Shizuoka Medical Center

This study aims to examine the current practice patterns of Japanese urologists in treating male anterior urethral strictures and to compare these results with international trends. A 16-item questionnaire, adapted from surveys conducted in other countries, was distributed to members of the Japanese Urological Association (JUA) in 2024. Statistical analyses, including Pearson's chi-square test and logistic regression, were performed to identify factors influencing treatment preferences. We emailed 9898 JUA members, and 1028 (10.4%) responded. 835 (81.2%) handled five or fewer urethral stricture cases annually. While 968 (94.2%) had experience with urethral dilatation, 937 (91.1%) with direct vision internal urethrotomy (DVIU), only 308 (30.0%) had experience with excision and primary anastomosis, and 102 (9.9%) with any oral mucosal graft urethroplasty. For the two hypothetical clinical cases, referring to specialists was selected in 707 (68.8%) and 618 (60.1%), respectively, whereas urethroplasty was chosen in 133 (12.9%) and 243 (23.6%), respectively. Seven hundred seventy-four (75.3%) felt the literature supported going straight to definitive urethroplasty if necessary, and this was significantly associated with being under 50 years of age, holding instructor status, and limiting the indication for DVIU to strictures ≤ 1 cm. Japanese urologists exhibit limited urethroplasty experience and widely utilize transurethral treatments. The majority of members prefer to refer to a specialist, indicating that, in addition to the difficulty of urethroplasty, making indication decisions is also challenging. It is hoped that evidence-based medical practice will become more widespread.

Abstract This meta-analysis aimed to evaluate the long-term outcomes of a low-intensity anticoagulation (LA) strategy in patients undergoing mechanical aortic valve replacement. A systematic search of the databases was conducted through October 2024. Single-arm meta-analysis was performed to estimate the pooled late outcomes associated with LA. The Kaplan–Meier survival curve was reconstructed using individual patient data from included studies to assess overall survival. A standard meta-analysis was then conducted to compare outcomes between LA and standard anticoagulation (SA). Eight studies, comprising 2,426 patients and 21,062.7 patient-years, were included. Five studies involved comparable groups, while three were single-arm studies. The pooled valve-related mortality rate with LA was 0.05 per 100 patient-year, with incidences of prosthetic valve thrombosis, composite of bleeding and thromboembolism, bleeding, and thromboembolism being 0.03, 1.5, 0.93, and 0.46 per 100 patient-year, respectively. The Kaplan–Meier analysis showed overall survival rates at 10 years of 88.5%. Compared with SA, LA was associated with significantly lower risks of all-cause mortality (hazard ratio [HR]: 0.50; 95% confidence interval [CI]: 0.37–0.68; p < 0.01), composite outcome (HR: 0.49; 95% CI: 0.37–0.66; p < 0.01), and bleeding (HR: 0.37; 95% CI: 0.26–0.52; p < 0.01). There were no significant differences in valve thrombosis (HR: 0.52; 95% CI: 0.13–2.11; p = 0.36) or thromboembolic event rates (HR: 0.88; 95% CI: 0.50–1.54; p = 0.65). This meta-analysis suggests that LA is associated with reduced risks of all-cause mortality and bleeding compared with SA, while thromboembolic risks remain comparable.

ABSTRACTA case of acute type B aortic dissection (intramural hematoma) complicated by superior mesenteric artery aneurysm is herein reported. It is suggested that the coexistence of aortic dissection and superior mesenteric artery aneurysm should be based upon the shared etiology.

