A case of metastatic cancer with markedly elevated PSA level that was not detected by repeat prostate biopsy

BACKGROUND: Prostate-specific antigen (PSA) is a widely used specific tumor marker for prostate cancer. We experienced a case of metastatic prostate cancer that was difficult to detect by repeat prostate biopsy despite a markedly elevated serum PSA level. CASE PRESENTATION: A 64-year-old man was referred to our hospital with lumbar back pain and an elevated serum PSA level of 2036 ng/mL. Computed tomography, bone scintigraphy, and magnetic resonance imaging showed systemic lymph node and osteoblastic bone metastases. Digital rectal examination revealed a small, soft prostate without nodules. Ten-core transrectal prostate biopsy yielded negative results. Androgen deprivation therapy (ADT) was started because of the patient’s severe symptoms. Twelve-core repeat transrectal prostate biopsy performed 2 months later, and transurethral resection biopsy performed 5 months later, both yielded negative results. The patient refused further cancer screening because ADT effectively relieved his symptoms. His PSA level initially decreased to 4.8 ng/mL, but he developed castration-resistant prostate cancer 7 months after starting ADT. He died 21 months after the initial prostate biopsy from disseminated intravascular coagulation. CONCLUSION: CUP remains a considerable challenge in clinical oncology. Biopsies of metastatic lesions and multimodal approaches were helpful in this case

Adaptive Management of Migratory Birds Under Sea Level Rise

International audienceThe best practice method for managing ecological systems under uncertainty is adaptive management (AM), an iterative process of reducing uncertainty while simultaneously optimizing a management objective. Existing solution methods used for AM problems assume that the system dynamics are stationary, i.e., described by one of a set of pre-defined models. In reality ecological systems are rarely stationary and evolve over time. Importantly, the effects of climate change on populations are unlikely to be captured by stationary models. Practitioners need efficient algorithms to implement AM on real-world problems. AM can be formulated as a hidden model Markov Decision Process (hmMDP), which allows the state space to be factored and shows promise for the rapid resolution of large problems. We provide an ecological dataset and performance metrics for the AM of a network of shorebird species utilizing the East Asian-Australasian flyway given uncertainty about the rate of sea level rise. The non-stationary system is modelled as a stationary POMDP containing hidden alternative models with known probabilities of transition between them. We challenge the POMDP community to exploit the simplifications allowed by structuring the AM problem as an hmMDP and improve our benchmark solutions

Hiking Routes Building Project in Yokoze Town Conducted by Prof. Iwamura’s Undergraduate Seminars, Part 1. the Land Features and Problems to be Solved

本報告は，2018年度～2022年度に埼玉県横瀬町で岩村2年・3年ゼミが行った「横瀬町ハイキング路造成プロジェクト」のうち，観光地としてみた横瀬町の土地の特徴と，課題をまとめた報告書である．学生とともに横瀬町を平地部，丘陵部，山岳部を，季節を変えてくまなく歩き，また秩父札所巡礼路，横瀬町を舞台にしたアニメの舞台巡りのルート，一般の登山道，地元住民が健康のために歩く「クアオルト」エリア，農家レストラン・農家カフェを巡る散策路，横瀬町の観光スポットを，毎回テーマを変えて実際に訪問・踏破し，特徴を記録，魅力や問題点を検討してきた．2023年2月には，町長・副町長・道の駅支配人・役場振興課の職員の方々の前で，横瀬町の観光歩行路の特徴と課題をまとめ，9つの観光歩行コースの提案を行った． 本報告は，その時の報告を元にゼミ担当教員の岩村が更に整理したもので，観光地としての横瀬町の特徴と観光歩行路の課題およびその改善方法を抽出・提案したものである．17実践報告Practice reportdepartmental bulletin pape

Human animal contact, land use change and zoonotic disease risk: a protocol for systematic review.

