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Living donor liver transplantation has expanded in recent years, particularly in North America. As experience with this procedure has matured over the last 25 years, centers are increasingly faced with potential living donors who are more medically complex. As donors move through the evaluation process, completing the informed consent process continues to be challenged by a paucity of granular data demonstrating long-term outcomes and overall safety specifically in the otherwise "healthy" living liver donor population. Two recently published studies examined long-term outcomes post-living liver donation using Korean registry data and reported similar results, with excellent overall survival when compared to appropriately matched controls. However, the authors of these studies were presented differently, with one reporting an alarmist view based on one aspect of a suboptimal analysis approach using an inappropriate comparator group. Herein, the North American Living Liver Donor Innovation Group (NALLDIG) consortium discusses these two studies and their potential impact on living liver donation in North America, ultimately highlighting the importance of scientific integrity in data presentation and dissemination when using transplant registry data.

Toshihiro Saito,1 Shuichi Komatsubara,2 Noboru Hara,3 Tsutomu Nishiyama,3 Akiyoshi Katagiri,4 Fumio Ishizaki,5 Akihiko Hatano,6 Takeshi Komeyama,7 Shugo Hanyu,8 Masahiro Terunuma,9 Tomoyuki Imai,10 Hideto Go,11 Hiroaki Iida,12 Shigenori Kurumada,13 Shunsuke Yamaguchi,4,14 Keisuke Takeda,5,15 Takashi Ando,14,15 Tatsuhiko Hoshii,5 Takashi Kasahara,5 Yoshihiko Tomita5 1Department of Urology, Niigata Cancer Center Hospital, Niigata, Japan; 2Department of Urology, Niigata Minami Hospital, Niigata, Japan; 3Department of Urology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minamiuonuma, Japan; 4Department of Urology, Niigata Prefectural Central Hospital, Joetsu, Japan; 5Department of Renal and Urinary Pathology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan; 6Department of Urology, Niigata Prefectural Shibata Hospital, Shibata, Japan; 7Department of Urology, Nagaoka Red Cross Hospital, Nagaoka, Japan; 8Department of Urology, Kashiwazaki General Hospital and Medical Center, Kashiwazaki, Japan; 9Department of Urology, Nagaoka Chuo General Hospital, Nagaoka, Japan; 10Department of Urology, Niigata City General Hospital, Niigata, Japan; 11Department of Urology, Niigata Saiseikai Sanjo Hospital, Sanjo, Japan; 12Department of Urology, Joetsu General Hospital, Joetsu, Japan; 13Department of Urology, Saiseikai Niigata Hospital, Niigata, Japan; 14Department of Urology, Tachikawa General Hospital, Nagaoka, Japan; 15Department of Urology, Murakami General Hospital, Murakami, JapanCorrespondence: Toshihiro SaitoDepartment of Urology, Niigata Cancer Center Hospital, 2-15-3 Kawagishi-cho, Niigata, 951-8566, JapanTel +81-25-266-5111Fax +81-25-233-3849Email urotoshi@niigata-cc.jpPurpose: This study aims to investigate the utility of prostate-specific antigen (PSA) screening by conducting an all-case survey of newly diagnosed prostate cancer patients at Niigata Prefecture, Japan.Patients and Methods: Depending on whether patients were subjected to screening, information was prospectively collected on all prostate cancer patients newly diagnosed between October 1, 2019, and September 30, 2020, at all institutions in Niigata Prefecture where urologists performing prostate biopsy routinely work and differences in clinical parameters were investigated.Results: PSA was measured in 478 out of 1332 patients (35.8%) as part of a community health screening. The rate of metastatic carcinoma (M1) in all patients was 14.9%. When patients were divided into three categories of population-based screening (community health screening and workplace health screening), opportunistic screening (PSA measurements at complete medical check-ups or on patient request), and testing triggered by clinical symptoms or findings, the proportion of metastatic cancer was 4.5%, 3.7%, and 30.6%, respectively, demonstrating that the number of distant metastases was significantly lesser in all patients who underwent screening.Conclusion: The one-year all-case survey of newly diagnosed prostate cancer patients demonstrated that PSA screening significantly contributed to the early diagnosis of current prostate cancer in Japan.Keywords: prostate cancer, PSA screening, population-based screening, opportunistic screening, one-year all-case survey

