Purpose: The prognosis for patients with metastatic renal cell carcinoma (RCC) has markedly improved with the advent of molecular targeted agents and immune checkpoint inhibitors. However, few studies have reported the outcomes of systemic therapy in metastatic RCC patients undergoing dialysis. This study aimed to evaluate the clinical outcomes of systemic therapy for metastatic RCC patients on dialysis. Materials and Methods: We retrospectively reviewed 253 patients with metastatic RCC (17 on dialysis and 236 not on dialysis) who received systemic therapy at Keio University Hospital in Japan. Progression-free survival (PFS), overall survival (OS), and cancer-specific survival (CSS) were assessed using the Kaplan-Meier method. Results: Clear cell RCC was diagnosed pathologically in 52.9% of dialysis patients and 82.6% of nondialysis patients (p=0.007). Among dialysis patients, 58.8% were classified as intermediate risk and 41.2% as poor risk. Regarding first-line therapy, 4 dialysis patients received cytokine therapy, 11 received tyrosine kinase inhibitors, 1 received mammalian target of rapamycin inhibitors, and 1 received immune checkpoint inhibitors. The median PFS (6.9 months, p<0.001), OS (21.2 months, p=0.001), and CSS (29.1 months, p=0.003) were all significantly shorter in dialysis patients. After propensity score matching, no significant difference was observed in PFS. However, significant differences persisted in OS and CSS between the dialysis and nondialysis groups. Conclusion Both OS and CSS were significantly shorter in dialysis patients with metastatic RCC compared to those not on dialysis.

Data concerning clinical cases of pesticide poisoning/disorders were collected from members of the Japanese Association of Rural Medicine during 2001-2003, and were analyzed statistically.A total of 194 cases of poisoning/disorders by pesticide exposure were reported from 36 hospitals and other medical institutions. Suicide cases accounted for 74% of the total number of cases, which was followed by the cases caused by exposure during spraying (17%) and drinking/eating by mistake (7%).In 144 suicide cases, those of males accounted for 52%, the middle-aged and older people constituted the majority. By types of clinical manifestations, almost all of the cases were acute or subacute pesticide poisoning (98%). Organophosphate insecticides were the most frequent inducers of the cases (39%), which was followed by bipyridylium herbicides (23%). When it comes to the outcome, more than 80% of suicide cases with paraquat products resulted in death.There were 39 cases of pesticide poisoning/disorders resulting from exposure during spraying, preparation or settling, and working in sprayed area. In these cases, males accounted for 70% the middle-aged and older people made up the majority. By types of clinical manifestations, the cases of acute or subacute pesticide poisoning accounted for 39%, which was followed by acute dermatitis (33%), chemical burn (14%), and ocular disorders (11%). The pesticides that induced clinical cases varied greatly. Main factors contributing to the onset of pesticide poisoning/disorders were insufficient protective clothing (44%), self conceit (19%), insufficient information (14%), and carelessness (12%).
Pesticides ; Clinical ; Poisoning aspects ; Acute ; Cases

In japan, pesticides have been used increasingly after World War II and pesticide poisoning has been a major issue of rural medicine. In other Asian countries, pesticide poisoning also seems to be a great concern of rural medicine and occupational and environmental medicine as well. We reviewed the results of research on the prevention of pesticide poisoning in Asia with the reports of international organizations and articles which appeared in medical journals.The WHO Glabal Information Network on Chemicals worked out an international protocol to collect and analyze the cases of pesticide poisoning, and is carrying out hospital-based surveys in east and south Asia from 1998. These data were discussed in comparison with the results of our hospital-based survey of pesticide poisoning in 1998-2000.Also, FAO has been exploring the concept of “community integrated pest management (CIPM)” from 1999, in Asian countries. In a project related to this, farmers were asked to report their pesticide use and symptoms, and researchers analyzed the data and gave advice to the farmers, and these practices produced so fruitful findings that the farmers have come to refrain from using hazardous pesticides of their own accord. These research projects are expected to complementarily contribute to the prevention of pesticide poisoning. We resumed the hospital-based survey of pesticide poisoning in 1996, and have collected and analyzed several hundreds cases. In order to reduce pesticide poisoning in Japan and other Asian countries, we are interested in rendering cooperation in those projects.
Pesticides ; Poisoning aspects ; Prevention ; Asia ; Review [Publication Type]

