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Occurrences of thyroid cancer and breast cancer metachronously or synchronously are common for women. Explanations for these associations include detection bias, shared hormonal risk factors, and genetic susceptibility, but the etiology behind specific associations is not elucidated well. The importance of the relationship between breast and thyroid cancer will continue to become evident and physicians should be aware of this association in caring for thyroid and breast cancer survivors. We report a case of synchronous papillary thyroid cancer and breast ductal cancer.

We report a successful case of gastric cancer with esophageal hiatal hernia treated by laparoscopic surgery. The patient was a 75-year-old woman who was referred to our hospital with a diagnosis of early gastric cancer with esophageal hiatal hernia. Laparoscopic distal gastrectomy with lymph node dissection and esophageal hiatal hernia repair using primary suture method without mesh were performed simultaneously. She had a good postoperative course without the recurrence of both cancer and hernia.

An 87-year-old man visited his previous doctor because of jaundice, abdominal pain, and disturbance of consciousness. He was diagnosed with cholangitis and panperitonitis and was referred to our hospital. Emergency laparotomy revealed biliary peritonitis. However, the bile leak point was unclear. Two days after surgery, endoscopic retrograde cholangiopancreatography was performed and revealed hilar bile duct stenosis, slight dilation of the intrahepatic bile duct, and bile leakage from the peripheral left intrahepatic bile duct to the abdominal free space. Endoscopic nasobiliary drainage was performed, and bile leakage decreased. He was discharged from our hospital with improvement from jaundice and peritonitis. Intrahepatic bile duct rupture with neoplastic obstruction of the bile duct is extremely rare. To date, only two cases of intrahepatic bile duct rupture with intrahepatic cholangiocarcinoma have been published.

Chronic myeloid leukemia (CML) stem cells have been identified to promote CML relapse due to their quiescent cell cycle and tyrosine kinase inhibitor resistance. Therefore, their eradication is important for the cure of CML. We herein identified the quiescent CML stem cell fraction using a G0 marker that can visualize quiescent cells. Whole-transcriptome analysis of imatinib-resistant, quiescent CML stem cells revealed that NF-κB is activated via inflammatory signals in the same cells. The combination of imatinib and an inhibitor of this inflammatory signal (IRAK1/4 inhibitor) effectively eliminated CML stem cells and attenuated PD-L1 expression in CML stem cells. Furthermore, the combination of anti-PD-L1 antibody and imatinib effectively eliminated CML stem cells in the presence of T-cell immunity, indicating the importance of creating an environment in which T cells can attack CML stem cells. Thus, IRAK1/4 inhibitors exert two effects: blocking CML stem cell survival and proliferation signals by inhibiting NF-κB and blocking T cell immune evasion by reducing PD-L1 expression in CML stem cells. Collectively, their combination may be one of the attractive strategies for achieving a radical cure for CML. Discussions regarding the possibility of future medications seem warranted.

Antitumor immune response is generally suppressed in different ways in many types of tumors. In fact, a variety of immunosuppressive cells, such as regulatory T cells, myeloid-derived suppressor cells, and tumor-associated macrophages, surround the tumor modulate antigen-presenting cells and effector T cells. The strategy to abreact the immunosuppressive conditions is necessary for a successful immunotherapy against cancers. Particularly, the improvement of the tumor microenvironment (TME) from this point is important for cancer immunotherapy. The checkpoint blockade as the representative success of the cancer immunotherapy can reactive the suppressed T cells. However, the efficacy of this treatment is limited. Therefore, it is necessary to evaluate the TME to establish more valid cancer immunotherapies. In addition, we need to pay attention to the relation of the therapy to immune responses. When tumor cells are killed by the antitumor agents, such as anticancer drugs, it is important that the cell death guides a secondary immune response by the antigen-presenting cells, particularly dendritic cells. Here, we discuss how the positive and negative effects by immune regulatory cells or stimulatory cells influence the subsequent immune dynamics in the TME. This will also lead to the development of new therapies to activate immunosuppressive conditions in the TME.