BackgroundNephronophthisis (NPH) is an autosomal recessive kidney disease, and NPHP1 is the most frequently affected gene. Tubulointerstitial fibrosis is the major phenotype of NPHP1-deficient NPH. The pathophysiology of NPHP1-deficient NPH is unclear because models representing the disease pathophysiology are lacking. Herein, we aimed to create a novel pathological model of NPH using 3D kidney organoids derived from human-induced pluripotent stem cells (iPSCs) and elucidated the pathophysiology while searching for therapeutic candidates.MethodsNPHP1-deficient kidney organoids were generated from iPSCs. Fibrosis was induced by treatment with IL-1β. The effects of the Hippo signaling pathway inhibitors as therapeutic candidates were assessed. Fibrotic status was evaluated using immunofluorescence and quantitative PCR.ResultsNPHP1−/− kidney organoids were generated from iPSCs. Fibrosis induction with IL-1β considerably increased the expression of fibronectin and transcription of fibrosis-related genes in NPHP1−/− organoids. Long-term culture of NPHP1−/− organoids induced substantial fibrogenesis compared with wild-type organoids. Co-immunoprecipitation analysis revealed the binding of NPHP1 to LATS1/2—the main constituents of the Hippo pathway. IL-1β administration increased the expression of the key Hippo pathway genes in NPHP1−/− organoids. By contrast, the Hippo pathway inhibitors ameliorated IL-1β-induced fibrogenesis in NPHP1−/− organoids. Because one of the inhibitors, verteporfin, is in clinical use, its practical availability is expected from a drug-repositioning perspective.ConclusionsHippo signaling pathway is involved in the fibrotic changes associated with NPHP1-deficient NPH and the Hippo pathway inhibitors could be therapeutic agents.Clinical trial numberNot applicable.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13287-025-04567-0.

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

BackgroundPostoperative shoulder stiffness (POSS) is one of the most common complications of arthroscopic rotator cuff repair (ARCR). Although adduction restriction is commonly observed in the early postoperative period, it remains unclear whether a prolonged duration of this restriction impacts the development of POSS. The aim of this study was to investigate whether early postoperative adduction restriction is associated with the occurrence of POSS 1 year after ARCR.MethodsThis retrospective cohort study included patients who underwent ARCR at a single institution between April 2017 and June 2018. A total of 96 shoulders were analyzed. Active and passive range of motion were assessed preoperatively and at 12 months postoperatively. Adduction restriction was evaluated in two positions: the droop position and the intermediate position. Adduction restriction was defined as resolved when the medial side of the arm made contact with the side of the body. Based on these evaluations, the duration of persistent postoperative adduction restriction was evaluated. POSS was defined as passive external rotation at the side of less than 30° at 12 months after surgery according to the previous studies. Patients were assigned to one of two groups: Group N, without POSS group, or Group S, with POSS group. Propensity score matching was used to ensure comparability between groups. The duration of persistent postoperative adduction restriction was compared between the groups.ResultsAfter propensity score matching, 38 shoulders were analyzed (19 in Group N and 19 in Group S). While no significant difference in the duration of persistent postoperative adduction restriction in the droop position between the groups was observed, the duration in the intermediate position was significantly shorter in Group N compared to Group S (7 ± 3 weeks vs. 10 ± 4 weeks, P = .007).ConclusionThe duration of persistent adduction restriction in the intermediate position was significantly longer in shoulders with POSS at 12 months after ARCR compared to those without POSS. Prolonged early postoperative adduction restriction may associate with the occurrence of POSS 12 months after ARCR.

This meta-analysis evaluates outcomes in patients undergoing bioprosthetic aortic valve replacement (bAVR), comparing different antithrombotic strategies. We conducted a systematic search through May 2024. A standard meta-analysis compared outcomes between patients who received anticoagulation therapy (AC) and those who did not. Therapeutic categories were subdivided into four groups: AC alone, AC with antiplatelet therapy (AP), AP alone, and no antithrombotic therapy. A network meta-analysis was performed for these categories. The review included 16 studies, comprising a total of 59,054 patients. There was no significant difference in all-cause mortality rates (HR: hazard ratio [95% CI: confidence interval] = 0.98 [0.77-1.25], P = .88) or thromboembolic events (HR [95% CI] = 0.91 [0.65-1.28], P = .60) between patients with and without AC. However, bleeding events were significantly higher in patients receiving AC (HR [95% CI] = 1.55 [1.20-2.00], P < .01). Network meta-analysis showed that AP alone was associated with lower mortality rates compared with other therapeutic categories. Additionally, AP alone was associated with fewer bleeding events compared with AC alone and AC with AP. This meta-analysis suggests that AP alone in patients undergoing bAVR is associated with superior outcomes compared with other antithrombotic strategies.