Hiroharu Kamioka,1 Yasunori Mori,2 Takahiko Horiuchi,3 Takahito Hayashi,4 Koichiro Ohmura,5 Satoru Yamaguchi,6 Mitsutoshi Kato7 1Faculty of Regional Environment Science, Tokyo University of Agriculture, Tokyo, Japan; 2Mie Prefecture Health and Environment Research Institute, Yokkaichi, Mie, Japan; 3Department of Internal Medicine, Kyushu University Beppu Hospital, Beppu, Oita, Japan; 4Department of Legal Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan; 5Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan; 6Department of Oriental Medicine, Saitama Medical University, Saitama, Japan; 7Kato Clinic of Internal Medicine, Tokyo, JapanCorrespondence: Hiroharu KamiokaFaculty of Regional Environment Science, Tokyo University of Agriculture, 1-1-1 Sakuragaoka, Setagaya-Ku, Tokyo 156-8502, JapanTel/Fax +81 35477 2587Email h1kamiok@nodai.ac.jpPurpose: To clarify the relationship between daily hot water bathing (HWB) at home and glycemic control in middle-aged and elderly ambulatory patients with type 2 diabetes mellitus (T2DM).Methods: We defined hemoglobin A1c (HbA1c) as the main outcome. We set 7.0% based on the mean value of the dependent variable as the cut-off point for analysis. Frequency of HWB was an explanatory variable. A two-sample t-test was used to compare between groups with continuous variables. Multiple logistic regression analysis was performed for frequency, adjusted age, sex, BMI, T2DM duration (Model 1), and other confounding factors (Model 2). Odds ratio (OR) and 95% confidence interval (95% CI) were calculated.Results: Among 838 patients, there was a significant difference (p< 0.001) in age between males (n=528, 62.8± 8.7 years) and females (n=310, 65.0± 8.1 years). In Model 1, compared with participants who used HWB more than seven times a week, those with poorly controlled HbA1c were significantly associated with low frequency of HWB: four to six times a week (OR 1.32, 95% CI 0.87– 1.99) and less than three times a week (OR 1.43, 95% CI 0.98– 2.10); p-value for overall trend was 0.041. In Model 2, p-value for overall trend was 0.138.Conclusion: A higher frequency of HWB was moderately associated with a decreased risk of poor glycemic control in middle-aged and elderly ambulatory patients with T2DM.Keywords: hot water bathing, type 2 diabetes, hemoglobin A1c, middle-aged and elderly ambulatory patients

Hitoki Saito,1 Momoko Ebashi,2 Masaru Kushimoto,3 Jin Ikeda,3 Fujiko Egashira,1 Suguru Yamaguchi,1 Kentaro Watanabe1 Katsuhiko Ogawa,2,4 Yutaka Suzuki,3,4 Hisamitsu Ishihara,1 Midori Fujishiro1,4 1Division of Diabetes and Metabolic Diseases, Nihon University School of Medicine, Tokyo, Japan; 2Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan; 3Division of General Medicine, Department of Internal Medicine, Nihon University, Tokyo, Japan; 4Department of Internal Medicine, Nihon University Hospital, Tokyo, Japan Abstract: Patients with diabetes mellitus (DM) are at increased risk of infections, with the urinary tract being the most frequent infection site. Incomplete bladder emptying, frequent urination and abdominal distension are typical symptoms of urinary tract infections (UTIs). A 68-year-old female with a long history of poorly controlled type 2 DM (T2DM) visited our hospital complaining of urinary retention, which was initially diagnosed as cystitis by another doctor. The urologist at our hospital identified a skin rash extending from the left hip to her genital area. A dermatologist was consulted. She was clinically diagnosed with herpes zoster (HZ) involving the left sacral dermatome area. As Elsberg syndrome (ES) was suspected, a lumbar puncture was performed, revealing aseptic meningitis associated with varicella zoster virus (VZV) infection. Intravenous acyclovir with urinary catheterization in combination with methylprednisolone pulse therapy resulted in a good clinical course. HZ very uncommonly involves sacral dermatomes, but it can develop in patients with prolonged poorly controlled DM. Furthermore, early diagnosis can be difficult when patients have diabetic peripheral neuropathy, which may mask symptoms related to skin lesions. Because this disease is potentially severe, detailed examination is important for clinicians managing patients with DM who have complaints indicative of urinary tract disorders. Keywords: herpes zoster, urinary retention, diabetic neuropathy