Purpose: The nutrition support team at our hospital introduced a flowchart to ensure smooth initiation of early enteral nutrition after open heart surgery. We assessed the effectiveness and safety of early enteral nutrition using the flowchart., Methods: We examined 240 patients who had undergone cardiovascular surgery between November 2013 and September 2015. The patients were divided into 2 groups for comparison;the flowchart intervention group( n=120) and the non-intervention group( n=120)., Results: The postoperative enteral nutrition in the intervention and the non-intervention groups was begun at 28.3 (23.2~40.5) hours and 37.0 (26.7~44.9) hours (p=0.04), respectively. There was no difference in the length of intensive care unit stay or postoperative infection rate. However, the length of hospital stay was prolonged in the intervention group (11.0 days versus 9.0 days;p<0.01). The rate of gastrointestinal complication was also comparable( 28% versus 21%;p=0.23)., Conclusion: Our study suggests that early enteral nutrition may be safely promoted by introducing the flowchart in patients who have undergone open heart surgery. Further investigation is needed to clarify the effectiveness.

With the aging of society, surgery for elderly colorectal cancer(CRC)patients is also increasing. We examined 11 elderly CRC patients who underwent palliative resection in our institute. The reasons other than age for which palliative resection was chosen, included dementia, basic disease, and social backgrounds such as living alone, etc. Although surgery was possible according to the ECOG PS and other examinations before surgery, 3 patients(27.3%)who developed respiratory or circulatory complications after surgery died in the hospital. From the viewpoint of retrospective P-POSSUM evaluation, unreasonable surgical decisions were not made. However, recovery was difficult once complications occurred in the subject group. The postoperative hospital stay, excluding inpatient deaths, was over 1 month due to rehabilitation, discharge adjustment, etc. Therefore, palliative treatment other than surgery should be considered for elderly CRC patients.

(Purpose) We created an image reconstructing multiparametric MRI system called VIVID (Visualization of Various Integration with Diffusion) and examined the efficacy of VIVID in detecting prostate cancer. (Methods and materials) The subjects were 80 patients who underwent one target biopsy with reference to MRI images in addition to 8-20 biopsies. (Results) The significant cancer detection rate was 61%, the significant cancer detection rate of PI-RADS 4 or 5 was 55%, and the significant cancer detection rate of VIVID score 4 or 5 was 55%. Three cases with PI-RADS 4 at TZ lesion with positive T2WI only were evaluated as having VIVID scores 1 or 2. Cancer was not detected with target biopsy from the site. (Conclusion) Our finding suggest that VIVID correctly excludes TZ lesions with only T2WI positively in multiparametric MRI.

The serum Helicobacter pylori titers are good markers for population-based H. pylori screening and treatment programs because the tests used to estimate these titers are noninvasive, inexpensive, and convenient. However, the reference range of 3-10U/mL, which is used as a standard in commercially available serum H. pylori antibody kit E plate Eiken H. pylori antibody II, is regarded as a gray-zone cutoff value to indicate H. pylori infection status. We aimed to clarify the gray-zone cutoff values of H. pylori infection status with new serum H. pylori antibody kits using latex immunoassay. We enrolled 256 patients who underwent endoscopic examination and H. pylori tests at the Inui Clinic of Internal Medicine or IMS Ota Central General Hospital between January 2013 and December 2015. Serum H. pylori titers were measured using Type L Wako H. pylori antibody J (Wako-LIA), H. pylori-latex Seiken (Denka-LIA), and LZ test Eiken H. pylori antibody (Eiken-LZ). In patients with a positive diagnosis of H. pylori infection, the positive diagnostic values (sensitivity, specificity, and positive predictive value) using Wako-LIA, Denka-LIA, and Eiken-LZ were (94.6%, 86.0%, and 79.1%), (95.7%, 90.2%, and 84.6%), and (85.9%, 92.1%, and 85.9%), respectively;in patients with a negative diagnosis of H. pylori infection, the diagnostic values (sensitivity, specificity, and negative predictive value) using Wako-LIA, Denka-LIA, and Eiken-LZ were (96.9%, 83.5%, and 85.6%), (96.9%, 78.7%, and 82.2%) and (95.3%, 67.7%, and 75.0%), respectively. In this study, the gray-zone cutoff value indicating H. pylori infection status was between 4.0 and 8.7U/mL for Wako-LIA, between 10.0 and 15.2U/mL for Denka-LIA, and between 5.6 and 10.0U/mL for Eiken-LZ. Therefore, we propose that lower titers of the positive antibody are important to diagnose H. pylori infection using Wako-LIA and Denka-LIA. However, when using Eiken-LZ, high titers of the negative antibody should be considered diagnostically important.

