ObjectiveGrowth differentiation factor 15 (GDF-15) has emerged as a potential biomarker for neurodegenerative diseases. Although elevated serum GDF-15 levels have been reported in Parkinson's disease (PD), their association with clinical features has not been fully characterized.MethodsWe evaluated serum GDF-15 concentrations in 40 patients with PD and analyzed their relationships with clinical measures, including motor severity (MDS-UPDRS), quality of life (PDQ-39), sleep disturbances (PDSS-2), autonomic symptoms (SCOPA-AUT), and cognitive function (MoCA-J).ResultsHigher serum GDF-15 levels were associated with older age and greater symptom burden across multiple domains. Significant relationships were observed with MDS-UPDRS Parts I-III and total scores, PDQ-39 summary index and bodily discomfort index, two different PDSS-2 domains (motor symptoms at night and PD symptoms at night), and SCOPA-AUT total and gastrointestinal dysfunction scores. After adjusting for age, the associations between serum GDF-15 levels and MDS-UPDRS Part II, Part III, and total scores remained significant. No sex-related differences were detected. A trend toward lower MoCA-J scores with increasing GDF-15 levels was observed but did not reach statistical significance.ConclusionSerum GDF-15 levels are linked to both motor and nonmotor aspects of PD and may reflect overall disease burden. Further longitudinal studies are needed to determine their value for disease monitoring and prognosis.
Evidence regarding the association between oral environment and the inflammatory bowel disease (IBD), including ulcerative colitis (UC), exists. However, evidence regarding the association between oral health parameters and disease activity of UC is limited. This study aimed to evaluate the association between remaining tooth number and toothbrushing frequency and mucosal healing (MH) in Japanese UC patients. The study included 275 patients with UC. Information on lifestyle and oral health parameters was collected via self-administered questionnaires. The definition of MH was based on the Mayo endoscopic subscore (MES) of 0. The prevalence of MH in this cohort was 24.7
OBJECTIVES:We aimed to evaluate the prognostic utility of subclassifying patients with intermediate-risk prostate cancer into favorable and unfavorable subgroups in a large Japanese cohort undergoing radical prostatectomy, focusing on adverse pathology and oncologic outcomes. METHODS:We retrospectively analyzed 1485 intermediate-risk patients from the MICAN (Medical Investigation Cancer Network) study registry who underwent radical prostatectomy between 2010 and 2020 in Ehime Prefecture, Japan. Patients were categorized into favorable or unfavorable intermediate-risk groups based on the National Comprehensive Cancer Network (NCCN) guideline. We examined up-grading, up-staging, and adverse pathology defined as pathological ≥T3, grade group ≥ 4, or lymph node involvement. Kaplan-Meier analysis was used to evaluate prostate-specific antigen (PSA) failure-free survival and overall survival. RESULTS:Among 1485 patients, 590 (40.2%) were classified as having favorable intermediate risk and 879 (59.8%) as having unfavorable intermediate risk. Up-grading and up-staging were observed more frequently in the unfavorable group. Adverse pathology was more frequent in the unfavorable group (64.8%) than that in the favorable group (39.4%) (p < 0.001). The 5-year PSA failure-free survival rates were 92.1% for the favorable group and 80.1% for the unfavorable group (p < 0.001). Although the 5-year overall survival rate did not reach statistical significance (98.4% vs. 97.9%, p = 0.085), the favorable group showed a trend toward better survival. CONCLUSIONS:The subclassification of intermediate-risk prostate cancer into favorable and unfavorable groups is prognostically meaningful in Japanese patients undergoing radical prostatectomy. Higher rates of adverse pathological findings and inferior PSA failure-free survival in the unfavorable group support the clinical utility of this subclassification.
AIM:To investigate the prognostic factors of hepatic steatosis detected using abdominal ultrasonography (AUS). After identifying low body mass index (BMI) as a potential risk factor, we explored the association between ultrasound-detected hepatic steatosis (UDHS) and long-term outcomes in underweight patients. METHODS:We retrospectively analyzed 8599 patients who underwent AUS from 2010 to 2015 at six medical centers. Patients with advanced liver disease or viral hepatitis were excluded. In Analysis 1, patients' baseline characteristics were compared between patients with and without UDHS. In Analysis 2, using Cox proportional hazards model, we assessed the risk factors for mortality among patients with UDHS. In Analysis 3, we conducted a propensity score-matched analysis of patients with BMI < 18.5 to evaluate UDHS impact on survival and causes of death. Alcohol consumption data were unavailable; therefore, etiologic classification was not possible. RESULTS:Altogether, 2370 were diagnosed with UDHS. Male sex, low BMI, and diabetes mellitus were significantly associated with increased mortality among patients with UDHS. Among patients with BMI < 18.5, those with UDHS had significantly higher mortality rate than those without UDHS (43.8% vs. 14.6%, p = 0.0035). Nonhepatic malignancy were the leading cause of death in this group. CONCLUSIONS:UDHS in underweight patients was associated with worse prognosis in this exploratory matched analysis. This finding may suggest a higher-risk subgroup and requires confirmation in larger prospective studies.
Ureterorenoscopy (URS) is a widely accepted approach for managing upper urinary tract stones, including renal calculi measuring > 20 mm. However, an elevated intrapelvic pressure (IPP) during URS can lead to infectious and procedural complications. We developed a simple irrigation technique and evaluated its efficiency in reducing IPP during URS. In this technique, a 14/16-Fr ureteral access sheath (UAS) was advanced to the ureteropelvic junction or distal to the stone. A 4.7-Fr single-J ureteral stent was inserted through the UAS, with the tip placed in the renal pelvis or upper calyx. The stent enabled continuous fluid outflow and reduced the IPP. We defined this technique as the “Continuous Alternative Reduction of the intrapelvic Pressure” (CARP) system. The study comprised: (1) IPP measurements in a representative case comparing conventional URS and the CARP system, and (2) a retrospective analysis of patients treated using the CARP system between June 2020 and October 2024, excluding those with staghorn calculi. The CARP system significantly reduced the IPP. In the conventional URS setup, pressure exceeded 100 cmH₂O during flushing, whereas the CARP system maintained pressures below 25 cmH₂O. Overall, 34 renal and 45 ureteral stones were analyzed. The median stone burden was 20.5 mm for renal and 18.2 mm for ureteral stones. The stone-free rates were 97.1
