医師採取および自己採取法を用いた日本人男性性器HPV感染症の疫学調査

金沢大学医薬保健研究域医学系Eighty-one male patients who attended urological clinic were enrolled in this study. From each participant, self-sampling and doctor-sampling subjects were collected by rubbing penile glans by cotton swab. After DNA was extracted from each subject, HPV-DNA test and genotyping were performed. HPV-DNA was detected in 31% of doctor-sampling and in 28% in self-sampling subjects, and 26% of patients had HPV detections in both samples. Compared to doctor-sampling subjects, sensitivity and specificity of HPV detection in self sampling were 91% and 93%, respectively. Complete or partial matching of HPV genotypes detected in both samples was 70%, suggesting that HPV type distribution in both samples was in good agreement. Use of self-sampling rubbed subjects may be useful for screening of penile HPV infection in men.泌尿器科を受診した男性81例を対象に、陰茎の擦過検体を医師および自己採取の2種類採取し、両検体のHPV検出率およびHPV遺伝子型を比較することで、自己採取法の有用性について検討した。HPV陽性率は医師採取31％、自己採取28％であり、両検体でHPV陽性であったのは26%であった。HPV検出における自己採取検体の感度は91％、特異度は93％であった。また両検体でHPV陽性であった検体の70％で、検出された遺伝子型が完全もしくは部分一致しており、検出された遺伝子型は総じて自己採取検体の方が多かった。男性においても陰茎擦過による自己採取検体を用いたHPV検査は有用であると推察された。研究課題/領域番号:70792810, 研究期間(年度):2020-04-01 – 2022-03-31出典：研究課題「医師採取および自己採取法を用いた日本人男性性器HPV感染症の疫学調査」課題番号70792810（KAKEN：科学研究費助成事業データベース（国立情報学研究所）） （https://kaken.nii.ac.jp/ja/report/KAKENHI-PROJECT-20K18110/20K18110seika/）を加工して作

Prevalence of human papillomavirus infection in the oropharynx and urine among sexually active men: a comparative study of infection by papillomavirus and other organisms, including Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma spp., and Ureaplasma spp

13301甲第4173号博士（医学）金沢大学博士論文要旨Abstract 以下に掲載：BMC Infectious Diseases 14(43) pp.1-8 2014. BioMed Central. 共著者：Kazufumi Nakashima, Kazuyoshi Shigehara, Shohei Kawaguchi, Akira Wakatsuki, Yoshitomo Kobori, Kazuyoshi Nakashima, Yasunori Ishii, Masayoshi Shimamura, Toshiyuki Sasagawa, Yasuhide Kitagawa, Atsushi Mizokami, Mikio Namik

Use of preoperative factors including urodynamic evaluations and nerve-sparing status for predicting urinary continence recovery after robot-assisted radical prostatectomy: Nerve-sparing technique contributes to the reduction of postprostatectomy incontinence

Aims: To examine which preoperative factors, including urodynamic evaluations, and operative procedures could predict continence status after robot-assisted radical prostatectomy (RARP) in this study. Materials and Methods: Univariate and multivariate logistic regression analyses of preoperative factors such as age, body mass index, prostate-specific antigen level before biopsy, prostate size before surgery, membranous urethral length measured using magnetic resonance imaging (MRI), bladder compliance and maximum urethral closure pressure (MUCP) measured by urodynamic study (UDS), and nerve-sparing (NS) status predicting 24-hr pad test >2 g/day at 1 year after RARP were examined in 111 patients enrolled in this study. Results: The number of patients with incontinence at 1 year after RARP was 39 (35.1%). The only predictive factor for urinary continence was NS grades. To investigate the contribution of NS to urinary continence, 84 patients underwent UDS three times; before, immediately after, and 1 year after RARP. Chronological UDS revealed that recovery patterns of storage and voiding functions were the same among non-NS, unilateral-NS, and bilateral-NS groups, and that higher degrees of NS contributed to lesser decreases in MUCP and longer functional urethral length (FUL) after RARP. Conclusion: Preoperative factors, including the results of UDS, could not predict continence 1 year after RARP. The NS procedure contributed to continence status. NS favorably affected MUCP and FUL; however, it did not affect bladder function after RARP. Neurourol. Urodynam. 35:1034–1039, 2016. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.Embarogo Period 12 month

