ヒニョウキカ リョウイキ ニオケル ロボット シエン シュジュツ ノ ゲンジョウ ト カダイ

There has been a dramatic change in the management of the urologic diseases replacing open surgery by minimally invasive surgeries. Robotic-assisted surgery provides a precise, highly magnified 3-D view and less venous oozing associated with pneumoperitoneum, which has led to a better anatomical understanding of fine structures. It also offers finger-controlled movement and the Endowrist technology that allows for a greater degree of freedom of laparoscopic instruments. Great progress has been made in urologic surgery such as radical prostatectomy or partial nephrectomy during the past several years. Robot-assisted radical prostatectomy （RARP） Laparoscopic procedure was first introduced to radical prostatectomy in 1997. Although laparoscopic radical prostatectomy had a steep learning curve, it was less invasive and enabled more precise observation of architecture. The da Vinci surgical system was developed in 1999. Afterward, robot-assisted radical prostatectomy was initially reported in 2001. Since the operative procedure was established by Menon et al. the next year, RALP has been widely expanded. RARP has been reported to have less blood loss and complication rate, better functional outcome, and equivalent oncological outcome compared to open or laparoscopic radical prostatectomies. The appearance of RARP allowed for precise recognition of the structures related to radical prostatectomy. Further discussion on appropriate case selection and operative methods is necessary. In addition, studies involving intraoperative visualization of nerves or cancer sites should also be desired. Robot-assisted partial nephrectomy （RAPN） Nephron-sparing surgery has become the standard of care for surgical extirpation of small renal masses. Robot-assisted laparoscopic surgery offers peculiar features, such as 7 degrees of motion, 3-dimensional visualization, improved dexterity, and elimination of physiologic tremors. These characteristics potentially allow RAPN to provide decreased intraoperative estimated blood loss (EBL) and shortened warm ischemia time (WIT) and operative time compared with the laparoscopic approach. Some previous studies showed that RAPN offers better outcomes to laparoscopic partial nephrectomy. Problems solved in the future Validation of cost-efficiency has not yet been elucidated. The future of medicine may lie in translational approaches individualizing the treatment by further improvement of imaging technology. Further physiological or intraoperative imaging study should also be encouraged. To establish reliable training system is also expected

血精液を主訴とした精嚢腺筋症の1例

62歳, 男性.血精液を主訴として来院.精嚢炎を疑い抗菌剤投与を行い軽快した。その後再発したため, 尿道膀胱鏡を行ったが異常を認めなかった.精嚢造影では右精嚢は描出されず, CTにて前立腺右背側に内容均一な腫瘤を認めた。経直腸超音波検査にて右精嚢の腫大を認め, 超音波ガイド下生検を行ったところ, 明らかな異常所見をえられなかった.診断目的で手術を行い前立腺および精嚢を摘出した.病理学的診断は精嚢腺筋症であった.A 62-year-old man presented in 1987 with hematospermia. No abnormal findings were observed by cystourethroscopy. Ultrasound showed the enlargement of the right seminal vesicle. The right seminal vesicle could not be visualized by seminal vesiculography. Computed tomographic scan revealed a homogeneous mass at the right dorsolateral aspect of the prostate. Surgical exploration was performed. The prostate and bilateral seminal vesicle were resected. Pathological diagnosis was adenomyosis of the right seminal vesicle

Thioredoxin interacting protein protects mice from fasting induced liver steatosis by activating ER stress and its downstream signaling pathways

Under normal conditions, fasting results in decreased protein disulfide isomerase (PDI) activity and accumulation of unfolded proteins, leading to the subsequent activation of the unfolded protein response (UPR)/autophagy signaling pathway to eliminate damaged mitochondria. Fasting also induces upregulation of thioredoxin-interacting protein (TXNIP) expression and mice deficient of this protein (TXNIP-KO mice) was shown to develop severe hypoglycemia, hyperlipidemia and liver steatosis (LS). In the present study, we aimed to determine the role of TXNIP in fasting-induced LS by using male TXNIP-KO mice that developed LS without severe hypoglycemia. In TXNIP-KO mice, fasting induced severe microvesicular LS. Examinations by transmission electron microscopy revealed mitochondria with smaller size and deformities and the presence of few autophagosomes. The expression of beta-oxidation-associated genes remained at the same level and the level of LC3-II was low. PDI activity level stayed at the original level and the levels of p-IRE1 and X-box binding protein 1 spliced form (sXBP1) were lower. Interestingly, treatment of TXNIP-KO mice with bacitracin, a PDI inhibitor, restored the level of LC3-II after fasting. These results suggest that TXNIP regulates PDI activity and subsequent activation of the UPR/autophagy pathway and plays a protective role in fasting-induced LS

Protocol for a comparison study of 1-day (single dose) versus 2-day prophylactic antibiotic administration in Holmium Laser enucleation of the prostate (HoLEP): a randomized controlled trial [version 2; peer review: 2 approved]