BACKGROUND: Zoonotic diseases pose a significant risk to human health globally. The interrelationship between humans, animals, and the environment plays a key role in the transmission of zoonotic infections. Human-animal contact (HAC) is particularly important in this relationship, where it serves as the pivotal interaction for pathogen spillover to occur from an animal reservoir to a human. In the context of disease emergence linked to land-use change, increased HAC as a result of land changes (e.g., deforestation, agricultural expansion, habitat degradation) is frequently cited as a key mechanism. We propose to conduct a systematic literature review to map and assess the quality of current evidence linking changes in HAC to zoonotic disease emergence as a result of land-use change. METHOD: We developed a search protocol to be conducted in eight (8) databases: Medline, Embase, Global Health, Web of Science, Scopus, AGRIS, Africa-Wide Info, and Global Index Medicus. The review will follow standard systematic review methods and will be reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. The search will consist of building a search strategy, database search, and a snowballing search of references from retrieved relevant articles. The search strategy will be developed for Medline (through PubMed) and EMBASE databases. The search strategy will then be applied to all eight (8) databases. Retrieved articles will be exported to EndNote 20 where duplicates will be removed and exported to Rayyan®, to screen papers using their title and abstract. Screening will be conducted by two independent reviewers and data extraction will be performed using a data extraction form. Articles retrieved will be assessed using study quality appraisal tools (OHAT-Office for Health Assessment and Technology Risk of Bias Rating Tool for Human and Animal Studies, CCS-Case Control Studies, OCCSS-Observational Cohort and Cross-Sectional Studies, and CIS-Controlled interventional studies). Data will be analysed using descriptive statistics and a meta-analysis where data permits. DISCUSSION: The review will provide an important systematic literature aggregate of existing evidence on the role and evidence quality linking HAC to the emergence of zoonoses via land-use change. The outcome of the proposed review will produce a high-level evidence document that could inform intervention points and further research priorities. REGISTRATION: The review will be registered with PROSPERO

Assessing carbon stocks using indigenous peoples' field measurements in Amazonian Guyana

Accurate estimations of carbon stocks across large tracts of tropical forests are key for participation in programs promoting avoided deforestation and carbon sequestration, such as the UN REDD+ framework. Trained local technicians can provide such data, and this, combined with satellite imagery, allows robust carbon stock estimation across vegetation classes and large areas. In the first comprehensive survey in Guyana conducted by indigenous people, ground data from 21 study sites in the Rupununi region were used to estimate above ground tree carbon density across a diversity of ecosystems and land use types. Carbon stocks varied between village sites from 1Tg to 22.7Tg, and these amounts were related to stem density and diameter. This variation was correlated with vegetation type across the region, with savannas holding on average 14MgCha-1 and forests 153MgCha-1. The results indicated that previous estimates based on remotely sensed data for this area may be inaccurate (under estimations). There were also differences in carbon densities between village sites and uninhabited control areas, which are presumably driven by community use. Recruiting local technicians for field work allowed (a) large amounts of ground data to be collected for a wide region otherwise hard to access, and (b) ensured that local people were directly involved in Guyana's Low Carbon Development Strategy as part of REDD+. This is the first such comprehensive survey of carbon stocks, carbon density and vegetation types over a large area in Guyana, one of the first countries to develop such a program. The potential inclusion of forests held by indigenous peoples in REDD+ programs is a global issue: we clearly show that indigenous people are capable of assessing and monitoring carbon on their lands

Limited flexibility in departure timing of migratory passerines at the East-Mediterranean flyway

The rapid pace of current global warming lead to the advancement of spring migration in the majority of long-distance migratory bird species. While data on arrival timing to breeding grounds in Europe is plentiful, information from the African departure sites are scarce. Here we analysed changes in arrival timing at a stopover site in Israel and any links to Enhanced Vegetation Index (EVI) on the species-specific African non-breeding range in three migratory passerines between 2000–2017. Differences in wing length between early and late arriving individuals were also examined as a proxy for migration distance. We found that male redstart, but not females, advanced arrival to stopover site, but interestingly, not as a response to EVI phenology. Blackcap and barred warbler did not shift arrival timing significantly, although the arrival of blackcap was dependent on EVI. Barred warbler from the early arrival phase had longer wings, suggesting different populations. Our study further supports the existence species-specific migration decisions and inter-sexual differences, which may be triggered by both exogenous (local vegetation condition) and endogenous cues. Given rapid rate of changes in environmental conditions at higher latitudes, some migrants may experience difficulty in the race to match global changes to ensure their survival