Routine examination of bone mineral density(BMD)by DXA(dual energy X-ray absorptiometry)is useful to predict bone fracture in both CKD nondialysis and dialysis patients. The cutoff value of BMD to predict bone fracture is different between genders and its predictive power is better in patients with lower serum PTH levels than higher counterpart. Increase in serum bone specific alkaline phosphatase is a better predictor of the bone fracture than serum PTH levels.

The first terrestrial vertebrates emerged from water and adapted to living on land approximately 360 million years ago (late Devonian). In particular, amphibians are thought to have surface epithelia that changed from multilayered epithelia into keratinized stratified squamous epithelia by acquiring stratum corneum (SC), which is composed of several dead cell layers that serve as an air liquid interface barrier. Then, reptiles appeared and became a major terrestrial vertebrate group approximately 340 million years ago by forming hard SC. About 220 million years ago, mammals radiated by acquiring soft and moisturized SC, and endogenous retroviruses were thought to be actively integrated into mammalian genomes. Skin ASpartic Protease (SASPase)/ASPRV1 is the mammalian-specific endogenous retroviral-derived protease. SASPase-deficient mice had dry skin and aberrant accumulation of profilaggrin, which is another mammalian-specific gene that regulates SC barrier function and is a major predisposing factor for atopic dermatitis. These findings indicate that the retroviral element SASPase was integrated into the first mammalian species and was involved in the adaptive evolution of mammals, as it facilitates moisturization of skin SC. It is possible that other uncharacterized endogenous retroviruses were also involved in epidermal barrier function.

Chronic renal failure (CRF) is related to cardiac diseases. Cardiac surgery is also related to postoperative acute kidney injury (AKI). It means heart and kidney have close relationship. We analyzed recent published data to understand how to manage CRF patients undergoing cardiovascular surgeries. We compared endovascular surgery and open procedure for aortic aneurysm, especially about contrast media-related renal damage, On or Off CABG or PCI for ischemic heart disease. We also discussed the relation between cardiopulmonary bypass and AKI and the risk factors causing AKI after CPB. Finally, we discussed prevention and treatment options of CPB related AKI, including furosemide, hANP mannitol, and statin. Published evidence in this area is still insufficient, but many studies are still carried out focusing on postoperative AKI. In the future we may be able to find the best answer for managing CRF patients undergoing cardiovascular surgeries.

Zinc (Zn) is essential for normal cell structure and physiology. Its deficiency causes growth retardation, neuronal degeneration, and immunodeficiency. Zn homeostasis is tightly controlled through Zn transporters and metallothioneins, which regulate Zn concentration and Zn distribution in individual cells, and contributes to Zn-binding protein in cells. Although many molecules involved in these processes have Zn-binding motifs, the molecular mechanisms underlying the role of Zn in the immune system have not been clarified. Recently, we and other groups have demonstrated that Zn plays diverse and specific roles in vivo and in vitro, in studies on the genetic knockout of Zn transporter functions. In this review, we discuss the impact of Zn on mast cell-mediated allergy and T cell-mediated immune responses. We also describe Zn dysregulation as a leading health problem in allergy and immune responses.

A 60-year-old male was referred to our institution for investigation of intractable hypertension. Coarctation of the aorta was detected by computed tomography (CT). Bilateral internal thoracic arteries played an important role as a collateral source to the lower extremity. Coronary angiography showed stenosis at the ostium of left main trunk. Ascending aorta to bilateral external iliac artery bypass grafting and off-pump coronary artery bypass grafting (OPCAB) was done simultaneously, this is because we had to harvest left internal thoracic artery as a conduit for coronary artery bypass grafting(CABG).Postoperative course was uneventful. The patient was discharged 10 days after the operation. We could perform less-invasive surgery despite the simultaneous operations.