Background: The best method of antimicrobial prophylaxis administration for surgical site infection (SSI) in transurethral holmium laser resection and enucleation of the prostate (HoLEP)/bipolar transurethral enucleation (TUEB) remains controversial. The purpose of this study is to compare one-day and two-day cefazolin in a randomized 2nd-phase study to help establish a protocol with a 95% confidence interval (CI) for SSI prevention. Methods: Patients undergoing HoLEP/TUEB for benign prostate hyperplasia without preoperative pyuria will be enrolled and randomized to receive prophylactic antibiotic administration for HoLEP/TUEB in two groups, 1-day (single dose) cefazolin and 2-day cefazolin. The primary endpoint is the occurrence rate of postoperative urinary tract infection or urogenital infection within 30 days after HoLEP/TUEB with a statistical 95% CI in comparison between those groups. Secondary outcomes include the kind of infectious disease and evidence of diagnosis, day of diagnosis of infectious disease, performance of urine or blood culture, detection of bacteria, treatments, duration of treatments, AEs other than surgical site infection, and drug-induced AEs. Discussion: The results of this study will provide evidence for defining the optimal duration of cefazolin prophylactic antibiotic administration for SSI. Trial registration: This study was registered in the University Hospital Medical Information Network-Clinical Trial Registry (UMIN000027955) based on recommendations from the International Committee of Medical Journal Editors (ICMJE) on July 1st 2017

Milliarcsecond-Scale Structure in the Gamma-Ray Loud Quasar PKS 1622-297

We have made a high-resolution VLBI observation of the gamma-ray loud quasar PKS 1622-297 with the HALCA spacecraft and ground radio telescopes at 5 GHz in 1998 February, almost three years after the source exhibited a spectacular GeV gamma-ray flare. The source shows an elongated structure toward the west on the parsec scale. The visibility data are well modeled by three distinct components; a bright core and two weaker jet components. Comparison with previous observations confirms that the jet components have an apparent superluminal motion up to 12.1 h^{-1}c, with the inner jet components having lower superluminal speeds. We apply the inverse Compton catastrophe model and derive a Doppler factor, \delta, of 2.45, which is somewhat lower than that of other gamma-ray loud active galactic nuclei (AGNs), suggesting the source was in a more quiescent phase at the epoch of our observation. As an alternative probe of the sub-parsec scale structure, we also present the results from multi-epoch ATCA total flux monitoring, which indicate the presence of persistent intraday variability consistent with refractive interstellar scintillation. We examine the gamma-ray emission mechanism in the light of these observations.Comment: 10 pages, 6 figures, 3 tables, to appear in PASJ, Vol.58, No.

Hormonal Therapy Resistant Estrogen-receptor Positive Metastatic Breast Cancer Cohort (HORSE-BC) Study : Current Status of Treatment Selection in Japan

The Hormonal therapy resistant estrogen-receptor positive metastatic breast cancer cohort (HORSE-BC) study is a multicenter observational study evaluating the efficacy and safety of secondary endocrine therapy (ET) for postmenopausal cases of metastatic breast cancer (MBC) with poor response to primary ET. In this initial report we analyze the HORSE-BC baseline data to clarify the current status of treatment selection for MBC in Japan. Baseline data for the 50 patients enrolled in HORSE-BC were analyzed, including patient characteristics, types of secondary ET, and reasons for selecting secondary ET. Postoperative recurrence was detected in 84% of patients (42/50) and de novo stage IV breast cancer in 16% (8/50). Forty-one patients (41/50; 82%) received fulvestrant, 5 patients (10%) received selective estrogen receptor modulators (SERMs), 3 patients (6%) received ET plus a mammalian target of rapamycin (mTOR) inhibitor, and 1 patient received an aromatase inhibitor (AI) as the secondary ET. Forty-five patients selected their secondary ET based on its therapeutic effect, while 14 patients selected it based on side effects. Most patients with progression after primary ET selected fulvestrant as the secondary ET based on its therapeutic and side effects. We await the final results from the HORSE-BC study

Size-dependent decoherence of excitonic states in semiconductor microcrystallites

The size-dependent decoherence of the exciton states resulting from the spontaneous emission is investigated in a semiconductor spherical microcrystallite under condition $a_{B}\ll R_{0}\leq\lambda$. In general, the larger size of the microcrystallite corresponds to the shorter coherence time. If the initial state is a superposition of two different excitonic coherent states, the coherence time depends on both the overlap of two excitonic coherent states and the size of the microcrystallite. When the system with fixed size is initially in the even or odd coherent states, the larger average number of the excitons corresponds to the faster decoherence. When the average number of the excitons is given, the bigger size of the microcrystallite corresponds to the faster decoherence. The decoherence of the exciton states for the materials GaAs and CdS is numerically studied by our theoretical analysis.Comment: 4 pages, two figure