Changes in penile length after radical prostatectomy: Investigation of the underlying anatomical mechanism

Objective: To measure changes in penile length (PL) over time before and after radical prostatectomy (RP), and to investigate the underlying mechanisms for these changes. Patients and Methods: The stretched PL (SPL) of 102 patients was measured before, 10 days after, and at 1, 3, 6, 9, 12, 18 and 24 months after RP. The perpendicular distance from the distal end of the membranous urethra to the midline of the pelvic outlet was measured on mid-sagittal magnetic resonance imaging (MRI) slice at three time points: preoperatively; 10 days after RP; and 12 months after RP. Pre- and postoperative SPLs were compared using paired Student\u27s t-test. Predictors of PL shortening at 10 days and at 12 months after RP were evaluated on univariate and multivariate analyses. Results: The SPL was shortest 10 days after RP (mean PL shortening from preoperative level: 19.9 mm), and gradually recovered thereafter. SPL at 12 months after RP was not significantly different from preoperative SPL. On MRI examination, the distal end of membranous urethra was found to have moved proximally (mean proximal displacement: 3.9 mm) at 10 days after RP, and to have returned to the preoperative position at 12 months after RP. On univariate analysis, only the volume of the removed prostate was a predictor of SPL change at 10 days after surgery; on multivariate analysis, the association was not statistically significant. No predictor of SPL change was found at 12 months after RP. Conclusion: The SPL was shortest at 10 days after RP and gradually recovered thereafter in the present study. Anatomically, the glans and corpus spongiosum surrounding the urethra are an integral structure, and the proximal urethra is drawn into the pelvis during urethrovesical anastomosis. This is the first report showing that slight vertical repositioning of the membranous urethra after RP causes changes in SPL over time. These results can help inform patients about changes in penile appearance after RP. © 2017 BJU International.Embargo Period 12 month

Effects of luseogliflozin on estimated plasma volume in patients with heart failure with preserved ejection fraction

Aims Sodium glucose co-transporter 2 inhibitors have diuretic effects in both patients with glycosuria and with natriuresis. We sought to assess the effect of luseogliflozin on estimated plasma volume (ePV) in patients with type 2 diabetes and heart failure with preserved ejection fraction (HFpEF). Methods and results This study was a post-hoc analysis of the MUSCAT-HF trial (UMIN000018395), a multicentre, prospective, open-label, randomized controlled trial that assessed the effect of 12 weeks of luseogliflozin (2.5 mg, once daily, n = 83) as compared with voglibose (0.2 mg, three times daily, n = 82) on the reduction in brain natriuretic peptide (BNP) in patients with type 2 diabetes and HFpEF. The analysis compared the change in ePV calculated by the Straus formula from baseline to Weeks 4, 12, and 24, using a mixed-effects model for repeated measures. We also estimated the association between changes in ePV and changes in other clinical parameters, including BNP levels. Luseogliflozin significantly reduced ePV as compared to voglibose at Week 4 {adjusted mean group-difference -6.43% [95% confidence interval (CI): -9.11 to -3.74]}, at Week 12 [-8.73% (95%CI: -11.40 to -6.05)], and at Week 24 [-11.02% (95%CI: -13.71 to -8.33)]. The effect of luseogliflozin on these parameters was mostly consistent across various patient clinical characteristics. The change in ePV at Week 12 was significantly associated with log-transformed BNP (r = 0.197, P = 0.015) and left atrial volume index (r = 0.283, P = 0.019). Conclusions Luseogliflozin significantly reduced ePV in patients with type 2 diabetes and HFpEF, as compared with voglibose. The reduction of intravascular volume by luseogliflozin may provide clinical benefits to patients with type 2 diabetes and HFpEF