Preoperative Butyrylcholinesterase Level as an Independent Predictor of Overall Survival in Clear Cell Renal Cell Carcinoma Patients Treated with Nephrectomy

The prognostic factors for the overall survival (OS) of clear cell renal cell carcinoma (ccRCC) patients treated with nephrectomy are not well defined. In the present study, we investigated the prognostic significance of preoperative butyrylcholinesterase (BChE) levels in 400 ccRCC patients undergoing radical or partial nephrectomy from 1992 to 2013 at our institution. Univariate and multivariate analyses were performed to determine the clinical factors associated with OS. Among the enrolled patients, 302 were diagnosed with organ-confined disease only (T1-2N0M0), 16 with lymph node metastases, and 56 with distant metastases. The median preoperative BChE level was 250 U/L (normal range, 168–470 U/L), and median follow-up period was 36 months. The 3-year OS rate in patients with preoperative BChE levels of ≥100 U/L was significantly higher than in those with levels of <100 U/L (89.3% versus 77.7%, P=0.004). On univariate analysis, performance status; anemia; hypoalbuminemia; preoperative levels of BChE, corrected calcium, and C-reactive protein; and distant metastasis status were significantly associated with OS. Multivariate analysis revealed that preoperative BChE levels and distant metastasis status were significantly associated with OS. Our findings suggest a possible role of preoperative BChE levels as an independent predictor of OS after nephrectomy in ccRCC patients

Implications of global environmental change for the burden of snakebite.

Snakebite envenoming is a set of intoxication diseases that disproportionately affect people of poor socioeconomic backgrounds in tropical countries. As it is highly dependent on the environment its burden is expected to shift spatially with global anthropogenic environmental (climate, land use) and demographic change. The mechanisms underlying the changes to snakebite epidemiology are related to factors of snakes and humans. The distribution and abundance of snakes are expected to change with global warming via their thermal tolerance, while rainfall may affect the timing of key activities like feeding and reproduction. Human population growth is the primary cause of land-use change, which may impact snakes at smaller spatial scales than climate via habitat and biodiversity loss (e.g. prey availability). Human populations, on the other hand, could experience novel patterns and morbidity of snakebite envenoming, both as a result of snake responses to environmental change and due to the development of agricultural adaptations to climate change, socioeconomic and cultural changes, development and availability of better antivenoms, personal protective equipment, and mechanization of agriculture that mediate risk of encounters with snakes and their outcomes. The likely global effects of environmental and demographic change are thus context-dependent and could encompass both increasing and or snakebite burden (incidence, number of cases or morbidity), exposing new populations to snakes in temperate areas due to "tropicalization", or by land use change-induced snake biodiversity loss, respectively. Tackling global change requires drastic measures to ensure large-scale ecosystem functionality. However, as ecosystems represent the main source of venomous snakes their conservation should be accompanied by comprehensive public health campaigns. The challenges associated with the joint efforts of biodiversity conservation and public health professionals should be considered in the global sustainability agenda in a wider context that applies to neglected tropical and zoonotic and emerging diseases

A mechanistic model of snakebite as a zoonosis: Envenoming incidence is driven by snake ecology, socioeconomics and its impacts on snakes.

Snakebite is the only WHO-listed, not infectious neglected tropical disease (NTD), although its eco-epidemiology is similar to that of zoonotic infections: envenoming occurs after a vertebrate host contacts a human. Accordingly, snakebite risk represents the interaction between snake and human factors, but their quantification has been limited by data availability. Models of infectious disease transmission are instrumental for the mitigation of NTDs and zoonoses. Here, we represented snake-human interactions with disease transmission models to approximate geospatial estimates of snakebite incidence in Sri Lanka, a global hotspot. Snakebites and envenomings are described by the product of snake and human abundance, mirroring directly transmitted zoonoses. We found that human-snake contact rates vary according to land cover (surrogate of occupation and socioeconomic status), the impacts of humans and climate on snake abundance, and by snake species. Our findings show that modelling snakebite as zoonosis provides a mechanistic eco-epidemiological basis to understand snakebites, and the possible implications of global environmental and demographic change for the burden of snakebite