Satoru Shimura

Clinical significance of p53, mdm2, and bcl-2 proteins in renal cell carcinoma.

OBJECTIVES To improve our understanding of the clinical relevance of p53, mdm2, and bcl-2 protein overexpression in renal cell carcinoma, we retrospectively investigated the immunohistochemical expression of p53, murine double minute 2 (mdm2), and bcl-2 and the relationship of this expression to clinicopathologic characteristics. p53 regulates the transcription of downstream effectors such as the oncoprotein mdm2, and bcl-2 has been shown to inhibit apoptosis triggered by wild-type p53. METHODS The expression of p53, mdm2, and bcl-2 protein was studied by immunohistochemical methods in paraffin-embedded nephrectomy specimens from 112 patients whose clinicopathologic data confirmed renal cell carcinoma. RESULTS The expression of the p53 and bcl-2 protein was recognized in 15 (13.4%) and 52 (42.0%) cases, respectively; the expression of the mdm2 protein, however, was seen in only 2 cases (1.8%). No correlation was noted between these three proteins and any clinicopathologic parameters, except p53 expression and Stage T1-2/T3-4 (P = 0.0208). However, in multivariate analysis, stage (hazard ratio 3.586; P = 0.0002), expression of p53 (hazard ratio 6.090; P = 0.0126) and of mdm2 (hazard ratio 22.016; P = 0.0156), and coexpression of p53/mdm2 (hazard ratio 6.146; P = 0.0005) demonstrated a statistically significant effect on prognosis by proportional hazards regression tests. CONCLUSIONS Our results indicate that stage, p53 expression, mdm2 expression, and coexpression of p53/mdm2 are useful to predict the clinical outcome in patients with renal cell carcinoma.

Sufficient prophylactic efficacy with minor adverse effects by intravesical instillation of low-dose bacillus Calmette-Guérin for superficial bladder cancer recurrence

Background: Intravesical instillation of bacillus Calmette‐Guérin (BCG) is the most efficient strategy for prophylaxis of superficial bladder cancer recurrence. Adverse effects of BCG are major obstacles, but the reduction of BCG dose could minimize these effects. The efficacy and adverse effects of half‐dose (40 mg) BCG, Tokyo 172 strain, were prospectively evaluated.

A Web-Based Survey of Erection Hardness Score and Its Relationship to Aging, Sexual Behavior, Confidence, and Risk Factors in Japan

Introduction Erection hardness is an elemental component of mens sexual quality of life that can be easily measured by the Erection Hardness Score (EHS). However, there are few published data regarding EHS, and there is little understanding of its relationships to aging, mens sexual behavior, sexual confidence, and risk factors in Japan. Aim To assess EHS and how it correlates to aging, sexual behaviors, sexual self-confidence, and risk factors in a Japanese population database. Methods A web-based cross-sectional nationwide survey conducted between March and May 2009 in Japan. Main Outcome Measures EHS, lifestyle factors, comorbidities, general health, sexual confidence, frequency of sexual behaviors, and attitudes toward treatment of erectile dysfunction (ED). Results A total of 7,710 men with a mean age of 39.3 ± 13.0 years participated in this survey. In 6,528 participants who were not using phosphodiesterase type 5 inhibitors, 3,540 (54.2%) had EHS ≤ 3 and 1,196 (18.3%) had EHS ≤ 2. We found a significant age-dependent decrease in EHS, sexual confidence, and frequency of sexual activities. Sexual confidence was strongly associated with higher EHS but was also associated with older age groups, presence of offspring, awareness of better general health, and greater frequency of sexual activity. In age-adjusted multivariate logistic regression, risk factors for a lower EHS (defined as EHS ≤ 2) were heavy smoking, which was defined as more than two packs per day (odds ratio [OR], 1.7) or a history of metabolic syndrome (OR, 1.4), hypertension (OR, 1.2), and diabetes mellitus (OR, 1.4). Conclusions EHS correlates to various elements, such as aging, sexual behaviors, sexual confidence, and ED-related risk factors, and can be a valuable tool in clinical practice for monitoring and treating ED and thereby improving the quality of life for men and their sexual partners. Kimura M, Shimura S, Tai T, Kobayashi H, Baba S, Kano M, and Nagao K. A web-based survey of Erection Hardness Score and its relationship to aging, sexual behavior, confidence, and risk factors in Japan. Sex Med 2013;1:76–86.

Profiling Characteristics of Men Who Use Phosphodiesterase Type 5 Inhibitors Based on Obtaining Patterns: Data from the Nationwide Japanese Population

INTRODUCTION Worldwide, certain subsets of men bypass healthcare provider (HCP) interactions and obtain phosphodiesterase type 5 inhibitors (PDE5i) from uncontrolled sources. AIM To stratify men who are PDE5i users based on their obtaining patterns and investigate the characteristics that differentiate these groups. METHODS A Web-based observational study conducted between March and June 2009 in Japan. MAIN OUTCOME MEASURES We stratified the reported obtaining patterns into three categories: men who had a prescription for PDE5is from HCP, those who obtained PDE5is from friends, and those who purchased PDE5is via the Internet. Logistic regressions were conducted to determine independent predictors for each obtaining patterns. Erection function was evaluated by erection hardness score (EHS). RESULTS Of 7,710 total recruited subjects, 1,144 men (14.8%) reported PDE5i use within the past year. Among 1,144 men, 625 men (54.6%) were prescribed PDE5i from HCP, whereas 267 men (23.4%) obtained PDE5i from friends and 252 men (22.0%) purchased PDE5i via the Internet. In a multivariable regression analyses, men being prescribed PDE5i from HCP were more likely to live in a northern area of Japan (OR 0.98), have a lower rate of smoking (OR 0.77), and have an awareness of ED (OR 3.04). In contrast, men who obtained PDE5i from friends were more likely to live in a southern area (OR 1.02), to have higher rate of alcohol intake and smoking (OR 1.20, OR 1.45), and lower awareness of ED (OR 0.39). Men purchasing PDE5i via the Internet were more likely to consider themselves to be in worse health (OR 0.85) and to have lower awareness of ED (OR 0.62). CONCLUSIONS Our results could help to identify men who may bypass HCP interactions. These findings could aid in the targeting of public service announcements designed to encourage men to avoid obtaining uncontrolled PDE5i and consult with HCPs to protect their health.