Liquid-based urine cytology as a tool for detection of human papillomavirus, Mycoplasma spp., and Ureaplasma spp. in men

金沢大学医薬保健研究域医学系Liquid-based urine cytology (LB-URC) was evaluated for cytological diagnosis and detection of human papillomavirus (HPV), Mycoplasma, and Ureaplasma. Midstream urine samples were collected from 141 male patients with urethritis and 154 controls without urethritis, and sediment cells were preserved in liquid-based cytology solution. Urethral swabs from urethritis patients were tested for the presence of Neisseria gonorrhoeae and Chlamydia trachomatis. Papanicolaou tests were performed for cytological evaluation. HPV, Mycoplasma, and Ureaplasma genomes were determined by PCR-based methods, and localization of HPV DNA in urothelial cells was examined by in situ hybridization (ISH). The β-globin gene was positive in 97.9% of LB-URC samples from urethritis patients and in 97.4% of control samples, suggesting that high-quality cellular DNA was obtained from the LB-URC samples. HPV DNA was detected in 29 (21.0%) urethritis cases and in five (3.3%) controls (P<0.05). HPV type 16 (HPV 16) was most commonly found in urethritis patients. Cytological evaluations could be performed for 92.1% of urethritis patients and 64.3% of controls. Morphological changes suggestive of HPV infection were seen in 20.7% of the HPV-positive samples, and ISH demonstrated the presence of HPV DNA in both squamous and urothelial cells in HPV-positive samples. Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma parvum, and Ureaplasma urealyticum were detected in 14.5%, 10.9%, 6.5%, and 12.3% of urethritis patients, respectively. The prevalence rates of these microorganisms (except Ureaplasma parvum) were significantly higher in urethritis cases than controls (P<0.05). LB-URC is applicable for detection of HPV, Mycoplasma, and Ureaplasma. HP infection occurs in urothelial cells, especially in gonococcal urethritis. Copyright © 2012, American Society for Microbiology. All Rights Reserved

男性尿路ヒトパピローマウィルス感染の自然史の解明

金沢大学附属病院泌尿器科本検討では、尿検体を用いて男性の尿路HPV感染率をスクリーニングし、その感染部位について検討した。泌尿器科外来を受診した患者845例における総HPVおよび高リスク型HPV検出率はそれぞれ6.2％、3.1％であった。疾患別にみると、尿道炎患者において検出率が最も高かった。一方、尿道炎を除く730例で検討すると尿路性器癌の患者からのHPV検出率が有意に高かった。次に、尿路上皮癌患者135例を対象として、膀胱洗浄尿を用いて調査したところHPV検出率は5.2％であった。頻度は低いものの、男性の尿路にもHPV感染は生じており、尿路上皮癌患者の膀胱にもHPV感染が生じているものと推察された。The present study investigated HPV prevalence and its natural history in the urinary tract among men. Urine samples were collected for a HPV analysis from 845 patients who attended at urological clinic. Among 803 valid samples, overall HPV and high-risk HPV prevalences were 6.2% and 3.1%, respectively. HPV and HR-HPV prevalences were the highest in men with urethritis, and were significantly higher than those without urethritis. On the other hand, a sub-analysis excluding men with urethritis demonstrated that urogenital cancer was a significant risk factor for HPV detection. In addition, another study was conducted to assess the HPV infection sites by using bladder washes among the patients with bladder carcinoma. HPV prevalence in 135 bladder washes samples was 5.2%.Although HPV infection do not frequently occurs in urinary tract compared to external genitalia, the present findings confirm that HPV can infect in urinary tract(urinary bladder) in men.研究課題/領域番号:18K16727, 研究期間(年度):2018-04-01 - 2020-03-31出典：「男性尿路ヒトパピローマウィルス感染の自然史の解明」研究成果報告書　課題番号18K16727（KAKEN：科学研究費助成事業データベース（国立情報学研究所））（https://kaken.nii.ac.jp/ja/report/KAKENHI-PROJECT-18K16727/18K16727seika/)を加工して作