Makoto Komatsuzaki, Toshifumi Takasusuki, Shigeki Yamaguchi Department of Anesthesiology, Dokkyo Medical University, School of Medicine, Mibu, Tochigi 321-0293, Japan Purpose: The interval from the peak to the end of the T wave (Tp–Te) on electrocardiography is considered a marker of ventricular arrhythmias. A previous study suggested that right stellate ganglion block prolonged QT and QT dispersion (QTD). We investigated the effect of thoracic epidural sympathetic block with 1% mepivacaine on QT, QTD, Tp–Te, and Tp–Te/QT by using computerized measurement. Patients and methods: After obtaining the approval of the ethics committee of Dokkyo Medical University Hospital, 23 patients with American Society of Anesthesiologists physical status I or II who were scheduled to undergo thoracic surgery were enrolled. An epidural catheter was inserted at the Th4–5 or 5–6 level and then used for injection of 7 mL of 1% mepivacaine. Changes in RR interval, QT, corrected QT (QTc), QTD, QTc dispersion (QTcD), Tp–Te, Tp–Te/QT, and Tp–Te/QTc before and after epidural injection were assessed by computerized measurement. Statistical analysis was performed by one-way ANOVA. Results: Systolic blood pressure was consistently suppressed 10–15 minutes after injection (baseline: 136±10 mmHg, 11 minutes: 113±12 mmHg, 12 minutes: 112±13 mmHg, 13 minutes: 112±12 mmHg, 14 minutes: 108±17 mmHg, 15 minutes: 111±14 mmHg; P

Akihiro Kuwahata,1,* Muneer Ahmed,2,* Kohei Saeki,3 Shinichi Chikaki,1 Miki Kaneko,1 Wenqi Qiu,1 Zonghao Xin,1 Shinji Yamaguchi,3 Akiko Kaneko,1 Michael Douek,2 Moriaki Kusakabe,3,4 Masaki Sekino1 1Department of Electrical Engineering and Information Systems, Graduate School of Engineering, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan; 2Division of Cancer Studies, King’s College London, Guy’s Hospital Campus, Great Maze Pond, London, UK; 3Graduate School of Agriculture and Life Sciences, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan; 4Matrix Cell Research Institute Inc., Ibaraki, Japan *These authors contributed equally to this work Background: Sentinel node biopsy using radioisotope and blue dye remains a gold standard for axillary staging in breast cancer patients with low axillary burden. However, limitations in the use of radioisotopes have resulted in emergence of novel techniques. This is the first in vivo study to assess the feasibility of combining the two most common novel techniques of using a magnetic tracer and indocyanine green (ICG) fluorescence.Materials and methods: A total of 48 mice were divided into eight groups. Groups 1 and 2, the co-localization groups, received an injection of magnetic tracers (Resovist® and Sienna+®, respectively) and ICG fluorescence; distilled water was used as the solvent of ICG. Groups 3 and 4, the diluted injection groups, received an injection of magnetic tracers (Resovist and Sienna+, respectively) and saline for dilution. Groups 5, 6, and 7, the control groups, received magnetic tracer (Resovist, Sienna+) and ICG alone, respectively. Fluorescent intensity assessment and iron quantification of excised popliteal lymph nodes were performed. Group 1', a co-localization group, received an injection of magnetic tracers (Resovist) and ICG' fluorescence: saline was used as the solvent for ICG.Results: Lymphatic uptake of all tracers was confined to the popliteal nodes only, with co-localization confirmed in all cases and no significant difference in fluorescent intensity or iron content of ex vivo nodes between the groups (except for Group 1'). There was no impact of dilution on the iron content in the diluted Sienna+ group, but it significantly enhanced Resovist uptake (P=0.005). In addition, there was a significant difference in iron content (P=0.003) in Group 1'.Conclusion: The combination of a magnetic tracer (Resovist or Sienna+) and ICG fluorescence is feasible for sentinel node biopsy and will potentially allow for precise transcutaneous node identification, in addition to accurate intraoperative assessment. This radioisotope-free “combined technique” warrants further assessment within a clinical trial. Keywords: sentinel node biopsy, combined technique, fluorescence dye, magnetic nanoparticles, dilutional effect