Immune checkpoint inhibitor (ICI) therapy increases the risk of immune-related adverse events (irAEs). In particular, combination checkpoint blockade (CCB) targeting inhibitory CTLA-4 and PD-1 receptors could lead to irAEs at a higher rate than ICI monotherapy. Management of irAEs is important while using ICIs. However, there are no reliable biomarkers for predicting irAEs. The aim of this study was to elucidate early B cell changes after CCB therapy in patients with renal cell carcinoma (RCC) and verify whether B cells can be a predictor of irAEs. This prospective cohort study was conducted with 23 Japanese patients with metastatic RCC. An increase in the proportion of CD21lo B cells and CD21lo memory B cells was confirmed following CCB therapy. Although there were no differences in clinical outcomes between irAE and no-irAE groups, the proportion of CD21lo B cells at baseline was lower in the irAE group, with a significant increase after the first cycle of CCB therapy. Further analysis revealed a moderate correlation between irAEs and CD21lo B cell levels at baseline (area under the curve: 0.83, cut-off: 3.13%, sensitivity: 92.3, specificity: 70.0). This finding indicates that patients with low baseline CD21lo B cell levels warrant closer monitoring for irAEs. The clinical registration number by the Certified Review Board of Ehime University is No. 1902011.
Background: Intraoperative urinary collecting system entry (CSE) in robot-assisted partial nephrectomy (RAPN) may cause postoperative urinary leakage and extend the hospitalization. Therefore, identifying and firmly closing the entry sites are important for preventing postoperative urine leakage. In RAPN cases expected to require CSE, we insert a ureteral catheter and inject dye into the renal pelvis to identify the entry sites. We retrospectively analyzed the factors associated with intraoperative CSE in RAPN and explored the indications of intraoperative ureteral catheter indwelling in RAPN.Methods: Of 104 Japanese patients who underwent RAPN at our institution from August 2016 to March 2020, 101 were analyzed. The patients were classified into CSE and non-CSE groups. The patients’ background characteristics, RENAL Nephrometry Score (RNS) and surgical outcomes were analyzed.Results: Intraoperative CSE was observed in 41 patients (41%). The CSE group had a significantly longer operative time, console time ischemic time, and hospital stay than the non-CSE group. In a multivariable analysis, the N-score (odds ratio [OR]=3.9, P<0.05) and RNS total score excluding the L-score (OR=3.1, P<0.05) were associated with CSE. In a logistic regression analysis, CSE showed a moderate correlation with the RNS total score excluding the L-score (AUC: 0.848, cut-off: 5, sensitivity: 0.83, specificity: 0.73). Conclusion: A ureteral catheter should not be placed in patients with an RNS total score (excluding the L-score) of ≤4.
BackgroundIntraoperative urinary collecting system entry (CSE) in robot-assisted partial nephrectomy (RAPN) may cause postoperative urinary leakage and extend the hospitalization. Therefore, identifying and firmly closing the entry sites are important for preventing postoperative urine leakage. In RAPN cases expected to require CSE, we insert a ureteral catheter and inject dye into the renal pelvis to identify the entry sites. We retrospectively analyzed the factors associated with intraoperative CSE in RAPN and explored the indications of intraoperative ureteral catheter indwelling in RAPN.MethodsOf 104 Japanese patients who underwent RAPN at our institution from August 2016 to March 2020, 101 were analyzed. The patients were classified into CSE and non-CSE groups. The patients’ background characteristics, RENAL Nephrometry Score (RNS) and surgical outcomes were analyzed.ResultsIntraoperative CSE was observed in 41 patients (41%). The CSE group had a significantly longer operative time, console time ischemic time, and hospital stay than the non-CSE group. In a multivariable analysis, the N-score (odds ratio [OR]=3.9, P<0.05) and RNS total score excluding the L-score (OR=3.1, P<0.05) were associated with CSE. In a logistic regression analysis, CSE showed a moderate correlation with the RNS total score (area under the curve [AUC]: 0.818, cut-off: 7, sensitivity: 0.80, specificity: 0.68) and RNS total score excluding the L-score (AUC: 0.848, cut-off: 5, sensitivity: 0.83, specificity: 0.73). ConclusionA ureteral catheter should not be placed in patients with an RNS total score ≤6 or RNS total score excluding the L-score of 3 or 4.
Pelvic organ prolapse (POP), including vaginal stump prolapse, is caused by the weakening of the pelvic floor muscles. In vaginal stump prolapse, the support mechanisms of pelvic organs are disrupted due to factors such as increased intra-abdominal pressure, resulting in the pelvic organs hanging down and escaping from the vaginal opening. Here, we report a case of vaginal stump prolapse that developed after bilateral nephroureteral hysterectomy, with recurrence due to an increase in intra-abdominal pressure from ascites associated with cirrhosis.
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