed rivers, fine sediment deposition contributes to the bed morphology and entrapment of plant seeds often leads to the evolution of vegetated areas. Therefore, it is important to understand the transport mechanisms of fine particles between and over large-grain gravels. The present work explores influence of the bursting phenomena on transport of fine grain particles between roughness elements through laboratory experiments. The rough bed consists of hemispherical elements fixed to the flume bed to mimic a natural gravel riverbed. First, two-components of flow velocity within and over the rough bed were measured by particle image velocimetry (PIV) combined with refractive-index matching (RIM). This visualizing method reveals the complex flow structure in a valley of the rough bed; especially, the formation of a horseshoe-shaped vortex at the upstream side of a roughness element. The linear stochastic estimation (LSE) of the conditional velocity field given an upward flow event near the channel bed demonstrates that the horseshoe vortex is temporarily enhanced after a high-momentum flow passes over the roughness crest and a sweep impinges onto the roughness surface. Next, the simultaneous analysis of particle trajectories and flow velocities was performed for some particle entrainment events between roughness elements. Most upward particle motions in the near-bed region are initiated by the upward flow induced by sweep and terminate below the roughness height. On the other hand, some of the particles lifted by sweep are transported beyond the roughness height by a following ejection event.

Backgrounds: High-volume (HV) metastatic castration-sensitive prostate cancer (mCSPC) is an aggressive disease. Despite this, we aimed to assess the metastatic patterns associated with a favorable prognosis in HV disease with bone metastasis (BM), including BM’s coexistence with lung metastasis (LM). Methods: We retrospectively analyzed 379 patients with synchronous mCSPC. They were categorized using the CHAARTED criteria as low-volume (LV) or HV with BM, classified based on extent of the disease from 1 to 4 (HV-EOD1–4) with or without LM. Multivariate Cox models for overall survival and castration-resistance-free survival assessed the prognostic values of HV-EOD1–4 compared with LV disease and the presence of LM. Site-specific radiographic progression at the time of castration-resistant prostate diagnosis was assessed in patients with BM and LM. Results: Multivariate analyses for overall survival showed no prognostic value of HV-EOD1 (hazard ratio [HR] 0.90; 95% confidence interval [CI] 0.43–1.85; p = 0.77), HV-EOD2 (HR 1.17; 95% CI 0.69–1.99; p = 0.57), and LM (HR 1.29; 95% CI 0.80–2.07; p = 0.29). In the analyses, HV-EOD ≤ 2 and LM did not influence castration resistance-free survival. LM showed a significantly lower incidence of radiographic progression to castration-resistant prostate cancer than BM (6.0% vs. 29.9%, p < 0.001). Conclusions: This study indicates the prognostic heterogeneity of HV disease considering BM and LM. These findings may aid in determining the treatment intensity for mCSPC.

A novel cancer vaccine consisting of 20 mixed peptides (KRM-20) was designed to induce cytotoxic T lymphocytes (CTL) against twelve different tumor-associated antigens. The aim of this phase II trial was to examine whether KRM-20 in combination with docetaxel and dexamethasone enhances the antitumor effects in patients with castration-resistant prostate cancer (CRPC). In this double-blind, placebo-controlled, randomized phase II study, we enrolled chemotherapy-naïve patients with CRPC from ten medical centers in Japan. Eligible patients were randomly assigned 1:1 centrally to receive either KRM-20 combined with docetaxel and dexamethasone (n = 25) or placebo with docetaxel and dexamethasone (n = 26). The primary endpoint was the difference in prostate-specific antigen (PSA) decline between each treatment. The rates of > 50% PSA decline in the two arms were similar (56.5% versus 53.8%; P = 0.851). Human leukocyte antigen (HLA)-matched peptide-specific immunoglobulin G (P = 0.018) and CTL (P = 0.007) responses in the KRM-20 arm significantly increased after treatment. The addition of KRM-20 did not increase toxicity. There were no between-group differences in progression-free or overall survival (OS). The addition of KRM-20 was safe, and similar PSA decline and HLA-matched peptide-specific CTL and IgG responses increased in combination with docetaxel and dexamethasone in CRPC patients. Subgroup analysis suggested that this treatment is favorable for CRPC patients with ≥ 26% lymphocytes or PSA levels of < 11.2 ng/ml, but further clinical trials comparing OS are required.

