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The prostate gland is the sole organ that uses not targeted but systematic biopsy in the pathological diagnosis of prostate cancer due to its anatomical location and lack of adequate imaging modality to depict cancer nodules clearly. The U.S. Preventive Services Task Force published that the harms of PSA based screening outweigh the benefits, yielding a grade D recommendation against screening. In this current situation, what we need is to optimize a biopsy template that maximizes the detection rate of clinically significant cancer and provides adequate pathological information for a treatment plan while minimizing the detection of indolent cancers and has good cost-effectiveness and safety. In this manuscript, optimal systematic biopsy templates and possible role of MRI-guided biopsy are reviewed.

Circadian rhythm of blood pressure (BP) is closely linked with sodium balance. With positive sodium balance the nocturnal BP is elevated, resulting in non-dipper pattern. Nocturnal BP elevation plays an important role in the cardio-renal association to cause the cardiovascular events. It is vey important, therefore, how to lower nocturnal hypertension especially in CKD.

When RAS inhibitors are prescribed as the first-line agent in hypertension, the combination of diuretics on them exerts several preferable effects in both blood pressure lowering and organ protection. As far as low-dose of diuretics, the unfavorable side effects such as hypokalemia and insulin resistance can be minimized by RAS inhibitors. Therefore, unless the compelling indication for Ca channel blockers exists, diuretics should be added on RAS inhibitors.

Among hypertensive cardiovascular complications only end-stage renal failure (ESRD) is progressively increasing, while the increases in the incidence of stroke and coronary heart disease have been suppressed. On the other hand, it is well established that CKD, especially due to diabetic nephropathy and IgA nephropathy, can be arrested into complete remission if treated in the early stages. Therefore, early detection program is highly and urgently required. To achieve this goal, we must consider what we can do now in nation-wide scale including patients, doctors and governments. There are remarkable regional differences in both the incidence of ESRD and the increasing rate within Japan. Japanese Society of Dialysis Therapy has the unique system to register the patients who reach ESRD, resulting in chronic dialysis therapy. Therefore, if we can build the patient identification system compatible to the above, then we immediately know who has reached ESRD. In this way, we can analyze the backgrounds of the ESRD patients to find out the risk factors of CKD in addition to the regional differences. I anticipate that the incidence of ESRD will be reduced in near future in Japan as seen in diabetic nephropathy in Denmark and USA. We must act now to accomplish this important issue: integrated care of CKD.

Pathogenesis of edema is in depth considered based on Starling's rule on capillary fluid dynamics. Edema can be divided into 4 types based on the mechanisms causing edema: increased capillary hydrostatic pressure, decreased plasma oncotic pressure, enhanced hydraulic permeability of capillary walls, and lymphatic obstruction. Each of the types can be further divided into generalized and local forms. Edema, defined as the expansion of interstitial fluid compartment, is initiated by imbalance of Starling forces across capillary walls between plasma and interstitium, but is maintained by enhanced sodium reabsorption from renal tubules.

Microalbuminuria is a sensitive marker of early renal damage in essential hypertension as well as diabetes mellitus. Elevated urinary albumin excretion has positive correlations with other cardiovascular risk factors. Microalbuminuria has an independent value to predict cardiovascular disease in the patients with not only diabetes mellitus but also with essential hypertension and even in general population. The seventh report of the joint national committee on prevention, detection, evaluation and treatment of high blood pressure (JNC 7) has adopted microalbuminuria or estimated glomerular filtration rate < 60 ml/min as one of the major cardiovascular risk factors. It is an important future task whether decrease in urinary albumin excretion with treatment improves prognosis of individual patients.

Ulcerative colitis, Crohn's disease and hemorrhage colitis are typical example of colon specific diseases. The targeting of the drugs for these colon specific diseases was attempted by a new technology, where ethylcellulose (EC) was used as pharmaceutical material. Especially, pressure-controlled colon delivery capsule (PCDC) made of EC is a unique system. PCDC was prepared by coating the inner surface of gelatin capsule with water-insoluble polymer, EC. By adjusting the coating thickness of EC membrane to be approximately 40 microns, colon delivery of dug were obtained both in beagle dogs and human volunteers. PCDC containing 5-ASA was prepared and was administered orally to beagle dogs. After administration, 5-ASA appeared into the systemic circulation at 3-5 h which corresponds to the colon arrival time confirmed with sulfasalazine.

Although many proteins and peptides were produced by gene-technology, their administration routes are limited to be i.v. route. To increase the clinical use of these products, oral dosage form is required. However, in the case of oral administration, proteins are degraded by digestive fluid having strong protease activity. To decrease the protease activity, protease inhibitors are administered concomitantly with proteins. Aprotinin, soybean trypsin inhibitors and gel-forming polymer such as Polycarbophil are representative protease inhibitors. Gel-forming polymers have both protease inhibiting activity and absorption enhancing effect on protein/peptides. The usefulness of these protease inhibitors have been suggested as an additive for the oral delivery of G-CSF and vasopressin derivatives.