Pesticide poisoning is one of the most inportant health issues associated with rural medicine, and chronic nervous and mental disorders are its importnat sequelae. We investigated suquela cases nationwide, and reviewed chronic nervous and mental disorders from a clinical and epidemiological point of view.
Our nationwide survey found one reported case of delayed neuropathy. The patient ingested organophosphorus insecticides, and showed delayed neuropathy dozens days after.
Cases of delayed neuropathy attributable to Mipafox was reported in1951.This disease is mainly caused by organophosphorus insecticides. Carbamate insecticides are also known as the agents to induce delayed neuropathy. Herbicide Glufosinate (Basta^TM) was put on the market in 1984. The case reports published during the 1990's pointed out that some Glufosinate poisonings cause amnesia and disorientation. Thesecases were reviewed according to the types of pesticides or their groups.
An epidemiological investigation of neurological and psychiatric desorders among such workers exposed to several types of pesticides as plantation workers and sheep dippers was made. These exposed workers were at high risk of mild cognitive dysfunction, tremor, weakness, and so on to a significant extent. Those children who were exposed to organochlorine insecticide and pollutant via placenta or milk were also surveyed whether they had impairments of nervous and mental development. Highly exposed children were significantly slow in development relative to their peers. The results of these investigations were also reviewed.

Data concerning clinical cases of pesticide-induced disorders were collected from members of the Japanese Association of Rural Medicine during 1998-2000 FY throughout the nation, and were analyzed statistically.
1) A total of 209 cases of poisoning by agricultural chemicals were reported from 49 hospitals and other medical institutions.
2) By types of clinical manifestations, the majority of the cases were acute or subacute pesticide poisoning (91%), which was followed by acute dermatitis (5%) and chemical burn (3%).
3) Suicide accounted for 67% of the pesticide poisoning cases, which was followed by accidental exposure on the job during spraying (17%), and so forth.
4) Organophosphate insecticides were the most frequent inducers of the clinical cases (34%), which was followed by bipyridylium herbicides (21%) and a carbamate insecticides (9%), and so forth.
5) There were 43 cases of intoxication during spraying, during preparation or settling, and working in sprayed areas By types of clinical manifestations, the majority of the cases were acute or subacute pesticide poisoning (56%), which was followed by acute dermatitis (23%) and chemical burn (16%).
6) Agricultural chemical compounds responsible for the clinical cases varied greatly. They induced organophosphate insecticides (19%), and bipyridylium herbicides (12%).
7) Main factors contributing to the onset of pesticide-related disorders were insufficient protective clothing (32%), carelessness (22%), and inevitable consequences of pesticide use (10%).

Usefulness of balneotherapy in diabetics were discussed. Plasma glucose levels in diabetics treated with insulin decreased significantly after thirty minutes exercise under 38°C hot springs pool. There were positive relationships on plasma glucose levels between before and after exercise in hot springs. Lipids metabolism were improved during three months' balneotherapy. The ratio of VLDL·LDL-cholesterol/HDL-cholesterol decreased. Basal levels of plasma cyclic AMP decreased slightly and plasma cyclic GMP significantly increased. Intrathecal injection of vitamin B₁₂ (mecobalamin, 2500μg) was apparently effective to reduce the pain on under limb in patients with diabetic peripheral neuropathy whose subjective symptom could not improved by any medications. The effect of mecobalamin was increased by bathing in hot springs. Usually, balneotherapeutic hospitals have facilities of rehabilitation system in Japan.
In conclusion, the balneotherapy by adding physical treatment is very benefit to normalize carbohydrate and lipid metabolism. Tranquilizing function of hot springs are effective on psychological disturbance, diabetic autonomic and peripheral neuropathy.