Emphysematous pyelonephritis (EPN) is a urinary tract infection progression characterized by gas retention in the renal tissues and a high mortality rate, but few cases have been reported. In this study, we present a 32-year-old primigravida with type 2 diabetes mellitus and a history of pyelonephritis who developed pyelonephritis at 29 weeks. Antimicrobial therapy was initiated; however, her clinical symptoms worsened. Ultrasonography and magnetic resonance imaging (MRI) led to a diagnosis of EPN. Fortunately, the patient improved with antibiotic therapy and delivered at 39 weeks.  Treatment for EPN may require invasive procedures such as percutaneous drainage or nephrectomy. Early diagnosis and timely intervention are crucial for the management of EPN during pregnancy. This case report highlights the need for imaging evaluation and tailored treatment strategies to balance maternal and fetal health in the treatment of EPN during pregnancy.

Transport of driftwood during heavy rainfall events can intensify the flood hazard. Driftwood accumulates at a bridge and backwater rises. Accumulated logs sink against the buoyancy force and the whole depth region is blocked. However, the mechanism governing the sink motion of accumulated logs at bridges is not fully understood. In this paper, we conducted the driftwood accumulation experiment at a bridge with a single pier to examine the formation and growth of log jam. The observations revealed that the accumulation process could be divided into four phases. Backwater rise was compared with the porous board tests to evaluate the blockage ratio of log jam. Next, we examined the effect of the velocity field on the accumulation process after a large number of logs accumulated at bridges. Simultaneous measurements of the instantaneous flow velocity below the log jam and the instantaneous motion of the incoming logs was conducted by PIV. Then, the effects of the approach flow velocity, channel width and model log length on the log jam formation were examined. These results revealed the governing parameter of the accumulation process (sink motion of logs) and the effect of the driftwood carpet shape.

Robot-assisted radical prostatectomy (RARP) has emerged as the predominant surgical approach globally, and various techniques have been proposed to improve functional outcomes. Despite these advances, however, functional impairment associated with surgery remains a major concern that affects patients' quality of life. Retzius-sparing RARP (RS-RARP) has been proposed as a surgical technique to preserve the Retzius space, and increasing evidence has demonstrated its effectiveness. However, the effect of RS-RARP on other functions remains unknown. Although some reports show the positive effect of Retzius-sparing RARP (RS-RARP) on urinary incontinence, the effects on other functions remain unknown. The present study retrospectively analyzed 132 patients who underwent RARP at Kitasato University Hospital between January 2020 and July 2021 (49 and 83 patients in the RS-RARP and conventional RARP groups, respectively). We compared the functional outcomes of RS-RARP and conventional RARP (C-RARP) using the Expanded Prostate Cancer Index Composite (EPIC). In addition, sexual function was compared among patients who underwent nerve-sparing procedures. Our findings revealed that, even at 12 months postoperatively, RS-RARP demonstrated significant preservation of urinary continence ( < 0.01) and sexual function compared to C-RARP ( = 0.03). No significant differences were observed in the bowel or hormonal domains. Even in patients who underwent nerve-sparing surgery, the EPIC score 12 months postoperatively was significantly higher with RS-RARP than with C-RARP ( < 0.01). RS-RARP tended to result in positive surgical margins more often than C-RARP (RS-RARP: 44.9%, C-RARP: 28.9%, = 0.06), without affecting the rate of biochemical recurrence (RS-RARP: 14.2%, C-RARP: 15.7%, = 0.81). Our results suggest a potential advantage of RS-RARP in preserving both urinary and sexual function.

BackgroundLittle data on the preoperative prognostic factors in radical cystectomy (RC) patients have made it difficult to choose the appropriate type of urothelial diversion (UD). This study aimed to investigate the prognostic role of UD, with a subgroup analysis of that of preoperative renal function.MethodsFrom 1990 to 2015, 279 patients underwent RC for bladder cancer at six hospitals affiliated with Kitasato University in Japan. All patients were divided into three groups: cutaneous ureterostomy (CU; n = 54), ileal conduit (IC; n = 139), and orthotopic neobladder (NB; n = 86). Patients were also stratified into three groups based on preoperative estimated glomerular filtration rate (eGFR) (mL/min/1.73 m2): normal eGFR (> 60 mL/min/1.73 m2; n = 149), moderately reduced eGFR (45–60 mL/min/1.73 m2; n = 66), and severely reduced eGFR (< 45 mL/min/1.73 m2; n = 37). Statistical analyses were performed to investigate prognostic values of UD and preoperative eGFR.ResultsKaplan–Meier analyses showed that progression-free survival (PFS) and cancer-specific survival (CSS) did not differ between the three types of UD groups. With regard to renal function, the preoperative severely reduced group had significantly worse PFS and CSS than the other groups. The multivariate analysis showed that severely reduced preoperative eGFR was an independent risk factor of worse PFS and worse CSS.ConclusionThe present study demonstrated that preoperative severe renal function was shown as an independent risk factor of both PFS and CSS.